Oral chemotherapy education: Hitting the mark?

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]

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

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.283 ◽

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.

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In-Practice Endocrine Surgery Fellowship: A Novel Training Model

Otolaryngology ◽

10.1177/0194599820962791 ◽

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.

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Spanning the canyon between stem cell transplantation and palliative care

Hematology ◽

10.1182/asheducation-2015.1.484 ◽

2015 ◽

Vol 2015 (1) ◽

pp. 484-489 ◽

Cited By ~ 13

Author(s):

Eric Roeland ◽

Grace Ku

Keyword(s):

Palliative Care ◽

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Medical Center ◽

Academic Medical Center ◽

Hematologic Malignancies ◽

Cost Of Care ◽

Academic Medical

Abstract Stem cell transplantation (SCT) and palliative care (PC) may initially appear to be distant extremes in the continuum of care of patients with hematologic malignancies, opposed by multiple obstacles preventing their integration. Rather, we will posit that both fields share many similarities and have much to learn from one another. PC has increasing relevance in cancer care given recent studies that link PC to improved quality-of-life, survival, and decreased cost of care. Understanding modern conceptualizations of PC and its role within SCT is key. Through the report of a single academic medical center experience with an integrated SCT and PC model over the last decade, we will discuss future opportunities for strengthening collaboration between SCT and PC. PC in SCT should be considered from the day of diagnosis and tied to need, not to prognosis.

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A chemotherapy privileging process for advanced practice providers at an academic medical center

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155219846959 ◽

2019 ◽

Vol 26 (1) ◽

pp. 116-123

Author(s):

Michelle A Carrasquillo ◽

Tyler A Vest ◽

Jill S Bates ◽

Aimee Faso ◽

Jessica Auten ◽

...

Keyword(s):

Supportive Care ◽

Nurse Practitioners ◽

Medical Center ◽

Academic Medical Center ◽

Physician Assistants ◽

Advanced Practice ◽

Training Process ◽

Academic Medical ◽

The Creation ◽

Oncology Practice

Purpose Nurse practitioners, physician assistants, and pharmacists are advanced practice providers who are highly trained and qualified healthcare professionals that can help support traditional demands on oncologists' increased time in direct patient care. The purpose of this study was to detail and assess the creation of a privileging process for this group of medical professionals within an academic medical center. Obtaining the designation of limited oncology practice provider (LOPP) gives the right to modify chemotherapy orders and to order supportive care medications. Methods An interdisciplinary team developed a comprehensive training process inclusive of required educational domains, knowledge goals, and educational activities to become an LOPP. In 2018, five years after the implementation of the privileging process, a survey was distributed to assess perceptions of the training process and integration of LOPPs within oncology practice. Results Most oncologists noted that working with LOPPs is beneficial to oncology practice (94%) and that they make modifying chemotherapy orders more efficient (87%). Greater than 82% of LOPPs also reported that their privileges streamline the chemotherapy process and make them feel valuable. Conclusion The creation of the LOPP designation is an effective way to integrate nurse practitioners, physician assistants, and pharmacists within oncology practice. The inclusion of a focused privileging process ensures the safety of cancer care provided and has created a streamlined process for chemotherapy modifications and supportive care.

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Using Process Analysis to Assess the Impact of Medical Education on the Delivery of Pain Services

Anesthesiology ◽

10.1097/aln.0b013e31824a88d0 ◽

2012 ◽

Vol 116 (4) ◽

pp. 931-939 ◽

Cited By ~ 3

Author(s):

Kayode A. Williams ◽

Chester G. Chambers ◽

Maqbool Dada ◽

Douglas Hough ◽

Ravi Aron ◽

...

Keyword(s):

Process Analysis ◽

Medical Center ◽

Academic Medical Center ◽

Discrete Event ◽

Economic Effects ◽

Free Standing ◽

Process Measures ◽

Average Completion Time ◽

Number Of Patients ◽

The Impact

Background The medical, social, and economic effects of the teaching mission on delivery of care at an academic medical center (AMC) are not fully understood. When a free-standing private practice ambulatory clinic with no teaching mission was merged into an AMC, a natural experiment was created. The authors compared process measures across the two settings to observe the differences in system performance introduced by the added steps and resources of the AMC's teaching mission. Methods After creating process maps based on activity times realized in both settings, the authors developed discrete-event simulations of the two environments. The two settings were comparable in the levels of key resources, but the AMC process flow included three residents/fellows. Simulation enabled the authors to consider an identical schedule across the two settings. Results Under identical schedules, the average accumulated processing time per patient was higher in the AMC. However, the use of residents allowed simultaneous processing of multiple patients. Consequently, the AMC had higher throughput (3.5 vs. 2.7 patients per hour), higher room utilization (82.2% vs. 75.5%), reduced utilization of the attending physician (79.0% vs. 93.4%), and a shorter average waiting time (30.0 vs. 83.9 min). In addition, the average completion time for the final patient scheduled was 97.9 min less, and the average number of patients treated before incurring overtime was 37.9% greater. Conclusions Although the teaching mission of the AMC adds processing steps and costs, the use of trainees within the process serves to increase throughput while decreasing waiting times and the use of overtime.

