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Arafat W, Fu P, Wagner AJ, Osterman T, Martin DB, Sugalski J, Heinrichs T, Racz J, Tevaarwerk AJ. Clinician Perspectives Regarding the Impact of Information Technology on Multidisciplinary Tumor Boards: A National Comprehensive Cancer Network Survey. JCO Clin Cancer Inform 2023; 7:e2300056. [PMID: 37944060 DOI: 10.1200/cci.23.00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/10/2023] [Accepted: 09/22/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE Multidisciplinary tumor boards (MTBs) support high-quality cancer care. Little is known about the impact of information technology (IT) tools on the operational and technical aspects of MTBs. The National Comprehensive Cancer Network EHR Oncology Advisory Group formed a workgroup to investigate the impact of IT tools such as EHRs and virtual conferencing on MTBs. METHODS The workgroup created a cross-sectional survey for oncology clinicians (eg, pathology, medical, surgical, radiation, etc) participating in MTBs at 31 National Comprehensive Cancer Network member institutions. A standard invitation e-mail was shared with each EHR Advisory Group Member with a hyperlink to the survey, and each member distributed the survey to MTB participants at their institution or identified the appropriate person at their institution to do so. The survey was open from February 26, 2022, to April 26, 2022. Descriptive statistics were applied in the analysis of responses, and a qualitative thematic analysis of open-ended responses was completed. RESULTS Individuals from 27 institutions participated. Almost all respondents (99%, n = 764 of 767) indicated that their MTBs had participants attending virtually. Most indicated increased attendance (69%, n = 514 of 741) after virtualization with the same or improved quality of discussion (75%, n = 557 of 741) compared with in-person MTBs. Several gaps between the current and ideal state emerged regarding EHR integration: 57% (n = 433 of 758) of respondents noted the importance of adding patients for MTB presentation via the EHR, but only 40% (n = 302 of 747) reported being able to do so most of the time. Similarly, 87% (n = 661 of 760) indicated the importance of documenting recommendations in the EHR, but only 53% (n = 394 of 746) reported this occurring routinely. CONCLUSION Major gaps include the lack of EHR integration for MTBs. Clinical workflows and EHR functionalities could be improved to further optimize EHRs for MTB management and documentation.
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Affiliation(s)
- Waddah Arafat
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Paul Fu
- City of Hope National Medical Center, Duarte, CA
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Cracchiolo JR, Arafat W, Atreja A, Bruckner L, Emamekhoo H, Heinrichs T, Raldow AC, Smerage J, Stetson P, Sugalski J, Tevaarwerk AJ. Getting ready for real-world use of electronic patient-reported outcomes (ePROs) for patients with cancer: A National Comprehensive Cancer Network ePRO Workgroup paper. Cancer 2023; 129:2441-2449. [PMID: 37224181 DOI: 10.1002/cncr.34844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Electronic patient‐reported outcome (ePRO) programs may offer advantages for patients with cancer, clinicians, health care systems, payors, and society in general; but developing and maintaining an ePRO program will require cancer centers to navigate defining meaningful problems, collecting ePROs, implementing action when those ePROs require intervention without over‐burdening clinicians, and monitoring the successes and failures of their ePRO programs. Physician informaticists from the National Comprehensive Cancer Network Electronic Health Record Advisory Group offer 10 guiding principles to consider when contemplating, building, or refining an ePRO program for patients with cancer.
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Affiliation(s)
| | - Waddah Arafat
- Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ashish Atreja
- University of California-Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Lauren Bruckner
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Hamid Emamekhoo
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Tricia Heinrichs
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania, USA
| | - Ann C Raldow
- University of California-Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
| | - Jeffrey Smerage
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | - Peter Stetson
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jessica Sugalski
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania, USA
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Chaiyachati KH, Krause D, Sugalski J, Graboyes EM, Shulman LN. A Survey of the National Comprehensive Cancer Network on Approaches Toward Addressing Patients' Transportation Insecurity. J Natl Compr Canc Netw 2023; 21:21-26. [PMID: 36634609 PMCID: PMC9888481 DOI: 10.6004/jnccn.2022.7073] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 09/08/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Addressing patients' social determinants of health is a national priority for cancer treatment centers. Transportation insecurity is one major challenge for patients undergoing active cancer treatment, and missing treatments can result in worse cancer treatment outcomes, including worse morbidity and mortality. How cancer treatment centers are addressing transportation insecurity is understudied. METHODS In January and February 2022, the NCCN Best Practices Committee conducted a survey of NCCN's 31 Member Institutions (currently 32 member institutions as of April 2022) to assess how centers were addressing patient transportation insecurity: how they screen for transportation insecurity, coordinate transportation, and fund transportation initiatives, and their plans to address transportation insecurity in the future. RESULTS A total of 25 of 31 (81%) NCCN Member Institutions responded to the survey, of which 24 (96%) reported supporting the transportation needs of their patients through screening, coordinating, and/or funding transportation. Patients' transportation needs were most often identified by social workers (96%), clinicians (83%), or patients self-declaring their needs (79%). Few centers (33%) used routine screening approaches (eg, universal screening of social risk factors) to systematically identify transportation needs, and 54% used the support of technology platforms or a vendor to coordinate transportation. Transportation was predominantly funded via some combination of philanthropy (88%), grants (63%), internal dollars (63%), and reimbursement from insurance companies (58%). Over the next 12 months, many centers were either going to continue their current transportation programs in their current state (60%) or expand existing programs (32%). CONCLUSIONS Many NCCN Member Institutions are addressing the transportation needs of their patients. Current efforts are heterogeneous. Few centers have systematic, routine screening approaches, and funding relies on philanthropy more so than institutional dollars or reimbursement from insurers. Opportunities exist to establish more structured, scalable, and sustainable programs for patients' transportation needs.
