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  • 1
    Online Resource
    Online Resource
    American Society of Clinical Oncology Statement: A Conceptual Framework to Assess the Value of Cancer Treatment Options
    American Society of Clinical Oncology (ASCO) ; 2015
    In:  Journal of Clinical Oncology Vol. 33, No. 23 ( 2015-08-10), p. 2563-2577
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 33, No. 23 ( 2015-08-10), p. 2563-2577
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2015.61.6706
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2015
    detail.hit.zdb_id: 2005181-5
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  • 2
    Online Resource
    Online Resource
    Updating the American Society of Clinical Oncology Value Framework: Revisions and Reflections in Response to Comments Received
    American Society of Clinical Oncology (ASCO) ; 2016
    In:  Journal of Clinical Oncology Vol. 34, No. 24 ( 2016-08-20), p. 2925-2934
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 34, No. 24 ( 2016-08-20), p. 2925-2934
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2016.68.2518
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2016
    detail.hit.zdb_id: 2005181-5
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  • 3
    Online Resource
    Online Resource
    Three-Year Results of a Medicare Advantage Cancer Management Program
    American Society of Clinical Oncology (ASCO) ; 2018
    In:  Journal of Oncology Practice Vol. 14, No. 4 ( 2018-04), p. e229-e237
    Details
    In: Journal of Oncology Practice, American Society of Clinical Oncology (ASCO), Vol. 14, No. 4 ( 2018-04), p. e229-e237
    Abstract: Reform of cancer care delivery seeks to control costs while improving quality. Texas Oncology collaborated with Aetna to conduct a payer-sponsored program that used evidence-based treatment pathways, a disease management call center, and an introduction to advance care planning to improve patient care and reduce total costs. Methods: From June 1, 2013, to May 31, 2016, 746 Medicare Advantage patients with nine common cancer diagnoses were enrolled. Patients electing for patient support services were telephoned by oncology nurses who assessed symptoms and quality of life and introduced advance care planning. Shared cost savings were determined by comparing the costs of drugs, hospitalization, and emergency room use for 509 eligible patients in the study group with a matched cohort of 900 Medicare Advantage patients treated by non–Texas Oncology providers. Physician adherence to treatment pathways and performance and quality metrics were evaluated. Results: During the 3 years of the study, the cumulative cost savings were $3,033,248, and savings continued to increase each year. Drug cost savings per patient per treatment month were $1,874 (95% CI, $1,373 to $2,376; P 〈 .001) after adjusting for age, diagnosis, and study year. Solid tumors contributed most of the savings; hematologic cancers showed little savings. For years 1, 2, and 3, adherence to treatment pathways was 81%, 84%, and 90%, patient satisfaction with patient support services was 94%, 93%, and 94%, and hospice enrollment was 55%, 57%, and 64%, respectively. Conclusion: A practice-based program supported by a payer sponsor can reduce costs while maintaining high adherence to treatment pathways and patient satisfaction in older patients.
    Type of Medium: Online Resource
    ISSN: 1554-7477 , 1935-469X
    URL: Article
    DOI: 10.1200/JOP.17.00091
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2018
    detail.hit.zdb_id: 3005549-0
    detail.hit.zdb_id: 2236338-5
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  • 4
    Online Resource
    Online Resource
    Pathways, Outcomes, and Costs in Colon Cancer: Retrospective Evaluations in Two Distinct Databases
    American Society of Clinical Oncology (ASCO) ; 2011
    In:  Journal of Oncology Practice Vol. 7, No. 3S ( 2011-05), p. 52s-59s
    Details
    In: Journal of Oncology Practice, American Society of Clinical Oncology (ASCO), Vol. 7, No. 3S ( 2011-05), p. 52s-59s
    Abstract: The goal of this study was to use two separate databases to evaluate the clinical outcomes and the economic impact of adherence to Level I Pathways, an evidence-based oncology treatment program in the treatment of colon cancer. Patients and Methods: The first study used clinical records from an electronic health record (EHR) database to evaluate survival according to pathway status in patients with colon cancer. Disease-free survival in patients receiving adjuvant treatment and overall survival in patients receiving first-line therapy for metastatic disease was calculated. The second study used claims data from a national administrative claims database to examine direct medical costs and use, including the cost of chemotherapy and of chemotherapy-related hospitalizations according to pathway status. Results: Overall costs from the national claims database—including total cost per case and chemotherapy costs—were lower for patients treated according to Level I Pathways (on-Pathway) compared with patients not treated according to Level I Pathways. Use of pathways was also associated with a shorter duration of therapy and lower rate of chemotherapy-related hospital admissions. Survival for patients on-Pathway in the EHR database was comparable with those in the published literature. Conclusion: Results from two distinct databases suggest that treatment of patients with colon cancer on-Pathway costs less; use of these pathways demonstrates clinical outcomes consistent with published evidence.
