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Hou HX, Li A, Thierauf JC, Lennerz JK. Diagnostic Test Utilization Management Strategies as an Opportunity for Equitable Access to Molecularly Informed Clinical Care. J Appl Lab Med 2024; 9:41-49. [PMID: 38167770 DOI: 10.1093/jalm/jfad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/25/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Companion diagnostics are an essential component of oncology. Timing, cost, and adaptability to new drug/biomarker approvals represent challenges in assuring value-based care. Overcoming these challenges requires strategies for equitable access and efficient integration. METHODS Based on prior laboratory improvements and payor policy implementations, we define equitable access in laboratory testing and conceptualized a framework for initiatives that optimize diagnostic performance. RESULTS We define equitable access as an imperative goal seeking to remove disparities that may arise due to financial hardships, geographical isolation, cultural differences, or other social determinants of health. We distinguish (a) utilization, as the practice pattern of ordered tests, (b) utilization management, as the evidence-based guidance of the utilization decisions, and (c) utilization management strategies, defined as the tools and techniques used to influence decision-making. These 3 dimensions establish a standardized vocabulary to clarify equitable alignment of strategies in specific care pathways. Alignment of logistic, administrative, and financial incentive structures is paramount when creating sustainable personalized care pathway programs. CONCLUSIONS Strategies to accomplish equitable and meaningful use of diagnostic tests can help enhance access to timely and accurate diagnoses, ultimately leading to improved patient outcomes.
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Affiliation(s)
- Helen X Hou
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Annie Li
- Department of Pathology, Center for Integrated Diagnostics Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | - Julia C Thierauf
- Department of Pathology, Center for Integrated Diagnostics Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | - Jochen K Lennerz
- Department of Pathology, Center for Integrated Diagnostics Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
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2
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Djulbegovic B, Hozo I, Lizarraga D, Thomas J, Barbee M, Shah N, Rubeor T, Dale J, Reiser J, Guyatt G. Evaluation of a fast-and-frugal clinical decision algorithm ('pathways') on clinical outcomes in hospitalised patients with COVID-19 treated with anticoagulants. J Eval Clin Pract 2023; 29:3-12. [PMID: 36229950 PMCID: PMC9840687 DOI: 10.1111/jep.13780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 01/27/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Critics have charged that evidence-based medicine (EBM) overemphasises algorithmic rules over unstructured clinical experience and intuition, but the role of structured decision support systems in improving health outcomes remains uncertain. We aim to assess if delivery of anticoagulant prophylaxis in hospitalised patients with COVID-19 according to an algorithm based on evidence-based clinical practice guideline (CPG) improved clinical outcomes compared with administration of anticoagulant treatment given at individual practitioners' discretion. METHODS An observational design consisting of the analysis of all acutely ill, consecutive patients (n = 1783) with confirmed COVID-19 diagnosis admitted between 10 March 2020 to 11 January 2022 to an US academic center. American Society of Haematology CPG for anticoagulant prophylaxis in hospitalised patients with COVID-19 was converted into a clinical pathway and translated into fast-and-frugal decision (FFT) tree ('algorithm'). We compared delivery of anticoagulant prophylaxis in hospitalised patients with COVID-19 according to the FFT algorithm with administration of anticoagulant treatment given at individual practitioners' discretion. RESULTS In an adjusted analysis, using combination of Lasso (least absolute shrinkage and selection operator) and propensity score based weighting [augmented inverse-probability weighting] statistical techniques controlling for cluster data, the algorithm did not reduce death, venous thromboembolism, or major bleeding, but helped avoid longer hospital stay [number of patients needed to be treated (NNT) = 40 (95% CI: 23-143), indicating that for every 40 patients (23-143) managed on FFT algorithm, one avoided staying in hospital longer than 10 days] and averted admission to intensive-care unit (ICU) [NNT = 19 (95% CI: 13-40)]. All model's selected covariates were well balanced. The results remained robust to sensitivity analyses used to test the stability of the findings. CONCLUSIONS When delivered using a structured FFT algorithm, CPG shortened the hospital stay and help avoided admission to ICU, but it did not affect other relevant outcomes.
