Implementation of a rapid access multidisciplinary bone metastases clinic to improve access to care at a large cancer center.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 79-79 ◽  
Author(s):  
Lauren Elizabeth Colbert ◽  
Meaghan Gomez ◽  
Sarah Todd ◽  
Chad Tang ◽  
Kaitlin Christopherson ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Orthopedic Surgery ◽  
Radiation Oncology ◽  
Multidisciplinary Care ◽  
Treatment Completion ◽  
Outpatient Setting ◽  
Cancer Center ◽  
Chi Square ◽  
Rapid Access ◽  
To Receive

79 Background: MD Anderson Cancer Center is a large cancer center with 44,000 new patients per year. Radiation therapy (RT) is an effective treatment for bone metastases that can reduce pain medication use and improve quality of life. Our goal was to assess the effect of implementing a rapid access multidisciplinary clinic for bone metastases (RABC). Methods: RABC was instituted to schedule patients for radiation oncology and orthopedic surgery consult within 48 hours of referral. Same day simulation and treatment times were held for these patients for one 8Gy fraction. Thirty sequential patients treated with one fraction to bony sites in the outpatient setting prior to implementation of the clinic were chosen as a comparison group. Time from consult order to consult visit (OTV) and from consult visit to treatment completion (CTT) were recorded, in addition to frequency of multidisciplinary care (MDC; orthopedic surgery and radiation oncology). Overall Time (OT) was calculated from referral to treatment completion. T-test and chi-square test were used for analyses. Results: Between April 2018 and July 2018, 72 patients were referred to RABC. 23 patients were seen in consultation and received RT. Sites treated were pelvis (N = 10), spine (N = 6), lower extremity (N = 4) and upper extremity (N = 3). Patients had one site (N = 20), two sites (N = 2) or three sites treated (N = 1). Histologies included breast (N = 5), thoracic (N = 7), gastrointestinal (N = 6), genitourinary (N = 2) and head/neck (N = 2). OTV was shorter for RABC patients (mean 3.3 [+/-5.7] vs. 9.5 days [12.4]; p = 0.02). CTT was also significantly shorter for RABC patients (mean 5.4 hours [+/-1.8] vs. 6.5 days [+/-6.5]; p < .0001). OT was also shorter (3.5 days [+/-5.6] vs. 16.4 days [+/-14.8]; p < .0001). RABC clinic patients were more likely to receive MDC (100% vs 28%; p < .0001). Conclusions: The rapid access bone metastases clinic significantly decreased overall time from consult to completion of treatment and also decreased time to access radiotherapy. Patients were also more likely to receive multidisciplinary evaluation. The RABC approach is a promising model to improve palliation for patients with painful bony metastases.

Abstract P841: The Impact of a Dedicated Pediatric Stroke Discharge Plan Upon Parent Preparedness for Clinic: Before and After the Start of Covid-19

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Cindy Nederveld ◽  
Vivian Thompson ◽  
Jacqueline Murray ◽  
Jennifer L Armstrong ◽  
Megan Barry ◽  
...  
Keyword(s):  
Multidisciplinary Care ◽  
Clinic Visit ◽  
Outpatient Setting ◽  
Pediatric Stroke ◽  
Chi Square ◽  
Discharge Plan ◽  
Before And After ◽  
Appointment Time ◽  
Chi Square Analysis ◽  
The Impact

