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Fischer HH, Eisert SL, Durfee MJ, Moore SL, Steele AW, McCullen K, Anderson K, Penny L, Mackenzie TD. The impact of tailored diabetes registry report cards on measures of disease control: a nested randomized trial. BMC Med Inform Decis Mak 2011; 11:12. [PMID: 21329495 PMCID: PMC3050679 DOI: 10.1186/1472-6947-11-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 02/17/2011] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Most studies of diabetes self-management that show improved clinical outcome performance involve multiple, time-intensive educational sessions in a group format. Most provider performance feedback interventions do not improve intermediate outcomes, yet lack targeted, patient-level feedback. METHODS 5,457 low-income adults with diabetes at eight federally-qualified community health centers participated in this nested randomized trial. Half of the patients received report card mailings quarterly; patients at 4 of 8 clinics received report cards at every clinic visit; and providers at 4 of 8 clinics received quarterly performance feedback with targeted patient-level data. Expert-recommended glycemic, lipid, and blood pressure outcomes were assessed. Assessment of report card utility and patient and provider satisfaction was conducted through mailed patient surveys and mid- and post-intervention provider interviews. RESULTS Many providers and the majority of patients perceived the patient report card as being an effective tool. However, patient report card mailings did not improve process outcomes, nor did point-of-care distribution improve intermediate outcomes. Clinics with patient-level provider performance feedback achieved a greater absolute increase in the percentage of patients at target for glycemic control compared to control clinics (6.4% vs 3.8% respectively, Generalized estimating equations Standard Error 0.014, p < 0.001, CI -0.131 - -0.077). Provider reaction to performance feedback was mixed, with some citing frustration with the lack of both time and ancillary resources. CONCLUSIONS Patient performance report cards were generally well received by patients and providers, but were not associated with improved outcomes. Targeted, patient-level feedback to providers improved glycemic performance. Provider frustration highlights the need to supplement provider outreach efforts. TRIAL REGISTRATION ClinicalTrials.gov: NCT00827710.
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Affiliation(s)
- Henry H Fischer
- Community Health Services, Denver Health and Hospital Authority, 777 Bannock St., Denver, 80204, USA
- University of Colorado Denver School of Medicine, University of Colorado Denver, 13001 E. 17thPlace, Aurora, 80045, USA
| | - Sheri L Eisert
- Community Health Services, Denver Health and Hospital Authority, 777 Bannock St., Denver, 80204, USA
- Colorado School of Public Health, University of Colorado Denver, 13001 E. 17thPlace, Aurora, 80045, USA
| | - M Josh Durfee
- Health Services Research, Denver Health and Hospital Authority, 777 Bannock St., Denver, 80204, USA
| | - Susan L Moore
- Health Services Research, Denver Health and Hospital Authority, 777 Bannock St., Denver, 80204, USA
| | - Andrew W Steele
- Community Health Services, Denver Health and Hospital Authority, 777 Bannock St., Denver, 80204, USA
- University of Colorado Denver School of Medicine, University of Colorado Denver, 13001 E. 17thPlace, Aurora, 80045, USA
| | - Kevin McCullen
- Quality Improvement, Denver Health and Hospital Authority, 777 Bannock St. Denver, 80204, USA
| | - Katherine Anderson
- Community Health Services, Denver Health and Hospital Authority, 777 Bannock St., Denver, 80204, USA
- University of Colorado Denver School of Medicine, University of Colorado Denver, 13001 E. 17thPlace, Aurora, 80045, USA
| | - Lara Penny
- Community Health Services, Denver Health and Hospital Authority, 777 Bannock St., Denver, 80204, USA
- University of Colorado Denver School of Medicine, University of Colorado Denver, 13001 E. 17thPlace, Aurora, 80045, USA
| | - Thomas D Mackenzie
- Community Health Services, Denver Health and Hospital Authority, 777 Bannock St., Denver, 80204, USA
- University of Colorado Denver School of Medicine, University of Colorado Denver, 13001 E. 17thPlace, Aurora, 80045, USA
- Quality Improvement, Denver Health and Hospital Authority, 777 Bannock St. Denver, 80204, USA
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Huober J, Gluz O, Hartmann A, Kates R, Kreipe HH, Pelz E, Thomssen C, Fischer HH, Moebus V, Augustin D, Weiss E, Erber R, Liedtke C, Kuhn W, Nitz U, Harbeck N. Abstract P2-09-14: Evidence for Predictive and Prognostic Impact of Molecular Classification in Taxane-Based Chemotherapy in Intermediate Risk Breast Cancer — An Analysis of the WSG EC-Doc Trial. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p2-09-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients with hormone receptor positive breast cancer (BC) and 1-3 positive lymph nodes (LN) belong to the intermediate risk-group. Among these patients chemoendocrine therapy may be considered. The prognostic role of molecular breast cancer subgroups and their predictive impact regarding taxane-and anthracycline based chemotherapy is unclear. This analysis evaluated the ability of molecular subtypes to predict outcome after standard FEC or EC-Doc chemotherapy in pts with 1-3 positive LN.