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Affiliation(s)
| | - Diana Krause
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | - Jessica Sugalski
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | | | - Lawrence N. Shulman
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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Arafat W, Fu P, Wagner AJ, Osterman T, Martin D, Sugalski J, Heinrichs T, Racz JM, Tevaarwerk AJ. Oncologist perspectives on tumor boards: Virtual meetings and EHR integration. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
46 Background: Tumor boards (TBs) are considered a key component for ensuring high quality cancer care. However, little is known about TB operational aspects that impact effectiveness. We aimed to understand how TBs leverage Electronic Health Record (EHR) functionalities and how pandemic-driven transitions from in-person TBs to virtual TBs impacted TB quality and effectiveness. Methods: The National Comprehensive Cancer Network (NCCN) Oncology EHR Advisory Group formed a Workgroup to assess the current state of TBs, obtain providers’ views on ideal TB state, and develop recommendations for improving TB quality and effectiveness. The Workgroup surveyed providers in various specialties at 31 NCCN Member Institutions in March 2022. Results: 846 providers from 27 institutions responded to the survey (n = 76 respondents were excluded from analysis because they reported not participating in TBs). Almost all (n = 764/767, 99%) indicated that one or more participants always or frequently attended TB meetings virtually. When comparing (newly established) virtual to (pre-pandemic) in-person TBs, 69% indicated increased attendance at virtual TBs. 65% reported no change in case volume, and 56% reported unchanged discussion quality while 19% reported increased discussion quality when comparing virtual to in-person TB meetings. In regards to EHR integration, several gaps between current and ideal state were noted. For instance, 40% always or frequently added patients to the TB roster via the EHR, but 57% reported this functionality to be very important or important for TBs. Additionally, 53% always or frequently document TB recommendations within the EHR, while 87% indicated EHR documentation of recommendations as very important or important. Respondents reported that barriers to documentation include resource constraints, concerns with patient access to documentation, legal and liability concerns, and poor EHR functionality. Conclusions: Overall, the majority of responding providers reported virtual TBs to be at least similar in quality to in-person TB meetings. A major gap identified by this study is the lack of documentation of TB recommendations in the EHR. Workflows and EHR functionalities could be improved to fully optimize the EHR for TB management and documentation.[Table: see text]
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Affiliation(s)
| | - Paul Fu
- City of Hope National Medical Center, Duarte, CA
| | - Andrew J. Wagner
- Center for Sarcoma and Bone Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Travis Osterman
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel Martin
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA
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Krause D, Sharrah K, Gross A, Bowers D, Mulkerin D, Brandt N, Kennedy K, Austin A, Begue A, Bell R, Raczyk C, Pickard T, Kubal T, Johnson D, Jeffries K, Dest V, Randall R, Sugalski J, Zecha G. Measuring Advanced Practice Provider Productivity at the National Comprehensive Cancer Network’s Member Institutions. J Adv Pract Oncol 2022; 13:507-513. [PMID: 35910498 PMCID: PMC9328455 DOI: 10.6004/jadpro.2022.13.5.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: The utilization of advanced practice providers (APPs) in oncology has been growing over the last decade; however, there is no standard method for assessing an APP's contributions to oncology care. Methods: The NCCN Best Practices Committee (BPC) created an APP Workgroup to develop recommendations to support the roles of APPs at NCCN Member Institutions. The Workgroup conducted surveys to understand how NCCN centers measure productivity. This article will review the survey results and provide recommendations for measuring APP productivity. Results: Although 54% of responding centers indicated they utilize relative value units (RVU) targets for independent APP visits, 88% of APPs are either unsure or do not believe RVUs are an effective measurement of overall productivity. Relative value units do not reflect non-billable hours, and APPs perform a significant number of non-billable tasks that are important to oncology practices. Sixty-six percent of APPs believe that measuring disease-based team productivity is a more reasonable assessment of APP productivity than measuring productivity at the individual level. Conclusion: Our recommendation for cancer centers is to focus on the value that APPs provide to overall care delivery. Advanced practice provider productivity metrics should consider not only the number of patients seen by APPs, but also the high quality and thorough care delivered that contributes to the overall care of the patient and practice. Advanced practice providers can help improve access to care, deliver improved outcomes, and increase patient and provider satisfaction. Reducing the focus on RVUs, accounting for important non-RVU–generating activities, and incorporating quality and team metrics will provide a better overall picture of APP productivity.