Background: The Colorado Pediatric Stroke Program provides comprehensive, multidisciplinary care for pediatric stroke patients and their families. The team, which includes dedicated inpatient and outpatient nurse coordinators, instituted a plan to support the transition from the inpatient to outpatient setting. Purpose: A survey was used to determine family preparedness for clinic and ease of scheduling their appointment. The data were collected before and after enacting remote scheduling and telehealth visits due to the COVID-19 pandemic. Methods: Our team provided educational materials and an outpatient appointment time to families at time of discharge starting in 2019. In January 2020, the stroke clinic staff surveyed parents and guardians about their preparedness for clinic. Telehealth encounters were initiated due to COVID-19 in March 2020, with staff conducting RedCAP surveys by telephone. The survey measured several components of visit preparedness and satisfaction including: understanding of diagnosis, reason for referral prior to clinic visit, familiarity with the stroke team prior to clinic visit, and ease in appointment scheduling. We compared results before and after March 2020 via two-tailed chi-square analysis or two-tailed Fischer’s test. Results: Prior to telehealth, families favorably reported responses with 92% (47/52) knowing the reason for referral, 86% (42/49) receiving educational material prior to clinic, and 84% (42/50) reporting familiarity with our team. All patients (50/50) reported that scheduling was easy. Only scheduling ease had a significant change during the pandemic, with 11% (2/11) of patients reporting difficulties with scheduling after starting telehealth ( P=0.03 ). Conclusion: Childhood stroke is a disease with significant morbidity and mortality, requiring close follow-up care. Families report robust preparedness for clinic after the implementation of a comprehensive discharge plan. Although small numbers, remote scheduling and telehealth transition may present previously unseen barriers to scheduling during the pandemic. During abrupt changes in clinical operations additional scheduling resources may be needed to ensure continuity of care.

Choosing oncology as specialization: Medical students' perception after clinical rotation in cancer center.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 10528-10528
Author(s):  
Omar Orlando Castillo Fernandez ◽  
Maria Lim ◽  
Lilian Hayde Montano ◽  
Gaspar Perez-Jimenez ◽  
Jhonattan Camaño ◽  
...  
Keyword(s):  
Palliative Care ◽  
Medical Students ◽  
Radiation Oncology ◽  
Cancer Care ◽  
Medical Oncology ◽  
Surgical Oncology ◽  
Cancer Center ◽  
Clinical Rotation ◽  
Chi Square ◽  
Field Methods

10528 Background: Cancer is a leading cause of death worldwide and the demand for oncologist and palliative care specialists is increasing dramatically. Two years ago, The Universidad de Panama incorporated Oncology in the curriculum in order to face the shortage of professionals involved in cancer care. Little information is available concerning young medical students desire to pursue a career in oncology.The aim of this study is to evalute medical students perception about Oncology as a specialization field. Methods: An electronic survey was sent to medical students from Universidad de Panama after finishing Oncology rotation the last 2 years. Chi square and Mann Whitney U tests were used to compare variables. Results: 145 questionnaries were responded (40%). 60% female and 40% male. Median age was 25 years old. Clinical rotation during Oncology practices were: 37% in Medical Oncology, 24% in Surgical Oncology, 21% in Radiation Oncology and 18% in Palliative Care. 20% (29) of students are highly motivated to pursue a career in Oncology. 8 in Radiation Oncology. 8 in Surgical Oncology, 8 in Medical Oncology and 5 in Palliative Care. Variable associated with a oncology preference were: male gender (p=0.007), lack of human resources (p=0.009), contact with patients and family (p=0.005), good experience with mentor (p=0.002), nature and complexity of disease (p<0.001). Potential emotional burden was negatively asssociated (p=0.004) with oncology preference. 66% of students acknowledged that clinical rotation changed positively their perception about cancer patient care and a third of students haved not rule out the possibility to choose Oncology in the near future. Conclusions: Early exposition to medical student to cancer care might help to reduce the global shortage of oncologist and palliative specialists.

Use of a rapid access multidisciplinary bone metastases clinic to decrease financial toxicity for patients undergoing single-fraction palliative radiation.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 24-24
Author(s):  
Jose Alberto Maldonado ◽  
Minsoo Kim ◽  
Prasamsa Pandey ◽  
Sarah Todd ◽  
Kaitlin Marie Christopherson ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Radiation Treatment ◽  
Travel Distance ◽  
Cancer Center ◽  
Cost Burden ◽  
Financial Toxicity ◽  
Single Fraction ◽  
Palliative Radiation ◽  
Rapid Access ◽  
Significant Difference

