Improving quality of cancer care by rapid adoption of new scientific evidence.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 62-62
Author(s):  
Joanne Schottinger ◽  
Violeta Rabrenovich ◽  
David Campen ◽  
Dean Fredriks
Keyword(s):  
Cancer Care ◽  
Scientific Evidence ◽  
Care Program ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Patient Centered ◽  
Chemotherapy Administration ◽  
Inpatient Settings ◽  
New Evidence

62 Background: The goal of the Kaiser Permanente (KP) Cancer Care Program is to provide patient-centered, evidence-based, safe care for all KP oncology patients. Multiple processes and information technology tools support KP’s clinicians in delivering the best care to our patients. Prior to 2008, chemotherapy ordering and administration across KP was paper-based, and the standardization of chemotherapy regimens was driven by prescribers’ preferences. KP Oncologists used more than 1,400 chemotherapy protocols. Pharmacy had varying systems for dosing alerts, and reliable chemotherapy administration data was not available for clinical quality improvement. Methods: By 2012, all KP regions had implemented the KP HealthConnect Beacon (KPHCB) system, which incorporates chemotherapy ordering, alerting, verifying, dispensing, and administration in ambulatory and inpatient settings. Important outcomes of the KPHCB implementation include: 1) our success in gaining agreements on standardization of chemotherapy protocols across the Program, and 2) implementation of a rapid process for adoption of new scientific evidence. Our approach includes an evaluation of the quality of the relevant scientific literature and an assessment of a particular treatment. The KP multidisciplinary team discusses and integrates the scientific evidence and clinical expertise of KP clinicians into KPHCB chemotherapy protocols. The new evidence-based protocols with supporting literature references are imbedded as a web link at the end of the each protocol and are available to clinicians within days following the publishing of new evidence. Results: An example of a rapid dissemination and adoption of evidence is the 2010 Pfizer’s and FDA’s announcement that the sale of Mylotarg would be voluntarily discontinued due to a fatal liver veno-occlusive disease. Within 48 hours, we identified 12 patients who received Mylotarg in 2010, and the treating oncologists were individually contacted and provided with the new information to discuss with patients, as appropriate. Conclusions: The benefits of KP’s rapid adoption of new evidence methodology are reaching over 40,000 cancer patients, receiving over 250,000 chemotherapy treatments annually.

scholarly journals The Use of Evidence-Based Acupuncture: Current Evidence

2022 ◽  
Author(s):  
Dedi Ardinata
Keyword(s):  
Clinical Evidence ◽  
Scientific Evidence ◽  
Current Evidence ◽  
Systematic Research ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Evidence Quality

Evidence-based medicine (EBM), which emphasizes that medical decisions must be based on the most recent best evidence, is gaining popularity. Individual clinical expertise is combined with the best available external clinical evidence derived from systematic research in the practice of EBM. The key and core of EBM is the hierarchical system for categorizing evidence. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system divides evidence quality into four categories: high, moderate, low, and very low. GRADE is based on the lowest quality of evidence for any of the outcomes that are critical to making a decision, reducing the risk of mislabeling the overall evidence quality, when evidence for a critical outcome is lacking. This principle is also used in acupuncture as a complementary and integrative treatment modality, but incorporating scientific evidence is more difficult due to a number of factors. The goal of this chapter is to discuss how to establish a clinical evidence system for acupuncture, with a focus on the current quality of evidence for a variety of conditions or diseases.

Evidence-Based Surgery

2017 ◽  
Author(s):  
Karl Y. Bilimoria ◽  
Benjamin S Brooke
Keyword(s):  
Scientific Evidence ◽  
Surgical Techniques ◽  
Internal Validity ◽  
Surgical Care ◽  
Evidence Based ◽  
Services Research ◽  
Surgical Decision ◽  
Evidence Based Surgery ◽  
Quality Of Research

The practice of surgery has undergone a dramatic evolution over the last century with the availability of new scientific evidence supporting different surgical techniques and management.  Evidence-based surgery is defined as the judicious and systematic application of scientific evidence to surgical decision making and the establishment of standards of surgical care. This includes efforts to appraise the strength of scientific evidence and evaluate the quality of research studies or evidence, as well as efforts to interpret and apply evidence to clinical practice. In this review, we discuss important methodology and approaches in surgical health services research to accomplish these goals and improve the quality of care in surgery. By providing this overview, we hope readers will be able to navigate the surgical literature and apply evidence-based science to their own surgical practice. This review contains 1 figure, 3 tables, and 43 references. Key words: bias, comparative effectiveness, confounding, evidence, external validity, implementation science, internal validity, pragmatic trials, quality, risk adjustment, surgery

