Staging documentation accuracy and adherence to workup and treatment guidelines: The M. D. Anderson Regional Care Center experience.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 244-244
Author(s):  
Amitabha Sarma ◽  
Sunil M. Patel ◽  
Laurie Sturdevant ◽  
Mee-chung Puscilla Ip ◽  
Carol L. Hundley ◽  
...  
Keyword(s):  
Guideline Adherence ◽  
Treatment Guidelines ◽  
Medical Oncology ◽  
Care Center ◽  
Diagnostic Workup ◽  
Adherence Rate ◽  
Monthly Basis ◽  
Medical Oncologists ◽  
Creative Interventions ◽  
Over Time

244 Background: MD Anderson Cancer (MDACC) disease-specific faculty experts have developed institutional guidelines for diagnostic workup and treatment of common tumor types. The institution has four Regional Care Centers in suburban Houston staffed by a total of 10general medical oncologists. The primary intent of this project was to measure the accuracy of staging documentation and adherence to guidelines. The secondary intent was to improve documentation and guideline adherence by regularly reporting results directly to the involved physicians. Methods: Between July 2009 and April 2012, charts for all new medical oncology visits for patients with breast, non-small cell lung, or colon cancer for whom no previous medical oncology plan had been implemented were reviewed by a team of quality nurses on a weekly basis. Source documents were analyzed for (a) adherence to MDACC diagnostic workup guidelines (n=782); (b) accuracy of both TNM and AJCC staging documentation (n=782); and (c) adherence to MDACC treatment guidelines (n=731). On a monthly basis, a graph with rates over time of guideline adherence and accuracy of staging documentation was provided to each general oncologist. Results: The adherence rate to MDACC diagnostic workup guidelines was 79%. The agreement rate for accurate documentation of both TNM and AJCC stage was 72%. The adherence rate to MDACC treatment guidelines was 94%. Providing monthly reports of individual results to each physician did not lead to an increase in the rates of adherence of accurate staging documentation. Analysis comparing all Regional Care Center medical oncologists (not provided to the involved physicians) showed significant variation in rates for all three categories. Conclusions: Providing MDACC Regional Care Center general medical oncologists with simple graphs over time reflecting guideline adherence and accuracy of documentation did not lead to any improvement on those measures. More creative interventions to improve performance in these realms will need to be explored.

Evaluation of Activation of a NCI National Clinical Trials Network (NCTN) Study S1826 for Hodgkin Lymphoma (HL) at Children's Oncology Group (COG) Institutions

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 20-20
Author(s):  
Sharon M. Castellino ◽  
Angela Punnett ◽  
Susan K Parsons ◽  
Nicholas P. DeGroote ◽  
Sally Muehle ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Research Funding ◽  
Design Research ◽  
Medical Oncology ◽  
Adolescent And Young Adult ◽  
Novel Agents ◽  
Successful Implementation ◽  
Institutional Infrastructure ◽  
Medical Oncologists ◽  
Tumor Boards