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Affiliation(s)
- Benjamin Djulbegovic
- Department of Computational & Quantitative Medicine, City of Hope, Beckman Research Institute, Duarte, California, USA.,Division of Health Analytics, Beckman Research Institute, Duarte, California, USA.,Evidence-Based Medicine & Comparative Effectiveness Research, Beckman Research Institute, Duarte, California, USA
| | - Iztok Hozo
- Department of Mathematics, Indiana University, Gary, Indiana, USA
| | - David Lizarraga
- Department of Computational & Quantitative Medicine, City of Hope, Beckman Research Institute, Duarte, California, USA.,Division of Health Analytics, Beckman Research Institute, Duarte, California, USA.,Evidence-Based Medicine & Comparative Effectiveness Research, Beckman Research Institute, Duarte, California, USA
| | - Joseph Thomas
- Rush University Medical Center (RUMC), Chicago, Illinois, USA.,Division of Hospital Medicine, Department of Hospital Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Barbee
- Rush University Medical Center (RUMC), Chicago, Illinois, USA.,Division of Hospital Medicine, Department of Hospital Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Nupur Shah
- Rush University Medical Center (RUMC), Chicago, Illinois, USA.,Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Tyler Rubeor
- Rush University Medical Center (RUMC), Chicago, Illinois, USA
| | - Jordan Dale
- Houston Methodist Academic Institute, Houston, Texas, USA
| | - Jochen Reiser
- Rush University Medical Center (RUMC), Chicago, Illinois, USA.,Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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3
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Kusch M, Labouvie H, Schiewer V, Talalaev N, Cwik JC, Bussmann S, Vaganian L, Gerlach AL, Dresen A, Cecon N, Salm S, Krieger T, Pfaff H, Lemmen C, Derendorf L, Stock S, Samel C, Hagemeier A, Hellmich M, Leicher B, Hültenschmidt G, Swoboda J, Haas P, Arning A, Göttel A, Schwickerath K, Graeven U, Houwaart S, Kerek-Bodden H, Krebs S, Muth C, Hecker C, Reiser M, Mauch C, Benner J, Schmidt G, Karlowsky C, Vimalanandan G, Matyschik L, Galonska L, Francke A, Osborne K, Nestle U, Bäumer M, Schmitz K, Wolf J, Hallek M. Integrated, cross-sectoral psycho-oncology (isPO): a new form of care for newly diagnosed cancer patients in Germany. BMC Health Serv Res 2022; 22:543. [PMID: 35459202 PMCID: PMC9034572 DOI: 10.1186/s12913-022-07782-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background The annual incidence of new cancer cases has been increasing worldwide for many years, and is likely to continue to rise. In Germany, the number of new cancer cases is expected to increase by 20% until 2030. Half of all cancer patients experience significant emotional and psychosocial distress along the continuum of their disease, treatment, and aftercare, and also as long-term survivors. Consequently, in many countries, psycho-oncological programs have been developed to address this added burden at both the individual and population level. These programs promote the active engagement of patients in their cancer therapy, aftercare and survivorship planning and aim to improve the patients' quality of life. In Germany, the “new form of care isPO” (“nFC-isPO”; integrated, cross-sectoral psycho-oncology/integrierte, sektorenübergreifende Psycho-Onkologie) is currently being developed, implemented and evaluated. This approach strives to accomplish the goals devised in the National Cancer Plan by providing psycho-oncological care to all cancer patients according to their individual healthcare needs. The term “new form of care" is defined by the Innovation Fund (IF) of Germany's Federal Joint Committee as “a structured and legally binding cooperation between different professional groups and/or institutions in medical and non-medical care”. The nFC-isPO is part of the isPO project funded by the IF. It is implemented in four local cancer centres and is currently undergoing a continuous quality improvement process. As part of the isPO project the nFC-isPO is being evaluated by an independent institution: the Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Germany. The four-year isPO project was selected by the IF to be eligible for funding because it meets the requirements of the federal government's National Cancer Plan (NCP), in particular, the “further development of the oncological care structures and quality assurance" in the psycho-oncological domain. An independent evaluation is required by the IF to verify if the new form of care leads to an improvement in cross-sectoral care and to explore its potential for permanent integration into the German health care system. Methods The nFC-isPO consists of six components: a concept of care (C1), care pathways (C2), a psycho-oncological care network (C3), a care process organization plan (C4), an IT-supported documentation and assistance system (C5) and a quality management system (C6). The two components concept of care (C1) and care pathways (C2) represent the isPO clinical care program, according to which the individual cancer patients are offered psycho-oncological services within a period of 12 months after program enrolment following the diagnosis of cancer. The remaining components (C3-C6) represent the formal-administrative aspects of the nFC-isPO that are intended to meet the legally binding requirements of patient care in the German health care system. With the aim of systematic development of the nFC-isPO while at the same time enabling the external evaluators to examine its quality, effectiveness and efficiency under conditions of routine care, the project partners took into consideration approaches from translational psycho-oncology, practice-based health care research and program theory. In order to develop a structured, population-based isPO care program, reference was made to a specific program theory, to the stepped-care approach, and also to evidence-based guideline recommendations. Results The basic version, nFC-isPO, was created over the first year after the start of the isPO project in October 2017, and has since been subject to a continuous quality improvement process. In 2019, the nFC-isPO was implemented at four local psycho-oncological care networks in the federal state North Rhine-Westphalia, in Germany. The legal basis of the implementation is a contract for "special care" with the German statutory health insurance funds according to state law (§ 140a SCB V; Social Code Book V for the statutory health insurance funds). Besides the accompanying external evaluation by the IMVR, the nFC-isPO is subjected to quarterly internal and cross-network quality assurance and improvement measures (internal evaluation) in order to ensure continuous quality improvement process. These quality management measures are developed and tested in the isPO project and are to be retained in order to ensure the sustainability of the quality of nFC-isPO for later dissemination into the German health care system. Discussion Demands on quality, effectiveness and cost-effectiveness of in the German health care system are increasing, whereas financial resources are declining, especially for psychosocial services. At the same time, knowledge about evidence-based screening, assessment and intervention in cancer patients and about the provision of psychosocial oncological services is growing continuously. Due to the legal framework of the statutory health insurance in Germany, it has taken years to put sound psycho-oncological findings from research into practice. Ensuring the adequate and sustainable financing of a needs-oriented, psycho-oncological care approach for all newly diagnosed cancer patients, as required by the NCP, may still require many additional years. The aim of the isPO project is to develop a new form of psycho-oncological care for the individual and the population suffering from cancer, and to provide those responsible for German health policy with a sound basis for decision-making on the timely dissemination of psycho-oncological services in the German health care system. Trial registration The study was pre-registered at the German Clinical Trials Register (https://www.drks.de/DRKS00015326) under the following trial registration number: DRKS00015326; Date of registration: October 30, 2018.
