bluuebunny/crossref_metadata_2025_split huggingface dataset:
Automating a program for the evidence-based reimbursement of oncology drugs across a complex network: Benefits and challenges.
Authors: Gilks John , Yurcan Marta , Yardley Tim , Gavura Scott , Kukreti Vishal 
Published: February 2017

39 Background: Ontario hospitals are reimbursed for IV chemotherapy through Cancer Care Ontario’s (CCO) New Drug Funding Program (NDFP). By 2009, 54 indications (annual budget $195MM) were managed through largely paper based processes. A new web based system (eClaims) was developed focusing on clinic workflow and integration to chemotherapy ordering systems. Interfaces were developed for CCO’s OPIS and commercial systems (HL7v3). eClaims provides users with clinical best practice, pre-approval, immediate adjudication and simple means of tracking outstanding claims. The benefits and challenges are described. Methods: Evaluation used several strategies: debriefs after each deployment; post-go live user surveys and lessons learned workshops. Results: eClaims was deployed in 80 hospitals over two years. At most sites (50/80) treatment data flows from CPOE systems to eClaims in near real time. Over 50% of claims are machine adjudicated. Newly approved indications can be posted within hours. The main learnings during the deployment process were the need to understand and adjust for hospital specific factors and the unique business relationships among clusters of hospitals. Survey responses were received at a 19% response rate. The later deployment groups reported greater satisfaction than earlier adopters with more positive responses in all categories. Workshop key theme was the need to match complex clinical workflows with design/build processes. Secondly, evaluation of historical data before migration is necessary. Conclusions: Introducing an application into complex, varied clinical workflows is difficult. The phased approach to deployment and evaluation worked, allowing for increasingly smooth go lives. Future work revolves around balancing user needs through eClaims modifications vs simplifying clinical processes to make the tool more usable.
Highmark and Allegheny Health Network: Partners in Quality Oncology Practice Initiative (QOPI) measures automation reporting.
Authors: Bird Kyle 
Published: February 2017

41 Background: ASCO’s QOPI Participation and Certification processes pose a daunting operational task for oncology practices nation-wide. The standardization and quality improvement initiatives required for Certification involve multiple constituents and often a longitudinal approach to quality and operations management. The human resources required for biannual abstraction can be burdensome given strained resources in an increasingly complex reimbursement environment. Allocating staff for retrospective medical record review requires a steep QOPI learning curve and time away from the clinic. The Allegheny Health Network and Highmark, the Nation’s tenth largest insurer, have partnered to create a monthly QOPI measures automation report which alleviates the burden of a purely human resource-based abstraction methodology. Additionally, 100% of Highmark insured, Allegheny Health Network QOPI qualifying patients are included in a monthly report to allow for near real-time clinical decision support. Methods: A multidisciplinary team was assembled with clinical and administrative representatives from Highmark and Allegheny Health Network. The team worked together in phase I of the project for over eight months to review and select specific QOPI measures that could be tracked through a custom-built, claims processing algorithm. Results: Initial data analysis included over seventy-five automated QOPI measures that would be able to be tracked and trended on a monthly basis – populated from Highmark claims data. The monthly report allows for a larger sample size with data tracking across all QOPI domains and disease sites. The multidisciplinary team has moved on to phase II of the project which will include sensitivity analyses and data refinement. Conclusions: QOPI measures automation is possible through an evolving relationship demonstrated through this unprecedented payer/provider initiative. While some of the QOPI reporting measures could be automated, human resources will still be required for annual abstraction in the on-going QOPI Certification phase. Once refined, automated measures will need to be verified to note changes in claims data and clinical documentation.
Moving toward patient-based funding through quality-based procedures (QBPs) for GI endoscopy and colposcopy.
Authors: Ratansi Nabeela , Langan Aimee , Blais Irene , Svara Erin , Houser Karla , McCurdy Bronwen , Moffatt Jessica , Elliott Lori 
Published: February 2017

