bluuebunny/crossref_metadata_2025_split huggingface dataset:
Streamlining urgent, same day oncology admissions from an ambulatory clinic and patient safety, patient experience, and team communication.
Authors: Greytok James , Sullivan Lauren , Curran Shauna , Gilmore Jennifer , Rotow Julia K. , Pullo Anna , Marlowe Gail , Yenulevich Eric , Grenon Nina , McCormack Mary , Lakhani Hakim , Bagley Janet , Wagner Andrew J. , Wadleigh Martha 
Published: October 2023

394 Background: The urgent, same-day, admission process for an ambulatory oncology patient is complex. Between January 1, 2021 and November 8, 2022, at least 35 safety reports were filed relating to urgent, same-day admissions yielding a rate of 1.72% of direct admissions resulting in a safety report. Issues included communication breakdowns (e.g. insufficient handoff, insufficient updates on patient condition, incorrect mode of communication which led to delays in care), admissions to incorrect teams, and admissions to locations ill-equipped to manage the patient’s acuity. Another challenge is the ambulatory facility, Dana-Farber Cancer Institute, and the admitting facility, Brigham and Women’s Hospital (BWH), are two different hospitals further complicating the admissions process. The goal was to streamline the urgent, same-day admission process, set expectations for the interdisciplinary teams involved, and determine a process to triage high acuity patients to the emergency department (ED) when warranted. Methods: The interdisciplinary workgroup identified gaps and pain points in the current state process. This collaborative effort led to new, streamlined workflows for key stakeholders in the process. New workflows were created for outpatient nurses, outpatient providers, and inpatient nurses. An important step in the new workflows revolves around establishing the rule that patients will be routed to the ED at 5pm if no bed will become available by clinic closing. This allows the patient to receive care quicker and triages the patient to the inpatient bed queue at an earlier point in the day. These workflows were posted in clinic and inpatient areas, distributed electronically, and presented in multiple team meetings. A new safety report event type, “Admissions from Clinic,” was created in the system to identify issues related to these processes. Results: From the date of implementation of the new workflows to the time of reporting (approximately 2.5 months), there have been 4 safety reports yielding a rate of 1.68% of direct admissions leading to safety reports. Most of these reports pertained to the bed tracking system not functioning properly leading to patients showing up to the inpatient floor before their bed was ready. Overall, the new workflows are functioning efficiently with no increase in the number of patients sent to the ED due to communication of bed availability at 5pm. Conclusions: Interdisciplinary collaboration involving key stakeholders in the direct admissions process from a cancer clinic to the inpatient setting, led to a reduction in safety reports generated regarding communication, patient safety and patient experience. There was no increase in patients being triaged to the ER at the end of the day.
Effectiveness of a dedicated therapist on improving prospective identification and pre-operative rehabilitation (PREHAB) to reduce post-operative treatment encounters for breast cancer-related lymphedema (BCRL) in a rural and underserved population.
Authors: Newberry Tara , Abrahamsen Betty , Brooks Heather Dawn , Bissell Charles 
Published: October 2023

399 Background: The rural and underserved have unique challenges and barriers to receiving evaluation and treatment for BCRL. Prospective identification and PREHAB for those at high risk including mastectomy over age 60, axillary node dissection, and radiation reduces the risk of BCRL and post-operative treatment encounters. In a rural Virginia breast program in 2021, 71% (40/56) of breast cancer (BC) patients were identified as high-risk for BCRL. Only fifteen percent (6/40) of high-risk patients received PREHAB with fifty-two percent (29/56) of total BC patients required post-operative encounters for treatment of BCRL. A quality improvement project to improve these numbers was implemented. Methods: We sought to increase the number of PREHAB encounters for patients at high-risk for developing BCRL and to decrease the total number of BC patients requiring post-operative BCRL treatment encounters. A Certified Lymphedema Therapist (CLT) prospectively identified patients at high-risk for development of BRCL during multidisciplinary breast cancer conference (MBCC). High-risk patients were offered PREHAB appointments, and the rates of PREHAB and post-operative intervention encounters were recorded. Results: In 2022, 76% (51/67) of BC patients were identified as high-risk for developing BCRL. Thirty-seven percent (19/51) received PREHAB, a 22% increase from 2021. The average number of visits was 7.7 visits for patients who received PREHAB and 19.2 visits for patients who did not. Forty-two percent (28/67) of total BC patients required post-operative encounters for treatment of BCRL, a 10% decrease from 2021. Barriers/Challenges: Both providers and patients showed limited engagement in the PREHAB model at the start of the program. Patient barriers to treatment included transportation and time limitations. Conclusions: A dedicated focus including high-risk screening, PREHAB, and a CLT at MBCC, can improve outcomes for BCRL in a rural and underserved population. Future investigation will include measuring BCRL rates over time.
Provider perspectives on radiation oncology quality practices in peer review.
Authors: Chang Leslie , Alcorn Sara Rachel , Wright Jean L. 
Published: October 2023

