scholarly journals Impact of a Longitudinal Intervention to Improve Care Coordination between a Hospital and a Hospice: A Quality Improvement Project

2021 ◽  
Vol 27 ◽  
pp. 216-221
Author(s):  
Spandana Rayala ◽  
Gayatri Palat ◽  
Jean Jacob Mathews
Keyword(s):  
Care Coordination ◽  
Hospice Care ◽  
Confidence Score ◽  
Workplace Culture ◽  
Cancer Treatments ◽  
Improvement Project ◽  
Patient Goals ◽  
Future Care ◽  
User Friendly ◽  
To Receive

Objectives: When patients with advanced cancer transition from systemic cancer treatments at MNJ Institute of Oncology to palliative and end-of-life care at a separate stand-alone non-governmental organisation-run hospice facility, there is insufficient transfer of health information, including details of cancer diagnosis and staging, past treatments, imaging reports and goals for future care. Without this information, the hospice care team is not adequately prepared to receive and deliver high-quality palliative care for these patients. This project aims to improve the care coordination between the hospital and hospice. Materials and Methods: The measures used are the self-reported confidence score on a scale of 0 to 10 related to knowledge about plan of care among staff who receives patients at hospice at baseline and during and after interventions. Interventions included recognizing the workplace culture and promoting ownership of the tasks, enhancing communication by creating user-friendly transfer forms and on-going assessment of the process. Results: Improvement in the care coordination in terms of communication of patient goals of care, from hospital to hospice. Conclusion: QI project and the steps involved helped the team to work towards solutions objectively. Seemingly excellent ideas may not be the most impactful and data collection demonstrates this and helps identify the most successful interventions.

Impact of a hospital specialty pharmacy in partnership with a free-standing care coordination organization on time to delivery and receipt of oral anticancer drugs.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 43-43
Author(s):  
Melissa Parsons Beauchemin ◽  
Morgan RL Lichtenstein ◽  
Rohit R. Raghunathan ◽  
Sahil D Doshi ◽  
Cynthia Law ◽  
...  
Keyword(s):  
Care Coordination ◽  
Multivariable Analysis ◽  
Cancer Center ◽  
Free Standing ◽  
Delivery Date ◽  
Anti Cancer ◽  
Before And After ◽  
Specialty Pharmacy ◽  
Insurance Data ◽  
To Receive

43 Background: Most oral anti-cancer drugs (OACD) prescriptions require extensive coordination between providers and payers, which can delay drug receipt. Specialty pharmacies are intended to facilitate communication between multiple entities to deliver OACDs with increased efficiency. In 2018, our cancer center partnered with Shields Health Solutions (SHS), a freestanding organization providing care coordination to implement a hospital-based specialty pharmacy. We evaluated the rate of failed drug receipt (FR) and time to drug receipt (TTR) before and after specialty pharmacy implementation. Methods: We prospectively collected data on all new OACD prescriptions for adult oncology patients at a large, urban cancer center from 1/1/2018 to 12/31/2019. In fall 2018, a specialty pharmacy was opened to facilitate drug procurement for patients. We collected patient demographic, clinical, and insurance data, OACD name, date prescribed, delivery date, and interactions with payers and financial assistance groups. For prescriptions received, TTR was the number of days from OACD prescription to patient receipt of the drug. FR was defined as failure to receive a prescribed OACD. We excluded OACD prescriptions for a washout period of two months during pharmacy initiation. We used multivariable logistic regression to examine factors associated with TTR > 7 days and FR before and after specialty pharmacy implementation. Results: In total, 883 patients were prescribed 1145 new OACDs. The majority of prescribed drugs were targeted treatment (56%, N = 646) and 72% (N = 819) required prior authorization (PA). Of all prescriptions, 86% (N = 999) were successfully received with an overall median TTR of 7 days. Adjusted analyses showed that patients were more likely to receive their drugs in less than 7 days after specialty pharmacy implementation (OR: 1.4 95% CI 1.04 – 1.81), p = 0.03). In an unadjusted analysis, patients were more likely to receive their initial medications after specialty pharmacy implementation, compared to before specialty pharmacy implementation (89% vs. 84%, p = 0.04). Multivariable analysis showed a trend toward more patients receiving drugs after specialty pharmacy implementation (OR: 1.42, 95% CI 0.98 – 2.03, p = 0.06). Conclusions: The implementation of a hospital-based specialty pharmacy in partnership with SHS decreased TTR. This difference is in part attributable to improved care coordination and communication. A centralized approach may improve overall efficiency due to fewer clinical practice disruptions.