43 Background: As part of the Ministry’s Health System Funding Reform initiative, Cancer Care Ontario is tasked to develop and implement Quality-Based Procedures (QBPs) for programs such as GI Endoscopy and Colposcopy. QBPs are clusters of patients with clinically related diagnoses or treatments that have been identified by an evidence-based framework as providing opportunity for improving quality outcomes and reducing costs. As stated by the Ministry, the goal is to reimburse providers for the types and numbers of patients treated, using evidence-informed rates associated with the quality of care delivered. Methods: QBPs are multiyear and have four key deliverables: Clinical: developing clinical best practices. Funding: tying best practices to pricing. Capacity Planning: understanding procedure types/volumes for capacity management. Monitoring/Evaluation: measuring the QBP’s impact. Developing the QBPs has involved: Creating Clinical Expert Advisory Groups (CEAG) of clinicians who are recognized for their knowledge and expertise. Tasking the CEAG to define quality and develop best practices informed by literature reviews, jurisdictional scans, and guidelines. Documenting these standards and clinical pathways in a clinical handbook, providing information on the practices that should be implemented to ensure consistent care delivery. The development of best practices is imperative to the foundation of the QBP and spans multiple years. Once best practice development is complete, it will be tied to pricing, where the procedure will be micro-costed based on workload, equipment, supplies, and other administrative costs. Results: The QBPs continue to evolve and aim to: Reduce practice variation. Improve patient outcomes. Improve system accountability. Improve cost-effectiveness of services. Effectiveness will be measured through a performance management framework, including an integrated QBP scorecard measuring appropriateness, access, and efficiency. Conclusions: The underpinning for moving towards an evidence-based, patient-based funding model involves defining quality standards and clincal best practices, and applying these guidelines to determine the cost of quality care.
Evaluating the confluence of oncology market trends and key levers to drive payment and delivery reform for treatment of multiple myeloma.
Authors: Waltersdorf Jenna , Barnes Lauren G. , Hussain Fauzea , Mitchell Kristi 
Published: February 2017

45 Background: A multi-factorial focus on treatment costs and the incremental improvement in outcomes has accelerated interest in payment and delivery reform in oncology, specifically a shift from fee-for-service to fee-for-value. As the landscape continues to evolve, there are key levers that will accelerate reform for specific cancer types. Our objective was to examine how broad oncology market trends and key levers for multiple myeloma (MM) intersect to drive payment and delivery reform. Methods: We evaluated 18 oncology market trends, classified the pervasiveness of each as nascent, emerging, or widespread, and assessed trends for specificity to MM compared to other cancers. We then evaluated six key levers that, within the context of each trend, may ripen MM for payment and delivery reform. Levers included 1) national guidelines; 2) quality measures; 3) prevalence/incidence relative to other cancer types; 4) advanced imaging or other high-cost treatment expenditures; 5) drug/biologic contribution toward treatment costs; and 6) approved companion diagnostic(s). Results: While some guidelines exist to address treatment of MM, there are gaps in recommendations that do not address the full continuum of care to guide physician decision making, giving this lever low influence to drive reform. One measure for quality improvement has been used at a broad national level, giving this lever moderate influence on reform. Today, characteristics of MM that trigger key levers make MM an unlikely focus for widespread reform initiatives. Conclusions: Most oncology market trends are cancer-type agnostic, but trend pervasiveness and their confluence with key levers will dictate the shape of alternative payment models for changes to treatment delivery and reimbursement. By developing additional quality measures and addressing guideline gaps, stakeholders may further trigger two key levers to ripen MM for payment and delivery reform. Reform initiatives may be expedited as additional treatment options are introduced to the market, and as stakeholders work to influence key levers and evaluate the feasibility for and implementation new payment and delivery models for MM.
Advanced radiation oncology technology within the Veterans Health Administration (VHA).
Authors: Dawson George A. , Cheuk Alice V. , Jolly Shruti , Gutt Ruchika , Fosmire Helen , Lutz Stephen T. , Anscher Mitchell Steven , Hagan Michael Philip , Moghanaki Drew , Hoffman-Hogg Lori , Kelly Maria D. 
Published: February 2017

