Public reporting outcomes of multidisciplinary cancer care: Conceptual issues.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 280-280
Author(s):  
James Austin Talcott
Keyword(s):  
Cancer Patient ◽  
Patient Outcomes ◽  
Cancer Care ◽  
Treatment Plan ◽  
Multidisciplinary Care ◽  
Collective Responsibility ◽  
Public Reporting ◽  
Analytic Description ◽  
Eligibility Criteria

280 Background: Patient outcomes are the most valid measures of quality of care. Public reporting makes them available to patients, referring physicians and payers. Our institution has committed to reporting all cancer patient outcomes. In carrying out that objective, we encountered novel analytical issues arising from differences between the usually reported treatments, surgical procedures, and multidisciplinary cancer care. We present important conceptual issues we identified. Methods: Analytic description of methodological issues encountered in publishing cancer patient outcomes. Results: Issues include: (1) Assigning responsibility. Patient outcomes of multidisciplinary cancer care can be influenced by multiple oncology specialties and institutions. While providers directly control only the treatment they provide, providers share collective responsibility for executing the treatment plan, coordinating care and vouching for the quality of collaborating providers. Therefore, reporting outcomes of one element of multidisciplinary care is incomplete and inadequate. (2) Claiming responsibility. Providers with institutional affiliations but no involvement in quality improvement or reporting processes should be excluded from public reporting. Minimum requirements to qualify for public institutional affiliation should be enforced and “free riders” identified. (3) Defining and presenting valid comparison populations. Treatment trials’ eligibility criteria and recruitment practices exclude poorer prognosis patients, producing biased comparisons to complete “registry” populations that distort patient expectations. Publishing outcomes of well-characterized subpopulations improves valid results and provides more individualized information. Conclusions: Reporting patient outcomes after multidisciplinary cancer care raises novel conceptual issues. We discuss our response to three important issues.

Clinical Integration of Digital Solutions in Health Care: An Overview of the Current Landscape of Digital Technologies in Cancer Care

2018 ◽  
pp. 1-9 ◽  
Author(s):  
Shivank Garg ◽  
Noelle L. Williams ◽  
Andrew Ip ◽  
Adam P. Dicker
Keyword(s):  
Quality Of Life ◽  
Artificial Intelligence ◽  
Health Care ◽  
Data Collection ◽  
Patient Outcomes ◽  
Cancer Care ◽  
Digital Health ◽  
Health Technologies ◽  
Health Care Value

Digital health constitutes a merger of both software and hardware technology with health care delivery and management, and encompasses a number of domains, from wearable devices to artificial intelligence, each associated with widely disparate interaction and data collection models. In this review, we focus on the landscape of the current integration of digital health technology in cancer care by subdividing digital health technologies into the following sections: connected devices, digital patient information collection, telehealth, and digital assistants. In these sections, we give an overview of the potential clinical impact of such technologies as they pertain to key domains, including patient education, patient outcomes, quality of life, and health care value. We performed a search of PubMed ( www.ncbi.nlm.nih.gov/pubmed ) and www.ClinicalTrials.gov for numerous terms related to digital health technologies, including digital health, connected devices, smart devices, wearables, activity trackers, connected sensors, remote monitoring, electronic surveys, electronic patient-reported outcomes, telehealth, telemedicine, artificial intelligence, chatbot, and digital assistants. The terms health care and cancer were appended to the previously mentioned terms to filter results for cancer-specific applications. From these results, studies were included that exemplified use of the various domains of digital health technologies in oncologic care. Digital health encompasses the integration of a vast array of technologies with health care, each associated with varied methods of data collection and information flow. Integration of these technologies into clinical practice has seen applications throughout the spectrum of care, including cancer screening, on-treatment patient management, acute post-treatment follow-up, and survivorship. Implementation of these systems may serve to reduce costs and workflow inefficiencies, as well as to improve overall health care value, patient outcomes, and quality of life.

Family physician involvement in cancer care and lung cancer patient emotional distress and quality of life

2010 ◽  
Vol 19 (11) ◽  
pp. 1719-1727 ◽  
Author(s):  
Michèle Aubin ◽  
Lucie Vézina ◽  
René Verreault ◽  
Lise Fillion ◽  
Éveline Hudon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Cancer Patient ◽  
Emotional Distress ◽  
Family Physician ◽  
Cancer Care ◽  
Lung Cancer Patient

