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Ligon JA, Hayashi M, Ciampa D, Kramer C, Guastella A, Fuchs RJ, Herati AS, Christianson MS, Chen AR. A multidisciplinary pediatric oncofertility team improves fertility preservation and counseling across 7 years. Cancer Rep (Hoboken) 2023; 6:e1753. [PMID: 36346013 PMCID: PMC9939996 DOI: 10.1002/cnr2.1753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/20/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oncofertility is a developing field of increasing importance, particularly in pediatric oncology, where most patients are likely to survive long-term and have not yet had the opportunity to have children. AIMS We performed a quality improvement initiative to increase our rates of fertility preservation counseling and referral through the implementation of a pediatric oncofertility team, and we report outcomes 7 years following implementation of our initiative. METHODS AND RESULTS We compare our baseline oncofertility survey to 44 post-intervention survey respondents and electronic medical record documentation for 149 patients treated in 2019. Ninety-five percent of post-intervention survey respondents recalled fertility counseling (baseline 70%, p = .004) and 89.3% were appropriately referred for fertility preservation (baseline 50%, p = .017). Counseling was documented in 60.4% of charts; 81% of patients analyzed by chart review were appropriately referred for fertility preservation. Fertility preservation outcomes differed by sex assigned at birth. CONCLUSION Creation of an oncofertility team produced improvements in fertility counseling and fertility preservation referral across an extended period of time.
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Affiliation(s)
- John A. Ligon
- Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins University (JHU)BaltimoreMarylandUSA
- Department of Pediatrics, Division of Hematology/OncologyUniversity of FloridaGainesvilleFloridaUSA
| | - Masanori Hayashi
- Department of Pediatrics—Hematology/oncology and Bone Marrow TransplantationUniversity of ColoradoAuroraColoradoUSA
| | - Devon Ciampa
- Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins University (JHU)BaltimoreMarylandUSA
| | - Cara Kramer
- Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins University (JHU)BaltimoreMarylandUSA
| | - Alfredo Guastella
- Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins University (JHU)BaltimoreMarylandUSA
| | - Robert J. Fuchs
- Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins University (JHU)BaltimoreMarylandUSA
| | - Amin S. Herati
- James Buchanan Brady Urological Institute and Department of UrologyJHUBaltimoreMarylandUSA
| | | | - Allen R. Chen
- Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins University (JHU)BaltimoreMarylandUSA
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2
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Power S, Bickel K, Chen RC, Chiang AC, Garrett-Mayer L, Makhoul I, Mougalian SS, Shapiro CL, Siegel R, Smith C, Rocque GB, Kozlik MM, Crist STS, Kamal A. Associations of Early Completion of Advance Directives With Key End-of-Life Quality Measures: Analysis of an ASCO Quality Oncology Practice Initiative Patient Cohort. JCO Oncol Pract 2023; 19:e520-e526. [PMID: 36669136 DOI: 10.1200/op.22.00464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Despite the growing calls for early and ubiquitous completion of advance directives (ADs), studies exploring links between AD completion and their impact on outcomes of patients with cancer have mixed conclusions. We used the ASCO Quality Oncology Practice Initiative (QOPI) registry to compare end-of-life (EOL) quality measures and the effect of QOPI certification among patients with and without early AD completion, defined as completion within the first three oncology visits after cancer diagnosis. METHODS Deidentified patient-level data were analyzed from the QOPI database from 2015 through 2017. Associations were assessed using Chi-square tests between early AD completion and patient enrollment in hospice < 7 days before death, chemotherapy receipt in the last 14 days of life, or with emergency room visits or intensive care unit admissions in the last 30 days of life. RESULTS Data from 31,558 patients eligible for the AD question were analyzed. Patients treated at QOPI-certified practices had higher rates of early AD completion than patients at non-certified practices. Early AD completion was not associated with differences in hospice enrollment for < 7 days before death, chemotherapy receipt in the last 14 days of life, or emergency room visits or intensive care unit encounters in the last 30 days of life. CONCLUSION The study found that QOPI certification is associated with higher rates of early AD completion. However, early AD completion was not associated with recognized EOL quality measures. Future research should focus on the timing, frequency, and content of AD conversations to demonstrate the impact on care at the EOL.
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Affiliation(s)
- Steve Power
- Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | | | - Ronald C Chen
- University of Kansas School of Medicine, Kansas City, KS
| | | | | | - Issam Makhoul
- CARTI, Central Arkansas Radiation Therapy Institute, Little Rock, AR
| | | | | | - Robert Siegel
- Bon Secours St Francis Cancer Center, Greenville, SC
| | | | - Gabrielle B Rocque
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL.,University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Birmingham, AL
| | | | | | - Arif Kamal
- Duke Cancer Institute, Duke University Medical Center, Durham, NC
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Chen RC, Garrett-Mayer E, Kamal AH, Makhoul I, Kozlik MMP, Crist STS, Chiang AC. Pre-Treatment Staging Imaging in Rectal Cancer: Results From the Quality Oncology Practice Initiative. JCO Oncol Pract 2022; 18:e1367-e1373. [PMID: 35353546 DOI: 10.1200/op.21.00455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE For patients with nonmetastatic rectal cancer, the National Comprehensive Cancer Network guidelines recommend initial staging using pelvic magnetic resonance imaging or endorectal ultrasound to determine the stage of the disease before initial therapy or surgery. This imaging workup helps determine the T and N staging, which is essential to determine optimal treatment for a patient. The current study examined practice concordance with this guideline using a quality measure in ASCO's Quality Oncology Practice Initiative (QOPI) that specifically addressed staging workup for patients with rectal cancer. METHODS From Fall 2016 through Fall 2019, 103 QOPI-participating practices reported performance on QOPI measure Colorectal 78, which addresses staging workup for patients with rectal cancer. The percentage and 95% CI of patients who received guideline-concordant imaging were calculated for each of the seven assessment time points. Difference of concordance rates between subsequent time points and the initial time point was assessed using logistic regression with random-effects models. In addition, 69 practices that submitted data in 2016 and 2017 were surveyed to gain insight on potential reasons for nonconcordance and the results were described. RESULTS At each time point, a total of 20-33 practices reported data across 1,158 unique patients. Adherence appeared to increase over time, with 38% of patients receiving guideline-recommended staging in Fall 2016, to 56% in Fall 2019. The practice survey revealed that nonconcordance was mostly because of lack of care coordination between oncology and surgery disciplines (n = 16 practices of 28, 57.1%) and a lack of awareness of appropriate staging scans (n = 8 practices, 28.6%). CONCLUSION As one half to one third of patients still do not receive appropriate imaging, our findings highlight the need for concerted quality improvement efforts that involve the multidisciplinary team to close this gap.
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Affiliation(s)
- Ronald C Chen
- University of Kansas Medical Center, Kansas City, KS
| | | | - Arif H Kamal
- Duke University, Duke Cancer Institute, Durham, NC
| | - Issam Makhoul
- University of Arkansas for Medical Sciences, Little Rock, AR
| | | | | | - Anne C Chiang
- Yale University, Yale Cancer Center, Yale University School of Medicine, New Haven, CT
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Stover AM, Kurtzman R, Walker Bissram J, Jansen J, Carr P, Atkinson T, Ellis CT, Freeman AT, Turner K, Basch EM. Stakeholder Perceptions of Key Aspects of High-Quality Cancer Care to Assess with Patient Reported Outcome Measures: A Systematic Review. Cancers (Basel) 2021; 13:cancers13143628. [PMID: 34298841 PMCID: PMC8306432 DOI: 10.3390/cancers13143628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary We conducted a review to identify important symptoms reported by patients on questionnaires (e.g., pain) that can be used to compare cancer centers on how well they provide care. For example, cancer centers could be compared on the percentage of patients with controlled pain after adjusting for demographic and clinical characteristics. Standard review methods were used to identify studies through August 2020. Searches generated 1813 articles and 1779 were coded as not relevant. The remaining 34 studies showed that patients, caregivers, clinicians, and healthcare administrators identify psychosocial care (e.g., distress) and symptom management as critical parts of high-quality care. Patients and caregivers also perceive that maintaining physical function and daily activities are important. Clinicians and healthcare administrators perceive control of specific symptoms to be important (e.g., pain, poor sleep, diarrhea). Results were used to inform testing of symptom questionnaires to compare the quality of care provided by six cancer centers. Abstract Performance measurement is the process of collecting, analyzing, and reporting standardized measures of clinical performance that can be compared across practices to evaluate how well care was provided. We conducted a systematic review to identify stakeholder perceptions of key symptoms and health domains to test as patient-reported performance measures in oncology. Stakeholders included cancer patients, caregivers, clinicians, and healthcare administrators. Standard review methodology was used, consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). MEDLINE/PubMed, EMBASE, and the Cochrane Library were searched to identify relevant studies through August 2020. Four coders independently reviewed entries and conflicts were resolved by a fifth coder. Efficacy and effectiveness studies, and studies focused exclusively on patient experiences of care (e.g., communication skills of providers) were excluded. Searches generated 1813 articles and 1779 were coded as not relevant, leaving 34 international articles for extraction. Patients, caregivers, clinicians, and healthcare administrators prioritize psychosocial care (e.g., distress) and symptom management for patient-reported performance measures. Patients and caregivers also perceive that maintaining physical function and daily activities are critical. Clinicians and administrators perceive control of specific symptoms to be critical (gastrointestinal symptoms, pain, poor sleep). Results were used to inform testing at six US cancer centers.
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Affiliation(s)
- Angela M. Stover
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
- Correspondence:
| | - Rachel Kurtzman
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC 27599, USA;
| | | | - Jennifer Jansen
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
| | - Philip Carr
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
| | - Thomas Atkinson
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - C. Tyler Ellis
- Department of Surgery, University of Louisville Health, Louisville, KY 40202, USA;
| | | | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Ethan M. Basch
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
- Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA;
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Shapiro CL, Zubizarreta N, Moshier E, Brockway JP, Mandeli J, Markham MJ, Kozlik MM, Crist S, Jacobsen PB. Quality Care in Survivorship: Lessons Learned From the ASCO Quality Oncology Practice Initiative. JCO Oncol Pract 2021; 17:e1170-e1180. [PMID: 34283637 DOI: 10.1200/op.21.00290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The ASCO Quality Oncology Practice Initiative (QOPI) project was established to evaluate the influence of guideline recommendations on routine clinical practice. METHODS QOPI provided summary data from 839 unique practices in which data were collected every six months from the Fall of 2015 to the Spring of 2019. From these data, six items were chosen based on their relationship to domains of survivorship. A zero-inflated negative binomial regression model was used to test for trends in QOPI measures adherence rates over time. The models were adjusted for the time period, region, practice-ownership, multispecialty site, fellowship program, and hospital type. RESULTS Smoking cessation counseling recommended and smoking cessation counseling administered or referred both increased over time, 50%-61% (adjusted incidence rate ratios (IRR), 1.028; 95% CI, 1.016 to 1.040; P < .001) and 34%-49% (adjusted IRR, 1.052; 95% CI, 1.035 to 1.070; P < .001), respectively. Infertility risks discussed before chemotherapy increased from 36% to 53% (adjusted IRR, 1.056; 95% CI, 1.035 to 1.078; P < .001) and fertility options discussed or referred to specialists increased from 23% to 38% (adjusted IRR, 1.074; 95% CI, 1.046 to 1.102; P < .001). Twenty-nine percent documented a positron emission tomography, computed tomography, or bone scan within the first 12 months for women diagnosed with early breast cancer treated for curative intent (adjusted IRR, 1.000; 95% CI, 0.977 to 1.024; P = .971). Tumor marker surveillance within 12 months increased from 78% to 87% (adjusted IRR, 1.018; 95% CI, 1.002 to 1.033; P = .023). CONCLUSION As scientific evidence to guide cancer survivorship care grows, the role of guideline recommendations permeating clinical practice using quality metrics will become increasingly important.
