Disparities between provider assessment and documentation of care needs in the care of adolescent and young adult patients with sarcoma.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 218-218
Author(s):  
Grace Eileen McKay ◽  
Amanda Marie Parkes

218 Background: Given the occurrence of cancer during a complex developmental time, adolescent and young adult (AYA) patients have unique psychosocial needs, necessitating supportive care guidelines including National Comprehensive Cancer Network (NCCN) AYA guidelines. We sought to assess compliance with NCCN AYA guidelines and compare to oncology provider identified AYA care needs. Methods: Retrospective chart review was performed on AYA patients (15-39 years) with sarcoma seen at least once in 2019 at the University of Wisconsin (UW), identifying documentation of discussions deemed critical per NCCN AYA guidelines. As per ASCO’s Quality Oncology Practice Initiative certification, we considered a threshold of 75% or higher to be compliant. Compliance was compared with an electronic survey of UW oncology providers regarding AYA patient needs, with items determined to have adequate resources if noted sufficient by >75% of providers. Results: We identified 43 AYA patients with sarcoma. As seen in table, <75% of patients had documentation regarding contraception, fertility, finances, genetics, social work referral and clinical trials indicating non-compliance. Surveys, completed by 38 oncology providers, showed significant discordance between provider’s perception of adequate access to resources and compliance on chart review. Conclusions: Disparities between oncology provider assessment of AYA care needs and lack of documentation of critical components of AYA patient care demonstrates the need for novel tools to evaluate AYA care needs beyond provider assessments. Care needs identified in our study will serve as the basis of an ongoing quality improvement project to better support AYA patients at UW. [Table: see text]

2021 ◽  
pp. OP.20.00938
Author(s):  
Grace E. McKay ◽  
Anna L. Zakas ◽  
Fauzia Osman ◽  
Cathy Lee-Miller ◽  
Priyanka Pophali ◽  
...  

PURPOSE: Given the occurrence of cancer during a complex developmental time, adolescent and young adult (AYA) patients have unique psychosocial needs that necessitate supportive care, which is optimally provided using National Comprehensive Cancer Network (NCCN) AYA guidelines. We sought to explore compliance with NCCN AYA guidelines and compare with oncology providers' perceptions of AYA care needs. METHODS: Retrospective chart reviews of AYA patients (15-39 years at time of cancer diagnosis) with sarcoma seen at least once in 2019 at the University of Wisconsin identified documentation of discussions deemed critical per NCCN AYA guidelines. As per the ASCO Quality Oncology Practice Initiative certification, we considered a threshold of these factors being discussed 75% of the time or higher to be compliant. Compliance was compared with an electronic survey of University of Wisconsin oncology providers regarding AYA patient needs, with items determined to have adequate resources if noted sufficient by at least 75% of providers. RESULTS: We identified 43 AYA patients with sarcoma. Less than 75% of patients had documentation of discussion of contraception, sexual health, fertility, finances, genetics, social work referral, and clinical trials indicating noncompliance with NCCN guidelines. Surveys, completed by 38 oncology providers, showed significant discordance between providers' perceptions of AYAs' access to resources and providers' documented discussions of supportive care resources. CONCLUSION: Disparities between oncology provider assessment of AYA care needs and documentation of critical components of AYA patient care demonstrate the need for novel tools to evaluate AYA care needs beyond provider assessments.


2021 ◽  
Author(s):  
Kee Kiat Yeo ◽  
Darcy E Burgers ◽  
Katelynn Brodigan ◽  
Karen Fasciano ◽  
A Lindsay Frazier ◽  
...  

Abstract Adolescent and young adult (AYA; ages 15-39) patients represent a population that experiences significant challenges in cancer care and research, exemplified by poorer clinical outcomes as well as unmet psychosocial and reproductive health needs. Despite central nervous system (CNS) tumors being one of the most common malignancies diagnosed in the age group, there is a clear paucity of AYA CNS tumor-specific publications, especially those related to the unique psychosocial and reproductive health needs of this population of patients. In this review, we examine various aspects of AYA oncological care including tumor biology, clinical outcome, clinical trials enrollment rate, site of care, unique psychosocial needs, and oncofertility. We assess the current state of these issues, highlight areas of deficiencies, and outline the steps needed to address these concerns. We emphasize the importance of comprehensive molecular testing as part of the diagnostic work-up, expansion of clinical trial availability, access to psychosocial care and oncofertility expertise, and the development of AYA-specific clinical research to define best practices and advancing care for this population.