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Affiliation(s)
- Michael Kusch
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany.
| | - Hildegard Labouvie
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Vera Schiewer
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Natalie Talalaev
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Jan C Cwik
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Sonja Bussmann
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Lusine Vaganian
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Alexander L Gerlach
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Antje Dresen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Natalia Cecon
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Sandra Salm
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Theresia Krieger
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Holger Pfaff
- University of Cologne, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Clarissa Lemmen
- Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Lisa Derendorf
- Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Christina Samel
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Anna Hagemeier
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Bernd Leicher
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Gregor Hültenschmidt
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Jessica Swoboda
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Peter Haas
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Anna Arning
- Krebsgesellschaft Nordrhein-Westfalen E.V, Düsseldorf, Germany
| | - Andrea Göttel
- Krebsgesellschaft Nordrhein-Westfalen E.V, Düsseldorf, Germany
| | | | - Ullrich Graeven
- Krebsgesellschaft Nordrhein-Westfalen E.V, Düsseldorf, Germany
| | - Stefanie Houwaart
- House of the Cancer Patient Support Associations of Germany, Bonn, Germany
| | - Hedy Kerek-Bodden
- House of the Cancer Patient Support Associations of Germany, Bonn, Germany
| | - Steffen Krebs
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Christiana Muth
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | | | - Marcel Reiser
- PIOH Köln - Praxis Internistischer Onkologie Und Hämatologie, Cologne, Germany
| | - Cornelia Mauch
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | | | | | | | | | | | | | | | | | | | | | | | - Jürgen Wolf
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
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4
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Wang W, Li E, Campbell K, McBride A, D'Amato S. Economic Analysis on Adoption of Biosimilar Granulocyte Colony-Stimulating Factors in Patients With Nonmyeloid Cancer at Risk of Febrile Neutropenia Within the Oncology Care Model Framework. JCO Oncol Pract 2021; 17:e1139-e1149. [PMID: 33961490 PMCID: PMC8360455 DOI: 10.1200/op.20.00994] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Value-based programs, such as the Oncology Care Model (OCM), seek to improve care for patients undergoing chemotherapy, while reducing total costs. The purpose of this study is to quantify the impact of adopting biosimilar granulocyte colony-stimulating factors (G-CSFs) for febrile neutropenia (FN) primary prophylaxis (PP) from a US practice perspective.
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Affiliation(s)
| | | | | | - Ali McBride
- University of Arizona Cancer Center, University of Arizona College of Pharmacy, Tucson, AZ
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5
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Ostropolets A, Zhang L, Hripcsak G. A scoping review of clinical decision support tools that generate new knowledge to support decision making in real time. J Am Med Inform Assoc 2020; 27:1968-1976. [PMID: 33120430 PMCID: PMC7824048 DOI: 10.1093/jamia/ocaa200] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/24/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE A growing body of observational data enabled its secondary use to facilitate clinical care for complex cases not covered by the existing evidence. We conducted a scoping review to characterize clinical decision support systems (CDSSs) that generate new knowledge to provide guidance for such cases in real time. MATERIALS AND METHODS PubMed, Embase, ProQuest, and IEEE Xplore were searched up to May 2020. The abstracts were screened by 2 reviewers. Full texts of the relevant articles were reviewed by the first author and approved by the second reviewer, accompanied by the screening of articles' references. The details of design, implementation and evaluation of included CDSSs were extracted. RESULTS Our search returned 3427 articles, 53 of which describing 25 CDSSs were selected. We identified 8 expert-based and 17 data-driven tools. Sixteen (64%) tools were developed in the United States, with the others mostly in Europe. Most of the tools (n = 16, 64%) were implemented in 1 site, with only 5 being actively used in clinical practice. Patient or quality outcomes were assessed for 3 (18%) CDSSs, 4 (16%) underwent user acceptance or usage testing and 7 (28%) functional testing. CONCLUSIONS We found a number of CDSSs that generate new knowledge, although only 1 addressed confounding and bias. Overall, the tools lacked demonstration of their utility. Improvement in clinical and quality outcomes were shown only for a few CDSSs, while the benefits of the others remain unclear. This review suggests a need for a further testing of such CDSSs and, if appropriate, their dissemination.
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Affiliation(s)
- Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - Linying Zhang
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
- NewYork-Presbyterian Hospital, New York, New York, USA
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6
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Gunaratne MDSK, Sahakian AJ, Abeykoon JP, Ansell SM, Gertz MA, Kapoor P, Paulus A, Ailawadhi S, Reeder CB, Witzig TE, Habermann TM, Novak AJ, Lacy MQ, Kyle RA, Go RS, Paludo J. Treatment facility volume and patient outcomes in Waldenstrom macroglobulinemia. Leuk Lymphoma 2020; 62:308-315. [PMID: 33054437 DOI: 10.1080/10428194.2020.1832669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Waldenstrom macroglobulinemia (WM) has an annual incidence of 3-3.2 cases per million-person/year. National Cancer Data Base was used to identify newly diagnosed WM cases requiring initiation of therapy and their annual facility volume was used to divide the treatment facilities into four quartiles (Qs). Cox regression was used to analyze the association between facility volume and survival, adjusted by demographics, socioeconomic, geographic, comorbidity factors and year of diagnosis. A total of 3064 patients treated in 795 facilities were included. The unadjusted median overall survival (OS) by facility volume was: Q1:6.5 years (5-year OS 55%), Q2:7 years (5-year OS 60%), Q3:8 years (5-year OS 64%), and Q4: NR (5-year OS 71%), p < 0.0001. Our results demonstrated that a volume-outcome relationship exists in WM and is an independent predictor of overall survival in addition to the established risk factors as age and disease severity.