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Affiliation(s)
| | - Nicole Zubizarreta
- The Tisch Cancer Institute, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Erin Moshier
- The Tisch Cancer Institute, Icahn School of Medicine at Mt Sinai, New York, NY
| | | | - John Mandeli
- The Tisch Cancer Institute, Icahn School of Medicine at Mt Sinai, New York, NY
| | | | | | | | - Paul B Jacobsen
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD
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Keating NL, Cleveland JLF, Wright AA, Brooks GA, Meneades L, Riedel L, Zubizarreta JR, Landrum MB. Evaluation of Reliability and Correlations of Quality Measures in Cancer Care. JAMA Netw Open 2021; 4:e212474. [PMID: 33749769 PMCID: PMC7985722 DOI: 10.1001/jamanetworkopen.2021.2474] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Measurement of the quality of care is important for alternative payment models in oncology, yet the ability to distinguish high-quality from low-quality care across oncology practices remains uncertain. OBJECTIVE To assess the reliability of cancer care quality measures across oncology practices using registry and claims-based measures of process, utilization, end-of-life (EOL) care, and survival, and to assess the correlations of practice-level performance across measure and cancer types. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used the Surveillance, Epidemiology, and End Results (SEER) Program registry linked to Medicare administrative data to identify individuals with lung cancer, breast cancer, or colorectal cancer (CRC) that was newly diagnosed between January 1, 2011, and December 31, 2015, and who were treated in oncology practices with 20 or more patients. Data were analyzed from January 2018 to December 2020. MAIN OUTCOMES AND MEASURES Receipt of guideline-recommended treatment and surveillance, hospitalizations or emergency department visits during 6-month chemotherapy episodes, care intensity in the last month of life, and 12-month survival were measured. Summary measures for each domain in each cohort were calculated. Practice-level rates for each measure were estimated from hierarchical linear models with practice-level random effects; practice-level reliability (reproducibility) for each measure based on the between-measure variance, within-measure variance, and distribution of patients treated in each practice; and correlations of measures across measure and cancer types. RESULTS In this study of SEER registry data linked to Medicare administrative data from 49 715 patients with lung cancer treated in 502 oncology practices, 21 692 with CRC treated in 347 practices, and 52 901 with breast cancer treated in 492 practices, few practices had 20 or more patients who were eligible for most process measures during the 5-year study period. Patients were 65 years or older; approximately 50% of the patients with lung cancer and CRC and all of the patients with breast cancer were women. Most measures had limited variability across practices. Among process measures, 0 of 6 for lung cancer, 0 of 6 for CRC, and 3 of 11 for breast cancer had a practice-level reliability of 0.75 or higher for the median-sized practice. No utilization, EOL care, or survival measure had reliability across practices of 0.75 or higher. Correlations across measure types were low (r ≤ 0.20 for all) except for a correlation between the CRC process and 1-year survival summary measures (r = 0.35; P < .001). Summary process measures had limited or no correlation across lung cancer, breast cancer, and CRC (r ≤ 0.16 for all). CONCLUSIONS AND RELEVANCE This study found that quality measures were limited by the small numbers of Medicare patients with newly diagnosed cancer treated in oncology practices, even after pooling 5 years of data. Measures had low reliability and had limited to no correlation across measure and cancer types, suggesting the need for research to identify reliable quality measures for practice-level quality assessments.
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Affiliation(s)
- Nancy L. Keating
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jessica L. F. Cleveland
- Department of Informatics and Analytics, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alexi A. Wright
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gabriel A. Brooks
- Section of Medical Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Laurie Meneades
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Lauren Riedel
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Jose R. Zubizarreta
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Statistics, Harvard Faculty of Arts and Sciences, Cambridge, Massachusetts
| | - Mary Beth Landrum
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Mulder RL, van Kalsbeek RJ, Hudson MM, Skinner R, Kremer LCM. The Critical Role of Clinical Practice Guidelines and Indicators in High-Quality Survivorship After Childhood Cancer. Pediatr Clin North Am 2020; 67:1069-1081. [PMID: 33131535 DOI: 10.1016/j.pcl.2020.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Childhood cancer survivors are at significant risk for late cancer treatment-related morbidity and mortality. Physicians involved in the care of childhood cancer survivors should be aware of these specific health problems and provide high-quality, long-term follow-up care to preserve and improve survivors' health. The steps required to achieve high-quality care include synthesizing evidence (systematic reviews are helpful in this regard), developing clinical policy from evidence into evidence-based clinical practice guidelines, disseminating and implementing clinical practice guidelines, and evaluating their impact on quality of care and survivor health outcomes with quality indicators. This article describes these cornerstones of evidence-based medicine.
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Affiliation(s)
- Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | | | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
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Bowles H, Tawfik B, Abernathy J, Lauer R, Hashemi N, Dayao Z. Pharmacist-Driven Oral Oncolytic Medication Education and Consent. JCO Oncol Pract 2020; 16:e1209-e1215. [DOI: 10.1200/jop.19.00418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: The numbers and types of oral oncolytics in oncology are expanding rapidly. Oral oncolytics have serious adverse effects, and pharmacist-driven patient education has the potential to reduce adverse events. The University of New Mexico Comprehensive Cancer Center (UNM CCC) initiated a patient education and consent process for oral oncolytics in our minority, rural, and economically disadvantaged population. PATIENTS AND METHODS: The UNM CCC initiated a pharmacist-driven education and consent process from August 2016 to October 2018. The process metric measured via statistical process control charts was the percentage of patients receiving oral oncolytic therapy who were educated and consented. The balancing metric was time for benefit investigation. The intervention was pharmacy team members providing standardized education for and obtaining consent from each patient, supported by electronic medical record orders, physician education, pharmacy notifications, and hospital discharge planning. RESULTS: The initial monthly education and consent rate was 17.9%, followed by 45.5% the subsequent month. This quickly grew to an average of 87.0% (95% CI, 81.5% to 92.4%) for the subsequent 15 months in which control was achieved. Additional changes increased the education rate to 95.7% (95% CI, 93.4% to 98.1%). These 2 periods were statistically different ( P = .0025). There was no change in time for benefit investigation (5.60 v 5.52 days; P = .75). CONCLUSION: A pharmacist-driven program for education and consent upon initiation of oral oncolytics is possible and can successfully educate a majority of patients. Future directions will include ensuring patient adherence and educating patients who fill oral oncolytic prescriptions outside UNM CCC.
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Affiliation(s)
- Harmony Bowles
- Section of Hematology and Oncology, Division of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Bernard Tawfik
- Section of Hematology and Oncology, Division of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Janet Abernathy
- Section of Hematology and Oncology, Division of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Richard Lauer
- Section of Hematology and Oncology, Division of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Neda Hashemi
- Section of Hematology and Oncology, Division of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Zoneddy Dayao
- Section of Hematology and Oncology, Division of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
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Vos EL, Koppert LB, Jager A, Vrancken Peeters MJTFD, Siesling S, Lingsma HF. From Multiple Quality Indicators of Breast Cancer Care Toward Hospital Variation of a Summary Measure. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1200-1209. [PMID: 32940238 DOI: 10.1016/j.jval.2020.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To improve quality in breast cancer care, large numbers of quality indicators are collected per hospital, but benchmarking remains complex. We aimed to assess the validity of indicators, develop a textbook outcome summary measure, and compare case-mix adjusted hospital performance. METHODS From a nationwide population-based registry, all 79 690 nonmetastatic breast cancer patients surgically treated between 2011 and 2016 in 91 hospitals in The Netherlands were included. Twenty-one indicators were calculated and their construct validity tested by Spearman's rho. Between-hospital variation was expressed by interquartile range (IQR), and all valid indicators were included in the summary measure. Standardized scores (observed/expected based on case mix) were calculated as above (>100) or below (<100) expected. The textbook outcome was presented as a continuous and all-or-none score. RESULTS The size of between-hospital variation varied between indicators. Sixteen (76%) of 21 quality indicators showed construct validity, and 13 were included in the summary measure after excluding redundant indicators that showed collinearity with others owing to strong construct validity. The median all-or-none textbook outcome score was 49% (IQR 42%-54%) before and 49% (IQR 48%-51%) after case-mix adjustment. From the total of 91 hospitals, 3 hospitals were positive (3%) and 9 (10%) were negative outliers. CONCLUSIONS The textbook outcome summary measure showed discriminative ability when hospital performance was presented as an all-or-none score. Although indicator scores and outlier hospitals should always be interpreted cautiously, the summary measure presented here has the potential to improve Dutch breast cancer quality indicator efforts and could be implemented to further test its validity, feasibility, and usefulness.
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Affiliation(s)
- Elvira L Vos
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
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Lo AC, Samuel V, Chen B, Savage KJ, Freeman C, Goddard K. Evaluation of the discussion of late effects and screening recommendations in survivors of adolescent and young adult (AYA) lymphoma. J Cancer Surviv 2020; 15:179-189. [PMID: 32767044 DOI: 10.1007/s11764-020-00922-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/31/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The study objective was to assess the discussion of late effects (LEs) and screening recommendations (SRs) for adolescent and young adults (AYAs) treated for lymphoma. METHODS A retrospective study was conducted on AYA lymphoma survivors aged 15-24 years at diagnosis who received radiation therapy (RT) ± chemotherapy between 1984 and 2010 at any of the six British Columbia (BC) Cancer treatment centers across the province. Charts were reviewed to evaluate discussion of LEs and SRs. Susceptibility to specific LEs was determined by reviewing treatment details. RESULTS Of 305 patients, 212 (70%) had documented discussion of at least one specific LE, 39 (13%) had non-specific documentation only, and 54 (18%) had no documented discussion of LEs. Accounting only for patients susceptible to each LEs, the most frequently discussed LEs was radiation-induced (RI) neoplasm (42%), and the least frequently discussed LEs was carotid artery stenosis (0.4%). The most common SRs discussed in susceptible patients was for RI breast cancer (43%). Of patients discharged between 1985 and 1999 vs 2000 and 2014, LEs were discussed in 63 vs 93% (P < 0.0005), and SRs were discussed in 30 vs 65%, respectively (P < 0.0005). Older age at discharge, presence of a discharge note, and occurrence of a discharge appointment were associated with increased discussion of SRs. CONCLUSIONS Most survivors of AYA lymphoma received some discussion of LEs and SRs, but each relevant LEs and SRs was discussed in only a minority of susceptible patients. IMPLICATIONS FOR CANCER SURVIVORS Survivors of AYA lymphoma and their primary care professionals may not be appropriately informed of health risks and how to screen for them.
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Affiliation(s)
- Andrea C Lo
- Department of Radiation Oncology, British Columbia (BC) Cancer, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada.
