bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evolution of multidisciplinary care: Experience of the National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP).
Authors: Friedman Eliot Lawrence , Morris Paul , Currens Margaret , Castro Kathleen M. , Clauser Steven B. , Prabhu Das Irene , Carrigan Angela , Rivero Silvana 
Published: February 2017

67 Background: A key aim of the NCCCP is to develop and improve the quality of multidisciplinary care (MDC). An assessment tool with nine key elements relevant to MDC structure and operations was developed to assess MDC maturity and set goals for continued quality improvement at individual sites and across the network. Methods: 14 NCCCP sites self-reported MDC assessments for lung, breast, and colorectal cancer in June 2010, 2011, and 2012 using an online reporting tool. Each site evaluated their level of maturity (level 1 = no MDC, level 5 = highly integrated MDC) in nine elements integral to the MDC process. Qualitative review of sites’ responses was also conducted. Results: MDC improvement was most evident in four of nine elements; case planning (CP), physician engagement (PE), integration of care coordination (ICC), and quality improvement (QI). The number of sites at level 3 or greater is reported in the table below. Integration of primary care providers and increased organizational support contributed to improved CP. PE was related to conditions of participation, insuring involvement of appropriate physicians in the MDC. The network focus on patient navigation was demonstrated by increase of ICC. Improvement in QI was related to increased participation of sites in physician and hospital quality initiatives (i.e., QOPI and RQRS), and an NCCCP project aimed at increasing referrals to genetics for patient with breast and colon cancer. Conclusions: The maturity of MDC reflected focused work of the Quality of Care sub-committee of the NCCCP. The efforts of working groups in patient navigation, genetics and physician conditions of participation was made evident in the improved performance in MDC’s for three of the four most common malignancies seen in the United States. We hope that this work will provide a blueprint for other health systems that wish to incorporate multidisciplinary care into their cancer programs. [Table: see text]
Use of a community of practice (CoP) platform as a model in regional quality improvements in cancer surgery: The Ottawa model.
Authors: Fung-Kee-Fung Michael , Boushey Robin P. , Morash Chris , Watters James , Morash Robin , Mackey Marlene , Smylie Jennifer 
Published: February 2017

68 Background: The Ottawa CoP model for developing multidisciplinary practitioner networks and integrating them with organizational processes was established in 2007 as a platform improving access to quality cancer surgery in one of the health regions (population 1,276,370) of Ontario, Canada. The three inter-disciplinary CoP collaboratives in breast, colorectal, and prostate cancer involve 230 care providers from 9 hospitals performing over 2,000 cancer surgeries per year. Objectives: 1) to address lack of coordination and standardization of care, 2) develop a regional platform for quality initiatives, and 3) bridge the gap between academic and community hospitals. Methods: Using the model, an academic tertiary care hospital and eight community hospitals partnered to support a regional quality improvement initiative that combines 1) educational outreach with audit and feedback to address variations in practice and 2) a unique platform for knowledge generation and innovation. Regional interdisciplinary teams developed a set of regional quality indicators (18) linked to mutually agreed standards and pathways. Regional registry was established to provide data feedback on performance against both provincial and regional standards. Best practices, innovations, and implementation progress are reviewed through sustained interactions between CoP members. Patient and care provider surveys are conducted. Results: The development and implementation of regional care standards and clinical pathways for three disease sites in 9 hospitals. Regional pathway compliance ranged 65-94%. Other significant improvements include: rectal cancer surgery centralization (80-90% per annum), increase in use of sentinel lymph node biopsies in breast cancer surgery (60-77% per annum) and a decreased positive prostate cancer surgical margin rate form 45% to 22%. Compliance with provincial guidelines for colon cancer surgery improved (20% increase 2006/2007 vs. 2010/2011). Increase in patient access to high-quality cancer surgery closer to home. Conclusions: Participation in the regional CoPs is associated with quality improvements at the system, patient, and professional levels.
The impact of patient navigation on receipt of quality breast cancer treatment in the national patient navigation research program.
Authors: Ko Naomi , Battaglia Tracy Ann , Darnell Julie , Calhoun Elizabeth , Snyder Frederick , Paskett Electra D. , Whitley Elizabeth , Wells Kristen J. , Young Heather A. , Karnad Anand B. , Griggs Jennifer J. , Warren-Mears Victoria ,   Patient Navigation Research Program
Published: February 2017

