Barriers to accessing healthcare services: A multidisciplinary approach towards improving pancreatic cancer survival in a Canadian province.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18018-e18018
Author(s):  
Elizabeth Faour ◽  
Bruce Colwell ◽  
Nathan William Dana Lamond ◽  
Stephanie Leann Snow ◽  
Alwin S. Jeyakumar ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Survival Data ◽  
Multidisciplinary Team ◽  
Barriers To Care ◽  
Healthcare Delivery ◽  
Wait Time ◽  
Cancer Center ◽  
Time Data ◽  
Access To Treatment ◽  
Improvement Project

e18018 Background: Pancreatic cancer (PC) is associated with the highest death rate among common malignancies and is the fourth leading cause of cancer-related death in North America. Despite similar access to treatment options across Canada, the province of Nova Scotia (NS) has the lowest 5-year survival rate for PC. To investigate reasons behind the poor PC outcomes in NS, a multidisciplinary team was created to investigate barriers to care and streamline patient flow. In 2016, initial data informed the reorganization of the hepatopancreaticobiliary (HPB) multidisciplinary team towards the goal of identifying and reducing barriers to care and, ultimately, improving survival. Methods: This quality improvement project included a retrospective chart review of PC patient data from a single institution (The NS Cancer Center), where over 80% of PC patients from this province are seen. A review of PC diagnosis, referrals patterns, and wait time data was undertaken. Results: Data was extracted on 365 patients with a diagnosis of PC between 2011 and 2014. During that period, only 40.4% of patients diagnosed with PC had a tissue diagnosis and just over 71% had a baseline CA19-9. Referral rate to Medical Oncology (MO) was 53%, mean wait time to see MO was 37.2 days and only 23% of patients received systemic treatment. Initiatives to improve access to care included standardization of diagnostic procedures, early triaging of referrals, transfer of port-a-cath (PAC) insertions from interventional radiology to the HPB surgeons, and the creation of provincial guidelines, which were implemented in 2016. Positive Improvements were observed in all identified barriers to care. Conclusions: Barriers to accessing care for PC patients in NS were identified, and a multidisciplinary team proposed provincial guidelines were implemented to expedite care. Preliminary results show improvement in all aspects of healthcare delivery. Survival data will be available in late 2019. [Table: see text]

Wait time reduction for patients awaiting chemotherapy infusion using a formal process improvement approach and sequential.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 92-92
Author(s):  
Andrew David Norden ◽  
Lori A. Buswell ◽  
Meg Amorati ◽  
Lois Arthur ◽  
Antoinette Bernard ◽  
...  
Keyword(s):  
Wait Time ◽  
Baseline Data ◽  
Cancer Center ◽  
Wait Times ◽  
Time Data ◽  
Statistical Process ◽  
Effect Analysis ◽  
Process Improvements ◽  
Reminder System ◽  
Exam Room

92 Background: At a community hospital satellite of an academic cancer center, baseline data indicated that 49% of patients waited longer than 30 minutes from arrival in the treatment chair until treatment was started, resulting in dissatisfaction and decreased chair turnover. Methods: A team was assembled, including physicians, nurses, pharmacists, and administrative staff. The team constructed a detailed process flow map and performed a cause-and-effect analysis. Wait time data were collected using the electronic scheduling system and time sheets. Additionally, nurses used a structured data collection sheet to categorize the reasons for prolonged wait times. A p-type statistical process control chart was constructed to track the proportion of infusion visits per day with wait times longer than 30 minutes. The team brainstormed process improvements and selected ones to implement by employing a priority/pay-off matrix. Results: Baseline data were assessed for 403 visits over a 3 week period. Of 232 visits with wait times longer than 30 minutes, 98 (42%) involved excessive waiting for the physician to see the patient or write orders. One of 4 physicians was responsible for 56 (57%) of these. This physician’s patients were seen exclusively in the infusion room, while the other physicians saw patients in the exam room before sending them to the infusion area. Three PDSA cycles were conducted: (1) All physicians started seeing patients in the exam room before sending them to infusion chairs, (2) Specific treatments were selected that could be routinely administered without the physician seeing the patient, and (3) A reminder system prompted physicians to enter treatment orders within 24 hours of each patient’s visit. After 6 months, 29% of patients waited longer than 30 minutes, down from 49% at baseline. Conclusions: These interventions implemented using PDSA cycles successfully reduced wait times. Measurement and presentation of data were critical in persuading physicians to practice in a more homogeneous fashion.

