bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health literacy screening prior to education for patients with cancer.
Authors: Berry Donna Lynn , Halpenny Barbara , Chang Peter , Hayes Julia H. , Noel Jon , Vedachalam Srik , Fox Erica , Sorrentino Erica 
Published: February 2017

155 Background: We have developed and tested the Personal Patient Profile-Prostate (P3P), an efficacious decision intervention for men with localized prostate cancer (LPC). Usability evaluations in minority men of varying education levels suggested additional development needs for this web-based intervention. Establishing the link between health literacy and comprehension and use of education materials is important as we develop interventions for all patients with cancer and is critical to assuring informed consent to treatment and adherence to therapeutic regimens. Appropriate methods of literacy assessment are infrequently used in clinical settings. Methods: The purpose of this analysis was to explore feasibility of health literacy testing prior to P3P use in minority men with a new diagnosis of LPC. Black and Hispanic men were recruited at 3 Boston hospitals. Prior to using the P3P, patients completed the Short Assessment of Health Literacy-English (SAHL-E), an 18-item measure of an adult’s ability to read and understand medical terms. Scores >14 indicate adequate health literacy. Assessment duration was recorded and demographic information collected. Results: Nine men participated in the first 3 months of the study. All identified as Black/African-American, and three also identified as Hispanic/Latino (Dominican, Central American, Cape Verdean). Participants’ median age was 68 (range 52-77), and education level ranged from less than high school diploma to post-graduate degree. Administration of the SAHL-E took from 4 to 12 minutes (median=5). Data completeness was high. Scores ranged from 5 to 18 (median=16), with two patients scoring below 14; these two with low health literacy were the only two without any college education and also required at least 10 minutes to complete the screening. Conclusions: The SAHL-E was a feasible approach to screening for health literacy in a sample of minority men prior to providing a patient decision support intervention. Preliminary results suggest some ability to identify those patients who will require greater support during use of educational interventions or understanding written documents.
Evolving techniques for negative pressure wound therapy and the value of grass roots comparative effectiveness research.
Authors: Lohman Robert , Jayaprakash Vijayvel , Dorafshar Amir , Gottlieb Lawrence , Franczyk Mieczyslawa 
Published: February 2017

160 Background: There is debate over the value of comparative effectiveness research to address national health problems, but less attention has focused on its value to solve smaller questions. We present an example of local, clinician initiated, and unfunded comparative effectiveness research to address problems related to negative pressure wound therapy (NPWT) at our hospital. NPWT was popularized as the VAC (Vacuum Assisted Closure, Kinetic Concepts, Inc., San Antonio, TX) system and became standard treatment for many inpatient wounds. Between 2000 and 2006, VAC was the only form of NPWT at our hospital. When it became apparent that VAC therapy was costly, and painful, clinicians tried an alternative method using wall suction and gauze (GSUC). In 2007 and 2008 a randomized prospective trial showed the techniques were equally effective while GSUC was less painful and less costly. After the trial, we tracked the frequency of VAC and GSUC use, as well as the cost of NPWT. Methods: From 2000 to 2011, 3,184 inpatients required NPWT; demographics, the method of treatment, and associated costs were recorded prospectively. Data from 2000 – 2006, when only VAC was available, was compared to data from 2009 – 2011, when both VAC and GSUC were available. Results: Between 2000 and 2006, all patients (N=1,746) were treated using the standard VAC. After 2008, fewer patients were treated using the VAC compared to GSUC: 21 (2%) vs 907 (98%), p=0.001. Between 2000 and 2006, the daily cost of therapy with VAC was $97.09/patient (SD=2.54). After 2008, the daily cost of therapy with VAC was $101.34/patient (SD=0.80) compared to $4.22/patient (SD=0.80) for GSUC, p=0.001. The average yearly direct cost of NPWT was $217,500 from 2000 – 2006 and then fell to fell to $14,690 per year for the period of 2009 – 2011, p=0.001. Conclusions: The tools of comparative effectiveness research can be scaled down to assess problems facing single institution. When encouraged to take ownership of the research process, clinicians will also take ownership of the results. In this case, a standard method of wound care was abandoned less than a year after an in-house trial showed it was more painful, more expensive, but not more effective than a homegrown method.
Improving quality and safety of oncology patient care: Standardization of the post-clinic message triage process.
Authors: Donohue Caitlin C. , Kaymakcalan Marina , Elfiky Aymen , Dalby Carole Kathleen , Bryar Julie M. , Jacobson Joseph O. 
Published: February 2017