72 Background: The discrepancy in breast cancer outcomes for underserved populations has been linked to lack of receipt of quality treatment. Patient navigation programs are being rapidly adopted as a model to improve cancer outcomes for these vulnerable populations, yet the effect of navigation on their quality of cancer care is unknown. Methods: We conducted a secondary analysis of the National Patient Navigation Research Program (PNRP) data to assess the impact of navigation on receipt of quality care among women diagnosed with breast cancer. Data pooled from 7 PRNP sites were used to determine the proportion of newly diagnosed cancer patients whose care met National Comprehensive Cancer Network (NCCN) quality metrics: 1) hormonal therapy for HR+ patients 2) post-lumpectomy radiation therapy; and 3) chemotherapy for hormone negative, >1cm tumors, in patients <70 years of age. Chi-square tests were performed to compare probability of receiving recommended care among navigated and control patients. Results: A total of 1,006 breast cancer patients eligible for treatment were enrolled across all sites: 491 (49%) in the intervention arm, 515 (51%) in the control arm (mean age: 56 years; 38% African American, 23% Hispanic; 13% uninsured and 38% Medicaid). Among those eligible for hormone therapy, 283/357 (79%) navigated patients received hormonal therapy compared to 237/371 (64%) of controls (p < 0.001). Among those eligible for radiation therapy post lumpectomy, 235/277 (85%) of navigated patients received radiation compared to 270/324 (83%) of controls (p=0.62). Among those eligible for chemotherapy, 79/122 (65%) of navigated patients received chemotherapy compared to 81/100 (81%) of controls (p < 0.007). Logistic regression models to determine the odds of receiving recommended care for navigated and non-navigated patients, adjusting for patient demographics, will be conducted. Conclusions: Navigation had a positive effect for receipt of hormonal therapy, but not for radiation therapy and chemotherapy. Future studies are needed to assess the role navigation may play in ensuring quality care for the most vulnerable.
Kaizen quality initiative to improve patient satisfaction and throughput in an academic cancer center.
Authors: Dougherty David , Murray Patti , Berkhof Julie Ann , Levandowski Lynn , Khorana Alok A. 
Published: February 2017

78 Background: Lean management principles have long been employed in manufacturing to improve operational efficiency but have only recently been adopted into healthcare settings. To address prolonged wait times and inadequate performance on patient satisfaction surveys, our cancer center utilized a Kaizen event as part of a quality improvement initiative. Methods: We utilized methods of Kaizen philosophy to evaluate all processes related to the patient experience in the outpatient facilities of the James P. Wilmot Cancer Center of the University of Rochester. The Kaizen initiative was conducted by a multidisciplinary group and consisted of an intensive 5-day induction period to identify problems within the system of care followed by regular quality improvement meetings. The group developed immediate solutions to some problems and identified priorities for the longer term. Changes in patient throughput times (time from clinic check-in to check-out) and patient satisfaction (utilizing Press-Ganey surveys) were tracked before and after initiating Kaizen and this report evaluates results over the first 12-month period. Results: Our Kaizen initiative involved a group of 17 faculty and staff who assembled during the induction period and met bi-monthly over the 12-month period from May 2011 to June 2012. Prior to the Kaizen intervention, mean throughput time for a 30-minute clinic visit was 80.34 minutes (n = 259; median 76; range 18 to 261) and mean overall patient satisfaction score for the quarter preceding the Kaizen was 89.3 (43rd percentile AHA Region 2). Over the 12 months following the Kaizen, mean throughput time reduced to 57.85 minutes (n = 249; median 53; range 11 to 205) and patient satisfaction scores improved to 91.9 (p<0.05; 63rdpercentile). Conclusions: Utilizing continuous process evaluation and Kaizen methodology, we reduced patient throughput times by 28% and improved patient satisfaction percentile rank by 20%. Ongoing efforts focus on utilizing continuous quality improvement to improve patient and family-centered cancer care. Kaizen is an effective, resource-neutral method for improving operational efficiency and patient-centered outcomes in an academic oncology practice.
Follow-up of long-term young breast cancer survivors.
Authors: Daly Corinne , Del Giudice Elisabeth M. , Sutradhar Rinku , Paszat Lawrence Frank , Wilton Drew , Rabeneck Linda , Baxter Nancy N. 
Published: February 2017

