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A Survey of the Perceived Quality of Patient Care in a Radiation Oncology Service: Results From 2002-2011
Poster Viewing Abstracts S541
Volume 84 Number 3S Supplement 2012 Results: Of the 2911 patients that met these criteria, 1184 (40.6%) had American Joint Committee on Cancer (AJCC) stage IIIA disease (3rd Edition 2000-2003, 6th Edition 2004-2007). The distribution for CCI was: 0Z45.1%, 1Z34.3%, 2+Z20.6%. Treatment modalities were: S+/NATZ 25.7%; R+CTXZ37.4%; RTZ18.8%; CTXZ18.2%. The percentage of patients to undergo S+/-NAT with stage IIIA/IIIB disease was 34.7/19.5%. Significant factors affecting treatment decision included stage, race, and CCI. Stage IIIB disease dominated the preference of a nonsurgical approach, with either CTX (adjusted odds ratio [OR]Z4.94, 95% confidence interval [CI]Z3.801-6.412) , RT (ORZ1.85, CIZ1.46-2.36) or R+CTX (ORZ1.86, CIZ1.53-2.25) compared to S+/-NAT. Higher CCI scores were found to be significantly associated with RT when modeling RT relative to S+/-NAT (ORZ1.39, CIZ1.05-1.82 and ORZ1.85, CIZ1.36-2.51 for scores of 1 vs. 0 and 2+ vs. 0, respectively). Finally, patients with a white race were more likely to receive S+/-NAT than those of a black race for both RT relative to the S+/-NAT model and R+CTX relative to the S+/-NAT model. Conclusions: Elderly patients with stage III NSCLC are treated predominantly with nonsurgical approaches. Contrary to national recommendations, approximately 20% of patients with stage IIIB disease undergo surgical management for unclear reasons (i.e. inaccurate diagnostic stage). Compared with nonsurgical methods, patients who undergo surgery are more likely to be stage IIIA, white race, and with a lower CCI. Author Disclosure: D.R. Gomez: None. K. Liao: None. J.Y. Chang: None. Z. Liao: None. S.M. Shirvani: None. R. Komaki: None. J.W. Welsh: None. S.G. Swisher: None. J.V. Heymach: None. B.D. Smith: None.
2860 Assessment of Compliance With NCCN Guidelines for Breast Cancer Patients Treated at a Comprehensive Cancer Center T. Dvorak and S. Constantino; M.D. Anderson Cancer Center Orlando, Orlando, FL Purpose/Objectives: There is an increasing emphasis on delivery of high quality care in general, and in radiation oncology in particular. One of the ways of evaluating quality of care is compliance with national treatment guidelines. The National Comprehensive Cancer Network (NCCN) guidelines are becoming a national standard of care for oncology. We assessed the compliance of our existing breast cancer clinical practice with NCCN Breast Cancer guidelines. Materials/Methods: We randomly identified 100 patients treated at our cancer center in 2010 from the cancer registry. These included patients with ductal carcinoma in-situ (nZ16), non-metastatic invasive breast cancer (nZ79), and metastatic breast cancer (nZ5). Breast cancer NCCN guidelines version 1.2011 was used as the standard guideline. A comprehensive set of guideline compliance metrics was developed, and was stratified into Workup, Radiation Oncology Treatment, and Follow Up categories. Results: Overall, 20% of patients were treated completely according to NCCN guidelines, 52% did not meet all NCCN guidelines, and 28% of patients did not have adequate information in the available medical record. In the Workup category, 24% were compliant, 39% were noncompliant, and 37% were unknown. In the Radiation Oncology Treatment category, 59% were compliant, 1% was noncompliant, 28% were not applicable, and 12% were unknown. In the Follow Up category, 66% were compliant, 10% were noncompliant, 4% were not applicable, and 20% were unknown. Major sources of noncompliance included inappropriate use of imaging, including staging PET scans, staging bone scans, and follow up chest xrays (38%); lack of complete pre-treatment labs (12%); and lack of timely genetics referral (11%). The one Radiation Oncology Treatment noncompliance was postmastectomy irradiation of a pT2N0(i+)M0 patient, who was felt to have high risk features. Conclusions: Our compliance with the Breast Cancer NCCN guidelines for radiation oncology treatment was high (99%) for patients where full medical record was available. However, our compliance with workup and follow up metrics was significantly worse, driven by relative “overordering” of staging PET scans and bone scans. For our follow up study,
we plan to assess the impact of nuclear medicine imaging utilization on our practice patterns. We are also developing a systemic approach to NCCN guideline compliance through the use of our electronic medical record, and will reassess our compliance in 2 years. Author Disclosure: T. Dvorak: Q. Leadership; ASTRO Communications Committee. S. Constantino: None.
