Electronic monitoring of patient-reported adherence and symptoms on oral chemotherapy at an academic and a community site.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 283-283
Author(s):  
Jim Doolin ◽  
Daniel Aaron Roberts ◽  
Christina Cibotti ◽  
Scott M Devlin ◽  
Holly Dowling ◽  
...  
Keyword(s):  
Median Time ◽  
Medical Center ◽  
Academic Medical Center ◽  
Symptom Assessment ◽  
Oral Chemotherapy ◽  
Community Practice ◽  
Financial Toxicity ◽  
Online Tool ◽  
Academic Medical ◽  
Patient Reported

283 Background: Monitoring of toxicity and adherence is often lacking for patients recently started on oral chemotherapy. National guidelines recommend active outreach to patients within a week after treatment start. We developed an online tool to actively reach out to patients newly started on oral chemotherapy at one academic medical center and community practice. Methods: A multi-disciplinary team, including patients, developed an online oral chemotherapy adherence, symptom, and financial toxicity assessment tool within REDCap. We implemented this tool for new oral chemotherapy prescriptions in May 2018 in the gastrointestinal oncology group of an academic medical center and a general community practice. To quantify the impact of this tool on symptom management, we completed a retrospective analysis of patients receiving new oral chemotherapy prescriptions at these same sites, in the 13 months immediately preceding clinical implementation of the online tool, May 2017 to May 2018. Results: In the pre-intervention historical cohort (n = 58) the median time to first symptom assessment by a clinician was 7 days (range 1 – 41 days, SD 7 days), median time to identifying a new or worsening symptom was 10 days (range 1-55 days, SD 10 days), and median time to clinical action regarding a new or worsening symptom was 10 days (range 1-104, SD 20 days). Our first intervention patient used the online tool in May 2018 to report symptoms of “nausea and fatigue,” 4 days after starting oral chemotherapy. This resulted in an oncology clinical nurse calling the patient to review symptom management by phone. Conclusions: The median time to first symptom assessment in our historical control cohort is 7 days, with standard deviation of 7 days, suggesting potential room for improvement. Thus far, the online tool has been completed by one patient. Further data will be reported regarding the uptake of this tool, the tool’s impact on quality measures, and patient reported symptoms, adherence, and financial toxicity.

Patients’ perspectives and outcomes on an oral chemotherapy education and electronic monitoring program.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18007-e18007
Author(s):  
Noah Xavier Tocci ◽  
Jim Doolin ◽  
Daniel Aaron Roberts ◽  
Christina Cibotti ◽  
Rebekah A Hartwell ◽  
...  
Keyword(s):  
Electronic Monitoring ◽  
Medical Center ◽  
Academic Medical Center ◽  
Monitoring Program ◽  
Management Program ◽  
Oral Chemotherapy ◽  
P Value ◽  
Online Tool ◽  
Significant Difference ◽  
Patient Reported

e18007 Background: Patients on oral chemotherapy (OC) often lack consistent education and monitoring, risking toxicity and poor adherence. We developed an OC management program including education and an online tool for active outreach. Methods: In November 2017, we initiated pharmacist-led education for patients newly prescribed OC at a community practice and in the gastrointestinal oncology group at an academic medical center (AMC). An online tool assessing adherence, symptoms, and financial toxicity was emailed to patients three days after starting OC. Non-responders were contacted for phone interviews. A random sample of 28 patients newly started on OC at both sites before the intervention in 2017 was analyzed at baseline. A retrospective chart analysis was done to collect time to symptom assessment, identification and action. A report generated date of first emergency department (ED) visit or hospitalization within the AMC. We conducted a Mann Whitney U-Test, using a one-sided p value of 0.025 with Bonferroni correction. Results: Sixty-nine of 106 eligible patients (66%) received education, of whom 36 (52.1%) received the online tool, and 13 (36.1%) responded. There was a significant difference between the intervention and baseline median times to first new/worsening symptoms (p = 0.0105) but otherwise there were no outcome improvements. Eight of 23 patients who did not respond to the electronic tool were interviewed and indicated that their illness impeded their ability to check email (n = 2), and that they never check email (n = 2). Conclusions: This OC management program improved time to detect new/worsening symptoms and could potentially improve outcomes after further patient accrual. Future investigation should examine ways to improve patient responsiveness to electronic patient-reported symptom tools. [Table: see text]

In-Practice Endocrine Surgery Fellowship: A Novel Training Model

2020 ◽  
pp. 019459982096279
Author(s):  
Hien T. Tierney ◽  
Leslie S. Eldeiry ◽  
Jeffrey R. Garber ◽  
Chia A. Haddad ◽  
Mark A. Varvares ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Medical Center ◽  
Academic Medical Center ◽  
Training Model ◽  
Time Frame ◽  
Fellowship Training ◽  
Endocrine Surgery ◽  
Community Practice ◽  
Senior Surgeon ◽  
Academic Medical