163 Background: Due to the rapidly increasing complexity of the treatment and management landscape of genitourinary oncology patients,the high volume of patient calls within our practice has raised safety concerns among providers about follow-through on issues and coordination of care. Survey data revealed that more than 20% of providers and staff (n=19) were unsatisfied with the existing message triage process and indicated that it was not the most efficient and timely way to respond to clinical messages. Patient survey data (n=94) and analysis of messages showed 80% of messages were related to direct patient care issues. The aim of this project was to analyze and streamline the message triage process with the goal of creating a standardized approach to respond to clinical messages in a timely and efficient manner. Methods: A multidisciplinary team constructed a process map, administered surveys, conducted cause-and-effect analyses, orchestrated brainstorming sessions, and used a priority/pay-off matrix to devise and implement an intervention using a standardized message template. Results: Baseline data showed that 18% of emails contained the necessary components to provide direction on who held responsibility for answering a message. Three Plan-Do-Study-Act (PDSA) cycles were conducted: (1) Education provided to administrative staff; (2) Implementation of email template; and (3) Subsequent modification in response to PDSA 2. After 3 weeks, 85% of emails contained the necessary components. Compared to a baseline of 79%, 96% of providers and staff prefer the new process. Conclusions: The interventions implemented using three sequential PDSA cycles resulted in an improved process for triaging clinical calls in conjunction with enhancing provider satisfaction. Additional steps are planned to further standardize the email notification template. [Table: see text]
Re-evaluating the inpatient use of routine diphenhydramine transfusion premedication practices.
Authors: Wong-Sefidan Ida , Roeland Eric 
Published: February 2017

164 Background: Routine diphenhydramine premedication to prevent allergic transfusion reactions is common practice despite lack of evidence. First-generation antihistamines are associated with a number of anticholinergic side effects such as sedation and cognitive impairment that impact patient care and increase cost. Because premedication should be evidence-based and patient-specific, the University of California, San Diego (UCSD) inpatient Bone Marrow Transplant (BMT) service implemented a transfusion premedication protocol, specifically addressing antihistamine use. Methods: To revise the protocol, a committee was formed. The committee reviewed evidence-based practices, challenges, pharmacology, and costs of antihistamines, and developed an inpatient BMT antihistamine premedication protocol that omitted pre-ordered diphenhydramine and offered cetirizine as a first-choice premedication. Antihistamine premedication was encouraged for high risk patients only. A retrospective comparison of antihistamine prophylaxis pre (2010-2011) and post (2011-2012) protocol implementation was completed. The number of antihistamine doses and transfusions was computed by a count from the electronic medical records. Results: Despite a 14% increase in transfusions, the number of BMT inpatient antihistamine premedication orders decreased by 26%. Diphenhydramine use decreased from 85.9% to 34.2%, while cetirizine use increased from 3.3% to 55.9%. Conclusions: The evidence-based, risk-stratified antihistamine premedication protocol decreased the use of diphenhydramine. Limitations include the retrospective design and lack of data comparing reactions in patients who did and did not receive premedication. Our institution plans to expand this study and complete a prospective evaluation of safely and rationally administered transfusion premedication with the goal to evaluate premedication-related toxicity and methods to improve the quality of life in our patients. [Table: see text]
Improving efficiencies in a hospital-based hematology outpatient service.
Authors: Rask Brittany A. , Zeldenrust Steven R. , Brandt Jessica , Hagan Heather , Witty Elizabeth , Larson Jennifer , Pederson Colleen , Herdahl Linda , Gallenberg DeWayne , Gronseth Daniel , Spaulding Tony 
Published: February 2017

165 Background: The Hematology Hospital Outpatient service at Rochester Methodist Hospital provides ambulatory outpatient care to patients who would normally be hospitalized on our inpatient services due to cytopenias and need for infusion/transfusion support. A quality project was conducted to streamline our process and decrease wait times. Methods: This project was a part of a Mayo Lean Collaborative initiative to increase customer satisfaction and eliminate waste. The first step was to collect baseline measurements to capture the non-value added waiting time of our entire outpatient process. These benchmark times were collected from 65 patients over 4 days. We evaluated these wait times to identify gaps in care and factors contributing to delays in our process. Data collected "before and after" each implementation phase determined if the change was beneficial. Results: Through our data collection, one major area of opportunity we identified was the wait time for CBC results. At baseline, patients were waiting in a room for 61.9 minutes for lab results. A major contributor to delay was the lack of carriers to send blood samples through the tube system being stocked in the outpatient area. We also discovered that the time from when the sample was placed in the carrier to the time it arrived in our lab was significant. Through a process analysis it was identified that the CBC tubes were being sent to a central lab prior to their final destination in the Hematology lab. We were able to re-route our CBCs directly to the hem lab. Data collected after the intervention showed we were receiving results at 51 minutes, therefore, eliminating 10.9 minutes off of an appointment. We also identified additional opportunities such as pre-assigning rooms, scheduling, exam room organization, and communication that were able to be addressed. Conclusions: As a result of this lean collaborative project we reduced patient wait time by 20.1 minutes and increased patient satisfaction. We were able to order interventions sooner thereby increasing patient safety. By process analysis, we identified multiple areas in our process that could be shortened with no additional cost.
Patient barriers to participation in clinical trials at a community cancer center.
Authors: Ramakrishnan Geethakumari Praveen , Ackler Joann R. , Gooptu Mahasweta , Braitman Leonard E , Tester William J. 
Published: February 2017