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Affiliation(s)
- Diana Krause
- From National Comprehensive Cancer Network (NCCN), Plymouth Meeting, Pennsylvania
| | - Karen Sharrah
- City of Hope National Medical Center, Duarte, California
| | - Anne Gross
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Daniel Mulkerin
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Nancy Brandt
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Kate Kennedy
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Annie Austin
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Aaron Begue
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rose Bell
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Cheryl Raczyk
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Todd Pickard
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Vanna Dest
- Yale Cancer Center/Smilow Cancer Hospital, New Haven, Connecticut
| | - Rory Randall
- University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Jessica Sugalski
- From National Comprehensive Cancer Network (NCCN), Plymouth Meeting, Pennsylvania
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Austin A, Jeffries K, Krause D, Sugalski J, Sharrah K, Gross A, Bowers D, Mulkerin D, Brandt N, Begue A, Bell R, Raczyk C, Pickard T, Johnson D, Dest V, Randall R, Zecha G, Kennedy K. A Study of Advanced Practice Provider Staffing Models and Professional Development Opportunities at National Comprehensive Cancer Network Member Institutions. J Adv Pract Oncol 2021; 12:717-724. [PMID: 34671501 PMCID: PMC8504930 DOI: 10.6004/jadpro.2021.12.7.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The National Comprehensive Cancer Network (NCCN) Best Practices Committee created an Advanced Practice Provider (APP) Workgroup to develop recommendations to support APP roles at NCCN Member Institutions. Methods The Workgroup conducted three surveys to understand APP program structure, staffing models, and professional development opportunities at NCCN Member Institutions. Results The total number of new and follow-up visits a 1.0 APP full-time equivalent conducts per week in shared and independent visits ranged from 11 to 97, with an average of 40 visits per week (n = 39). The type of visits APPs conduct include follow-up shared (47.2%), follow-up independent (46%), new shared (6.5%), and new independent visits (0.5%). Seventy-two percent of respondents utilize a mixed model visit type, with 15% utilizing only independent visits and 13% utilizing only shared visits (n = 39). Of the 95% of centers with APP leads, 100% indicated that leads carry administrative and clinical responsibilities (n = 20); however, results varied with respect to how this time is allocated. Professional development opportunities offered included posters, papers, and presentations (84%), leadership development (57%), research opportunities (52%), writing book chapters (19%), and other professional development activities (12%; n = 422). Twenty percent of APPs indicated that protected time to engage in development opportunities should be offered. Conclusion As evidenced by the variability of the survey results, the field would benefit from developing standards for APPs. There is a lack of information regarding leadership structures to help support APPs, and additional research is needed. Additionally, centers should continuously assess the career-long opportunities needed to maximize the value of oncology APPs.