Background: HL is an adolescent and young adult (AYA) cancer that lacks uniform approaches across medical and pediatric oncology. Differences include risk classification, chemotherapy backbone and use of radiation therapy. Heterogeneity in institutional programs and resources for AYAs adds to the gap in understanding why outcomes for AYA HL differ. In order to expedite equitable access to novel agents for AYA patients by medical and pediatric oncology providers, a NCTN facilitated trial for advanced stage HL was launched. The SWOG-led S1826 trial (NCT03907488), open to patients > 12 years of age, was activated in July 2019. We assessed barriers and facilitators to trial activation at COG institutions for this first in-kind approach. Methods: A web-based survey was distributed through the COG communications office to institutional principal investigators (PIs) of 216 institutions in North America. To achieve optimal response rates, the survey was distributed in four waves over a 6-week period. Branching logic differentiated questions for institutions that had opened or planned to open the trial vs. those who did not. Topics included institutional characteristics, joint partnership with medical oncologists to activate AYA trials, and specific barriers for opening this trial. Descriptive statistics were calculated using SAS v.7.1. Results: The response rate was 73% with 158 unique responses among 216 COG institutions queried. Among responding institutions 24% were freestanding children's hospitals; 18% were NCI-designated cancer centers. 55% of respondents indicated a known affiliation with another NCTN cooperative group other than COG. 31% indicated prior experience in participating in a non-COG led NCTN trial for other diseases. 42% of institutions reported a central trials infrastructure for joint pediatric and medical oncology trials. 44% indicated use of the central IRB mechanism, and 4% used a provincial IRB. While 40% had an established AYA oncology program, 30% reported regular lymphoma tumor boards with medical oncology; 8% indicated the ability to see AYA lymphoma patients in a joint pediatric and medical oncology clinic. The trial is open at 79/158 (50%) COG institutions to date and an additional 56 indicated future intent to open the trial. Among 135 COG institutions with open or intent-to-open status, 73% of institutional principal investigator (PI) were pediatric oncologists, 24% were medical oncologists and 4% were joint PIs. PI determination was based on: enrolling as a COG-only site (57%); institutional policy (5%); a discussion among investigators (23%); or other factors (14%). These were categorized as: more resources or anticipated patients in medical oncology (n=4); the trial being opened in medical oncology before pediatrics (n=11); being open in pediatrics before medical oncology (n=2); no interface for joint studies (n=1). Among the 14% of respondents who indicated the trial would not be opened, a competing trial was the reason in 35%. Other reasons included: lack of awareness of the trial, concerns about study design or chemotherapy backbone, lack of easily accessible protocol documents, anticipated lack of accrual, concerns around funding support, challenges with regulatory support, data management, or institutional process for medical and pediatric joint trials. Respondents' recommendations for facilitating activation of AYA intergroup studies include needs for: increased resources and funding; guidance on communication and navigation with medical oncologists for managing joint trials; institutional infrastructure for AYA trials; clearer rationale for a change in the chemotherapy backbone relative to prior COG studies; accessibility and consistency of protocol study naming conventions and protocol documents (i.e. therapy roadmap) on the COG electronic site. Conclusions: Successful implementation of AYA trials is germane to early access to novel agents for younger adolescents. Overall, COG institutions indicate a high level of endorsement for a NCTN AYA trial for HL with 85% indicating activation completed or planned. This survey suggests that AYA trials can be implemented successfully in a network but require education, early communication between pediatric and medical oncologists, and flexible infrastructure for all group participants. (Funding: U10CA180886, U10CA180888, and UG1CA233230) Disclosures Parsons: Seattle Genetics: Consultancy. Herrera:Bristol Myers Squibb: Consultancy, Other: Travel, Accomodations, Expenses, Research Funding; Merck: Consultancy, Research Funding; Genentech, Inc./F. Hoffmann-La Roche Ltd: Consultancy, Research Funding; Gilead Sciences: Consultancy, Research Funding; Seattle Genetics: Consultancy, Research Funding; Immune Design: Research Funding; AstraZeneca: Research Funding; Karyopharm: Consultancy; Pharmacyclics: Research Funding. Friedberg:Acerta Pharma - A member of the AstraZeneca Group, Bayer HealthCare Pharmaceuticals.: Other; Astellas: Consultancy; Kite Pharmaceuticals: Research Funding; Bayer: Consultancy; Seattle Genetics: Research Funding; Roche: Other: Travel expenses; Portola Pharmaceuticals: Consultancy.