Improving quality of cancer care: Lessons learned from the journey towards QOPI Certification.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 263-263
Author(s):  
Nafisa Abdelhafiez ◽  
Mona Mohamed Alshami ◽  
Mohammad Omar Al-Kaiyat ◽  
Tabrez Pasha ◽  
Nashmia Mutairi ◽  
...  
Keyword(s):  
Cancer Care ◽  
Treatment Plan ◽  
Lessons Learned ◽  
Team Members ◽  
Noticeable Improvement ◽  
Check System ◽  
American Society ◽  
Oncology Practice ◽  
Super Users

263 Background: To assess the quality of cancer care provided at our institution, we participated in Quality Oncology Practice Initiative (QOPI) of American Society of Clinical Oncology (ASCO). However, our initial two rounds revealed lower score than required for QOPI Certification. Our goal was to implement interventions based on lessons learned from the initial rounds. Methods: Prior to the third round and using plan-do-study-act (PDSA) cycles, we identified and worked on three processes: clarifying and enhancing the function of the team, optimizing communication and improving documentation. We created QOPI multi-disciplinary team to include more members from different disciplines. We enhanced the knowledge of the team regarding our electronic health records system (EHRS) by conducting educational sessions and nominating super users who are very competent in EHRS and peer-to-peer support was created. Members were entering data in group sessions with the help of super users. We established double check system for records to be reviewed by two team members before submission. communication was assured among team members through weekly in person meetings and with ASCO QOPI team via virtual meetings to address queries. Documentation was improved by creating newer templates that conform with QOPI requirements including chemotherapy treatment plan, end of treatment summary and documentation of treatment consent. Results: The implementation of these interventions over three PDSA cycles made noticeable improvement in the previously unmet standards resulting in a score that exceeded the benchmark in fall of 2017 (score of 93%). This made our practice eligible for on-site certification visit by ASCO QOPI surveyors on May 2018 to assess practice compliance with QOPI standards. After addressing the unmet standards from the visit, our center became the first QOPI Certified Center in the Middle East and Asia in October/2018. Conclusions: Our journey towards QOPI Certification highlights the importance of fundamental principles in health care: coordinated multidisciplinary team, effective communication and proper documentation that captures essential and critical items reflecting better quality of care.

Improving the quality of oral cancer drug delivery across a health system.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 184-184
Author(s):  
Katherine Enright ◽  
Rosemary Ku ◽  
Daniela Gallo-Hershberg ◽  
Aliya Pardhan ◽  
Leta Marie Forbes
Keyword(s):  
Patient Education ◽  
Cancer Care ◽  
Care Delivery ◽  
Treatment Plan ◽  
Quality Measures ◽  
Patient Specific ◽  
Cancer Drug ◽  
Use Of Technology ◽  
Adherence Monitoring

184 Background: Oral systemic therapy (ST) presents unique care delivery challenges. Gaps in patient education and monitoring for patients on oral ST delivery are well documented and can result in decreased adherence or increased toxicity. Within Ontario, cancer care is provincially coordinated through Ontario Health- Cancer Care Ontario (OH-CCO), but locally implemented by 14 Regional Cancer Programs (RCPs). Using a centrally coordinated, but regionally implemented quality improvement (QI) approach, we aimed to improve the quality of oral ST delivery across Ontario by enabling the use of patient specific monitoring plans to optimize treatment adherence and toxicity management. Methods: Between 2018 and 2020 a 2 year focused QI project was undertaken. A suite of 19 quality measures were developed to measure different quality domains for oral ST delivery including treatment plan documentation, patient education, toxicity/adherence monitoring and toxicity outcomes. In year 1, all regions used the suite of quality measures to establish baseline performance and develop a QI plan using rapid cycle improvement methodology to improve performance in at least 1 domain based on regional gaps and priorities. Projects were implemented and evaluated during year 2. OH-CCO provided QI coaching through dissemination of standardized QI tools, a monthly discussion forum and project specific feedback. At the end of year 2, a post-implementation evaluation was performed for each region. Results: 15 centers participated, representing all RCPs across Ontario. The participating centers implemented QI projects focused on treatment plan documentation (N = 3), patient education (N = 10) and toxicity/adherence management (N = 5), with some focusing on multiple domains. All centers reported an improvement in at least 1 domain (see Table). Key enablers identified include engagement with a multi-disciplinary team and the use of technology, while barriers include lack of onsite dispensing pharmacy. Future work will continue to focus on quality of oral ST delivery and better pharmacy integration. Conclusions: Through a centrally coordinated, locally implemented QI project, improvement in quality of oral ST care was achieved across Ontario. This model of QI focus has the potential to be adaptable across health systems. [Table: see text]

scholarly journals An analysis on medical expenses of multidisciplinary cancer care under health insurance