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Affiliation(s)
- Annie Austin
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | | | - Diana Krause
- National Comprehensive Cancer Network (NCCN), Plymouth Meeting, Pennsylvania
| | - Jessica Sugalski
- National Comprehensive Cancer Network (NCCN), Plymouth Meeting, Pennsylvania
| | - Karen Sharrah
- City of Hope National Medical Center, Duarte, California
| | - Anne Gross
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Daniel Mulkerin
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Nancy Brandt
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Aaron Begue
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rose Bell
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Cheryl Raczyk
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | | | - Vanna Dest
- Yale Cancer Center/Smilow Cancer Hospital, New Haven, Connecticut
| | - Rory Randall
- University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | | | - Kate Kennedy
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
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Tevaarwerk AJ, Chandereng T, Osterman T, Arafat W, Smerage J, Polubriaginof FCG, Heinrichs T, Sugalski J, Martin DB. Oncologist Perspectives on Telemedicine for Patients With Cancer: A National Comprehensive Cancer Network Survey. JCO Oncol Pract 2021; 17:e1318-e1326. [PMID: 34264741 PMCID: PMC9810123 DOI: 10.1200/op.21.00195] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The use of telemedicine expanded dramatically in March 2020 following the COVID-19 pandemic. We sought to assess oncologist perspectives on telemedicine's present and future roles (both phone and video) for patients with cancer. METHODS The National Comprehensive Cancer Network (NCCN) Electronic Health Record (EHR) Oncology Advisory Group formed a Workgroup to assess the state of oncology telemedicine and created a 20-question survey. NCCN EHR Oncology Advisory Group members e-mailed the survey to providers (surgical, hematology, gynecologic, medical, and radiation oncology physicians and clinicians) at their home institution. RESULTS Providers (N = 1,038) from 26 institutions responded in Summer 2020. Telemedicine (phone and video) was compared with in-person visits across clinical scenarios (n = 766). For reviewing benign follow-up data, 88% reported video and 80% reported telephone were the same as or better than office visits. For establishing a personal connection with patients, 24% and 7% indicated video and telephone, respectively, were the same as or better than office visits. Ninety-three percent reported adverse outcomes attributable to telemedicine visits never or rarely occurred, whereas 6% indicated they occasionally occurred (n = 801). Respondents (n = 796) estimated 46% of postpandemic visits could be virtual, but challenges included (1) lack of patient access to technology, (2) inadequate clinical workflows to support telemedicine, and (3) insurance coverage uncertainty postpandemic. CONCLUSION Telemedicine appears effective across a variety of clinical scenarios. Based on provider assessment, a substantial fraction of visits for patients with cancer could be effectively and safely conducted using telemedicine. These findings should influence regulatory and infrastructural decisions regarding telemedicine postpandemic for patients with cancer.
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Affiliation(s)
| | | | | | - Waddah Arafat
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey Smerage
- Rogel Comprehensive Cancer Center, University of Michigan; Ann Arbor, MI
| | | | - Tricia Heinrichs
- National Comprehensive Cancer Network, Plymouth Meeting, PA,Tricia Heinrichs, BS, National Comprehensive Cancer Network, 3025 Chemical Rd, Suite 100, Plymouth Meeting, PA 19462; Twitter: @AmyeTevaarwerkMD, @NCCN; e-mail:
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Tevaarwerk A, Osterman T, Arafat W, Smerage J, Polubriaginof FC, Heinrichs T, Sugalski J, Martin D. BIO21-011: Oncology Provider Perspectives on Telemedicine for Patients With Cancer: A National Comprehensive Cancer Network (NCCN®) Survey. J Natl Compr Canc Netw 2021. [DOI: 10.6004/jnccn.2020.7728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Waddah Arafat
- 3Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey Smerage
- 4Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI
| | | | | | | | - Daniel Martin
- 7University of Washington Medical Center, Seattle, WA
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Sugalski J, Franco T, Shulman LN, Cinar P, Bachman J, Crews JR, Olsen M, Schatz A, Kubal T. Creative Strategies Implemented During the Coronavirus Pandemic That Will Impact the Future of Cancer Care. J Natl Compr Canc Netw 2020; 19:1-5. [PMID: 33126204 DOI: 10.6004/jnccn.2020.7661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/28/2020] [Indexed: 11/17/2022]
Abstract
The coronavirus pandemic has significantly impacted operations at leading cancer centers across the United States. In the midst of the chaos, at least one silver lining has emerged: the development of new, creative strategies for delivering cancer care that are likely to continue post pandemic. The NCCN Best Practices Committee, which is composed of senior physician, nursing, and administrative leaders at NCCN Member Institutions, conducted a webinar series in June 2020 highlighting the most promising and effective strategies to date. Experts from NCCN Member Institutions participated in the series to share their experiences, knowledge, and thoughts about the future of cancer care.