24 Background: A rapid access bone metastases clinic (RABC) was instituted at MD Anderson Cancer Center (MDACC) to allow outpatient consult, simulation and radiation treatment (RT) initiation in < 6 hours for patients with painful bone metastases. Patients underwent multidisciplinary evaluation with orthopedics and radiation oncology. One aspect of financial toxicity is distress due to out-of-pocket (OOP) cost associated with a treatment. We hypothesized the RABC would decrease financial toxicity for MDACC patients over traditional RT. Methods: RABC patients surveyed between April 2018 and January 2020 were included. Patients were asked to estimate OOP cost for RT (including travel and treatment cost) and perceived cost burden of treatment. Travel distance was hometown distance to MDACC. Subset analyses were performed for patients receiving single fraction (1fx) and 2-5 fractions (2-5fx). Estimated OOP cost (1fx: RABCN= 34, nonRABCN= 20; 2-5fx: RABCN= 4, nonRABCN= 22), perceived cost burden (1fx: RABCN= 32, nonRABCN= 27; 2-5fx: RABCN= 7, nonRABCN= 38) and travel distance (1fx: RABCN= 34, nonRABCN= 28; 2-5fx: RABCN= 7, nonRABCN= 38) were compared using a Mann-Whitney U Test. Travel distance was also compared to OOP cost. Patients treated with 6+ fractions were excluded. Results: Median estimated OOP cost was significantly lower for 1fx RABC patients vs. 1fx non-RABC patients ($450 [IQR $187.5-$1,050] vs. $2,000 [$625-$4,000]; p = 0.008), but there was no significant difference for 2-5fx ($1,900 vs. $1,375; p = 0.593). Overall patient satisfaction with cost burden was high regardless of treatment setting (1fx: 10 [8-10]; 2-5fx: 10 [8-10]). Median travel distance was not significantly different between clinics (1fx: 245 [39.8-351.5] vs. 262.5 [83-879.3], p = 0.3651; 2-5fx: 274 [36-1293] vs. 176 [25-626], p = 0.2721). Travel distance was directly correlated with out of pocket cost for single fraction (1fx: R2= 0.125, p = 0.0109; 2-5fx: R2= 0.037, p = 0.3433). Conclusions: The establishment of a RABC at MDACC significantly decreased financial toxicity for 1fx patients receiving palliative RT, but not in the 2-5fx cohort. Increased financial toxicity was associated with longer travel distance for 1fx palliative radiation. Implementation of a similar model in local community centers may decrease financial toxicity for patients receiving palliative radiation.

Quality of gastrointestinal cancer care at a community hospital under the paradigm of multidisciplinary care.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 133-133
Author(s):  
Laurence E. McCahill ◽  
Sunil Konduri ◽  
Alan T. Davis ◽  
Mary May ◽  
Coralyn Martinez ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Care ◽  
Underserved Populations ◽  
Multidisciplinary Care ◽  
Quality Data ◽  
Cancer Center ◽  
Chi Square ◽  
Quality Cancer Care ◽  
Nurse Navigator ◽  
Underserved Patients

133 Background: Benefits of MDC have been established for other cancers but not GI malignancies. Benefits of GI NDC cancer care for underserved populations is yet to be quantified. Our GI-MDC was established to provide efficient, evidenced-based, high quality cancer care to patients of all ethnic and socioeconomic backgrounds. Methods: We prospectively identified underserved patients in seven categories. A GI nurse navigator (NN) contacted patients, coordinated appointments /diagnostic studies and prepared for prospective case evaluation and weekly multidisciplinary GI clinic. Health care efficiency/quality data was abstracted by an R.N. quality analyst. Outcomes were compared between underserved and non-underserved populations. Percentages were compared using Chi square and medians by Mann-Whitney U test. Results: From Jan 2010-July 2011, 208 patients were evaluated, with 137 confirmed new cancers, clinically estimated as Stage I=31, II=30, III=26, and IV=47. Among underserved patients, categories included age >80(n=26), public aid (n=28), uninsured (n=12), mental disability/impairment (n=15), incarcerated/institutionalized (n=4), and language barrier (n=2), more then one category could be selected. Outcomes are listed in the Table. Conclusions: A model of GI cancer care including a GI NN, treatment planning conference, and MDC clinic is feasible in a community cancer center. Preliminary data demonstrates small differences between underserved and non underserved patient populations. This model of health care may help to reduce disparities in cancer care. [Table: see text]

Improving the Accessibility of Patient Care Through Integration of the Hospital and Radiation Oncology Electronic Health Records

