In 2017, the CMS Quality Payment Program introduced the new Improvement Activities performance category where clinicians are rewarded for activities such as care coordination, beneficiary engagement and patient safety. ASCO has compiled these resources as you consider your own practice improvement activities.

Below are projects completed in the Quality Training Program to share expertise and provide ideas for others seeking to improve the quality of patient care. All the project presentations use the same framework, stating:

• the name of the organization and the individuals completing the work,
• the project problem statement and aim (goal),
• interventions, and
• baseline data and results (where available).

In this list, each project has been assigned a primary category (such as Care Coordination or Patient Safety) and secondary categories as appropriate. Note: Some projects may apply to multiple categories and subcategories.

Another resource as you consider your practice improvement activities is this crosswalk between CMS Improvement Activities and ASCO's Quality Programs.

Stavros Niarchos Foundation Grant Funded QTP Scholars

Project Title: Improving the Feeding Tube Placement Process for Head and Neck Radiation Oncology Patients, Memorial Hospital of Sweetwater County, Sweetwater County, WY 2023

Subcategory: Patient Care

Problem Statement: Between January 1, 2021, and May 31, 2023, 7 newly diagnosed head and neck cancer patients in Radiation Oncology at Memorial Hospital of Sweetwater County required feeding tubes to safely receive effective radiation therapy. 71% percent of these patients had 3 or more rework loops (deviations) within the feeding tube placement process, which led to patient and staff frustration, delayed discharge after feeding tube placement, interrupted radiation treatment, and increased cost.

 

Project Title: Improving Wait Times for GI Oncology Patients at Hartford Hospital Infusion Center, Hartford HealthCare Cancer Institute, Hartford, CT, 2023

Subcategory: On Time Treatment

Problem Statement: GI Oncology patients receiving chemotherapy at the Hartford Infusion Center experience a mean wait time of 81 minutes from the start of check-in to the start of their first medication, resulting in patient and staff dissatisfaction and inefficient use of resources.

 

Project Title: Enhancing Compliance with Hepatitis Screening Prior to Oncology Treatments at Adena Cancer Center, Adena Cancer Center, Chillicothe, OH, 2023

Subcategory: Patient Safety

Problem Statement: Opportunities for Improvement in Hepatitis Screening Prior to Oncology Treatments May -July, 2023. 35 100% 90% 30 80% 25 70% 60% 20 50% 15 40% 30% 10 20% 5 10% 0 0% Care coordination § § Infusion RN Staffing constraints with APPs prevents mandatory Care Coordination visits Infusion checklist does not include Hepatitis screening labs at this time Team did not order.

 

Care Coordination

Project Title: Retention of Patients from Referral to Simulation in Radiation Oncology, Oregon Health and Science University, Portland, OR, 2017

Subcategory: Patient Experience

Problem Statement: Between February and April 2017, 54% of patients in the Radiation Medicine Department were seen as a new patient consult at the OHSU Radiation Oncology Department* ≥ 2 weeks from the date of referral. This resulted in treatment delays, a decline in patient satisfaction, and possibly compromised patient outcomes.

 

Project: Decreasing Initiation of Chemotherapy Time in Elective Patients Admitted to an Inpatient Hematology Malignancy Unit, Montefiore, Brooklyn, NY, 2017

Subcategory: On-time Treatment Delivery

Problem Statement: 86% (n=25) of patients with hematologic malignancies admitted for elective chemotherapy in the oncology unit experienced a delay (greater than 6 hours) in initiating their treatment in the period of February to March 2017.

This delay results in an increased length of stay, decreased patient satisfaction, and an increase in resource utilization. 

 

Project: Reducing the admission-to-chemotherapy delay, Parkland Hospital and Health Systems, Dallas, TX, 2017

Subcategory: On-time Treatment Delivery

Problem Statement: Reducing the Length of Stay (LOS) is a high-priority objective. The 14-400 inpatient unit admits 1-2 patients daily for inpatient chemotherapy. Rooms are reserved for patients ahead of admission. Initiation of chemotherapy is often delayed -> adds a day to LOS. Median delay of 6.2 hours between arrival and initiation of chemotherapy in January-February 2017. 

 

Project: Creation of a Cross-Functional Care Team to Develop Individualized Care Plans in High Utilize Oncology Patients, Cleveland Clinic Foundation, Cleveland, OH, 2016

Subcategory: Hospital Readmission Prevention

Problem Statement: With growing attention to quality in health care, readmission has gained much of the national focus. At our institution, it has become clear that a small portion of our patient population drives a significant burden on our readmission rates and resource utilization. In fact, just 6% of all discharged patients account for a staggering 41% of all readmissions. However, patients who are most frequently readmitted have complex psychosocial barriers that no general intervention is likely to address

 

Project: Wilmot Cancer Institute Ambulatory Treatment Handoff Project, Wilmot Cancer Institute, Rochester, NY, 2016

Subcategory: Patient Safety

Problem Statement: Fifty-nine percent of reported medication events for patients receiving anti-cancer treatments at WCI Infusion Center on the same day as clinic visits from 7/24/2014 to 6/30/2016 were due to ineffective handoff communication. The completion rate of the WCI handoff tool from 10/1/2015 to 6/30/2016 for patients treated with anticancer therapy on the same day as a clinic visit is 32% (based on 25 audits per month, or 5% of patients.

 

Project: Reducing Emergency Room Visits in Patients Receiving IV Chemotherapy Using Care Coordination, Tennessee Oncology, Chattanooga, TN, 2016

Problem Statement: From January to June 2016, 96 patients receiving IV chemotherapy at the Memorial office had an Emergency Room visit. This results in emotional, psychosocial, and physical burdens for patients and is a preventable cost for patients and the healthcare system. 

 

Project: Coordination of Care for Patients Initiating Oral Oncolytic Therapy, Tennessee Oncology, Nashville, TN, 2018

Subcategory: On-time Treatment Delivery

Problem Statement: Our practice EMR had inaccurate C1-D1 documented on 90% of patients beginning oral oncolytic therapy in the baseline period of January 1, 2018, through June 30, 2018. As a result of inaccurate C1-D1, 70% of patients had initial MD follow-up visits scheduled at a time interval less than optimal time for assessment of drug-specific toxicity.

 

Project: Reducing the Inpatient Length of Stay of Oncology Patients in Low Socioeconomic Communities, Medical College of Wisconsin

Subcategory: On-time Treatment Delivery

Problem Statement: In Q1 2019 – Q4 2019, Milwaukee County patients of low socioeconomic status (SES) with solid tumor malignancies (with medical admissions) had an average length of stay of 7.2 days.  Patients in the high SES group had an average length of stay of 5.6 days.

 

Project: Reducing Delays in Chemotherapy Administration in the Therapeutic Medicine Center at New York-Presbyterian Queens, New York-Presbyterian Queens

Subcategory:  On-time Treatment Delivery

Problem Statement: During the last six months, patients with an oncologic diagnosis scheduled for outpatient chemotherapy in the Therapeutic Medicine Center at NewYork-Presbyterian/Queens experienced a median time from registration to treatment initiation of 112 minutes. This led to decreased patient satisfaction.

 

Project: Palliative Care Referrals at Hospital Sírio-Libanês –Itaim Unit, Brazil, 2020

Category: Care Coordination

Problem Statement: From July to December 2019 at HSL-Itaim, 5% of patients with metastatic cancer that had a 5-year survival of less than 10% (such as lung, upper GI, and CNS cancers) were referred to palliative care. This results in unnecessary or excessive nonbeneficial treatments at the end of life, poor psychological and spiritual support, and leads to a waste of resources.

 

Project: Improving Utilization of Supportive Care Resources and Palliative Care Medicine Consultations for Newly Diagnosed Glioblastoma Patients, Tisch Brain Tumor Center, Duke University, 2021

Category: Care Coordination

Problem Statement: At PRTBTC and Duke Cancer Institute, we have multiple available supportive care resources. These include dedicated social workers, a child-life specialist, a neuropsychologist, a neuropsychiatrist, and palliative care medicine providers. We reviewed records of newly diagnosed GBM patients seen for an initial consultation between January 1, 2020, and February 28, 2020. Twenty-two patients were identified. Despite the availability of supportive care resources, only 32% of newly diagnosed GBM patients utilized these resources, and 9% of newly diagnosed GBM received a palliative care medicine consultation.

 

Project: Improving Care Coordination for Patients on Oral Oncolytic Therapy, Hematology-Oncology Associates of Central New York, 2021

Category: Care Coordination

Problem Statement: 55% of Ibrance dispenses from The Patient Rx Center (TPRxC) occur outside of our specified timeframe; either more than 3 days after their office visit or the dispense occurred before the office visit. This results in inefficient care and wastes resources, impacting patient satisfaction and leading to both patient & staff frustration.

 

Project: Increasing Utilization of Cancer Survivorship Resources of African American Breast Cancer Patients, Loyola Medical University, 2021

Category: Care Coordination

Problem Statement: Between March 1, 2020, and March 1, 2021, <10% of African American breast cancer patients who received curative intent therapy utilized the Cardinal Bernardin Cancer Center Survivorship Clinic. The lack of utilization of this program leads to the inefficient application of resources, decreased survivorship care, reduced patient experience, and diminished opportunity for survivorship education/literacy.

 

Project: Improving utilization of hospice at the end of life for patients with advanced (solid tumor) cancer, Weill Cornell Medicine-New York Presbyterian, 2021

Category: Care Coordination

Problem Statement: From October 1, 2020, to January 31, 2021, only 27% of patients with solid tumor cancer and admission within 6 months prior at NYP/Weill Cornell Medicine utilized hospice services at end of life. This can result in patients not being able to receive the full benefit of hospice at the end of life, significant distress to patients and families, and frustration among staff and caregivers.

 

Project: It’s Complicated: Hospital Discharge Follow-Up Scheduling, Yale New Haven Hospital | Yale Cancer Center, 2021

Category: Care Coordination

Problem Statement: From January 2020 through December 2020… Overall, 48% of Smilow Cancer Hospital patients being discharged have an outpatient oncology provider follow-up appointment scheduled within 14 days of discharge. Lack of scheduled follow-up can lead to delays in patient care, negatively impact provider communication and disrupt care coordination.

 

Project: Intervention Aimed at Improving Delivery of New Oncology Drug Education to Nursing at Dana-Farber Cancer Institute Satellites. Dana Farber Cancer Institute, Boston, MA, 2021.

Category: Care Coordination

Problem Statement: Only 57% of nurses at DFCI satellites indicated on a survey delivered on 9/10/21 that they are either “somewhat comfortable or “very comfortable” administering newer oncology drugs. This is concerning for patient safety and staff satisfaction; the survey revealed nursing would like more drug education

 

Project: Multiple Myeloma Maintenance Therapy Improvement Project. Muhimbili National Hospital, Dar Es Salaam, Tanzania, 2021.

Category: Care Coordination

Problem Statement: Between June 2020- June 2021, an average of 29 patients/per month stopped their MM treatment; which led to relapse within 1-year (post 1^st induction) requiring a second induction and a 50% MM mortality in our hospital.

 

Project: Reducing Frequency of Radiation Therapy Treatment Planning Errors. AHNCI – Division of Radiation Oncology, Pittsburgh, PA, 2021.