Objective Endocrine surgery is an expanding field within otolaryngology. We hypothesized that a novel endocrine surgery fellowship model for in-practice otolaryngologists could result in expert-level training. Study Design Qualitative clinical study with chart review. Setting Urban community practice and academic medical center. Methods Two board-certified general otolaryngologists collaborated with a senior endocrine surgeon to increase their endocrine surgery expertise between March 2015 and December 2017. The senior surgeon provided intensive surgical training to both surgeons for all of their endocrine surgeries. Both parties collaborated with endocrinology to coordinate medical care and receive referrals. All patients undergoing endocrine surgery during this time frame were reviewed retrospectively. Results A total of 235 endocrine surgeries were performed. Of these, 198 thyroid surgeries were performed, including 98 total thyroidectomies (48%), 90 lobectomies (45%), and 10 completion thyroidectomies (5%). Sixty cases demonstrated papillary thyroid carcinoma, 11 follicular thyroid carcinoma, and 4 medullary thyroid carcinoma. Neck dissections were performed in 14 of the cases. Thirty-seven parathyroid explorations were performed. There were no reports of permanent hypoparathyroidism. Thirteen patients (5.5%) developed temporary hypoparathyroidism. Six patients (2.5%) developed postoperative seroma. Three patients (1.3%) developed postoperative hematomas requiring reoperation. One patient (0.4%) developed permanent vocal fold paralysis, and 3 patients (1.3%) had temporary dysphonia. Thirty-five of 37 (94.5%) parathyroid explorations resulted in biochemical resolution of the patient’s primary hyperparathyroidism. Conclusion This is the first description of a new fellowship paradigm where a senior surgeon provides fellowship training to attending surgeons already in practice.

scholarly journals Integration of Patient-reported Outcomes in a Total Joint Arthroplasty Program at a High-volume Academic Medical Center

2020 ◽  
Vol 4 (5) ◽  
pp. e20.00034 ◽  
Author(s):  
Surabhi Bhatt ◽  
Kristina Davis ◽  
David W. Manning ◽  
Cynthia Barnard ◽  
Terrance D. Peabody ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Patient Reported Outcomes ◽  
Medical Center ◽  
Academic Medical Center ◽  
High Volume ◽  
Joint Arthroplasty ◽  
Academic Medical ◽  
Patient Reported

Oral chemotherapy education: Hitting the mark?

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 221-221
Author(s):  
Jonathan L Berry ◽  
Jim W Doolin ◽  
Garrett Diltz ◽  
Tenzin Dechen ◽  
Natalia Forbath ◽  
...  
Keyword(s):  
Formal Education ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hematologic Malignancies ◽  
Oral Chemotherapy ◽  
Community Practice ◽  
Medication Persistence ◽  
Process Measures ◽  
Education Group ◽  
Oncology Practice

221 Background: ASCO’s Quality Oncology Practice Initiative (QOPI) includes process measures on oral chemotherapy education. Whether achievement of these measures has an impact on clinical outcomes and if an intervention to improve these measures can improve outcomes is not yet known. Methods: A retrospective analysis was conducted of patients initiated on oral chemotherapy in an academic medical center site and a community oncology practice between January 2016 and October 2019. The primary aim was to compare the time to emergency department (ED) within 90 days from initiation of oral chemotherapy of patients who met the QOPI process measure through an intervention of pharmacist-driven education with a comparison group of patients who had not received formal education. A secondary aim was to assess for a difference in oral chemotherapy medication persistence. Data were also analyzed by demographics, concurrent parenteral therapy, intent of therapy, and disease group. Results: 285 patients in the education group and 284 patients in the non-education group were analyzed. The education group had a higher proportion of patients with gastrointestinal and gynecologic cancers, and a lower proportion of patients with hematologic malignancies, compared to the non-education group. The education group also had a higher proportion of patients treated at the community practice compared to the non-education group. There was no statistical difference in median time-to-ED, with 49 days (IQR 37-74) in the education group and 59 days (IQR 41-60) in the non-education group (p=0.15). Conclusions: In patients receiving oral chemotherapy, pharmacist-driven education with improvement in QOPI process measures did not result in an improvement in time to ED. One factor contributing to this result may be that only 20% of patients required ED-level care within 90 days of starting oral We continue to collect data regarding medication persistence, which may be a more sensitive outcome measure. At this point, further work is needed to determine if achievement or modification of the QOPI oral chemotherapy process measures results in a clinically significant change in outcome. [Table: see text]

