scholarly journals A Multidisciplinary Approach to Implement Personalized Breast Cancer Treatment and Care Plans

2021 ◽  
Vol 28 (1) ◽  
pp. 767-782
Author(s):  
Rashida Haq ◽  
Amy Kong ◽  
Pauline Gulasingam
Keyword(s):  
Breast Cancer ◽  
Primary Care Physicians ◽  
Phase 1 ◽  
Data Entry ◽  
Implementation Process ◽  
Standard Of Care ◽  
Care Team ◽  
Quality Improvement Initiative ◽  
Team Members ◽  
Care Plans

Implementation of survivorship care plans remain a challenge. This quality improvement initiative aims to integrate personalized treatment plans (PTP) and care plans (PCP) into the existing workflow for breast cancer (BC) patients. Methods: Phase 1 was to identify multidisciplinary team members to generate and deliver PTP and PCP. Concurrently, Phase 2 was to deliver PTP and PCP to newly diagnosed invasive BC patients at chemotherapy initiation and completion, respectively. Iterative plan, do, study, act (PDSA) cycles were applied to refine the process. The proportion of information completed for PTP and PCP generation and its delivery by the care team were measured. Patient and provider satisfaction were also assessed. Implementation Process and Results: The care transfer facilitator (CTF) was identified to complete and deliver PTP, and their data entry increased from 0% to 76%, 80%, 92% consecutively during the last 4 PDSA cycles. PTP and PCP were provided to 85% of eligible BC patients. Patients agreed that PTP helped them to actively participate in their care (88%) and communicate with the oncology care team (86%). Primary care physicians agreed that PTP and PCP had the information needed to “stay in the loop” (80%), and oncologists agreed they should be incorporated into oncology clinics (100%). Conclusions: Integrating PTP and PCP generation and delivery into existing workflow has led to an increase in uptake, sustainability and provider buy-in. With limited resources, it remains difficult to find care team members to complete the forms. A dedicated personnel or survivorship clinic is required to successfully implement PTP and PCP as the standard of care.

Systematic development of a a breast cancer survivorship program at a small independent oncology practice.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 52-52 ◽  
Author(s):  
Cynthia Rogers ◽  
Shailesh R. Satpute
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Data Entry ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care Plans ◽  
Full Time ◽  
Survivorship Care ◽  
Breast Cancer Patients ◽  
Care Plans

52 Background: It is widely accepted that providing survivorship care plans leads to improvements in outcomes for cancer survivors. Treatment summaries are now part of ASCO and NCCN survivorship guidelines. We faced a unique challenge of implementing the survivorship care plan at the Jones Clinic as a small independent practice. The Jones Clinic consists of three full time physicians and two full time nurse practitioners. We see approximately 850 new patients per year. Methods: As a part of ASCO’s quality training program, we focused on the stage I – III (early stage) breast cancer patients who completed their initial therapy. We formed a team, identified the barriers, created a flow diagram of the process, assigned roles for each individual member and finally implemented the process. Results: The major issues identified were lack of provision in the electronic medical record (EMR) system for survivorship and lack of standardized data entry process. We created a system in the EMR for survivorship data entry and extraction of such data in a document. Since July 2015, one hundred percent of breast cancer patients completing adjuvant therapy at the Jones Clinic have received a survivorship treatment summary and a plan of care. The care plan is also shared with their primary care provider. Importantly, creating a survivorship document required less than 10 minutes of the provider’s time. Conclusions: We are now able to provide our patients with a survivorship care plan and address survivorship issues within thirty days of completion of therapy. Creating the care plan requires minimal time from the providers. Our new process meets ASCO guidelines for survivorship care plans and no additional staffing was needed. We now plan to provide a survivorship care plan to all oncology patients treated with curative intent.

scholarly journals Accuracy and Thoroughness of Treatment Summaries Provided as Part of Survivorship Care Plans Prepared by Two Cancer Centers

2017 ◽  
Vol 13 (5) ◽  
pp. e486-e495 ◽  
Author(s):  
Amye J. Tevaarwerk ◽  
William G. Hocking ◽  
Jamie L. Zeal ◽  
Mindy Gribble ◽  
Lori Seaborne ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Data Entry ◽  
Standard Of Care ◽  
Care Plan ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Cancer Centers ◽  
Treatment Summaries ◽  
Care Plans ◽  
Treatment Information