17 Background: Clinical trials are fundamental to innovative oncology. Participation rates in trials have declined nationally to < 5%. Barriers to participation exist at patient, physician, and protocol levels. This study seeks to identify barriers to enrollment in clinical trials at a community cancer center serving a diverse patient population. Methods: We conducted a descriptive cross-sectional study, including 160 eligible patients offered enrollment in 27 clinical trials from July 2010-December 2012. A standardized questionnaire was delivered by mail or in person. Patients who enrolled (acceptors) and decliners were compared using Fisher’s exact test for nominal variables and t test for normally distributed continuous variables. Results: Fifty-seven patients (36%) (males: 10, females: 47) returned the questionnaire. Thirty-three (58%) were enrolled in a clinical trial. Mean age of acceptors was 57 compared to 64 for decliners (p=0.007). Stage IV disease patients were more likely to enroll (Spearman rho= 0.33, p=0.01). Among patients with family support, 66% accepted participation compared to 40% of those without [p=0.05]. Twenty-eight of 33 (85%) who felt trust in their doctor affected their decision enrolled. Of those “comfortable with randomization,” 86% enrolled compared to 29% who were not [p<0.001]. 74% patients would participate in a trial if maximal information could be gathered before making a final decision. Acceptors stated altruism, contribution to research, trust in doctor and hope for cure while decliners mentioned uncertainty in research, drug side effects, mistrust in pharmaceutical industry and depression as most important reasons for their decision. Conclusions: Our results confirm barriers among diverse patients treated at a community cancer center. Study limitations include small sample size and predominance of female gender. Factors influencing enrollment identified include age, family support, patient’s insight into conduct of randomized trials, perceived drug side effects and the doctor-patient relationship. Success lies in bridging knowledge and communication gaps, careful protocol design, and establishing trusting relationships.
Using a new patient process to improve breast care access.
Authors: Miller Eleanor , Colon Jonathan , O'Connor Nancy 
Published: February 2017

171 Background: Access to timely care is of major focus in oncology. Clinicians and administration collaborated to improve the training and support for non medical staff involved in the new patient process at the breast center. The goal of the process was to improve upon the surgical triage of patient appointments for those with suspicious mammograms or newly diagnosed with breast cancer in less than one week, use the nurse practitioner clinics most effectively, and to triage other diagnoses and patients per updated guidelines, thereby increasing access to care. Methods: A new patient intake form was created with the assistance of IT and added to the electronic medical record as a tool for use by clinical and nonclinical staff. Clinicians and administration also met to update the new patient process forming a decision tree, which ultimately was developed into a manual. A series of in-services were held with scheduling and clinical staff for education and training. Education was also provided to refer patients with complex needs to the nurse navigator. Outcomes were measured by clinical and administrative staff. Results: Access to surgery clinics has improved for new breast patients since the process updates were implemented. Patients can be seen an average of 3.5 days sooner for both malignant and benign diagnoses. Access to the nurse practitioner clinic also improved by 9.4 days. Patients that are diagnosed within the health system can be seen within 3 days, and those that are diagnosed outside the system, within 7 days. Conclusions: It was the goal to improve access to the breast center by updating the intake and scheduling guidelines to see patients with a new diagnosis of breast cancer or other breast problems more quickly. Having guidelines that can be followed by clinical and non clinical staff promotes communication and collaboration, as well as a consistent approach among staff. In the future, the continued refinement of the new patient process and ongoing collaboration will further improve access to care.
Development of a quality assurance program at a community hospital breast center for elderly breast cancer patients who do not have axillary surgery.
Authors: Tito Elizabeth P. , Barthold Joseph , Lopez Marvin 
Published: February 2017