411 Background: Radiation oncology peer review involves presentation of new cases including pertinent patient history and case-specific qualitative treatment planning decisions. Yet implementation of peer recommendations is inconsistent. Thus, we sought to understand multidisciplinary perspectives on peer review to identify factors affecting stakeholder engagement. Methods: Participants in radiation oncology peer review completed semi-structured interviews and Likert surveys to explore the perceived value in peer review and its influence on their clinical practice and plan changes. Interviews were audio-recorded and transcribed, and two independent coders utilized a grounded theory approach to extract dominant themes. ANOVA and students t-test were used to analyze Likert scores. Results: Participants included 6 academic and 3 community radiation oncologists, 2 radiation oncology residents, 2 medical physicist, 2 radiation therapists, 4 dosimetrists and 1 industry representative. Analysis of interviews regarding perceived priorities of peer review revealed the following themes: understanding the clinical background to inform decision-making, detection of rare errors not found in other quality assurance processes, coherence in practice within an organization, and education on new techniques. Key facilitators included pre-planning communication between multidisciplinary teams, particularly for replanning and reirradiation scenarios. Barriers to adaptation of recommendations included resource limitations and lack of supporting data. Likert surveys (0=no importance, 10=highest importance) assigned a high value to the overall process (mean score: 8.3), reducing variation in practice (8.0), conformity of plans with institutional guidelines (7.8), and participant education (7.6), with a lower value placed on the detection of medical errors (7.4) and reduction of treatment incidents (6.9). When comparing Likert scores by provider, non-physicians rated overall importance of peer review (mean: 9.8 vs 6.5, p=0.03) and education (9.0 vs 6.7, p=0.02) significantly higher than physicians. There was no significant difference in Likert scores by academic vs community practice. Conclusions: All participants agreed peer review is an important process in radiation oncology quality assurance that may catch rare errors. However, there was significant variation in the perceived benefits of peer review, and a higher value was placed on alignment of clinical practice and non-physician participant education. Future processes to improve communication between multi-disciplinary teams was identified as beneficial to peer review discussions.
The state of workforce retention among US oncologists.
Authors: Schenkel Caroline , Levit Laura A. , Kirkwood Margaret Kelsey , Spence Rebecca , Hlubocky Fay J. , Back Anthony , Burke John M. , Friese Christopher Ryan , Gallagher Colleen M. , Lyckholm Laurie Jean , Page Ray D. , Paice Judith A. , Tetzlaff Eric Daniel , Morgante Jim D. , McGinnis Molly , Shanafelt Tait D. 
Published: October 2023

42 Background: With increasing incidence rate of human malignancy, it is critical to maintain an adequate oncologist workforce to meet the societal need for expected oncologic care. Methods: In January-February 2023, ASCO emailed a novel 36 item REDCap survey to 5892 U.S.-based ASCO physician members to evaluate career intentions. The survey included 2 questions from the Maslach Burnout Inventory (MBI). The survey was distributed through multiple ASCO channels in February-March 2023. Survey responses were compared to findings from a 2013 survey of 1345 oncologists by Shanafelt et al.1 Per convention, those with high levels of emotional exhaustion and/or depersonalization were categorized as having burnout. Results: 410 eligible responses were analyzed. Demographic characteristics of oncologists in active practice (ACs) (≥ 6 hours/week) and oncologists no longer in active practice (FCs) are summarized in the Table. Most ACs reported that their total work hours (57%) and hours spent on administrative work (68%) had increased since 2019 (pre-COVID). 49% reported an increase in patient care hours. Compared to ACs surveyed in 2013, a higher percentage of ACs surveyed in 2023 reported it was “likely” or “definite” they would leave their current practice within 2 years (21% vs. 17%, p=.049) or reduce their clinical work hours in the next 12 months (22% vs 16%; p=.009). High likelihood of leaving or reducing hours were associated with burnout (p=.002 and .003, respectively). When ACs were asked to identify up to 2 major work stressors, "Staffing levels” and “Use of the electronic health record” were the most common responses (47% of responders each) with “Payer policies and interactions” close behind (42%). Among retired FCs (42%, n=33), the median retirement age was 67 [IQR: 7]. A high proportion (42%, n=14) of these oncologists indicated they retired 2-4 years earlier than planned. Among FCs who had transitioned to non-clinical roles (56%, n=46), the median age to leave clinical practice was 58 [IQR: 21]. Among oncologists who had transitioned to non-clinical roles, the top reason for leaving clinical practice before age 50 was “Lack of satisfaction with clinical practice” (35%, n=6), while for those 50 or older it was “Desire for more work flexibility” (31%, n=9). Conclusions: The proportion of oncologists who intend to reduce clinical care hours or leave their current practice has risen over the past decade and is associated with professional burnout. Dissatisfaction with the practice environment has led some oncologists to leave clinical practice and/or retire earlier than planned. These trends have implications for the adequacy of the oncologist workforce to meet the needs of patients. (1) Shanafelt et al: J Clin Oncol 32(27), 2014. [Table: see text]
Development of ovarian cancer biomarker electronic clinical quality measure: Lessons learned.
Authors: Drumheller Caitlin , Wright Alexi A. , Liu Ying L 
Published: October 2023