Optimizing infusion wait time: Redesigning medication order verification/approval at a comprehensive cancer center.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14042-e14042
Author(s):  
Neda Hashemi-Sadraei ◽  
Zoneddy R. Dayao ◽  
Shenthol Sasankan ◽  
Andrea Cox ◽  
Sandra Peacock ◽  
...  
Keyword(s):  
Wait Time ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Wait Times ◽  
Medication Order ◽  
Time Data ◽  
Safety Standards ◽  
University Of New Mexico ◽  
Flat Dose ◽  
Nurse Assessment

e14042 Background: Nationwide, many cancer centers experience challenges with infusion center efficiency while maintaining high safety standards. Many factors contribute to long wait times for patients on the day of their infusion appointments. At University of New Mexico Comprehensive Cancer Center (UNMCCC), a contributing factor is the delays in verification or approval of medications. We conducted a project to improve order verification/approval workflow within a Plan-Do-Study-Act (PDSA) framework with the objective to decrease the infusion wait time. Methods: A multidisciplinary working group was formed consisting of the infusion floor physician lead, nurse lead, pharmacy lead, and analytics and process improvement leads. Upon exploring the infusion workflow database, disruptions in verification or approval of orders had a large impact on wait times. Order verification workflow was broken down into 3 steps: 1) physician assessment of patient and approval of orders, 2) infusion nurse assessment of patient, 3) pharmacist verification of order. Beginning Feb 2019, the following interventions were implemented in each section: 1) once patient was assessed by physician and orders approved, the patient was marked as “ready-to-treat”. 2) Pharmacist verified the order once “ready-to-treat” was communicated and initiated preparation of medications prior to arrival of patient to the infusion suit. 3) Infusion nurse assessment occurred once patient was seated on infusion chair. 4) Physicians were encouraged to pre-approve selected injections by the morning of patient appointment. Results: Prospective wait time was gathered for May 2019 using the real-time data available in the electronic medical record. Wait times were analyzed for patients receiving chemotherapy or flat dose injections. By marking appropriate patients “ready-to-treat” and moving pharmacist verification prior to infusion nurse assessment, there was an immediate decrease in wait time from 79 to 60 min. Selected injections which did not require mixing were pre-approved by the physician and stored in the medication dispensing system (Pyxis). This resulted in decrease in the injection wait time by 8.5 minutes, without wasting of drugs. Conclusions: Redesigning the medication order verification/approval workflow resulted in reduced wait times for patients receiving infusions or injections. We aim to further refine our PDSA cycles and ensure sustainability of change.

scholarly journals Decreased Wait Time and Increased Satisfaction With Bedside Pancreatic Enzyme Dosing for the Inpatient Adolescent With Cystic Fibrosis: A Quality Improvement Project Comparing Enzyme Self-Administration to Nurse Administration

2021 ◽  
Vol 8 ◽  
pp. 237437352098149
Author(s):  
Brandi Middour-Oxler ◽  
Margaret Gettis ◽  
Betsy Dye
Keyword(s):  
Cystic Fibrosis ◽  
Pancreatic Enzyme ◽  
Wait Time ◽  
Self Administration ◽  
Nurse Satisfaction ◽  
Improvement Project ◽  
Hospital Unit ◽  
Pediatric Inpatient ◽  
Inpatient Adolescent ◽  
Enzyme Delivery

For children with cystic fibrosis (CF), enzymes are essential with meals to absorb nutrients and ensure adequate growth. When hospitalized, CF patients typically rely on nurse-administered medications. Recently, a pediatric hospital unit began allowing adolescents with CF enzymes at the bedside. Postimplementation, a satisfaction questionnaire was administered to participating patients and nurses measuring patient and nurse satisfaction with access to bedside enzymes versus nurse administration and overall time for enzyme delivery. The survey utilized a 5-point Likert scale. The wait time for pancreatic enzymes decreased for self-administered enzymes when compared to those that were nurse administered. All (11/11) patients and 86% (12/14) of nurses preferred the self-administration of enzymes. Hospitalized pediatric CF patients and nurses had higher levels of satisfaction with enzyme self-administration. Immediate access to enzymes in room safes impact patient autonomy, reflecting home self-care practices. Decreases in wait times optimize nutritional growth and healing while hospitalized. As a result, a new limited scope policy allowing patient-administered enzymes is now in place in the pediatric inpatient CF unit.

scholarly journals Health Improvement Project Zanzibar: a new model of healthcare delivery

2015 ◽  
Vol 6 (5) ◽  
pp. 35-39 ◽  
Author(s):  
Mike Spencer ◽  
Fiona Greville-Heygate ◽  
Ramsay Singer ◽  
Jonathan Rees ◽  
Ruaraidh MacDonagh
Keyword(s):  
Healthcare Delivery ◽  
Health Improvement ◽  
Improvement Project ◽  
New Model

Efficacy and safety of 5-fluorouracil (5-FU) / levofolinate / irinotecan (FOLFIRI) for previously treated advanced pancreatic cancer (APC).