Methods: The EC-Doc trial randomized 2012 patients with 1-3 positive LN to 6x FEC/CMF vs. 4x EC followed by 4 x docetaxel (Doc). Significantly better DFS and OS in favor of EC-Doc was reported previously (Nitz et al., SABCS 2008). Protein expression data and central histology/grade (G) were available for 772 patients (Control n=390; EC-Doc n=382). Protein expression was measured on tissue micro arrays for ER, PR, Her2 (both IHC/FISH), Ki-67, Ck 5/6, and EGFR. Molecular subgroups were classified using ki-67 cutt-off of 13.25 % (Cheang et al. JNCI 2009). Results: There was no difference in baseline characteristics (age, LN, grade, tumor size, HR) between the entire ITT-study population and the investigated cohort of 772 pts. There were significantly more G 3 tumors in the basal and Her2 group and more G 1/2 tumors in the luminal A cohort. Distribution of molecular subtypes is as follows:
- Luminal A: HR+ (ER and/or PR+), low KI-67 and Her2-: 26.1%
- Luminal B: HR+ and either Ki-67 high or Her2+: 44.8%
- Her2: HR-and Her2+: 10.9%
- Triple negative (TN) basal-like ER/PR/Her2- ; Ck 5/6+ and/or EGFR+: 11.8%
- TN non-basal-like: TNBC; both Ck 5/6 and EGFR-: 6.4%
After median follow up of 64 months, both DFS (5y 90% vs. 80%, p=0.006) and OS (5y 95% vs. 92%, p=0.022) rates also significantly favored EC-Doc vs. FEC in this cohort. DFS rates were highest in luminal A and lowest in TN basal-like tumors.
In univariate analysis a significant benefit of EC-DOC vs. FEC for DFS is seen in luminal B patients (p=0.004; HR=0.41; (0.22-0.77)). EC-Doc was also better than FEC in HR-patients who were not “basal-like (p=.057; HR=0.385 (0.14 — 1.07).
In multivariate analysis including age, nodal status, tumor size, molecular subtypes, and chemotherapy regimen age, luminal A subtype, and interaction of EC-Doc and luminal B subtype (HR=0.44) influenced significantly DFS survival. Conclusions: These data provide evidence that molecular subtypes are associated with both different levels of benefit from EC-Doc and different DFS within each treatment group. These retrospective results will be validated within the prospective WSG PlanB trial.
Table/Figure 1: multivariate model for DFS
Tabid Parameters bssdciated with benefitfrctm EC-Dgccompared to CEF in a multivariate tnofiel tor DFS
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-09-14.