2017 ◽  
pp. 1-8
Author(s):  
Abhishek Ashok Solanki ◽  
Murat Surucu ◽  
Amishi Bajaj ◽  
Barbara Kaczmarz ◽  
Brendan Martin ◽  
...  
Keyword(s):  
Patient Care ◽  
Radiation Oncology ◽  
Multidisciplinary Care ◽  
Cancer Center ◽  
Health Records ◽  
Staff Members ◽  
Patients With Cancer ◽  
Electronic Health ◽  
The Impact

Purpose Radiation therapy (RT)–specific aspects of a patient’s cancer care commonly are documented and scheduled through a radiation oncology electronic health record (rEHR). However, patients who receive RT also receive multidisciplinary care from providers who use the hospital EHR (hEHR). We created an electronic interface to integrate our hEHR and rEHR to improve communication of the RT aspects of care between our department and the rest of the hospital. The objective of this study was to assess the impact of rEHR and hEHR integration on the accessibility of the RT-specific aspects of patient care to providers. Methods and Materials We performed a preintegration and postintegration survey of 175 staff members at our academic cancer center. Respondents rated the importance and accessibility of several RT encounters and documents on a Likert scale. The Wilcoxon-Mann-Whitney, χ2, and Fisher’s exact tests were used to compare preintegration and postintegration responses. Results There were 32 and 19 responses to the pre- and postintegration surveys, respectively. rEHR items most commonly reported to be at least moderately important were the dates of first treatment (n = 29 [91%]), last treatment (n = 29 [91%]), brachytherapy (n = 22 [69%]), radiosurgery (n = 22 [69%]), and computed tomography simulation (n = 21 [66%]). A drastic improvement was found in most items made visible in the hEHR through the interface. Conclusion By integrating our hEHR and rEHR, we improved the communication of patient care between the RT department and the multidisciplinary team. Institutions should pursue and support integration of the EHRs to improve the quality of care provided to patients with cancer.

Impact of a hospital specialty pharmacy in partnership with a free-standing care coordination organization on time to delivery and receipt of oral anticancer drugs.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 43-43
Author(s):  
Melissa Parsons Beauchemin ◽  
Morgan RL Lichtenstein ◽  
Rohit R. Raghunathan ◽  
Sahil D Doshi ◽  
Cynthia Law ◽  
...  
Keyword(s):  
Care Coordination ◽  
Multivariable Analysis ◽  
Cancer Center ◽  
Free Standing ◽  
Delivery Date ◽  
Anti Cancer ◽  
Before And After ◽  
Specialty Pharmacy ◽  
Insurance Data ◽  
To Receive

43 Background: Most oral anti-cancer drugs (OACD) prescriptions require extensive coordination between providers and payers, which can delay drug receipt. Specialty pharmacies are intended to facilitate communication between multiple entities to deliver OACDs with increased efficiency. In 2018, our cancer center partnered with Shields Health Solutions (SHS), a freestanding organization providing care coordination to implement a hospital-based specialty pharmacy. We evaluated the rate of failed drug receipt (FR) and time to drug receipt (TTR) before and after specialty pharmacy implementation. Methods: We prospectively collected data on all new OACD prescriptions for adult oncology patients at a large, urban cancer center from 1/1/2018 to 12/31/2019. In fall 2018, a specialty pharmacy was opened to facilitate drug procurement for patients. We collected patient demographic, clinical, and insurance data, OACD name, date prescribed, delivery date, and interactions with payers and financial assistance groups. For prescriptions received, TTR was the number of days from OACD prescription to patient receipt of the drug. FR was defined as failure to receive a prescribed OACD. We excluded OACD prescriptions for a washout period of two months during pharmacy initiation. We used multivariable logistic regression to examine factors associated with TTR > 7 days and FR before and after specialty pharmacy implementation. Results: In total, 883 patients were prescribed 1145 new OACDs. The majority of prescribed drugs were targeted treatment (56%, N = 646) and 72% (N = 819) required prior authorization (PA). Of all prescriptions, 86% (N = 999) were successfully received with an overall median TTR of 7 days. Adjusted analyses showed that patients were more likely to receive their drugs in less than 7 days after specialty pharmacy implementation (OR: 1.4 95% CI 1.04 – 1.81), p = 0.03). In an unadjusted analysis, patients were more likely to receive their initial medications after specialty pharmacy implementation, compared to before specialty pharmacy implementation (89% vs. 84%, p = 0.04). Multivariable analysis showed a trend toward more patients receiving drugs after specialty pharmacy implementation (OR: 1.42, 95% CI 0.98 – 2.03, p = 0.06). Conclusions: The implementation of a hospital-based specialty pharmacy in partnership with SHS decreased TTR. This difference is in part attributable to improved care coordination and communication. A centralized approach may improve overall efficiency due to fewer clinical practice disruptions.