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Vanessa Samuel
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ben Chen
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kerry J Savage
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre of Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Ciara Freeman
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre of Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Karen Goddard
- Department of Radiation Oncology, British Columbia (BC) Cancer, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Keng M, Quinn D, Cunningham G, Bingham J, Chiang A, Eisinger M, Gilligan T, Gilmore T, Guerrier V, Karri S, Kaufman L, Mohamed A, Srivastava P. ASCO Quality Training Program: A Five-Year Review. JCO Oncol Pract 2020; 16:e1243-e1248. [PMID: 32726173 DOI: 10.1200/op.20.00319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE ASCO introduced the Quality Training Program (QTP) in 2013 with the aim to train oncology professionals to design, implement, and lead successful quality improvement (QI) activities and assume leadership positions to champion culture change in their practices. METHODS The QTP is a formal 6-month program taught by QI faculty and mentored by QI coaches over 5 days of in-person learning across 3 sessions and hands-on learning at the participants' practices. Sessions include seminars, case examples, and small-group exercises. Participants attend in multidisciplinary teams and focus on a problem they wish to solve in their practice. Scheduled conference calls with QI coaches are held between sessions. Participants complete pre- and post-QTP surveys (10-point Likert scale, with 1 = no knowledge/competence and 10 = complete knowledge/competence) and provide direct written feedback. RESULTS Since its inception, QTP has had 15 courses (10 domestic and 5 international) with 120 teams and 544 total participants. QTP is led by an 8-member steering group with 16 faculty and coaches. All postsurvey items showed an increase in knowledge and competence. Each item's score was calculated as the mean difference between before and after scores. Participants stated an increase of 46%-84% (overall mean increase: knowledge, 38%; competence, 37%). The greatest increases were in methodology and practical tools to make changes in practice (writing an aim statement, implementing rapid improvement, using process analysis tools, flowcharting the process). The most common suggestion for improvement was allowing more time for the project. Participants are encouraged to write articles and present work in poster and plenary sessions. QTP courses have led to 7 manuscripts and 21 abstract presentations to national meetings. Six QTP alumni are now QI coaches and faculty. CONCLUSION The QTP is a successful QI course for oncology professionals who need to measure performance, investigate quality and safety issues, and implement change. It is the only oncology-focused QI training, as all faculty and coaches are providers and QI specialists with oncology experience, which makes this a unique opportunity. The success will provide further momentum to offer QTP domestically and around the world.
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Affiliation(s)
| | - Doris Quinn
- American Society of Clinical Oncology, Alexandria, VA
| | | | - John Bingham
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Terry Gilmore
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Laurie Kaufman
- The University of Texas MD Anderson Cancer Center, Houston, TX
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12
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Patel P, Kohn TP, Cohen J, Shiff B, Kohn J, Ramasamy R. Evaluation of Reported Fertility Preservation Counseling Before Chemotherapy Using the Quality Oncology Practice Initiative Survey. JAMA Netw Open 2020; 3:e2010806. [PMID: 32678451 PMCID: PMC7368166 DOI: 10.1001/jamanetworkopen.2020.10806] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE The opportunity to discuss fertility preservation is essential for patients of reproductive age with newly diagnosed cancer before the initiation of treatment. OBJECTIVE To identify factors associated with fertility preservation counseling among patients of reproductive age before initiating chemotherapy. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data obtained from the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative, an oncologist-led quality assessment program that surveys approximately 400 oncology practices biannually, from January, 2015, to June, 2019. MAIN OUTCOMES AND MEASURES The primary outcome was whether reproductive risks were discussed before initiation of chemotherapy. Multivariate logistic regression was performed to identify factors associated with fertility preservation counseling, controlling for age, sex, race/ethnicity, cancer type, year of study, region, clinic type (academic vs private), annual clinic volume, and rates of insurance coverage. RESULTS Among the 6976 patients of reproductive age (3571 men [51%]; mean (SD) age, 42.5 [7.1] years), with reproductive age ranging from 18 to 40 years for 3405 women and from 18 to 50 years for 3571 men, clinics reported that 3036 of 6976 patients (44%) received counseling regarding the risk of infertility associated with chemotherapy. Women were more likely to be informed (1912 of 3405 [56%]) compared with men (1126 of 3571 [32%]) (P < .001). Factors associated with reduced likelihood of fertility risk discussion included male sex (odds ratio [OR], 0.73; 95% CI, 0.60-0.90), increasing age (OR, 0.93; 95% CI, 0.92-0.94), private practice setting (OR, 0.70; 95% CI, 0.53-0.93), and lack of multidisciplinary team planning (OR, 0.54; 95% CI, 0.41-0.70). Factors associated with increased likelihood of fertility risk discussion included having breast cancer (OR, 1.39; 95% CI, 1.12-1.73) and lymphatic or hematopoietic cancers (OR, 1.79; 95% CI, 1.33-2.40), participating in each subsequent study year (OR, 1.16; 95% CI, 1.08-1.24), receiving care in an academic clinic (OR, 1.45; 95% CI, 1.05-2.01), and being a practice offering clinical trial enrollment (OR, 1.60; 95% CI, 1.13-2.29). States with legislatively mandated coverage of fertility preservation had significantly higher rates of fertility risk discussion compared with states without legislation (48.6% vs 39.6%, P < .001). CONCLUSIONS AND RELEVANCE The findings suggest that clinicians are more likely to counsel younger patients and female patients about reproductive risks before initiation of chemotherapy. State laws mandating fertility preservation coverage may be associated with improved frequency of fertility counseling before chemotherapy. Further awareness and implementation of ASCO guidelines appear to be needed to improve rates of fertility risk discussion and referrals to fertility specialists before chemotherapy.
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Affiliation(s)
- Premal Patel
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Taylor P. Kohn
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jordan Cohen
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Benjamin Shiff
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Jaden Kohn
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
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Stover AM, Urick BY, Deal AM, Teal R, Vu MB, Carda-Auten J, Jansen J, Chung AE, Bennett AV, Chiang A, Cleeland C, Deutsch Y, Tai E, Zylla D, Williams LA, Pitzen C, Snyder C, Reeve B, Smith T, McNiff K, Cella D, Neuss MN, Miller R, Atkinson TM, Spears PA, Smith ML, Geoghegan C, Basch EM. Performance Measures Based on How Adults With Cancer Feel and Function: Stakeholder Recommendations and Feasibility Testing in Six Cancer Centers. JCO Oncol Pract 2020; 16:e234-e250. [PMID: 32074014 PMCID: PMC7069703 DOI: 10.1200/jop.19.00784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patient-reported outcome measures (PROMs) that assess how patients feel and function have potential for evaluating quality of care. Stakeholder recommendations for PRO-based performance measures (PMs) were elicited, and feasibility testing was conducted at six cancer centers. METHODS Interviews were conducted with 124 stakeholders to determine priority symptoms and risk adjustment variables for PRO-PMs and perceived acceptability. Stakeholders included patients and advocates, caregivers, clinicians, administrators, and thought leaders. Feasibility testing was conducted in six cancer centers. Patients completed PROMs at home 5-15 days into a chemotherapy cycle. Feasibility was operationalized as ≥ 75% completed PROMs and ≥ 75% patient acceptability. RESULTS Stakeholder priority PRO-PMs for systemic therapy were GI symptoms (diarrhea, constipation, nausea, vomiting), depression/anxiety, pain, insomnia, fatigue, dyspnea, physical function, and neuropathy. Recommended risk adjusters included demographics, insurance type, cancer type, comorbidities, emetic risk, and difficulty paying bills. In feasibility testing, 653 patients enrolled (approximately 110 per site), and 607 (93%) completed PROMs, which indicated high feasibility for home collection. The majority of patients (470 of 607; 77%) completed PROMs without a reminder call, and 137 (23%) of 607 completed them after a reminder call. Most patients (72%) completed PROMs through web, 17% paper, or 2% interactive voice response (automated call that verbally asked patient questions). For acceptability, > 95% of patients found PROM items to be easy to understand and complete. CONCLUSION Clinicians, patients, and other stakeholders agree that PMs that are based on how patients feel and function would be an important addition to quality measurement. This study also shows that PRO-PMs can be feasibly captured at home during systemic therapy and are acceptable to patients. PRO-PMs may add value to the portfolio of PMs as oncology transitions from fee-for-service payment models to performance-based care that emphasizes outcome measures.
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Affiliation(s)
- Angela M. Stover
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Benjamin Y. Urick
- Department of Pharmacy, Center for Medication Optimization in the Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Randall Teal
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Connected Health Applications and Interventions (CHAI-Core), University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Maihan B. Vu
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Connected Health Applications and Interventions (CHAI-Core), University of North Carolina at Chapel Hill, Chapel Hill, NC
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jessica Carda-Auten
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Connected Health Applications and Interventions (CHAI-Core), University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Arlene E. Chung
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Departments of Medicine and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Antonia V. Bennett
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Anne Chiang
- Yale University and Smilow Cancer Center, Hartford, CT
| | | | | | - Edmund Tai
- Palo Alto Medical Foundation, Palo Alto, CA
| | - Dylan Zylla
- Park Nicollet Oncology Research, Frauenshuh Cancer Center, HealthPartners Institute, Minneapolis, MN
| | | | | | | | | | | | | | | | | | - Robert Miller
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Mary Lou Smith
- Patient Advocate
- Research Advocacy Network, Naperville, IL
| | | | - Ethan M. Basch
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Bylicki O, Didier M, Riviere F, Margery J, Grassin F, Chouaid C. Lung cancer and end-of-life care: a systematic review and thematic synthesis of aggressive inpatient care. BMJ Support Palliat Care 2019; 9:413-424. [PMID: 31473652 PMCID: PMC6923940 DOI: 10.1136/bmjspcare-2019-001770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 07/30/2019] [Accepted: 08/14/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Despite recent advances in thoracic oncology, most patients with metastatic lung cancer die within months of diagnosis. Aggressiveness of their end-of-life (EOL) care has been the subject of numerous studies. This study was undertaken to evaluate the literature on aggressive inpatient EOL care for lung cancer and analyse the evolution of its aggressiveness over time. METHODS A systematic international literature search restricted to English-language publications used terms associated with aggressiveness of care, EOL and their synonyms. Two independent researchers screened for eligibility and extracted all data and another a random 10% sample of the abstracts. Electronic Medline and Embase databases were searched (2000-20 September 2018). EOL-care aggressiveness was defined as follows: 1) chemotherapy administered during the last 14 days of life (DOL) or new chemotherapy regimen during the last 30 DOL; 2) >2 emergency department visits; 3) >1 hospitalisation during the last 30 DOL; 4) ICU admission during the last 30 DOL and 5) palliative care started <3 days before death. RESULTS Among the 150 articles identified, 42 were retained for review: 1 clinical trial, 3 observational cohorts, 21 retrospective analyses and 17 administrative data-based studies. The percentage of patients subjected to aggressive therapy seems to have increased over time. Early management by palliative care teams seems to limit aggressive care. CONCLUSIONS Our analysis indicated very frequent aggressive EOL care for patients with lung cancer, regardless of the definition used. The extent of that aggressiveness and its impact on healthcare costs warrant further studies.