Category: Care Coordination

Problem Statement: ANHCI provides [external beam] radiation treatment for approximately 400 patients per month. Each course of radiation treatment requires a patient-specific treatment planning process that will establish the type, dose, and frequency of radiation treatment the patient will receive, as well as the custom radiation beam design that will deliver dose to the prescribed treatment area(s). During the period of 1/1/2020 – 7/7/2021, it was found that there was a median of 4 errors per month. These errors increase the risk of downstream, systematic errors in radiation therapy treatment delivery.

 

Project: Patient Navigation in Harris Health System Lung Cancer Patients. Baylor College of Medicine, Houston, TX, 2022

Category: Care Coordination

Problem Statement: Harris Health System (HHS) is an integrated safety net health system, and the third largest safety net system in the country. The Baylor College of Medicine Dan L Duncan Comprehensive Cancer Center, The University of Texas MD Anderson Cancer Center and HHS partner to care for the underserved cancer patients in Harris County. New Lung Cancer patients often have delays from their diagnosis to treatment initiation.

 

Project: Reducing Variation in Nurse Navigator Engagement. Blue Ridge Cancer Care, Roanoke, VA, 2022

Category: Care Coordination

Problem Statement: Between January and March 2021, an average of 54% of all new cancer patients starting IV chemotherapy at all clinic locations did not have a Nurse Navigator (NN) introduction and initial assessment (NN I/IA) completed within one month after his/her initial consult visit.

Patient Safety 

Project: Improvement of Treatment Toxicity Grading According to the Common Terminology Criteria for Adverse Events (CTCAE), Contemporary Oncology Team, Athens, Greece, 2016

Subcategory: Treatment Toxicity, Documentation Improvement

Problem Statement: During the evaluation for QOPI® Certification in Spring 2016 it was noted that toxicity assessment was rarely graded according to the Common Terminology Criteria for Adverse Events (CTCAE) in the files of patients receiving treatment and this could hinder appropriate treatment dose modification. After collecting baseline data we determined that toxicity was graded according to CTCAE only in 26% of the patients receiving chemotherapy with epirubicin/cyclophosphamide and nab-paclitaxel and immunotherapy with nivolumab*. *Represents approximately 5-7% of the COT patient population under iv treatment. 

 

Project: Reduction of Invasive Fungal Infections in Patients with Acute Myeloid Leukemia Undergoing Induction or Re-induction Chemotherapy, University of Virginia Health System- Mohammed A Naeem, MD, PhD, Charlottesville, VA, 2016

Problem Statement: 21.7% of patients with AML undergoing induction or re-induction chemotherapy at UVA medical center had a proven/probable invasive fungal infection (IFI) leading to increased morbidity as evidenced by an increased number of medical emergency team (MET) calls.

 

Project: Prevention of Extravasations of Anticancer Therapy in the Oncology Clinic Infusion Patient, Allegheny Health Network Cancer Institute, Pittsburgh, PA, 2018

Problem Statement: The Allegheny Health Network Cancer Institute Medical Oncology Clinic’s extravasation rate January 2017- September 2018 was 0.12%. An extravasation results in negative patient experience and outcomes related to increased pain, tissue injury, and inappropriate medication administration.

 

Project: Minimize the risk of patients with phase I trials treatment, Institut Català d’Oncologia, H Duran i Reynals (L’Hospitalet-Barcelona), Spain, 2019 

Subcategory: Patient Satisfaction

Problem Statement: Medical Emergency SOP accomplishment despite the several necessary services, especially the ambulance activation and ICU admission.

Oral Chemotherapy

Project: Timely Delivery of Oral Androgen Targeted Therapy, City of Hope, 2019

Subcategory: On-time Treatment Delivery

Problem Statement: There are delays of 29 days average (20 median) in the HOME delivery by specialty pharmacies of ORAL hormone therapy to metastatic prostate cancer patients seen at the Duarte Campus.

 

Project:  Improving the Rate of patient counseling by the pharmacist prior to starting oral oncolytic therapy with capecitabine, UT Southwestern Medical Center, Simmons Comprehensive Cancer Center, Dallas, TX, 2017

Subcategory: Patient Safety, Process Improvement

Problem Statement: Between January and May 2017, only 40.7% (n=11/27) of patients at the Simmons Cancer Center at UT Southwestern were counseled by a UT Southwestern pharmacist prior to the first dose of the oral chemotherapy drug capecitabine, exposing these patients to the risks of toxicity and non-adherence. 

 

Project: Reducing dispensation of antineoplastic oral treatment delay in Medical Oncology Service, Reina Sofía University Hospital, Spain, 2019 

Subcategory: On-time Delivery

Problem Statement: Endpoint: To reduce waiting time for oral drugs dispensation/administration

• More than 20% of patients are treated with oral chemotherapy or targeted therapy
• More than 1800 consultations/year estimated for oral treatment
• More than 4,500 blood extractions/year.
• Over 2 hours median waiting time for dispensation.

 

Project: Oral Anticancer Medication Adherence, Grady Health System, Atlanta, GA, 2016

Subcategory: Treatment Adherence

Problem Statement: A retrospective review of 30 patients during 2013-2016 demonstrated a 30% adherence to oral anticancer medications (OAM). Adherence*: Drug available ≥ 80% to < 120% of days evaluated. *Adherence was calculated using the “days covered” method. 

 

Project: Improving Oral Chemotherapy Fulfillment Processes and Implementation of a Pharmacist-Managed Oral Chemotherapy Follow-Up Program, Cone Health Cancer Center at Alamance Regional, Burlington, NC, 2015

Subcategory: On-time Treatment Delivery

Problem Statement: Development of oral chemotherapy agents is expanding. Concerns regarding access and adherence to oral chemotherapy treatment have arisen. Process of initiating a patient on oral chemotherapy varies significantly among institutions.

• Hospital vs. specialty pharmacy
• Delay in prescription fulfillment affects treatment adherence and potentially patient outcomes if treatment is postponed for days to weeks

 

Project: Improving Oral Chemotherapy Consent Compliance, Adena Cancer Center

Subcategory: N/A

Problem Statement: On average from August through December 2019, only 62% of all Adena Cancer Center Medical Oncology patients prescribed new oral chemotherapy signed an Informed Consent prior to beginning therapy. Lack of compliance in providing informed consent leads to opportunities related to regulatory guidance for the Medical Oncology clinic and compromises patient safety and autonomy.

 

Project: Improve Safety and Compliance of Oral Antineoplastic Agents, Texas Tech University Health Sciences Center

Subcategory: Patient Safety

Problem Statement: It is critical for patients, who have been prescribed an oral antineoplastic agent, to have a timely lab screening in order for the physician to determine any safety issues in a timely manner.

During the months of Nov 2019 and January 2020, the average number of days between the writing of a prescription for a new oral antineoplastic agent, at the county hospital’s pharmacy, and the availability of lab results (per guidelines) was 38 days.

This led to delays in toxicity assessments and dose adjustment.

Documentation Improvement

Project: Epic Staging Improvement Project, City of Hope, 2019

Subcategory: Care Coordination

Problem Statement: Over 55 % of patients with breast and prostate cancer have no staging data on the staging forms in Epic and only 3% of breast and prostate cancer patients have complete staging in Epic at City of Hope clinics within one month of diagnosis.  This has negative impacts on continuity of care, research/clinical outcomes and analysis, authorizations and patient outcomes.

 

Project: Improving molecular/cytogenetics documentation in EPIC for tumors, City of Hope, CA, 2019

Subcategory: Process Improvement

Problem Statement: Providers spend a significant amount of time 1 hour (7 min per patient and 9 patients per day) to search for molecular data in EPIC, which delays the optimized molecular-guided treatment and reduces the efficiency of provider's practice.

 

Project: Increase the percent of advance directives in patient medical records, Tennessee Oncology, PLLC, Murfreesboro, TN, 2017

Subcategory: Patient Education

Problem Statement: Advance care planning is often initiated too late and well into a serious illness. This leads to added stress and high resource utilization at the end of life which is contrary to many patients’ wishes.1,2 Ideally, discussions about what is important to patients should start early.2 An advance directive (AD) documents patient preferences for end-of-life care. It is estimated, that 25-50% of new cancer diagnosis patients in our clinic have an existing AD, while less than 2% of patients have an AD in their medical record. 

 

Project:  Creating a Safer Medical Record: ICD code entered and correct​, Assistência Multidisciplinar em Oncologia-Clinica AMO, Salvador, Bahia, Brazil, 2017

Subcatergory: Process Improvement and Care Coordination

Problem Statement: In 2016 at AMO, 20.7% of our patients following the third visit have missing or incorrect ICD documentation in the appropriate field in the electronic medical record (EMR). This leads to lack of coordination amongst the multidisciplinary team and inconsistencies in data gathering and analysis focused on clinical research and management

 

Project: Improving Plan of Care Documentation in Pain Management, JPS Health Network Center for Cancer Care, Fort Worth, TX, 2016

Subcategory: Pain Management

Problem Statement: Results for the Spring 2016 QOPI data submission identified ‘Plan of care for moderate/severe pain documented’ measure at 0%, compared with 70.94% for the QOPI average benchmark. This area was prioritized as an improvement opportunity due in part to the frequently cited relationship between effective pain management and improved patient satisfaction and outcomes, as well as decreased ER and unscheduled clinic visits.

 

Project: Improving Oral Chemotherapy Documentation in the Breast Medical Oncology Outpatient Practice, Icahn School of Medicine at Mount Sinai, New York, NY, 2016

Subcategory: Oral Chemotherapy 

Problem Statement: 0 % of Breast Oncology patients have complete or easily found documentation of an oral chemotherapy care plan as per QOPI standards, resulting in clinical providers spending an inordinate amount of time trying to find answers to patient phone calls regarding dosage, adverse effects and follow up schedule 

 

Project: Providing Treatment Summary and Survivorship Care Plan to Early-Stage Breast Cancer Patients Beyond Their Initial Therapy in a Smaller Community-based Practice Set-up, The Jones Cancer Clinic, Germantown, TN, 2015

Subcategory: Patient Education

Problem Statement: Breast cancer survivors at the Jones Clinic currently do not receive a written summary of their treatment plan. It has been recognized in the area of oncology that this information is important to improve quality of care for survivors as they move beyond their cancer.

 

Project: Improving the Consenting and Education Process for Patients Starting on Oral Oncology Medications, Mary Bird Perkins – Our Lady of the Lake Cancer Center, Baton Rouge, LA, 2015

Subcategory: Patient Education, Patient Safety, Oral Chemotherapy, Treatment Adherence       

Problem Statement: Oral oncology medication prescribing is on the rise within the Mary Bird Perkins - Our Lady of the Lake Cancer Center Medical Oncology Clinic. Given that these medications are self-administered, drug compliance is a concern. Appropriate patient education directly impacts drug adherence. Currently, there is implied consent while educating patients on side effects and written informed consent is obtained 0% of the time. This creates a patient safety and risk management problem. 

        

Project Title: Improving Documentation of Pain Management at MedStar Washington Cancer Institute, MedStar Washington Cancer Institute,  Washington, D.C., 2013/2014

Subcategory: Pain Management

Problem Statement: Twenty five percent of MedStar Washington Cancer Institute hematology oncology clinic outpatients with pain ≥ 4 did not have documented plan of care for pain, potentially resulting in inadequate pain control. This was evidenced in Quarter II 2013 data.

 

Project: MD Epic Documentation for Colon Cancer, Palo Alto Medical Foundation, Palo Alto, CA, 2013/2014

Problem Statement: 100% of oncology providers document in Epic using a free-form style, hindering timely, accurate, and sustainable clinical data collection, analysis and reporting. Without data, quality improvement in patient care is uninformed, anecdotal and progress cannot be measured. Value cannot be determined.

