EMR Chemotoxicity Risk Calculator To Decrease Chemotherapy Toxicity

Study Overview
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Brief Summary
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This study will formally test the quality improvement intervention of an EMR based tool that informs medical oncologists visiting a patient for the first time of potential risk of chemotherapy toxicity.

Official Title
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Effect of an EMR Chemotoxicity Risk Calculator Availability To Decrease Chemotherapy Toxicity in Adults With Cancer

Conditions
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Oncology, Chemotherapeutic Toxicity, Metastatic Solid Tumor

Intervention / Treatment
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* Other: Chemotherapy toxicity tool
* Other: Oncology Consultation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: New outpatient visits with a medical oncologist following a new diagnosis of cancer and no prior history of chemotherapy treatment. aged > 65 will be included. Exclusion Criteria: Patients who opt out of clinical research will be excluded from analysis, but not the intervention (which will be applied to all patients). Specifically, as sometimes opt-in/opt out status is coded ambiguously in the data we will only analyze results of patients with clear opt in and no history of opt out. Patients with no EHR data after initial oncologist appointment.

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Providers, who were selected based on having at least 20 new patients with metastatic solid tumors in a 6-month period in 2021, will be randomized in a 1:1 ratio, stratified by quartiles of patient volume.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Usual Care<br> | Other: Oncology Consultation<br>* Oncologists will consult new patient with a new diagnosis of cancer.<br>|
| Experimental: Chemotherapy Toxicity Tool<br> | Other: Chemotherapy toxicity tool<br>* CARG is an EMR based tool that informs medical oncologists visiting a patient for the first time of potential risk of chemotherapy toxicity. This intervention will make available a simple calculator which includes: Gender, Height and weight, Cancer Subtype, Hemoglobin, How is your hearing (with hearing aid, if needed)?, Number of falls in the past 6 months, Can you take your own medicines, Does your health limit you in walking one block., During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)? and Glomerular filtration rate. The CARG chemotoxicity calculator will be built into the patient navigator and its use will be assessed on a monthly basis and used to inform iteration.<br>* Other names: CARG;Other: Oncology Consultation<br>* Oncologists will consult new patient with a new diagnosis of cancer.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Unplanned hospitalization rate | Measured at the patient level as a binary outcome (yes/no) based on date of initial visit with the oncologist. | Within 3 months of the Index Visit with the oncologist | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Healthcare contact days | Measured at the patient level as a continuous outcome (number of days). | Within 3 and 6 months of the Index Visit with the oncologist | 
| Chemotherapy use rate | Measured at the patient level as a binary outcome (yes/no) if patient ever received systemic cancer-directed treatment. | Within 3 months of the Index Visit with the oncologist | 
| Chemotherapy modification rate | Measured at the patient level as a binary outcome (yes/no) if patient had dose, schedule, or number of chemotherapy changed. | Within 3 months of the Index Visit with the oncologist | 
| Palliative Care Referral | Measured at the patient level as a binary outcome (yes/no) based on presence of a scheduled palliative care appointment | Within 6 months of the Index Visit with the oncologist | 
| Chemotherapy toxicity tool use rate | Measured at the patient level as a binary outcome (yes/no) based on whether the oncologist used the tool for that patient. | Within 3 months of the Index Visit with the oncologist |