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Affiliation(s)
| | | | | | | | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Aneel Paulus
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Craig B Reeder
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | - Anne J Novak
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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7
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Mahar AL, Davis LE, Bubis LD, Li Q, Sutradhar R, Coburn NG, Barbera L. Factors associated with receipt of symptom screening in the year after cancer diagnosis in a universal health care system: a retrospective cohort study. ACTA ACUST UNITED AC 2019; 26:e8-e16. [PMID: 30853804 DOI: 10.3747/co.26.4160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose Patient-reported symptom data are collected prospectively by a provincial cancer agency to mitigate the significant symptom burden that patients with cancer experience. However, an assessment of whether such symptom screening occurs uniformly for those patients has yet to be performed. In the present study, we investigated patient, disease, and health system factors associated with receipt of symptom screening in the year after a cancer diagnosis. Methods Patients diagnosed with cancer between 2007 and 2014 were identified. We measured whether 1 or more symptom screenings were recorded in the year after diagnosis. A multivariable modified Poisson regression with robust error variance was used to identify predictors [age, comorbidity, rurality, socioeconomic status, immigration status, cancer site, registration at a regional cancer centre (cc), and year of diagnosis] of being screened for symptoms. Results Of 425,905 patients diagnosed with cancer, 163,610 (38%) had 1 or more symptom screening records in the year after diagnosis, and 75% survived at least 1 year. We identified variability in symptom screening by primary cancer site, regional cc, age, sex, comorbidity, material deprivation, rurality of residence, and immigration status. Patients who had been diagnosed with melanoma or endocrine cancers, who were not registered at a regional cc, who lived in the most urban areas, who were elderly, and who were immigrants were least likely to undergo symptom screening after diagnosis. Conclusions Our evaluation of the implementation of a population-based symptom screening program in a universal health care system identified populations who are at risk for not receiving screening and who are therefore future targets for improvements in population symptom screening and better management of cancer-related symptoms at diagnosis.
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Affiliation(s)
- A L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB
| | - L E Davis
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON
| | - L D Bubis
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON
| | | | - R Sutradhar
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON.,ICES, Toronto, ON
| | - N G Coburn
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON.,ICES, Toronto, ON.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON
| | - L Barbera
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON.,ICES, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
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8
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Doherty M, Miller-Sonet E, Gardner D, Epstein I. Exploring the role of psychosocial care in value-based oncology: Results from a survey of 3000 cancer patients and survivors. J Psychosoc Oncol 2018; 37:441-455. [PMID: 30451102 DOI: 10.1080/07347332.2018.1504851] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To explore the psychosocial needs of cancer patients and survivors across the United States and their implications for value-based oncology. DESIGN A secondary analysis of findings from a cross-sectional national online survey. SAMPLE Respondents were sampled and stratified by cancer type and geographic region to approximate the cancer-affected population of the United States. Breast, prostate, and colorectal were the most common cancers reported. Across surveys, the majority of respondents were female (57%), over 55 (60%), and white (70%) and had at least some college (36%). METHODS Six online surveys were administered to cohorts of approximately 500 unique cancer patients and survivors. Survey topics included: (1) diagnosis, (2) treatment planning, (3) communication with providers, (4) insurance and financial concerns, (5) quality of life, side effects, and symptoms, and (6) survivorship and end-of-life. Descriptive analyses were used to explore psychosocial needs and experiences across three domains of patient-centered value in oncology. FINDINGS Each survey received 500-527 responses. Respondents most commonly reported needing more information regarding their insurance coverage and out-of-pocket costs (65%), access to clinical trials (89%), and support organizations (45%). Forty-one percent were very or extremely distressed about cancer's impact on their ability to work and over 25% reported high-levels of cancer-related financial hardship. CONCLUSIONS Patients and survivors reported significant unmet informational needs, financial hardship, distress, and symptoms or treatment side effects that interfered with daily life. Implications for Psychosocial Providers or Policy: Providers and payment reform advocates can improve value in oncology by ensuring access to comprehensive psychosocial care and informational support.
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Affiliation(s)
- Meredith Doherty
- a Graduate Center of the City University of New York , New York , NY , USA
| | | | - Daniel Gardner
- c Silberman School of Social Work at Hunter College , City University of New York , New York , NY , USA
| | - Irwin Epstein
- c Silberman School of Social Work at Hunter College , City University of New York , New York , NY , USA
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9
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Robinson JC. Value-Based Physician Payment in Oncology: Public and Private Insurer Initiatives. Milbank Q 2018; 95:184-203. [PMID: 28266072 DOI: 10.1111/1468-0009.12249] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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10
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Kwon H, Lee JH, Woo J, Lim W, Moon BI, Paik NS. Efficacy of a clinical pathway for patients with thyroid cancer. Head Neck 2018; 40:1909-1916. [PMID: 29637689 DOI: 10.1002/hed.25175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 12/06/2017] [Accepted: 02/15/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Clinical pathways have been proposed as a way to improve organizational efficiency and maximize patient outcomes. However, little is known as to whether a clinical pathway is effective for thyroid cancer. METHODS The study subjects included 216 patients who were managed after clinical pathway implementation and 145 control patients. Length of stay, cost per patient, and nurses' satisfaction were compared in the 2 groups. RESULTS Mean length of stay was 0.8 days shorter in the clinical pathway group than in the control group (2.9 vs 3.7 days; P = .023). Cost per patient was also lower in the clinical pathway than in the control group (USD $3953.00 vs USD $4636.00; P < .001). Nurses' overall satisfaction scores improved from 71.6% before to 82.5% after implementation of the clinical pathway and their job characteristics scores increased from 61.1% to 75.0%. CONCLUSION Implementation of a clinical pathway for thyroid cancer can improve nurses' satisfaction with reduction of hospital stay and costs.