420 Background: ASCO received funding from the Gordon & Betty Moore Foundation’s Diagnostic Excellence Initiative to develop and test a biomarker electronic Clinical Quality Measure (eCQM) in ovarian cancer. Methods: Working collaboratively with a Technical Expert Panel (TEP), ASCO staff explored the development of an eCQM, Appropriate Germline Testing for Ovarian Cancer Patients to assess the rates of testing for BRCA1/2 germline mutations in adult ovarian cancer patients. The measure underwent clinical workflow analysis; feasibility; face, empiric, and data element validity; and signal-to-noise reliability testing. Results: Feasibility testing indicated an inability to reliably differentiate between germline and somatic BRCA1/2 testing in an eCQM specification due to both a lack of specificity in existing codes, and inconsistent use of appropriate codes to reflect germline testing. Among the 32 individual clinicians across 12 testing sites, overall measure performance ranged from 6.25 to 100 percent, with a 52.3 percent mean performance score (95 percent CI [39.9, 64.7]), indicating a performance gap and variation in care in germline testing among the ovarian cancer patient population. Conclusions: This measure development effort illustrated a scenario where medical practice has advanced beyond current data availability and coding specificity in a way that impacts stakeholder ability to reliably assess the delivery of personalized cancer care and minimize the burden of that measurement. While we concluded the implementation of an eCQM to assess rates of germline testing in ovarian cancer patients was infeasible and premature, ASCO continues to advance the registry-based Clinical Quality Measure (CQM) version of the measure, as testing indicated the CQM is reliable, valid, and reflected continued variation in care. ASCO supports efforts to advance towards robust, meaningful digital quality measures using things like Fast Healthcare Interoperability Resources (FHIR) and Minimal Common Data Elements (mCODE) initiatives, which will enable more standardized data capture and increase the availability and utility of granular data needed for assessing quality cancer care. ASCO also seeks to expand the denominator of this measure to include additional cancer types where germline BRCA1/2 testing is appropriate. Denominator expansion will not only significantly broaden the impact of the measure, but also increase longevity of the measure’s potential use in cross-cutting reporting initiatives such as the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs).
Impact of an embedded oncology clinical pharmacist in an outpatient oncology center.
Authors: Dean Latanya , Cabebe Elwyn Clement , Hsu Carissa , Chang Abraham , Tse Stephanie Agnes , Ceballos Erika 
Published: October 2023

424 Background: Oncology pharmacists are uniquely positioned to improve the quality of care provided to patients with cancer within the team-based setting. Some benefits include providing information that supports safe and cost-effective use of medications relative to supportive care management, drug-drug interaction evaluation, patient counseling, answering drug information questions, and reducing physician workload. The primary objective of this study is to evaluate the benefit of a full-time clinical pharmacist in the ambulatory oncology setting through documenting pharmacist-driven clinical interventions, correspondence of those interventions with cost avoidance, and perceived benefit from provider and patient satisfaction surveys. Methods: Pharmacists were in clinic Monday through Thursday, covering three medical oncologists each day. Interventions were documented through EPIC i-Vents. The categories included: adverse events, drug interactions, lab monitoring, medication reconciliation, order clarification, patient education/counseling, drug information, and supportive care. Pharmacist interventions correlated with cost avoidance benefits based on values from prior publications. Weekly surveys were sent to the providers to assess satisfaction of the program and to improve workflow. Results: The data from this pilot program reflects the study period starting January 9, 2023 through June 1, 2023. The financial impact, as calculated from the pharmacist interventions, cost avoidance values and time spent resulted in the estimated cost avoidance of $169,321.10 based on a total of 839 interventions. Other interventions were made that were not given a cost value. Thus, the estimated cost savings is likely an under-estimation of the true cost savings provided from this service during this five-month study period. Extended providers (n = 5) and medical oncologists (n = 3) surveys indicated an overall strong agreement to the benefits of an oncology pharmacist’s involvement in clinic. The pilot program is currently working on a method to gather patient surveys to assess patient satisfaction. Conclusions: This study demonstrates the clinical and financial benefit of an embedded oncology pharmacist in the outpatient oncology clinic. As we move into an era with increasing approvals of oncology medications, coupled with increasing complexity of care, this service may help address some of the unmet gaps to improve collaborative and comprehensive patient-centered care.
A multidisciplinary approach to adequate antibiotic use in a clinical oncology ward.
Authors: Todaro Pupo Juliana , Silva Junior Moacyr , Tuma Paula , Flores Francisco Maurilio , Pelegrini Paula , de Paula Russo Fernanda Aparecida , Luiz Vasconcelos Ana , Araújo Sergio Eduardo Alonso , Cendoroglo Neto Miguel 
Published: October 2023