2021 ◽  
Vol 17 (6) ◽  
pp. 445-453
Author(s):  
Angelina Vascimini, PharmD ◽  
Kevin Duane, PharmD ◽  
Stacey Curtis, PharmD

Objective: The opioid epidemic is frequently discussed including the staggering numbers involved with coprescribing opioids and benzodiazepines associated with death. Community pharmacists, with the help of a system intervention, have a unique opportunity to help reduce the coprescribing of benzodiazepines and opioids and reduce the associated risk of death.Design: A single center retrospective chart review was conducted after a system intervention was placed, as a quality improvement project, from November 2019 to May 2020.Setting: Independent community pharmacy.Patients/participants: Data included demographics, dosing of each medication pre- and post-intervention, and naloxone status.Main outcome(s) measures: The primary outcome evaluated was reduction in dose/discontinuation of these prescriptions. The secondary outcome evaluated was the number of naloxone prescriptions ordered per protocol and picked up.Results: The primary outcome did not show statistical difference; however, the secondary outcomes showed statistical significance.Conclusion: In conclusion, community pharmacists, with the help of evolving technologies, can reduce harm associated with the coprescribing of benzodiazepines and opioids.


Author(s):  
Avishay A. Adri

INTRODUCTION: Acute manic episodes are a psychiatric emergency related to violence and poor patient outcomes. Combination psychotropic therapy utilizing a mood stabilizer and an atypical antipsychotic has been shown to be more efficacious for treating acute mania compared to monotherapy with either mood stabilizers or antipsychotics alone. This quality improvement project implemented evidence-based interventions for treating acute mania. The mania pathway protocol was created as a comprehensive clinical guide for guiding mania treatment. The protocol was implemented on an inpatient psychiatric unit for patients with mania diagnoses including manic/mixed episodes of bipolar disorder or schizoaffective disorder. AIMS: (1) to improve the treatment of mania by using evidence-based interventions for rapid mood stabilization and (2) to educate psychiatric providers on up-to-date interventions for treating acute manic states. METHOD: Psychiatric providers were evaluated for knowledge enhancement through a pre-/post–educational session quiz. A retrospective chart review was used for data collection for patients treated with the mania pathway protocol. The retrospective chart review spanned 8 weeks post project implementation. Young Mania Rating Scale (YMRS) scores were analyzed to measure the effect on mania severity. RESULTS: The percentage decrease in mean Young Mania Rating Scale scores from admission to the fifth day of hospitalization was 61%. All psychiatric providers proved knowledge attainment by scoring 100% on the postintervention quiz. CONCLUSIONS: Rapid mood stabilization may be achieved by using a combination therapy–based mania protocol. Educational sessions can enhance psychiatric provider knowledge with regard to evidence-based treatments for mania.


2019 ◽  
Vol 33 (4) ◽  
pp. 491-496
Author(s):  
Rachel A. Kennedy ◽  
Margie E. Padilla ◽  
Sweta Andrews ◽  
Emily J. Christenberry ◽  
Stella Winters ◽  
...  

Purpose This quality improvement project aimed to assess the elements of the current workflow process that meets requirements for transitions of care from a family medicine inpatient to outpatient service following the Transitional Care Management (TCM) program developed by the Centers for Medicare & Medicaid Services. The purpose of the study was to assess the current family medicine workflow and determine whether the current process meets the criteria for billing and calculate the potential loss of reimbursement. Methods Interviews with key personnel, review of practice policies, and a retrospective chart review were performed for clinic patients discharged from the inpatient to outpatient family medicine service. Results A total of 37 patients met inclusion criteria for the chart review. Of these, 8% of patients seen at the outpatient clinic met all criteria for TCM. Potential reimbursement for those who met TCM criteria was $293.14 USD; the estimated potential TCM reimbursement for patients not meeting criteria was $1997.76 USD. Conclusion Standardized, team-based TCM services have shown to decrease readmission rates for high-risk patient populations. Results from this project identified processes in place at the family medicine practice to facilitate the development of a standardized transitional care service which could meet both TCM and best practice models.