How to Search and Critique Scientific Evidence for Decision-Making

2017 ◽  
pp. 100-123
Author(s):  
Mayuree Tangkiatkumjai ◽  
Win Winit-Watjana ◽  
Li-Chia Chen
Keyword(s):  
Alternative Medicine ◽  
Complementary And Alternative Medicine ◽  
Literature Search ◽  
Scientific Evidence ◽  
Clinical Decision ◽  
Evidence Based ◽  
Search Terms ◽  
Based Medicine ◽  
Complementary And Alternative

A clinical decision on the use of complementary and alternative medicine (CAM) should be made based on evidence-based medicine (EBM) together with practitioner's knowledge and experiences. This chapter describes the process of EBM, including how to address a clinical question, do a systematic search for appropriate evidence with key search terms, appraise the evidence and make a clinical decision on CAM applications. An effective literature search should be performed by using a structured search strategy in searching biomedical and CAM databases, such as the National Center for Complementary and Alternative Medicine (CAM Citation Index). Few standard tools are recommended to evaluate the quality of CAM studies, i.e. the CONSORT extension for herbal interventions and STRICTA for RCTs of acupuncture. Additionally, some guidelines for designing RCTs in Chinese herbal medicine (CHM) can also be adopted to critique CAM literature. A clinical decision on choosing optimal CAM for patient care should be based on the current best evidence emerged from the EBM process.

Integrative Oncology

2021 ◽  
pp. 470-478
Author(s):  
Santhosshi Narayanan ◽  
Gabriel Lopez ◽  
Jun J. Mao ◽  
Wenli Liu ◽  
Lorenzo Cohen
Keyword(s):  
Symptom Management ◽  
Care Plan ◽  
Integrative Approach ◽  
Evidence Based ◽  
Patient Centered ◽  
Open Communication ◽  
Patients With Cancer ◽  
Comprehensive Plan ◽  
Body Practices

Patients with cancer often seek an integrative approach to their care in hope of a cure or symptom management. The integrative care plan requires a patient-centered approach that involves attention to their concerns and developing a comprehensive plan involving physical, mind-body, and social modalities in collaboration with the patient’s main oncology team and colleagues in palliative care, pain management, psychiatry, and rehabilitation. A personalized symptom management strategy utilizing an evidence-based application of conventional and nonconventional therapies can help improve quality of life and optimize treatment outcomes. Recommendation of modalities such as acupuncture, massage, and mind-body practices, as well as open communication and discussion on herbs and supplements, their safety, and interactions with cancer and chemotherapy, is critical to achieve optimal clinical outcomes.

Acupuncture in Neurological Disorders: An Evidence-Based Overview

2020 ◽  
pp. 449-494
Author(s):  
Alexandra Dimitrova
Keyword(s):  
Neurological Disorders ◽  
Large Scale ◽  
Healthcare Providers ◽  
Evidence Based ◽  
Tunnel Syndrome ◽  
Meta Analyses ◽  
New Evidence ◽  
Common Misconceptions

Over the past 20 years acupuncture has been rapidly gaining in popularity both in clinical practice and in research. New evidence for the benefits of acupuncture in various disorders is emerging seemingly every week, and recent large-scale systematic reviews and meta-analyses have suggested that acupuncture’s benefits in pain conditions can be maintained long term. At present the strongest evidence for acupuncture in the treatment of neurological disorders is in the fields of migraine, tension headaches, diabetic neuropathy, carpal tunnel syndrome, and Bell’s palsy. Recent trials suggest that acupuncture may be used as an adjunct in stroke rehabilitation and in improving the quality of life in patients with Parkinson’s disease and dementia. Despite recent mechanistic research advances, much remains unknown about acupuncture’s mechanism of action and there are common misconceptions about the origins of modern-day acupuncture. As acupuncture is being rapidly integrated into mainstream medical practice and increasingly being sought by patients, healthcare providers and neurologists in particular need to be educated about its applications and benefits for various neurological disorders. Our hope is that this chapter will serve toward this educational goal.