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Affiliation(s)
- Jessica Sugalski
- 1National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | | | - Lawrence N Shulman
- 3Abramson Cancer Center at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pelin Cinar
- 4Department of Medicine, Division of Medical Oncology, University of California San Francisco, San Francisco
| | - James Bachman
- 5University of Colorado Cancer Center, Aurora, Colorado
| | | | - MiKaela Olsen
- 7The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; and
| | - Alyssa Schatz
- 1National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
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10
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Khera N, Sugalski J, Krause D, Butterfield R, Zhang N, Stewart FM, Carlson RW, Griffin JM, Zafar SY, Lee SJ. Current Practices for Screening and Management of Financial Distress at NCCN Member Institutions. J Natl Compr Canc Netw 2020; 18:825-831. [DOI: 10.6004/jnccn.2020.7538] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/15/2020] [Indexed: 11/17/2022]
Abstract
Background: Financial distress from medical treatment is an increasing concern. Healthcare organizations may have different levels of organizational commitment, existing programs, and expected outcomes of screening and management of patient financial distress. Patients and Methods: In November 2018, representatives from 17 (63%) of the 27 existing NCCN Member Institutions completed an online survey. The survey focused on screening and management practices for patient financial distress, perceived barriers in implementation, and leadership attitudes about such practices. Due to the lack of a validated questionnaire in this area, survey questions were generated after a comprehensive literature search and discussions among the study team, including NCCN Best Practices Committee representatives. Results: Responses showed that 76% of centers routinely screened for financial distress, mostly with social worker assessment (94%), and that 56% screened patients multiple times. All centers offered programs to help with drug costs, meal or gas vouchers, and payment plans. Charity care was provided by 100% of the large centers (≥10,000 unique annual patients) but none of the small centers that responded (<10,000 unique annual patients; P=.008). Metrics to evaluate the impact of financial advocacy services included number of patients assisted, bad debt/charity write-offs, or patient satisfaction surveys. The effectiveness of institutional practices for screening and management of financial distress was reported as poor/very poor by 6% of respondents. Inadequate staffing and resources, limited budget, and lack of reimbursement were potential barriers in the provision of these services. A total of 94% agreed with the need for better integration of financial advocacy into oncology practice. Conclusions: Three-fourths of NCCN Member Institutions reported screening and management programs for financial distress, although the actual practices and range of services vary. Information from this study can help centers benchmark their performance relative to similar programs and identify best practices in this area.
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Affiliation(s)
- Nandita Khera
- 1Mayo Clinic Alix School of Medicine, Phoenix, Arizona
| | - Jessica Sugalski
- 2National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | - Diana Krause
- 2National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | | | - Nan Zhang
- 1Mayo Clinic Alix School of Medicine, Phoenix, Arizona
| | - F. Marc Stewart
- 3Fred Hutchinson Cancer Research Center, University of Washington Children’s Hospital, Seattle, Washington
| | - Robert W. Carlson
- 2National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | | | | | - Stephanie J. Lee
- 3Fred Hutchinson Cancer Research Center, University of Washington Children’s Hospital, Seattle, Washington
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Melton L, Krause D, Sugalski J. Psychology Staffing at Cancer Centers: Data From National Comprehensive Cancer Network Member Institutions. JCO Oncol Pract 2020; 16:e1343-e1354. [PMID: 32603250 DOI: 10.1200/op.20.00087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The field of psycho-oncology is relatively undeveloped, with little information existing regarding the use of psychologists at cancer centers. Comprising 30 leading cancer centers across the United States, the National Comprehensive Cancer Network (NCCN) set out to understand the trends in its Member Institutions. METHODS The NCCN Best Practices Committee surveyed NCCN Member Institutions regarding their use of psychologists. The survey was administered electronically in the spring/summer of 2017. RESULTS The survey was completed by 18 cancer centers. Across institutions, 94% have psychologists appointed to provide direct care to their cancer center patients. The number of licensed psychologist full-time equivalents (FTEs) on staff who provide direct patient care ranged from < 1.0 FTE (17%) to 17.0-17.9 FTEs (6%). Regarding psychologist appointments, 41% have both faculty and staff appointments, 41% have all faculty appointments, and 18% have all staff appointments. Forty-three percent of institutions indicated that some licensed psychologists at their centers (ranging from 1%-65%) do not provide any direct clinical care, and 57% indicated that all licensed psychologist on staff devote some amount of time to direct clinical care. The percent of clinical care time that is spent on direct clinical care ranged from 15%-90%. CONCLUSION There is great variability in psychology staffing, academic appointments, and the amount of direct patient care provided by on-staff psychologists at cancer centers.