8 Background: Evidence suggests breast cancer patients can be offered follow-up by family physician without concern of important recurrence–related serious clinical events occurring more frequently or quality of life being negatively affected. This study describes population-based patterns of follow-up care in 5-year recurrence-free young breast cancer survivors to determine factors influencing continued oncology follow-up in Ontario, Canada. Methods: We conducted a retrospective population-based cohort study using cancer registry and administrative data. Women diagnosed with an incident breast cancer aged 20-44 between 1992 and 1999, survived for at least 5 years and recurrence-free for 5 years past diagnosis were identified in the Ontario Cancer Registry. Each survivor was matched to 5 control women with the same calendar year of birth and place of residence in Ontario. We determined outpatient physician visits with primary care, medical, radiation and surgical oncology physicians to investigate trends associated with increasing survivorship and compared visit rates to controls. We used negative binomial regression to investigate factors predicting high utilization of oncology services among survivors after 5-year recurrence survival. Results: We identified 4,581 survivors and 22,898 controls. By year 10, 51% breast cancer survivors were still being followed by an oncologist. In the survivors, fewer physician visits were observed among recurrence-free breast cancer survivors as time increased from diagnosis (Visit Rate Ratio [VRR] =0.95, 95% CI: 0.94, 0.96). Breast cancer survivors diagnosed from 1992-1995 had a higher rate of physician visits than those diagnosed from 1996-1999 (VRR = 1.16, 95% CI: 1.07, 1.25). More oncologist visits were associated with patients visiting a female oncologist (VRR = 1.20, 95% CI: 1.09, 1.33) and fewer visits were associated with patients visiting an oncologist who practiced outside of a regional cancer center (VRR = 0.67, 95% CI: 0.58, 0.77). Conclusions: Oncology visits of young breast cancer survivors after 5-year survival were associated with oncologist factors indicating that prolonged oncology follow-up in breast cancer survivors may be driven by practice patterns rather than patients’ needs.
Minimizing wait time between chemotherapy and radiotherapy treatments.
Authors: Sauerbaum James J. , DeMaio Gina , Geiger Bradley , Cunningham Regina , Holmes Marianna , Avellino Amy , Cohen Roger B. , Metz James M. , Evans Tracey L. 
Published: February 2017

82 Background: Members of the scheduling teams at the Abramson Cancer Center observed prolonged delays between chemotherapy and radiation therapy treatments scheduled by staff from 2 independent departments leading to inconvenience for patients receiving concurrent chemo- and radiation therapy (CRpts). Methods: An analysis of baseline data over 6 weeks revealed that for 157 unique consecutive patients undergoing daily chemotherapy and radiation (a total of 353 encounters), the mean time between scheduled treatments was 122 minutes. For 39% of encounters the wait time was greater than 120 minutes. To improve the adjacency of chemotherapy and radiation appointments and to consistently reduce wait time between treatments to less than 120 minutes, we formed a Chemotherapy/Radiation Scheduling Task Force consisting of patient service representatives, practice managers, and physician and nurse advisors. We determined that CRpts should be scheduled using a “huddle” strategy whereby prospectively identified CRpts are simultaneously scheduled for both treatments in a coordinated manner. Identifying CRpts for coordinated scheduling was facilitated by the creation of a chemo-radiation scheduling inbox to which clinicians and support staff e-mail names of new CRpts in order to alert the scheduling team. Our two lead schedulers meet 2-3 times per week to coordinate patient schedules. A weekly scorecard of the wait times for CRpts patients is distributed via e-mail to the clinicians and support staff. Results: Over the past 6 months, we have used the huddle method for 80% of 986 consecutive CRpt encounters. Our average wait time for huddle-scheduled encounters has been reduced to 62.5 minutes with only 9% of encounters having wait times over 120 minutes. For non-huddle-scheduled encounters, the average wait time is 129 minutes with 57% having wait times over 120 minutes. Conclusions: Utilization of a huddle scheduling method has successfully reduced wait time for CRpts. Use of the huddle method continues to grow with staff training and awareness of the new process.
Enabling quality improvement in systemic cancer treatment through a collaborative approach.
Authors: Simanovski Vicky , Hertz Sherrie , Green Esther , Meertens Elaine , Kaizer Leonard , Krzyzanowska Monika K. , Burns Judy , Woltman Kelly 
Published: February 2017