52 Background: The rapid evolution of technology in the treatment of cancer has paralleled other technological advancements in modern society. Intensity Modulated Radiotherapy (IMRT), Image Guided Radiotherapy (IGRT), Brachytherapy (BT), Cone Beam Computed Tomography (CBCT), Stereotactic Radiosurgery (SRS), and Stereotactic Body Radiotherapy (SBRT) facilitate treatment with higher, more conformal radiation doses, potentially improving cancer control while reducing normal tissue toxicity. Recent Surveillance, Epidemiology and End Results (SEER) program data and physician surveys indicate prostate BT is declining and the integration of SRS and SBRT is slower compared to IMRT. As utilization of technology increases, an understanding of its availability within the VHA is necessary to ensure quality and patient safety. Methods: An electronic survey was sent to 82 Radiation Oncologists (ROs)at 38 active VHA Radiation Oncology Centers with subsequent follow-up phone calls. The survey occurred from May-June 2014. ROs were queried on the availability of advanced RT technologies including IMRT, IGRT, BT, CBCT, SRS and SBRT at their facility. Practitioner specific details: years in practice, academic appointment and VHA employment status were collected. Results: Responses were obtained from 62 ROs representing 75% of VHA ROs and 34 or 89% of facilities. Full time VHA employees made up 60% of respondents with 35% in practice for <5 years and 34% practicing for >20 years; 71% held an academic appointment. The Table shows on site availability of advanced RT technologies within the 34 VHA sites that responded. Conclusions: For veterans receiving cancer treatment, VHA ROs are able to routinely use IMRT and IGRT with CBCT capabilities. However, stereotactic (SRS and SBRT) and BT services are less available, and may require referrals externally or to other VHA facilities. Limited availability of SRS and SBRT parallels the community experience. Likewise the decreasing utilization of BT is common to the VHA and private sector. SBRT, SRS and BT require significant expertise and technology. [Table: see text]
Quality breast screening begins with quality technologists: Exploring workplace satisfaction among mammographic technologists.
Authors: Marsh Katie , Benefield Thad , Durham Danielle , Bowling J. Michael , Henderson Louise 
Published: February 2017

53 Background: To provide a quality patient experience, radiologists depend on the technologists’ skillset and interactions with patients, both of which may be impacted by satisfaction in the workplace. We identified factors related to the technologists’ job satisfaction, separately for lead and non-lead technologists. Methods: We sent a 50-item survey to 912 mammographic technologists (238 lead and 674 non-lead) throughout North Carolina. Survey items included questions on education and training, work experience, interaction with radiologists and other technologists, and job satisfaction. Job satisfaction was based on a 5-point scale ranging from 1 (strongly agree) to 5 (strongly disagree) for questions on workplace decision making and control, supervisor support, and performance feedback. Using a regression tree analysis, we identified factors related to technologist job satisfaction. All variables significant in the regression tree analysis (p-value<0.05) were included in a linear regression model. Results: A total of 433 mammographic technologists responded to the survey (response rate 47.5%; 95% CI 44.2-50.7). Of these, 128 were lead (response rate 53.8%; 95% CI 47.4-60.1) and 305 were non-lead (response rate 45.3%; 95% CI 41.5-49.0). The mean job satisfaction among lead and non-lead technologists was 1.96 (SD 0.72; range 1 to 4.25). Linear regression analyses revealed that for lead and non-lead technologists, hours of administrative work (p<0.0001), having frequent communication with radiologists (p=0.01), and having a mentor in the workplace (p=0.002) were related to increased job satisfaction. Being a lead technologist was associated with higher job satisfaction (p=0.0004). The number of diagnostic mammograms performed per week was inversely related to job satisfaction for lead technologists (p=0.002). Conclusions: There were little differences in factors that influence mammographic technologists’ job satisfaction for lead versus non-lead technologists. Future studies should explore if technologists’ job satisfaction affects recall rates and patient perceptions of quality care.
Quality indicators of end-of-life cancer care: What rate is right?
Authors: Barbera Lisa Catherine , Sutradhar Rinku , Burge Fred , McGrail Kim , Fassbender Konrad , Lawson Beverley , Pataky Reka , Potapov Alex , Peacock Stuart , Chu Anna , Liu Ying , Seow Hsien 
Published: February 2017