Impact of medical mistrust (MM) on perceptions of tumor genomic profiling (TGP) among African American (AA) cancer patients: Application of perceptual mapping (PM).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e22527-e22527
Author(s):  
Michael J. Hall ◽  
Paul D'Avanzo ◽  
Yana Chertock ◽  
Jesse A Brajuha ◽  
Sarah Bauerle Bass
Keyword(s):  
Cancer Patients ◽  
Test Performance ◽  
Information Needs ◽  
University Hospital ◽  
Urban Site ◽  
Cancer Center ◽  
Medical Mistrust ◽  
Chi Square ◽  
Perceptual Mapping ◽  
Chi Square Analysis

e22527 Background: TGP is widely used to identify targetable mutations for precision cancer treatment and clinical trials. Many patients have poor understanding of TGP and are unaware of possible secondary hereditary risks. Lack of clarity regarding the relevance of informed consent and genetic counseling further magnify risks for patients. AA patients have lower genetic knowledge and health literacy and higher MM than Caucasian patients, making them especially vulnerable in the clinical setting. Perceptions of TGP in AA cancer patients have not been well-characterized. Methods: 120 AA pts from 1 suburban and 1 urban site (Fox Chase Cancer Center[FCCC] and Temple University Hospital[TUH]) were surveyed. A k-means cluster analysis using a modified MM scale was conducted; chi-square analysis assessed demographic differences. Perceptual mapping (PM)/multidimensional scaling and vector modeling was used to create 3-dimensional maps to study how TGP barriers/facilitators differed by MM group and how message strategies for communicating about TGP may also differ. Results: Data from 112 analyzable patients from FCCC (55%) and TUH (45%) were parsed into less MM (MM-L, n = 42, 37.5%) and more MM (MM-H, n = 70, 72.5%) clusters. MM-L and MM-H clusters were demographically indistinct with no significant associations by sex (p = 0.49), education (p = 0.3), income (p = 0.65), or location (p = 0.43); only age was significant (older = higher MM, p = 0.006). Patients in the MM-H cluster reported higher concerns about TGP, including cost (p < 0.001), insurance discrimination (p < 0.001), privacy breaches (p = 0.001), test performance/accuracy (p = 0.001), secondary gain by providers (p < 0.001) and provider ability to explain results (p = 0.04). Perceptual mapping identified both shared and contrasting barriers between MM clusters (Table). Conclusions: More than 2/3 of AA patients comprised a MM-H cluster. Communication strategies should focus on concerns about family and how to discuss TGP with an oncologist. PM can identify distinct and shared information needs of vulnerable populations undergoing TGP. [Table: see text]

scholarly journals Comparison of blood plasma and gelatin solution in resuscitation of children with dengue shock syndrome

2009 ◽  
Vol 49 (6) ◽  
pp. 322
Author(s):  
Suryadi Nicolaas Napoleon Tatura ◽  
Novie Homenta Rampengan ◽  
Jose Meky Mandei ◽  
Ari Lukas Runtunuwu ◽  
Max FJ Mantik ◽  
...  
Keyword(s):  
Blood Plasma ◽  
Dengue Shock Syndrome ◽  
Shock Rate ◽  
Gelatin Solution ◽  
Chi Square ◽  
Management Guidelines ◽  
Exact Test ◽  
Chi Square Test ◽  
A Prospective Study ◽  
To Receive