524 QUALITY IMPROVEMENT PROJECT: INCORPORATING COMPREHENSIVE GERIATRIC ASSESSMENT INTO COMMUNITY HOSPITAL CLERKING

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
A Oates
Keyword(s):  
Quality Improvement ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Community Hospital ◽  
Quality Improvement Project ◽  
Junior Doctors ◽  
Medical Team ◽  
Improvement Project ◽  
Efficient Detection ◽  
User Friendly

Abstract Elderly patients transferred to community hospitals often have complex medical, social, psychological, functional and pharmacological backgrounds that require careful assessment in order to create and deliver a high quality, patient-centred care plan. Unfortunately, time pressures experienced by staff in acute hospitals can make Comprehensive Geriatric Assessment (CGA) unfeasible for every patient. Moreover, junior members of the medical team may be unsure as to which aspects of a patient’s background and presentation constitute important elements of a CGA. Failure to recognise and document pertinent issues can lead to prolonged admissions, disjointed care and failed discharges. Admission to a community hospital presents a convenient ‘checkpoint’ in the patient’s hospital journey at which to undertake a CGA. Recording the relevant information in an effective clerking proforma when the patient is admitted ensures that this information is displayed clearly and in a way that is accessible to all members of the multidisciplinary team. The pre-existing clerking proforma at Amersham Community Hospital omitted several important elements of CGA (such as examination of feet and gait, assessment of mood, FRAX-UK score, creation of a problem list etc.) The aim of this quality improvement project was to create a thorough, yet user-friendly and time-efficient clerking proforma which incorporated the important components of CGA. Using BGS guidance and NICE quality standards, alongside suggestions from the medical team, the existing clerking proforma was adapted and reformed. After one month, feedback from the team was used to further improve the clerking proforma, ensuring that it was user-friendly, whilst meeting the standards set out by NICE and BGS. This was repeated as part of a second PDSA cycle. The improved clerking proforma enables junior doctors to undertake a thorough and holistic assessment, promoting efficient detection of issues and the delivery of a higher quality of care.

scholarly journals A service improvement project exploring the extent of need for allied health care professionals within neuro-oncology in Velindre Cancer Centre.

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv9-iv9
Author(s):  
Rachel Evans ◽  
Hayley Williams ◽  
Lisa Love-Gould ◽  
Owen Tilsley ◽  
James Powell ◽  
...  
Keyword(s):  
Patient Education ◽  
Health Care Professionals ◽  
Service Improvement ◽  
Language Therapy ◽  
Support Worker ◽  
Improvement Project ◽  
Cancer Centre ◽  
Future Care ◽  
Limited Opportunity ◽  
Research And Education

Abstract Given the highly complex and holistic needs of neuro-oncology patients, gold standard guidelines recommend that support is best served by a coordinated multi-disciplinary team (MDT) to provide seamless care from diagnosis to end of life (NICE 2018). Allied Healthcare Professionals (AHPs) including occupational therapy (OT), physiotherapy (PT), speech and language therapy (SLT) and dietitians (DT) are recognised as key professions within the MDT. As there is no designated AHP team at Velindre Cancer Centre, input can be reactive and fragmented with limited opportunity for patient education or service developments. The aim of the project was to scope and evaluate the level of AHP need the neuro-oncology population attending Velindre Cancer Centre. A service improvement grant funded a Band 4 Therapies support worker to conduct the project. The project involved a number of elements including the implementation of a revised neuro-oncology screening tool, strategic effort to improve patient education and self-management and engaging patients and staff to guide future service developments. The mixed methods approach yielded rich quantitative and qualitative data. The results demonstrated that whilst AHP input was beneficial to patient care, significant unmet needs were highlighted and demands for services exceeded the teams’ capacity. Therefore a designated neuro-oncology therapies team should be a central consideration for future care to enable timely, responsive, equitable and seamless MDT working. Greater AHP resource would also enable greater AHP involvement in research and education to revolutionise care in order to fully meet the needs of this vulnerable and complex patient group.

scholarly journals 17 Improving Frailty Identification and Comprehensive Geriatric Assessment (CGA) Completion on the Wards