88 Background: The Regional Systemic Treatment Program at Cancer Care Ontario (CCO) aims to ensure the highest quality of systemic treatment is available to Ontarians, as close to home as possible. CCO initiated a provincial collaborative with the aim of improving the safe delivery of parenteral chemotherapy from orders through preparation, to administration, for patients, and providers. Methods: From April 2011 to March 2012, interdisciplinary hospital teams across Ontario followed multiple Plan, Do, Study, Act cycles to perform QI projects focusing on safe delivery of systemic treatment. Over this period, three in-person sessions educating participants on improvement methodology were held. Monthly teleconferences and an electronic discussion forum encouraged a culture of knowledge sharing and collaboration. Results: 113 participants from 26 teams participated in a total of 81 improvement initiatives. 96% of participants surveyed indicated that the collaborative provided a valuable opportunity to network with peers, share ideas, and discuss lessons learned. During the collaborative, teams reported their progress on a scale of 1-5. At May 2011, teams averaged a self-assessment score of 1, indicating no progress had been made. By February 2012, this increased to an average score of 4, indicating significant progress and achievement of at least one improvement objective/goal. CCO has leveraged the foundations built by the collaborative to develop a Regional Quality and Safety Network. This network provides a regular forum for health care providers and administrators to share knowledge and collaborate on strategies for improving quality and safety in the delivery of systemic treatment. Conclusions: The collaborative demonstrated that the use of a formal quality improvement model is a successful mechanism for regional engagement; that provides the foundation necessary for building a provincial network with common goals and understanding regarding quality improvement. By educating participants, supporting local efforts and enabling knowledge transfer and exchange, the collaborative showed that shared ideas and even small changes can lead to large-scale improvements for patients and providers.
Understanding and improving chemotherapy ordering and delivery using process elicitation and validation.
Authors: Mertens Wilson C. , Christov Stefan C. , Cassells Lucinda Jane , Avrunin George S. , Clarke Lori A. , Osterweil Leon J. , Marquard Jenna L. 
Published: February 2017

89 Background: Chemotherapy order/administration consists of complex, interrelated processes where errors have potentially severe consequences. We report a study that quantitatively and qualitatively evaluated chemotherapy delivery employing a formal process definition language to elicit and describe rigorously the process, then applied mathematical validation techniques to confirm the description, analogously to how computer software development and other industries use accurate, precise process definitions to assure soundness through redundancy and correct event sequencing. Methods: The process, including exceptional situations and individuals’ recognition of and responses to these, was elicited through informal, unstructured interviews with members of an interdisciplinary team. The resulting process description (or process definition), written in a notation developed for software development process assessment, guided chemotherapy process validation consisting of rigorous process definition analysis, direct observations, and semi-structured interviews to confirm the elicited details for the treatment plan sub-process. Results: The overall process definition yielded 467 steps; 207 steps (44%) were dedicated to handling 59 exceptional situations. Validation yielded 82 unique process events (35 new expected but not yet described steps, 16 new exceptional situations, and 31 new steps in response to exceptional situations). Process participants actively altered the process as ambiguities and conflicts were discovered by the elicitation and validation components of the study. Chemotherapy error rates (evaluated by our safety reporting system) declined during and after the project (p <.001). Conclusions: The initial elicitation methods and subsequent validation discussions supported rapid adoption of changes, improved communication regarding the process, and yielded error reduction. A combination of rigorous elicitation and validation methods creates increasingly accurate descriptions of complex but repetitive medical processes, leading to identification and removal of existing process defects while avoiding the creation of new defects as processes evolve.
The use of a palliative care tool in a community private practice.
Authors: Mahmood Tallat , Shock Helen , Severson Jane , Blayney Douglas W. ,   Michigan Oncology Quality Consortium Palliative Care Demonstration Project Lead Team
Published: February 2017