173 Background: Sentinel lymph node biopsy (slnb) is the standard of care for patients with invasive breast cancer. Yet, in some patients, the nodal information will not change the treatment and the risk of a clinically relevant axillary event is low. It may be reasonable to offer observation of the axilla. However, this recommendation is outside national treatment guidelines. Our breast center developed a pilot program through which we offer elderly women with co-morbidities the option of avoiding axillary surgery for their invasive breast cancer and follow their outcomes. Methods: A pilot program was implemented to provide a structured method of evaluating and following elderly women with invasive breast cancer who did not have axillary surgery. Criteria for avoidance of axillary surgery were developed, cases were reviewed prospectively at multidisciplinary tumor board, data was collected and analyzed annually from 2010 to 2012. Results: Between 2010 and 2012, 282 patients had surgery for breast cancer at our hospital; 263 patents qualified for slnb by NCCN guidelines. Nineteen women did not have a slnb (Table). All cases were discussed at multidisciplinary tumor board. All women had negative axilla by exam and imaging prior to surgery. Patients were followed by annual axillary exams and imaging. One patient had a loco-regional recurrence (LRR) which was seen on axillary ultrasound. She died with disease from metastatic lung cancer. One patient, who refused radiation, developed an in breast tumor recurrence (IBTR). Conclusions: Breast cancer treatment is evolving at a rapid pace and becoming more conservative. This trend leads to practice changes before guidelines have been adjusted. Lacking a national registry, a system should be in place at hospitals to make these transitions in a safe, educated, data-driven process. Our pilot program provides a structure in which women who did not have sentinel node biopsies are evaluated, educated and followed. [Table: see text]
Time-to-simulation for radiation oncology patients in an academic department.
Authors: Kapadia Nirav S. , Lash Kathy Ann 
Published: February 2017

176 Background: In 2011, one of the two clinical simulators in our department was decomissioned in order to enable the construction of a clinical magnetic resonance (MR) simulator. As result, our clinical simulator capacity decreased resulting in increased wait times for patients undergoing treatment planning. In turn, there was a perceived increase in the number of patients added onto the simulator schedule (add-ons) immediately following consultation. This created problems of workflow on the simulator and increased clinic wait times for previously scheduled patients. A clinical Lean team was formed with the intent of 1) quantifying the number of daily add-ons and 2) identifying predictors of add-ons so that the frequency of add-ons could be predicted and if possible, load-leveled. Methods: Over an eight-week period, frequency of simulator add-ons was correlated with de-identified patient data abstracted from the medical record using one-way ANOVA and student t-tests to assess the statistical hypothesis that a patient, disease, or provider factor increased the likelihood of a patient add-on. Interviews were conducted with the clinical staff to determine perceived frequency of add-ons, predictors of add-ons, and to evaluate the rationale for add-ons. Results: On average, 7.9 (range 7.3-8.7) simulations were performed daily in our department and 0.95 (0.7-1.4) patients were added onto the simulator daily. Patient demographics, day of consultation, inpatient vs outpatient status, treating and referring physician, as well as cancer diagnosis were examined. A statistical trend for add-on patients on Friday (p=0.064, vs. Monday) was found. One physician's patients accounted for 36% of the Friday add-ons over the eight week period. The physician was interviewed and her rationale for adding-on patients was determined. Conclusions: The mean number of add-on patients was determined to be acceptably low in our department and was on average less than one patient daily. A trend for an increased likelihoood of add-on patients with a particular Friday provider was noted and as such future efforts will be directed at mitigating the number of this physician's add-on patients.
Improving quality of care within the NCI Community Cancer Centers Program (NCCCP) network.
Authors: Castro Kathleen M. , Friedman Eliot Lawrence , Mack Nadesa , Siegel Robert D. , Eisenstein Jana , Prabhu Das Irene , Clauser Steven 
Published: February 2017

178 Background: The National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP) was initiated to expand cancer research and deliver quality cancer care in communities. A program goal was support of quality care initiatives. Twenty-one community sites in 16 states participated in the network providing care to approximately 40,000 cancer patients/year. We describe strategies for implementation of a structured quality program within our network. Methods: Four components served as the foundation for quality efforts: 1) increasing multidisciplinary care (MDC) programs; 2) ASCO QOPI participation; 3) Commission on Cancer Rapid Quality Reporting System (RQRS) participation; and 4) expansion of genetic counseling/services. A Quality of Care subcommittee formed to guide quality efforts within the network. Clinicians from the network served as subcommittee leadership and each site designated a quality of care lead. The subcommittee met by teleconference monthly, developed goals, shared best practices, developed processes to accomplish goals and documented improvements in priority areas. Results: Strategies employed to improve quality included: assessment tool development, participation in national quality reporting initiatives, review and monitoring of network data, and network performance improvement projects. Conclusions: The NCCCP identified areas of needed quality improvement. In addition, the network developed implementation strategies and created benchmarks that measure program quality. Participants benefitted from the opportunity to interface with one another and set network goals, while adopting strategies to best fit their own practices and community sites. [Table: see text]