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Affiliation(s)
- Olivier Bylicki
- Pneumologie, Hopital d'Instruction des Armees Percy, Clamart, France
| | - Morgane Didier
- Service de Pneumologie, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Frederic Riviere
- Pneumologie, Hopital d'Instruction des Armees Percy, Clamart, France
| | - Jacques Margery
- Pneumologie, Hopital d'Instruction des Armees Percy, Clamart, France
| | - Frederic Grassin
- Pneumologie, Hopital d'Instruction des Armees Percy, Clamart, France
| | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal de Creteil, Creteil, France
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Keating NL, O'Malley AJ, Onnela JP, Gray SW, Landon BE. Influence of Peer Physicians on Intensity of End-of-Life Care for Cancer Decedents. Med Care 2019; 57:468-474. [PMID: 31008900 PMCID: PMC6522329 DOI: 10.1097/mlr.0000000000001124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The intensity of end-of-life care varies substantially both within and between areas. Differing practice patterns of individual physicians are likely influenced by their peers. OBJECTIVE To assess whether intensity of end-of-life care previously provided by a physician's peers influences patterns of care at the end-of-life for that physician's patients. RESEARCH DESIGN Observational study. SUBJECTS A total of 185,947 fee-for-service Medicare enrollees with cancer who died during 2006-2010 who were treated by 26,383 physicians. MEASURES Spending in the last month of life, >1 emergency room visit, >1 hospitalization, intensive care unit admission in the last month of life, chemotherapy within 2 weeks of death, no/late hospice, terminal hospitalization. RESULTS Mean (SD) spending in the last month of life was $16,237 ($17,124). For each additional $1000 of spending for a peer physician's patients in the prior year, spending for the ego physician's patients was $83 higher (P<0.001). Among physicians with peers both in and out of their practice, more of the peer effect was explained by physicians outside of the practice ($72 increase for each $1000 increase by peer physicians' patients, P<0.001) than peer physicians in the practice ($27 for each $1000 increase by within-practice peer physicians' patients, P=0.01). Results were similar across the other measures of end-of-life care intensity. CONCLUSIONS Physician's peers exert influence on the intensity of care delivered to that physician's patients at the end-of-life. Physician education efforts led by influential providers and provider organizations may have potential to improve the delivery of high-value end-of-life care.
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Affiliation(s)
- Nancy L Keating
- Department of Health Care Policy, Harvard Medical School
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Alistair James O'Malley
- The Department of Biomedical Data Science and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Stacy W Gray
- Department of Medical Oncology, City of Hope Cancer Center, Duarte, CA
| | - Bruce E Landon
- Department of Health Care Policy, Harvard Medical School
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Howard AF, Tran J, Aparicio A, Lo A, Ullett A, McKenzie M, Srikanthan A, Goddard K. Documentation of Late-Effects Risks and Screening Recommendations for Adolescent and Young Adult Central Nervous System, Soft Tissue, or Bone Tumor Survivors Treated with Radiotherapy in British Columbia, Canada. J Adolesc Young Adult Oncol 2019; 8:142-148. [DOI: 10.1089/jayao.2018.0081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A. Fuchsia Howard
- Faculty of Applied Sciences, School of Nursing, University of British Columbia, Vancouver, Canada
| | - Jordan Tran
- MD Undergraduate Program, University of British Columbia, Vancouver, Canada
| | - Analuisa Aparicio
- University of St. Andrews School of Medicine, Scotland, United Kingdom
| | - Andrea Lo
- Department of Radiation Oncology, BC Cancer, Vancouver, Canada
| | - Avril Ullett
- Specialized Clinics, Patient Experience and Interprofessional Practice, BC Cancer, Vancouver, Canada
| | | | | | - Karen Goddard
- Department of Radiation Oncology, BC Cancer, Vancouver, Canada
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Ganz PA. Improving the Quality and Value of Cancer Care: A Work in Progress-The 2016 Joseph V. Simone Award and Lecture. J Oncol Pract 2018; 12:876-879. [PMID: 27531382 DOI: 10.1200/jop.2016.015339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Patricia A Ganz
- University of California Los Angeles (UCLA) Fielding School of Public Health and Jonsson Comprehensive Cancer Center at UCLA, Los Angeles, CA
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18
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Newcomer LN, Malin JL. Payer View of High-Quality Clinical Pathways for Cancer. J Oncol Pract 2018; 13:148-150. [PMID: 28282279 DOI: 10.1200/jop.2016.020503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Klein A, Hermes-Moll K, Osburg S, Walawgo T, Mödder M, Baumann W. [Feedback strategies for routine surveys of quality indicators in outpatient oncology care]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2018; 134:18-26. [PMID: 29428626 DOI: 10.1016/j.zefq.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The study deals with the efficiency and possible improvements of quality promotion with quality indicators (QI). The goal is to investigate the practical use of feedback from QI surveys in the field of oncology office practices. It captures both the acceptance of results and the independent initiation of search- and improvement strategies. The value of best practice examples is of further interest. METHODS Within one year, data of six QI of 31 physicians from 24 oncology practices were collected twice and the results were sent back in individual reports including a benchmarking. Practices with particularly good results in individual QI sectors were surveyed in semi-structured telephone interviews about their processes. Based on these results, best practice examples were created and provided to all participating practices to stimulate improvement. Further, two paper-based surveys about the acceptance and handling of results as well as the use of best practice examples were conducted. RESULTS The practices accepted the reported results as an instrument to assess their own care quality (70 %) and indicated that had been able to identify improvement potentials (75 %). Improvement strategies were developed or planned by approximately every second practice in the respective sectors. The practices were interested in the best practice examples and rated them as helpful (70 %). Many of them indicated that they were already taking up some of the suggestions for improving the organization of their own processes or were planning to do so. CONCLUSION The extraction of information on QI from patient files is a tedious task for the practices. Both the implementation of the necessary internal measures after receiving the results report as well as the adaptation of external process examples to their own processes is challenging. Nevertheless, oncology practices benefit from the feedback of the results of QI surveys and best practice examples. Thus, QI surveys and the reporting of results can actively encourage quality development.
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Affiliation(s)
- Astrid Klein
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland.
| | - Kerstin Hermes-Moll
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland
| | - Sandra Osburg
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland
| | - Thomas Walawgo
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland
| | - Martin Mödder
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland
| | - Walter Baumann
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland
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Abstract
BACKGROUND Non small cell lung cancer (NSCLC) diagnosis and treatment is a highly complex process, requiring managerial skills merged with clinical knowledge and experience. Integrated care pathways (ICPs) might be a good strategy to overview and improve patient's management. The aim of this study was to review the ICPs of NSCLC patients in a University Hospital and to identify areas of quality improvement. MATERIALS AND METHODS The electronic medical records of 169 NSCLC patients visited at the University Hospital were retrospectively reviewed. Quality of care (QoC) has been measured trough fifteen indicators, selected according main international Guidelines and approved by the multi-disciplinary team for thoracic malignancies. Results have been compared with those of a similar retrospective study conducted at the same hospital in 2008. RESULTS A total of 146 patients were considered eligible. Eight of fifteen indicators were not in line with the benchmarks. We compared the results obtained in the two separate periods. Moreover, we process some proposal to be discussed with the general management of the hospital, aimed to redesign NSCLC care pathways. CONCLUSIONS ICPs confirm to be feasible and to be an effective tool in real life. The periodic measurement of QoC indicators is necessary to ensure clinical governance of patients pathways.
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Landercasper J, Fayanju OM, Bailey L, Berry TS, Borgert AJ, Buras R, Chen SL, Degnim AC, Froman J, Gass J, Greenberg C, Mautner SK, Krontiras H, Ramirez LD, Sowden M, Wexelman B, Wilke L, Rao R. Benchmarking the American Society of Breast Surgeon Member Performance for More Than a Million Quality Measure-Patient Encounters. Ann Surg Oncol 2018; 25:501-511. [PMID: 29168099 PMCID: PMC5758679 DOI: 10.1245/s10434-017-6257-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Nine breast cancer quality measures (QM) were selected by the American Society of Breast Surgeons (ASBrS) for the Centers for Medicare and Medicaid Services (CMS) Quality Payment Programs (QPP) and other performance improvement programs. We report member performance. STUDY DESIGN Surgeons entered QM data into an electronic registry. For each QM, aggregate "performance met" (PM) was reported (median, range and percentiles) and benchmarks (target goals) were calculated by CMS methodology, specifically, the Achievable Benchmark of Care™ (ABC) method. RESULTS A total of 1,286,011 QM encounters were captured from 2011-2015. For 7 QM, first and last PM rates were as follows: (1) needle biopsy (95.8, 98.5%), (2) specimen imaging (97.9, 98.8%), (3) specimen orientation (98.5, 98.3%), (4) sentinel node use (95.1, 93.4%), (5) antibiotic selection (98.0, 99.4%), (6) antibiotic duration (99.0, 99.8%), and (7) no surgical site infection (98.8, 98.9%); all p values < 0.001 for trends. Variability and reasons for noncompliance by surgeon for each QM were identified. The CMS-calculated target goals (ABC™ benchmarks) for PM for 6 QM were 100%, suggesting that not meeting performance is a "never should occur" event. CONCLUSIONS Surgeons self-reported a large number of specialty-specific patient-measure encounters into a registry for self-assessment and participation in QPP. Despite high levels of performance demonstrated initially in 2011 with minimal subsequent change, the ASBrS concluded "perfect" performance was not a realistic goal for QPP. Thus, after review of our normative performance data, the ASBrS recommended different benchmarks than CMS for each QM.
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Affiliation(s)
| | | | - Lisa Bailey
- Bay Area Breast Surgeons, Inc, Oakland, CA, USA
| | | | | | | | | | | | | | | | - Caprice Greenberg
- University of Wisconsin School of Public Health and Medicine, Madison, WI, USA
| | | | | | | | | | | | - Lee Wilke
- University of Wisconsin School of Public Health and Medicine, Madison, WI, USA
| | - Roshni Rao
- Columbia University Medical Center, New York, NY, USA
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Clough JD, Strawbridge LM, LeBlanc TW, Hammill BG, Kamal AH. Association of Practice-Level Hospital Use With End-of-Life Outcomes, Readmission, and Weekend Hospitalization Among Medicare Beneficiaries With Cancer. J Oncol Pract 2017; 12:e933-e943. [PMID: 27531384 DOI: 10.1200/jop.2016.013102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the relationships between hospital use of treating oncology practices and patient outcomes. PATIENTS AND METHODS Retrospective analysis of 397,646 Medicare beneficiaries who received anticancer therapy in 2012. Each beneficiary was associated with a practice; practices were ranked on the basis of risk-adjusted hospital use, that is, inpatient intensity. Outcomes included 30-day readmission, weekend admissions, intensive care unit stays in the last month of life, and hospice stay of ≥ 7 days. Outcomes were measured for each quartile of practice-level inpatient intensity. We fit multivariable logistic regression models to calculate adjusted odds ratios (ORs) for each outcome for each quartile of inpatient intensity. RESULTS Total 30-day readmissions were 22.8% and 31.9% (OR, 1.45; 95% CI, 1.39 to 1.50) for patients in practices with the lowest versus highest quartiles of inpatient intensity, respectively; unplanned readmissions were 19.8% and 27.1% (OR, 1.36; 95% CI, 1.31 to 1.41), respectively. The proportion of admissions that occurred on weekends was similar across quartiles. Patients of practices in the highest quartiles of inpatient intensity had higher rates of death in an ICU stay in the last month of life (25.5% versus 18.0%; OR, 1.33; 95% CI, 1.19 to 1.49) and a lower rate of hospice stay of at least 7 days (50.9% to 42.5%; OR, 0.79; 95% CI, 0.74 to 0.86). CONCLUSION Medical oncology practices that seek to reduce hospitalizations should consider focusing initially on processes related to end-of-life care and care transitions.