2861 A Survey of the Perceived Quality of Patient Care in a Radiation Oncology Service: Results From 2002-2011 M. Eguiguren Bastida, J. Minguez, C. Blanco, J. Urraca, A. Querejeta, I. Uranga, J. Ciria, G. Rodriguez, S. Caffiero, and E. Guimon; Hospital Donostia, San Sebastian, Spain Purpose/Objective(s): The objective of the study is to present the results about the quality perceived by the patient in our service and look for areas to improve. Materials/Methods: From January 2002 to December 2011, we performed semiannually an standardized survey about the quality perceived based on a system ISO 9001. We collected the following aspects of the radiation therapy treatment: get an appointment, first consultation, simulation, verification and starting treatment, information provided, waiting time, accessibility and comfort and overall assessment. Each item is assessed as very good (MB) good (B), regular (R), bad (M), do not know/no answer (NS/NC). Semiannually, selected 60 patients undergoing radical intent radiation therapy, anonymously and voluntarily answered the survey. Results: A total of 1140 surveys were distributed, 774 were answered and analyzed. The average of the semiannually answered and analyzed surveys was 43 (72%). The overall assessment MB-B was 99%. One of the best valued aspects was the physician treatment, valued as MB-B in a 97.75%. One of the worst valued aspect was the waiting time, which was more than 15 minutes for the consulting in 47%, for simulation in 42%, and for daily treatment in 56%. Only the 54.6% of the patients treated with delay did know about it. You can see the other results on the poster. Conclusions: These results has allowed us to analyze the quality perceived by our patients and to look for areas to improve. We can see that they are satisfied with the overall assessment but we have to improve on the waiting time and on the information about the delays. Our results are within the average of the literature. Author Disclosure: M. Eguiguren Bastida: None. J. Minguez: None. C. Blanco: None. J. Urraca: None. A. Querejeta: None. I. Uranga: None. J. Ciria: None. G. Rodriguez: None. S. Caffiero: None. E. Guimon: None.
2862 Improvement in IMRT Quality Assurance Rates: A Quality Improvement Project at a Large Academic Institution J.L. Johnson,1 L. Dong,2 B. Riley,1 M. Kantor,1 J. Kanke,1 T. HmarLagroun,1 M.T. Gillin,1 G.S. Ibbott,1 T.A. Buchholz,1 and P. Das1; 1The University of Texas MD Anderson Cancer Center, Houston, TX, 2Scripps Proton Therapy Center, San Diego, CA Purpose/Objective(s): Our goal was to improve rates of conducting patient-specific quality assurance (QA) prior to the first treatment among patients undergoing intensity modulated radiation therapy (IMRT). This project was conducted in a large academic institution using performance quality improvement (PQI) tools. Materials/Methods: A process map was created defining numerous steps from the patient’s initial simulation and concluding with the start of treatment. Root cause analysis was conducted using a fishbone diagram and Pareto diagram to identify potential causes of failure to complete IMRT QA prior to the first treatment. Specific interventions were developed based on the root cause analysis. In January 2011, a Grand Rounds was held to develop support from faculty and staff. In April 2011, guidelines were adopted for the following: (A) IMRT QA before the first treatment, instead of the third treatment, was made mandatory, (B) Radiation treatment plans were required to be completed and approved by 4 PM the business day prior to the first treatment, to allow sufficient time for
