scholarly journals Evaluating the Impact of Treatment Care Planning on Quality Measures

2019 ◽  
Vol 15 (3) ◽  
pp. e271-e276 ◽  
Author(s):  
Gabrielle B. Rocque ◽  
Courtney P. Williams ◽  
Amanda R. Hathaway ◽  
Karina I. Halilova ◽  
Carrie T. Stricker ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Improvement ◽  
Early Stage ◽  
Intervention Group ◽  
Quality Measures ◽  
Care Plan ◽  
Control Group ◽  
Improvement Project ◽  
Improved Performance ◽  
The Impact

PURPOSE: The Center for Medicare & Medicaid Innovation Oncology Care Model (OCM) requires documentation of a 13-point Institute of Medicine care management plan for Medicare patients. In addition, OCM includes evaluation of quality using key performance measures that align with the ASCO Quality Oncology Practice Initiative (QOPI). Both efforts are designed to improve patient-centered care and foster patients’ engagement in their care plan. METHODS: A multicenter quality improvement project was conducted to develop a strategy to meet the OCM treatment planning (TP) requirement (Plan), pilot clinician education coupled with use of electronic TP in early-stage breast cancer (Do), evaluate the impact of TP on QOPI measures (Study), and develop recommendations for future implementation (Act). RESULTS: Thirty-three clinical providers and 171 women with breast cancer were included. Improved performance on several QOPI measures was observed for the intervention group compared with the historical control group. CONCLUSION: Meeting the OCM TP requirement through incorporating a technology solution provided an opportunity for quality improvement and preparation for full-scale TP within the OCM. TP delivery was associated with improved performance on select ASCO QOPI measures, which is likely to correspond with improved performance on quality measures within OCM.

Effects of Mindfulness-Based Stress Reduction (MBSR) on Health Among Breast Cancer Survivors

2010 ◽  
Vol 33 (8) ◽  
pp. 996-1016 ◽  
Author(s):  
Yaowarat Matchim ◽  
Jane M. Armer ◽  
Bob R. Stewart
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Stress Reduction ◽  
Breast Cancer Survivors ◽  
Early Stage ◽  
Intervention Group ◽  
Psychological Outcomes ◽  
Control Group ◽  
Control Group Design ◽  
Quasi Experimental

The purpose of this study was to examine the effects of a MBSR program on physiological and psychological outcomes among early-stage breast cancer survivors. A quasi-experimental, pre-and posttest control group design was selected. The intervention group received the MBSR intervention. The control group received no MBSR intervention. ANOVA and ANCOVA were used to analyze data. The intervention group demonstrated statistically significant improvement in physiological and psychological outcomes including reduced blood pressure, heart rate, and respiratory rate and increased mindfulness state at the level of p = .05 to p = .001. The effects of MBSR on reducing stress in this sample were statistically significant on the physiological outcome (morning cortisol) at the measurement after the intervention completion, but this effect was not sustained at 1-month follow-up. MBSR showed a trend toward improving psychological outcomes by reducing mood disturbance in this sample.

scholarly journals Mobile App for Symptom Management and Associated Quality of Life During Systemic Treatment in Early Stage Breast Cancer: Nonrandomized Controlled Prospective Cohort Study

10.2196/17408 ◽  
2020 ◽  
Vol 8 (8) ◽  
pp. e17408
Author(s):  
Cvetka Grašič Kuhar ◽  
Tjaša Gortnar Cepeda ◽  
Timotej Kovač ◽  
Matjaž Kukar ◽  
Nina Ružić Gorenjec
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Systemic Therapy ◽  
Early Stage ◽  
Intervention Group ◽  
Health Resources ◽  
Control Group ◽  
Global Quality ◽  
Global Quality Of Life