430 Background: Infectious complications are related to high morbidity and mortality among oncology patients. Despite prompt attention being given to its management, many times the prescription of antibiotics is inadequate or overuse, mainly in palliative care. A multidisciplinary team is essential to take care this complex patient and to support the best practice to antibiotic prescription. Methods: We established a multidisciplinary team with support of medical specialists in clinical oncology (physicians, nurses, pharmacies and residents) and infection control (physician and nurse) to evaluate the antibiotic use, indication and period of use based on local antibiotic stewardship guidelines. Antimicrobial consumption was assessed using Defined daily dose (DDD). A drive diagram was created, and the actions were implemented. The data were collected pre intervention (from January to October 2022) and post intervention (from November 2022 to May 2023). Results: The main therapeutic uses were identified as ceftriaxone (DDD = 134.26), piperacillin-tazobactam (DDD = 112.13), metronidazole (DDD = 134.26) meropenem (DDD= 27.14), and teicoplamine (DDD= 23.69). The final stages of life were the main offender based on our guideline. The average antimicrobial consumption during the final 72 hours of life was 41%. According to these data the following actions were taken: 1) improve the palliative risk identification system; 2) assess the pertinence of antimicrobial use in end-of-life care; 3) creation of the one protocol in this subgroup of patients 4) an applicative was created, allowing the insertion of the advice by the medical team and the follow-up by the pharmaceutical team. In post intervention period, with these multi modal strategies the average consumption in end-of-life care reduced to 18%. Conclusions: A creation of a multidisciplinary team in oncologic care with a particular focus in antibiotic stewardship improved the adherence antibiotics protocols and had an impact in patients end of life.
Chronic care management: An opportunity to drive quality outcomes in oncology care.
Authors: Pate Amanda , Lammersfeld Carolyn , Anderson Katherine , Markman Maurie 
Published: October 2023

444 Background: CMS approved Chronic (CCM) and Principal Care Management (PCM) to improve patient care. These services are typically non-face-to-face; providers can bill ≥ twenty minutes /month. In oncology, this may help with comorbidity and symptom management to reduce the risk and expense of avoidable hospitalizations and ER visits and pay providers for time spent. In 2021, a system of community cancer centers initiated a program with a partner to manage chronic conditions more effectively at home. Approximately three hundred people were enrolled. A review of the data found that patients did not meet the medical criteria for the program, and care was not billable. An internal program was created to improve the enrollment process and financial sustainability. A clinical needs assessment was completed with our oncologists, outlining revised criteria for patient enrollment. Qualified patients were enrolled by their attending oncologist during the initial face-to-face visit and assigned a dedicated RN. Methods: Three hundred unenrolled, actively treating patients were randomly selected from January 2023 to May 2023 by a group of data analysts not associated with the program to be compared to enrolled patients who have been enrolled on average six months. Patients were compared by age, gender, cancer type, and race. The LACE Index for Readmission, a validated tool using the length of stay, acuity of admission, comorbidities, and ER visits to predict the risk of readmission, was done retrospectively by RNs for all patients. Enrolled patients received a comprehensive clinical needs assessment by RNs, and a provider-approved care plan was created. RNs provided patients with education on lifestyle modification and assisted in setting achievable goals. The care plan was monitored with weekly calls, providing the opportunity to respond to patients’ needs proactively. Symptom and medication management were provided, and psychological and nutritional needs were addressed. This coordination of services was documented in the electronic health record, and superbills were created and sent to billing and coding monthly. Results: See table. Conclusions: The purpose of this study was to compare hospital admissions between the groups. Our findings suggest that CCM and PCM may reduce unplanned admissions, with physician engagement pivotal in driving appropriate enrollment. The current program is labor-intensive and further investigation is required to determine the most cost-effective way of scaling the program with the possible use of artificial intelligence, RPM, or other technology.[Table: see text]