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
D Verma ◽  
F Bonora ◽  
R Walker ◽  
M Kaneshamoorthy ◽  
L Bafadhel
Keyword(s):  
Older People ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Elderly Care ◽  
Frail Older People ◽  
Clinical Frailty Scale ◽  
Improvement Project ◽  
Qualitative Feedback ◽  
Complicated Course ◽  
User Friendly

Abstract Introduction The Comprehensive Geriatric Assessment (CGA) is known to deliver substantial and measurable health improvements to frail older people, including increased independence and a reduction in mortality.1 The Clinical Frailty Scale (CFS) can detect older adults at higher risk of complicated course and longer hospital stay.2 Despite the known benefits, previous audits has shown poor documentation on geriatric wards at Southend Hospital. Therefore, we devised a Quality Improvement Project to improve the uptake of both these. Methods A total of two Plan Do Study Act (PDSA) cycles were completed where CGA completion and CFS documentation was audited. Each cycle lasted two weeks (25 patients). Qualitative feedback was obtained from the members of multidisciplinary team to aid improvements. The baseline audit was based on the introduction of a 2-page ward proforma for all new patients. The first intervention was an improved 2-page ward-proforma. The second intervention was a single page ward-proforma. Results Originally, 40% of new patients admitted onto the ward had a CGA assessment and CFS score. After the first intervention, 79% (19) patients had a CFS score and a CGA assessment. 21% had a full CGA completed and 58% had partial CGA. Feedback included wanting a single page proforma to increase uptake. Questions needed to be more unambiguous and more tick boxes. After the second intervention 100% (25) patients had a CFS score and a CGA assessment. 40% (10) had a full CGA completed and 60% (15) had a partial CGA. Feedback include incorporating the ward round documentation to avoid repetition. Conclusions The results show that by using a focused, concise and user-friendly proforma, uptake of the Comprehensive Geriatric Assessment and Clinical Frailty Scale can be significantly increased, bringing substantial and measurable health improvements to frail older people admitted to elderly care wards. References 1. Welsh TJ, Gordon AL, Gladman JR. Int J Clin Pract. 2014;68(3):290–293. 2. Juma S, Taabazuing MM, Montero-Odasso M. Can Geriatr J. 2016;19(2):34–39.

Parenteral Hydration in Patients with Advanced Cancer (DRAFT)

2018 ◽  
Author(s):  
Carlos Eduardo Paiva ◽  
Bianca Sakamoto Ribeiro Paiva
Keyword(s):  
Quality Of Life ◽  
Advanced Cancer ◽  
Clinical Case ◽  
Fluid Intake ◽  
Hospice Care ◽  
Important Study ◽  
The Common ◽  
To Receive

There has been much debate about the role of parenteral hydration in the last weeks and days of life. In this important study, 129 patients with advanced cancer receiving hospice care with mild to moderate dehydration who were no longer able to maintain adequate fluid intake were randomized to receive parenteral hydration of either 1 L or 100 ml of normal saline per day subcutaneously. Parenteral hydration did not significantly improve the symptoms related to dehydration, the occurrence of delirium, fatigue, quality of life, and overall survival. At the end of the chapter, a clinical case leads readers to consider the common practice of parenteral hydration.

scholarly journals Health Care Use by Older Adults With Acute Myeloid Leukemia at the End of Life

2017 ◽  
Vol 35 (30) ◽  
pp. 3417-3424 ◽  
Author(s):  
Rong Wang ◽  
Amer M. Zeidan ◽  
Stephanie Halene ◽  
Xiao Xu ◽  
Amy J. Davidoff ◽  
...  
Keyword(s):  
Health Care ◽  
Acute Myeloid Leukemia ◽  
End Of Life ◽  
End Of Life Care ◽  
Older Patients ◽  
Myeloid Leukemia ◽  
Hospice Care ◽  
Life Care ◽  
To Receive ◽  
Acute Myeloid