Purpose: Treatment summaries prepared as part of survivorship care planning should correctly and thoroughly report diagnosis and treatment information. Methods: As part of a clinical trial, summaries were prepared for patients with stage 0 to III breast cancer at two cancer centers. Summaries were prepared per the standard of care at each center via two methods: using the electronic health record (EHR) to create and facilitate autopopulation of content or using manual data entry into an external software program to create the summary. Each participant's clinical data were abstracted and cross-checked against each summary. Errors were defined as inaccurate information, and omissions were defined as missing information on the basis of the Institute of Medicine recommended elements. Results: One hundred twenty-one summaries were reviewed: 80 EHR based versus 41 software based. Twenty-four EHR-based summaries (30%) versus six software-based summaries (15%) contained one or more omissions. Omissions included failure to provide dates and specify all axillary surgeries for EHR-based summaries and failure to specify receptors for software-based summaries. Eight EHR-based summaries (10%) versus 19 software-based summaries (46%) contained one or more errors. Errors in EHR-based summaries were mostly discrepancies in dates, and errors in software-based summaries included incorrect stage, surgeries, chemotherapy, and receptors. Conclusion: A significant proportion of summaries contained at least one error or omission; some were potentially clinically significant. Mismatches between the clinical scenario and templates contributed to many of the errors and omissions. In an era of required care plan provision, quality measures should be considered and tracked to reduce rates, decrease inadvertent contributions from templates, and support audited data use.

An Analysis of Electronic Health Record Work to Manage Asynchronous Clinical Messages among Breast Cancer Care Teams

2021 ◽  
Vol 12 (04) ◽  
pp. 877-887
Author(s):  
Bryan D. Steitz ◽  
Kim M. Unertl ◽  
Mia A. Levy
Keyword(s):  
Breast Cancer ◽  
Electronic Health Record ◽  
Cancer Care ◽  
Medical Center ◽  
Asynchronous Communication ◽  
Care Team ◽  
Health Record ◽  
Breast Cancer Care ◽  
Team Members ◽  
Electronic Health

Abstract Objective Asynchronous messaging is an integral aspect of communication in clinical settings, but imposes additional work and potentially leads to inefficiency. The goal of this study was to describe the time spent using the electronic health record (EHR) to manage asynchronous communication to support breast cancer care coordination. Methods We analyzed 3 years of audit logs and secure messaging logs from the EHR for care team members involved in breast cancer care at Vanderbilt University Medical Center. To evaluate trends in EHR use, we combined log data into sequences of events that occurred within 15 minutes of any other event by the same employee about the same patient. Results Our cohort of 9,761 patients were the subject of 430,857 message threads by 7,194 employees over a 3-year period. Breast cancer care team members performed messaging actions in 37.5% of all EHR sessions, averaging 29.8 (standard deviation [SD] = 23.5) messaging sessions per day. Messaging sessions lasted an average of 1.1 (95% confidence interval: 0.99–1.24) minutes longer than nonmessaging sessions. On days when the cancer providers did not otherwise have clinical responsibilities, they still performed messaging actions in an average of 15 (SD = 11.9) sessions per day. Conclusion At our institution, clinical messaging occurred in 35% of all EHR sessions. Clinical messaging, sometimes viewed as a supporting task of clinical work, is important to delivering and coordinating care across roles. Measuring the electronic work of asynchronous communication among care team members affords the opportunity to systematically identify opportunities to improve employee workload.

Completeness and accuracy of survivorship care plans (SCPs) prepared via two methods: Electronic health record (EHR) auto-population versus manual data entry.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 62-62
Author(s):  
Amye Tevaarwerk ◽  
Jamie L Zeal ◽  
Mindy Gribble ◽  
Kevin A Buhr ◽  
Douglas Wiegmann ◽  
...  
Keyword(s):  
Clinical Data ◽  
Data Entry ◽  
Standard Of Care ◽  
Advanced Practice ◽  
Breast Cancer Patients ◽  
Care Plans ◽  
Using Data ◽  
Iom Recommendations ◽  
Site Training

