Prospective study of an AI enabled online intervention to increase delivery of guideline compliant cancer care, on the ground.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2011-2011
Author(s):  
C S. Pramesh ◽  
Bhawna Sirohi ◽  
Shona Milon Nag ◽  
Sudeep Gupta ◽  
Benjamin O. Anderson ◽  
...  
Keyword(s):  
Prospective Study ◽  
Primary Tumor ◽  
Cancer Care ◽  
Treatment Plan ◽  
Online Intervention ◽  
Expert Review ◽  
Treatment Plans ◽  
Tumor Distribution ◽  
To Receive

2011 Background: Despite survival benefits of guideline compliant cancer care, under treatment and over treatment are prevalent. Navya is an AI enabled online intervention that matches a patient’s medical record with NCCN and NCG guidelines (National Cancer Grid, India) and layers live multidisciplinary expert review to recommend actionable treatment plans. It was developed to standardize care and mitigate morbidity and mortality, by delivering on-t ime, guideline based expert treatment plans. Methods: From July 2019 to January 2020, all patients who received a Navya treatment plan based on guidelines and live expert review were included. Intended treatment plans were prospectively collected from the patient. Compliance of intended plans with NCCN (including Resource Stratified Framework) or NCG was measured. Noncompliant intended plans were categorized as overtreatment or undertreatment. After delivery of Navya plan, prospective phone follow up assessed whether noncompliant intended plans were changed to guideline compliant care. Results: Of 1707 consecutive patients who received a Navya plan, 1549 intended plans were available. Patients were diverse with respect to geographic, socioeconomic, and primary tumor distribution: West of India: 28%, North: 26%, East: 21%, South: 15%, Central: 7%, International: 3%; 35% of patients with income < $300/month; GI: 23%, Breast: 14%, Head & Neck: 11%, Thoracic: 10%. Of the 1549 intended plans, 441 (28.47% (95% CI ± 0.26%)) were not compliant with NCCN or NCG. Undertreatment was 35%, overtreatment 26%, incomplete staging workup 28% and 11% could not be categorized. Of 441 patients with noncompliant intended plans, 80.19% (± 0.97%) shared the Navya plan with their treating oncologists and 50.40% (± 0.88%) changed their intended plan to receive the Navya treatment plan. Intervention with Navya increased on-the -ground guideline compliance by ~15% (from 71.53% ±0.42% to 85.87% ± 1.73%). Conclusions: Guideline compliant care ensures best achievable clinical outcomes with existing therapies. A technological earthshot that significantly increases adoption of guideline based care is the first step towards cancer moonshots.

Willingness to Travel for Cellular Therapy: The Influence of Follow-Up Care Location, Oncologist Continuity, and Race

2021 ◽  
pp. OP.21.00312
Author(s):  
Zachary A. K. Frosch ◽  
Esin C. Namoglu ◽  
Nandita Mitra ◽  
Daniel J. Landsburg ◽  
Sunita D. Nasta ◽  
...  
Keyword(s):  
Travel Time ◽  
Cellular Therapy ◽  
Treatment Plan ◽  
Admission Rate ◽  
B Cell Lymphoma ◽  
Travel Times ◽  
Importance Weights ◽  
Follow Up Care ◽  
Treatment Plans

PURPOSE Patients weigh competing priorities when deciding whether to travel to a cellular therapy center for treatment. We conducted a choice-based conjoint analysis to determine the relative value they place on clinical factors, oncologist continuity, and travel time under different post-treatment follow-up arrangements. We also evaluated for differences in preferences by sociodemographic factors. METHODS We administered a survey in which patients with diffuse large B-cell lymphoma selected treatment plans between pairs of hypothetical options that varied in travel time, follow-up arrangement, oncologist continuity, 2-year overall survival, and intensive care unit admission rate. We determined importance weights (which represent attributes' value to participants) using generalized estimating equations. RESULTS Three hundred and two patients (62%) responded. When all follow-up care was at the center providing treatment, plans requiring longer travel times were less attractive ( v 30 minutes, importance weights [95% CI] of –0.54 [–0.80 to –0.27], –0.57 [–0.84 to –0.29], and –0.17 [–0.49 to 0.14] for 60, 90, and 120 minutes). However, the negative impact of travel on treatment plan choice was mitigated by offering shared follow-up (importance weights [95% CI] of 0.63 [0.33 to 0.93], 0.32 [0.08 to 0.57], and 0.26 [0.04 to 0.47] at 60, 90, and 120 minutes). Black participants were less likely to choose plans requiring longer travel, regardless of follow-up arrangement, as indicated by lower value importance weights for longer travel times. CONCLUSION Reducing travel burden through shared follow-up may increase patients' willingness to travel to receive cellular therapies, but additional measures are required to facilitate equitable access.

