bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality initiative (QI) to improve molecular testing in newly diagnosed (ND) stage 4 non-small cell lung cancer (NSCLC-4): An Integra Connect (IC) database study.
Authors: Smith Robert E. , Gart Mike , Choksi Rushir J. , Petro Daniel P. , Scott Jeffrey A. , Varughese Prateesh , Stockton Matt 
Published: September 2022

304 Background: In August 2019 IC partnered with University of Pittsburg Medical Center (UPMC) on a QI aimed at improving outcomes in stages 3 and 4 NSCLC. This report details the findings, interventions, and results in the stage 4 cohort to date. Guidelines advocate broad molecular profiling and completion of biomarker testing prior to initiation of initial therapy (KF Mileham,2022). However, real world data has shown a high rate of treatment initiation without biomarker testing due to low rate of testing and, if tested, treatment prior to results reporting (H West,2021; J Nicholas, 2021) in this disease state having a 5-year survival of only 7% (N Howlander). Based on analysis of the US Oncology Network it was found that only 46% of patients (pts) with metastatic NSCLC received testing for PD-L1, EGFR, ALK, ROS1, and BRAF-V600E (J Nicholas, 2021). Methods: By querying the UPMC and IC databases, 910 patients (pts) with ND NSCLC-4 were identified who received an initial line of therapy, excluding squamous carcinoma pts unless documented never-smokers, during 1/1/2017- 12/31/2021. Date of EGFR test ordered, date of test result report to electronic health record, and date of treatment initiation were captured. Also included were test orders for the NCCN recommended biomarker panel of PD-L1, ALK, ROS1, BRAF, RET, MET, and NTRK. The data were evaluated in three time periods for the QI: Phase 1 of 1339 days (1/1/2017-8/31/2020) for baseline, Phase 2 of 122 days (9/1/2020-12/31/20) post physician leadership intervention, and Phase 3 of 516 days (1/1/2021-5/31/2022) performance measurement period. Baseline and on-going measurement of testing metrics was performed with physician leadership intervention for identified gaps in care. Additionally, surveys were implemented to assess caregiver perceptions. The use of chart curation and software-based monitoring tools powered by IC enabled providers to understand current levels of testing and track performance over time. Results: Median age was 68 (range 36 - 89) and 49% male. As shown in Data Table, EGFR testing at baseline was 94% and increased to 98%. Testing of the entire biomarker panel noted above increased from 52% baseline to 70% at this point in Phase 3. While only 72% had treatment initiated after EGFR result at baseline, this improved to 83% during Phase 3. Conclusions: This QI led to improvement in rates of broad biomarker testing and initiation of treatment only after results were made available in this NSCLC-4 population. While this initiative was not designed to evaluate outcomes, one would expect outcome improvement over baseline with higher guideline adherence.[Table: see text]
Improving performance status documentation using an electronic medical record tool.
Authors: Emmich Megan , Holle Lisa 
Published: September 2022

309 Background: Performance status (PS) is used regularly in oncology care to select appropriate cancer treatment, track changes in level of functioning, and determine clinical trial eligibility. In addition, the American Society of Clinical Oncology (ASCO)/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards requires that on each clinical encounter, staff performs and documents a patient assessment that includes 8 elements; one of which is PS. Currently, little instruction is provided on how to utilize and record a more standardized criteria, such as PS with either ECOG or Karnofsky scores, in the electronic medical record (EMR) which results in suboptimal documentation. We assessed documentation of PS before and after implementation of a tool within the EMR at our outpatient cancer center. Methods: Using the Plan-Do-Study-Act (PDSA) technique, a quality improvement project was developed to determine if our center was consistent with the ASCO/ONS guidelines. An EMR tool was developed that enabled clinicians to standardize PS documentation within an encounter via population of a flowsheet to improve compliance. Clinicians were educated on guidelines and utilization of the PS tool and data was collected pre- and post- implementation. A survey was developed and administered to assess PS tool use and to learn of any barriers to implementation. Based on survey results, we created a reminder tip sheet for clinicians to utilize the PS tool; a subsequent chart review was completed. Results: In a random pre-study 50 chart review, 0% of encounters in our lung and breast clinic had PS documented. At the time of pre-tool implementation, due to the lack of a retrievable flowsheet, we did not obtain a reliable PS documentation percentage. After education and tool implementation, 2481 random encounters were evaluated of which 315 encounters (12.6%) documented PS and used the PS tool. A total of 7 (35%) clinicians completed the survey: 4 physicians and 3 advanced practice registered nurses. Of those who responded, 57% used the PS tool, 71% used a note template with ECOG PS embedded, and 85.7% were willing to alter their note template to incorporate ECOG PS. Barriers identified included: limited time, workflow constraints and redundant documentation. After tip sheet implementation, 66% of encounters documented PS; however, only 6 out of those 33 encounters (18%) documented PS using the PS EMR tool. Conclusions: Documentation support tools help facilitate care and enable measurement of guideline concordance, but once implemented it can be challenging to maintain adherence. Although this study improved overall PS documentation (0 to 66%), we were only able to demonstrate a 6% increase in the use of our PS documentation tool. While PS tool implementation was feasible, adoption of the additional tool was not universal. We aim to gather additional clinician input to improve PS documentation completion and guideline adherence.
Supporting high-risk oncology patients with an outpatient transitional care management program.
Authors: Bhattacharya Manisha , Graziano Regina , Wahal Evanne , Alexander Julie , O'Connor Lynne , Cumberledge Rene , East Avigayil , Zandberg Dan Paul , Thomas Roby Antony 
Published: September 2022