Preparing for an Epidemic: Cancer Care in an Aging Population

2014 ◽  
pp. 133-137 ◽  
Author(s):  
Ya-Chen Tina Shih ◽  
Arti Hurria
Keyword(s):  
Older Adults ◽  
Cancer Care ◽  
Care Delivery ◽  
Quality Care ◽  
Aging Population ◽  
Population Based ◽  
Cancer Drug ◽  
Evidence Based ◽  
Evidence Based Care

The Institute of Medicine's (IOM) Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population was charged with evaluating and proposing recommendations on how to improve the quality of cancer care, with a specific focus on the aging population. Based on their findings, the IOM committee recently released a report highlighting their 10 recommendations for improving the quality of cancer care. Based on those recommendations, this article highlights ways to improve evidence-based care and addresses rising costs in health care for older adults with cancer. The IOM highlighted three recommendations to address the current research gaps in providing evidence-based care in older adults with cancer, which included (1) studying populations which match the age and health-risk profile of the population with the disease, (2) legislative incentives for companies to include patients that are older or with multiple morbidities in new cancer drug trials, and (3) expansion of research that contributes to the depth and breadth of data available for assessing interventions. The recommendations also highlighted the need to maintain affordable and accessible care for older adults with cancer, with an emphasis on finding creative solutions within both the care delivery system and payment models in order to balance costs while preserving quality of care. The implementation of the IOM's recommendations will be a key step in moving closer to the goal of providing accessible, affordable, evidence-based, high-quality care to all patients with cancer.

scholarly journals A home-based comprehensive care model in patients with Multiple Sclerosis: A study pre-protocol

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 872 ◽  
Author(s):  
Lufei Young ◽  
Kathleen Healey ◽  
Mary Charlton ◽  
Kendra Schmid ◽  
Rana Zabad ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Intervention Group ◽  
Care Program ◽  
Comprehensive Care ◽  
Care Model ◽  
Patient Centered ◽  
Home Based ◽  
Comprehensive Care Model

Background Disability is prevalent in individuals with multiple sclerosis (MS), leading to difficulty in care access, significant caregiver burden, immense challenges in self-care and great societal burden.  Without highly coordinated, competent and accessible care, individuals living with progressive MS experience psychological distress, poor quality of life, suffer from life-threatening complications, and have frequent but avoidable healthcare utilizations. Unfortunately, current healthcare delivery models present severe limitations in providing easily accessible, patient-centered, coordinated comprehensive care to those with progressive MS. We propose a home-based comprehensive care model (MAHA) to address the unmet needs, challenges, and avoidable complications in individuals with progressive MS with disabling disease.Objective The article aims to describe the study design and methods used to implement and evaluate the proposed intervention.  Method The study will use a randomized controlled design to evaluate the feasibility of providing a 24-month, home-based, patient-centered comprehensive care program to improve quality of life, reduce complications and healthcare utilizations overtime (quarterly) for 24 months. A transdisciplinary team led by a MS-Comprehensivist will carry out this project. Fifty MS patients will be randomly assigned to the intervention and usual care program using block randomization procedures. We hypothesize that patients in the intervention group will have fewer complications, higher quality of life, greater satisfaction with care, and reduced healthcare utilization. The proposed project is also expected to be financially sustainable in fee-for-service models but best suited for and gain financial success in valued-based care systems.  Discussion This is the first study to examine the feasibility and effectiveness of a home-based comprehensive care management program in MS patients living with progressive disability. If successful, it will have far-reaching implications in research, education and practice in terms of providing high quality but affordable care to population living with severe complex, disabling conditions.

We’re All in This Together

2018 ◽  
Author(s):  
Cheryl Krauter
Keyword(s):  
Quality Of Life ◽  
Cancer Care ◽  
Well Being ◽  
Work Life ◽  
Personal Meaning ◽  
Evidence Based ◽  
Professional Lives ◽  
Survivorship Care ◽  
Life Balance

This chapter highlights and endorses a focus on continued progress in the area of integrative cancer care that assists the needs of the patients and also includes attention to the well-being of clinicians in cancer survivor care. Introducing a simple, relational structure that allows for both patients and clinicians to create a healing connection is one workable solution to the issues of quality survivorship care that can provide meaning and satisfaction to all concerned. The chapter provides evidence-based material on the vital importance of providing clinicians with meaningful support in their professional lives. It addresses their work–life balance and the importance of restoring their sense of personal meaning and quality of life to prevent burnout.

