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Walesa MB, Denny A, Patel A, Mulcahy M, Kircher S, George C, Tsarwhas D, Ross A, Platanias LC, Poylin V, Yang AD, Barnard C, Bilimoria KY, Merkow RP. Enhancement and Implementation of a Health Information Technology Module to Improve the Discrete Capture of Cancer Staging in a Diverse Regional Health System. JCO Oncol Pract 2023; 19:e957-e966. [PMID: 37527464 DOI: 10.1200/op.23.00104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/10/2023] [Accepted: 05/30/2023] [Indexed: 08/03/2023] Open
Abstract
PURPOSE Cancer staging is the foundation for all cancer management decisions. For real-time use, stage must be embedded in the electronic health record as a discrete data element. The objectives of this quality improvement (QI) initiative were to (1) identify barriers to utilization of an existing discrete cancer staging module, (2) identify health information technology (HIT) solutions to support discrete capture of cancer staging data, and (3) increase capture across the oncology enterprise in our diverse health system. METHODS Six sigma QI methodologies were used to define barriers and solutions to improve discrete cancer staging. Design thinking principles informed solution development to test prototypes. Two multidisciplinary teams of disease-specific clinicians within GI and genitourinary conducted phased testing pilots to determine health system solutions. Solutions were expanded to all oncology specialties across our health system. RESULTS Baseline average discrete staging capture across our health system was 31%. Poor workflow efficiency, limited accountability, and technical design gaps were key barriers to timely, complete staging. Implementation of more than 25 design enhancements to a HIT solution and passive user alerts led to a postimplementation capture rate of 58% across 55 outpatient clinics involving more than 400 clinicians. CONCLUSION We identified key barriers to discrete data capture and designed solutions through iterative use of QI methodologies and disease-specific pilots. After implementation, discrete capture of cancer staging nearly doubled across our diverse health system. This approach is scalable and transferable to other initiatives to develop and implement clinically relevant HIT solutions across a diverse health system.
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Affiliation(s)
| | | | | | - Mary Mulcahy
- Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Sheetal Kircher
- Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | - Dean Tsarwhas
- Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Ashley Ross
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leonidas C Platanias
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Vitaly Poylin
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anthony D Yang
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Karl Y Bilimoria
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Ryan P Merkow
- Division of Surgical Oncology, University of Chicago, Chicago, IL
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Enamandram SS, Burk KS, Dang PA, Mar WW, Centerbar C, Boland GW, Khorasani R. Radiology Patient Outcome Measures: Impact of a Departmental Pay-for-Performance Initiative on Key Quality and Safety Measures. J Am Coll Radiol 2021; 18:969-981. [PMID: 33516768 DOI: 10.1016/j.jacr.2020.12.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/14/2020] [Accepted: 12/31/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Assess impact of a multifaceted pay-for-performance (PFP) initiative on radiologists' behavior regarding key quality and safety measures. METHODS This institutional review board-approved prospective study was performed at a large, 12-division urban academic radiology department. Radiology patient outcome measures were implemented October 1, 2017, measuring report signature timeliness, critical results communication, and generation of peer-learning communications between radiologists. Subspecialty division-wide and individual radiologist targets were specified, performance was transparently communicated on an intranet dashboard updated daily, and performance was financially incentivized (5% of salary) quarterly. We compared outcomes 12 months pre- versus 12 months post-PFP implementation. Primary outcome was monthly 90th percentile time from scan completion to final report signature (CtoF). Secondary outcomes were percentage timely closed-loop communication of critical results and number of division-wide peer-learning communications. Statistical process control analysis and parallel coordinates charts were used to assess for temporal trends. RESULTS In all, 144 radiologists generated 1,255,771 reports (613,273 pre-PFP) during the study period. Monthly 90th percentile CtoF exhibited an absolute decrease of 4.4 hours (from 21.1 to 16.7 hours) and a 20.9% relative decrease post-PFP. Statistical process control analysis demonstrated significant decreases in 90th percentile CtoF post-PFP, sustained throughout the study period (P < .003). Between 95% (119 of 125, July 1, 2018, to September 30, 2018) and 98.4% (126 of 128, October 1, 2017, to December 31, 2017) of radiologists achieved >90% timely closure of critical alerts; all divisions exceeded the target of 90 peer-learning communications each quarter (range: 97-472) after January 1, 2018. DISCUSSION Implementation of a multifaceted PFP initiative using well-defined radiology patient outcome measures correlated with measurable improvements in radiologist behavior regarding key quality and safety parameters.
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Affiliation(s)
- Sheila S Enamandram
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kristine S Burk
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Radiology Department Quality and Safety Officer; Director of Quality and Safety for the Abdominal Imaging and Intervention Division, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pragya A Dang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wenhong W Mar
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cynthia Centerbar
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Giles W Boland
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Chair of the Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ramin Khorasani
- Director of the Center for Evidence Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Vice Chair of Quality and Safety, Department of Radiology Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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O'Hanlon CE, Lindvall C, Lorenz KA, Giannitrapani KF, Garrido M, Asch SM, Wenger N, Malin J, Dy SM, Canning M, Gamboa RC, Walling AM. Measure Scan and Synthesis of Palliative and End-of-Life Process Quality Measures for Advanced Cancer. JCO Oncol Pract 2020; 17:e140-e148. [PMID: 32758085 DOI: 10.1200/op.20.00240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Monitoring and improving the quality of palliative and end-of-life cancer care remain pressing needs in the United States. Among existing measures that assess the quality of palliative and end-of-life care, many operationalize similar concepts. We identified existing palliative care process measures and synthesized these measures to aid stakeholder prioritization that will facilitate health system implementation in patients with advanced cancer. METHODS We reviewed MEDLINE/PubMed-indexed articles for process quality measures related to palliative and end-of-life care for patients with advanced cancer, supplemented by expert input. Measures were inductively grouped into "measure concepts" and higher-level groups. RESULTS Literature review identified 226 unique measures from 23 measure sources, which we grouped into 64 measure concepts within 12 groups. Groups were advance care planning (11 measure concepts), pain (7), dyspnea (9), palliative care-specific issues (6), other specific symptoms (17), comprehensive assessment (2), symptom assessment (1), hospice/palliative care referral (1), spiritual care (2), mental health (5), information provision (2), and culturally appropriate care (1). CONCLUSION Measure concepts covered the spectrum of care from acute symptom management to advance care planning and psychosocial needs, with variability in the number of measure concepts per group. This taxonomy of process quality measure concepts can be used by health systems seeking stakeholder input to prioritize targets for improving palliative and end-of-life care quality in patients with advanced cancer.
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Affiliation(s)
- Claire E O'Hanlon
- Veterans Affairs Greater Los Angeles Health Care System, Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute; and Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Karl A Lorenz
- Veterans Affairs Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, CA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Karleen F Giannitrapani
- Veterans Affairs Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, CA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Melissa Garrido
- Veterans Affairs Boston Healthcare System, Partnered Evidence-Based Policy Resource Center, Boston, MA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Steven M Asch
- Veterans Affairs Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, CA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Neil Wenger
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA
| | | | - Sydney Morss Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MDThe views expressed are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government
| | - Mark Canning
- Veterans Affairs Greater Los Angeles Health Care System, Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA
| | - Raziel C Gamboa
- Veterans Affairs Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, CA
| | - Anne M Walling
- Veterans Affairs Greater Los Angeles Health Care System, Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA.,Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA
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