    Type of Medium: Online Resource
    ISSN: 1554-7477 , 1935-469X
    URL: Article
    DOI: 10.1200/JOP.2011.000318
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2011
    detail.hit.zdb_id: 3005549-0
    detail.hit.zdb_id: 2236338-5
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  • 5
    Online Resource
    Online Resource
    A randomized study to improve care for young women with breast cancer at community and academic medical oncology practices in the United States: The Young and Strong study
    Wiley ; 2019
    In:  Cancer Vol. 125, No. 11 ( 2019-06), p. 1799-1806
    Details
    In: Cancer, Wiley, Vol. 125, No. 11 ( 2019-06), p. 1799-1806
    Abstract: A multicenter educational and supportive care intervention for young women with breast cancer implemented at community and academic practices across the United States does not appear to improve rates of attention to fertility. However, patients and providers report that the intervention educated them and improved care.
    Type of Medium: Online Resource
    ISSN: 0008-543X , 1097-0142
    URL: Article
    DOI: 10.1002/cncr.31984
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 1479932-7
    detail.hit.zdb_id: 2599218-1
    detail.hit.zdb_id: 2594979-2
    detail.hit.zdb_id: 1429-1
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  • 6
    Online Resource
    Online Resource
    Evaluation of the Reliability of Electronic Medical Record Data in Identifying Comorbid Conditions among Patients with Advanced Non-Small Cell Lung Cancer
    Hindawi Limited ; 2011
    In:  Journal of Cancer Epidemiology Vol. 2011 ( 2011), p. 1-5
    Details
    In: Journal of Cancer Epidemiology, Hindawi Limited, Vol. 2011 ( 2011), p. 1-5
    Abstract: Background . Traditional methods for identifying comorbidity data in EMRs have relied primarily on costly and time-consuming manual chart review. The purpose of this study was to validate a strategy of electronically searching EMR data to identify comorbidities among cancer patients. Methods . Advanced stage NSCLC patients ( N = 2,513 ) who received chemotherapy from 7/1/2006 to 6/30/2008 were identified using iKnowMed, US Oncology's proprietary oncology-specific EMR system. EMR data were searched for documentation of comorbidities common to advanced stage cancer patients. The search was conducted by a series of programmatic queries on standardized information including concomitant illnesses, patient history, review of systems, and diagnoses other than cancer. The validity of the comorbidity information that we derived from the EMR search was compared to the chart review gold standard in a random sample of 450 patients for whom the EMR search yielded no indication of comorbidities. Negative predictive values were calculated. Results . The overall prevalence of comorbidities of 22%. Overall negative predictive value was 0.92 in the 450 patients randomly sampled patients (36 of 450 were found to have evidence of comorbidities on chart review). Conclusion . Results of this study suggest that efficient queries/text searches of EMR data may provide reliable data on comorbid conditions among cancer patients.
    Type of Medium: Online Resource
    ISSN: 1687-8558 , 1687-8566
    URL: Article
    DOI: 10.1155/2011/983271
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2011
    detail.hit.zdb_id: 2473564-4
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  • 7
    Online Resource
    Online Resource
    Impact of a cancer management program.