62 Background: To improve care for side effects and coordinate follow up, SCPs should correctly and thoroughly report details regarding diagnosis and treatment. However, literature is lacking regarding SCP accuracy and completeness. We audited SCPs for errors and omissions, as part of a clinical trial conducted at two cancer centers. Methods: SCPs were prepared for Stage 0-3 breast cancer patients by 1 of 2 methods, which was based on the standard of care at each center: 1) EHR-based: auto-populated using data entered into the EHR by oncologists for clinical use. SCP finalized by oncologist or advanced practice provider; and 2) Manual entry: prepared by an RN using manual transfer of clinical data into software program. Each participant’s clinical data was abstracted from her chart, with audit and cross-check against each SCP. In the case of discrepancies, oncologists reviewed the chart and adjudicated the “correct” information, as well as completeness and error. Omissions were defined by missing SCP information required per IOM recommendations; errors were defined as data reported in the SCP that did not match the chart. Results: Two sites enrolled 128 women between 11/2013-12/2014; 80 received EHR-based vs 41 manual SCPs. Omissions: 24 (30%) EHR-based versus 6 (15%) manual SCPs contained at least 1 omission. Omissions included failure to provide some dates and specific axillary surgery type (sentinel vs axillary) for EHR-based SCPs and failure to specify receptors for manual SCPs. Errors: 7 (9%) EHR-based versus 19 (46%) manual SCPs contained at least one error. The majority of EHR-based SCP errors were minor discrepancies in dates. Errors in manual SCPs included chemotherapy regimen, incorrect receptors, incorrect stage and axillary surgeries; stage and surgery errors were affected by poor fit with templated SCP fields. Conclusions: Little is known about SCP accuracy and completeness. Manually prepared SCPs may have a higher rate of errors while EHR-based SCPs may have more omissions. Differences in preparation (site, training of preparer) could also account for these differences. In an era of required SCP provision, measures of SCP quality should be considered.

scholarly journals Toward improved goals-of-care documentation in advanced cancer: report on the development of a quality improvement initiative

2017 ◽  
Vol 24 (6) ◽  
pp. 383 ◽  
Author(s):  
I. Harle ◽  
S. Karim ◽  
W. Raskin ◽  
W.M. Hopman ◽  
C.M. Booth
Keyword(s):  
Breast Cancer ◽  
Palliative Care ◽  
Quality Improvement ◽  
Advance Care Planning ◽  
Quality Improvement Initiative ◽  
Care Planning ◽  
Documentation System ◽  
Goals Of Care ◽  
Care Plans ◽  
Advance Care

Background Documentation of advance care planning for patients with terminal cancer is known to be poor. Here, we describe a quality improvement initiative.Methods Patients receiving palliative chemotherapy for metastatic lung, pancreatic, colorectal, and breast cancer during 2010–2015 at the Cancer Centre of Southeastern Ontario were identified from electronic pharmacy records.Clinical notes were reviewed to identify documentation of care plans in the event of acute deterioration. After establishing baseline practice, we sought to improve documentation of goals of care and referral rates to palliative care. Using quality improvement methodology, we developed a guideline, a standardized documentation system, and a process to facilitate early referral to palliative care.Results During 2010–2015, 456 patients were included in the baseline cohort: 63% with lung cancer, 16% with colorectal cancer, 13% with pancreatic cancer, and 7% with breast cancer. Care goals in the event of an acute illness were documented by medical oncologists in 6% of cases (26 of 456). Of the 456 patients, 47% (n = 214) were seen by palliative care; care goals were documented by palliative care in 48% of the patients seen (103 of 214). With those baseline data in hand, a local practice guideline and process was developed to facilitate the identification of patients for whom advance care planning and early palliative care referral should be considered. A system was also established so that goals-of-care documentation will be supported with a written framework and broadly accessible in the electronic medical record.Conclusions Low rates of documentation of advance care planning and referral to palliative care persist and have stimulated a local quality improvement initiative.

scholarly journals Classification and analysis of asynchronous communication content between care team members involved in breast cancer treatment

JAMIA Open ◽  
2021 ◽  
Vol 4 (3) ◽  
Author(s):  
Bryan D Steitz ◽  
Lina Sulieman ◽  
Jeremy L Warner ◽  
Daniel Fabbri ◽  
J Thomas Brown ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Language Processing ◽  
Medical Center ◽  
Clinical Information ◽  
Research Literature ◽  
Asynchronous Communication ◽  
Care Team ◽  
Message Content ◽  
Team Members ◽  
Sentence Level

Abstract Objective A growing research literature has highlighted the work of managing and triaging clinical messages as a major contributor to professional exhaustion and burnout. The goal of this study was to discover and quantify the distribution of message content sent among care team members treating patients with breast cancer. Materials and Methods We analyzed nearly two years of communication data from the electronic health record (EHR) between care team members at Vanderbilt University Medical Center. We applied natural language processing to perform sentence-level annotation into one of five information types: clinical, medical logistics, nonmedical logistics, social, and other. We combined sentence-level annotations for each respective message. We evaluated message content by team member role and clinic activity. Results Our dataset included 81 857 messages containing 613 877 sentences. Across all roles, 63.4% and 21.8% of messages contained logistical information and clinical information, respectively. Individuals in administrative or clinical staff roles sent 81% of all messages containing logistical information. There were 33.2% of messages sent by physicians containing clinical information—the most of any role. Discussion and Conclusion Our results demonstrate that EHR-based asynchronous communication is integral to coordinate care for patients with breast cancer. By understanding the content of messages sent by care team members, we can devise informatics initiatives to improve physicians’ clerical burden and reduce unnecessary interruptions.