Background Providing patients with cancer who are undergoing systemic therapy with useful information about symptom management is essential to prevent unnecessary deterioration of quality of life. Objective The aim was to evaluate whether use of an app for symptom management was associated with any change in patient quality of life or use of health resources. Methods Outpatients with early stage breast cancer receiving systemic therapy were recruited at the Institute of Oncology in Ljubljana, Slovenia. Patients who received systemic therapy between December 2017 and March 2018 (control group) and between April 2018 and September 2018 (intervention group) were eligible. All patients received standard care, but only those in the intervention group were asked to use mPRO Mamma, an Android-based smartphone app, in addition. The app supported daily tracking of 50 symptoms, allowed users to grade their symptom severity (as mild, moderate, or severe), and also provided in-depth descriptions and recommendations based on reported symptom level. Patient-reported outcomes in both groups were assessed through the European Organisation for Research and Treatment of Cancer (EORTC) core (C-30) and breast cancer (BR-23) questionnaires, as well as a questionnaire about health resources use. The primary outcomes were the difference in the global quality of life between groups and the difference in summary score of the EORTC C-30 questionnaire between groups after 3 time periods (the first week of treatment, the first treatment cycle, and the entire treatment). The secondary outcome was the use of health resources (doctor visits and hospitalizations) in each time period. Other scales were used for exploratory analysis. Results The mean difference between the intervention group (n=46) and the control group (n=45) in global quality of life (adjusted for baseline and type of surgery) after the first week was 10.1 (95% CI 1.8 to 18.5, P=.02). The intervention group summary scores were significantly higher than those of the control group after the first week (adjusted mean difference: 8.9, 95% CI 3.1 to 14.7, P=.003) and at the end of treatment (adjusted mean difference: 10.6, 95% CI 3.9 to 17.3, P=.002). Use of health resources was not statistically significant between the groups in either the first week (P=.12) or the first treatment cycle (P=.13). Exploratory analysis findings demonstrated clinically important improvements (indicated by EORTC C-30 or BR-23 scale scores)—social, physical, role, and cognitive function were improved while pain, appetite loss, and systemic therapy side effects were reduced. Conclusions Use of the app enabled patients undergoing systemic therapy for early stage breast cancer to better cope with symptoms which was demonstrated by a better global quality of life and summary score after the first week and by a better summary score at the end of treatment in the intervention group compared to those of the control group, but no change in the use of health resources was demonstrated.

scholarly journals A Physician-Driven Quality Improvement Stewardship Intervention Using Lean Six Sigma Improves Patient Care for Community-Acquired Pneumonia

2021 ◽  
Author(s):  
Lea M. Monday ◽  
Omid Yazdanpaneh ◽  
Caleb Sokolowski ◽  
Jane Chi ◽  
Ryan Kuhn ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Six Sigma ◽  
Intervention Group ◽  
Community Acquired Pneumonia ◽  
Lean Six Sigma ◽  
Audit And Feedback ◽  
Control Group ◽  
The Impact

ABSTRACT Introduction The Infectious Diseases Society of America (IDSA) recommends a minimum of 5 days of antibiotic therapy in stable patients who have community-acquired pneumonia (CAP). However, excessive duration of therapy (DOT) is common. Define, measure, analyze, improve, and control (DMAIC) is a Lean Six Sigma methodology used in quality improvement efforts, including infection control; however, the utility of this approach for antimicrobial stewardship initiatives is unknown. To determine the impact of a prospective physician-driven stewardship intervention on excess antibiotic DOT and clinical outcomes of patients hospitalized with CAP. Our specific aim was to reduce excess DOT and to determine why some providers treat beyond the IDSA minimum DOT. Methods A single-center, quasi-experimental quality improvement study evaluating rates of excess antimicrobial DOT before and after implementing a DMAIC-based antimicrobial stewardship intervention that included education, prospective audit, and feedback from a physician peer, and daily tracking of excess DOT on a Kaizen board. The baseline period included retrospective CAP cases that occurred between October 2018 and February 2019 (control group). The intervention period included CAP cases between October 2019 and February 2020 (intervention group). Results A total of 123 CAP patients were included (57 control and 66 intervention). Median antibiotic DOT per patient decreased (8 versus 5 days; p < 0.001), and the proportion of patients treated for the IDSA minimum increased (5.3% versus 56%; p < 0.001) after the intervention. No differences in mortality, readmission, length of stay, or incidence of Clostridioides difficile infection were observed between groups. Almost half of the caregivers surveyed were aware that as few as 5 days of antibiotic treatment could be appropriate. Conclusions A physician-driven antimicrobial quality improvement initiative designed using DMAIC methodology led to reduced DOT and increased compliance with the IDSA treatment guidelines for hospitalized patients with CAP reduced without negatively affecting clinical outcomes.

scholarly journals 75. Less is More: A Physician-Driven Quality Improvement Stewardship Initiative to Reduce Excessive Duration of Antibiotic Therapy in Veterans Hospitalized with Community-Acquired Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S55-S56
Author(s):  
Lea M Monday ◽  
Omid Yazdanpanah ◽  
Caleb Sokolowski ◽  
Joseph Sebastian ◽  
Ryan Kuhn ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Community Acquired Pneumonia ◽  
Audit And Feedback ◽  
Patient Specific ◽  
Control Group ◽  
Less Is More ◽  
Historic Control ◽  
The Impact