57 Background: Many publications use administrative health care data to describe quality of care indicators at the end of life (EOL). However, very little is available to help decide on optimal rates for these indicators. The purpose of this abstract is to develop data-driven and achievable benchmark rates for EOL quality indicators using administrative data from 4 provinces in Canada. Methods: Five quality indicators of EOL care were defined and measured using linked administrative data for each of the 33 regions across British Columbia, Alberta, Ontario and Nova Scotia. These were: emergency department (ED) use, intensive care unit (ICU) admission, physician house calls (MD) and nursing visits at home (RN) prior to death, and death in hospital (DH). First, an empiric benchmark was defined by determining indicator rates among the top ranked regions to include the top decile of patients overall. Second, funnel plots were used to graph the age and sex adjusted indicator rates for each region along with the overall average value and 95% confidence limits (CL) that accounted for region size. Results: There was significant variation in rates for each indicator among the regions. Minimum and maximum rates for ED, ICU, RN, MD and DH varied approximately 2 to 4 fold across the regions with MD showing the greatest variation. Benchmark rates based on the top decile performers were: ED 34%, ICU 2%, MD 34%, RN 63%, DH 38%. With the exception of ICU, funnel plots demonstrated that mean indicator rates and their 95% CL were uniformly worse than these benchmarks even after adjusting for age and sex. Additionally, few regions met the benchmark rates. Conclusions: There is significant variation in EOL quality indicators across regions in 4 provinces in Canada. The combination of these two methods allows each region to determine its performance relative to both a benchmark and the overall average. As a result, each region is then able to gauge their performance with greater context which facilitates priority setting and resource deployment. These two methods demonstrate how decreasing variation and striving for a target can drive quality improvement. Deriving benchmark values from ‘real world’ data offers the advantage of realistically achievable targets.
The effectiveness of the shared medical visit among patients with a gynecologic malignancy undergoing chemotherapy along the Texas-Mexico border.
Authors: Castañeda Kayla E. , Hernandez Loretta L. , Mulla Zuber , Greenberg Harvey , Saldivar J. Salvador 
Published: February 2017

63 Background: The goal of this program was developed in response to The Institute of Medicine’s (IOM) “Crossing the Quality Chasm: A New Health System for the 21st Century” (2001) to provide patient-centered care that would result in improved patient satisfaction and decreased stress through the use of a shared medical visit (SMV) for patients with a gynecologic malignancy undergoing chemotherapy in place of an individual visit. Methods: The study design was a prospective cohort at a university health sciences center located on the Texas-Mexico border. A total of 20 patients will be enrolled in the SMV and 20 in the individualized visit. Participants attended group sessions with the provider that combined assessment, education, and social support. Patient-centered care was achieved by assisting them to obtain their own vital signs and by using a facilitative learning approach during the educational and social support component. Patients in the comparison group were patients who continued in the individual visits. The average differences between the pre- and post-session scores for perceived stress and patient satisfaction were calculated for both groups. Differences between both patient groups were tested for statistical significance using the Student’s independent two sample t-test. Results: The first twelve patients completed pre- and post-session questionnaires on perceived stress and patient satisfaction. For perceived stress, a lower score indicated lower stress. The average change in score for the individual group (n=6) was 0.67, and the average change in score for the SMV group (n=6) was -2.83 (p=0.28). For patient satisfaction, a higher score indicated higher satisfaction. The average change in score for the individual group (n=6) was -5.5; the average change in score for the SMV group (n=6) was -7.5 (p=0.80). Conclusions: Overall, patients felt they benefited from the shared medical visit. While the results of our interim analyses were not statistically significant, it appears that patient stress with the shared medical visit model may decrease over time. Based on our preliminary results we will continue to enroll patients and evaluate this unique program.
Involving patients to improve their care through real-time patient reported outcome (PRO)-CTCAE chemotoxicity surveys in an outpatient chemodaycare (DC) setting: Evaluating patient acceptability.
Authors: Solomon Hannah , Brown Catherine , Vennettilli Ashlee , Zarrin Aein , Dobriyal Aditi , Chen Linda , Pat Vivien , Ho Anthea , Xin Cindy , Irwin Margaret , Wang TIan Qi , Gonos Christina , Merali Zahra , Wong Lauren , Xu Wei , Howell Doris , Liu Geoffrey 
Published: February 2017