95 Background: Although symptom assessment is a routine part of oncology care, data from the Michigan Oncology Quality Consortium (MOQC) showed variation in individual practice (Health Affairs 31:718, 2012). As part of the MOQC Palliative Care Demonstration Project, we implemented the Edmonton Symptom Assessment System(ESAS) in a private oncology clinic. ESAS is a valid and reliable assessment tool that evaluates nine common symptoms experienced by cancer patients. Our target population was patients with active cancer undergoing chemotherapy. Methods: Initial implementation focused on patients of only one of the practice’s physicians. Symptoms rated >3 were considered symptomatic and were addressed by the physician. To monitor overall performance, a practice profile was compiled from the individual ESAS results. For symptoms with the greatest severity and incidence, targeted resources were developed and integrated in new electronic medical record templates and educational sessions with patients. Results: Managing change incrementally with weekly reassessment of implementation problems was effective. Use of the ESAS tool allowed for a focused discussion of the patient symptomatology and lead to better efficiency for the physician. Understanding the symptom burden of the patient population and implementing practice wide interventions helped to reduce the symptom burden at an individual patient level. Conclusions: The ease of use of the ESAS tool makes it highly successful in the private oncology practice setting. Profiling the symptom burden at a practice level facilitates targeted improvements and monitoring of performance over time. [Table: see text]
The value of a genetic counselor for patient identification.
Authors: Eichmeyer Jennifer N. , Zuckerman Dan Sayam , Beck Thomas M. , Camilo Nicolas , Sproat Patty , Burnham Christa 
Published: February 2017

97 Background: Advances in genetics are rapidly changing cancer care and requiring institutions to maximize the unique skills of genetics professionals. The identification of genetic syndromes is vital for prevention and management of families with high cancer risks. Despite this high risk patients and families who qualify for genetic counseling are not referred; this is due to increasing responsibilities on physicians. Genetic counselors could be utilized to review new oncology charts to improve identification. Methods: A genetics assessment tool developed by NCI Community Cancer Centers Program generated baseline measurements of 2010 tumor registry data of patients meeting NCCN guidelines for genetics evaluation. A weekly list of new oncology patients was provided to a genetic counselor who reviewed each H&P dictation focusing on the pathology, age, and family history sections. The genetic counselor notified the oncologist by email or through the EMR system, and the physician discussed genetic counseling with patient or approved the order. Post implementation of the chart review program was measured using 2011 tumor registry data. Results: In 2010 58% of total applicable patients were offered a genetics evaluation. In 2011 this improved to 70%. Based on disease type: 69% (breast), 59% (colon), 29% (ovary), and 20% (uterine) were offered a genetics evaluation in 2010. In 2011 these numbers were 76% (breast), 64% (colon), 91% (ovary), and 20% (uterine). Over a 10-month period a total of 122 patients were identified through the chart review program by the genetic counselor. Three of these were confirmed to have a genetic mutation for one of the hereditary cancer syndromes. An average week included review of 73 charts for 10 medical oncologists, 4 radiation oncologists, 4 pediatric oncologists, which generated 60 to 80 minutes of work weekly for the counselor. Conclusions: This program improved patient identification and allowed physicians to become more aware of opportunities for genetic consultation that led to a streamlined referral process and allowed more applicable patients to receive counseling and testing. Project funded in whole or part with Federal Funds from the National Cancer Institute, National Institutes of Health, Contract No. HHSN261200800001E.