313 Background: Transitional Care Management initiatives (TCM) financially support comprehensive outpatient followup in the first 30 days after acute care discharge. TCM programs require patient contact within 2 days of discharge, an outpatient appointment within 7-14 days, patient education, and moderate-high complexity medical decision-making that supports successful outpatient transition. To date, TCM is often utilized to provide additional reimbursement for qualifying primary care post-discharge followup, but could be applied to align incentives in busy oncology practices. We present a novel application of TCM to enhance post-discharge cancer care with the goal of reducing readmissions for high-risk oncology patients. Methods: We identified patients discharged from our health system’s cancer hospital with a “Highest” risk of readmission as determined by an internally developed machine learning clinical algorithm built into the EMR. Patients were targeted with a post-discharge phone call within 48 hours offering an in-person or telemedicine appointment within 72 hours. The Transitional Care Clinic (TCC) visit guidelines promote connection to ancillary services such as physical and occupational therapy, medication management, and dietetics. The TCC can offer interventions to address emergent medical needs such as fluids, transfusions, and symptom management. Results: In the first three months of the TCC program, the 30-day readmission risk algorithm identified 136 cancer patients discharged from the designated cancer hospital in the “Highest” readmission risk category. 121 of those patients were previously admitted within one year. 72 of the 136 “Highest” risk patients were referred to the cancer center TCC workflow and 60 patients were eligible for a TCC appointment. 18 patients had appointments scheduled (30%) with 83% completed (15/18). 22% of scheduled appointments were via telemedicine (4/18) and 100% of these appointments were completed. Conclusions: TCM programs can be adapted to reward timely hospital followup for oncology patients after discharge. TCM requirements overlap with several common elements of readmission reduction initiatives, but EMR tools for identifying patients at highest readmission risk may need additional adaptation into clinic workflows to promote a high capture rate that justifies program support. Future longitudinal cohort analysis will establish if the TCC is able to reduce cancer-related readmissions in high-risk populations.
Improving documentation of zoledronic acid interval in ambulatory oncology patients.
Authors: Dandawate Tanvi 
Published: September 2022

323 Background: Therapy plan orders for certain repetitive medications such as Zoledronic Acid do not always reflect the interval administered. This creates a patient safety risk as patients may get extra or fewer doses than required, a lack of clarity for pharmacy dispensing and nurses administering the medication and delays for patients while the orders are corrected. In a 3-month period, 30 safety reports of Zoledronic Acid therapy plan discrepancies were reported. Methods: Baseline data was determined using manual chart review of a sample of 50 patients, reviewing documentation of Zoledronic Acid interval in four fields in the chart. 58% of patients had an incorrect interval in therapy plan title and 12% of charts had discrepancies in other fields. In initiating this improvement project, we identified and engaged key stakeholders (nurses, providers, IT, patient safety and pharmacists) in DFCI oncology outpatient areas in a series of interactive meetings to share baseline data and use quality improvement tools (process mapping and impact-effort matrix) to identify solutions. In PDSA cycle 1, the options of Zoledronic Acid therapy plans were modified from having separate plans for each interval to a single therapy plan with options to select the interval. This was done with the goal of reducing the number of fields with the interval to reduce discrepancies in interval. In PDSA cycle 2, a team of pharmacists reviewed charts of patients who had an appointment with a provider and were on Zoledronic acid weekly, for 12 weeks. Charts with interval discrepancies were sent to the ordering provider for correction. This was done for two disease groups over a period of 6 months. Results: Post the completion of PDSA cycle 1, an analysis of 7165 dispenses showed that Zoledronic Acid therapy plans containing information apart from medication name in title decreased from 90% in 2019 to 0.4% in 2021. PDSA cycle 2 addressed discrepancies in another 126 patient charts, reducing the overall discrepancies from 12% to 7%. Conclusions: This project demonstrates multidisciplinary approach to identifying solutions to discrepancies around Zoledronic Acid intervals in patient charts has reduced this patient safety risk. The solutions implemented in PDSA cycle 1 was a system-based solution with a high impact. PDSA cycle 2 helped mitigate the safety risk further. Additional system-based solutions are essential in the long term to reduce documentation variability and improve quality and safety of care for patients receiving Zoledronic Acid.
Claims-based cardiac monitoring (CM) in patients (Pts) receiving trastuzumab (TZ).
Authors: Bandini Lindsey , Denlinger Crystal S. , Duggan Goldstein Sarah Ford , Marinkovich Wendy , Edge Stephen B. , Carlson Robert W. 
Published: September 2022