Abstract Background The IDSA and American Thoracic Society (IDSA/ATS) Community Acquired Pneumonia (CAP) guidelines recommend 5 days of therapy for clinically stable patients that defervesce, however, duration of therapy (DOT) is often longer. Pharmacists curb this via antimicrobial stewardship (AMS), but budgetary constraints are barriers to robust AMS programs in some hospitals. Physicians are increasingly encouraged to participate in quality improvement (QI) and are a potential resource to improve AMS. We sought to determine the impact of a prospective, physician-driven stewardship intervention on DOT and clinical outcomes in hospitalized veterans with CAP, with the goal to reduce the median DOT by at least 1 day within 5 months. Methods This single center, quasi-experimental QI study evaluated two concurrent physician-driven interventions over a 5-month period in an inner-city Veterans Affairs Hospital. Using DMAIC (Define, measure, analyze, improve, and control) methodology, the Chief Resident in Quality and Safety (CRQS) provided monthly education and daily audit and feedback with patient-specific DOT recommendations. Clinical outcomes were followed until 30 days post discharge. Results A total of 123 patients with CAP were included (57 in the historic control group and 66 in the AMS intervention group). The AMS intervention significantly increased the proportion of CAP patients treated with a 5-day treatment course (56% versus 5.3%, p< 0.0001), and reduced the proportion of patients treated beyond 7 days (12.1% versus 70.2%, p< 0.0001). Median DOT per patient was reduced significantly (5 versus 8 days, p< 0.0001). Median excess antibiotic days were significantly reduced (0 versus 3, p< 0.0001) and 118 days of unnecessary antibiotics were avoided (62 versus 180). 30-day all-cause mortality, all-cause readmission, and Clostridium difficile infection were similar between groups. Median LOS was similar between groups (p=0.246). DOT in the Historic Control Group Versus Stewardship Intervention Group Conclusion A physician driven QI stewardship intervention in hospitalized CAP patients significantly reduced the total antibiotic DOT and excess antibiotic days without adversely affecting patient outcomes. Providers can be educated through physician driven interventions resulting in substantial improvements in appropriate antibiotic use. Disclosures All Authors: No reported disclosures

scholarly journals Learning from Lean: a quality improvement project using a Lean-based improvement approach to improve discharge for patients with frailty in an acute care hospital

2021 ◽  
Vol 10 (4) ◽  
pp. e001393
Author(s):  
Thomas James Rollinson ◽  
Joy Furnival ◽  
Sarah Goldberg ◽  
Aklak Choudhury
Keyword(s):  
Quality Improvement ◽  
Acute Care Hospital ◽  
Quality Improvement Project ◽  
Value Stream Mapping ◽  
Care Hospital ◽  
Improvement Project ◽  
National Initiative ◽  
Improved Performance ◽  
The Uk ◽  
The Impact

A Lean-based improvement approach was used to complete a quality improvement project (QIP) focused on improving speed and quality of discharge of frail patients on two wards at a large teaching hospital in the UK. This was part of a national initiative to embed continuous improvement within the trust. The aim of the QIP was to improve the proportion of prenoon discharges to 33% of total patients discharged from the ward each day. An ‘improvement practice process’ followed, which included seven discrete workshops that took the QIP through four distinct phases—understand, design, deliver and sustain. Several improvement methods and tools were used, including value stream mapping and plan–do–study–act (PDSA) cycles. Ten PDSA cycles were implemented across the clinical areas, including improved planning and data collection of discharge, improved communication between nursing and medical staff, and earlier referrals to community hospitals for discharge. Improved performance was identified through the outcome metric prenoon discharges on both wards, with the average increasing from 8% to 24% on ward X and from 9% to 19% on ward Y, with no other significant change seen in other measures. Pettigrew et al’s context–content–process change model was used to structure the learning from the QIP, which included the impact of varying ward contexts, the format of conducting improvement with staff, the importance of organisational support, the need for qualitative measures, agreeing to an apposite aim and the power of involving service users. The original aim of 33% prenoon discharges was not achieved, yet there was clear learning from completing the QIP which could contribute to ongoing improvement work. This identified that the Lean-based improvement approach used was effective to some degree for improving discharge processes. Further focus is required on collecting qualitative data to identify the impact on staff, especially related to behaviour and culture change.