Background Dengue shock syndrome (DSS) is characterized bysevere vascular leakage and hemostasis disorder. It is the cause of death in 1 to 5 percent of cases. WH 0 management guidelines for resuscitation remain empirical rather than evidence-based.Objective To find out the alternative fluids to replace plasmaleakage in DSS.Methods We performed a prospective study and randomizedcomparison of plasma and gelatin solution for resuscitation ofIndonesian children with DSS. We randomly assigned 25 subjectswith DSS to receive plasma and 25 children to receive gelatinfluid. Statistical analyse were performed using chi-square test,Fisher's exact test, t test, Mann-Whitney test.Results The increment of pulse pressure width and the decrement of hematocrit in subjects treated with gelatin were higher than that of plasma atfour-hour therapy (P=0.002 and P=0.017). Only one patient died caused by unusually manifestation of DSS. The increment of body temperature in subjects treated with plasma was higher than that of gelatin at four-hour therapy (P=O.Oll). The decrement of platelet count in subjects treated with gelatin were less than that of plasma (P=0.018). The increment of diuresis rate in subjects treated with gelatin was higher than that of plasma at twenty-hour therapy (P<O.OOOl). The decrement of respiratory rate in subjects treated with gelatin was higher than that of plasmaat twenty-eight hour therapy (P=0.018). There was no differencein studied variables : total volume rate, blood pressure, pulse rate, re-shock rate, clinical fluid overload, allergy reactions, bleeding manifestations, and length of stay (P>0.05).Conclusions Gelatin solution can be used as volume replacementin resuscitation of DSS if blood plasma is not available especiallyat four-hour therapy.

scholarly journals Willingness to Accept COVID-19 Vaccine and Its Determinants among Nigeria Citizens: A Web-based Cross-sectional Study

2021 ◽  
pp. 13-22
Author(s):  
Olanrewaju Davies Eniade ◽  
Abayomi Olarinmoye ◽  
Agofure Otovwe ◽  
Funke E. Akintunde ◽  
Omowumi O. Okedare ◽  
...  
Keyword(s):  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Outcome Variable ◽  
Willingness To Accept ◽  
Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Other Information ◽  
Level Of Significance ◽  
To Receive

Background: The peculiarity in Nigerians’ demographic, socio-economic and cultural pattern necessitated the need to explore potential COVID-19 vaccine acceptance. This study investigated the determinants of willingness to receive COVID-19 vaccine in Nigeria. Methods: An online cross-sectional study among the general population in Nigeria. Data were collected using an electronic questionnaire.  A total of 368 individuals participated in the research. The outcome variable was willingness to accept COVID-19 vaccine coded as “Yes=1 and No=0.”  Basic socio-demographic information of participants and other information related to COVID-19 were obtained. Stata MP 14 was used for the statistical analysis. Descriptive statistics were presented, test of association were carried out using chi square and a binary logistic regression was used to assess the determinants of willingness to accept COVID-19 vaccine. All analyses were performed at 5% level of significance. Results: The mean age of the respondents was 29.4 + 9.65 years.  Majority of the study participants were female (58.9%), Yoruba (74.7%) and dwellers of urban area (68.5%). Also, 85.6% have attained tertiary level of education. Two-fifth (40.5%) of respondent reported their willingness to take the COVID-19 if made available. Majority (69.8%) of those that are willing to take the vaccine would prefer a live attenuated form and 39.6% would prefer the vaccine administered intramuscularly. Age group≥40 years (AOR: 5.20, CI: 1.02- 26.41), currently married (AOR: 2.81, CI: 1.05 – 7.53) and susceptibility to COVID 19 infection (AOR: 2.52, CI: 1.21 – 5.26) were associated with likelihood of willingness to accept COVID-19 vaccine. Conclusion: Despite the fact that majority were at risk of COVID-19 infection, willingness to receive COVID-19 vaccine was low among Nigerians. Level of maturity in terms of age and marriage as well as susceptibility to COVID-19 infection increased the likelihood of accepting COVID-19 infection. In Furtherance, younger ones, unmarried and non-susceptible individual may require more efforts tailored towards enrichment of understanding about the importance of COVID-19 vaccine in other to improve the acceptance of COVID-19 vaccine in Nigeria.

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