64 Background: In a busy DC setting, the efficiency of identifying important treatment toxicities is essential to quality care. Using a systematic approach to collecting patient-reported outcomes in the waiting rooms of DC units is one possible means of improving care while involving patients. This study reports such a pilot study, and the associated assessment of patient acceptance of this approach. Methods: 156 cancer patients over the age of 18 receiving chemotherapy treatment at Princess Margaret Cancer Centre completed a patient-reported chemotoxicity assessment using PRO-CTCAE items on tablet technology. Main symptoms assessed were: fatigue, nausea and vomiting, diarrhea and constipation, pain, aching muscles and/or joints and dysgeusia. Patient’s perception on the usefulness of PROMs and their willingness to complete such a tool routinely was assessed. Results: The median age was 53.5 (range: 19-88 years), 38% were male and 66% were Caucasian. Over 80% did not find the survey overly time consuming (or made their visit more difficult). Less than 1% were distressed by the survey questions. Over 80% reported that the survey asked the appropriate questions. While 81% considered the PROMs useful in informing their physician of their symptoms, 25% reported they would not be willing to complete the survey at each clinic visit. Another 25% were unsure of their feelings toward this approach. 93% were happy to complete the survey using tablet touchscreen technology. Conclusions: Most patients found the survey method of self-reporting one’s symptoms to be acceptable, non-distressful, and an important practice. From the patient perspective, the process of reporting one’s symptoms using tablet touchscreen technology is both simple and feasible.Yet, only 50% of patients would be willing to complete this survey at every clinic visit. Additional mixed-methods analysis looking at patient characteristics associated with acceptance/non-acceptance and willingness to complete the survey on a regular basis is ongoing and will be reported at the conference.
Evaluation of a system-level organizational approach to person-centered care education and implementation toolkit.
Authors: Moody Lesley , Shamji Hannah , Green Esther , Macdougall Laura , Peek Naomi , Singh Simron 
Published: February 2017

67 Background: Cancer Care Ontario (CCO) is an Ontario government agency which drives quality and improvement in the delivery of care and the patient experience for the Ontario cancer system. Person-Centred Care (PCC) has been identified as a goal from the recent Institute of Medicine (IOM) report and as a corporate strategic priority at CCO. As an initial step in a province-wide PCC strategy, CCO is developing and internally disseminating a patient engagement toolkit and eLearning module with expansion to regional cancer programs. Methods: The PCC eLearning module defines the care approach and explains the corporate goals and objectives of practicing PCC at CCO. Pre- and post-evaluation metrics are embedded to measure module impact on a rating scale with respect to: (1) understanding of PCC; (2) willingness to include the patient voice in CCO work; and (3) understanding of the role of patients who serve as advisors at CCO. The Patient Engagement Toolkit was developed as a step-by-step guide on why and how to engage Patients and Family Advisors (PFAs) in different organizational contexts. To test effectiveness and impact, we piloted the toolkit in 6 interactive sessions across 7 departments with 184 CCO employees over 2 months (Clinical Program and Quality Initiatives, Regional Program, Communication, Finance/Procurement/Facilities, HR, Business Analyst/Project Management Office). We are taking a comprehensive mixed methods evaluation approach with online surveys and key informant interviews to identify uptake and barriers. Results: Preliminary findings suggest considerable increase in the understanding of PCC and the role of PFAs at CCO, with 138 current instances of patient engagement in 1 quarter. After an introduction to the toolkit, many employees (86.7%) understood the value of engaging PFAs and most (63.7%) felt willing to start. Conclusions: Initial program evaluation demonstrates an increase in the understanding and implementation of direct (e.g., joining committees/working groups) and indirect PFA engagement (e.g., speaking at events/in focus groups) across CCO departments. Further evaluation of the toolkit at a provincial level is needed.