Driving quality improvement with public reporting: Use of imaging tests outside guidelines for early-stage breast cancer in Ontario.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 193-193 ◽  
Author(s):  
Colleen Bedford ◽  
Angel Arnaout ◽  
Rebecca Anas ◽  
Christina Catley ◽  
Mark Clemons ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Improvement ◽  
Cancer Patients ◽  
Early Stage ◽  
Distant Metastases ◽  
Public Reporting ◽  
Early Stage Breast Cancer ◽  
System Quality ◽  
Breast Cancer Patients ◽  
The Impact

193 Background: Most patients diagnosed with breast cancer will have early stage (stage I or II) disease, with low chance of distant metastases. Thus most guidelines, including Choosing Wisely, recommend against imaging tests for distant metastases in asymptomatic early stage breast cancer. Despite this, most (86%) of these patients in Ontario received these tests from which they are not likely to benefit and may result in investigations that can be invasive and delay treatment. Publicly reported indicators, such as those in Ontario’s Cancer System Quality Index (CSQI), can bring research findings to action by identifying areas for improvement and facilitating ongoing assessment. In practice, this can be challenging due to limitations in administrative data. Moreover, relatively few quality improvement indicators focus on efficiency, the dimension of quality looking at best use of resources to achieve desired outcomes. We sought to examine trends in the use of imaging tests in early stage breast cancer and to drive quality improvement efforts via public reporting. Methods: Data from the Ontario Cancer Registry, the Discharge Abstract Database and the Ontario Health Insurance database was used to identify how many Ontario breast cancer patients diagnosed with early stage breast cancer received staging tests from 2012–2014. Imaging tests included were ultrasound, CT scan, MRI, x-ray and bone scan. The results were subsequently shared with the Regional Cancer Centres and publically released in the CSQI. Results: From 2012 to 2014, 75.1, 72.7 and 71.3% respectively of early stage breast cancer patients received at least one imaging test for staging. This is much higher than the 5-10% of patients expected to need tests due to symptoms or comorbidities. While the regional variation ranged from 47-80%, the rates were high across the province with no clear pattern. Conclusions: Public reporting may be having some effect on overtesting, but rates remain high. Following outreach by the Cancer Quality Council of Ontario and Cancer Care Ontario, targeted regional interventions are being developed and implemented, the impact of which will be assessed and reported in future releases of the CSQI.

Quality Improvement Project: Implementing Guidelines Supporting Noninvasive Respiratory Management for Premature Infants

2014 ◽  
Vol 33 (5) ◽  
pp. 245-254 ◽  
Author(s):  
Aksana Waskosky ◽  
Tricia K. Huey
Keyword(s):  
Quality Improvement ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Intervention Group ◽  
Quality Improvement Project ◽  
Control Group ◽  
Quality Improvement Initiative ◽  
Improvement Project ◽  
Respiratory Management ◽  
Intensive Care Nursery

Purpose: Based on research evidence, the purpose was to implement noninvasive approaches in the initial respiratory stabilization of preterm infants.Design: Quality improvement project.Sample: One hundred fourteen infants admitted to the neonatal intensive care nursery (NICN) from January 1, 2012 to May 31, 2012 served as a historical control group. Ninety-four infants admitted from January 1, 2013 to May 31, 2013 served as the intervention group.Results: After implementation of the quality improvement initiative, there was a statistically significant increase in the rate of using continuous positive airway pressure (CPAP) by 65.3 percent for initial respiratory stabilization of preterm infants.

scholarly journals Mobile App for Symptom Management and Associated Quality of Life During Systemic Treatment in Early Stage Breast Cancer: Nonrandomized Controlled Prospective Cohort Study (Preprint)

2019 ◽  
Author(s):  
Cvetka Grašič Kuhar ◽  
Tjaša Gortnar Cepeda ◽  
Timotej Kovač ◽  
Matjaž Kukar ◽  
Nina Ružić Gorenjec
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Systemic Therapy ◽  
Early Stage ◽  
Intervention Group ◽  
Health Resources ◽  
Control Group ◽  
Global Quality ◽  
Global Quality Of Life