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.

Care coordination for oral oncolytics through pharmacy integration and cycle 1-day 1 documentation.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 260-260
Author(s):  
Nancy Walker Peacock ◽  
Stacey McCullough ◽  
Jared Crumb ◽  
Leah Owens ◽  
Laura Kaufman ◽  
...  
Keyword(s):  
Process Improvement ◽  
Treatment Plan ◽  
Processing System ◽  
Subsequent Treatment ◽  
Pharmacy Staff ◽  
Drug Counseling ◽  
Medical Oncologists ◽  
Treatment Plans ◽  
Oral Oncolytics

260 Background: The growing number of oral oncolytic therapies (OOTs) necessitates a standardized EMR workflow that integrates pharmacy activities for dispense and patient management and standardizes cycle-1/day-1 (C1D1) documentation. Our practice’s treatment plans contain appropriately timed OOT follow-up activities including labs, physician follow-up visits, and pharmacy calls for toxicity and adherence checks, however complications in prescription fulfillment such as prior authorization, co-pay assistance, or inability of in-practice pharmacy to dispense limit the predictability of C1D1 dates of OOTs. Methods: An EMR query identified patients at a single clinic location of 5-medical oncologists (MDs) for whom oral oncolytic treatment plans were entered from January 1 to June 30, 2018. C1D1 date entered by the MD in the EMR was compared to the pharmacy processing system dispense date. Ten patients were identified, and 10% (1/10) had an accurate C1D1 documented within the EMR. As part of the ASCO Quality Training Program, to improve the accuracy of C1D1 documentation, a new workflow was implemented whereby: (1) a “hold” activity was added to new EMR treatment plans so that C1D1 remained pending until patients had received medication; (2) clinic checkout staff provided patients with information on the in-practice pharmacy and expectations for next steps; (3) pharmacists utilized existing reporting tools to identify newly entered treatment plans and transcribed orders into e-prescriptions sent to our practice pharmacy; (4) the pharmacy workflow ensued with pharmacy staff leading patient engagement, drug counseling; (5) pharmacists confirm C1D1, document within EMR (6) subsequent treatment plan activities were scheduled. Results: Following education and process changes within the clinic and pharmacy, accurate C1D1 documentation occurred in 90% (9/10) of patients initiating OOTs. Conclusions: Including pharmacy fulfillment time in EMR workflow can improve C1D1 documentation accuracy and associated management of OOTs. Education regarding roles and processes of prescribing MDs, pharmacy staff and clinic staff will be required to scale this process improvement throughout the organization.

scholarly journals The Association between Age, Comorbidities and Use of Radiotherapy in Women with Breast Cancer: Implications for Survival

2018 ◽  
Author(s):  
Jimmy T. Efird ◽  
Sharyn Hunter ◽  
Sally Chan ◽  
Sarah Jeong ◽  
Susan L. Thomas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Women ◽  
Related Factors ◽  
Hazard Ratios ◽  
American College Of Surgeons ◽  
Treatment Plans ◽  
Measure Of Association ◽  
Near Future ◽  
To Receive

Background: Radiotherapy plays an important role in the management and survival of patients with breast cancer. The aim of this study was to examine the association between age, comorbidities and use of radiotherapy in this population. Methods: Patients diagnosed with breast cancer from 2004&ndash;2013 were identified from the American College of Surgeons National Cancer Database (NCDB). Follow-up time was measured from the date of diagnosis (baseline) to the date of death or censoring. Adjusted hazard ratios (aHR) and 95% confidence intervals (95%CI) were used as the measure of association. Results: Independently of comorbidities and other important outcome-related factors, patients &gt;65 years of age who received radiotherapy survived significantly longer than those who did not receive radiotherapy (aHR = 0.53, 95%CI = 0.52&ndash;0.54). However, as women aged, those with comorbidities were less likely to receive RT (adjusted P-trend by age &lt;0.0001). Conclusions: The development of decision-making tools to assist clinicians, and older women with breast cancer and comorbidities, are needed to facilitate personalized treatment plans regarding RT. This is particularly relevant as the population ages and the number of women with breast cancer is expected to increase in the near future.