Purpose Little is known about the patterns and predictors of the use of end-of-life health care among patients with acute myeloid leukemia (AML). End-of-life care is particularly relevant for older adults with AML because of their poor prognosis. Methods We performed a population-based, retrospective cohort study of patients with AML who were ≥ 66 years of age at diagnosis and diagnosed during the period from 1999 to 2011 and died before December 31, 2012. Medicare claims were used to assess patterns of hospice care and use of aggressive treatment. Predictors of these end points were evaluated using multivariable logistic regression analyses. Results In the overall cohort (N = 13,156), hospice care after AML diagnosis increased from 31.3% in 1999 to 56.4% in 2012, but the increase was primarily driven by late hospice enrollment that occurred in the last 7 days of life. Among the 5,847 patients who enrolled in hospice, 47.4% and 28.8% started their first hospice enrollment in the last 7 and 3 days of life, respectively. Among patients who transferred in and out of hospice care, 62% received transfusions outside hospice. Additionally, the use of chemotherapy within the last 14 days of life increased from 7.7% in 1999 to 18.8% in 2012. Patients who were male and nonwhite were less likely to enroll in hospice and more likely to receive chemotherapy or be admitted to intensive care units at the end of life. Conversely, older patients were less likely to receive chemotherapy or have intensive care unit admission at the end of life, and were more likely to enroll in hospice. Conclusion End-of-life care for older patients with AML is suboptimal. Additional research is warranted to identify reasons for their low use of hospice services and strategies to enhance end-of-life care for these patients.

The Concept of the Receipts & Promotions Cloud Service: a New Level of Communication between Bank, Store, and Customer

2020 ◽  
Vol 26 (12) ◽  
pp. 697-700
Author(s):  
V. I. Belovitskiy ◽  
Keyword(s):  
Mobile Application ◽  
Cloud Service ◽  
Complete Information ◽  
Cloud Services ◽  
Software Products ◽  
Wide Range ◽  
Software Product ◽  
Plastic Card ◽  
User Friendly ◽  
To Receive

The development of cloud services improving the interaction of banks, stores and customers becomes high-demanded by digitalized society, that is ready to use innovative software products. The Receipts & Promotions cloud service, developed at the concept level, allows to realize the idea of providing complete information of a receipt in electronic form along with printed receipt for the Mir plastic card holders through the "Privet, Mir!" mobile application. Information from electronic receipts accumulated in the Mir cloud will allow the customer to receive personalized bonus offers from the stores — partners of the program, as well as manage the family budget. The introduction of the service opens up the wide opportunities to the stores for communication with customers. The Receipts & Promotions service is able to become the first software product based on the collection and analysis of information from electronic receipts linked to a specific user. The system of flexible personalization of bonus offers and their assessment by customers is unique and not implemented in other software products. It will be possible to consider the display of electronic receipts in the "Privet, Mir!" mobile application in a user-friendly interface as the first fully automated option of providing electronic receipts to a wide range of users.

scholarly journals P004 Rheumatologist vs pathology department: correlation of crystal identification in synovial fluid analysis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
A Abdalla
Keyword(s):  
Synovial Fluid ◽  
University Hospital ◽  
Joint Fluid ◽  
Correct Identification ◽  
Pathology Laboratory ◽  
Improvement Project ◽  
Fluid Analysis ◽  
Polarized Microscopy ◽  
To Receive ◽  
Msu Crystals

Abstract Background/Aims  Crystal arthritis is the commonest inflammatory arthritis in adults. Diagnosis relies mostly on the correct identification of crystals under red-compensated polarized microscopy with assessment of birefringence. This is done routinely in our department when opportunity arises. Failure to appropriately identify crystals may result in lengthy hospitalisations, complications, avoidable repeated urgent visits, and unnecessary cost. We aimed to examine the agreement between rheumatology vs pathology-based microscopy for crystal analysis. There is currently no standardized pathway for synovial fluid crystal analysis in our tertiary centre in Dublin. Methods  A prospective study at Mater Misericordiae University Hospital - Dublin, was started in Dec 2019. Synovial fluid samples were obtained from acutely inflamed joints where clinically indicated. Fresh samples which were found to contain crystals (MSU or CPP) by a rheumatology consultant or trained registrar using compensated polarized microscopy, were also simultaneously sent to our pathology laboratory to receive similar analysis. Ethical approval was granted and all patients consented for their joint fluid to receive double analysis. Results  33 samples have been analysed to date. 13 samples of MSU crystals and 20 CPP crystals (table 1). Both rheumatologist and pathologist agreed on all but only one MSU sample. The pathologist identified CPP crystals only on 2/20 samples. The fluid analysis was carried out within the same working day by rheumatologist Vs. median of 2.3 working days for the result by the pathologist. Conclusion  The study showed a high agreement between rheumatologists and pathologists on identification of MSU crystals (92%), but very poor agreement on CPP crystals (only 10%). A quality improvement project is currently underway to address this issue and bridge the gap. Majority of Rheumatologists don't routinely perform crystal analysis using polarized microscopy and rely on their local cellular pathology lab for the results. Rheumatologists need to liaise with their local pathologists to optimise and streamline the process of crystal microscopy specially CPP crystals. P004 Table 1:crystals samples analysed through rheumatology and pathologyCPPD positiveMSU positiveRheumatologist2013Pathologist212Total2013 Disclosure  A. Abdalla: None.