Organization- and System-Level Factors Influencing Implementation Overview of Case Studies

2018 ◽  
Author(s):  
Stephanie B. Wheeler
Keyword(s):  
Case Studies ◽  
Psychosocial Support ◽  
Medical Center ◽  
Academic Medical Center ◽  
System Level ◽  
Differential Outcomes ◽  
System P ◽  
Academic Medical ◽  
Patient Reported ◽  
Integrated Health Care System

Organization- and health system-level determinants of cancer outcomes are critical to understand. Studies focusing only on individual- or provider-level factors contributing to differential outcomes may mask the important, and often far-reaching, influence of organizational and system-wide structures, policies, norms, and behaviors that drive outcomes. This chapter explores case studies including implementation of patient reported outcomes symptom monitoring within a large academic medical center; cancer patient navigation programs to reduce social, economic, cultural, and system barriers to timely cancer care; how psychosocial support has been integrated into community-based and Veterans Administration (VA) oncology programs; and implementing Lynch syndrome testing within a VA integrated health care system.

scholarly journals Immediate Postoperative Pain Scores Predict Neck Pain Profile up to 1 Year Following Anterior Cervical Discectomy and Fusion

2017 ◽  
Vol 8 (3) ◽  
pp. 231-236 ◽  
Author(s):  
Owoicho Adogwa ◽  
Aladine A. Elsamadicy ◽  
Victoria D. Vuong ◽  
Ankit I. Mehta ◽  
Raul A. Vasquez ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Neck Pain ◽  
Medical Center ◽  
Academic Medical Center ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Regression Methods ◽  
Pain Scores ◽  
Academic Medical ◽  
Patient Reported

Study Design: Retrospective cohort review. Objective: To assess whether immediate postoperative neck pain scores accurately predict 12-month visual analog scale–neck pain (VAS-NP) outcomes following Anterior Cervical Discectomy and Fusion surgery (ACDF). Methods: This was a retrospective study of 82 patients undergoing elective ACDF surgery at a major academic medical center. Patient reported outcomes measures VAS-NP scores were recorded on the first postoperative day, then at 6-weeks, 3, 6, and 12-months after surgery. Multivariate correlation and logistic regression methods were utilized to determine whether immediate postoperative VAS-NP score accurately predicted 1-year patient reported VAS-NP Scores. Results: Overall, 46.3% male, 25.6% were smokers, and the mean age and body mass index (BMI) were 53.7 years and 28.28 kg/m2, respectively. There were significant correlations between immediate postoperative pain scores and neck pain scores at 6 weeks VAS-NP ( P = .0015), 6 months VAS-NP ( P = .0333), and 12 months VAS-NP ( P = .0247) after surgery. Furthermore, immediate postoperative pain score is an independent predictor of 6 weeks, 6 months, and 1 year VAS-NP scores. Conclusion: Our study suggests that immediate postoperative patient reported neck pain scores accurately predicts and correlates with 12-month VAS-NP scores after an ACDF procedure. Patients with high neck pain scores after surgery are more likely to report persistent neck pain 12 months after index surgery.

scholarly journals Improved Adherence Rates and Clinical Outcomes of an Integrated, Closed-Loop, Pharmacist-Led Oral Chemotherapy Management Program

2018 ◽  
Vol 14 (6) ◽  
pp. e324-e334 ◽  
Author(s):  
Benyam Muluneh ◽  
Molly Schneider ◽  
Aimee Faso ◽  
Lindsey Amerine ◽  
Rowell Daniels ◽  
...  
Keyword(s):  
Closed Loop ◽  
Medical Center ◽  
Academic Medical Center ◽  
Medication Possession Ratio ◽  
Response Rates ◽  
Management Program ◽  
Oral Chemotherapy ◽  
Molecular Response ◽  
Major Molecular Response ◽  
Patient Reported