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Affiliation(s)
- Laura Melton
- University of Colorado School of Medicine, Aurora, CO
| | - Diana Krause
- National Comprehensive Cancer Network, Plymouth Meeting, PA
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Poston JN, Sugalski J, Gernsheimer TB, Marc Stewart F, Pagano MB. Mitigation strategies for anti-D alloimmunization by platelet transfusion in haematopoietic stem cell transplant patients: a survey of NCCN ® centres. Vox Sang 2020; 115:334-338. [PMID: 32080868 DOI: 10.1111/vox.12899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/23/2020] [Accepted: 02/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES D-negative patients are at risk of developing an alloantibody to D (anti-D) if exposed to D during transfusion. The presence of anti-D can lead to haemolytic transfusion reactions and haemolytic disease of the newborn. Anti-D alloimmunization can also complicate allogeneic haematopoietic stem cell transplantation (HSCT) with haemolysis and increased transfusion requirements. The goal of this study was to determine whether cancer centres have transfusion practices intended to prevent anti-D alloimmunization with special attention in patients considered for HSCT. METHODS AND MATERIALS To understand transfusion practices regarding D-positive platelets in D-negative patients with large transfusion needs, we surveyed the 28 cancer centres that are members of the National Comprehensive Cancer Network® (NCCN® ). RESULTS Nineteen centres responded (68%). Most centres (79%) avoid transfusing D-positive platelets to RhD-negative patients when possible. Four centres (21%) avoid D-positive platelets only in D-negative women of childbearing age. If a D-negative patient receives a D-positive platelet transfusion, 53% of centres would consider treating with Rh immune globulin (RhIg) to prevent alloimmunization in women of childbearing age. Only one centre also gives RhIg to all D-negative patients who are HSCT candidates including adult men and women of no childbearing age. CONCLUSION There is wide variation in platelet transfusion practices for supporting D-negative patients. The majority of centres do not have D-positive platelet transfusion policies focused on preventing anti-D alloimmunization specifically in patients undergoing HSCT. Multicentre, longitudinal studies are needed to understand the clinical implications of anti-D alloimmunization in HSCT patients.
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Affiliation(s)
- Jacqueline N Poston
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,BloodworksNW Research Institute, Seattle, WA, USA
| | - Jessica Sugalski
- National Comprehensive Cancer Network, Plymouth Meeting, PA, USA
| | - Terry B Gernsheimer
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - F Marc Stewart
- Seattle Cancer Care Alliance, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Monica B Pagano
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.,Department of Laboratory Medicine, Transfusion Medicine Division, University of Washington, Seattle, WA, USA
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13
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Khera N, Sugalski J, Krause D, Butterfield R, Zhang N, Smedley W, Stewart FM, Griffin JM, Zafar Y, Lee S. Current practice for screening and management of financial distress at NCCN member institutions. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11615 Background: Deficiencies and barriers exist to delivering comprehensive and affordable cancer care. Understanding the variation in organizational commitment, existing programs, and expected outcomes for screening and management of financial distress is needed. Methods: Representatives from 17 of 27 NCCN Member Institutions (63%) completed an online survey in November 2018 conducted by the NCCN Best Practices Committee. Centers were classified based on number of unique patients seen per year, as large ( > 10,000) (76%), or small ( < 10,000) (34%). The survey focused on institutions’ screening and management practices for patient financial distress, perceived barriers in implementation, and leadership attitudes. Results: Routine screening for financial distress was reported by 77% of centers, and most used social worker assessments (94%). 56% screened patients throughout the cancer journey. Help with drug costs, meal or gas vouchers and payment plans were offered by 100% of centers. Formal pre-authorization programs and assistance with claims and denials was offered by 81%. Charity care for medical costs was provided by 100% of the large centers compared to only 33% of small centers (p = 0.03). Median number of social workers (24 vs. 3; p = 0.01) and pharmacy representatives (6 vs. 2; p = 0.02) was also different between large and small centers. 76% evaluated the impact of financial advocacy services through number of patients assisted (85%), bad debt and charity write-offs (85%) or patient satisfaction surveys (54%). 6% and 12% reported overall effectiveness of institutional practice for screening and management of financial distress as poor/ very poor respectively. Inadequate staffing and real time resources (69%), limited institutional budget (50%), lack of reimbursement (50%), and clinical time constraints (50%) were reported as potential barriers in provision of these services. 94% agreed about stronger integration of financial advocacy services into oncology practice and 84% felt that success of these services should be a quality metric. 31% of large centers vs. 100% of small centers plan to increase staffing in this area in the next 5 years. Conclusions: Majority of NCCN Member Institutions report screening and management programs for financial distress, though the actual practices and range of services vary widely. Information from this study can help centers benchmark their performance relative to similar cancer programs and identify best practices in this area.