Longitudinal assessment of disability amongst patients of bipolar and unipolar depressive disorders presenting to a tertiary care center in North India

2022 ◽  
pp. 002076402110701
Author(s):  
Rajesh Sagar ◽  
Mahadev Singh Sen ◽  
Nand Kumar ◽  
Nishtha Chawla
Keyword(s):  
Depressive Disorders ◽  
Rating Scale ◽  
Bipolar Depression ◽  
Disability Evaluation ◽  
Care Center ◽  
Tertiary Care ◽  
Severity Of Illness ◽  
North India ◽  
Longitudinal Assessment ◽  
Over Time

Objectives: To assess and compare the changes in disability scores associated with Bipolar Depression (BD) and Unipolar Depression (UD) over 1 year. Methods: A longitudinal study was taken up in adults diagnosed with unipolar or bipolar depressive disorder with current depressive episode. Diagnosis was made according to Schedule for Clinical Assessment in Neuropsychiatry. Severity scoring was done using Hamilton’s Depression (HAM-D) rating scale and Hamilton’s Anxiety (HAM-A) rating scale. Disability was assessed using Indian Disability Evaluation and Assessment Scale (IDEAS) and London handicap Scale (LHS) at baseline, 6 and 12 months. Results: Sixty participants were recruited (42 UD and 18 BD). No significant differences were seen in socio-demographic parameters, except higher education levels and males being overrepresented in UD. Significant differences at baseline were seen in HAM-D ( p = .001) and HAM-A ( p = .003) scores. The extent of disability was seen to correlate with severity of illness only in case of BD at baseline. No significant differences were seen in the IDEAS scores at baseline. IDEAS score improved at each follow-up assessment ( p < .001). LHS showed significant improvement over time in UD ( p < .001), but not BD ( p = .076). Percentage individuals meeting cut-off for benchmark disability (>40%) were comparable at baseline but were significantly more in the BD at 12-months ( p = .049). Conclusion and implications: Disability in psychiatry occurs equally amongst unipolar and bipolar depressive disorders and tends to improve over time, although the level of improvement may differ. It may not always correspond to severity of illness. These factors should be considered while certifying disability.

Diagnosis and First-Line Treatment of Breast Cancer in Italian General Hospitals

1986 ◽  
Vol 72 (3) ◽  
pp. 273-283 ◽  
Author(s):  
◽  
A. Liberati ◽  
R. Fossati ◽  
F. Parazzini ◽  
S. Marsoni ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Guidelines ◽  
Task Force ◽  
Therapeutic Process ◽  
Diagnostic Delay ◽  
Radical Mastectomy ◽  
Breast Cancer Patients ◽  
Monthly Basis ◽  
General Hospitals

The quality of the diagnostic and therapeutic process of 1262 newly diagnosed breast cancer patients was evaluated in 63 Italian general hospitals over the period March 1983 - April 1984. Most of the patients (91 %) discovered their own lesion, which was a nodule in 83 % of the cases. Practice of breast self examination was reported by 418 (33 %) patients, only 28 % of whom did that on a regular monthly basis. A diagnostic delay > 3 months was present in 36 % of the patients. Among the preoperative work-up examinations, skeletal X-ray or bone scan was not performed in 20 % of patients, whereas other essential examinations were done in most. The Patey type of radical mastectomy was the most frequent surgical procedure; quadrantectomy was performed in only 26 % of eligible patients, more frequently in younger (34 %) than in older patients (21 %). Adjuvant chemotherapy was recommended for 11 % and 6 % of pre- and postmenopausal N— patients, and for 78 % and 47 % of pre- and postmenopausal N+ patients. Forty-three of the 63 participating hospitals reported they adhered to the guidelines defined by the Italian Breast Cancer Task Force (F.O.N.Ca.M.) but this was not associated with substantial evidence of better quality of care. Similarly, no associations emerged between several hospitals' organizational features and adherence to recommended treatment guidelines. The study is ongoing to assess the quality of postsurgical treatment and to measure its impact on patients' survival.

scholarly journals Development by a Large Integrated Health Care System of an Objective Methodology for Evaluation of Medical Oncology Service Sites

2012 ◽  
Vol 8 (2) ◽  
pp. 70-70
Author(s):  
Marija Bjegovich-Weidman ◽  
Jill Kahabka ◽  
Amy Bock ◽  
Jacob Frick ◽  
Helga Kowalski ◽  
...  
Keyword(s):  
Health Care ◽  
Employee Engagement ◽  
Health Care System ◽  
Patient Experience ◽  
Primary Care Physicians ◽  
Medical Oncology ◽  
Cost Savings ◽  
Full Time ◽  
Medical Oncologists ◽  
Care System