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Affiliation(s)
- Hyungju Kwon
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea.,Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Joon-Hyop Lee
- Thyroid and Endocrine Surgery Section, Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Joohyun Woo
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea.,Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Woosung Lim
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea.,Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Byung-In Moon
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea.,Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Nam Sun Paik
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea.,Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
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11
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Venigalla S, Nead KT, Sebro R, Guttmann DM, Sharma S, Simone CB, Levin WP, Wilson RJ, Weber KL, Shabason JE. Association Between Treatment at High-Volume Facilities and Improved Overall Survival in Soft Tissue Sarcomas. Int J Radiat Oncol Biol Phys 2018; 100:1004-1015. [PMID: 29485042 PMCID: PMC5830163 DOI: 10.1016/j.ijrobp.2017.12.262] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE Soft tissue sarcomas (STS) are rare malignancies that require complex multidisciplinary management. Therefore, facilities with high sarcoma case volume may demonstrate superior outcomes. We hypothesized that STS treatment at high-volume (HV) facilities would be associated with improved overall survival (OS). METHODS AND MATERIALS Patients aged ≥18 years with nonmetastatic STS treated with surgery and radiation therapy at a single facility from 2004 through 2013 were identified from the National Cancer Database. Facilities were dichotomized into HV and low-volume (LV) cohorts based on total case volume over the study period. OS was assessed using multivariable Cox regression with propensity score-matching. Patterns of care were assessed using multivariable logistic regression analysis. RESULTS Of 9025 total patients, 1578 (17%) and 7447 (83%) were treated at HV and LV facilities, respectively. On multivariable analysis, high educational attainment, larger tumor size, higher grade, and negative surgical margins were statistically significantly associated with treatment at HV facilities; conversely, black race and non-metropolitan residence were negative predictors of treatment at HV facilities. On propensity score-matched multivariable analysis, treatment at HV facilities versus LV facilities was associated with improved OS (hazard ratio, 0.87, 95% confidence interval, 0.80-0.95; P = .001). Older age, lack of insurance, greater comorbidity, larger tumor size, higher tumor grade, and positive surgical margins were associated with statistically significantly worse OS. CONCLUSIONS In this observational cohort study using the National Cancer Database, receipt of surgery and radiation therapy at HV facilities was associated with improved OS in patients with STS. Potential sociodemographic disparities limit access to care at HV facilities for certain populations. Our findings highlight the importance of receipt of care at HV facilities for patients with STS and warrant further study into improving access to care at HV facilities.
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Affiliation(s)
- Sriram Venigalla
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Kevin T Nead
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ronnie Sebro
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - David M Guttmann
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sonam Sharma
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
| | - William P Levin
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Robert J Wilson
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kristy L Weber
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jacob E Shabason
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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12
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Rotenstein LS, Kerman AO, Killoran J, Balboni TA, Krishnan MS, Taylor A, Martin NE. Impact of a clinical pathway tool on appropriate palliative radiation therapy for bone metastases. Pract Radiat Oncol 2017; 8:266-274. [PMID: 29429920 DOI: 10.1016/j.prro.2017.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/29/2017] [Accepted: 12/06/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE Clinical pathways increase compliance with treatment guidelines, improve outcomes, and reduce costs. Guidelines recommend single fraction radiation therapy (SFRT) for palliation of uncomplicated bone metastases, but implementation is variable. We examined the effects of a pathway tool on SFRT rates in an academic radiation oncology practice. METHODS AND MATERIALS Using published literature, clinical guidelines, and expert input, we designed a clinical pathway for bone metastases radiation therapy displayed on a Web-based electronic interface. In March 2016, the pathway launched on a palliative radiation service at the Dana Farber/Brigham and Women's Cancer Center main campus and at affiliated community sites. Providers were surveyed pre- and postimplementation to assess expectations and elicit feedback. Rates of pathway utilization, compliance with SFRT recommendations, and reasons for noncompliance were assessed. RESULTS The final pathway includes 20 endpoints and several validated prognostic scoring systems. It was used in 38% of 723 bone metastases radiation prescriptions, with appropriate SFRT rates rising from 18% before implementation to 48% after launch (P < .01). Major reasons for rejecting recommendations included disagreement with life expectancy prognostication and patient convenience. The pathway increased physicians' confidence regarding compliance with treatment guidelines and made it easier to find well-supported treatment recommendations. Workflow disruptions and the inability to handle nuanced situations emerged as limitations. CONCLUSIONS Our experience demonstrates the utility of clinical pathway decision support for bone metastases radiation in complex academic settings. Next steps include increasing the pathway's ease of use, refining the pathway's prognostic abilities, and measuring cost savings related to the pathway.
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Affiliation(s)
- Lisa S Rotenstein
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alexander O Kerman
- University of Chicago Pritzker School of Medicine, Chicago, Illinois; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joseph Killoran
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tracy A Balboni
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Monica S Krishnan
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Allison Taylor
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Neil E Martin
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts.