 

Project: Improving Advance Care Planning and Documentation for UICC Patients, University of Illinois Cancer Center, Chicago, IL, 2013/2014

Subcategory: Patient Experience, Advance Care Planning

Problem Statement: WHAT: Advance care planning discussions in the ambulatory care setting are poorly documented. – 23% of patients currently receive advance care planning in the ambulatory care setting as documented in the last two clinic visits – 9% of our metastatic solid tumor patients are receiving advance care planning discussion in the ambulatory care setting documented by the 3rd visit. 5

• WHO: Metastatic solid tumor patients
• WHERE: Oncology clinic setting
• WHEN: Within 2 months or by the 3rd visit whichever is first
• WHY: Prevent medically futile care at end of life – Improve communication about prognosis and goals of care early on – Increase hospice utilization and referrals from ambulatory setting – Promote aggressive symptom direct care for improved quality of life

 

Project: Improving Advanced Directive Discussion and Documentation in Thoracic Oncology Patients, The Laura and Isaac Perlmutter Cancer Center at  New York University Langone, New York, NY, 2013/2014

Subcategory: Patient Experience, Advance Care Planning

Problem Statement: 99% of NYU Cancer Center patients do not have an Advance Directive (AD) discussed and documented in their electronic medical records, during all phases of their cancer care. Research indicates that this may contribute to :

• A high rate of hospitalizations and readmissions (Dartmouth 1,2)
• Increase in ICU utilization (Dartmouth 1,2)
• Increased healthcare costs (Dartmouth 1,2)
• Decreased palliative care utilization (Dartmouth 1,2)
• Increased patient and family suffering (Support Trial)
• Decreased patient satisfaction (Support Trial)

 

Project: Improving Documentation for Oral Chemotherapy at Trillium Health Partners, Trillium Health Partners, Toronto, Ontario, Canada, 2013

Subcategory: Oral Chemotherapy, Patient Safety

Problem Statement: During observations of 24 charts in October 2013 at Trillium Health Partners – Queensway Site, only 67% (8/12) of the components of an oral chemotherapy plan (as defined by ASCO‐ONS) were documented in the medical record. This represents a potential safety risk as complete information regarding the oral chemotherapy plan was not readily accessible to all health team

 

Project: Improving Phone Triage System for Oncology Outpatients, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, 2013/2014

Problem Statement:  Abramson Cancer Center outpatients are dissatisfied with the management of their phone correspondences to the oncology practices. Delays in symptom and medication management result in frequent patient complaints and low Press Ganey access ranking.

 

Project: Implementation of a Written Chemotherapy Consent from Zero to Compliant in 6 Months, West Virginia University & Mary Babb Randolph Cancer Center, Morgantown, WV, 2013/2014

Subcategory: Patient Safety, Patient Experience

Problem Statement: Original consent process: Recording of verbal acknowledgment of patient consent in clinic note

• Not in a easily retrievable location in the medical record.
• Inconsistencies in the communication of risk / benefit between clinicians
• Lack of documentation of communication of treatment goals
• Lack of written chemotherapy consent may lead to patient dissatisfaction in care, poor communication and other adverse events.

Patients at WVU/MBRCC do not have written chemotherapy consent in the medical record prior to the start of therapy. Implementation of written consent will result in improved patient safety, education, understanding, and ensure proper communication.

1) Storm C, et al. Informed Consent for Chemotherapy: ASCO Member Resources: JOP November 2008 2) Treleaven J, et al. Obtaining Consent for Chemotherapy: British Society for Haematology 2005. 3) Michels D, Cahill, M. Informed Consent and Chemotherapy: JOP September 2005 

 

Project: Oral Capecitabine Documentation in the Electronic Medical Record Flow sheet, Yolanda G. Barco Oncology Institute, Meadville, PA, 2013/2014

Subcategory: Oral Chemotherapy, Patient Safety

Problem Statement: Patients at Yolanda G. Barco Oncology Institute (YGBOI) are often prescribed oral anti-neoplastic agents such as Capecitabine (Xeloda ^®). There is no standardized documentation of the dose prescribed, dosage adjustments, or dose administered per cycle (dose intensity) in the current EMR flow sheet making tracking of chemotherapy toxicities, dose intensities, and therapy adjustments time consuming, cumbersome, and potentially dangerous to patients.

 

Project: Increasing the rate of documented nutrition plan for new cancer patients seen at the Simmons Comprehensive Cancer Center outpatient GI oncology clinic, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, 2018

Subcategory: Care Coordination

Problem Statement: Among new patients assessed in the GI oncology clinic at SCCC in 09/2017 there was documented nutrition assessment and plan in only 41% of patients within the first 3 months of establishing their care at the cancer center. This low rate of nutritional assessments and plan can lead to worsening malnutrition, poor patient satisfaction, declining performance status, increased toxicities to treatment, and higher admissions to hospital.

 

Project: The Journey to QOPI Certification, Hospital Zambrano Hellion, TecSalud, Mexico, 2018

Problem Statement: A retrospective abstraction of 20 patients’ chart between August to December 2017, resulted in only 47% compliance with the 84 QOPI metrics at the Zambrano Breast Cancer Center. 

 

Project: Providing Survivorship Care to Hematology Patients at WCI, Washington Cancer Institute, MedStar Washington Hospital Center, Washington DC, 2018 

Subcategory:  Supportive Care

Problem Statement: ASCO guidelines recommend providing survivorship care to cancer patients who have completed treatment with curative intent. Cancer and the long-term effects of its treatment impact the future health and psychological wellness of the survivors.  The Committee of Cancer (COC) recommendations state care plans should be delivered to 50% of the patients per disease state in the year 2018. 33% of patients with a hematologic malignancy seen at the Washington Cancer Institute between  Jan 1, 2016- June 30, 2018, received treatment summaries and survivorship care plans.

 

Project: Improving the Documentation of Advance Directives in the Medical Record of a Comprehensive Community Cancer Center, Valley-Mount Sinai Comprehensive Cancer Care, Paramus, NJ, 2018

Problem Statement: At Valley-Mount Sinai Comprehensive Cancer Care, only 20% of patients with solid malignancy seen in the outpatient clinic have an advance directive in their charts. Lacking this information may lead to decreased knowledge regarding a patient's end-of-life wishes and a decrease in the quality of end-of-life care.

 

Project: Homogenization of Data Collection In Medical Records, MD ANDERSON CANCER CENTER Madrid, Spain, 2019

Subcategory: Care Coordination

Problem Statement: Lack of homogeneity of the medical records in the first visit.

Opportunity: To optimize the time of the professionals to find all the pertinent information of the patient, making it clearer and collecting all the necessary data so the patient can have access to a better care. Likewise, it will be more feasible to have more order in the collection of data from our statistics.

 

Project: Decrease Undocumented Advance Directives, Sidney Health Center Cancer Care

Subcategory: Process Improvement

Problem Statement: From July 2019 to January 2020, 67% of new patient referrals at SHC Medical Oncology did not have an Advance Directive (which include health care power of attorney, POLST (physician orders for life-sustaining treatment) or Living Will) documented in their electronic medical record by the 3rd visit or before cancer‐directed treatment (defined as oral or infusional chemotherapy, immunotherapy, or radiation therapy) whichever came first*. We personally witnessed that the lack of this documentation subsequently resulted in the inability to fulfill our patient’s wishes during end-of-life care.

 

Project: Improving Oral Oncolytic Documentation and Teaching in a Safety-Net Outpatient Oncology Practice, Zuckerberg San Francisco General Hospital

Subcategory: Patient Safety, Patient Experience

Problem Statement: Between September and December 2019, none of the patients who started on oral oncolytics at ZSFG hematology-oncology clinics had complete documentation of oral oncolytic education and a complete documented care plan. An average of 6 out of 15 components as per QOPI and ASCO-ONS standards were documented in the EHR.

This results in potential increased risk of toxicity, increased patient non-adherence to therapy, and poor adherence to follow-up schedule for lab monitoring, dose adjustment, and toxicity assessment.

 

Project: Improving Compliance of Documentation of Oral Chemotherapy, St. Jude Affiliate Program, 2020

Category: Documentation Improvement

Problem Statement: 17.4% of oral chemotherapy patient adherence documentation is non-compliant (per St. Jude standards) at 3 St. Jude affiliate clinics.  This leads to re-work, poor research data quality, and healthcare team frustrations.

 

Project: Systematic assessment of symptoms in oncology outpatient with advanced disease, Infanta Leonor Hospital, Spain, 2020

Category: Documentation Improvement

Problem Statement:

• Patients with advanced cancer spectrum of symptoms that encompasses the physical, psychic and social sphere. The lack of systematic evaluation of these symptoms in clinical practice may lead to inappropriate medical attention that negatively impacts on the well-being and quality of life of patients, entails an increase in the use of health resources and can even compromise survival.
• By January 2020, we did not use any standardized method to document the symptoms experienced by patients in the Oncology department at Infanta Leonor Hospital. We only collected the most prevalent ones according to the type of tumor or those that the patient reported spontaneously which it involved that a lot of valuable information was missed.

 

Project: Adverse Drug Reaction (ADR) Communication, Gundersen Health System, 2021

Category: Documentation Improvement

Problem Statement: Between January and December of 2020, patients receiving outpatient infusion therapy at Gundersen Infusion centers (Lacrosse, Onalaska, Winona) had 97 adverse drug reactions (ADR) while receiving the intravenous drugs. Of these ADRs, 41% were not clearly communicated to the ordering provider which could lend to repeat infusions. Ultimately, this can compromise patient safety, reduce quality of care and influence care experience.

 

Project: Improving chemotherapy toxicity documentation, Mayo Clinic Cancer Center, 2021

Category: Documentation Improvement

Problem Statement: During the month of January 2021, an average of 64.5% of patients over the age of 65 seen at Mayo Clinic Rochester had pre-chemotherapy toxicity assessment completed by a healthcare provider:

• Providers = 60.2%
• RN & Pharmacy = 68.7%

 

Project: Improving Learning Needs Assessment Documentation, USC-Norris Cancer Center, 2021

Category: Documentation Improvement

Problem Statement: A patient comprehensive learning needs assessment is not integrated into the clinical practices at the Norris Women’s Health Center. This could potentially result in less effective patient education, treatment adherence, and decreased patient satisfaction. This patient-centered practice deficit is further compounded by the missed opportunity to provide culturally competent care. The African American & LatinX breast cancer patient population treated at Norris Women’s Health will be the focus group for this project.

 

Project: Improving Physician Goals of Care Discussion Documentation for Hematology Oncology Patients in the Outpatient Oncology Clinic, UC San Diego Health, Moores Cancer Center, San Diego, CA, 2021

Category: Documentation Improvement

Problem Statement: Physician Goals of Care discussions with Hematology Oncology patients starting a new regimen of IV outpatient chemotherapy are poorly documented in the Advance Care Planning (ACP) tab in Epic (5.2%), adversely affecting care coordination at key transitions of care and leading to delay in executing patient care according to their goals of care (GOC) plan.

 

Project: I-DO GOC: Improving Documentation in Oncology with Goals of Care, Kaiser Permanente, San Francisco, CA, 2022.