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Affiliation(s)
| | | | | | | | | | - Warren Smedley
- Patient Care Connect - Powered By UAB Health System, Birmingham, AL
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14
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Sugalski J, Mulkerin D, Caires R, Moore PJ, Fahy RF, Gordon JN, Augustyniak CZ, Szymanski GM, Olsen MM, Frantz DK, Quinn MA, Kidd SK, Cartwright DM, Kimbro LG, Carlson RW, Stewart FM. National Comprehensive Cancer Network (NCCN) infusion efficiency workgroup study: Optimizing patient flow in infusion centers. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Rebecca Caires
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Penny J. Moore
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | - Gina M. Szymanski
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | | | - Marisa A. Quinn
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Sharol K. Kidd
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA
| | | | - Lisa G. Kimbro
- National Comprehensive Cancer Network, Fort Washington, PA
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15
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Calton BA, Alvarez-Perez A, Portman DG, Ramchandran KJ, Sugalski J, Rabow MW. The Current State of Palliative Care for Patients Cared for at Leading US Cancer Centers: The 2015 NCCN Palliative Care Survey. J Natl Compr Canc Netw 2017; 14:859-66. [PMID: 27407126 DOI: 10.6004/jnccn.2016.0090] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/25/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND ASCO and IOM recommend palliative care (PC) across health care settings for patients with serious illnesses, including cancer. This study provides an overview of the current availability, structure, and basic quality of PC services within NCCN Member Institutions. METHODS A PC survey was developed by NCCN staff and a working group of PC experts from 11 NCCN Member Institutions under the auspices of the NCCN Best Practices Committee. The survey was piloted and refined by 3 working group members and sent electronically to all 26 NCCN Member Institutions. NCCN staff and working group leaders analyzed the survey data. RESULTS A total of 22 of 26 institutions responded (85%). All respondents (100%) reported an inpatient PC consult service (staffed by an average of 6.8 full-time equivalents [FTEs], seeing 1,031 consults/year with an average length of stay [LOS] of 10 days). A total of 91% of respondents had clinic-based PC (with an average of 469 consults/year, staffed by an average of 6.8 FTEs, and a 17-day wait time). For clinics, a comanagement care delivery model was more common than strict consultation. Home-based PC (23%) and inpatient PC units (32%) were less prevalent. Notably, 80% of institutions reported insufficient PC capacity compared with demand. Across PC settings, referrals for patients with solid tumors were more common than for hematologic malignancies. Automatic or "triggered" referrals were rare. The most common services provided were symptom management (100%) and advance care planning (96%). Most programs were funded through fee-for-service billing and institutional support. Partnerships with accountable care organizations and bundled payment arrangements were infrequent. PC program data collection and institutional funding for PC research were variable across institutions. CONCLUSIONS Despite the prevalence of PC inpatient and clinic services among participating NCCN Member Institutions, PC demand still exceeds capacity. Opportunities exist for expansion of home-based PC and inpatient PC units, optimizing referrals, research, and payer collaborations.
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Affiliation(s)
- Brook A Calton
- From Division of Geriatrics, UCSF, San Francisco, California; Department of Supportive and Palliative Care, Roswell Park Cancer Institute, Buffalo, New York; Supportive Care Medicine, Moffitt Cancer Center, and University of South Florida, Tampa, Florida; Stanford Cancer Institute, Stanford, California; National Comprehensive Cancer Network, Fort Washington, Pennsylvania; and UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Amy Alvarez-Perez
- From Division of Geriatrics, UCSF, San Francisco, California; Department of Supportive and Palliative Care, Roswell Park Cancer Institute, Buffalo, New York; Supportive Care Medicine, Moffitt Cancer Center, and University of South Florida, Tampa, Florida; Stanford Cancer Institute, Stanford, California; National Comprehensive Cancer Network, Fort Washington, Pennsylvania; and UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Diane G Portman
- From Division of Geriatrics, UCSF, San Francisco, California; Department of Supportive and Palliative Care, Roswell Park Cancer Institute, Buffalo, New York; Supportive Care Medicine, Moffitt Cancer Center, and University of South Florida, Tampa, Florida; Stanford Cancer Institute, Stanford, California; National Comprehensive Cancer Network, Fort Washington, Pennsylvania; and UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California. From Division of Geriatrics, UCSF, San Francisco, California; Department of Supportive and Palliative Care, Roswell Park Cancer Institute, Buffalo, New York; Supportive Care Medicine, Moffitt Cancer Center, and University of South Florida, Tampa, Florida; Stanford Cancer Institute, Stanford, California; National Comprehensive Cancer Network, Fort Washington, Pennsylvania; and UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Kavitha J Ramchandran
- From Division of Geriatrics, UCSF, San Francisco, California; Department of Supportive and Palliative Care, Roswell Park Cancer Institute, Buffalo, New York; Supportive Care Medicine, Moffitt Cancer Center, and University of South Florida, Tampa, Florida; Stanford Cancer Institute, Stanford, California; National Comprehensive Cancer Network, Fort Washington, Pennsylvania; and UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Jessica Sugalski