EMR-linked cancer tracker facilitates lung and liver cancer care.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 77-77 ◽  
Author(s):  
Tamar H. Taddei ◽  
Laura Hunnibell ◽  
Anne DeLorenzo ◽  
Mirta Rosa ◽  
Donna Connery ◽  
...  
Keyword(s):  
Liver Cancer ◽  
Cancer Care ◽  
Tracking System ◽  
Treatment Plan ◽  
Safety Net ◽  
Easy Access ◽  
Web Based ◽  
Lung Cancers ◽  
Radiology Reports

77 Background: VA Connecticut Healthcare System has developed a web-based, EMR-linked Cancer Care Tracking System (CCTS) to facilitate tracking and follow-up of patients with imaging abnormalities concerning for lung or liver cancer. The tracker was developed to facilitate the efforts of a multidisciplinary team at the center of which is a cancer navigator. Methods: CCTS was first envisioned in 2007 when VACT hired a care navigator and implemented a radiology coding system to identify potential cancers. This created the need for a tool to process abnormal images and track the clinical steps required to reach a definitive diagnosis and treatment plan. CCTS was initially used for lung cancers and was expanded to track hepatocellular carcinoma (HCC) in 2009 with additional funding. In addition to case discovery, it offers easy access to patient information with live links to the VA EMR, a surveillance feature, and scheduling, alerting, and reporting functions. In 2011, the system was enhanced with a natural language processing (NLP) program that automatically identifies radiology reports describing potentially malignant lung or liver lesions. Results: CCTS has been in daily operation since February 2010, with 1,778 patients and 2,503 patients tracked in 2010 and 2011, respectively. Addition of NLP technology significantly increases the accuracy of identification of patients with lung or liver nodules. The NLP system identified 21% of all new cases with potential malignancies whose management could have been delayed through coding omissions or errors. Benefits of CCTS and our cancer care coordination program have included a decrease of 25 days in the time from abnormal image to treatment of lung cancer, a significant increase in the diagnosis of stage I/II lung cancers from 32% to 48%, and an increase in the incidence of liver cancer from 1% to 5% of all cancers at VACT. Conclusions: A web-based, EMR-linked cancer care tracking system (CCTS) improves cancer detection, prevents loss to follow-up, provides a safety net for radiology coding omissions or errors, and improves provider efficiency. CCTS is an innovative tool to support multidisciplinary cancer care and has broad applicability to any electronic medical record.

scholarly journals Going for Broke: A Longitudinal Study of Patient-Reported Financial Sacrifice in Cancer Care

2018 ◽  
Vol 14 (9) ◽  
pp. e533-e546 ◽  
Author(s):  
Fumiko Chino ◽  
Jeffrey M. Peppercorn ◽  
Christel Rushing ◽  
Jonathan Nicolla ◽  
Arif H. Kamal ◽  
...  
Keyword(s):  
Cancer Care ◽  
Baseline Survey ◽  
Patients With Cancer ◽  
Risks And Benefits ◽  
Patient Reported ◽  
Insured Patients ◽  
To Receive ◽  
Over Time ◽  
Out Of Pocket Costs

Purpose: Patients with cancer are at risk for substantial treatment-related costs; however, little is known about patients’ willingness to sacrifice to receive cancer care and how their attitudes and burden may change with time. Patients and Methods: We conducted a longitudinal survey of insured patients with solid tumor cancers receiving chemotherapy or hormonal therapy. Patients were surveyed at two time points about their willingness to make financial sacrifices and their actual sacrifices, including out-of-pocket costs. Patient attitudes and sacrifices were compared over time. Results: Of 349 patients approached, 300 completed the baseline survey (86% response) and 245 completed the follow-up survey 3 months later (82% retention). Median patient-reported cancer-related out-of-pocket costs for patients who completed both surveys were $393 per month (range, $0 to $26,586 per month) at baseline and $328 per month (range, $0 to $8,210 per month) at follow-up. At baseline, 49% were willing to declare personal bankruptcy, 38% were willing to sell their homes, and ≥ 65% were willing to make other sacrifices, including borrowing money to afford their cancer care. Upon follow-up, there were minor decreases in willingness; the maximum net change was a 7% decline in patients willing to declare bankruptcy. Actual sacrifice increased over time; the greatest increase was in patients who used their savings (increased from 41% to 54%). Conclusion: A large proportion of insured patients with cancer were willing to make considerable personal and financial sacrifices to receive care; these attitudes did not change greatly over time. Shared decision making is important to ensure patients fully understand the goals, risks, and benefits of therapy before they make such personal sacrifices.

scholarly journals Identifying Critically Ill Patients at Risk of Malnutrition and Underfeeding: A Prospective Study at an Academic Hospital

2019 ◽  
Vol 9 (2) ◽  
pp. 314-320 ◽  
Author(s):  
Fatemeh Osooli ◽  
Saeed Abbas ◽  
Shadi Farsaei ◽  
Payman Adibi
Keyword(s):  
Prospective Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Small Body ◽  
Trauma Patients ◽  
Medical Patients ◽  
Nutrition Risk ◽  
Factors Associated ◽  
To Receive