scholarly journals Outcomes of Patients With Cancer Discharged to a Skilled Nursing Facility After Acute Care Hospitalization

2020 ◽  
Vol 18 (7) ◽  
pp. 856-865
Author(s):  
Sarguni Singh ◽  
Megan Eguchi ◽  
Sung-Joon Min ◽  
Stacy Fischer
Keyword(s):  
Acute Care ◽  
Skilled Nursing Facility ◽  
Home Healthcare ◽  
Categorical Variables ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Patients With Cancer ◽  
Patient Goals ◽  
Patient Groups ◽  
To Receive

Background: After discharge from an acute care hospitalization, patients with cancer may choose to pursue rehabilitative care in a skilled nursing facility (SNF). The objective of this study was to examine receipt of anticancer therapy, death, readmission, and hospice use among patients with cancer who discharge to an SNF compared with those who are functionally able to discharge to home or home with home healthcare in the 6 months after an acute care hospitalization. Methods: A population-based cohort study was conducted using the SEER-Medicare database of patients with stage II–IV colorectal, pancreatic, bladder, or lung cancer who had an acute care hospitalization between 2010 and 2013. A total of 58,770 cases were identified and patient groups of interest were compared descriptively using means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Logistic regression was used to compare patient groups, adjusting for covariates. Results: Of patients discharged to an SNF, 21%, 17%, and 2% went on to receive chemotherapy, radiotherapy, and targeted chemotherapy, respectively, compared with 54%, 28%, and 6%, respectively, among patients discharged home. Fifty-six percent of patients discharged to an SNF died within 6 months of their hospitalization compared with 36% discharged home. Thirty-day readmission rates were 29% and 28% for patients discharged to an SNF and home, respectively, and 12% of patients in hospice received <3 days of hospice care before death regardless of their discharge location. Conclusions: Patients with cancer who discharge to an SNF are significantly less likely to receive subsequent oncologic treatment of any kind and have higher mortality compared with patients who discharge to home after an acute care hospitalization. Further research is needed to understand and address patient goals of care before discharge to an SNF.

scholarly journals Pharmosome: an integrative and collective database for exploration and analysis of single nucleotide polymorphisms associated with disease

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 14 ◽  
Author(s):  
Peter T. Habib ◽  
Alsamman M. Alsamman ◽  
Sameh E. Hassanein ◽  
Kerolos M. Yousef ◽  
Aladdin Hamwieh
Keyword(s):  
Phylogenetic Trees ◽  
Drug Response ◽  
Nucleotide Polymorphisms ◽  
Nucleotide Polymorphism ◽  
Single Nucleotide ◽  
Web Based ◽  
Consensus Sequences ◽  
Python Programming ◽  
User Friendly ◽  
To Receive

Current single nucleotide polymorphism (SNP) databases are limited to a narrow set of SNPs, which has led to a lack of interactivity between different databases, limited tools to analyze and manipulate the already existing data, and complexity in the graphical user interface. Here we introduce Pharmosome, a web-based, user-friendly and collective database for more than 30,000 human disease-related SNPs, with dynamic pipelines to explore SNPs associated with disease development, drug response and the pathways shared between different genes related to these SNPs. Pharmosome implements several tools to design primers to detect SNPs in large genomes and facilitates analysis of different SNPs to determine relationships between them by aligning sequences, constructing phylogenetic trees, and providing consensus sequences illustrating the connections between SNPs. Pharmosome was written in the Python programming language using the Django web framework in combination with HTML, CSS, and JavaScript to receive user inputs, and process and export the sorted result to the interface. Pharmosome is available from: https://pharmosome.herokuapp.com/.

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