- From Division of Geriatrics, UCSF, San Francisco, California; Department of Supportive and Palliative Care, Roswell Park Cancer Institute, Buffalo, New York; Supportive Care Medicine, Moffitt Cancer Center, and University of South Florida, Tampa, Florida; Stanford Cancer Institute, Stanford, California; National Comprehensive Cancer Network, Fort Washington, Pennsylvania; and UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Michael W Rabow
- From Division of Geriatrics, UCSF, San Francisco, California; Department of Supportive and Palliative Care, Roswell Park Cancer Institute, Buffalo, New York; Supportive Care Medicine, Moffitt Cancer Center, and University of South Florida, Tampa, Florida; Stanford Cancer Institute, Stanford, California; National Comprehensive Cancer Network, Fort Washington, Pennsylvania; and UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
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Childers T, Kamboj M, Sugalski J, Antonelli D, Bingener-Casey J, Cannon J, Cluff K, Davis KA, Dellinger PE, Dowdy S, Duncan K, Fedderson J, Glasgow R, Hall B, Hirsch M, Hutter M, Kimbro L, Kuvshinoff B, Makary M, Morris M, Nehring S, Ramamoorthy S, Scott R, Sovel M, Strong V, Webster A, Wick E, Carlson R, Sepkowitz K. Risk Adjustment of Surgical Site Infection Rates Following Colon Surgery. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Teresa Childers
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mini Kamboj
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Donna Antonelli
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | | | - Karie Cluff
- University of Utah Medical Center, Salt Lake City, UT
| | | | | | - Sean Dowdy
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - Kim Duncan
- University of Nebraska Medical Center, Omaha, NE
| | | | - Robert Glasgow
- Department of Surgery, University of Utah Medical Center, Salt Lake City, UT
| | - Bruce Hall
- Barnes-Jewish Hospital, Washington University in Saint Louis, St. Louis, MO
| | | | - Matthew Hutter
- General & Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA
| | - Lisa Kimbro
- National Comprehensive Cancer Network, Fort Washington, PA
| | - Boris Kuvshinoff
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY
| | - Martin Makary
- Department of Surgery, Johns Hopkins Medicine, Baltimore, MD
| | | | - Sharon Nehring
- Surgery Clinical Research Office, Mayo Clinic - Minnesota, Rochester, MN
| | | | - Rebekah Scott
- University of California, San Diego Health System, San Diego, CA
| | | | | | | | - Elizabeth Wick
- Department of Surgery, Johns Hopkins Medicine, Baltimore, MD
| | - Robert Carlson
- National Comprehensive Cancer Network, Fort Washington, PA
| | - Kent Sepkowitz
- Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, NY
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17
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Sugalski J, Stewart FM, Carlson RW. NCCN's Commitment to Medication Safety: The Vincristine Initiative. J Natl Compr Canc Netw 2016; 14:959-60. [DOI: 10.6004/jnccn.2016.0102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/07/2016] [Indexed: 11/17/2022]
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18
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Sugalski J. Abstract No. 21: Vein Center Marketing Analysis: A Comparison of Several Marketing Mediums to Determine Cost and Overall Effectiveness. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Porterfield JG, Porterfield LM, Bray L, Sugalski J. A prospective study utilizing a transtelephonic electrocardiographic transmission program to manage patients in the first several months post-ICD implant. Pacing Clin Electrophysiol 1991; 14:308-11. [PMID: 1706843 DOI: 10.1111/j.1540-8159.1991.tb05112.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We prospectively enrolled 20 consecutive patients (11 men and 9 women; mean age 63 +/- 9.5 years) post-AICD implant in a transtelephonic electrocardiographic transmission (TET) program. The monitor was chosen for its retrograde (30 seconds) and antegrade memory capabilities (45 seconds). The patients were discharged from the hospital after receiving instructions to utilize the system for any cardiac symptoms. The monitor was worn 1-3 months (mean 2.5 +/- 0.7 months). During the follow-up period there were 54 TETs received. Nine were for documented AICD discharges, 19 were for symptoms associated with arrhythmias (11 of these 19 reported AICD discharges that were not documented), and 26 for symptoms not associated with arrhythmias. Eight of the 9 AICD discharges documented were appropriate for ventricular tachycardia (mean 185 +/- 40 beats/min). The arrhythmias associated with symptoms were: atrial fibrillation (12); nonsustained ventricular tachycardia (3); ventricular couplets (2); ventricular premature beats (10); and atrial premature contractions (2). Several TETs documented multiple arrhythmias. The most common symptoms not associated with arrhythmias were shortness of breath, dizziness, chest pain, and nervousness. Office interrogation of the AICDs revealed 12 of the 20 patients (60%) had received AICD discharges, with 5 of these 12 patients unaware of this occurring. We found the TET monitoring system a useful tool in the management of the AICD patient the first several months postoperatively. We were able to assess device function and avoid unnecessary office visits and/or hospitalizations.
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Affiliation(s)
- J G Porterfield
- University of Tennessee, Department of Medicine, Methodist Hospital, Memphis
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