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Affiliation(s)
- J Huober
- On behalf of WSG/AGO Study Group. Kantonspital St. Gallen, St. Gallen, Switzerland; West German Study Group, Moenchengladbach, Germany; University of Erlangen/Dept. Pathology, Germany; University of Hannover, Germany; Institute of Pathology, Viersen, Germany; University of Halle/Saale, Halle, Germany; Ev. Hospital, Gelsenkirchen, Germany; Hospital Frankfurt-Hoechst, Frankfurt/Main, Germany; Hospital Deggendorf/Breast Center, Deggendorf, Germany; Hospital Boeblingen/Breast Center, Boeblingen, Germany; University Hospital Muenster, Germany; University Hospital Bonn, Germany; Breast Center Niederrrhein, Bethesda Hospital, Moenchengladbach, Germany; University Hospital Cologne, Dept. OB&GYN
| | - O Gluz
- On behalf of WSG/AGO Study Group. Kantonspital St. Gallen, St. Gallen, Switzerland; West German Study Group, Moenchengladbach, Germany; University of Erlangen/Dept. Pathology, Germany; University of Hannover, Germany; Institute of Pathology, Viersen, Germany; University of Halle/Saale, Halle, Germany; Ev. Hospital, Gelsenkirchen, Germany; Hospital Frankfurt-Hoechst, Frankfurt/Main, Germany; Hospital Deggendorf/Breast Center, Deggendorf, Germany; Hospital Boeblingen/Breast Center, Boeblingen, Germany; University Hospital Muenster, Germany; University Hospital Bonn, Germany; Breast Center Niederrrhein, Bethesda Hospital, Moenchengladbach, Germany; University Hospital Cologne, Dept. OB&GYN
| | - A Hartmann
- On behalf of WSG/AGO Study Group. Kantonspital St. Gallen, St. Gallen, Switzerland; West German Study Group, Moenchengladbach, Germany; University of Erlangen/Dept. Pathology, Germany; University of Hannover, Germany; Institute of Pathology, Viersen, Germany; University of Halle/Saale, Halle, Germany; Ev. Hospital, Gelsenkirchen, Germany; Hospital Frankfurt-Hoechst, Frankfurt/Main, Germany; Hospital Deggendorf/Breast Center, Deggendorf, Germany; Hospital Boeblingen/Breast Center, Boeblingen, Germany; University Hospital Muenster, Germany; University Hospital Bonn, Germany; Breast Center Niederrrhein, Bethesda Hospital, Moenchengladbach, Germany; University Hospital Cologne, Dept. OB&GYN
| | - R Kates
- On behalf of WSG/AGO Study Group. Kantonspital St. Gallen, St. Gallen, Switzerland; West German Study Group, Moenchengladbach, Germany; University of Erlangen/Dept. Pathology, Germany; University of Hannover, Germany; Institute of Pathology, Viersen, Germany; University of Halle/Saale, Halle, Germany; Ev. Hospital, Gelsenkirchen, Germany; Hospital Frankfurt-Hoechst, Frankfurt/Main, Germany; Hospital Deggendorf/Breast Center, Deggendorf, Germany; Hospital Boeblingen/Breast Center, Boeblingen, Germany; University Hospital Muenster, Germany; University Hospital Bonn, Germany; Breast Center Niederrrhein, Bethesda Hospital, Moenchengladbach, Germany; University Hospital Cologne, Dept. OB&GYN
| | - HH Kreipe
- On behalf of WSG/AGO Study Group. Kantonspital St. Gallen, St. Gallen, Switzerland; West German Study Group, Moenchengladbach, Germany; University of Erlangen/Dept. Pathology, Germany; University of Hannover, Germany; Institute of Pathology, Viersen, Germany; University of Halle/Saale, Halle, Germany; Ev. Hospital, Gelsenkirchen, Germany; Hospital Frankfurt-Hoechst, Frankfurt/Main, Germany; Hospital Deggendorf/Breast Center, Deggendorf, Germany; Hospital Boeblingen/Breast Center, Boeblingen, Germany; University Hospital Muenster, Germany; University Hospital Bonn, Germany; Breast Center Niederrrhein, Bethesda Hospital, Moenchengladbach, Germany; University Hospital Cologne, Dept. OB&GYN
| | - E Pelz
