David W. Dougherty

Gemcitabine and Other New Cytotoxic Drugs: Will Any Find Their Way Into Primary Therapy?

Primary treatment for classic Hodgkin lymphoma (HL) remains highly effective with chemotherapy alone or combined-modality therapy. The limitations of therapy have been related to toxicity and efficacy in subsets of patients. The introduction of a number of new and novel cytotoxic agents has provided opportunities for investigating their use in the treatment of HL. This article briefly reviews current primary treatment strategies for HL and examines the existing data for both new cytotoxic agents and other selected novel agents in the treatment of HL.

Development and implementation of competency-based orientation program for advanced practice providers at an academic cancer center.

119 Background: Increased utilization of Advanced Practice Providers (APPs) has been identified as a means to increase oncology visit capacity and improve productivity. Many APPs have little experience in oncology or are new to the APP role. As a result, there is a need for a comprehensive, competency-based orientation and mentorship program to aid in this transition and ensure effective integration of APPs into the complex oncology environment. METHODS We developed and implemented a comprehensive, competency-based orientation and mentorship program for APPs hired into the Wilmot Cancer Institute. In addition to basic institutional orientation, APPs are assigned primary & secondary preceptors and complete a 12-week oncology-specific orientation that includes specific clinical activities relevant to their role. Oncology educational articles and lectures are provided and APPs meet weekly with preceptors to identify goals, accomplishments and improvement needs. Faculty mentors are assigned for additional oncology-specific and professional development, as well as oversight of chemotherapy ordering. If deficiencies are identified, APPs are provided an Individual Development Plan with milestones necessary for progression. RESULTS From January 2013 to July 2015, 16 APPs were hired and enrolled into the orientation program. 11 APPs had no prior oncology experience and 10 had no prior experience as an APP. 14 of 16 APPs (87.5%) successfully completed the orientation program. 2 APPs were placed on Individual Development Plans and subsequently did not complete the program. All 14 APPs successfully completing orientation have been retained in their position, leading to 100% retention rate for those completing the program since its inception. CONCLUSIONS This framework for a comprehensive, competency-based orientation and mentorship program for APPs at an academic cancer center has improved our ability to successfully integrate APPs into the cancer care environment. In addition, APPs having difficulty transitioning or who are unable to complete the orientation were efficiently identified, leading to individualized improvement plans required for ongoing employment.

Opportunities for improved end-of-life (EOL) care for adult patients with advanced cancer: Results of a longitudinal assessment of care provided by Quality Oncology Practice Initiative (QOPI) participants.

132 Background: End of life care of patients with advanced cancer has received recent attention because of evidence of widespread variation in utilization of aggressive therapies and interventions and possible suboptimal use of palliative care and hospice services. QOPI, the ASCO sponsored quality assessment program, has been available to all United States physician members since January 2006 and has assessed EOL care since its inception. The current analysis explores whether the increased national focus on EOL and increased availability of palliative care and hospice services has resulted in improvements in EOL care as reported by QOPI participants. METHODS Data was aggregated across all EOL care quality measures for 9 sequential semi-annual QOPI collection periods from 2008 through 2012. Trends were analyzed among rates of eligible patients related to hospice enrollment and timing of enrollment, palliative care referrals, discussions about hospice and palliative care, and chemotherapy administration at the end of life. The Cochran-Armitage trend test was performed to determine the significance of trends and differences in measure performance over time. RESULTS From Fall 2008 to Fall 2012, the rate of hospice enrollment for appropriate patients improved by 7.4% [51.8% to 59.2%; p<0.0001] and the rate of hospice enrollment or palliative care referral improved by 5.6% [63.3% to 68.9%; p<0.0001]. Modest improvements were seen in the rates of hospice enrollment more than 3 and 7 days before death [2.8%, 2.6%], discussion of hospice or palliative care with patients not referred for these services within the last 2 months of life [2.7% increase; 19% to 21.7%], and chemotherapy administration within the last 2 weeks of life [2.4% improvement from 13.7% to 11.3%]. CONCLUSIONS Despite modest increases in the rate of hospice enrollment and palliative care referrals over time, EOL care for adult patients with cancer associated with QOPI practices remains suboptimal. Opportunities exist to increase more meaningful participation in hospice and palliative care and to reduce exposure to chemotherapy near death.

Kaizen quality initiative to improve patient satisfaction and throughput in an academic cancer center.

78 Background: Lean management principles have long been employed in manufacturing to improve operational efficiency but have only recently been adopted into healthcare settings. To address prolonged wait times and inadequate performance on patient satisfaction surveys, our cancer center utilized a Kaizen event as part of a quality improvement initiative. METHODS We utilized methods of Kaizen philosophy to evaluate all processes related to the patient experience in the outpatient facilities of the James P. Wilmot Cancer Center of the University of Rochester. The Kaizen initiative was conducted by a multidisciplinary group and consisted of an intensive 5-day induction period to identify problems within the system of care followed by regular quality improvement meetings. The group developed immediate solutions to some problems and identified priorities for the longer term. Changes in patient throughput times (time from clinic check-in to check-out) and patient satisfaction (utilizing Press-Ganey surveys) were tracked before and after initiating Kaizen and this report evaluates results over the first 12-month period. RESULTS Our Kaizen initiative involved a group of 17 faculty and staff who assembled during the induction period and met bi-monthly over the 12-month period from May 2011 to June 2012. Prior to the Kaizen intervention, mean throughput time for a 30-minute clinic visit was 80.34 minutes (n = 259; median 76; range 18 to 261) and mean overall patient satisfaction score for the quarter preceding the Kaizen was 89.3 (43rd percentile AHA Region 2). Over the 12 months following the Kaizen, mean throughput time reduced to 57.85 minutes (n = 249; median 53; range 11 to 205) and patient satisfaction scores improved to 91.9 (p<0.05; 63rdpercentile). CONCLUSIONS Utilizing continuous process evaluation and Kaizen methodology, we reduced patient throughput times by 28% and improved patient satisfaction percentile rank by 20%. Ongoing efforts focus on utilizing continuous quality improvement to improve patient and family-centered cancer care. Kaizen is an effective, resource-neutral method for improving operational efficiency and patient-centered outcomes in an academic oncology practice.