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 407-407
Author(s):  
Hiromichi Shirasu ◽  
Takeshi Kawakami ◽  
Satoshi Hamauchi ◽  
Takahiro Tsushima ◽  
Akiko Todaka ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Treatment Cycle ◽  
Initial Dosage ◽  
Advanced Pancreatic Cancer ◽  
Previous Treatment ◽  
Progression Free Survival ◽  
Cancer Center ◽  
Line Treatment ◽  
Median Treatment ◽  
Treatment Line

407 Background: 5-fluorouracil (5-FU) / levofolinate / irinotecan (FOLFIRI) is one of the preferred regimens for patients (pts) with advanced pancreatic cancer (APC) who received prior gemcitabine-based therapy in the National Comprehensive Cancer Network Guidelines. However, its survival benefit or safety in clinical practice is unclear. Methods: We retrospectively assessed the data of consecutive pts with APC who received FOLFIRI as a second or later-line treatment after gemcitabine-based therapy at Shizuoka Cancer Center between May 2014 and March 2020. Results: The characteristics of 102 pts included in this analysis were as follows: median age (range), 67 (39-78) y; male/female, 55/47; ECOG PS0/1/2, 21/72/9; the number of metastatic sites 0/1/2/3/4, 7/48/35/8/4; unresectable/recurrent, 84/18; UGT1A1 status wild/*6 or*28 heterozygous/homo or double-heterozygous/unknown, 40/40/5/17; treatment line of FOLFIRI 2nd/3rd/4th, 64/32/6. Previous treatment history according to the treatment line of FOLFIRI was as follows: 2nd-line, all patients received GEM-based regimen, GEM plus nanoparticle albumin bound paclitaxel in 63 pts (98.4%) and GEM in 1 (1.6%); 3rd, GEM-based and S1 in 20 (62.5%), GEM-based and 5-FU/levofolinate/oxaliplatin (FOLFOX) in 12 (37.5%); 4th, GEM-based, FOLFOX and S-1 or other agent in 5 (83.3%), 2 GEM-based regimens and S1 in 1 (16.7%). The median treatment cycle was 5 (range 1-55). The median treatment cycle according to the treatment line was as follows: 2nd-line, 7(1-55); 3rd, 4(1-14); 4th, 3.5(1-10). The initial dosage for each cytotoxic agent was as follows: bolus 5-FU injected/omited 72/30; continuous 5-FU 2400/2000/1200 mg/m2, 88/13/1; irinotecan 180/150/120/less than or equal to 100mg/m2, 27/59/13/3. The overall response rate (ORR) and disease control rate (DCR) were 5.9% and 52.9%, respectively. ORR and DCR according to the treatment line were as follows: 2nd-line, 9.3/64.1%; 3rd, 0/68.8%; 4th, 0/50.0%. At the median follow up 6.5 M, the median overall survival (OS) and progression free survival (PFS) were 6.6M and 3.1M, respectively. The median OS and PFS according to the treatment line were as follows: 2nd-line, 8.1/3.6M; 3rd, 5.1/2.1M; 4th, 6.6/2.0M. Adverse events (AEs) were observed in 70.8% pts. Grade 3 or higher AEs occurred in 27.2% pts [neutropenia in 26 (25.2%) pts, febrile neutropenia in 4 (3.9%) pts, nausea in 4 (3.9%) pts, decreased appetite in 3 (2.9%) pts]. No treatment related deaths were observed. Conclusions: FOLFIRI is well tolerated and effective especially in the second-line treatment for pts with gemcitabine-refractory APC.

Pancreatic cancer outcomes in Nova Scotia: Searching for small windows of opportunity.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16219-e16219
Author(s):  
Peiran Sun ◽  
Ravi Ramjeesingh
Keyword(s):  
Older Adults ◽  
Pancreatic Cancer ◽  
Multivariate Analysis ◽  
Nova Scotia ◽  
Group Performance ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Healthcare Delivery ◽  
Wait Times ◽  
Significant Difference