324 Background: TZ in HER2-positive breast cancer (BC) has established improved outcomes in certain Pts. TZ carries a black box warning and a recommendation for CM in all Pts prior to and during treatment (tx) Few studies have evaluated real-world CM compliance during tx. Methods: Retrospective, cross-sectional analysis was conducted to identify CM compliance among BC pts receiving TZ, using a limited data set of administrative claims data consisting of female Pts who were continuously insured over a 24-month period between Jan 1, 2019 and Dec 31, 2020, as provided through a secure portal by Blue Cross Blue Shield Association. [1] . BC diagnosis was confirmed by ICD-9 code, while tx with TZ or biosimilar was confirmed through Healthcare Common Procedure Coding System codes. A care episode spanned 14 months, including 123 days prior to first TZ dose (Index Date) and at least 307 days of follow up. Two cohorts (eligibility for both dx and continually insured status of female commercial Pts, 2018-2019 and 2019-2020) were analyzed across four tx Phases (Pre-Tx Phase [days -123-+ Index Date as day 1], Phase 1 [days 61-123], Phase 2 [days 153-215], Phase 3 [days 245-307]). Phase denominators were calculated independently, only including Pts with ongoing TZ tx for each Phase. [1] Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. Results: Pts in each Phase and cohort ranged from 2,304 (Full Compliance 2019-2020) to 3,263 (Pre-Tx 2019-2020). Similar results were seen in both cohorts, with highest proportion of Pts receiving CM in Pre-Tx phase. Overall compliance in Pre-Tx Phase and all subsequent Phases was low; nearly two-thirds of Pts missed one or more CM tests. Drop-off in CM testing occurred in each subsequent tx Phase (Table). Conclusions: Continued decline in CM over time suggests lack of awareness for potential late TZ cardiac toxicity. Further research regarding why Pts are not receiving recommended baseline and on-treatment CM is needed. Routine CM during TZ tx may be a quality indicator for practices, payers, and quality improvement programs.[Table: see text]
Increasing tobacco cessation counseling and referral in a statewide oncology collaborative.
Authors: Ruiz Martinez Mariem , Griggs Jennifer J. , Liu Manlan , DeVries Kelly 
Published: September 2022

327 Background: Oncology providers are uniquely positioned to provide tobacco cessation interventions because the motivation to quit can increase at the time of a cancer diagnosis. Physician advice to quit smoking increases the likelihood of a quit attempt by 25%. The Michigan Oncology Quality Consortium (MOQC), a physician-led quality improvement consortium of nearly all oncology practices in Michigan, has made tobacco cessation counseling and referral a priority. Methods: The Michigan Oncology Quality Consortium (MOQC) began abstracting tobacco cessation counseling and referrals from oncology medical records into the Quality Improvement Practice Initiative (QOPI) platform of the American Society of Clinical Oncology (ASCO) beginning in 2014. MOQC has developed and disseminated effective resources to ensure that practices in the consortium have access to tobacco cessation services through a grant to the Michigan Department of Health and Human Services (MDHHS). In 2017, performance on this measure was selected as one of our value-based reimbursement (VBR) measures. We also compared our data with responses from the Behavioral Risk Factor Surveillance System (BRFSS) obtained through MDHHS in response to the following question: “Earlier you indicated that you currently smoke cigarettes. Has your doctor or other health professional ever advised you of, or referred you to, a program or other resources available to help you stop smoking?”. Results: Between 2015 and 2021, 6,048 patients were included in the measure denominator. In 2015, only 44% of patients had documented counseling or referral to tobacco cessation services. Performance on this measure has increased each year as shown in the table. Data from the BRFSS Michigan Department of Health and Human Services (MDHHS) also show year-over-year improvement in patient reports of having been advised to quit. Conclusions: Our statewide collaborative successfully increased the proportion of patients who smoke who were either counseled to quit smoking or who were referred to smoking cessation services. The decrease in performance in 2020 and 2021 was likely to be the result of the COVID-19 pandemic. The addition of the VBR may have contributed to the success of our program. Through a partnership with HBOM- Health Behavior Optimization for Michigan, MOQC will create additional measures to continue to incentivize practices to get back to pre-pandemic levels of tobacco cessation referrals.[Table: see text]
Modifiable risk factors for falls among older adults with advanced cancer.
Authors: Jensen-Battaglia Marielle , Mohamed Mostafa Refaat , Loh Kah Poh , Wells Megan , Tylock Rachael , Ramsdale Erika E. , Canin Beverly , Geer Jodi , O'Rourke Mark Allen , Liu Jijun , Mohile Supriya Gupta , Wildes Tanya Marya 
Published: September 2022