Purpose: To address the growing use of oral anticancer therapy, an integrated, closed-loop, pharmacist-led oral chemotherapy management program was created within an academic medical center. Methods: An integrated, closed-loop, pharmacy-led oral chemotherapy management program was established. From September 2014 until June 2015, demographic information, rates of adherence, patient understanding of treatment, pharmacist interventions, patient and provider satisfaction, and molecular response rates in patients with chronic myeloid leukemia (CML) were collected. Results: After full implementation, 107 patients were enrolled in our oral chemotherapy management program from September 2014 until June 2015. All patients were educated before starting oral chemotherapy, and using pre- and postassessment tests, comprehension of oral chemotherapy treatment increased from 43% to 95%. Patient-reported adherence was 86% and 94.7% for the GI/breast and malignant hematology patient populations, respectively, and these were validated with medication possession ratio, revealing adherence rates of 85% and 93.9% for the GI/breast and malignant hematology patient populations, respectively. A total of 350 encounters with a clinical pharmacist and 318 adverse effects were reported, which led to 235 interventions. This program led to a higher major molecular response rate (83%) in our CML population compared with published clinical trials (average major molecular response rates, 40% and 60% with 1- and 2-year follow-up, respectively). Conclusion: An innovative model was developed and resulted in improved patient knowledge regarding oral chemotherapy, improved adherence rates that exceeded nationally established thresholds, and superior major molecular response outcomes for patients with CML compared with published literature. As a result, this model has produced the gold standard in managing patients receiving oral chemotherapy.

scholarly journals Evaluation of a Pharmacist Led Oral Chemotherapy Clinic: A Pilot Program in the Gastrointestinal Oncology Clinic at an Academic Medical Center

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 46 ◽  
Author(s):  
Julianne O. Darling ◽  
Farah Raheem ◽  
Katelyn C. Carter ◽  
Elizabeth Ledbetter ◽  
Jennifer F. Lowe ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Clinic Visit ◽  
Oral Chemotherapy ◽  
Satisfaction Survey ◽  
Pilot Program ◽  
Continuous Variables ◽  
Percentage Difference ◽  
Academic Medical ◽  
Strongly Agree

Oral chemotherapy represents a major patient-centric advancement in therapy convenience. However, ownership of safe and correct administration of these agents requires significant patient education. To address this challenge, an in-person pharmacist-led oral chemotherapy education clinic in gastrointestinal oncology patients within an academic medical center was created and assessed. In this pilot program, a medication-specific quiz was administered to patients before and after education performed by a pharmacist to assess patient understanding of their new oral chemotherapy. A five-question satisfaction survey was also administered at the conclusion of the pharmacist clinic visit. Primary outcome was the percentage difference between pre-and post-education quiz scores. Secondary outcomes included patient satisfaction, time to treatment initiation, and number of pharmacist interventions. Frequencies and medians were used to describe categorical and continuous variables, respectively. Of the 18 patients analyzed, 50% were male and median age was 59.5 years. Approximately 28% had colon cancer, and 61% were treated with capecitabine. The median post-education scores improved from a pre-education score of 75% to 100%. Overall, seventeen of the eighteen patients responded with “strongly agree” to all satisfaction survey statements. An in-person oncology pharmacist-led oral chemotherapy education session demonstrated an improvement in patients’ understanding of their new oral chemotherapy treatment.

scholarly journals Internal Medicine Residents' Ambulatory Management of Core Geriatric Conditions

2017 ◽  
Vol 9 (3) ◽  
pp. 338-344 ◽  
Author(s):  
Kathryn E. Callahan ◽  
Lindsay A. Wilson ◽  
Juliessa M. Pavon ◽  
James F. Lovato ◽  
Hal H. Atkinson ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Older Adults ◽  
Medical Center ◽  
Academic Medical Center ◽  
Active Management ◽  
Community Practice ◽  
Chart Audit ◽  
Geriatric Conditions ◽  
Academic Medical ◽  
Problem Lists

ABSTRACT Background Adults aged 65 years and older account for more than 33% of annual visits to internal medicine (IM) generalists and specialists. Geriatrics experiences are not standardized for IM residents. Data are lacking on IM residents' continuity experiences with older adults and competencies relevant to their care. Objective To explore patient demographics and the prevalence of common geriatric conditions in IM residents' continuity clinics. Methods We collected data on age and sex for all IM residents' active clinic patients during 2011–2012. Academic site continuity panels for 351 IM residents were drawn from 4 academic medical center sites. Common geriatric conditions, defined by Assessing Care of Vulnerable Elders measures and the American Geriatrics Society IM geriatrics competencies, were identified through International Classification of Disease, ninth edition, coded electronic problem lists for residents' patients aged 65 years and older and cross-checked by audit of 20% of patients' charts across 1 year. Results Patient panels for 351 IM residents (of a possible 411, 85%) were reviewed. Older adults made up 21% of patients in IM residents' panels (range, 14%–28%); patients ≥ 75 (8%) or 85 (2%) years old were relatively rare. Concordance between electronic problem lists and chart audit was poor for most core geriatric conditions. On chart audit, active management of core geriatric conditions was variable: for example, memory loss (10%–25%), falls/gait abnormality (26%–42%), and osteoporosis (11%–35%). Conclusions The IM residents' exposure to core geriatric conditions and management of older adults was variable across 4 academic medical center sites and often lower than anticipated in community practice.

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