“The waiting is the worst”: Development of a next day access (NDA) program for patients with cancer.

205 Background: Delays in access to treatment can cause anxiety and distress in patients with cancer. Time to treatment is increasing nationally, with retrospective analyses showing worse outcomes in patients with longer times to treatment initiation. It is critical to implement interventions that enhance navigation, improve access to cancer care, and eliminate operational and cultural barriers to prompt establishment of care and subsequent treatment initiation. We piloted a program for oncologic consultation within 1 business day in two subspecialty clinics and two network sites within our NCI designated comprehensive cancer center. Methods: Each pilot team created an implementation plan, with algorithms defining patients “eligible” for NDA. Generally, patients with a diagnosis or findings suggestive of cancer were eligible; full records were not required prior to the NDA visit. Interventions included adjusting physician templates and use of specific scripting to set expectations for patients prior to NDA visit. An institutional dashboard was created to display metrics--including new patient volume, % NDA visits, and reasons for non-utilization. Plan-Do-Study-Act cycles were completed every 2 weeks to assess data input/validity and address challenges. Patients seen via NDA completed a brief anonymous survey regarding their experience. Results: In 7 months, a total of 3107 new patients were seen across the 4 pilot sites, 900 (29.8%) of whom met “next day appropriate” criteria, and 370 (12%) of whom were seen via NDA. Uptake of NDA appointments was higher in patients with breast cancer. NDA patient satisfaction was extremely high, with 96% indicating that expectations were met or exceeded. Over half (56%) responded that a timely appointment was important when choosing a cancer center. The most common reasons patients were not seen via NDA included: specific provider requested (41%), specific date requested (23%), unavailable next day appointment (6%). Cultural barriers, particularly from treating physicians, included feeling that NDA appointments were inefficient with incomplete data, less time for clinical review, and increased burden due to last minute new patients; operational challenges included insufficient staffing and ensuring complete/accurate data collection. During 12/2019 – 2/2020, median time to first visit ranged from 17 to 36 days; median time to first visit decreased in 3 of the 4 pilot sites to 6-20 days 1 year later. Conclusions: Overall, 12% of patients were seen via NDA Success of this pilot required extensive effort to address change management and perceived barriers. Deployment in other disease teams and community sites is underway.[Table: see text]

Abnormal Pap Follow-Up among Criminal-Legal Involved Women in Three U.S. Cities

Criminal-legal involved women experience significant barriers to preventive cervical care, and consequently there is a higher incidence of cervical cancer in this population. The purpose of this study is to identify variables that may facilitate abnormal Pap follow-up among criminal-legal involved women living in community settings. The study included n = 510 women with criminal-legal histories, from three U.S. cities—Birmingham, AL; Kansas City, KS/MO; Oakland, CA. Participants completed a 288-item survey, with questions related to demographics, social advantages, provider communication, and reasons for missing follow-up care. There were n = 58 women who reported abnormal Pap testing, and n = 40 (69%) received follow-up care. Most women received either repeat Pap/HPV testing (n = 15, 38%), or colposcopy and/or biopsy (n = 14, 35%). Women who did not follow-up (n = 15, 26%) cited that they forgot (n = 8, 53%), were uninsured (n = 3, 20%), or were reincarcerated (n = 3, 20%). In a multivariate analysis, both having a primary care provider (OR 4.6, 95% CI 1.3–16.0) and receiving specific provider communication about follow-up (OR 3.8, 95% CI 1.1–13.2) were independent predictors for abnormal Pap follow-up. Interventions that offer linkages to providers in the community or ensure abnormal Pap care plans are communicated effectively may mitigate the disparate incidence of cervical cancer among criminal-legal involved women.

Efficiency and the scope of outsourced services: a client firm’s absorptive capacity perspective of knowledge-intensive services

PurposeStrategic literature has focused on how economies of scale in a firm offering outsourcing may generate incentives for clients to increase the outsourced services, but there has been limited research on how the clients’ features may influence the scope of services that they hire with an outsourcing provider. This study analyzes whether a client’s efficiency motivates it to increase ties with a specific provider of knowledge-intensive services in the context of business process outsourcing (BPO). We further explore whether industry conditions moderate the relationship.Design/methodology/approachA research framework is developed consisting of three main hypotheses. We combine industry data and proprietary and financial data from a longitudinal sample of 107 client firms of a multinational outsourcing service provider to test our hypotheses.FindingsWe find that more efficient firms hire more services from an outsourcing provider and that the munificence of the client firm’s industry positively moderates this relationship. Our results suggest that efficient clients can better keep transaction costs under control when accessing, assimilating, and exploiting the knowledge embedded in an expanded set of services provided by an outsourcing supplier.Originality/valueThis study extends the absorptive capacity perspective by showing that a client’s efficiency reinforces its opportunities to absorb knowledge-intensive services from a supplier when expanding the range of operations in the context of BPO.