328 Background: Older adults with cancer are more likely to fall than those without cancer, but the factors driving this increased risk are not fully understood. Falls may lead to injury, dependence, hospitalization, and death. Given the interventions available to reduce fall risk, identifying risk factors amenable to intervention for older adults with cancer is critical to provide targeted care and improve health outcomes. Methods: To examine factors associated with patient-reported falls within a 6 month follow up period, we analyzed data previously collected in a nationwide cluster randomized trial (ClinicalTrials.gov: NCT02107443; PI: Mohile, NCORP UG1CA189961). Patients were eligible if age ≥70, stage III/IV solid tumor or lymphoma with palliative treatment intent, and ≥1 geriatric assessment impairment (GA). A GA summary with tailored recommendations was given to oncologists in practices randomized to the intervention, but not usual care. We combined intervention and usual care groups and evaluated baseline risk factors for falls over a 6 month follow up including: prior falls, fear of falling (FOF), activity limitation due to FOF, activities of daily living, Short Physical Performance Battery, Timed Up and Go (TUG), Older Americans Resources Survey (physical health scale), cognition, polypharmacy, potentially inappropriate medications (PIM), and neurotoxic treatment agents. Incidence rate ratios (IRR) were estimated using generalized linear mixed models controlling for the study arm and practice site. Fully adjusted multivariable models were built for factors associated with follow up falls (p≤0.15) in bivariate. Results: Of 541 patients (mean age: 77, SD: 5.27), 140 (26%) patients had prior falls in the past 6 months. Over 6 months of follow up 467 (86%) had falls data for ≥ 1 follow up timepoint and 344 (64%) had complete follow up. Of those contributing any follow up data 103 patients (22%) reported at least one fall. In adjusted models prior falls, impaired TUG, and number of PIM were associated with higher incidence of falls over 6 months (see Table). Conclusions: Prior falls, TUG, and PIM are prospectively associated with falls among older adults with advanced cancer. These factors are feasible to assess and amenable to interventions such as rehabilitation or deprescribing. Future studies focused on implementation of fall risk reduction in the oncology setting are needed to determine the most effective ways to reduce fall risk in this vulnerable population. Clinical trial information: NCT02107443. [Table: see text]
What is the prognostic value of lymph node yield on the outcomes of patients with oral cavity squamous cell carcinoma?
Authors: Khalil Carlos , Khoury Mark , Fu Rui , Enepekides Danny , Higgins Kevin , Karam Irene , Bayley Andrew , Poon Ian , Truong Tra , Husain Zain Ali , Eskander Antoine 
Published: September 2022

330 Background: Lymph node metastases are associated with poor prognosis in oral cavity squamous cell carcinoma (OCSCC). In colorectal, lung, and gastric cancers, the number of lymph nodes removed during primary surgery, lymph node yield (LNY), is an established quality indicator that links with patient survival. As such, clinical guidelines have included a minimum (18) number of nodes to be resected, despite a lack of statistical evidence that supports such a LNY threshold. Currently, this kind of recommendation does not exist for OCSCC. Here, we used a novel single-centre dataset to evaluate the prognostic capacity of LNY on regional failure, locoregional recurrence and disease-free survival (DFS) in patients with OCSCC treated by primary neck surgery. Methods: This retrospective cohort study took place at Sunnybrook Hospital in Toronto, Canada and involved chart review data of all adult patients with treatment-naive OCSCC undergoing primary neck dissection. For each outcome, we first used the maximally selected rank statistics and a bias-corrected C-index to identify an optimal threshold of LNY, and then used a multivariable Cox proportional hazards model to assess the association between high LNY (> threshold) and each outcome. Results: Among the 579 OCSCC patients receiving primary neck dissection, 61.7% (n = 357) were male with mean age of 62.9 years (SD: 13.1) at cancer diagnosis. When adjusting for sociodemographic and clinical factors, LNY > 15 was significantly associated with improved DFS (adjusted HR [aHR]: 0.73, 95% CI: 0.54-0.98) and locoregional control (aHR: 0.68, 95% CI: 0.49-0.95), while LNY > 11 was associated with better regional control (aHR: 0.45, 95% CI: 0.26-0.76). Conclusions: Our study findings suggested high LNY to be a strong independent predictor of various patient-level quality of surgical care metrics. The optimal LNY we found (15 or 11) was lower than the conventionally recommended (18), which calls for further research to establish the validity in practice.