2021 ◽  
Vol 64 (10) ◽  
pp. 711-716
Author(s):  
Myungjin Jung ◽  
Byungyul Jun
Keyword(s):  
Health Insurance ◽  
Cancer Patients ◽  
Cancer Care ◽  
Treatment Plan ◽  
Multidisciplinary Care ◽  
Therapeutic Modality ◽  
Patient Treatment ◽  
Medical Expenses ◽  
Hospitalization Costs ◽  
Treatment Plans

Background: Cancer has been the leading cause of death in Korea for more than 40 years. As the aging population in the country increases, this trend is expected to continue. Cancer care is also being subdivided into specialties according to the development of medical technology. This division of care has made it difficult for a single physician to set up a complete cancer treatment plan. As a result, the call for multidisciplinary care has risen. Multidisciplinary cancer care allows physicians to share opinions and choose optimal patient treatment plans across multiple specialties. In August 2014, the Ministry of Health and Welfare designated a set number of approved multidisciplinary treatments and has included them under its health insurance coverage. As a result, multidisciplinary care is rapidly increasing.Current Concepts: An analysis on cancer care was conducted from 2014 to 2018, which examined the average medical expenses, hospitalization costs, and surgery costs per person according to therapeutic modality. Findings showed that multidisciplinary care decreased the overall cost of medical care in cancer patients compared to segmented care provided by single specialty physicians.Discussion and Conclusion: This study predicted that multidisciplinary care would be effective in reducing medical expenses. Cancer patients do not need to be treated by individual subspecialty physicians when personalized care treatment plans through a multidisciplinary approach is possible. The results of this study show that the Korean government should expand health insurance premium support and coverage for multidisciplinary cancer care.

scholarly journals The optimisation of noninvasive ventilation in amyotrophic lateral sclerosis: a systematic review

2019 ◽  
Vol 54 (3) ◽  
pp. 1900261 ◽  
Author(s):  
David O'Brien ◽  
Theocharis Stavroulakis ◽  
Susan Baxter ◽  
Paul Norman ◽  
Stephen Bianchi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Amyotrophic Lateral Sclerosis ◽  
Noninvasive Ventilation ◽  
Grey Literature ◽  
Multidisciplinary Care ◽  
Future Research ◽  
Eligibility Criteria ◽  
Respiratory Management ◽  
Lateral Sclerosis

BackgroundNoninvasive ventilation (NIV) prolongs survival and quality of life in amyotrophic lateral sclerosis (ALS); however, its benefits depend upon the optimisation of both ventilation and adherence. We aimed to identify factors associated with effective initiation and ongoing use of NIV in ALS to develop evidence-based guidance and identify areas for further research.MethodsWe searched 11 electronic databases (January 1998 to May 2018) for all types of quantitative and qualitative studies. Supplementary grey literature searches were conducted. Records were screened against eligibility criteria, data were extracted from included studies and risk of bias was assessed. We present findings using a narrative synthesis.ResultsWe screened 2430 unique records and included 52 quantitative and six qualitative papers. Factors reported to be associated with NIV optimisation included coordinated multidisciplinary care, place of initiation, selection of interfaces, ventilator modes and settings appropriate for the individual patient, and adequate secretion management. The literature indicated that patients with significant bulbar dysfunction can still derive considerable benefit from NIV if their needs are met. Research emphasises that obstructive airway events, mask leak and uncontrolled secretions should be addressed by adjustments to the interface and machine settings, and the concomitant use of cough augmentation.ConclusionThis review highlights that NIV optimisation requires an individualised approach to respiratory management tailored to the differing needs of each patient. Ultimately, this should lead to improved survival and quality of life. This review expands on recommendations in current international guidelines for NIV use in ALS and identifies areas for future research.

Improvement of time to develop treatment plan at a specialized sarcoma center.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 127-127 ◽  
Author(s):  
Adriana Chavez ◽  
Prachee Singh ◽  
Jaime Anderson ◽  
Andrea Aleman ◽  
Colleen Jernigan ◽  
...  
Keyword(s):  
Decision Making ◽  
Median Time ◽  
Patient Outcomes ◽  
Process Improvement ◽  
Treatment Plan ◽  
Rapid Development ◽  
Insufficient Data ◽  
Improvement Project ◽  
Imaging Results