e16219 Background: While pancreatic cancer (PC) globally has poor outcomes, there are still regional variation in PC outcomes in Canada. Nova Scotia (NS) has been documented to have some of the worst outcomes in PC but the details and barriers to the care of PC in NS have never been analyzed. Methods: A retrospective chart review was performed on PC patients (pts) diagnosed in NS from 2013 to 2017 for patient characteristics, referral pattern, treatments and wait times. Cox proportional hazards methods were used to analyze overall survival (OS) with Age, Stage, Eastern Cooperative Oncology Group Performance Status (PS), Charleston Comorbidity Index (CCI), receiving ERCP and receiving chemotherapy as covariates in the multivariate analysis. Results: 667 consecutive pts were identified, which included 357 males and 310 females with a median age of 71 at diagnosis. 42 (6.25%) lived beyond 2 years, while 163 (24.4%) survived for under 30 days and 260 (39%) survived for under 60 days. Patients with a limited survival (under 30 days) when compared to pts who survived > 60 days are older (mean 75 vs 71, P < 0.05), had a higher proportion of ECOG > 2 (81.6% vs 20.3%, P < 0.01), and a higher proportion of stage 4 disease (73.9% vs 41.2%, P < 0.01). There was no significant difference in any measure of wait times. Pts with limited survival were less likely to be seen by Medical Oncology (MO) (20.9% vs 70.9%, P < 0.001), and less likely to receive chemotherapy (1.2% vs 45%, P < 0.001) or ERCP (27% vs 53.8%, P < 0.01). Multivariate analysis showed that receiving ERCP (P = 0.027) and chemotherapy(P < 0.001) are independent predictors of survival, even when accounting for PS, CCI, stage, and age. Conclusions: Analysis of PC outcomes in NS demonstrates a large proportion of pts dying within 30 days of diagnosis. Those pts are older and present with higher stage and worse PS but did not have any significant difference in diagnostic and referral wait times. Those pts receive fewer referrals to Oncology services, fewer potentially life prolonging treatments and we uniquely discovered ERCP as an independent predictor of survival in our population. While further work is needed, this study characterized some of the unique challenges of PC care in NS as a province with a higher proportional of older adults and highlights potential opportunities to improve early healthcare delivery in older adults with limited windows for care.

scholarly journals Group Therapy Treatment for Food Selectivity (FS17-05-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Sean Logie ◽  
Courtney Gengler ◽  
Lesley Wofford ◽  
Emily Hecht
Keyword(s):  
Group Therapy ◽  
Exposure Therapy ◽  
Wait Time ◽  
Token Economy ◽  
Food Selectivity ◽  
Improvement Project ◽  
Novel Foods ◽  
Funding Sources ◽  
Exposure Sessions ◽  
Evidenced Based

Abstract Objectives The purpose of this quality improvement project was to implement a group exposure therapy intervention to more efficiently serve the patients that are referred to our hospital due to severe food selectivity. Methods The intervention used evidenced-based practices such as systematic desensitization, a token economy, counterconditioning, and parent training to help patients expand their food repertoire. The intervention is a 12-week multi-family group therapy for children that range in age from 4–14. Patients are placed into groups of no more than six members of similar age. In 11 of the sessions, therapists direct patients through an exposure hierarchy with novel foods and record the number of bites patients take of each food. In 4–5 sessions, a psychologist meets with parents separately to discuss how to use exposure therapy to treat food selectivity. We examined data from the groups that ran from March 2016 to June 2018. Results Using a Wilcoxon Signed-Ranks Test, we compared the number of bites of novel foods that patients took in the first and last food exposure sessions. Results indicated that patients took significantly more bites of novel foods in the last group (median = 34) compared to the first group (median = 8.5), z = 4.79, P < .001. Conclusions The outcomes of this project suggest that time-limited group interventions may help children who struggle with severe food selectivity. Time-limited groups also may also decrease treatment wait time for patients with severe food selectivity because patients can be seen simultaneously and with clear start and end date for the service. Funding Sources N/A. Supporting Tables, Images and/or Graphs

scholarly journals Variation in long-term oncologic outcomes by type of cancer center accreditation: An analysis of a SEER-Medicare population with pancreatic cancer

2020 ◽  
Vol 220 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Zhi Ven Fong ◽  
David C. Chang ◽  
Chin Hur ◽  
Ginger Jin ◽  
Angela Tramontano ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Oncologic Outcomes ◽  
Cancer Center ◽  
Medicare Population

scholarly journals Additive Hazard Regression for the Analysis of Clustered Survival Data from Case-Cohort Studies

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
June Liu ◽  
Yi Zhang
Keyword(s):  
Cohort Studies ◽  
Survival Data ◽  
Failure Time ◽  
Weight Functions ◽  
Disease Rate ◽  
Failure Time Data ◽  
Finite Sample ◽  
Time Data ◽  
Cohort Design ◽  
Clustered Survival Data

The case-cohort design is an effective and economical method in large cohort studies, especially when the disease rate is low. Case-cohort design in most of the existing literature is mainly used to analyze the univariate failure time data. But in practice, multivariate failure time data are commonly encountered in biomedical research. In this paper, we will propose methods based on estimating equation method for case-cohort designs for clustered survival data. By introducing the event failure rate, three different weight functions are constructed. Then, three estimating equations and parameter estimators are presented. Furthermore, consistency and asymptotic normality of the proposed estimators are established. Finally, the simulation results show that the proposed estimation procedure has reasonable finite sample behaviors.

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