- On behalf of WSG/AGO Study Group. Kantonspital St. Gallen, St. Gallen, Switzerland; West German Study Group, Moenchengladbach, Germany; University of Erlangen/Dept. Pathology, Germany; University of Hannover, Germany; Institute of Pathology, Viersen, Germany; University of Halle/Saale, Halle, Germany; Ev. Hospital, Gelsenkirchen, Germany; Hospital Frankfurt-Hoechst, Frankfurt/Main, Germany; Hospital Deggendorf/Breast Center, Deggendorf, Germany; Hospital Boeblingen/Breast Center, Boeblingen, Germany; University Hospital Muenster, Germany; University Hospital Bonn, Germany; Breast Center Niederrrhein, Bethesda Hospital, Moenchengladbach, Germany; University Hospital Cologne, Dept. OB&GYN
| | - C Thomssen
- On behalf of WSG/AGO Study Group. Kantonspital St. Gallen, St. Gallen, Switzerland; West German Study Group, Moenchengladbach, Germany; University of Erlangen/Dept. Pathology, Germany; University of Hannover, Germany; Institute of Pathology, Viersen, Germany; University of Halle/Saale, Halle, Germany; Ev. Hospital, Gelsenkirchen, Germany; Hospital Frankfurt-Hoechst, Frankfurt/Main, Germany; Hospital Deggendorf/Breast Center, Deggendorf, Germany; Hospital Boeblingen/Breast Center, Boeblingen, Germany; University Hospital Muenster, Germany; University Hospital Bonn, Germany; Breast Center Niederrrhein, Bethesda Hospital, Moenchengladbach, Germany; University Hospital Cologne, Dept. OB&GYN
| | - HH Fischer
- On behalf of WSG/AGO Study Group. Kantonspital St. Gallen, St. Gallen, Switzerland; West German Study Group, Moenchengladbach, Germany; University of Erlangen/Dept. Pathology, Germany; University of Hannover, Germany; Institute of Pathology, Viersen, Germany; University of Halle/Saale, Halle, Germany; Ev. Hospital, Gelsenkirchen, Germany; Hospital Frankfurt-Hoechst, Frankfurt/Main, Germany; Hospital Deggendorf/Breast Center, Deggendorf, Germany; Hospital Boeblingen/Breast Center, Boeblingen, Germany; University Hospital Muenster, Germany; University Hospital Bonn, Germany; Breast Center Niederrrhein, Bethesda Hospital, Moenchengladbach, Germany; University Hospital Cologne, Dept. OB&GYN
| | - V Moebus
- On behalf of WSG/AGO Study Group. Kantonspital St. Gallen, St. Gallen, Switzerland; West German Study Group, Moenchengladbach, Germany; University of Erlangen/Dept. Pathology, Germany; University of Hannover, Germany; Institute of Pathology, Viersen, Germany; University of Halle/Saale, Halle, Germany; Ev. Hospital, Gelsenkirchen, Germany; Hospital Frankfurt-Hoechst, Frankfurt/Main, Germany; Hospital Deggendorf/Breast Center, Deggendorf, Germany; Hospital Boeblingen/Breast Center, Boeblingen, Germany; University Hospital Muenster, Germany; University Hospital Bonn, Germany; Breast Center Niederrrhein, Bethesda Hospital, Moenchengladbach, Germany; University Hospital Cologne, Dept. OB&GYN
| | - D Augustin
- On behalf of WSG/AGO Study Group. Kantonspital St. Gallen, St. Gallen, Switzerland; West German Study Group, Moenchengladbach, Germany; University of Erlangen/Dept. Pathology, Germany; University of Hannover, Germany; Institute of Pathology, Viersen, Germany; University of Halle/Saale, Halle, Germany; Ev. Hospital, Gelsenkirchen, Germany; Hospital Frankfurt-Hoechst, Frankfurt/Main, Germany; Hospital Deggendorf/Breast Center, Deggendorf, Germany; Hospital Boeblingen/Breast Center, Boeblingen, Germany; University Hospital Muenster, Germany; University Hospital Bonn, Germany; Breast Center Niederrrhein, Bethesda Hospital, Moenchengladbach, Germany; University Hospital Cologne, Dept. OB&GYN
| | - E Weiss
- On behalf of WSG/AGO Study Group. Kantonspital St. Gallen, St. Gallen, Switzerland; West German Study Group, Moenchengladbach, Germany; University of Erlangen/Dept. Pathology, Germany; University of Hannover, Germany; Institute of Pathology, Viersen, Germany; University of Halle/Saale, Halle, Germany; Ev. Hospital, Gelsenkirchen, Germany; Hospital Frankfurt-Hoechst, Frankfurt/Main, Germany; Hospital Deggendorf/Breast Center, Deggendorf, Germany; Hospital Boeblingen/Breast Center, Boeblingen, Germany; University Hospital Muenster, Germany; University Hospital Bonn, Germany; Breast Center Niederrrhein, Bethesda Hospital, Moenchengladbach, Germany; University Hospital Cologne, Dept. OB&GYN