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Affiliation(s)
- Jeffrey D Clough
- Duke University School of Medicine, Durham, NC; and Centers for Medicare & Medicaid Services, Baltimore, MD
| | - Larisa M Strawbridge
- Duke University School of Medicine, Durham, NC; and Centers for Medicare & Medicaid Services, Baltimore, MD
| | - Thomas W LeBlanc
- Duke University School of Medicine, Durham, NC; and Centers for Medicare & Medicaid Services, Baltimore, MD
| | - Bradley G Hammill
- Duke University School of Medicine, Durham, NC; and Centers for Medicare & Medicaid Services, Baltimore, MD
| | - Arif H Kamal
- Duke University School of Medicine, Durham, NC; and Centers for Medicare & Medicaid Services, Baltimore, MD
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Landercasper J, Bailey L, Buras R, Clifford E, Degnim AC, Thanasoulis L, Fayanju OM, Tjoe JA, Rao R. The American Society of Breast Surgeons and Quality Payment Programs: Ranking, Defining, and Benchmarking More Than 1 Million Patient Quality Measure Encounters. Ann Surg Oncol 2017; 24:3093-3106. [PMID: 28766206 PMCID: PMC5594033 DOI: 10.1245/s10434-017-5940-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND To identify and remediate gaps in the quality of surgical care, the American Society of Breast Surgeons (ASBrS) developed surgeon-specific quality measures (QMs), built a patient registry, and nominated itself to become a Center for Medicare and Medicaid Services (CMS) Qualified Clinical Data Registry (QCDR), thereby linking surgical performance to potential reimbursement and public reporting. This report provides a summary of the program development. METHODS Using a modified Delphi process, more than 100 measures of care quality were ranked. In compliance with CMS rules, selected QMs were specified with inclusion, exclusion, and exception criteria, then incorporated into an electronic patient registry. After surgeons entered QM data into the registry, the ASBrS provided real-time peer performance comparisons. RESULTS After ranking, 9 of 144 measures of quality were chosen, submitted, and subsequently accepted by CMS as a QCDR in 2014. The measures selected were diagnosis of cancer by needle biopsy, surgical-site infection, mastectomy reoperation rate, and appropriateness of specimen imaging, intraoperative specimen orientation, sentinel node use, hereditary assessment, antibiotic choice, and antibiotic duration. More than 1 million patient-measure encounters were captured from 2010 to 2015. Benchmarking functionality with peer performance comparison was successful. In 2016, the ASBrS provided public transparency on its website for the 2015 performance reported by our surgeon participants. CONCLUSIONS In an effort to improve quality of care and to participate in CMS quality payment programs, the ASBrS defined QMs, tracked compliance, provided benchmarking, and reported breast-specific QMs to the public.
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Affiliation(s)
| | - Lisa Bailey
- Bay Area Breast Surgeons, Inc., Oakland, CA, USA
| | | | - Ed Clifford
- Baylor Scott and White Healthcare, Dallas, TX, USA
| | | | | | | | | | - Roshni Rao
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Enright KA, Taback N, Powis ML, Gonzalez A, Yun L, Sutradhar R, Trudeau ME, Booth CM, Krzyzanowska MK. Setting Quality Improvement Priorities for Women Receiving Systemic Therapy for Early-Stage Breast Cancer by Using Population-Level Administrative Data. J Clin Oncol 2017; 35:3207-3214. [PMID: 28682683 DOI: 10.1200/jco.2016.70.7950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Routine evaluation of quality measures (QMs) can drive improvement in cancer systems by highlighting gaps in care. Targeting quality improvement at QMs that demonstrate substantial variation has the potential to make the largest impact at the population level. We developed an approach that uses both variation in performance and number of patients affected by the QM to set priorities for improving the quality of systemic therapy for women with early-stage breast cancer (EBC). Patients and Methods Patients with EBC diagnosed from 2006 to 2010 in Ontario, Canada, were identified in the Ontario Cancer Registry and linked deterministically to multiple health care databases. Individual QMs within a panel of 15 QMs previously developed to assess the quality of systemic therapy across four domains (access, treatment delivery, toxicity, and safety) were ranked on interinstitutional variation in performance (using interquartile range) and the number of patients who were affected; then the two rankings were averaged for a summative priority ranking. Results We identified 28,427 patients with EBC who were treated at 84 institutions. The use of computerized physician electronic order entry for chemotherapy, emergency room visits or hospitalizations during chemotherapy, and timely receipt of chemotherapy were identified as the QMs that had the largest potential to improve quality of care at a system level within this cohort. Conclusion A simple ranking system based on interinstitutional variation in performance and patient volume can be used to identify high-priority areas for quality improvement from a population perspective. This approach is generalizable to other health care systems that use QMs to drive improvement.
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Affiliation(s)
- Katherine A Enright
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Nathan Taback
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Melanie Lynn Powis
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Alejandro Gonzalez
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Lingsong Yun
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Rinku Sutradhar
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Maureen E Trudeau
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Christopher M Booth
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Monika K Krzyzanowska
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
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An Assessment of the Quality Oncology Practice Initiative: Lessons Learned From a Detailed Assessment of a Well-Established Profession-Based Performance Measurement Program. J Healthc Qual 2017; 39:e49-e58. [DOI: 10.1097/jhq.0000000000000054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang X, Knight LS, Evans A, Wang J, Smith TJ. Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer. J Oncol Pract 2017; 13:e496-e504. [PMID: 28221897 DOI: 10.1200/jop.2016.018093] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The benefits of hospice for patients with end-stage disease are well established. Although hospice use is increasing, a growing number of patients are enrolled for ≤ 7 days, a marker of poor quality of care and patient and family dissatisfaction. In this study, we examined variations in referrals among individuals and groups of physicians to assess a potential source of suboptimal hospice use. METHODS We conducted a retrospective chart review of 452 patients with advanced cancer referred to hospice from a comprehensive cancer center. We analyzed patient length of service (LOS) under hospice care, looking specifically at median LOS and percent of short enrollments (%LOS ≤ 7), to examine the variation between individual oncologists and divisions of oncologists. RESULTS Of 394 successfully referred patients, median LOS was 14.5 days and %LOS ≤ 7 was 32.5%, consistent with national data. There was significant interdivisional variation in LOS, both by overall distribution and %LOS ≤ 7 ( P < .01). In addition, there was dramatic variation in median LOS by individual physician (range, 4 to 88 days for physicians with five or more patients), indicating differences in hospice referral practices between providers (coefficient of variation > 125%). As one example, median LOS of physicians in the Division of Thoracic Malignancies varied from 4 to 33 days, despite similarities in patient population. CONCLUSION Nearly one in three patients with cancer who used hospice had LOS ≤ 7 days, a marker of poor quality. There was significant LOS variability among different divisions and different individual physicians, suggesting a need for increased education and training to meet recommended guidelines.
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Affiliation(s)
- Xiao Wang
- The Johns Hopkins University School of Medicine; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Hospital, Baltimore; and Gilchrist Services, Hunt Valley, MD
| | - Louise S Knight
- The Johns Hopkins University School of Medicine; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Hospital, Baltimore; and Gilchrist Services, Hunt Valley, MD
| | - Anne Evans
- The Johns Hopkins University School of Medicine; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Hospital, Baltimore; and Gilchrist Services, Hunt Valley, MD
| | - Jiangxia Wang
- The Johns Hopkins University School of Medicine; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Hospital, Baltimore; and Gilchrist Services, Hunt Valley, MD
| | - Thomas J Smith
- The Johns Hopkins University School of Medicine; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Hospital, Baltimore; and Gilchrist Services, Hunt Valley, MD
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Neuss M, Rocque G, Zuckerman D, Chiang A, Katta S, Wollins D, Kamin D, Edge S. Establishing a Core Set of Performance Measures to Improve Value in Cancer Care: ASCO Consensus Conference Recommendation Report. J Oncol Pract 2016; 13:135-140. [PMID: 28029299 DOI: 10.1200/jop.2016.017954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michael Neuss
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama at Birmingham, and Birmingham Veterans Affairs Medical Center, Birmingham, AL; St Luke's Mountain States Tumor Institute, Boise ID; Yale Cancer Center, New Haven, CT; American Society of Clinical Oncology, Alexandria, VA; Roswell Park Cancer Institute, Buffalo, NY
| | - Gabrielle Rocque
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama at Birmingham, and Birmingham Veterans Affairs Medical Center, Birmingham, AL; St Luke's Mountain States Tumor Institute, Boise ID; Yale Cancer Center, New Haven, CT; American Society of Clinical Oncology, Alexandria, VA; Roswell Park Cancer Institute, Buffalo, NY
| | - Dan Zuckerman
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama at Birmingham, and Birmingham Veterans Affairs Medical Center, Birmingham, AL; St Luke's Mountain States Tumor Institute, Boise ID; Yale Cancer Center, New Haven, CT; American Society of Clinical Oncology, Alexandria, VA; Roswell Park Cancer Institute, Buffalo, NY
| | - Anne Chiang
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama at Birmingham, and Birmingham Veterans Affairs Medical Center, Birmingham, AL; St Luke's Mountain States Tumor Institute, Boise ID; Yale Cancer Center, New Haven, CT; American Society of Clinical Oncology, Alexandria, VA; Roswell Park Cancer Institute, Buffalo, NY
| | - Sweatha Katta
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama at Birmingham, and Birmingham Veterans Affairs Medical Center, Birmingham, AL; St Luke's Mountain States Tumor Institute, Boise ID; Yale Cancer Center, New Haven, CT; American Society of Clinical Oncology, Alexandria, VA; Roswell Park Cancer Institute, Buffalo, NY
| | - Dana Wollins
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama at Birmingham, and Birmingham Veterans Affairs Medical Center, Birmingham, AL; St Luke's Mountain States Tumor Institute, Boise ID; Yale Cancer Center, New Haven, CT; American Society of Clinical Oncology, Alexandria, VA; Roswell Park Cancer Institute, Buffalo, NY
| | - Deborah Kamin
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama at Birmingham, and Birmingham Veterans Affairs Medical Center, Birmingham, AL; St Luke's Mountain States Tumor Institute, Boise ID; Yale Cancer Center, New Haven, CT; American Society of Clinical Oncology, Alexandria, VA; Roswell Park Cancer Institute, Buffalo, NY
| | - Stephen Edge
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama at Birmingham, and Birmingham Veterans Affairs Medical Center, Birmingham, AL; St Luke's Mountain States Tumor Institute, Boise ID; Yale Cancer Center, New Haven, CT; American Society of Clinical Oncology, Alexandria, VA; Roswell Park Cancer Institute, Buffalo, NY
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Bergerot CD, Philip EJ, Bergerot PG, Elias S, Guimarães DP, Forones NM, Baiocchi OCCG, Batista NA, De Domenico EBL. Quality Oncology Practice Initiative Can Guide and Improve Oncology Providers' Training in Brazil. J Glob Oncol 2016; 3:189-193. [PMID: 28717759 PMCID: PMC5493225 DOI: 10.1200/jgo.2016.006148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE It has become crucial to translate scientific findings and to find ways by which to mobilize local resources to improve the quality and accessibility of cancer care in developing countries. This study seeks to provide insight into challenge through examining differences in clinician documentation of patients with cancer treated at a Brazilian Public University Hospital. METHODS ASCO Quality Oncology Practice Initiative (QOPI) measures were used to examine the care provided in the departments of breast, colorectal, lymphoma, gynecology, and lung cancers. For this study, data from a representative sample of patients receiving chemotherapy in the previous month were extracted and quality of cancer care indicators examined. RESULTS Certain elements of medical care were consistently and appropriately documented, including cancer diagnosis and stage, chemotherapy planning, administration, and summary. In general, considering the specific cancer management measures, patients received recommended care in accordance with recognized guidelines. Despite this, a number of important gaps in care were identified, including the assessment and treatment of pain, documentation of chemotherapy intention, symptom and toxicity management, patients' psychosocial status, and provision of a treatment summary at care completion. CONCLUSION These findings are encouraging in terms of adherence to core treatment guidelines in cancer care in Brazil. However, results suggest important opportunities for improving care across a number of domains, many of which represent a challenge throughout both developing and developed countries. This study may also provide preliminary guidance for enhancing educational and training programs for professionals and students alike, to implement high-quality, comprehensive cancer care.