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13
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14
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Zon RT, Edge SB, Page RD, Frame JN, Lyman GH, Omel JL, Wollins DS, Green SR, Bosserman LD. American Society of Clinical Oncology Criteria for High-Quality Clinical Pathways in Oncology. J Oncol Pract 2017; 13:207-210. [DOI: 10.1200/jop.2016.019836] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Robin T. Zon
- Michiana Hematology-Oncology PC, Mishawaka, IN; Roswell Park Cancer Institute, Buffalo, NY; The Center for Cancer and Blood Disorders, Fort Worth, TX; Charleston Area Medical Center, Charleston, WV; Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Cancer Research Advocate, Grand Island, NE; American Society of Clinical Oncology, Alexandria, VA; and City of Hope, Rancho Cucamonga, CA
| | - Stephen B. Edge
- Michiana Hematology-Oncology PC, Mishawaka, IN; Roswell Park Cancer Institute, Buffalo, NY; The Center for Cancer and Blood Disorders, Fort Worth, TX; Charleston Area Medical Center, Charleston, WV; Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Cancer Research Advocate, Grand Island, NE; American Society of Clinical Oncology, Alexandria, VA; and City of Hope, Rancho Cucamonga, CA
| | - Ray D. Page
- Michiana Hematology-Oncology PC, Mishawaka, IN; Roswell Park Cancer Institute, Buffalo, NY; The Center for Cancer and Blood Disorders, Fort Worth, TX; Charleston Area Medical Center, Charleston, WV; Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Cancer Research Advocate, Grand Island, NE; American Society of Clinical Oncology, Alexandria, VA; and City of Hope, Rancho Cucamonga, CA
| | - James N. Frame
- Michiana Hematology-Oncology PC, Mishawaka, IN; Roswell Park Cancer Institute, Buffalo, NY; The Center for Cancer and Blood Disorders, Fort Worth, TX; Charleston Area Medical Center, Charleston, WV; Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Cancer Research Advocate, Grand Island, NE; American Society of Clinical Oncology, Alexandria, VA; and City of Hope, Rancho Cucamonga, CA
| | - Gary H. Lyman
- Michiana Hematology-Oncology PC, Mishawaka, IN; Roswell Park Cancer Institute, Buffalo, NY; The Center for Cancer and Blood Disorders, Fort Worth, TX; Charleston Area Medical Center, Charleston, WV; Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Cancer Research Advocate, Grand Island, NE; American Society of Clinical Oncology, Alexandria, VA; and City of Hope, Rancho Cucamonga, CA
| | - James L. Omel
- Michiana Hematology-Oncology PC, Mishawaka, IN; Roswell Park Cancer Institute, Buffalo, NY; The Center for Cancer and Blood Disorders, Fort Worth, TX; Charleston Area Medical Center, Charleston, WV; Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Cancer Research Advocate, Grand Island, NE; American Society of Clinical Oncology, Alexandria, VA; and City of Hope, Rancho Cucamonga, CA
| | - Dana S. Wollins
- Michiana Hematology-Oncology PC, Mishawaka, IN; Roswell Park Cancer Institute, Buffalo, NY; The Center for Cancer and Blood Disorders, Fort Worth, TX; Charleston Area Medical Center, Charleston, WV; Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Cancer Research Advocate, Grand Island, NE; American Society of Clinical Oncology, Alexandria, VA; and City of Hope, Rancho Cucamonga, CA
| | - Sybil R. Green
- Michiana Hematology-Oncology PC, Mishawaka, IN; Roswell Park Cancer Institute, Buffalo, NY; The Center for Cancer and Blood Disorders, Fort Worth, TX; Charleston Area Medical Center, Charleston, WV; Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Cancer Research Advocate, Grand Island, NE; American Society of Clinical Oncology, Alexandria, VA; and City of Hope, Rancho Cucamonga, CA
| | - Linda D. Bosserman
- Michiana Hematology-Oncology PC, Mishawaka, IN; Roswell Park Cancer Institute, Buffalo, NY; The Center for Cancer and Blood Disorders, Fort Worth, TX; Charleston Area Medical Center, Charleston, WV; Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Cancer Research Advocate, Grand Island, NE; American Society of Clinical Oncology, Alexandria, VA; and City of Hope, Rancho Cucamonga, CA
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15
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Ersek JL, Nadler E, Freeman-Daily J, Mazharuddin S, Kim ES. Clinical Pathways and the Patient Perspective in the Pursuit of Value-Based Oncology Care. Am Soc Clin Oncol Educ Book 2017; 37:597-606. [PMID: 28561657 DOI: 10.1200/edbk_174794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The art of practicing oncology has evolved substantially in the past 5 years. As more and more diagnostic tests, biomarker-directed therapies, and immunotherapies make their way to the oncology marketplace, oncologists will find it increasingly difficult to keep up with the many therapeutic options. Additionally, the cost of cancer care seems to be increasing. Clinical pathways are a systematic way to organize and display detailed, evidence-based treatment options and assist the practitioner with best practice. When selecting which treatment regimens to include on a clinical pathway, considerations must include the efficacy and safety, as well as costs, of the therapy. Pathway treatment regimens must be continually assessed and modified to ensure that the most up-to-date, high-quality options are incorporated. Value-based models, such as the ASCO Value Framework, can assist providers in presenting economic evaluations of clinical pathway treatment options to patients, thus allowing the patient to decide the overall value of each treatment regimen. Although oncologists and pathway developers can decide which treatment regimens to include on a clinical pathway based on the efficacy of the treatment, assessment of the value of that treatment regimen ultimately lies with the patient. Patient definitions of value will be an important component to enhancing current value-based oncology care models and incorporating new, high-quality, value-based therapeutics into oncology clinical pathways.