Category: Documentation Improvement

Problem Statement: Between January 2020-June 2020, zero percent of KP SF medical oncologists documented Goals of Care conversations in the agreed-upon Life Care Planning Tab in the EMR for Stage IV (Lung, Esophageal, Gallbladder, Liver, Biliary, Pancreatic, and Gastric Carcinomas). As a result, health care providers did not have easy access to these GOCs which possibly led to unwanted interventions, increased cost of care, and decreased provider, patient, and family satisfaction.

Process Improvement

Project: Development and Implementation of a Distress Screening and Management Process,​Tennessee Oncology, Franklin, TN, 2017

Subcategory: Emotional Distress, Documentation Improvement

Problem Statement: In the Fall 2016 QOPI abstraction, data revealed that while 97% of patients on active cancer treatment at Tennessee Oncology were being screened for emotional distress, only 51% had documented evidence of “action taken to address problems with emotional well-being by the second office visit,” suggesting inadequate attention to the patients’ emotional needs. 

 

Project: Reducing the admission-to-chemotherapy delay​, Parkland Hospital and Health Systems, Dallas, TX, 2017

Subcategory: Care Coordination

Problem Statement: Reducing the Length of Stay (LOS) is a high priority objective. The 14-400 inpatient unit admits 1-2 patients daily for inpatient chemotherapy. Rooms are reserved for patients ahead of admission. Initiation of chemotherapy is often delayed -> adds a day to LOS. Median delay of 6.2 hours between arrival and initiation of chemotherapy in January-February 2017. 

 

Project: Increasing On Time Treatment Time Delivery In Radiation Medicine, Oregon Health and Science University, Portland, OR, 2016

Subcategory: On-time Treatment Delivery, Radiation Therapy

Problem Statement: Sixty-two percent of final Physics Quality Assurance (PQA) approvals for treatment plans (including 3D/IMRT/Arc/SBRT/SRS plans) are not completed by 8:00 AM the day prior to the patient’s first treatment appointment. 

 

Project: Improving Start-Up Times in Oncology Clinical Trials, University of New Mexico Comprehensive Cancer Center/ New Mexico Cancer Care Alliance, 2018

Subcategory: Care Coordination, Patient Experience

Problem Statement: Delays in opening clinical trials impact patient care. The time to open clinical trials at UNM CCC/ NMCCCA is 33 weeks. While there are no national benchmarks, average timeline ranges from 4 -24 weeks.

 

Project: Heparin Induced Thrombocytopenia Quality Improvement directed at reduced Testing (HIT-QUIT), Michigan State University- College of Human Medicine, Ascension Providence Hospitals, Southfield and Novi, MI, 2018

Subcategory: Care Coordination

Problem Statement: The Ascension Providence health system recognized unnecessary testing for heparin-induced thrombocytopenia (HIT) to be a hospital-wide issue. The underlying components to this problem include miseducation in testing for HIT, use of heparin instead of other anticoagulants for the prevention of DVTs, assay ordering within the hospital operating system, and laboratory processing of the assays.

 

Project: Pancreatic Cancer Biobank, Mitchell Cancer Institute/The University of South Alabama, Mobile, AL, 2018

Subcategory: Care Coordination

Problem Statement: Bio-banking blood specimens from patients with cancer is instrumental to research conducted by basic scientists and clinicians. Only 7 % of patients with pancreatic cancer (PC) did get their blood bio-banked at MCI. This negatively impacts grants funding and efforts to reach milestones necessary for NCI designation.

 

Project: Evaluation of the inclusion rate in clinical trials of bladder cancer patients evaluated for first time in Oncology Department, Hospital Clínico San Carlos, Madrid, Spain, 2019

Subcategory: Care Coordination

Problem Statement: Between January and November 2018 the percentage of patients with GU tumors enrolled in clinical trials was 39%. Lower percentage of enrollment in clinical trials in Bladder cancer compared to other GU tumors.

• Prostate cancer 43%
• Kidney cancer 47%
• Bladder cancer 24%

 

Project: Antibiotic Administration Time Decrease in Urgent Care of Medical Oncology Service patients being treated with potentially neutropenia inducing Regimens, Hospital Universitario Central de Asturias, Madrid, Spain, 2019

Subcategory: On-time Treatment Delivery

Problem Statement: Oncological patients under cytotoxic treatment that present fever have an average time of antibiotics administration of 11h (median 4h07’) when admitted and identified at the Emergency Room Service at HUCA due to diverse causes

• International guidelines recommend antibiotic administration in the 1^st hour: “The golden hour”.

 

Project: Optimization of the management of a medical oncology consultation (OM) and decrease of the waiting time linked to the administration of a systemic treatment, University Hospital Marques de Valdecilla, 2019

Subcategory: Care Coordination

Problem Statement: 30% (n = 21) of cancer patients experienced a hospital stay of more than 4 hours in the period from November 15-27, 2018. Oncology patient care must be multidisciplinary and involve different services. The administration of systemic treatment (both oral and intravenous) involves the Oncology Pharmacy units, the Medical Day Hospital and the outpatient clinics of medical oncology. The lack of coordination between these units implies an increase in the hospital stay of outpatients with the consequent impairment in their quality of life

 

Project: Optimization of screening tools in patients eligible to receive Immune Checkpoint Inhibitors (ICPI), La Paz University Hospital, Madrid-Spain, 2019

Subcategory: Advance Care Planning

Problem Statement: Immune Checkpoint Inhibitors

• Incorporation of a new therapeutic group
• Different side effects
• Variability in prevention and management 
• of immune related side effects

Implementation of protocols

   An adequate baseline screening is performed before receiving treatment with ICPI?

 

Project: Discharge optimization on an inpatient ward, Champalimaud Foundation, Portugal, 2020

Category: Process Improvement

Problem Statement: During January and December 2019, 66% of all medical and surgical patients had late discharges (after 3 PM) from Champalimaud Foundation inpatient ward. Associated to a limited number of beds, delayed discharges cause recovery overbooking, difficulties on patient admission, negative healthcare team pressure, patient dissatisfaction and probable reduction in quality of care.

 

Project: Analysis Of The Hospital Admissions Of Oncological Patients, Hospital Universitario Lucus Augusti, Spain, 2020

Category: Process Improvement

Problem Statement: An increase has been observed in the number of cancer patients admitted to the Oncology Service in recent months:  12-15 -> 24-26 patients admitted / day which affects the quality of patient care.

 

Project: Analysis of the excessive number of hospital admissions in Medical Oncology compared to other hospitals in the Region of Murcia, Hospital General Universitario Santa Lucía, Spain, 2020

Category: Process Improvement

Problem Statement: We have detected, in comparison to other oncology departments, with a similar or greater population area, a disproportionately higher number of hospital admissions.

 

Project: Addressing Portal and Phone Message Disparities, Winship Cancer Institute, 2021

Category: Process Improvement

Problem Statement: In September-November 2020, 12,100 portal and phone messages were received by breast medical, surgery, and radiation oncology clinics on the main campus at Winship Cancer Institute with 17% more messages from White than Black patients accounting for the racial proportion of patients seen in our clinic. This disparity could reflect differences in access to the care team and disease management.  The overall large number of messages may reflect unmet needs not currently addressed during clinic visits.  

 

Project: PREVIO: A Framework for Quality Improvement (QI) in Preventing Immune-Oncology Related Complications at the Ottawa Hospital, The Ottawa Hospital, Ottawa, ON, 2022.

Category: Process Improvement

Problem Statement: From September 2020 to March 2021. Overall, 45% of Ottawa Cancer Center patients on Nivolumab/Ipilimumab requiring supportive medications did not receive these within 5 days of symptom onset. Inadequate irAE management may lead to increased ER visits, admissions, hospital LOS, premature treatment discontinuation due to toxicity, and increased morbidity/mortality for patients.

 

Project: Interhospital Transfer Quality Improvement Project, University of Virginia, Charlottesville, VA, 2022.

Category: Process Improvement

Problem Statement: A median of 67% of patients transferred to the UVA hematology and oncology acute care floor from July - December 2021, did not have a clinical update documented in Epic within 12 hours of arrival to the acute care floor. This included:

Vital signs
Overall clinical status
This can lead to an inadequate level of care upon arrival.

Patient Access

Project: Reducing the number of unscheduled ETC visits for Breast Oncology patients, City of Hope, 2019

Subcategory: Patient Education

Problem Statement: 58% of symptomatic breast cancer patients who present or are directed to the Evaluation and Treatment Center (ETC) during business hours (M-F 8:00 AM to 5:00 PM) are unscheduled. This leads to inappropriate ETC utilization, capacity issues, and longer patient wait times.

 

Project: Improving New Patient Access by Decreasing Missed Appointments to First Visit, Parkland Hospital and Health Systems, Dallas, TX, 2016

Subcategory: Process Improvement

Problem Statement: Analysis of the new appointments scheduled for newly diagnosed cancer patients had a 39% incomplete rate for the first scheduled appointment. 

• 61% Completion
• 27% Cancelled
• 13% No Show

Analysis includes medical/surgical oncology and GYN oncology clinics

• Evaluation period May 01 – Jul 31, 2016 

 

Project: Uhealth Patient Communication of Cancer Symptoms, University of Miami, Sylvester Comprehensive Cancer Center, 2018

Subcategory: Process Improvement

Problem Statement: Recent Survey Demonstrated 21% of Patients Experiencing Symptoms in between visits did not report them. (Feb – Mar 2018). A recent clinic survey including 28 patients demonstrated that

• 86% (24) had symptoms in-between visits
• 14% (4) Had no symptoms in-between visits
• 79% (19) of those with symptoms called to report
• 21% (5) did not call to report symptoms
• 13% (3) did not know the number to call

 

Project: Increasing New Patient Accrual to Clinical Trials in the GU Medical Oncology Clinic, Vanderbilt University Medical Center / Vanderbilt Ingram Cancer Center, Nashville, TN, 2018

Subcategory: Care Coordination

Problem Statement: The GU medical oncology clinic enrolled 5% of new patients seen between March 1 and May 31, 2018 to clinical trials.  There is a desire to increase clinical trial accrual in order to provide our patients with access to new therapies and to fulfill our commitment as a NCI-designated cancer center. Note:  While GU is only 1 of 9 solid tumor clinics at Vanderbilt, improved accrual within the GU group will contribute significantly to that commitment. If effective, the process could improve cancer center accrual from all solid tumor clinic groups.

 

Project: Reducing Parkland Medical Oncology Infusion No-Show Rate, Parkland Health and Hospital System

Subcategory: Process Improvement

Problem Statement: PHHS Medical Oncology Infusion center has a 16.4% no-show rate of patients scheduled for infusions and injections in January 2020, resulting in dissatisfaction and wasted resources in a resource-limited system.

 

Project: Improving Missed Follow-up Appointments within a Community Oncology Practice Serving the Under-Served, West Cancer Center & Research Institute

Subcategory: Process Improvement

Problem Statement: In the third quarter of 2019, two of our clinicians had an on-treatment follow-up “no-show” rate of 24% at their inner city clinics. Missed appointments impact care as well as access to appointments for other patients, leading to worse cancer outcomes among under-served populations. Evaluation Period: July – September 2019.

 

Project: Decrease the Missed/Cancelled Appointment Rate of African American Breast Cancer Patients for New and Follow up Appts, Bon Secours Hampton Roads Medical Oncology, 2021

Category: Patient Access

Problem Statement: From January 1, 2019, to December 31, 2019, African American breast cancer patients at the Bon Secours Medical Oncology in Norfolk, VA had a 16% rate of missed/cancellations for both new patient and follow-up appointments. This impacts care by delaying diagnosis and treatment of African American breast cancer patients.