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Affiliation(s)
- Cristiane Decat Bergerot
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
| | - Errol J Philip
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
| | - Paulo Gustavo Bergerot
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
| | - Simone Elias
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
| | - Daiane Pereira Guimarães
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
| | - Nora Manoukian Forones
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
| | - Otavio Cesar Carvalho Guimarães Baiocchi
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
| | - Nildo Alves Batista
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
| | - Edvane Birelo Lopes De Domenico
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
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Riblet NBV. Transitioning to Academic Quality-Improvement Work Within the Field of Oncology: Opportunities and Challenges. J Oncol Pract 2016; 12:855-858. [PMID: 27328794 DOI: 10.1200/jop.2016.013193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Natalie B V Riblet
- Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine at Dartmouth, Hanover; and The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
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Reid Ponte P, Berry D, Buswell L, Gross A, Hayes C, Kostka J, Poyner-Reed M, West C. Transforming Oncology Care: Developing a Strategy and Measuring Success. Semin Oncol Nurs 2016; 32:110-21. [PMID: 27137468 DOI: 10.1016/j.soncn.2016.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To examine accountability and performance measurement in health care and present a case study that illustrates the link between goal setting and measurement and how a strategic plan can provide a framework for metric selection. DATA SOURCES National reports, literature review and institutional experience. CONCLUSION Nurse leaders and clinicians in oncology settings are challenged to anticipate future trends in oncology care and create a culture, infrastructure, and practice environment that supports innovation, advancement of oncology nursing practice and excellence in patient- and family-centered care. Performance metrics assessing key processes and outcomes of care are essential to meet this challenge. IMPLICATIONS FOR NURSING PRACTICE With an increasing number of national organizations offering their version of key quality standards and metrics, it is critical for nurses to have a formal process in place to determine and implement the measures most useful in guiding change for a particular clinical setting.
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Chiang AC. Why the Quality Oncology Practice Initiative Matters: It's Not Just About Cost. Am Soc Clin Oncol Educ Book 2016; 35:e102-e107. [PMID: 27249710 DOI: 10.1200/edbk_160113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The nature and cost of cancer care is evolving, affecting more patients and often involving expensive treatment options. The upward cost trends also coincide with a national landscape of increasing regulatory mandates that may demand improved outcomes and value, but that often require significant up-front investment in infrastructure to achieve safety and quality. Oncology practices participating in the American Society of Clinical Oncology (ASCO) Institute for Quality's Quality Oncology Practice Initiative (QOPI) and the QOPI Certification Program (QCP) continue to grow in number and reflect changing demographics of the provision of cancer care. QOPI and QCP benchmarking can be used to achieve quality improvement and to build collaborative quality communities. These programs may be useful tools for oncology practices to comply with new legislation such as the Medicare Access and CHIP Reauthorization Act (MACRA).
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Affiliation(s)
- Anne C Chiang
- From the Yale University School of Medicine, New Haven, CT
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McNiff KK, Jacobson JO. Aiming for ideal care: a proposed framework for cancer quality improvement. J Oncol Pract 2015; 10:339-44. [PMID: 25398953 DOI: 10.1200/jop.2014.001305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The authors review the advances made in oncology over the past 50 years and describe methods for closing the gap in care quality.
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Massard V, Salleron J, Krakowski I, Conroy T, Weber B. Chemotherapy at the End of Life: Factors of Prescription. J Palliat Med 2015; 18:658-9. [PMID: 26087120 DOI: 10.1089/jpm.2015.0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vincent Massard
- 1 Department of Medical Oncology, Institut de Cancérologie de Lorraine , Vandoeuvre-lès-Nancy, France
| | - Julia Salleron
- 2 Unit of Biostatistics, Institut de Cancérologie de Lorraine , Vandoeuvre-lès-Nancy, France
| | - Ivan Krakowski
- 1 Department of Medical Oncology, Institut de Cancérologie de Lorraine , Vandoeuvre-lès-Nancy, France .,3 Palliative Care Department, Institut de Cancérologie de Lorraine , Vandoeuvre-lès-Nancy, France
| | - Thierry Conroy
- 1 Department of Medical Oncology, Institut de Cancérologie de Lorraine , Vandoeuvre-lès-Nancy, France
| | - Béatrice Weber
- 1 Department of Medical Oncology, Institut de Cancérologie de Lorraine , Vandoeuvre-lès-Nancy, France
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Blayney DW. Do Wise Choices Translate Into Cost Savings and Improved Outcomes? J Oncol Pract 2015; 11:344-5. [PMID: 26060226 DOI: 10.1200/jop.2015.004937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Siegel RD, Castro KM, Eisenstein J, Stallings H, Hegedus PD, Bryant DM, Kadlubek PJ, Clauser SB. Quality improvement in the national cancer institute community cancer centers program: the quality oncology practice initiative experience. J Oncol Pract 2015; 11:e247-54. [PMID: 25538082 PMCID: PMC4371125 DOI: 10.1200/jop.2014.000703] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP) began in 2007; it is a network of community-based hospitals funded by the NCI. Quality of care is an NCCCP priority, with participation in the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) playing a fundamental role in quality assessment and quality improvement (QI) projects. Using QOPI methodology, performance on quality measures was analyzed two times per year over a 3-year period to enhance our implementation of quality standards at NCCCP hospitals. METHODS A data-sharing agreement allowed individual-practice QOPI data to be electronically sent to the NCI. Aggregated data with the other NCCCP QOPI participants were presented to the network via Webinars. The NCCCP Quality of Care Subcommittee selected areas in which to focus subsequent QI efforts, and high-performing practices shared voluntarily their QI best practices with the network. RESULTS QOPI results were compiled semiannually between fall 2010 and fall 2013. The network concentrated on measures with a quality score of ≤ 0.75 and planned voluntary group-wide QI interventions. We identified 13 measures in which the NCCCP fell at or below the designated quality score in fall 2010. After implementing a variety of QI initiatives, the network registered improvements in all parameters except one (use of treatment summaries). CONCLUSION Using the NCCCP as a paradigm, QOPI metrics provide a useful platform for group-wide measurement of quality performance. In addition, these measurements can be used to assess the effectiveness of QI initiatives.
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Affiliation(s)
- Robert D Siegel
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT; National Cancer Institute, Bethesda, MD; Norton Cancer Institute, Louisville, KY; Gibbs Cancer Center-Spartanburg Healthcare System, Spartanburg, SC; Mary Bird Perkins-Our Lady of the Lake Cancer Center, Baton Rouge, LA; and American Society of Clinical Oncology, Alexandria, VA
| | - Kathleen M Castro
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT; National Cancer Institute, Bethesda, MD; Norton Cancer Institute, Louisville, KY; Gibbs Cancer Center-Spartanburg Healthcare System, Spartanburg, SC; Mary Bird Perkins-Our Lady of the Lake Cancer Center, Baton Rouge, LA; and American Society of Clinical Oncology, Alexandria, VA
| | - Jana Eisenstein
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT; National Cancer Institute, Bethesda, MD; Norton Cancer Institute, Louisville, KY; Gibbs Cancer Center-Spartanburg Healthcare System, Spartanburg, SC; Mary Bird Perkins-Our Lady of the Lake Cancer Center, Baton Rouge, LA; and American Society of Clinical Oncology, Alexandria, VA
| | - Holley Stallings
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT; National Cancer Institute, Bethesda, MD; Norton Cancer Institute, Louisville, KY; Gibbs Cancer Center-Spartanburg Healthcare System, Spartanburg, SC; Mary Bird Perkins-Our Lady of the Lake Cancer Center, Baton Rouge, LA; and American Society of Clinical Oncology, Alexandria, VA
| | - Patricia D Hegedus
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT; National Cancer Institute, Bethesda, MD; Norton Cancer Institute, Louisville, KY; Gibbs Cancer Center-Spartanburg Healthcare System, Spartanburg, SC; Mary Bird Perkins-Our Lady of the Lake Cancer Center, Baton Rouge, LA; and American Society of Clinical Oncology, Alexandria, VA
| | - Donna M Bryant
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT; National Cancer Institute, Bethesda, MD; Norton Cancer Institute, Louisville, KY; Gibbs Cancer Center-Spartanburg Healthcare System, Spartanburg, SC; Mary Bird Perkins-Our Lady of the Lake Cancer Center, Baton Rouge, LA; and American Society of Clinical Oncology, Alexandria, VA
| | - Pam J Kadlubek
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT; National Cancer Institute, Bethesda, MD; Norton Cancer Institute, Louisville, KY; Gibbs Cancer Center-Spartanburg Healthcare System, Spartanburg, SC; Mary Bird Perkins-Our Lady of the Lake Cancer Center, Baton Rouge, LA; and American Society of Clinical Oncology, Alexandria, VA
| | - Steven B Clauser
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT; National Cancer Institute, Bethesda, MD; Norton Cancer Institute, Louisville, KY; Gibbs Cancer Center-Spartanburg Healthcare System, Spartanburg, SC; Mary Bird Perkins-Our Lady of the Lake Cancer Center, Baton Rouge, LA; and American Society of Clinical Oncology, Alexandria, VA
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Mayer DK, Shapiro CL, Jacobson P, McCabe MS. Assuring Quality Cancer Survivorship Care: We've Only Just Begun. Am Soc Clin Oncol Educ Book 2015:e583-e591. [PMID: 25993226 DOI: 10.14694/edbook_am.2015.35.e583] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Clinical practice guidelines, quality metrics, and performance improvement projects are the key tools of the national movement to improve and assure quality cancer care. Each of these evaluation instruments is intended to assess quality from a unique perspective, including that of the individual provider, the practice/hospital, and the health care system. A number of organizations have developed or endorsed quality measures specific to cancer, however, these have not formally included survivorship measures. Fortunately, the American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network, the American Cancer Society, and the American College of Surgeons (ACoS) have taken a leadership role in developing survivorship guidelines and quality metrics. Both ASCO and ACoS have focused their efforts on the treatment summary and care plan, a document that was proposed in the 2006 Institute of Medicine report on cancer survivorship. ASCO has proposed a care plan template for implementation and incorporation into the electronic health records (EHR), which will lend itself to structure, process, and outcome measurement. ACoS, conversely, has included the care plan in its cancer program standards with annual evaluation metrics. In addition, ASCO has developed a number of key survivorship-relevant metrics as part of its Quality Oncology Practice Initiative (QOPI), a tool developed to measure quality cancer care and assess adherence to guidelines across academic and community practices. Together, these efforts will direct us to more effective ways to disseminate guideline recommendations and to better methods of assessing quality survivorship care nationally.