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Affiliation(s)
- Jennifer L Ersek
- From the Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Baylor University Medical Center, Dallas, TX
| | - Eric Nadler
- From the Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Baylor University Medical Center, Dallas, TX
| | - Janet Freeman-Daily
- From the Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Baylor University Medical Center, Dallas, TX
| | - Samir Mazharuddin
- From the Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Baylor University Medical Center, Dallas, TX
| | - Edward S Kim
- From the Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Baylor University Medical Center, Dallas, TX
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16
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Glode AE, May MB. Rising Cost of Cancer Pharmaceuticals: Cost Issues and Interventions to Control Costs. Pharmacotherapy 2016; 37:85-93. [PMID: 27862122 DOI: 10.1002/phar.1867] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The rising cost of pharmaceuticals and, in particular, cancer drugs has made headline news in recent years. Several factors contribute to increasing costs and the burden this places on the health care system and patients. Some of these factors include costly cancer pharmaceutical research and development, longer clinical trials required to achieve drug approval, manufacturing costs for complex compounds, and the economic principles surrounding oncology drug pricing. Strategies to control costs have been proposed, and some have already been implemented to mitigate cancer drug costs such as the use of clinical treatment pathways and tools to facilitate cost discussions with patients. In this article, we briefly review some of the potential factors contributing to increasing cancer pharmaceutical costs and interventions to mitigate costs, and touch on the role of health care providers in addressing this important issue.
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Affiliation(s)
- Ashley E Glode
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado
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17
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Go RS, Al-Hamadani M, Shah ND, Crowson CS, Holton SJ, Habermann EB. Influence of the treatment facility volume on the survival of patients with non-Hodgkin lymphoma. Cancer 2016; 122:2552-9. [DOI: 10.1002/cncr.30038] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/08/2016] [Accepted: 02/29/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Ronald S. Go
- Division of Hematology, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Mayo Clinic; Rochester Minnesota
| | - Mohammed Al-Hamadani
- Department of Medical Research; Gundersen Medical Foundation; La Crosse Wisconsin
- Department of Medicine, Chicago Medical School; Rosalind Franklin University of Medicine and Science; North Chicago Illinois
| | - Nilay D. Shah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Mayo Clinic; Rochester Minnesota
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - Cynthia S. Crowson
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | | | - Elizabeth B. Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Mayo Clinic; Rochester Minnesota
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
- Division of Surgery, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
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18
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Zon RT, Frame JN, Neuss MN, Page RD, Wollins DS, Stranne S, Bosserman LD. American Society of Clinical Oncology Policy Statement on Clinical Pathways in Oncology. J Oncol Pract 2016; 12:261-6. [DOI: 10.1200/jop.2015.009134] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The use of clinical pathways in oncology care is increasingly important to patients and oncology providers as a tool for enhancing both quality and value. However, with increasing adoption of pathways into oncology practice, concerns have been raised by ASCO members and other stakeholders. These include the process being used for pathway development, the administrative burdens on oncology practices of reporting on pathway adherence, and understanding the true impact of pathway use on patient health outcomes. To address these concerns, ASCO’s Board of Directors established a Task Force on Clinical Pathways, charged with articulating a set of recommendations to improve the development of oncology pathways and processes, allowing the demonstration of pathway concordance in a manner that promotes evidence-based, high-value care respecting input from patients, payers, and providers. These recommendations have been approved and adopted by ASCO’s Board of Directors on August 12, 2015, and are presented herein.
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Affiliation(s)
- Robin T. Zon
- Michiana Hematology-Oncology PC, South Bend, IN Charleston Area Medical Center, Charleston, WV; Vanderbilt-Ingram Cancer Center, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; American Society of Clinical Oncology, Alexandria, VA; Polsinelli Shughart, Washington, DC; and City of Hope, Rancho Cucamonga, CA
| | - James N. Frame
- Michiana Hematology-Oncology PC, South Bend, IN Charleston Area Medical Center, Charleston, WV; Vanderbilt-Ingram Cancer Center, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; American Society of Clinical Oncology, Alexandria, VA; Polsinelli Shughart, Washington, DC; and City of Hope, Rancho Cucamonga, CA
| | - Michael N. Neuss
- Michiana Hematology-Oncology PC, South Bend, IN Charleston Area Medical Center, Charleston, WV; Vanderbilt-Ingram Cancer Center, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; American Society of Clinical Oncology, Alexandria, VA; Polsinelli Shughart, Washington, DC; and City of Hope, Rancho Cucamonga, CA
| | - Ray D. Page
- Michiana Hematology-Oncology PC, South Bend, IN Charleston Area Medical Center, Charleston, WV; Vanderbilt-Ingram Cancer Center, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; American Society of Clinical Oncology, Alexandria, VA; Polsinelli Shughart, Washington, DC; and City of Hope, Rancho Cucamonga, CA
| | - Dana S. Wollins
- Michiana Hematology-Oncology PC, South Bend, IN Charleston Area Medical Center, Charleston, WV; Vanderbilt-Ingram Cancer Center, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; American Society of Clinical Oncology, Alexandria, VA; Polsinelli Shughart, Washington, DC; and City of Hope, Rancho Cucamonga, CA
| | - Steven Stranne
- Michiana Hematology-Oncology PC, South Bend, IN Charleston Area Medical Center, Charleston, WV; Vanderbilt-Ingram Cancer Center, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; American Society of Clinical Oncology, Alexandria, VA; Polsinelli Shughart, Washington, DC; and City of Hope, Rancho Cucamonga, CA
| | - Linda D. Bosserman
- Michiana Hematology-Oncology PC, South Bend, IN Charleston Area Medical Center, Charleston, WV; Vanderbilt-Ingram Cancer Center, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; American Society of Clinical Oncology, Alexandria, VA; Polsinelli Shughart, Washington, DC; and City of Hope, Rancho Cucamonga, CA
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19
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Go RS, Bottner WA, Gertz MA. Making the Case to Study the Volume-Outcome Relationship in Hematologic Cancers. Mayo Clin Proc 2015; 90:1393-9. [PMID: 26298310 DOI: 10.1016/j.mayocp.2015.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/25/2015] [Accepted: 07/02/2015] [Indexed: 11/17/2022]
Abstract
The positive relationship between the volume of health services (hospital and physician) and health-related outcomes is established in the complex surgical treatment of cancers and certain nononcologic medical conditions. However, this topic has not been systematically explored in the medical management of cancers. We summarize the limited current state of knowledge about the volume-outcome relationship in the management of hematologic cancers and provide reasons why further research on this subject is necessary. We highlight the relatively low annual volume of hematologic cancers in the United States, the increasing complexity of making a diagnosis due to constant change in classification and prognostication, the rapid availability of novel agents with unique mechanisms of action and toxicities, and the proliferation of treatment guidelines distinct to each disease subtype. We also discuss the potential implications pertaining to medical practice and trainee education, including effects on quality of care, access and referral patterns, and subspecialty training.