Volume 84 Number 3S Supplement 2012 Results: Of the 2911 patients that met these criteria, 1184 (40.6%) had American Joint Committee on Cancer (AJCC) stage IIIA disease (3rd Edition 2000-2003, 6th Edition 2004-2007). The distribution for CCI was: 0Z45.1%, 1Z34.3%, 2+Z20.6%. Treatment modalities were: S+/NATZ 25.7%; R+CTXZ37.4%; RTZ18.8%; CTXZ18.2%. The percentage of patients to undergo S+/-NAT with stage IIIA/IIIB disease was 34.7/19.5%. Significant factors affecting treatment decision included stage, race, and CCI. Stage IIIB disease dominated the preference of a nonsurgical approach, with either CTX (adjusted odds ratio [OR]Z4.94, 95% confidence interval [CI]Z3.801-6.412) , RT (ORZ1.85, CIZ1.46-2.36) or R+CTX (ORZ1.86, CIZ1.53-2.25) compared to S+/-NAT. Higher CCI scores were found to be significantly associated with RT when modeling RT relative to S+/-NAT (ORZ1.39, CIZ1.05-1.82 and ORZ1.85, CIZ1.36-2.51 for scores of 1 vs. 0 and 2+ vs. 0, respectively). Finally, patients with a white race were more likely to receive S+/-NAT than those of a black race for both RT relative to the S+/-NAT model and R+CTX relative to the S+/-NAT model. Conclusions: Elderly patients with stage III NSCLC are treated predominantly with nonsurgical approaches. Contrary to national recommendations, approximately 20% of patients with stage IIIB disease undergo surgical management for unclear reasons (i.e. inaccurate diagnostic stage). Compared with nonsurgical methods, patients who undergo surgery are more likely to be stage IIIA, white race, and with a lower CCI. Author Disclosure: D.R. Gomez: None. K. Liao: None. J.Y. Chang: None. Z. Liao: None. S.M. Shirvani: None. R. Komaki: None. J.W. Welsh: None. S.G. Swisher: None. J.V. Heymach: None. B.D. Smith: None.
2860 Assessment of Compliance With NCCN Guidelines for Breast Cancer Patients Treated at a Comprehensive Cancer Center T. Dvorak and S. Constantino; M.D. Anderson Cancer Center Orlando, Orlando, FL Purpose/Objectives: There is an increasing emphasis on delivery of high quality care in general, and in radiation oncology in particular. One of the ways of evaluating quality of care is compliance with national treatment guidelines. The National Comprehensive Cancer Network (NCCN) guidelines are becoming a national standard of care for oncology. We assessed the compliance of our existing breast cancer clinical practice with NCCN Breast Cancer guidelines. Materials/Methods: We randomly identified 100 patients treated at our cancer center in 2010 from the cancer registry. These included patients with ductal carcinoma in-situ (nZ16), non-metastatic invasive breast cancer (nZ79), and metastatic breast cancer (nZ5). Breast cancer NCCN guidelines version 1.2011 was used as the standard guideline. A comprehensive set of guideline compliance metrics was developed, and was stratified into Workup, Radiation Oncology Treatment, and Follow Up categories. Results: Overall, 20% of patients were treated completely according to NCCN guidelines, 52% did not meet all NCCN guidelines, and 28% of patients did not have adequate information in the available medical record. In the Workup category, 24% were compliant, 39% were noncompliant, and 37% were unknown. In the Radiation Oncology Treatment category, 59% were compliant, 1% was noncompliant, 28% were not applicable, and 12% were unknown. In the Follow Up category, 66% were compliant, 10% were noncompliant, 4% were not applicable, and 20% were unknown. Major sources of noncompliance included inappropriate use of imaging, including staging PET scans, staging bone scans, and follow up chest xrays (38%); lack of complete pre-treatment labs (12%); and lack of timely genetics referral (11%). The one Radiation Oncology Treatment noncompliance was postmastectomy irradiation of a pT2N0(i+)M0 patient, who was felt to have high risk features. Conclusions: Our compliance with the Breast Cancer NCCN guidelines for radiation oncology treatment was high (99%) for patients where full medical record was available. However, our compliance with workup and follow up metrics was significantly worse, driven by relative “overordering” of staging PET scans and bone scans. For our follow up study,
we plan to assess the impact of nuclear medicine imaging utilization on our practice patterns. We are also developing a systemic approach to NCCN guideline compliance through the use of our electronic medical record, and will reassess our compliance in 2 years. Author Disclosure: T. Dvorak: Q. Leadership; ASTRO Communications Committee. S. Constantino: None.