    American Society of Clinical Oncology (ASCO) ; 2012
    In:  Journal of Clinical Oncology Vol. 30, No. 34_suppl ( 2012-12-01), p. 227-227
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 34_suppl ( 2012-12-01), p. 227-227
    Abstract: 227 Background: US Oncology, Inc., Texas Oncology (TxO) and Aetna are engaged in a pilot program, Innovent Oncology (IOP) to evaluate clinical and financial impacts of Pathways (PW), a nursing call intervention for chemotherapy patients (pt support services-PSS), and an advance care planning (ACP) initiative. We report quality initiatives, PW compliance and ACP, from the program at 18 months, and IP and ER admits at 12 months. Methods: Eligible Aetna pts with PW diagnoses, treated by TxO were enrolled. PW compliance was tracked. PSS calls occurred at regular intervals during chemotherapy. Symptoms, quality of life, and depression were screened each call with referrals to TxO as needed for management. ACP was initiated in month 2 of IOP. To support IOP, a leadership team comprising physicians, pharmacists and nurses was established. IP,ER data on predefined subgroups were compared to diagnosis-adjusted rates from the baseline prior year. Results: The program enrolled 184 patients from June 1, 2010 – Decembe 30, 2011 with 278 regimens ordered. Pathway adherence improved from 67% to 75%. 81% enrolled in PSS; of these, 83% were introduced to ACP, with 11% (n=16) completing a full ACP discussion. PSS made 906 calls to pts and assessed pain at 80% of contacts. IP, ER utilization rates after 12 months of IOP are reported (see Table). Conclusions: This is a preliminary evaluation with small numbers. Results suggest cancer patients can be identified pre-treatment; a proactive nurse call system is feasible and well received; a symptom assessment tool can be systematically implemented, communication on ACP initiated; and a pathways program enhanced. A reduction of ER visits by 39.8%, IP admits by 16.5 %, and inpatient days/member by 35.9% are very promising trends. A bootstrap shows 97% of scenarios with IP utilization reduction, and 96% with ER utilization reduction. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2012.30.34_suppl.227
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2012
    detail.hit.zdb_id: 2005181-5
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  • 8
    Online Resource
    Online Resource
    Patient-centered conversations: Advance care planning values in the adult oncology population.
    American Society of Clinical Oncology (ASCO) ; 2014
    In:  Journal of Clinical Oncology Vol. 32, No. 31_suppl ( 2014-11-01), p. 147-147
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 32, No. 31_suppl ( 2014-11-01), p. 147-147
    Abstract: 147 Background: Over the past 2 years a structured advance care planning program (ACP) has been created, piloted and is evaluated monthly at 10 Texas Oncology practices. This program is a systematic process for assessing patient values, is physician supported and is delivered by advanced practice providers at each site. Patient values and quality of life are at the center of the conversations, enhancing patient-centered care and communication with their oncology providers. Targeted patient populations include metastatic lung, pancreatic and colon cancers. Methods: Over the past 14 months, 332 patients engaged in ACP in ten sites. Descriptive statistics for each site were calculated and examined to explore 1) ACP counseling sessions, 2) number of Patient Values questionnaires completed, 3) frequency of code status documentation in the health record, and 4) hospice enrollment for both the targeted and all metastatic populations. Results: A three month review revealed the ACP work within all metastatic populations at the ten sites. Targeted population totals showed continued increase in the percentages of patient ACP engagement at each site. For the practice as a whole, and the targeted population, 9-23% of patients have received an ACP counseling visit. There have been 149 completed Patient Values questionnaires. In the electronic health record, there are 2,233 (24%) patients who have a documented code status. A range of hospice enrollment from 8-28% in the targeted populations has continued to improve hospice length of stay. Conclusions: The patient is invited to explore their treatment options, their personal values and the completion of the advance directive documents. Truthful conversations are critical between patient and provider in order to create a meaningful treatment plan, and to allow the patient to gain understanding about their options. Early palliative care referrals are integrated into each session for symptom management through local partnerships with palliative care physicians. Education regarding life-sustaining interventions help the patient determine their choices for medical care. Having ACP counseling is important at any stage of health and particularly within life-limiting disease.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2014.32.31_suppl.147
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2014
    detail.hit.zdb_id: 2005181-5
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  • 9
    Online Resource
    Online Resource
    Impact of pathways on chemotherapy administration before death.