2020 ◽  
Vol 59 (4-5) ◽  
pp. 429-435 ◽  
Author(s):  
Rachel H. Alinsky ◽  
Kayla Percy ◽  
Hoover Adger ◽  
Diana Fertsch ◽  
Maria Trent

The American Academy of Pediatrics recommends pediatric providers routinely screen for, assess, and treat substance use and substance use disorders among adolescents, a process called “Screening, Brief Intervention, and Referral to Treatment,” or “SBIRT.” Because there are limited data on how Maryland pediatric practices have adopted SBIRT, a quality improvement initiative was developed within the Maryland Adolescent and Young Adult Health Collaborative Improvement and Innovation Network using a “Plan/Do/Study/Act” approach. A 2-part provider training was conducted regarding screening and motivational interviewing, and the “CRAFFT” screening tool was integrated into the practice’s electronic medical record. Results from evaluation demonstrated significant improvements in provider knowledge, attitudes, and screening behavior. The association between substance use and sexual behavior suggests a need for further expansion of this model with inclusion of sexual health screening. Overall, this study demonstrates that SBIRT implementation into a general pediatric practice is highly feasible, acceptable, and shows preliminary effectiveness.


2018 ◽  
Vol 7 (5) ◽  
pp. 612-617 ◽  
Author(s):  
Laura Mitchell ◽  
Seline Tam ◽  
Jeremy Lewin ◽  
Amirrtha Srikanthan ◽  
Carol Heck ◽  
...  

Author(s):  
Grace E. McKay ◽  
Anna L. Zakas ◽  
Fauzia Osman ◽  
Amanda Parkes

Background: Given a link between sarcomas and hereditary cancer predisposition syndromes, including Li-Fraumeni syndrome, the consideration for genetic counseling is recommended for all adolescent and young adult (AYA) patients diagnosed with sarcoma. The aim of this study was to evaluate factors influencing genetic consultations in AYA patients with sarcoma at the University of Wisconsin (UW). Methods: A retrospective chart review was performed on AYA patients diagnosed with sarcoma between the ages of 15 and 39 years who were seen at least once between 2015 to 2019 at UW. Our chart review identified discussions regarding genetics, referrals to genetics, genetic consultations, and results of genetic testing. Variables hypothesized to affect patient referrals for genetic consultation were identified a priori. Descriptive statistical methods and a univariate analysis were used to identify patient characteristics associated with genetic counseling referral. Results: We identified 87 AYA patients with sarcoma. Only 19 (22%) of these patients had documentation of a discussion about genetics, 15 (17%) of whom were subsequently referred for genetic consultation. Of these 15 patients, 9 (60%) were seen in consultation. All 9 patients seen by genetics underwent genetic testing, with 4 (44%) of these patients having identified heritable cancer predisposition syndromes. Likelihood for genetics referral was linked most strongly to documented genetics discussion with an oncology provider (P<.001). Conclusions: Despite the recommendation for consideration for genetic counseling in AYA patients with sarcoma, <25% of such patients in our study had a documented discussion about genetics. Supporting this need, all referred patients met criteria for genetic testing, and 44% of tested patients were found to have a heritable cancer predisposition syndrome. These data support the initial conversation by a provider as critical to genetic referral and suggest the need for more specific national recommendations for the genetic evaluation of all AYA patients with sarcoma.


2019 ◽  
Vol 28 (3) ◽  
pp. 477-487 ◽  
Author(s):  
Emma Nicklin ◽  
Galina Velikova ◽  
Claire Hulme ◽  
Rocio Rodriguez Lopez ◽  
Adam Glaser ◽  
...  

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