 

Project: Increase Screening for Financial Coverage for Newly Diagnosed African American Breast Cancer Patients, Parkland Health and Hospital, 2021

Category: Patient Access

Problem Statement: In Parkland Health and Hospital System, we saw 341 new breast cancer patients in 2019, of whom 33% were African American. Of the African American breast cancer patients, 34% were uninsured leading to a higher risk for cancer-related financial toxicity. Currently, on average less than 5% of our breast oncology patients see a financial counselor, while less than 2% of our African American breast cancer patients see a financial counselor. None of our patients are being screened for financial coverage outside of their initial encounter with a financial counselor. This leads to missed opportunities for matching patients with available funding opportunities to help with medical expense coverage.

 

Project: Bridging the Divide: Decreasing No Show Rates among African American Breast Cancer Patients, University of Maryland Greenebaum Comprehensive Cancer Center, 2021

Category: Patient Access

Problem Statement: Between September 2019-August 2020, African American breast oncology patients seen at the UMGCCC located in Baltimore MD demonstrated a disproportionally high rate (13.2%) of no-shows relative to other groups seen in the cancer center. High no-show rates can lead to untimely treatment, delays of care, increased cost of care and variation of clinical outcomes for patients.

Patient Education

Project: Patient and caregiver education, Acreditar Oncology, 2019

Subcategory: Supportive Care

Problem Statement: Patients with breast cancer in neo and adjuvant settings did not receive adequate orientations before the therapy. 100% did not receive medical advice about fertility, pregnancy test, hair loss; these patients do not understand the risks related to the treatment they undergo, the changes in the habits of life and in the daily routine. So they cannot make the necessary adaptations, also adhere to the proposed treatment. We identified this problem during the QOPI certification survey and this patient care directly interferes in quality of life, safety, and clinical outcomes.

 

Project: Reducing Morning Hypoglycemia in Children Undergoing Treatment for ALL, St. Jude Children’s Research Hospital, Memphis, TN, 2017

Subcategory: Process Improvement, Symptom Management

Problem Statement: 32% of children on therapy for ALL at the Charlotte and Tulsa St. Jude affiliates experienced morning hypoglycemia based on a clinic blood sugar result of <70 mg/dl between January and March 2017 putting patients at risk of symptomatic hypoglycemia and corresponding procedure delays, increased resource utilization, decreased patient satisfaction and risk for adverse cognitive outcomes.

 

Project: Decreasing the Risk of Financial Toxicity in an Ambulatory Oncology Practice, North Shore University Health System, Kellogg Cancer Center, Highland Park, IL, 2016

Subcategory: Drug Costs

Problem Statement: 0% of North Shore University Health System Kellogg Cancer Center patients routinely receive information on the financial risks of high-cost cancer therapies, as well as available financial support services, resulting in significant financial and overall distress and compromised informed decision making. 

 

Project: Improve Optimal Treatment in Head & Neck Cancer Patients, Feist-Weiller Cancer Center, Shreveport, LA, 2013/2014

Subcategory: Process Improvement, Symptom Management

Problem Statement: Since 2011 in Feist-Weiller Cancer Center, 50% of Head and Neck cancer patients receiving Cisplatin 100mg/m2 day 1 and every 21 days (total 3 doses) with concurrent radiation, 35 fractions (CIS/XRT) have not been able to complete their therapy as per protocol (dose over time interval) leading to suboptimal therapy. Based on 2003 ECOG Study article, An Intergroup Phase III Comparison of Standard Radiation Therapy and Two Schedules of Concurrent Chemoradiotherapy in Patients With Unresectable Squamous Cell Head and Neck Cancer, by DJ Adelstein et al, the non-completion rate was 15%.

 

Project: HPV Education and Vaccination, IMIP, Brazil, 2018

Subcategory: Patient Education

Problem Statement: Zero percent of the IMIP patient population has systematic education about HPV vaccination, possibly contributing to low HPV vaccination rates in their children

 

Project: Improving Adherence With Oral Antiemetic Agents in Breast Cancer Patients Receiving Chemotherapy, Center for Breast Health, Bethesda, MD, 2013/2014

Problem Statement: Only 59% of breast cancer patients are compliant with medication prescribed for chemotherapy-induced nausea and vomiting (CINV), leading to

• Increased nausea and vomiting during chemotherapy
• Decreased ability to perform normal activities
• Additional office visits for hydration and parenteral antiemetics
• Aversion to subsequent cycles of chemotherapy
• Poor patient experience

 

Project: Improving the use of Pegfilgrastim in Lung Cancer Patients at the Taussig Cancer Institute of the Cleveland Clinic, Cleveland Clinic, Cleveland, OH, 2013/2014

Subcategory: Process Improvement

Problem Statement: 20% of lung cancer patients treated at the Taussig Cancer Institute of the Cleveland Clinic Foundation, are administered prophylactic pegfilgrastim.

• The inappropriate use of prophylactic growth factors increases morbidity and unnecessary cost to health care organizations.
• In the current healthcare market, it is critical to eliminate waste and unnecessary treatments for our patients.
• Each dose of pegfilgrastim causes increased cost to the health care system and our patients:
  • $15,090 charged for each dose patient. $3,253 reimbursed per dose for CMS patients
• The national guidelines for prophylactic growth factors are inconsistent.

 

Project: Thoracic Oncology Referral Pilot: Survivorship Care Plans, University of Miami/Sylvester Comprehensive Cancer Center, 2018

Subcategory: Documentation Improvement, Process Improvement, Care Coordination

Problem Statement: For CY2017 there were a total of three referrals (~3%) of eligible patients in the Thoracic Oncology group to the Survivorship Program. Survivorship discussions and care plan deliveries are required by CoC Standard 3.3.

 

Project: Integrating Family Caregivers into Gynecologic Cancer Education & Support Services, Magee Women’s Hospital of UPMC, Pittsburgh, PA, 2018

Subcategory: Supportive Care

Problem Statement: Based on a medical record review of gyn onc patients receiving chemotherapy during a one-week period in July, 2018, only 19% of charts included any documentation of a family member and no (0%) charts included documentation of caregiver concerns or needs (n=36). Based on a needs assessment of family caregivers conducted between 9/17 and 12/17, 50% of caregivers report 9 or more distressing unmet needs (n=56, score of > 4 on 0-10 scale). These data suggest that family caregivers are not receiving the support they need in the gynecologic cancer program to effectively care for themselves and their loved ones.

 

Project: Improving counseling on risk of infertility for patients with cancer at Johns Hopkins, The Johns Hopkins Sidney Kimmel Cancer Center, 2020

Category: Patient Education

Problem Statement: Between June 2019 and January 2020, only 37% (n=25/68) of patients of child-bearing potential at the Johns Hopkins Sidney Kimmel Cancer Center reported they were counseled by their oncologist on the risk of infertility prior to initiation of systemic therapy.

 

Project: Meeting the Standard of Care: Sexual Health Counseling for Prophylactic Oophorectomy and Ablative Surgery. UPMC Magee-Womens Hospital Gynecologic Oncology Program, Pittsburgh, PA, 2021.

Category: Patient Education

Problem Statement: Premenopausal women are referred to Magee Womens Hospital/UPMC Gynecologic Oncology for prophylactic or ablative oophorectomy. Research has consistently demonstrated a significant decrease in sexual health following surgery. The current standard of care consists of providing education, counseling, and referral to help mitigate these symptoms. At Magee, a medical record review from April 2019 to present shows that only 22% of women receive this standard of care during the perioperative continuum of care.

 

Project: Implementation of a Proactive Outreach Program to Patients with Gastrointestinal Malignancies Starting New Chemotherapy Regimens, Fox Chase Cancer Center, Philadelphia, PA, 2022.

Category: Patient Education

Problem Statement: From July – December 2021, zero (0) gastrointestinal (GI) medical oncology patients were proactively contacted through a standard process within 72 hours of their first cycle of a new intravenous (IV) chemotherapy treatment

This led to urgent interventions to manage patient inquiries and symptoms by team members across Fox Chase Cancer Center yielding increased wrap-around care through phone triage calls, urgent care/emergency room visits, and hospitalizations, as well as increased patient/provider dissatisfaction

 

Project: Standardizing triage nurse – provider communication in an acute care setting, St. Jude’s Children’s Research Hospital, Memphis, TN, 2022.

Category: Patient Education

Problem Statement: Numerous events, including a significant adverse patient event, have been reported involving the after-hours triage process in the medicine room. Clinical providers report that standardized handoff obtained from triage nurses occurs only 25% of the time, which leads to more than 75% of providers having decreased comfort in giving a clinical decision due to lack of important information.

ER Visit Reduction

Project: Decrease YRCC Patient ED Utilization, Yuma Regional Cancer Center, 2019

Subcategory: Process Improvement

Problem Statement: Reduce potentially avoidable ED visits for YRCC patients on active IV chemotherapy to 6% by June 15, 2019.

 

Project: Reduction of daytime ED visits by active chemotherapy patients to Long Island Medical Center from Monter Cancer Center, Northwell Health Cancer Institute, 2019

Subcategory: Process Improvement

Problem Statement: Monter Cancer Center oncology patients, on active chemotherapy, are presenting to the Long Island Jewish Emergency Department resulting in their care managed by providers not familiar with their treatment, increased financial toxicity, poor patient experience and potential treatment delays. On average 11.3 patients per week present to the ED during the hours of 9 AM and 5 PM, we have an opportunity to intervene so patients can be evaluated by their own oncology care team outside the emergency department and improve patient experience.  

 

Project: Navigating Stage IV Patients to Reduce Emergency Room Admissions, Instituto de Oncologia do Vale, Sao José dos Campos / Sao Paulo, Brazil, 2017

Subcategory: Process Improvement and Patient Experience

Problem Statement: In 2016, Stage IV Patients at IOV-SJC had a monthly average ratio* of 3.8 admissions to Emergency Room (ER). More than 70% of these complaints are potentially manageable. These ER admissions worsen patients’ experience of care, increase global costs and can impact their quality of life (QoL). Pain, constipation, fever, fatigue, nausea/vomiting, diarrhea and dehydration are the clinical conditions that we consider as “manageable or preventable ER admissions”. Problem Statement * Stage IV Patients ER Admission / Total Chemo Patients(monthly)

 

Project: Reducing Emergency Room Visits in Patients Receiving IV Chemotherapy Using Care Coordination, Tennessee Oncology, Chattanooga, TN, 2016

Subcategory: Care Coordination

Problem Statement: From January to June 2016, 96 patients receiving IV chemotherapy at the Memorial office had an Emergency Room visit. This results in emotional, psychosocial, and physical burden for patients and is a preventable cost for patients and the healthcare system. 

 

Project: Reduction of Oncology Patients Visits to The Emergency Room, Memorial Cancer Institute, Hollywood, FL, 2015

Subcategory: Process Improvement

Problem Statement: 48% of Memorial Cancer Institute patients’ E.R. visits occur during business hours causing an over utilization of E.R. services, in lieu of our physicians’ practices. 

 

Project: Patient Centered Cancer Care Assess & Reduce Preventable Emergency Department Visits, The Comprehensive Cancer Center of Rhode Island Hospital, Providence, RI, 2013/2014

Subcategory: Patient Education, Process Improvement

Problem Statement: During calendar year 2013, 224 Rhode Island Hospital (RIH) adult cancer patients presented to the RIH Emergency Department (ED). Retrospective review indicates up to 50% of these ED visits were avoidable. In our resource-restricted environment, we must focus resources to avoid costly ED visits for “non-emergent” care.