    American Society of Clinical Oncology (ASCO) ; 2013
    In:  Journal of Clinical Oncology Vol. 31, No. 15_suppl ( 2013-05-20), p. 6580-6580
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 15_suppl ( 2013-05-20), p. 6580-6580
    Abstract: 6580 Background: Continuing IV chemotherapy (chemo) in patients (pts) with advanced cancer near death neither extends survival nor improves quality, but does increase costs. Pathways (PW) programs have focused on comparing treatment (tx) costs but have not evaluated the impact on chemo given near death. The primary goal is to evaluate IV chemo administered in the last 14 days of life for pts treated On-PW vs. Off-PW. Methods: Eligible pts: in US Oncology’s (USO) iKnowMed (iKM) EHR; diagnosis (dx) of breast, colon, NSCLC, SCLC or pancreas cancer; 〉 /=3 visits to a USO clinic; assessed for Level I PW compliance in the last 12 mths of life; and a documented date of death. IV chemo received in the last year of life was assessed. Pts were defined On-PW if all tx was On-PW or if pts did not receive IV chemo 12 mths before death (best supportive care). Pts were defined Off-PW if any tx received was Off-PW. PW-status, age, sex, dx, and last line of therapy (LOT) received were assessed. Multivariate logistic regression analysis was used to assess if PW status predicted likelihood of chemo within 14-days of death. Results: From 7/1/09-6/30/12, 12,551 pts met inclusion criteria. PW status was independently associated with chemo 14 days before death. Pts treated Off-PW had a two-fold higher odds of receiving IV chemo within 14 days of death compared to pts treated On-PW (OR: 1.99; 95% CI: 1.77-2.26), see the Table. Findings were similar for each dx. Tx for pts On-PW vs Off-PW showed lower mean last LOT overall (1 vs. 2) and by dx. Conclusions: Pts On-PW were less likely to receive IV chemo within 14 days of death and had fewer LOT. This suggests adherence to Level I PWs is associated with improved quality metrics. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2013.31.15_suppl.6580
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2013
    detail.hit.zdb_id: 2005181-5
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  • 10
    Online Resource
    Online Resource
    The value of a quality metric.
    American Society of Clinical Oncology (ASCO) ; 2012
    In:  Journal of Clinical Oncology Vol. 30, No. 34_suppl ( 2012-12-01), p. 239-239
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 34_suppl ( 2012-12-01), p. 239-239
    Abstract: 239 Background: The value of a quality metric is tied to improving outcomes or reducing costs while maintaining outcomes. In the last year ASCO/ONS Chemotherapy Safety metric 1F has changed from requiring current BLS (Basic Life Support) certification for all clinical personnel to requiring only one currently certified professional be present during chemotherapy administration (CA). For this study we evaluated the need for BLS training in outpatient chemotherapy delivery. Methods: Texas Oncology maintains a voluntary drug occurrence system, web-based and accessible at all sites. Occurrences with severity Grade 6 (transfer to a more intensive facility or temporary harm to patient) or higher (7 or 8) were collected for 2008-2 nd q 2011. Use of BLS and AED and outcomes were tracked through chart review. Results: There were 188 instances of Grade 6 or higher events of which 5 involved BLS. There were no events where an AED was triggered. All 5 patients were transferred alive to a hospital. All events were drug reactions. During the same period there were 779, 805 CAs, 371,693 unique patients with 15,394,601 patient visits. Facility reports were also queried for 2010 with no additional events identified. Conclusions: 1) The need for BLS recertification is unproven in this setting. 2) AED triggering did not occur in this time frame, 3) Protocols for addressing severe drug reactions are of prime importance. 4) Quality metrics may or may not add value to a quality program and require validation. 5) The original BLS requirement was burdensome. 6) The incidence of true cardiac arrest in this setting is remarkably low.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2012.30.34_suppl.239
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2012
    detail.hit.zdb_id: 2005181-5
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