scholarly journals Characterizing communication patterns among members of the clinical care team to deliver breast cancer treatment

2019 ◽  
Vol 27 (2) ◽  
pp. 236-243 ◽  
Author(s):  
Bryan D Steitz ◽  
Kim M Unertl ◽  
Mia A Levy
Keyword(s):  
Breast Cancer ◽  
Electronic Health Record ◽  
Medical Center ◽  
Clinical Care ◽  
Communication Patterns ◽  
Care Team ◽  
Health Record ◽  
Team Members ◽  
The Subject ◽  
Electronic Health

Abstract Objective Research to date focused on quantifying team collaboration has relied on identifying shared patients but does not incorporate the major role of communication patterns. The goal of this study was to describe the patterns and volume of communication among care team members involved in treating breast cancer patients. Materials and Methods We analyzed 4 years of communications data from the electronic health record between care team members at Vanderbilt University Medical Center (VUMC). Our cohort of patients diagnosed with breast cancer was identified using the VUMC tumor registry. We classified each care team member participating in electronic messaging by their institutional role and classified physicians by specialty. To identify collaborative patterns, we modeled the data as a social network. Results Our cohort of 1181 patients was the subject of 322 424 messages sent in 104 210 unique communication threads by 5620 employees. On average, each patient was the subject of 88.2 message threads involving 106.4 employees. Each employee, on average, sent 72.9 messages and was connected to 24.6 collaborators. Nurses and physicians were involved in 98% and 44% of all message threads, respectively. Discussion and Conclusion Our results suggest that many providers in our study may experience a high volume of messaging work. By using data routinely generated through interaction with the electronic health record, we can begin to evaluate how to iteratively implement and assess initiatives to improve the efficiency of care coordination and reduce unnecessary messaging work across all care team roles.

Developing a Sociotechnical Intervention for Delivery of Cardiovascular Care in Rural Communities: A Participatory Design Approach (Preprint)

2021 ◽  
Author(s):  
Michelle Partogi ◽  
Simon Gaviria-Valencia ◽  
Nancy Pick ◽  
Maya Kessler ◽  
Jay Mitchell ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Clinical Practice ◽  
Rural Communities ◽  
Participatory Design ◽  
Clinical Decision ◽  
Care Team ◽  
Team Members ◽  
Sociotechnical System ◽  
Care Plans ◽  
Cardiovascular Care

BACKGROUND Clinical practice guidelines recommend antiplatelet and statin therapies, blood pressure control and cessation of tobacco products for atherosclerotic cardiovascular disease (ASCVD) patients. However, these strategies for risk modification are underused by patients with ASCVD, especially in rural communities. The needs of and resources available to rural patients with cardiovascular disease are different than their urban/suburban counterparts, requiring a distinct approach to their care. Interventions developed without considering the unique needs of rural populations often fail. Approaches tailored to this population are needed. OBJECTIVE Using a Participatory Design (PD) approach, a multidisciplinary team sought to develop a sociotechnical intervention to enable rural primary care teams to systematically improve the cardiovascular health of patients with ASCVD. The intervention included adapting an existing technology for delivery of expert guideline recommendations into clinical practice in rural communities. METHODS Development took place in four stages: I) Initial Understanding, II) Ideation and Experimentation, III) Prototyping the Intervention, and IV) Designing the Sociotechnical System. Our team observed clinical encounters, interviewed patients, and conducted workshops with rural care team members to develop viable intervention concepts. We then iteratively prototyped in a routine clinical practice and refined a pilotable version of the intervention with extensive stakeholder feedback. RESULTS The sociotechnical intervention was created with input from clinical team members (n=35) in Austin and Adams, Minnesota. This collaboration resulted in contextually-grounded workflows and a clinical decision support tool that [1] identifies patients with ASCVD who would benefit from additional care touchpoints, [2] aggregates crucial medical information for clinical decision-making, and [3] assigns the appropriate care team role to determine care plans. The resulting intervention enables care teams to systematically, collaboratively, and proactively deliver care for patients with ASCVD. CONCLUSIONS The PD process was invaluable in developing a cardiovascular intervention that establishes a sociotechnical system comprised of novel responsibilities, workflows, and technology while acknowledging capacities and limitations of rural health care clinics. Next steps involve the evaluation of the intervention impact on standard metrics of quality cardiovascular care and the dissemination of the intervention to other clinic locations while maintaining core values of human-centered design.

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