BACKGROUND Providing patients with cancer who are undergoing systemic therapy with useful information about symptom management is essential to prevent unnecessary deterioration of quality of life. OBJECTIVE The aim was to evaluate whether use of an app for symptom management was associated with any change in patient quality of life or use of health resources. METHODS Outpatients with early stage breast cancer receiving systemic therapy were recruited at the Institute of Oncology in Ljubljana, Slovenia. Patients who received systemic therapy between December 2017 and March 2018 (control group) and between April 2018 and September 2018 (intervention group) were eligible. All patients received standard care, but only those in the intervention group were asked to use mPRO Mamma, an Android-based smartphone app, in addition. The app supported daily tracking of 50 symptoms, allowed users to grade their symptom severity (as mild, moderate, or severe), and also provided in-depth descriptions and recommendations based on reported symptom level. Patient-reported outcomes in both groups were assessed through the European Organisation for Research and Treatment of Cancer (EORTC) core (C-30) and breast cancer (BR-23) questionnaires, as well as a questionnaire about health resources use. The primary outcomes were the difference in the global quality of life between groups and the difference in summary score of the EORTC C-30 questionnaire between groups after 3 time periods (the first week of treatment, the first treatment cycle, and the entire treatment). The secondary outcome was the use of health resources (doctor visits and hospitalizations) in each time period. Other scales were used for exploratory analysis. RESULTS The mean difference between the intervention group (n=46) and the control group (n=45) in global quality of life (adjusted for baseline and type of surgery) after the first week was 10.1 (95% CI 1.8 to 18.5, <i>P</i>=.02). The intervention group summary scores were significantly higher than those of the control group after the first week (adjusted mean difference: 8.9, 95% CI 3.1 to 14.7, <i>P</i>=.003) and at the end of treatment (adjusted mean difference: 10.6, 95% CI 3.9 to 17.3, <i>P</i>=.002). Use of health resources was not statistically significant between the groups in either the first week (<i>P</i>=.12) or the first treatment cycle (<i>P</i>=.13). Exploratory analysis findings demonstrated clinically important improvements (indicated by EORTC C-30 or BR-23 scale scores)—social, physical, role, and cognitive function were improved while pain, appetite loss, and systemic therapy side effects were reduced. CONCLUSIONS Use of the app enabled patients undergoing systemic therapy for early stage breast cancer to better cope with symptoms which was demonstrated by a better global quality of life and summary score after the first week and by a better summary score at the end of treatment in the intervention group compared to those of the control group, but no change in the use of health resources was demonstrated.

The Impact of the Theory-Based Training on Beliefs of Women towards Breast Cancer Screening Behaviors

2020 ◽  
Vol 16 (3) ◽  
pp. 229-235
Author(s):  
Alireza Didarloo ◽  
Leila Mokhtary ◽  
Hamid-Reza Khalkhali ◽  
Soheila Ahangarzadeh-Rezaei
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Health Beliefs ◽  
Educational Intervention ◽  
Intervention Group ◽  
Health Belief ◽  
Control Group ◽  
Belief Model ◽  
Screening Behaviors

Background: Breast cancer is the most prevalent type of cancer among women that is fatal if not diagnosed and treated in due time. Health beliefs play an important role in people's willingness to engage in health-promoting behaviors. Objective: The aim of the study was to examine the effects of the health belief model (HBM)-based training intervention on women’s health beliefs towards breast cancer screening behaviors. Methods: The study of educational intervention was conducted on women referred to healthcare centers. The sample was selected by convenient sampling and randomly assigned to control and intervention groups of 50 subjects. The intervention group received the theory-based training intervention, but the control group received only the routine care. Champion’s Health Belief Model Scale (CHBMS) was used for collecting the study data. Data analysis was performed using independent t-test, paired t-test, Chi-squared test, and correlation coefficient in SPSS software version 16.00. Results: The mean age of the subjects for control and intervention groups was 39.06±9.78, 38.32±8.27, respectively. Overall, 38%, 12% and 13%of the subjects reported breast selfexamination behavior, mammography and clinical breast examinations, respectively. Before the intervention program, the overall mean score of health beliefs in groups of control and intervention was 160.82±23.28, and 159.14±20.61, respectively. After educational intervention, the overall mean score of beliefs in the intervention group changed from 159.14±20.61 to 195.26±24.42, and it was statistically significant (p<0.001). In the control group, after the intervention, no significant changes were observed in the mean score of total health beliefs and were not statistically significant (p>0.05). Among the variables of the HBM, women's perceived self-efficacy toward breast selfexamination experienced the most positive change after an educational intervention. Conclusion: Our results indicated that HBM-based training significantly improved women’s beliefs toward breast cancer screening behaviors. It is suggested that trainers in the healthcare system use these educational approaches to promote people’s beliefs toward breast cancer and its screening methods.

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