| | - R Erber
- On behalf of WSG/AGO Study Group. Kantonspital St. Gallen, St. Gallen, Switzerland; West German Study Group, Moenchengladbach, Germany; University of Erlangen/Dept. Pathology, Germany; University of Hannover, Germany; Institute of Pathology, Viersen, Germany; University of Halle/Saale, Halle, Germany; Ev. Hospital, Gelsenkirchen, Germany; Hospital Frankfurt-Hoechst, Frankfurt/Main, Germany; Hospital Deggendorf/Breast Center, Deggendorf, Germany; Hospital Boeblingen/Breast Center, Boeblingen, Germany; University Hospital Muenster, Germany; University Hospital Bonn, Germany; Breast Center Niederrrhein, Bethesda Hospital, Moenchengladbach, Germany; University Hospital Cologne, Dept. OB&GYN
| | - C Liedtke
- On behalf of WSG/AGO Study Group. Kantonspital St. Gallen, St. Gallen, Switzerland; West German Study Group, Moenchengladbach, Germany; University of Erlangen/Dept. Pathology, Germany; University of Hannover, Germany; Institute of Pathology, Viersen, Germany; University of Halle/Saale, Halle, Germany; Ev. Hospital, Gelsenkirchen, Germany; Hospital Frankfurt-Hoechst, Frankfurt/Main, Germany; Hospital Deggendorf/Breast Center, Deggendorf, Germany; Hospital Boeblingen/Breast Center, Boeblingen, Germany; University Hospital Muenster, Germany; University Hospital Bonn, Germany; Breast Center Niederrrhein, Bethesda Hospital, Moenchengladbach, Germany; University Hospital Cologne, Dept. OB&GYN
| | - W Kuhn
- On behalf of WSG/AGO Study Group. Kantonspital St. Gallen, St. Gallen, Switzerland; West German Study Group, Moenchengladbach, Germany; University of Erlangen/Dept. Pathology, Germany; University of Hannover, Germany; Institute of Pathology, Viersen, Germany; University of Halle/Saale, Halle, Germany; Ev. Hospital, Gelsenkirchen, Germany; Hospital Frankfurt-Hoechst, Frankfurt/Main, Germany; Hospital Deggendorf/Breast Center, Deggendorf, Germany; Hospital Boeblingen/Breast Center, Boeblingen, Germany; University Hospital Muenster, Germany; University Hospital Bonn, Germany; Breast Center Niederrrhein, Bethesda Hospital, Moenchengladbach, Germany; University Hospital Cologne, Dept. OB&GYN
| | - U Nitz
- On behalf of WSG/AGO Study Group. Kantonspital St. Gallen, St. Gallen, Switzerland; West German Study Group, Moenchengladbach, Germany; University of Erlangen/Dept. Pathology, Germany; University of Hannover, Germany; Institute of Pathology, Viersen, Germany; University of Halle/Saale, Halle, Germany; Ev. Hospital, Gelsenkirchen, Germany; Hospital Frankfurt-Hoechst, Frankfurt/Main, Germany; Hospital Deggendorf/Breast Center, Deggendorf, Germany; Hospital Boeblingen/Breast Center, Boeblingen, Germany; University Hospital Muenster, Germany; University Hospital Bonn, Germany; Breast Center Niederrrhein, Bethesda Hospital, Moenchengladbach, Germany; University Hospital Cologne, Dept. OB&GYN
| | - N, Harbeck
- On behalf of WSG/AGO Study Group. Kantonspital St. Gallen, St. Gallen, Switzerland; West German Study Group, Moenchengladbach, Germany; University of Erlangen/Dept. Pathology, Germany; University of Hannover, Germany; Institute of Pathology, Viersen, Germany; University of Halle/Saale, Halle, Germany; Ev. Hospital, Gelsenkirchen, Germany; Hospital Frankfurt-Hoechst, Frankfurt/Main, Germany; Hospital Deggendorf/Breast Center, Deggendorf, Germany; Hospital Boeblingen/Breast Center, Boeblingen, Germany; University Hospital Muenster, Germany; University Hospital Bonn, Germany; Breast Center Niederrrhein, Bethesda Hospital, Moenchengladbach, Germany; University Hospital Cologne, Dept. OB&GYN
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