Delivering more, earlier, and better goals-of-care conversations to seriously ill oncology patients.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 39-39 ◽  
Author(s):  
Rachelle Bernacki ◽  
Joanna Paladino ◽  
Daniela Lamas ◽  
Mathilde Hutchings ◽  
Josh Lakin ◽  
...  
Keyword(s):  
Chart Review ◽  
Systematic Approach ◽  
Care Program ◽  
Cluster Randomized Trial ◽  
Patient Centered ◽  
Goals Of Care ◽  
Serious Illness ◽  
Clinician Training ◽  
Patient Values

39 Background: Patients with serious illness routinely receive treatments that are not aligned with their goals. Earlier clinical conversations about patients’ values and priorities lead to more goal-concordant care and improved quality of life, but these conversations often happen too late or not at all. The Serious Illness Care Program has designed a systematic approach to train and support clinicians in conducting more, earlier, and better conversations about goals of care with their patients. Objectives: Evaluate clinician adoption and acceptability of the training program and the Serious Illness Conversation Guide; determine the frequency, timing, and quality of goals of care documentation before death. Methods: Cluster-randomized trial including oncology clinicians and their patients. Intervention: clinician identification of high risk patients; 2½ hour clinician training on the Serious Illness Conversation Guide; email trigger/reminder; EMR documentation. Preliminary chart review to extract goals-of-care conversations for deceased patients in intervention and control. Results: 90 oncology clinicians: 47 intervention; 43 control. Of 47 intervention clinicians, 46 are trained and rate the training as effective (4.3/5). 97% of trained clinicians who have been triggered have adopted the Conversation Guide and find it acceptable (4.2/5). 342 patients enrolled: 176 intervention; 166 control; 38% have died (n = 131). A preliminary chart review revealed more goals-of-care conversations occurred before death in intervention compared to control (92% versus 70%, p = 0.0037); intervention conversations took place four months earlier than control (median 143 days versus 63 days, p = 0.0008). In addition, conversations were more patient centered (95% versus 45%, p < 0.001) and more readily retrievable in the EMR (68% versus 28%, p < 0.001). Conclusions: Preliminary data about the Serious Illness Care systematic approach demonstrate strong clinician adoption and acceptability. The intervention results in more, earlier, and better conversations about patient values and priorities, in addition to more patient-centered and retrievable documentation of goals of care in the medical record. Clinical trial information: NCT01786811.

Using a disease pathway management approach to improve the quality of breast cancer care in Ontario.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 109-109
Author(s):  
Andrea Eisen ◽  
Jasmin Soobrian ◽  
Ashley Tyrrell ◽  
Clement Li ◽  
Derek Muradali ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Quality Indicators ◽  
Cancer Care ◽  
Evidence Based ◽  
Breast Cancer Care ◽  
Patient Journey ◽  
The Impact

109 Background: Disease Pathway Management (DPM) is used by Cancer Care Ontario (CCO) to set priorities for cancer control, plan cancer services, and improve the quality of care in Ontario by promoting standardization. The DPM approach applies a framework to examine the performance of the entire system from prevention to end of life care, and to identify any gaps within the system. In 2014, DPM began its breast cancer pathway initiative by mapping the patient journey, depicting evidence-based best practice along the breast cancer care continuum, identifying where further guidance is needed for clinical decision making, and identifying gaps in quality of care and performance measurement indicators. Objective: To evaluate the impact of DPM on quality assessment of breast cancer care in Ontario. Methods: DPM convened a multidisciplinary breast cancer working group (WG) of 40 experts from across Ontario. The WG held 12 meetings and used guidelines developed by CCO’s Program in Evidence Based Care (or other sources as needed) to generate pathways for the prevention, screening and diagnosis, treatment, and follow-up care for breast cancer. The pathways were used as a framework to review the existing inventory of provincial breast cancer quality indicators, and to identify areas where evidence based guidance is needed. The pathways were subjected to an extensive review process before publication. Results: The expert WG identified 28 priority areas, including opportunities to develop guidance in areas where it is lacking (e.g. role of perioperative breast MRI; indications for contralateral prophylactic mastectomy) and system barriers that may hinder optimal care (e.g. biomarker assessment). The WG also used the pathways as a framework for evaluating performance measurement indicators by mapping 48 existing quality indicators for breast cancer to the pathway. Conclusions: The CCO DPM Breast Cancer pathways facilitated a province-wide, multidisciplinary process to promote quality standards, to identify gaps and overlaps in performance and quality measurement, and to recommend additional indicators more relevant to the quality of breast cancer care in Ontario.

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