2861 A Survey of the Perceived Quality of Patient Care in a Radiation Oncology Service: Results From 2002-2011 M. Eguiguren Bastida, J. Minguez, C. Blanco, J. Urraca, A. Querejeta, I. Uranga, J. Ciria, G. Rodriguez, S. Caffiero, and E. Guimon; Hospital Donostia, San Sebastian, Spain Purpose/Objective(s): The objective of the study is to present the results about the quality perceived by the patient in our service and look for areas to improve. Materials/Methods: From January 2002 to December 2011, we performed semiannually an standardized survey about the quality perceived based on a system ISO 9001. We collected the following aspects of the radiation therapy treatment: get an appointment, first consultation, simulation, verification and starting treatment, information provided, waiting time, accessibility and comfort and overall assessment. Each item is assessed as very good (MB) good (B), regular (R), bad (M), do not know/no answer (NS/NC). Semiannually, selected 60 patients undergoing radical intent radiation therapy, anonymously and voluntarily answered the survey. Results: A total of 1140 surveys were distributed, 774 were answered and analyzed. The average of the semiannually answered and analyzed surveys was 43 (72%). The overall assessment MB-B was 99%. One of the best valued aspects was the physician treatment, valued as MB-B in a 97.75%. One of the worst valued aspect was the waiting time, which was more than 15 minutes for the consulting in 47%, for simulation in 42%, and for daily treatment in 56%. Only the 54.6% of the patients treated with delay did know about it. You can see the other results on the poster. Conclusions: These results has allowed us to analyze the quality perceived by our patients and to look for areas to improve. We can see that they are satisfied with the overall assessment but we have to improve on the waiting time and on the information about the delays. Our results are within the average of the literature. Author Disclosure: M. Eguiguren Bastida: None. J. Minguez: None. C. Blanco: None. J. Urraca: None. A. Querejeta: None. I. Uranga: None. J. Ciria: None. G. Rodriguez: None. S. Caffiero: None. E. Guimon: None.
2862 Improvement in IMRT Quality Assurance Rates: A Quality Improvement Project at a Large Academic Institution J.L. Johnson,1 L. Dong,2 B. Riley,1 M. Kantor,1 J. Kanke,1 T. HmarLagroun,1 M.T. Gillin,1 G.S. Ibbott,1 T.A. Buchholz,1 and P. Das1; 1The University of Texas MD Anderson Cancer Center, Houston, TX, 2Scripps Proton Therapy Center, San Diego, CA Purpose/Objective(s): Our goal was to improve rates of conducting patient-specific quality assurance (QA) prior to the first treatment among patients undergoing intensity modulated radiation therapy (IMRT). This project was conducted in a large academic institution using performance quality improvement (PQI) tools. Materials/Methods: A process map was created defining numerous steps from the patient’s initial simulation and concluding with the start of treatment. Root cause analysis was conducted using a fishbone diagram and Pareto diagram to identify potential causes of failure to complete IMRT QA prior to the first treatment. Specific interventions were developed based on the root cause analysis. In January 2011, a Grand Rounds was held to develop support from faculty and staff. In April 2011, guidelines were adopted for the following: (A) IMRT QA before the first treatment, instead of the third treatment, was made mandatory, (B) Radiation treatment plans were required to be completed and approved by 4 PM the business day prior to the first treatment, to allow sufficient time for