 

Project: Reducing Unnecessary Emergency Department Visits for Medical Oncology Patients on Active Treatment, The Sidney Kimmel Cancer Center at Thomas Jefferson University, 2020

Category: ER Visit Reduction

Problem Statement: Currently, 47.2% of medical oncology patients on active treatment (receiving IV or oral chemotherapy within the last 30 days) who present to the ED have conditions that do not require hospital admission.  These visits are costly, may be preventable, and detract from patient experience.

 

Project: Implementation of a PROM tool in patients with hematological malignancies in the Lymphoma and Chronic Lymphocytic Leukemia program, Hospital Universitario Fundación Jiménez Díaz, Spain, 2020

Category: ER Visit Reduction

Problem Statement: In March-May 2019 we analyzed 24 patients with lymphoid malignancies (Lymphoma, CLL), treated with antineoplastic agents in our Lymphoma Unit. We detected 117 moderate-severe Aes (4%), related and not related to the treatment leading to ER consultation or unscheduled hospitalization. GRADE 2-3 AE IMPACT ON QUALITY OF CARE: Delay or diminution of dosis in treatment: 4,27 % of total Aes; Unscheduled visits: 25,64 % of total Aes (emergency room and visits without annotation); Serious complications and hospitalizations: 6,84 % of total AEs

 

Project: Decrease the disparity in ED utilization, West Cancer Center and Research Institute, 2021

Category: ER Visit Reduction

Problem Statement: From January 2020 to February 2021, West Cancer Center and Research Institute patients of African origin (AO) undergoing treatment (surgery, chemotherapy, and/or radiation) for early breast cancer undergoing treatment had a 46% increase in emergency department utilization in Midsouth for pain complaints compared their counterparts of European origin (EO) resulting in poor patient satisfaction and increased resource utilization.

 

Project: Improving Access to the UCSF Cancer Acute Care Clinic, University of California San Francisco, San Francisco, CA, 2021

Category: ER Visit Reduction

Problem Statement: From its opening in September 2019 through August 2021, a total of 413 patients were evaluated at UCSF’s Cancer Acute Care Clinic (CACC), which is an average of 17 patients per month. This represents an approximate 90% under-utilization of available resources at the CACC and resulted in patients being seen in the ED for care.

 

Project: Mapping the Oncology Landscape, UCLA Health, Los Angeles, CA, 2021

Category: ER Visit Reduction

Problem Statement: Cancer is the top costing condition at UCLA. Of UCLA cancer patients in 2021 (n=23,444), about 1700 (1%) per year are Anthem members.

Anthem data suggest that UCLA does not meet performance targets on several measures, including Avoidable ED Visits.

The Anthem Oncology Medical Home (AOMH) model is intended to improve the patient journey, manage financial risk, and decrease the total cost of care, but UCLA cancer service lacks a way to assess and measure defined workflows that would support the AOMH model.

This understanding will facilitate implementing interventions using AOMH as small tests of change with the Anthem population, as a scalable model to be implemented in the entire cancer population in the future.

 

Project: Reducing preventable emergency room or hospital admissions for oncology patients within 30-days of receiving outpatient chemotherapy. UCDH Comprehensive Cancer Center, Sacramento, CA, 2021

Category: ER Visit Reduction

Problem Statement: From July 2020 to June 2021, 14.25% of UCDH Comprehensive Cancer Center patients receiving outpatient chemotherapy had a preventable admission* within 30 days of administration, contributing to poor patient outcomes, possible treatment delays/dose reduction, and increased cost to provide care. The rate for GYN oncology patients was 20.86%.

*preventable diagnosis defined by CMS core measure OP-35

 

Project: Decrease emergency room patients' visit suggested by fellows on call after office hours, Allegheny Health Network Cancer Institute, Pittsburgh, PA, 2022.

Category: ER Visit Reduction

Problem Statement: ER visits suggested by fellows on call after office hours. From 10/2021 to 1/2022, there were 50 encounters noted that fellows on call suggested patients visit the ER. It increases ER burden, especially during the ongoing COVID pandemic, decreases patients' satisfaction, and increases the healthcare financial cost.

Patient Experience

Project: Improving the African-American Experience at Taussig-a Quality Improvement Initiative through the ASCO Quality Training Program, Cleveland Clinic Taussig Cancer Center, 2021

Category: Patient Experience

Problem Statement: At Taussig Cancer Center, from 1/1/19-9/30/20, Black patients reported worse satisfaction with regard to communication and teamwork as compared to White patients in the outpatient setting, which could be contributing to poorer health outcomes.

 

Project: Level Loading, Oregon Health and Science University-Dorothy Ryan, MD, Portland, OR, 2017

Subcategory: Process Improvement

Problem Statement: Beginning at time of sim order, 42% of OHSU Radiation Medicine new starts are unequally distributed among the treatment machines and days of the week which results in decreased patient and staff satisfaction.

 

Project:  Retention of Patients from Referral to Simulation in Radiation Oncology, Oregon Health and Science University- Bridgett Sparkman, Portland, OR, 2017

Subcategory: Process Improvement

Problem Statement: Between February and April 2017, 54% of patients in the Radiation Medicine Department were seen as a new patient consult at the OHSU Radiation Oncology Department* ≥ 2 weeks from the date of referral. This resulted in treatment delays, decline in patient satisfaction and possibly compromised patient outcomes. 

 

Project: A Multidisciplinary Effort to Decrease Time from Admission to Chemotherapy on an Inpatient Oncology Unit, University of Virginia Health System-Louise Man, MD, Charlottesville, VA, 2016

Subcategory: On-time Treatment Delivery

Problem Statement: Many oncology patients at the University of Virginia are admitted for scheduled inpatient chemotherapy (chemo) administration for established diagnoses. These patients frequently experience delays in starting chemo after their arrival on the inpatient oncology unit. Delays are made known by patient complaints and also directly observed by physicians, nurses, and clinical pharmacists. These delays negatively impact healthcare resource utilization, length of stay, and may delay other patients’ admissions. 

 

Project: Reducing the Percent of ICU Deaths of Patients With Advanced Cancer at Stanford Health Care, Stanford Cancer Center, Palo Alto, CA, 2015

Subcategory: Process Improvement, Decrease in ICU deaths

Problem Statement: In 2014, 40.4% of patients with solid tumors admitted to the Stanford Healthcare ICU died with advanced-stage disease.  This compromised the patients’ quality of life and resulted in excessive costs for patients and their families.

 

Project: Total Lab Times, Clearview Cancer Institute, Huntsville, AL, 2013/2014

Subcategory: Patient Experience, Process Improvement

Problem Statement: Over the past 6 months, patient wait times have continually increased in the lab with a current average of 55% of patients having greater than a 20-minute total lab time. Increased total lab times lead to increased delays in seeing the Providers and receiving treatment. Several factors have contributed to this:

• In the last four years, we have not increased the number of phlebotomists, however, we have grown by 9-11% annually in patient volume.
• Overscheduling patients in AM slots.
• Lab-only draws are not being scheduled in appropriate time slots.
• Employees’ work and lunch schedules.
• Stocking Times.

Telephone Triage

Project: Redesign the Triage Workflow to Align With the RN Role by Redirecting Non-Triage Calls, New Mexico Cancer Care/CHRISTUS St Vincent Regional Cancer Center, Santa Fe, New Mexico, 2015

Subcategory: Process Improvement

Problem Statement: In a five-week period between June 22, 2015, and July 24, 2015 Triage received 2149 calls.

• Data review indicates that 950 (44%) of these calls were unrelated to symptom management and the patient’s treatment plan.
• We must redirect the calls to the appropriate area/staff members, and reassign the medication refills, so the RNs can focus their efforts on managing patient care and related issues.

 

Project: Utilizing a Case Management System to Reduce the Response Time for Symptom Management Calls, Tennessee Oncology, 2015

Subcategory: Process Improvement, Patient Safety, Patient Experience

Problem Statement: The Saint Thomas West clinic receives an average of 500 calls daily. There is no effective process for appropriately categorizing or prioritizing incoming patient phone calls, or to address symptom management calls according to evidence-based protocols. Additionally, there is neither a system to track symptom management calls, nor a procedure to determine whether they are being handled correctly and on a timely basis. 

 

Project: Outpatient Oncology Office Telephone System Improvement Project, Regional Cancer Care Associates: Central Jersey Division, 2013/2014

Subcategory: Patient Experience

Problem Statement: Telephone access for patients is their primary mode of communication with a doctor’s office; ineffective phone systems results in patient low satisfaction rates. 30% of RCCA-CJ Division’s patients in November 2013 perceived a call wait time longer than 5 minutes, 30% did not have their call reason resolved and 42% expressed dissatisfaction with the phone system.

 

Project: Reduce the time spent on non-nursing telephone functions performed by triage nurses, Medical Oncology Hematology Consultants, 2020

Category: Telephone Triage

Problem Statement: In February 2020, the triage nurses at Medical Oncology Hematology Consultants (MOHC) spent an average of 60 minutes per day on non-nursing functions, resulting in decreased job satisfaction and delay in patient care.

On-time Treatment Delivery

Project: Reduction in time between cervical cancer diagnosis and treatment​, Instituto de Medicina Integral Prof Fernando Figueira (IMIP), Recife, Pernambuco, Brazil, 2017

Subcategory: Care Coordination

Problem Statement: For 135 patients treated in 2016/2017, the median time between cervical cancer diagnosis and treatment was 107 days. Brazilian Health Regulations suggest 60 days as a limit.

 

Project: Treatment of Febrile Neutropenia at the University of Virginia, University of Virginia, Emily Couric Cancer Center, Charlottesville, VA, 2015

Subcategory: Patient Safety

Problem Statement: Febrile neutropenia is a common complication in oncology patients and is associated with significant morbidity and mortality if untreated. Both national and international guidelines recommend the administration of appropriate antibiotics within one hour of a febrile neutropenic episode. Upon review of time-to-antibiotic administration for febrile neutropenia events at our institution, a significant percentage (~55% in 2012) were not administered antibiotics within 1-hour of the event.

 

Project: Reduction of Time from Admission to Initiation of Chemotherapy on Inpatient Hematology and Bone Marrow Transplant Services, University of Wisconsin Carbone Cancer Center, Madison, WI, 2015

Subcategory: Patient Safety, Patient Experience

Problem Statement: Patients admitted to the hematology and bone marrow transplant service for scheduled chemotherapy average 7 hours between arriving on the B6/6 inpatient unit and starting chemotherapy. This delay results in later chemotherapy start times leading to decreased patient satisfaction and prolonged hospitalization. Moreover, this lag also leads to a disproportionate amount of chemotherapy assigned to the evening shift. During these hours there is decreased pharmacy staffing and fewer clinicians readily available to clarify treatment orders. All of these factors affect patient safety and may result in increased chemotherapy-related errors.