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Affiliation(s)
- Deborah K Mayer
- From the School of Nursing, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Dubin Breast Center, Translational Breast Cancer Research, Tisch Cancer Institute, Mount Sinai Medical Center, Division of Hematology/Medical Oncology, Tisch Cancer Institute, New York, NY; Clinical Programs, Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Charles L Shapiro
- From the School of Nursing, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Dubin Breast Center, Translational Breast Cancer Research, Tisch Cancer Institute, Mount Sinai Medical Center, Division of Hematology/Medical Oncology, Tisch Cancer Institute, New York, NY; Clinical Programs, Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Jacobson
- From the School of Nursing, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Dubin Breast Center, Translational Breast Cancer Research, Tisch Cancer Institute, Mount Sinai Medical Center, Division of Hematology/Medical Oncology, Tisch Cancer Institute, New York, NY; Clinical Programs, Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mary S McCabe
- From the School of Nursing, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Dubin Breast Center, Translational Breast Cancer Research, Tisch Cancer Institute, Mount Sinai Medical Center, Division of Hematology/Medical Oncology, Tisch Cancer Institute, New York, NY; Clinical Programs, Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY
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Symptoms: Menopause, Infertility, and Sexual Health. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 862:115-41. [PMID: 26059933 DOI: 10.1007/978-3-319-16366-6_9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
By 2022, the number of survivors is expected to grow to nearly 18 million. Therefore, addressing acute and chronic negative sequelae of a cancer diagnosis and its treatments becomes a health imperative. For women with a history of breast cancer, one of the common goals of treatment and prevention of recurrence is to reduce circulating concentrations of estradiol, especially in women with hormone receptor positive breast cancer. Hormone deprivation after a diagnosis of breast cancer impacts physiological targets other than in the breast tissue and can result in unwanted side effects, all of which can negatively impact quality of life and function and cause distress. Symptoms that are most strongly linked by evidence to hormone changes after cancer diagnosis and treatment include hot flashes, night sweats, sleep changes, fatigue, mood changes, and diminishing sexual function, including vaginal atrophy (decreased arousal, dryness and dyspareunia), infertility, decreased desire and negative self-image. Weight gain and resulting body image changes are often concomitants of the abrupt onset of treatment-induced menopause. The purpose of this chapter is to briefly review what is known about the advent of premature menopause in women treated for breast cancer, menopausal symptoms that are exacerbated by endocrine treatments for breast cancer, and the associated concerns of hot flashes and related menopausal symptoms, sexual health and fertility issues. We will discuss limitations in the current research and propose strategies that address current limitations in order to move the science forward.
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Hershman DL, Ganz PA. Quality of Care, Including Survivorship Care Plans. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 862:255-69. [PMID: 26059941 DOI: 10.1007/978-3-319-16366-6_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
With the expectation of prolonged survival in the vast majority of women diagnosed with breast cancer, making initial treatment decisions that minimize or prevent late complications, and maximize the quality as well as quantity of life, is absolutely critical. Unfortunately, such care is not uniformly delivered. Patient, provider, and system barriers contribute to delays in cancer care, lower quality of care, and poorer outcomes in vulnerable populations, including low income, underinsured, and racial/ethnic minority populations. Covering the costs of cancer care is a major concern for many cancer survivors, and as a result, a major challenge will be to provide cost-effective follow-up care by reducing overuse of unnecessary tests and procedures so that access to effective medications can be preserved. One of the recently promoted means of improving the coordination of care for breast cancer survivors has been the use of survivorship care planning, as coordination of care will be absolutely essential to deliver high-quality care. Patient navigation is another approach to help overcome healthcare system barriers and facilitate timely access to quality medical care. Understanding the challenges and opportunities in delivering high-quality cancer care is one of the most critical issues of the day. With the large numbers of breast cancer patients and the tremendous advances in our understanding of the disease and treatments (leading to large numbers of survivors), breast cancer will likely be the focus of new models for the delivery of better and more efficient cancer care.
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Affiliation(s)
- Dawn L Hershman
- Medicine and Epidemiology, Herbert Irving Comprehensive Cancer Center Columbia University, 161 Fort Washington, 1068, New York, NY, 10032, USA,
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Quinn GP, Block RG, Clayman ML, Kelvin J, Arvey SR, Lee JH, Reinecke J, Sehovic I, Jacobsen PB, Reed D, Gonzalez L, Vadaparampil ST, Laronga C, Lee MC, Pow-Sang J, Eggly S, Franklin A, Shah B, Fulp WJ, Hayes-Lattin B. If you did not document it, it did not happen: rates of documentation of discussion of infertility risk in adolescent and young adult oncology patients' medical records. J Oncol Pract 2014; 11:137-44. [PMID: 25549654 DOI: 10.1200/jop.2014.000786] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The adolescent and young adult (AYA) population is underserved because of unique late-effect issues, particularly future fertility. This study sought to establish rates of documentation of discussion of risk of infertility, fertility preservation (FP) options, and referrals to fertility specialists in AYA patients' medical records at four cancer centers. METHODS All centers reviewed randomized records within the top four AYA disease sites (breast, leukemia/lymphoma, sarcoma, and testicular). Eligible records included those of patients: diagnosed in 2011, with no prior receipt of gonadotoxic therapy; age 18 to 45 years; with no multiple primary cancers; and for whom record was not second opinion. Quality Oncology Practice Initiative methods were used to evaluate documentation of discussion of risk of infertility, discussion of FP options, and referral to a fertility specialist. RESULTS Of 231 records, 26% documented infertility risk discussion, 24% documented FP option discussion, and 13% documented referral to a fertility specialist. Records were less likely to contain evidence of infertility risk and FP option discussions for female patients (P = .030 and .004, respectively) and those with breast cancer (P = .021 and < .001, respectively). Records for Hispanic/Latino patients were less likely to contain evidence of infertility risk discussion (P = .037). Records were less likely to document infertility risk discussion, FP option discussion, and fertility specialist referral for patients age ≥ 40 years (P < .001, < .001, and .002, respectively) and those who already had children (all P < .001). CONCLUSION The overall rate of documentation of discussion of FP is low, and results show disparities among specific groups. Although greater numbers of discussions may be occurring, there is a need to create interventions to improve documentation.
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Affiliation(s)
- Gwendolyn P Quinn
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Rebecca G Block
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Marla L Clayman
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Joanne Kelvin
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Sarah R Arvey
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Ji-Hyun Lee
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Joyce Reinecke
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Ivana Sehovic
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Paul B Jacobsen
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Damon Reed
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Luis Gonzalez
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Susan T Vadaparampil
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Christine Laronga
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - M Catherine Lee
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Julio Pow-Sang
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Susan Eggly
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Anna Franklin
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Bijal Shah
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - William J Fulp
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Brandon Hayes-Lattin
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
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Blayney DW, McNiff K, Eisenberg PD, Gilmore T, Jacobsen PB, Jacobson JO, Kadlubek PJ, Neuss MN, Simone J. Development and Future of the American Society of Clinical Oncology's Quality Oncology Practice Initiative. J Clin Oncol 2014; 32:3907-13. [DOI: 10.1200/jco.2014.56.8899] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Douglas W. Blayney
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | | | | | - Terry Gilmore
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | | - Michael N. Neuss
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
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Shulman LN, Mpunga T, Tapela N, Wagner CM, Fadelu T, Binagwaho A. Bringing cancer care to the poor: experiences from Rwanda. Nat Rev Cancer 2014; 14:815-21. [PMID: 25355378 DOI: 10.1038/nrc3848] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The knowledge and tools to cure many cancer patients exist in developed countries but are unavailable to many who live in the developing world, resulting in unnecessary loss of life. Bringing cancer care to the poor, particularly to low-income countries, is a great challenge, but it is one that we believe can be met through partnerships, careful planning and a set of guiding principles. Alongside vaccinations, screening and other cancer-prevention efforts, treatment must be a central component of any cancer programme from the start. It is also critical that these programmes include implementation research to determine programmatic efficacy, where gaps in care still exist and where improvements can be made. This article discusses these issues using the example of Rwanda's expanding national cancer programme.
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Affiliation(s)
- Lawrence N Shulman
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02215, USA; and at Partners In Heath, 888 Commonwealth Avenue, third Floor, Boston, Massachusetts 02215, USA
| | - Tharcisse Mpunga
- Ministry of Health, Government of Rwanda, P.O. Box 84, Kigali, Rwanda; and at the University of Rwanda College of Medicine and Health Sciences, P.O. Box 59, Musanze, Rwanda
| | - Neo Tapela
- Partners In Health - Inshuti Mu Buzima, P.O. Box 3432, Kigali, Rwanda; and at the Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115 USA
| | - Claire M Wagner
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Temidayo Fadelu
- Partners In Heath - Inshuti Mu Buzima, P.O. Box 3432, Kigali, Rwanda
| | - Agnes Binagwaho
- Ministry of Health, Government of Rwanda, PO Box 84, Kigali, Rwanda; Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115; and at the Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, New Hampshire 03755, USA
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Lim C, Cheung MC, Franco B, Dharmakulaseelan L, Chong E, Iyngarathasan A, Singh S. Quality Improvement: An Assessment of Participation and Attitudes of Medical Oncologists. J Oncol Pract 2014; 10:e408-14. [DOI: 10.1200/jop.2014.001515] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Canadian medical oncologists face limitations to participating in QI initiatives as a result of lack of time, publication resources, and knowledge about ongoing initiatives. Improving networking opportunities and prioritizing QI at the institutional level can address this need.
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Affiliation(s)
- Charles Lim
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
| | - Matthew C. Cheung
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
| | - Bryan Franco
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
| | | | - Evan Chong
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
| | - Amesha Iyngarathasan
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
| | - Simron Singh
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
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Jacobsen PB, Lee JH, Fulp W, Siegel EM, Shibata D, Laronga C, Gray J, Tanvetyanon T, Schreiber F, Brown R, Levine R, Cartwright T, Abesada-Terk G, Kim G, Alemany C, Faig D, Sharp P, Markham MJ, Malafa M. Florida Initiative for Quality Cancer Care: Changes in Psychosocial Quality of Care Indicators Over a 3-Year Interval. J Oncol Pract 2014; 11:e103-9. [PMID: 25352389 DOI: 10.1200/jop.2014.001525] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Identifying and addressing psychosocial concerns is increasingly recognized as an important aspect of cancer care that needs to be improved. As part of the Florida Initiative for Quality Cancer Care, medical record reviews were conducted to evaluate cancer care, including psychosocial care, at oncology practices in Florida in 2006. Results were subsequently disseminated to the practices, and performance was reassessed at the same practices in 2009. METHODS Data were available for patients with colorectal, breast, and non-small-cell lung cancer first seen by a medical oncologist in 2006 (n = 1,609) and 2009 (n = 1,720) at the same 10 practice sites. Performance on each psychosocial indicator was evaluated for overall change over time and for variability in change based on practice site and cancer type. RESULTS The percentage of patients identified as having a problem in emotional well-being increased significantly over time, from 24% to 31% among those assessed (P = .002) and from 13% to 16% overall (P = .026). In contrast, there no significant changes over time in assessment of emotional well-being (53% to 51%, P = .661) or in action taken to address problems (57% to 45%, P = .098). CONCLUSION Findings suggest more intensive efforts than audit and feedback will be required to improve the quality of psychosocial care and that greater recognition of problems with emotional well-being may tax the ability of practices to link patients with appropriate services. Systematic research is needed to identify and disseminate effective strategies for implementing routine assessment of well-being and addressing the increased demands for care this will generate.