127 Background: Treatment of new patients at the MD Anderson Sarcoma Medical Oncology Clinic can take up to 1 to 2 weeks from their initial consultation depending on the information available for review. Treatment delays can result in poor patient outcomes, adversely affecting the quality of care provided. There are numerous processes involved in the development of a treatment plan that could be improved to reduce the time to finalization of treatment plan. Methods: We undertook a quality improvement project involving key clinic and administrative team members. We performed detailed process mapping and developed a cause and effect diagram to identify and prioritize opportunities for improvement. We measured the time in hours from the patient’s initial appointment to finalization of a treatment plan. Baseline data (before process improvement implementation) was collected retrospectively through chart review. Post-implementation data was collected prospectively. For process improvement, we focused on two deficiencies that were regarded as the key causes of delay to develop a finalized treatment plan (1) insufficient data for decision making at the time of new patient visit, and (2) delays in obtaining diagnostic imaging. Results: Due to insufficient data for decision-making available at the time of initial consultation, the median time to develop a treatment plan is 72 hours. After initiating process improvement, the median time to develop a treatment plan decreased to approximately 7 hours. Conclusions: Improving the quality of data available for the medical oncologist prior to initial consultation greatly enhances the rapid development of finalized treatment plan. Availability of an early treatment plan improves patient outcomes, diminishes patient anxiety, and decreases the costs incurred by the patient awaiting a treatment plan at a specialized oncology clinic.

scholarly journals Lung cancer care trajectory at a Canadian centre: an evaluation of how wait times affect clinical outcomes

2017 ◽  
Vol 24 (5) ◽  
pp. 302 ◽  
Author(s):  
G. Kasymjanova ◽  
D. Small ◽  
V. Cohen ◽  
R.T. Jagoe ◽  
G. Batist ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Patient Outcomes ◽  
Cancer Care ◽  
Wait Time ◽  
Treatment Modalities ◽  
Wait Times ◽  
Model Of Care ◽  
Time Intervals ◽  
Lung Cancer Patients

Background Lung cancer continues to be one of the most common cancers in Canada, with approximately 28,400 new cases diagnosed each year. Although timely care can contribute substantially to quality of life for patients, it remains unclear whether it also improves patient outcomes. In this work, we used a set of quality indicators that aim to describe the quality of care in lung cancer patients. We assessed adherence with existing guidelines for timeliness of lung cancer care and concordance with existing standards of treatment, and we examined the association between timeliness of care and lung cancer survival.Methods Patients with lung cancer diagnosed between 2010 and 2015 were identified from the Pulmonary Division Lung Cancer Registry at our centre.Results We demonstrated that the interdisciplinary pulmonary oncology service successfully treated most of its patients within the recommended wait times. However, there is still work to be done to decrease variation in wait time. Our results demonstrate a significant association between wait time and survival, supporting the need for clinicians to optimize the patient care trajectory.Interpretation It would be helpful for Canadian clinicians treating patients with lung cancer to have wait time guidelines for all treatment modalities, together with standard definitions for all time intervals. Any reductions in wait times should be balanced against the need for thorough investigation before initiating treatment. We believe that our unique model of care leads to an acceleration of diagnostic steps. Avoiding any delay associated with referral to a medical oncologist for treatment could be an acceptable strategy with respect to reducing wait time.

scholarly journals Self-efficacy and quality of life after strokeİnme sonrası öz etkililik ve yaşam kalitesi

2017 ◽  
Vol 14 (2) ◽  
Author(s):  
Serpil Topçu ◽  
Sıdıka Oğuz
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Patient Outcomes ◽  
Health Care System ◽  
Self Efficacy ◽  
Treatment Process ◽  
Treatment Plan ◽  
Stroke Patients ◽  
The World

limitations in the world and Turkey. For this reason, Stroke symptoms can be very stressful for caregivers and it can be a burden of health care system. Positive patient outcomes can be achieved with proper management of the treatment process. Treatment plan according to stroke patients psychologic adaptations such as self-efficacy and patient ability to self-care activities. The aim of this study is to provide a context of relationship with self-efficacy, quality of life and stroke.  Özetİnme tüm dünyada ve ülkemizde sakatlıklara ve kısıtlılıklara neden olan ciddi bir sağlık sorunudur. Bu özelliği nedeni ile hasta, hasta ailesi, tıbbi personel ve sağlık sistemine ağır yükler getirmektedir. Tedavi sürecinin doğru yönetilmesi ile olumlu hasta çıktılarına ulaşmak mümkündür. Tedaviye yön vermek için, hastaların mevcut yapabilirlik düzeyinin analiz edilmesi, tedavi ve bakıma katılım için hazır oluş durumunun bilinmesi gereklidir.  Bu derlemede, inme hastalarının tedavi planını düzenlemede rehber olacağı düşünülen, yaşam kalitesi ve öz etkililik kavramları ve bu kavramların inme ile ilişkisinin tartışılması amaçlanmıştır.

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