Purpose: Malnutrition is highly prevalent in critically ill patients and is associated with the increased healthcare-related cost and poor patient outcomes. Identifying the factors associated with undernutrition may assist nutritional care. Therefore, this study was designed to identify factors associated with malnutrition and inadequate energy intake to improve nutritional support in intensive care unit (ICU). Methods: This prospective study was conducted on 285 random samples of ICU patients. We reported time to initiate the enteral nutrition, percent of the adequately received nutrition, and development of malnutrition during the follow-up period. Moreover, variables and clinical outcomes associated with calories underfeeding and malnutrition were reported. Results: In 28.6% of samples, enteral feeding was initiated greater than 48 hours after ICU admission. During follow-up, 87.4% and 83.3% of patients failed to receive at least 80% of protein and energy target, and malnutrition developed in 84% of study population. Moreover, surgical and medical patients compared to trauma patients were associated with underfeeding. However, only nutrition risk in the critically ill score (NUTRIC) score ≥5 could predict malnutrition development in our study. Finally, underfeeding contributed significantly to a more mortality rate both in ICU and hospital. Conclusion: Our findings revealed that the majority of nutritionally high-risk patients failed to receive adequate calories and subsequently developed malnutrition. The present study added valuable information to the small body of literature about the factors affecting nutritional decline and malnutrition during the ICU stay.

scholarly journals Outcomes associated with a negotiated asthma treatment plan

2012 ◽  
Vol 9 (3) ◽  
pp. 175-182 ◽  
Author(s):  
Noreen M Clark ◽  
Yi-An Ko ◽  
Z Molly Gong ◽  
Timothy R Johnson
Keyword(s):  
Health Care ◽  
Treatment Plan ◽  
Symptom Control ◽  
Emergency Department Visits ◽  
Health Care Use ◽  
Oral Steroid ◽  
Oral Steroids ◽  
Treatment Plans ◽  
Asthma Outcomes

Negotiated treatment plans are increasingly recommended in asthma clinical care. However, limited data are available to indicate whether this more patient-engaged process results in improved health outcomes. The aim of this study was to determine the associations between the presence of a negotiated treatment plan and the outcomes related to adherence to the medical regimen, symptom control, and health care use. The focus of the study was on women, the subgroup of adult patients, who are most vulnerable for negative asthma outcomes. Data were collected by telephone interview and medical record review from 808 women diagnosed with asthma at baseline, first year, and second year follow-up. Associations were examined between the presence of a negotiated treatment plan at baseline and subsequent asthma outcomes. Women with a negotiated treatment plan reported more adherent to prescribed asthma medicines (odds ratio (OR) = 2.41, 95% confidence interval (CI) = (1.82, 3.19)) and those with a plan and using oral steroids at baseline had less oral steroid use at follow-up (OR = 0.21, 95% CI = (0.05, 0.93)). Women with a negotiated plan also had more days (17%, 95% CI = (8, 27)) and nights (31%, 95% CI = (16, 48)) with symptoms than those without such a plan. No differences in hospitalizations, emergency department visits, or urgent physician office visits were noted between the groups. Patients with higher education levels were more likely to have a negotiated treatment plan. Negotiated treatment plans appear to have achieved greater adherence to prescribed asthma medicines and less need for oral steroids but were not related to fewer symptoms of asthma or reductions in urgent health care use. Additional strategies may be needed to reduce symptom and health services utilization outcomes.

Response to an Education Program for Parents About Adult Pertussis Vaccination

2009 ◽  
Vol 30 (6) ◽  
pp. 589-592 ◽  
Author(s):  
Pui-Ying Iroh Tam ◽  
Paul Visintainer ◽  
Donna Fisher
Keyword(s):  
Prospective Study ◽  
Educational Intervention ◽  
Pertussis Vaccine ◽  
Tetanus Toxoid ◽  
Education Program ◽  
Acellular Pertussis Vaccine ◽  
Diphtheria Toxoid ◽  
A Prospective Study ◽  
To Receive

We designed a prospective study to evaluate the effectiveness of an educational intervention designed to increase awareness and knowledge of pertussis among parents and grandparents of newborns. We also evaluated its effect on their willingness to receive the tetanus toxoid-diphtheria toxoid-acellular pertussis vaccine. There was a statistically significant (P < .05) increase in participants' knowledge about pertussis and in their willingness to receive vaccination after our education program. However, follow-up several months after participants underwent the intervention revealed that only 12 (8%) of 150 participants had been vaccinated.

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