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Affiliation(s)
- Paul B Jacobsen
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Ji-Hyun Lee
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - William Fulp
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Erin M Siegel
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - David Shibata
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Christine Laronga
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Jhanelle Gray
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Tawee Tanvetyanon
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Fred Schreiber
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Richard Brown
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Richard Levine
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Thomas Cartwright
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Guillermo Abesada-Terk
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - George Kim
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Carlos Alemany
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Douglas Faig
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Philip Sharp
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Merry-Jennifer Markham
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Mokenge Malafa
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
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Yang LL, Zhang XC, Yang XN, Yang JJ, Wang Z, Chen HJ, Yan HH, Xu CR, Guan JL, He YY, Zhong WZ, An SJ, Wu YL. Lung cancer treatment disparities in China: a question in need of an answer. Oncologist 2014; 19:1084-90. [PMID: 25223463 DOI: 10.1634/theoncologist.2014-0007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Substantial progress has been made in the treatment of malignancies in the People's Republic of China in recent years. The goal of this study was to identify the extent to which national treatment guidelines are being used to customize patient care in lung cancer and to analyze the reasons for treatment disparities. METHODS Patient characteristics and treatments were investigated retrospectively for the period from October 2004 to January 2013 using the outpatient database of the Guangdong Lung Cancer Institute (GLCI) in China. RESULTS A total of 2,535 outpatients with lung cancer were studied in this retrospective analysis. The treatment disparity was 45.3%. Overall, 20.6% of patients with stage I non-small cell lung cancer (NSCLC) were overtreated, and 20.1% of stage II patients were undertreated. Only 19.6% of stage IIIA patients and 30.7% of stage IIIB patients underwent the recommended combination of chemotherapy and radiotherapy, respectively. For advanced NSCLC, the greatest treatment disparity appeared in the second-line setting and beyond. Patients who were positive for epidermal growth factor receptor (EGFR) and receiving EGFR tyrosine kinase inhibitors experienced significant prolongation of survival compared with patients who were EGFR negative or whose EGFR mutation status was unknown (hazard ratio: 0.79; p = .037). The treatment disparities were significantly larger among patients aged younger than 65 years and in patients from developing regions compared with patients aged 65 years and older and from developed regions, respectively (p < .001, p = .046). The difference in treatment disparity was statistically significant between GLCI and other hospitals (p < .001). CONCLUSION This retrospective study of a large number of patients from an outpatient oncology database demonstrated large disparities in the treatment of lung cancer in China. It is important to develop a new guideline for recommendations that are based on resource classification.
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Affiliation(s)
- Lu-Lu Yang
- Southern Medical University, Guangzhou, Guangdong, People's Republic of China; Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Xu-Chao Zhang
- Southern Medical University, Guangzhou, Guangdong, People's Republic of China; Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Xue-Ning Yang
- Southern Medical University, Guangzhou, Guangdong, People's Republic of China; Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Jin-Ji Yang
- Southern Medical University, Guangzhou, Guangdong, People's Republic of China; Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Zhen Wang
- Southern Medical University, Guangzhou, Guangdong, People's Republic of China; Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Hua-Jun Chen
- Southern Medical University, Guangzhou, Guangdong, People's Republic of China; Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Hong-Hong Yan
- Southern Medical University, Guangzhou, Guangdong, People's Republic of China; Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Chong-Rui Xu
- Southern Medical University, Guangzhou, Guangdong, People's Republic of China; Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Ji-Lin Guan
- Southern Medical University, Guangzhou, Guangdong, People's Republic of China; Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Yan-Yan He
- Southern Medical University, Guangzhou, Guangdong, People's Republic of China; Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Wen-Zhao Zhong
- Southern Medical University, Guangzhou, Guangdong, People's Republic of China; Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - She-Juan An
- Southern Medical University, Guangzhou, Guangdong, People's Republic of China; Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Yi-Long Wu
- Southern Medical University, Guangzhou, Guangdong, People's Republic of China; Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
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Tewari P, Franklin AR, Tarek N, Askins MA, Mofield S, Kebriaei P. Hematopoietic stem cell transplantation in adolescents and young adults. Acta Haematol 2014; 132:313-25. [PMID: 25228557 DOI: 10.1159/000360211] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs) are a very unique subset of our population journeying through a dynamic stage of their lives. This age group often remains understudied as a separate entity because they are commonly lumped into either pediatric or adult subgroups. METHODS Here we review acute and chronic issues surrounding hematopoietic stem cell transplantation (HSCT) with a focus on the AYA age group. RESULTS HSCT is a commonly used treatment modality for patients with certain types of cancers. AYA patients undergoing HSCT present a very unique perspective, circumstances, medical, psychological and social issues requiring a diligent workup, care and follow-up. CONCLUSION The medical care of these patients should be approached in a multidisciplinary method involving the patient, caregivers, physicians, psychologists and social workers.
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Laronga C, Gray JE, Siegel EM, Lee JH, Fulp WJ, Fletcher M, Schreiber F, Brown R, Levine R, Cartwright T, Abesada-Terk G, Kim G, Alemany C, Faig D, Sharp P, Markham MJ, Shibata D, Malafa M, Jacobsen PB. Florida Initiative for Quality Cancer Care: improvements in breast cancer quality indicators during a 3-year interval. J Am Coll Surg 2014; 219:638-45.e1. [PMID: 25086813 DOI: 10.1016/j.jamcollsurg.2014.03.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/17/2014] [Accepted: 03/31/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Florida Initiative for Quality Cancer Care (FIQCC), composed of 11 practice sites across Florida, conducted its initial evaluation of adherence to breast cancer quality of care indicators (QCI) in 2006, with feedback provided to encourage quality improvement efforts at participating sites. In this study, our objective was to reassess changes over time resulting from these efforts. STUDY DESIGN Quality care indicators were derived from the Quality Oncology Practice Initiative, the National Comprehensive Cancer Network, the American College of Surgeons, and expert panel consensus. Medical records were reviewed for breast cancer patients first seen by medical oncologists in 2009 at the FIQCC sites, using the same performance indicators as in 2006. Statistical comparisons of 2006 vs 2009 data across sites were made by Pearson chi-square exact test using Monte Carlo estimation. RESULTS Charts of 602 patients in 2006 and 636 patients in 2009 were compared. Performance on medical oncology QCI improved over time for documentation of clinical trial participation discussion (p = 0.001), documentation of consent for chemotherapy (p = 0.047), definitive surgery done after neoadjuvant chemotherapy (p = 0.017), and planned dose of chemotherapy consistent with published regimens (p = 0.02). Improvements in surgical QCI were seen for documentation of specimen orientation (p < 0.001), inking of margins (p < 0.0001), and performance of sentinel lymph node biopsy (p = 0.035). CONCLUSIONS The 2006 FIQCC study identified several medical and surgical oncology QCI improvement needs. Quality improvement efforts resulted in better performance for numerous metrics, therefore speaking to the benefits of reassessment of adherence to performance indicators to guide QCI efforts.
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Affiliation(s)
| | | | | | | | | | | | - Fred Schreiber
- Center for Cancer Care & Research/Watson Clinic, Lakeland, FL
| | - Richard Brown
- Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota, FL
| | | | | | | | | | - Carlos Alemany
- Florida Institute of Research, Medicine & Surgery, Orlando, FL
| | - Douglas Faig
- North Broward Medical Center, Deerfield Beach, FL
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Neuss MN. The measure of a physician, the measure of our practices: what we measure reflects what we believe. J Oncol Pract 2014; 10:221-2. [PMID: 24839287 DOI: 10.1200/jop.2014.001410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Physicians cannot charge forward with measures, incentives, penalties, and public reporting without first understanding how to allow for the appropriate variation of care as determined by patient beliefs, preferences, and comorbidities.
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Jacobson JO, Quinn D, Gilligan T, Corning Davis B, Dalby C, Bretsch J, McNiff K. The ASCO Quality Training Program: Designing and Implementing a Medical Specialty Society–Based Quality Improvement Training Program. J Oncol Pract 2014; 10:203-5. [DOI: 10.1200/jop.2014.001399] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The mission of ASCO”s Quality Training Program is “to teach oncology providers to engage in successful quality improvement activities in their practice settings and to train oncologists to assume quality leadership positions and champion quality initiatives.”
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Affiliation(s)
- Joseph O. Jacobson
- Dana-Farber Cancer Institute, Boston, MA; The University of Texas MD Anderson Cancer Center, Houston TX; Cleveland Clinic, Cleveland OH; North Shore Medical Center, Salem, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Doris Quinn
- Dana-Farber Cancer Institute, Boston, MA; The University of Texas MD Anderson Cancer Center, Houston TX; Cleveland Clinic, Cleveland OH; North Shore Medical Center, Salem, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Timothy Gilligan
- Dana-Farber Cancer Institute, Boston, MA; The University of Texas MD Anderson Cancer Center, Houston TX; Cleveland Clinic, Cleveland OH; North Shore Medical Center, Salem, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Barbara Corning Davis
- Dana-Farber Cancer Institute, Boston, MA; The University of Texas MD Anderson Cancer Center, Houston TX; Cleveland Clinic, Cleveland OH; North Shore Medical Center, Salem, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Carole Dalby
- Dana-Farber Cancer Institute, Boston, MA; The University of Texas MD Anderson Cancer Center, Houston TX; Cleveland Clinic, Cleveland OH; North Shore Medical Center, Salem, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Jennifer Bretsch
- Dana-Farber Cancer Institute, Boston, MA; The University of Texas MD Anderson Cancer Center, Houston TX; Cleveland Clinic, Cleveland OH; North Shore Medical Center, Salem, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Kristen McNiff
- Dana-Farber Cancer Institute, Boston, MA; The University of Texas MD Anderson Cancer Center, Houston TX; Cleveland Clinic, Cleveland OH; North Shore Medical Center, Salem, MA; and American Society of Clinical Oncology, Alexandria, VA
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Tanvetyanon T, Lee JH, Fulp WJ, Schreiber F, Brown RH, Levine RM, Cartwright TH, Abesada-Terk G, Kim GP, Alemany C, Faig D, Sharp PV, Markham MJ, Malafa M, Jacobsen PB. Changes in the care of non-small-cell lung cancer after audit and feedback: the Florida initiative for quality cancer care. J Oncol Pract 2014; 10:e247-54. [PMID: 24737876 DOI: 10.1200/jop.2013.001275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Audit and feedback have been widely used to enhance the performance of various medical practices. Non-small-cell lung cancer (NSCLC) is one of the most common diseases encountered in medical oncology practice. We investigated the use of audit and feedback to improve the care of NSCLC. METHODS Medical records were reviewed for patients with NSCLC first seen by a medical oncologist in 2006 (n = 518) and 2009 (n = 573) at 10 oncology practices participating in the Florida Initiative for Quality Cancer Care. In 2008, feedback from 2006 audit results was provided to practices, which then independently undertook steps to improve their performance. Sixteen quality-of-care indicators (QCIs) were evaluated on both time points and were examined for changes in adherence over time. RESULTS A statistically significant increase in adherence was observed for five of 16 QCIs. Adherence to brain staging using magnetic resonance imaging or computed tomography scan for stage III NSCLC (57.8% in 2006 v 82.8% in 2009; P = .001), availability of chemotherapy flow sheet (89.2% v 97.0%; P < .001), documentation of performance status for stage III and IV disease (43.4% v 51.3%; P < .001), availability of pathology report for patients undergoing surgery (95.2% v 99.2%; P = .02), and availability of signed chemotherapy consent (69.5% v 76.3%; P = .04). There were no statistically significant decreases in adherence on any QCIs. CONCLUSION Audit with feedback was associated with a modest but important improvement in the treatment of NSCLC. Whether these changes are durable will require long-term follow-up.
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Affiliation(s)
- Tawee Tanvetyanon
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL
| | - Ji-Hyun Lee
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL
| | - William J Fulp
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL
| | - Fred Schreiber
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL
| | - Richard H Brown
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL
| | - Richard M Levine
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL
| | - Thomas H Cartwright
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL
| | - Guillermo Abesada-Terk
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL
| | - George P Kim
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL
| | - Carlos Alemany
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL
| | - Douglas Faig
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL
| | - Philip V Sharp
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL
| | - Merry-Jennifer Markham
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL
| | - Mokenge Malafa
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL
| | - Paul B Jacobsen
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL
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50
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Affiliation(s)
- Mark T. Hughes
- General Internal Medicine and Berman Institute of Bioethics, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-0941;
| | - Thomas J. Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-0005;
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