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Affiliation(s)
- Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN.
| | - Wayne A Bottner
- Section of Hematology, Gundersen Health System, La Crosse, WI
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20
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Robinson JC, Howell S. Specialty Pharmaceuticals: Policy Initiatives To Improve Assessment, Pricing, Prescription, And Use. Health Aff (Millwood) 2014; 33:1745-50. [DOI: 10.1377/hlthaff.2014.0498] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- James C. Robinson
- James C. Robinson ( ) is Leonard D. Schaeffer Professor of Health Economics, Division of Health Policy and Management, at the University of California, Berkeley
| | - Scott Howell
- Scott Howell is senior vice president, clinical services, at Cardinal Health Specialty Solutions, in Dublin, Ohio
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21
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Ye Z, Palazzo JP, Lin L, Lai Y, Guiles F, Myers RE, Han J, Xing J, Yang H. Postoperative hyperphosphatemia significantly associates with adverse survival in colorectal cancer patients. J Gastroenterol Hepatol 2013; 28:1469-75. [PMID: 23611210 PMCID: PMC3775915 DOI: 10.1111/jgh.12237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Hyperphosphatemia has been implicated in the development and treatment of various cancers. However, whether it can be used as a direct prognostic marker of colorectal cancer (CRC) has remained unexplored. Given new insights into the importance of hyperphosphatemia in CRC, we sought to evaluate the association of hyperphosphatemia with the clinical outcomes of this disease. METHODS In a retrospective analysis of a well-characterized clinic-based cohort with 1241 CRC patients, we assessed the association of postoperative hyperphosphatemia with patient overall survival. RESULTS Postoperative hyperphosphatemia measured within the first month after surgery was significantly associated with CRC survival. Compared to patients with a normal phosphate level, those with hyperphosphatemia exhibited a significant unfavorable overall survival with a hazard ratio (HR) of 1.84 (95% confidence interval [CI] 1.49-2.29, P = 2.6 × 10(-8) (log-rank P = 1.2 × 10(-7) ). Stratified analyses indicated the association was more pronounced in patients with colon (HR = 2.00, 95% CI 1.57-2.56, P = 3.17 × 10(-8) ) but not rectal cancer (HR = 0.96, 95% CI 0.58-1.59, P = 0.889) (P interaction = 0.023), as well as in those not receiving chemotherapy (HR = 2.15, 95% CI 1.59-2.90, P = 6.2 × 10(-7) ) but not in those receiving chemotherapy (HR = 1.30, 95% CI 0.92-1.82, P = 0.136) (P interaction = 0.012). Flexible parametric survival model demonstrated that the increased risk for death conferred by postoperative hyperphosphatemia persisted over 150 months after surgery. CONCLUSION Our data indicated that postoperative hyperphosphatemia might be used as a prognostic marker of CRC patients after surgery. Since phosphate level is routinely tested in clinics, it may be incorporated into clinical models to predict CRC survival.
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Affiliation(s)
- Zhong Ye
- Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Juan P. Palazzo
- Department of Pathology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Liz Lin
- Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Yinzhi Lai
- Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Fran Guiles
- Oncology Data Service, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ronald E. Myers
- Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jin Han
- Department of Pharmacy, Rush University Medical Center, Chicago, IL 60612
| | - Jinliang Xing
- Experimental Teaching Center, Fourth Military Medical University, Xi’an, 710032, China
| | - Hushan Yang
- Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA,Correspondence to: Hushan Yang, PhD, Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA. Tel: 215-503-6521; Fax: 267-336-0247;
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22
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Cruz-Hernández JJ, Rodríguez CA. SEOM guidelines 2013: a response to the needs of Spanish oncologists. Clin Transl Oncol 2013; 15:975-6. [PMID: 23925725 DOI: 10.1007/s12094-013-1097-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 07/28/2013] [Indexed: 11/29/2022]
Affiliation(s)
- J J Cruz-Hernández
- Spanish Society of Medical Oncology, Servicio de Oncología Médica, Hospital Clínico Universitario, Po San Vicente, 58-182, 37007, Salamanca, Spain
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Brufsky A, Lokay K. How to Develop and Deliver Pathway-Based Care. Hematol Oncol Clin North Am 2013; 27:843-50, x. [DOI: 10.1016/j.hoc.2013.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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