 

Project: Reduce Time to Chemotherapy Administration, Grupo Oncoclinicas do Brazil – NOB-BA, 2018

Subcategory: Care Coordination, Process Improvement, Patient Experience

Problem Statement: Long waiting time has been a common complaint in the satisfaction questionnaires regularly distributed in the clinics. During February and March 2018, the mean time from check in at the reception to (fast track) chemotherapy administration or the procedure was 38 minutes. Excessive wait times negatively impact patient and staff satisfaction

 

Project: Improving Time to Initiation of Bone Modifying Agents in Patients with Newly Diagnosed Multiple Myeloma, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, 2018

Problem Statement: Current ASCO guidelines recommend that all patients on active anti-myeloma therapy receive concurrent supportive care treatment with a bone modifying agent (BMA) to decrease the risk of skeletal-related events (SRE). At Cleveland Clinic, the average time difference between the start date of anti-myeloma therapy and the start date of a BMA in newly diagnosed patients is 10.5 weeks.

 

Project: Reducing Time to High Dose Methotrexate Administration on an Inpatient Oncology Ward, University of Virginia, Charlottesville, VA, 2018

Problem Statement: All patients who received high-dose methotrexate at the University of Virginia from 5/2017-5/2018 experienced a median 8-hour delay resulting in increased length of stay, increased cost of care, and decreased patient satisfaction.

 

Project: Reduction of patient waiting time from the appointment with the oncologist to the administration to the intravenous treatment. Hospital Clínico Universitario de Santiago de Compostela - Servicio de Oncología, Spain, 2019

Subcategory: Care Coordination, Process Improvement

Problem Statement: The appointment of patients for the administration of chemotherapy in Day Hospital results in long waiting times that imply a worsening in their quality of life.

 

Project: Delays in Admissions for Scheduled Chemotherapy, University of Virginia Health, 2020

Category: On-Time Treatment Delivery

Problem Statement: Between January 1 and August 16, 2020, 35% of University of Virginia patients, with planned admissions to 8 West for scheduled chemotherapy were rescheduled. This led to delays in chemotherapy, a decrease in patient satisfaction, and increased administrative burden on clinic staff.

 

Project: Decreasing Inpatient Chemotherapy Initiation Delays at Memorial Regional Hospital, Memorial Cancer Institute, 2020

Category: On-Time Treatment Delivery

Problem Statement: Between June and December 2019, hematology-oncology patients admitted for elective chemotherapy at Memorial Regional Hospital had a median delay of 10 hours to initiate chemotherapy infusion from time of admission.  This contributes to increased cost to the healthcare system and patient dissatisfaction.

 

Project: Delay in surgical treatment of prostate cancer, Complejo Hospitalario Universitario de Cáceres, Spain, 2020

Category: On-Time Treatment Delivery

Problem Statement: Patients with suspected prostate cancer who were referred to our multidisciplinary team from 1/2020- 3/2020 experienced a median 6-month delay until radical prostatectomy was performed resulting in patient with disease progression and decreased patient satisfaction​

 

Project: Reduce the waiting time from arrival at the hospital until the administration of immunotherapy in an oncology unit, Hospital Universitario De Canarias-San Cristobal De La Laguna-Tenerife, Spain, 2020

Category: On-Time Treatment Delivery

Problem Statement: Many oncology patients at our hospital are admitted for scheduled outpatient immunotherapy administration, really short-term infusions for established diagnoses.

• These patients frequently experience delays in starting immunotherapy, averaging many hours after their arrival at the outpatient oncology unit. Delays are made known by patient complaints.
• These delays negatively impact healthcare resource utilization, length of stay, may delay other patients’ admissions, and decrease patient satisfaction.
• In addition, this delay also leads to a disproportionate amount of immunotherapy assigned to the same shift, affects patient safety, and may result in increased immunotherapy-related errors.

 

Project: Reducing chemotherapy infusion wait times for the Medisprof Cancer Center patients, from arrival to treatment start, Romania, 2020

Category: On-Time Treatment Delivery

Problem Statement: One of the most frequent complaints of patients is the long wait time for chemotherapy infusion, from check-in to check-out -> source of decreased patient satisfaction. Our actions on this project will focus on analyzing the time spent by patients who need chemotherapy and on-site blood tests before the chemotherapy. The aim is to reduce the waiting time by 50% in the first 3 months (from implementation).

 

Project: Improving Time to Molecular Testing Results in Patients with Newly Diagnosed, Metastatic Non-Small Cell Lung Cancer (NSCLC), Kaiser Permanente, 2021

Category: On-Time Treatment Delivery

Problem Statement: Currently there are delays from diagnosis to next-generation sequencing (NGS) results in patients with metastatic non-small cell lung cancer (NSCLC). At our institution, it takes a median of 24 days for patients with a pathological diagnosis to receive results of NGS, compared to 15 days recommended by ASCO and 10 days seen in the MYLUNG Consortium study. Specifically, delays in NGS results can lead to

• Increased patient fear and anxiety
• Inappropriate use of front-line therapies
• Increased mortality

 

Project: Decreasing Chemotherapy Administration Delays in Electively Admitted patients to a Hematology-Oncology Unit, UT Health San Antonio/Mays Cancer Center, 2021

Category: On-Time Treatment Delivery

Problem Statement: An average of 20-25 patients were electively admitted to UHS per month in 2019 for inpatient chemotherapy administration. The median time between the patient's admission to UHS and when chemotherapy is started is 19.1 hours. This delay results in an increased LOS and resource utilization along with decreased patient satisfaction.

 

Project: Reducing Early and Late Arrivals of Medical Oncology Patients to Infusion for Treatment. Allegheny Health Network, Pittsburgh, PA, 2021.

Category: On-time Treatment Delivery

Problem Statement: At the Allegheny General Hospital (AGH) Cancer Institute

For the period from January 18 through January 29, 2021

• 51% of the established medical oncology patients arrived at their scheduled infusion appointment greater than or equal to 15 minutes earlier (37%), or later (14%), than their scheduled appointment time
• Of 373 patient appointments, 32% were coupled and 68% were uncoupled
• Among those with coupled visits, 40% arrived early and 24% arrived late totally 64%
• Deviations in patient arrival times to infusion create disruptions to patient outcomes, staff satisfaction, and overall patient experience

Emotional Distress

Project: Improving distress in breast cancer patients, University of Virginia, Charlottesville, VA, 2017

Problem Statement: From February 1st to March 31st, 2017, the UVA Cancer Center assessed distress in just 13% of their breast cancer patients seen on their second visit, leading to a lack of timely communication and intervention with patients in distress along with not meeting of the Commission on Cancer’s accreditation requirements.

 

Project: Incorporating Distress Screening Tool in an Oncology Office Setting, University Oncology, Augusta, GA, 2015

Subcategory: Distress Screening Tool, Documentation Improvement, Supportive Care

Problem Statement: Identifying and addressing all of the stressors within the relationship-centered care process of our practice will enhance our ability to better relieve or lessen distress, hopefully improving outcomes. The integration of ambulatory and hospital-based services also offers the ability to impact admissions and hospital length of stay, both impacted by psychosocial issues that can severely compound symptoms related to the primary disease and its treatment. An effective process may, therefore, reduce the overall cost of care while maximizing outcomes and patient outcomes and patient satisfaction.

 

Project: Emotional Distress Assessment and Management Initiative, Smilow Cancer Hospital at Yale-New Haven, New Haven, CT, 2013/2014

Subcategory: Distress Screening Tool

Problem Statement: In Spring 2012 QOPI abstraction results, 49% (217/445) of Smilow Cancer Hospital patients had documented assessment of “emotional well-being assessed by the second office visit” identifying a barrier to addressing patient emotional needs. – Compliance in 2 of our 10 cancer care centers identified for improvement pilot was below 12% Note: QOPI data based on physician documentation in paper chart

 

Project: Incorporating Emotional Distress Tool for Cancer Treatment Patients, Ralph Lauren Center for Cancer Care, Harlem, NY, 2016

Subcategory: Emotional Distress, Documentation Improvement, Distress Screening Tool

Problem Statement: Distress screening is a proven method to quickly assess and manage common symptoms and stressors of chemotherapy patients. RLCCC shows 0% compliance by not utilizing standardized methods to assess distress in its patient population which historically has high levels of distress. 

 

Project: Documentation of distress in Hematology/Oncology Patients, Malcolm Randall VA Medical Center, Gainesville FL, 2018

Subcategory: Supportive Care

Problem Statement: 61% of hematology/oncology patients at Malcom Randall VA Medical Center experienced distress based on a department NCCN distress tool survey between April to June 2018 which place patients at risk because a failure to assess patient distress may negatively impact patient compliance, patient satisfaction, and the overall patient experience.

 

Project: Evaluation of the emotional state of the oncological patient in first or second visit, Hosp. Gen. Univ. J.M. Morales Meseguer, Spain, 2019

Subcategory: Supportive Care

Problem Statement: Medical Emergency SOP accomplishment in spite of the several necessary services, especially the ambulance activation and ICU admission.

 

Project: Improving Distress Screening, Hartford HealthCare Cancer Institute

Subcategory: N/A

Problem Statement: 84% of new patients receiving treatment at Hartford Hospital’s Infusion Center (August 2019 – January 2020) were not screened for distress. The absence of a standard approach to distress screening results in a failure to systematically connect patients to the appropriate support services.  This negatively impacts their emotional well-being and quality of life and ultimately interferes with their ability to cope with cancer and treatment.

 

Project: Distress screening documention for African American breast cancer patients, Howard University Cancer Center, 2021

Category: Emotional Distress

Problem Statement: Distress screening was documented for only 40% of African American breast cancer patients for the period of Jan –Dec, 2019.  Lack of routine documentation and management of patient distress negatively affects patient quality of life, continuity of care, and clinical outcomes.

Management of Treatment Side Effects

Project: Standardizing early identification and treatment of Febrile Neutropenia (FN), Hartford Healthcare Cancer Institute (HHC-CI), 2018

Subcategory: Care Coordination, On-time Treatment Delivery

Problem Statement: Patients undergoing treatment with chemotherapy are at risk for neutropenic fever which can lead to severe sepsis and death if not treated properly. The goal of this project is to standardize the treatment of neutropenic fever in the first 48 hours at HOCC to reduce variation and improve outcomes. The literature recommends a triage to antibiotic time of less than one hour in patients with neutropenic fever.

 

Project: Steroid Tapering for Patients with Spinal Cord Compression or Symptomatic Brain Metastases, Jackson Memorial Hospital, 2018

Subcategory: Documentation Improvement, Patient Safety, Process Improvement

Problem Statement: Between Nov-17 and Feb-18 76% of patients with spinal cord compression or symptomatic brain metastases did not receive appropriate tapering of steroids following completion of radiation treatment. This leads to unnecessary side effects from continued steroid use, ultimately leading to an inefficient use of resources, including time and money.

 

Project: Control of Adverse Events (AE) in Lung Cancer Patients Receiving Immune Checkpoint Inhibitors (ICPI) Through a Multidisciplinary Education Program, Ramón y Cajal Hospital, Madrid - Spain, 2018

Subcategory: Documentation Improvement, Patient Safety, Care Coordination

Problem Statement: We analyzed 45 patients with lung cancer, treated with ICPI, during 2017. We detected 55% of moderate-severe AEs (33% G2 AEs and 12% of G3 AEs), related and not related to these drugs. GRADE 2-3 AE IMPACT ON QUALITY OF CARE, Delay in treatment: 31% of total AEs, Unscheduled visits: 19% of total AEs (emergency room and visits without annotation), Serious complication: 11% of total AEs, Patient dissatisfaction with access to Symptom Control Providers: Not quantified (informal patient statements).