Purpose: Aurora Health Care (AHC) is the largest health care system in Wisconsin, with 14 acute care hospitals. In early 2010, a group of 18 medical oncologists became affiliated with AHC. This affiliation added 13 medical oncology infusion clinics to our existing 12 sites. In the era of health care reform and declining reimbursement, we need an objective method and criteria to evaluate our 25 outpatient medical oncology sites. We developed financial, clinical, and strategic tools for the evaluation and management of our cancer subservice lines and outpatient sites. The key to our success has been the direct involvement of stakeholders with a vested interest in the services in the selection of the criteria and evaluation process. Methods: We developed our objective metrics for evaluation based on strategic, financial, operational, and patient experience criteria. Strategic criteria included: population trends, full-time equivalent (FTE) medical oncologists/primary care physicians, FTE radiation oncologists, FTE oncologic surgeons, new annual cases of patients with cancer, and market share trends. Financial criteria per site included: physician work relative value units, staff FTE by type, staff salaries, and profit and loss. Operational criteria included: facility by type (clinic v hospital based), hours of operation, and facility detail (eg, No. of chairs, No. of procedure and examination rooms, square footage). Patient experience criteria included: nursing model primary/nurse navigators, multidisciplinary support at site, Press Ganey (South Bend, IN; health care performance improvement company) results, and employee engagement score. Results: The outcome of our data analysis has resulted in the development of recommendations for AHC senior leadership and geographic market leadership to consider the consolidation of four sites (phase one, four sites; phase two, two sites) and priority strategic sites to address capacity issues that limit growth. The recommendations if implemented would result in significant cost savings, currently being quantified as a result of consolidation and improved efficiency. A reinvestment of these cost savings would be required to address facility expansion and program enhancement to maximize patient-centered expert care consistently across all of our remaining sites of service.

Practice Patterns and Guideline Adherence of Medical Oncologists in Managing Patients with Early Breast Cancer

2009 ◽  
Vol 7 (7) ◽  
pp. 697-706 ◽  
Author(s):  
Jill A. Foster ◽  
Maziar Abdolrasulnia ◽  
Hamidreza Doroodchi ◽  
Joan McClure ◽  
Linda Casebeer
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Guideline Adherence ◽  
Practice Patterns ◽  
Medical Oncologists

Examination of current Algoma District cancer program practices and local referral processes for patients with prostate cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 352-352
Author(s):  
Daniella Febbraro ◽  
Silvana Spadafora
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Medical Oncology ◽  
Stage Iv ◽  
Standards Of Care ◽  
Study Patient ◽  
Medical Oncologist ◽  
Northern Ontario ◽  
Cancer Program ◽  
Medical Oncologists

352 Background: The Algoma District Cancer Program (ADCP) is located in Sault Ste. Marie, ON, Canada and services the needs of the 125,000 individuals residing in the Algoma District, which has an area of approximately 49,000 square kilometres. Due to its geographic isolation in Northern Ontario, maintaining standards of care can be challenging to deliver. The objective of this project is to document any improvements in the referral process and treatment of patients with prostate cancer at the ADCP since the arrival of new medical oncologists in July 2013. Methods: Patients who had been seen by a medical oncologist at ADCP from July 2013 to July 2015 were included in this study. Patient charts were analyzed in order to gather information including date of diagnosis, stage at time of referral, date of consult with medical oncologist, previous treatments trialed, and dates of treatment. Patients were divided into two groups, diagnosed prior to 2014 and after 2014, to examine progress at ADCP. Results: From July 2013 to July 2015, there were 73 patients seen by a medical oncologist at ADCP with a diagnosis of prostate cancer. Of these patients, 54 were diagnosed prior to 2014 and 19 were diagnosed after 2014. For all patients diagnosed prior to 2014, the average number of years from diagnosis to a medical oncology consult was 5.24 years, with the longest being 19 years for two patients. In comparison, for all patients diagnosed after 2014, a medical oncologist saw them only 0.26 years on average after they were diagnosed. Since 2014, lines of therapy administered after referral to medical oncology have become greater than before 2014. Specifically for stage IV prostate cancer patients, the average number of lines of therapy ordered by a medical oncologist has increased for patients diagnosed after 2014. Conclusions: Since the arrival of new medical oncologists at ADCP in July 2013, the average number of years after diagnosis that a patient is referred to the clinic has decreased, while the average lines of therapies utilized after their consult with a medical oncologist has increased, showing an improvement in both referral processes and adherence to standard guidelines in the treatment of prostate cancer patients.