Understanding the Evolving Continuing Medical Education Needs of Physicians Managing Patients with TD

This study sought to understand the evolving continuing medical education (CME) needs of physicians managing patients with tardive dyskinesia (TD). A case-based survey was developed, and later updated, to assess current practice, knowledge, and attitudes of neurologists and psychiatrists in the management of patients with TD. The original and updated survey were fielded in May 2018 and March 2020, respectively, to US-practicing psychiatrists and neurologists. Results were obtained from 213 psychiatrists and 187 neurologists in 2018 and from 125 psychiatrists and 128 neurologists in 2020. Less than half of physicians in both 2018 and 2020 were able to correctly identify the prevalence of TD in patients on maintenance antipsychotics, with many underestimating reported prevalence. Respondents reported moderate familiarity with VMAT2 inhibitor therapies for TD, with self-reported familiarity increasing more among neurologists than psychiatrists since the 2018 study. Psychiatrists are more likely than neurologists to take responsibility for medical management of TD symptoms and antipsychotic medication adjustment. Despite recommendations from APA guidelines and AAN reviews, 15% of physicians would use an anticholinergic to manage TD symptoms and only about half would opt for a VMAT2 inhibitor. There was a larger increase in VMAT inhibitor use between 2018 and 2020 among neurologists as compared to psychiatrists. The findings support the need for CME on TD focused toward specific provider groups. While both types of specialists would benefit from CME on the topic of TD epidemiology, there is an increased need for CME that includes treatment updates among psychiatrists.Funding. Neurocrine Biosciences, Inc.

The omics discovery REST interface

The Omics Discovery Index is an open source platform that can be used to access, discover and disseminate omics datasets. OmicsDI integrates proteomics, genomics, metabolomics, models and transcriptomics datasets. Using an efficient indexing system, OmicsDI integrates different biological entities including genes, transcripts, proteins, metabolites and the corresponding publications from PubMed. In addition, it implements a group of pipelines to estimate the impact of each dataset by tracing the number of citations, reanalysis and biological entities reported by each dataset. Here, we present the OmicsDI REST interface (www.omicsdi.org/ws/) to enable programmatic access to any dataset in OmicsDI or all the datasets for a specific provider (database). Clients can perform queries on the API using different metadata information such as sample details (species, tissues, etc), instrumentation (mass spectrometer, sequencer), keywords and other provided annotations. In addition, we present two different libraries in R and Python to facilitate the development of tools that can programmatically interact with the OmicsDI REST interface.

The Omics Discovery REST interface

The Omics Discovery Index is an open source platform that can be used to access, discover and disseminate omics datasets. OmicsDI integrates proteomics, genomics, metabolomics, models and transcriptomics datasets. Using an efficient indexing system, OmicsDI integrates different biological entities including genes, transcripts, proteins, metabolites and the corresponding publications from PubMed. In addition, it implements a group of pipelines to estimate the impact of each dataset by tracing the number of citations, reanalysis and biological entities reported by each dataset. Here, we present the OmicsDI REST interface to enable programmatic access to any dataset in OmicsDI or all the datasets for a specific provider (database). Clients can perform queries on the API using different metadata information such as sample details (species, tissues, etc), instrumentation (mass spectrometer, sequencer), keywords and other provided annotations. In addition, we present two different libraries in R and Python to facilitate the development of tools that can programmatically interact with the OmicsDI REST interface.

PASIFIKA FUTURES WHĀNAU ORA: F’INE – Nurturing the Future for Pasifika LGBTQI

F’INE Aotearoa, through Pasifika Futures Whānau Ora programme, is supporting Pacific Lesbian, Gay, Bisexual, Transgender, Queer and Intersex (LGBTQI) individuals and their families to transform their lives and achieve their aspirations. The LGBTQI community in New Zealand experience significant disadvantage across a range of areas affecting wellbeing, including higher rates of poor mental health, depression and anxiety 1,2,3. For Pacific LGBTQI, the disadvantages are compounded further. F’INE, an LGBTQI specific provider in New Zealand, is working to change this.

Patient Satisfaction With Providers: Do Patient Surveys Give Enough Information to Help Providers Improve Specific Behaviors

Background: Patient satisfaction surveys ask patients specific questions about provider behavior such as whether they were satisfied with the provider’s instructions about medications or time spent with the patient. It’s unclear how responses to these surveys can help providers focus on specific behaviors to improve. Methods: In a primary care setting, we analyzed Press Ganey patient experience survey responses. We examined the 10 questions dealing with satisfaction specific to the care provider experience. We used the “Top Box” counts (counts of most favorable responses) and Top Box% (percentage of most favorable response) for categorical and continuous measures of patient satisfaction. Results: For 12 consecutive months, 652 providers of 1014 accumulated at least 300 total responses from patients for the 10 provider-related questions. Only 8 of the 652 providers had significant differences ( P < .05) in Top Box% for the 10 questions. Correlation of responses between the questions were between 0.86 and 0.96. Analysis of variance showed that 87% of the total variation in the Top Box% of the 10 questions was between providers and only 13% within providers. Factor analysis found no independent factors within the 10 questions (ie, a one factor model was sufficient; P < .0001). Conclusion: Patient survey questions appear to ask about specific provider behaviors that contribute to patient experience. However, the responses to 10 different questions are highly correlated and may not give providers or management enough statistically significant information to focus patient experience improvement efforts for individual providers.

Higher Education Faculty Perceptions of Open Textbook Adoption

<p class="3">The high cost of tuition and textbooks can have a negative impact on potential students from lower socioeconomic backgrounds. Open Educational Resources (OER) offers students a way to save educational costs while utilizing high-quality open textbooks. Up until now, there have been few studies focused on a specific provider of open textbooks. This study investigates open textbooks provided by OpenStax. Specifically, this study uses the COUP framework to examine: (1) cost reduction, (2) outcomes, (3) uses, and (4) the faculty perceptions of the quality of OpenStax textbooks. Additionally, we expanded the framework to address (5) the relationship between the perceived quality of the OpenStax textbook and the faculty perception of student performance, (6) the faculty’s intention to continue to adopt OpenStax textbooks, and (7) the perceived importance of accessibility to faculty who use OpenStax textbooks. Overall, the findings suggest that a significant amount of financial savings and a number of pedagogical shifts can be supported by the use of OpenStax textbooks.</p>