 

Project: Development of a Standard Protocol to address the high incidence of clinical and sub-clinical heart failure in our adult Acute Myeloid Leukemia population, University of Virginia Medical Center, Charlottesville, VA, 2018

Subcategory: Management of Treatment Side Effects

Problem Statement: Fifteen percent of patients with newly diagnosed Acute Myeloid Leukemia at the University of Virginia receiving anthracycline-containing chemotherapy between March 2011 and March 2017 had evidence of clinical heart failure within 1 year of induction. The reported incidence of heart failure in patients who receive similar lifetime doses of anthracyclines in other patient populations is reported to be between 3-5%. This has significant implications for transplant eligibility and long-term morbidity and mortality.  Our institution does not have a standard protocol for how to screen, risk stratify, or monitor patients for the development of this important treatment side effect. On retrospective review, 31% of our acute leukemia patients completed a standard screening and diagnostic cardiac evaluation based on our proposed ideal standard.

 

Project: Adherence to International Guidelines in the management of patients with immune-related adverse events treated at Hospital Clínico San Carlos, Spain, 2020

Category: Management of Treatment Side Effects

Problem Statement: Between October 2019 and June 2020, only 21% of patients with G3 and G4 immune-related adverse events at Hospital Clínico San Carlos received the proper management of toxicity according to International Guidelines (dose and duration of steroid therapy, supportive treatment and follow-up), which could increase the risk of a new outbreak of the same toxicity or complications due to steroid treatment

Advance Care Planning

Project: Courageous Endeavor: Capturing Care Preferences for Late Stage Hematology Patients, City of Hope, 2019

Subcategory: Supportive Care

Problem Statement: Only 31% of our deceased Hematology patients had a goal of care discussion documented more than 7 days prior to death. This results in care that may not be aligned with patient and family preferences as well as inappropriately increasing healthcare costs.

 

Project: Improving End of Life Care with Advance Care Planning, Sweetwater Regional Cancer Center

Subcategory: N/A

Problem Statement: Between December 2019 and January 2020, five of our patients were admitted to the hospital, four were discharged to hospice and died within a week. None of those patients had advance directives. In November and December 2019, all oncology patient charts were reviewed and only 7% (12/174) had advance directives. We believe an established advance directive could have helped avoid unnecessary hospitalization, improved end-of-life care, and reduced wasteful health care costs.

Patient Satisfaction

Project: Reducing length of stay after open cytoreductive surgery for patients with gynecologic cancers, City of Hope, 2019

Subcategory: Patient Access

Problem Statement: For calendar year 2018, the average length of stay (LOS) was 11.21 days for patients undergoing open cytoreductive surgery for gynecologic cancers. LOS is linked to patient satisfaction, cost, and access.

 

Project: Malnutrition in patients with pancreatic cancer. Impact of an oncology nursing consultation in their evolution and the level of patient's satisfaction, Hospital Universitario Ramon y Cajal, Madrid – Spain. 2019 

Subcategory: Care Coordination

Problem Statement: Pancreatic cancer is an aggressive disease, which occurs with high rates of malnutrition throughout its evolution.

Preliminary analysis: population of 25 patients (88%)

• Albumin < 3mg/dL (52%)
• BMI < 16m2 (36%)
• Weight loss > 10% in previous 6 months (76%)

 

Project: Genomic Testing in Ovarian Cancer Patients. Kaiser Permanente Northern California, San Francisco, CA, 2021.

Category: Patient Satisfaction

Problem Statement: Somatic genomic testing for ovarian cancer patients is not consistently ordered in San Francisco and the DSA by the time of completion of

chemotherapy. This leads to incomplete information when devising a treatment plan leading to suboptimal care, including delays in treatment, and provider and patient dissatisfaction.

 

Project: Anthem Home Health Anti-Emetic Compliance. University of California, Irvine, CA, 2021.

Category: Patient Satisfaction

Problem Statement: Only 20% of patients enrolled in the Chao Family Cancer Center Anthem Home Care Program and receiving highly emetogenic treatment are within compliance with day 1 anti-emetic pre-medications leading to

• Poor patient satisfaction
• Increased need for provider communication
• Increased ED visits

 

Project: A Quality Improvement Initiative to Increase Patient Satisfaction Scores. Maryland Oncology Hematology, Rockville, MD, 2022

Category: Patient Satisfaction

Problem Statement: Maryland Oncology Hematology, PA (MOH) is made up of six divisions/practices with 15 sites of service. We strive to provide quality care. MOH started patient satisfaction surveys six months ago. We found that only 50 % of the time our division's patient satisfaction surveys achieve the organization's standard (60% of the answers are in the range of very good or excellent). By working to improve our scores, we can improve the quality of care we provide and increase our market presence.

Patient Care

Project: Analysis of the incidence of intrahospital systemic treatment in terminal patients, Fundación Instituto Valenciano de Oncología, Valencia, Spain, 2019

Subcategory: Supportive Care

Problem Statement: Approximately 30% of the patients with advanced cancer continue receiving systemic treatments toward the end of life. Among them, about 2-5% receive their last cancer-related treatment within 15 days before death. We want to assess the percentage of patients who received systemic treatment (ST) in their last 15 days in the Oncology ward of our hospital. We believe that an intervention in treatment administration in the last phases of life will have a beneficial impact on the patients since we will reduce side effects, prolonged admissions and the risk of dying unnecessarily in an intensive care unit.

 

Project: Aggressiveness of Cancer Care Near the end of Life, Hospital Universitario Fundación Jiménez Díaz, Spain, 2020

Category: Patient Care

Problem Statement: Aggressive management of cancer care near the end of life is harmful, associated with decreased quality of life, and increases health costs needlessly. Fifty-five percent of the patients at our hospital suffer at least one aggressiveness event in the last month of life. A substantial portion of these is avoidable.

Burnout

Project: Impact of Burn-Out Syndrome in Oncology Personnel and its Improvement through Specific Interventions, Consorcio Hospital General Universitario de Valencia, Spain, 2019 

Subcategory: Beneficiary Engagement

Problem Statement: 78% of oncology-related workers (doctors, nurses…) experience burnout syndrome, the characteristics of which include emotional and physical exhaustion, cynicism and depersonalization, and a lack of personal and professional fulfillment. The repercussions of burnout include a decrease in the quality of both institutional processes and attention paid to patients.

 

Project: Physician burnout: An Innovative way to find “Sanity out of Madness” in the Infusion Center of a Cancer Institute, Medstar Washington Hospital Center, Washington, DC, 2019

Problem Statement: In the time period from June 21, 2019, to August 30, 2019, we noted that 13.18% of patients scheduled to receive chemotherapy at WCI infusion center had missing orders on the day of the infusion, which resulted in up to a 111-minute delay in starting chemotherapy. This, in turn, resulted in stress/burnout among 42.1% of providers and 55.6% of supportive staff in addition to patient dissatisfaction. ​

 

Project: Reducing Burnout Among Hematology Oncology Fellows at MUSC​, Medical University of South Carolina, Charleston, SC, 2019 

Problem Statement: In 2019, hematology-oncology fellows at MUSC were surveyed to have an overall Mini-Z workplace score of 28.9* regarding workplace satisfaction, burnout, etc., compared to 30.6 for the national benchmark and an ASCO QTP peer group.​ These results may be negatively impacting job & team satisfaction, overall well-being, and may be associated with suboptimal patient care.​

 

Project: Improving Efficiency of Same-Day Ill Calls, University of Nebraska Medical Center, Omaha, NE, 2019 

Problem Statement: Case managers and clinic triage nurses take an average of 30 minutes to schedule a same-day appointment for an ill patient to be seen by a provider. ​These metrics show that the lack of a standardized process and flow, in addition to the normal daily tasks of the case managers, may be contributing to team stress. This could potentially be contributing to burnout among team members.​

 

Project: Reducing Burnout among Oncology Physicians ​in King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia, 2019 

Problem Statement: In the fall of 2019, 55% of oncology physicians reported severe occupational burnout, which could negatively affect clinician performance, productivity, and quality of patient care.​

 

Project: Decreasing the Number of Authorization Denials in an Academic Medical Oncology Practice, Seidman Cancer Center, Cleveland, OH, 2019 

Problem Statement: In 2018, First Pass Denial Rates averaged 8.41% per month at Seidman Cancer Center leading to peer-to-peer requests that consume the time and effort of providers, which cause frustrations and contribute to burnout and impact patient care. ​

 

Project: Improving Documentation of Patients’ Adherence to Oral Chemotherapy on ​the St. Jude TOTAL 17 Clinical Trial​, St. Jude Children's Research Hospital, Memphis, TN, 2019   

Problem Statement: A burnout survey completed in August 2019 showed the EMR, particularly the lack of standard documentation of oral chemotherapy adherence on T17 contributes to provider burnout. The T17 required documentation compliance of 13% generates many redundant email exchanges between the T17 team in Memphis and the affiliate teams seeking clarification and leading to frustration from both sides.​

 

Project: Improving the rate of universal genetic counseling for pancreatic adenocarcinoma at the Cleveland Clinic, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, 2019 

Problem Statement: The referral rate for genetic counseling by medical oncologists at Cleveland Clinic Main Campus for patients who are newly diagnosed with pancreatic adenocarcinoma from April 1 to June 30, 2019, was an average of 9.0%. ​This impacts cancer screening for patients and their families; potential treatments available to patients; and burnout among oncologists.

 

Project: Time to Blood Repletion for Stem Cell Transplant Patients, University of Virginia Health System, Charlottesville, VA, 2019 

Problem Statement: In May-September 2019, 55% of blood repletion orders took more than 60 minutes to be placed for SCT patients. This led to the frustration of nursing staff due to an imbalanced workload, a cluster of orders, and delayed care in treatments.​

 

Project: Reducing burnout among UVA Hem/Onc fellows​, University of Virginia Health System​, Charlottesville, VA, 2019    

Problem Statement: During the past year, 100% of Hematology/Oncology fellows at the University of Virginia have felt overworked and stressed during in-patient call rotation, which contributes to their feeling of burnout.​

 

Project: Targeting Laboratory Order Entry To Improve EMR Workflow, Smilow Cancer Hospital at Yale New Haven Health System, New Haven, CT, 2019 

Problem Statement: The burnout rate for Oncologists at YNHH is 53%. Excess EMR Documentation is the highest driver of burnout. Time spent in laboratory order entry leads to excess EMR use. MDs in the Trumbull office spent twice as long entering orders per day (MDs in Trumbull spend 20 minutes per day putting in orders​ compared to MDs across the network who spend 10 minutes per day​).

Chemotherapy Safety

Project: Proper Management of Patients Using Doxorubicin, Sociedade Beneficente Israelita Albert Einstein, São Paulo, SP, 2022

Category: Chemotherapy Safety

Problem Statement: Between the months of August 2021 and July 2022, 306 patients started treatment with doxorubicin, of these 49% (149) were inadequately managed, without performing the Echocardiogram within 30 days before the therapy, as recommended by the Brazilian Guideline of Cardio-Oncology.

Palliative Care

Project: Increasing the Percentage of Stage IV Cancer Patients Who See a Palliative Care Provider Within 8 Weeks of Initial Consult With Medical Oncology. Minnesota Oncology, Minneapolis, MN, 2022

Category: Palliative Care

Problem Statement: In 2021, across Minnesota Oncology’s 11 clinic locations, the mean of Stage IV cancer patients seen by a palliative care provider within 8 weeks of their initial consult with their medical oncology provider was 21.47% leading to poor symptom control, decreased patient and caregiver satisfaction, and increased costs associated with ER visits and hospitalizations.