Measuring Supportive Care in Medical Oncology Practice: Lessons Learned From the Quality Oncology Practice Initiative

2008 ◽  
Vol 26 (23) ◽  
pp. 3832-3837 ◽  
Author(s):  
Kristen K. McNiff ◽  
Michael N. Neuss ◽  
Joseph O. Jacobson ◽  
Peter D. Eisenberg ◽  
Pamela Kadlubek ◽  
...  
Keyword(s):  
Supportive Care ◽  
Chart Review ◽  
Medical Oncology ◽  
Quality Measurement ◽  
Lessons Learned ◽  
Self Assessment ◽  
Improvement Program ◽  
Medical Oncologists ◽  
American Society ◽  
Oncology Practice

We provide a brief review of the use of quality measures to assess supportive care in the medical oncology office. Specifically, we discuss the development and implementation of supportive care measures in the Quality Oncology Practice Initiative (QOPI), a voluntary quality measurement and improvement program of the American Society of Clinical Oncology. QOPI has demonstrated that medical oncologists voluntarily engage in self-assessment and often select measures related to supportive care for measurement and improvement. Results to date have demonstrated that there is room for improvement in this domain. Because supportive care measures appropriate for use through structured chart review in the outpatient oncology setting are not generally available in the published literature, measures have been developed and tested through the program. Additional measures are in development for implementation in QOPI in 2008.

Interpretation in Consultations With Immigrant Patients With Cancer: How Accurate Is It?

2011 ◽  
Vol 29 (20) ◽  
pp. 2801-2807 ◽  
Author(s):  
Phyllis N. Butow ◽  
David Goldstein ◽  
Melaine L. Bell ◽  
Ming Sze ◽  
Lynley J. Aldridge ◽  
...  
Keyword(s):  
Health Professional ◽  
Medical Oncology ◽  
Newly Diagnosed ◽  
Incurable Cancer ◽  
Face To Face ◽  
Health Team ◽  
Patients With Cancer ◽  
Medical Oncologists ◽  
Original Speech

Purpose Immigrants with cancer often have professional and/or family interpreters to overcome challenges communicating with their health team. This study explored the rate and consequences of nonequivalent interpretation in medical oncology consultations. Patients and Methods Consecutive immigrant patients with newly diagnosed with incurable cancer, who spoke Arabic, Cantonese, Mandarin, or Greek, were recruited from the practices of 10 medical oncologists in nine hospitals. Their first two consultations were audio taped, transcribed, translated into English and coded. Results Thirty-two of 78 participants had an interpreter at 49 consultations; 43% of interpreters were family, 35% professional, 18% both a professional and family, and 4% a health professional. Sixty-five percent of professional interpretations were equivalent to the original speech versus 50% for family interpreters (P= .02). Seventy percent of nonequivalent interpretations were inconsequential or positive; however, 10% could result in misunderstanding, in 5% the tone was more authoritarian than originally intended, and in 3% more certainty was conveyed. There were no significant differences in interpreter type for equivalency of interpretations. Conclusion Nonequivalent interpretation is common, and not always innocuous. Our study suggests that there may remain a role for family or telephone versus face-to-face professional interpreters. Practice implications: careful communication between oncologists and interpreters is required to ensure optimal communication with the patient.

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