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

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18007 ◽

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]

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2348. Incorporating Electronic Medical Record Hard Stops to Reduce Inappropriate Clostridioides difficile Testing at an Academic Medical Center: A Quality Improvement Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2026 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S807-S808

Author(s):

Seetha Lakshmi ◽

Kimberly Atrubin ◽

Andrew Myers ◽

Jonathan Teter ◽

Ripal Jariwala ◽

...

Keyword(s):

Quality Improvement ◽

Medical Record ◽

Electronic Medical Record ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Quality Improvement Initiative ◽

Process Measures ◽

Clostridioides Difficile ◽

Phone Calls

Abstract Background Clostridioides difficile is the most common pathogen causing healthcare-associated infections. This study highlights the multi-disciplinary efforts to reduce C. difficile infections (CDI) at a large, tertiary care teaching facility. Methods A quality improvement study was performed between March 2017 and April 2018, using six Plan-Do-Study-Act cycles that included transmission prevention, diagnostic stewardship, education, and antimicrobial stewardship. Process measures included hand hygiene, isolation precautions, low-level disinfection compliance, number of tests ordered, lab cancelation of tests, and compliance with the Electronic Medical Record (EMR) hard stop for patients with laxative use, and negative C.difficile test in the past 7 days. Results A total of 2,046 C. difficile tests were ordered during the initiative. Of the 124 patients with a positive C. difficile LabID event, 50% were male with a median age of 65 years (range: 11–92 years). A 53% reduction in C. difficile LabID events (7.5 to 4 events per 10,000 patient-days, P < 0.001), with a pronounced decrease between cycle 4 and 5 (5.4 to 2.9 events per 10,000 patient-days, P < 0.001) was achieved. The largest decrease in C. difficile lab tests ordered was seen after implementation of the EMR hard-stop (cycle 5), with fewer than 0.5 LabID events per 1,000 patient-days for each subsequent month after EMR hard-stop implementation. Frequent reasons for physician phone calls to Infection prevention department was related to chronic use of lactulose in patients with cirrhosis (30%) and unexplained diarrhea (70%). Based on provider feedback, EMR changes were made to remove lactulose from the hard-stop and offer infectious disease consultation upfront. There was 99% compliance with electronic medical record hard stop. There was a nonsignificant increase in lab cancelations due to inappropriate stool specimens over time (1.9% to 3.1% from cycle 1 to 6, P = 0.28) A 55% reduction in hospital-onset CDI surveillance events (from 6.9 to 3.2 per 10,000 patient-days, P < 0.001) was noted. Conclusion A multi-disciplinary Quality Improvement initiative is a successful strategy in reducing CDI events, with the largest decrease seen with introduction of EMR hard stops. Disclosures All authors: No reported disclosures.

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

Journal of Oncology Practice ◽

10.1200/jop.17.00039 ◽

2018 ◽

Vol 14 (6) ◽

pp. e324-e334 ◽

Cited By ~ 19

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.

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

Pharmacy ◽

10.3390/pharmacy8010046 ◽

2020 ◽

Vol 8 (1) ◽

pp. 46 ◽

Cited By ~ 1

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.

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Artificial Intelligence in Health Care: Insights From an Educational Forum

Journal of Medical Education and Curricular Development ◽

10.1177/2382120519889348 ◽

2019 ◽

Vol 6 ◽

pp. 238212051988934 ◽

Cited By ~ 1

Author(s):

Andrew B Barbour ◽

Jennifer M Frush ◽

Luke A Gatta ◽

William C McManigle ◽

Niobra M Keah ◽

...

Keyword(s):

Artificial Intelligence ◽

Health Care ◽

Formal Education ◽

Healthcare Professionals ◽

Medical Curriculum ◽

Medical Center ◽

Academic Medical Center ◽

Lessons Learned ◽

Medical Systems ◽

Academic Medical

Discussions surrounding the future of artificial intelligenc (AI) in healthcare often cause consternation among healthcare professionals. These feelings may stem from a lack of formal education on AI and how to be a leader of AI implementation in medical systems. To address this, our academic medical center hosted an educational summit exploring how to become a leader of AI in healthcare. This article presents three lessons learned from hosting this summit, thus providing guidance for developing medical curriculum on the topic of AI in healthcare.

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