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Reducing Variability in Blood and Marrow Pre-Transplant Assessment Based on the Hematopoietic Cell Transplantation-Specific Comorbidity Index
S356
Abstracts / Biol Blood Marrow Transplant 23 (2017) S18–S391
Figure 2. Easy notebook based on video modules.
Outcome: The first two modules developed focused on posttransplant medication adherence and diet-related guidelines to prevent infectious complications. Patients and caregivers were instructed on the use of the applications and given unlimited access via tablets while in the hospital. A short survey was conducted by an HSCT provider to obtain feedback. 100% of those surveyed felt the program was effective, consistent with written materials, easy to use and requested access for use at home. 80% stated the program was comprehensive and suggested additional topics. 10% requested a printed version of the videos to bring home where internet access would not be feasible. This led to a new, printed notebook of easy to follow instructions based on the video (Figure 2).
Methods: We reviewed comorbidity of 96 patients who received autologous (66) and allogeneic (30) transplants in the period 2013-2015. When stratified into low, intermediate, and high-risk groups based on scores of 0, 1-2, or ≥3, respectively, 76% of all patients were assessed as high-risk, 18.8% as intermediate-risk, and five percent were reported in the lowrisk group. The most prevalent comorbidity captured by the HCT-CI was pulmonary disease defined by abnormalities in forced expiratory volume in one second (FEV1) or diffusion capacity of carbon monoxide (DLCO). Results: Combined pulmonary comorbidity: severe (44.8%) and moderate (35.1%) was the most important contributor to a high comorbidity score (79.4% of the sample). From nonpulmonary comorbidities, psychiatric disturbance (42.3%), obesity (24.8%), and diabetes (21.6%) had the highest prevalence. Since pre-transplant patients are frequently anemic (41% had Hb <12 g/dL), adjusting DLCO results for hemoglobin is an important aspect of determining pulmonary disease severity. The HCI-CI recommends the Dinakara method, however the Cotes method has been used in 51.5% of test results in the total sample, and 48.5% were not adjusted for Hb. Cotes equations are favored by the American Thoracic Society/ European Respiratory Society guidelines and routinely chosen for Hb adjustment. Institutional variation in pulmonary function testing and reporting lead to further score discrepancies as 26.8% of assessments were performed at external medical centers, and 77% of these did not report adjusted DLCO. We re-adjusted retrospectively predicted values of patients with pulmonary comorbidity based on DLCO for Hb measured within 30 days before the pulmonary test using the Dinakara method. The individual comorbidity score was reduced in 31.3% of the patients, and the risk category decreased in 19.8%. Conclusion: The efficacy of the HCI-CI for prediction of transplant survival and outcomes has been previously validated in allogeneic and autologous transplants. We will implement a process of DLCO re-adjustment for Hb using Dinakara method for all patients evaluated for blood and marrow transplant to correct the overestimated risk of mortality.
496
Reducing Variability in Blood and Marrow PreTransplant Assessment Based on the Hematopoietic Cell Transplantation-Specific Comorbidity Index Yordanka N. Koleva 1, Michelle P. Zeller 2, Suzette Entwisle 1, Nereida Parada 3, Hana Safah 4. 1 Blood & Marrow Transplant, Tulane University Medical Center, New Orleans, LA; 2 Blood & Marrow Transplant, Tulane Medical Center, New Orleans, LA; 3 Section of Pulmonary, Critical Care and Environmental Medicine, Tulane School of Medicine, New Orleans, LA; 4 Hematology and Medical Oncology, Tulane Medical Center, New Orleans, LA
Designing Electronic Health Record Tools for Efficient CIBMTR Data Management Cindy Kramer 1, Colleen Butcher 1, Michelle Hudspeth 2, Jennifer Joi Jaroscak 2, Robert Stuart 3, Elizabeth J. Williams 1, Leah Judd 1, Saurabh Chhabra 4, Amanda Littleton 1, Valeriy Sedov 1, Juan Carlos Varela 1, Kristy Martin 1, Laura Cole 5, Rebecca Welsh 5, Melinda Cone 5, Yolanda Williams 5. 1 Blood and Marrow Transplant Program, Medical University of South Carolina, Charleston, SC; 2 Pediatric Hematology/Oncology, Medical University of South Carolina, Charleston, SC; 3 Hollings Cancer Center Medical University of South Carolina, Charleston, SC; 4 Medical College of Wisconsin, Charleston, SC; 5 The Medical University of SC, Charleston, SC
Background: Pre-transplant risk assessment of patients with hematologic malignancies includes a comorbidity score based on the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) criteria. The HCT-CI score is used among other factors to predict expected outcomes for both autologous and allogeneic donor transplants. A high comorbidity score of patients transplanted at our center has been observed in multi-institutional comparisons across Sarah Cannon Blood Cancer Network. Objectives: The purpose of this single center study was to determine factors that impacted the comorbidity scores of patients evaluated for blood and marrow transplant.
Background: Blood and Marrow Transplant (BMT) centers must maintain less than an 8% error rate to maintain a good standing with the Center for International Blood and Marrow Transplantation Research (CIBMTR). Creating specific electronic health records (EHR) tools for accurate and efficient data management for CIBMTR is complex. The CIBMTR staging forms in an electronic format can enable efficient and accurate entry of the required patient data during the patients’ visits. Objective: The objective was to design an electronic reporting tool for CIBMTR data and integrate it with the Epic EHR system in order to provide a high quality of accurate and efficient data management for BMT centers.
495
Abstracts / Biol Blood Marrow Transplant 23 (2017) S18–S391
Figure 2. Easy notebook based on video modules.
Outcome: The first two modules developed focused on posttransplant medication adherence and diet-related guidelines to prevent infectious complications. Patients and caregivers were instructed on the use of the applications and given unlimited access via tablets while in the hospital. A short survey was conducted by an HSCT provider to obtain feedback. 100% of those surveyed felt the program was effective, consistent with written materials, easy to use and requested access for use at home. 80% stated the program was comprehensive and suggested additional topics. 10% requested a printed version of the videos to bring home where internet access would not be feasible. This led to a new, printed notebook of easy to follow instructions based on the video (Figure 2).
Methods: We reviewed comorbidity of 96 patients who received autologous (66) and allogeneic (30) transplants in the period 2013-2015. When stratified into low, intermediate, and high-risk groups based on scores of 0, 1-2, or ≥3, respectively, 76% of all patients were assessed as high-risk, 18.8% as intermediate-risk, and five percent were reported in the lowrisk group. The most prevalent comorbidity captured by the HCT-CI was pulmonary disease defined by abnormalities in forced expiratory volume in one second (FEV1) or diffusion capacity of carbon monoxide (DLCO). Results: Combined pulmonary comorbidity: severe (44.8%) and moderate (35.1%) was the most important contributor to a high comorbidity score (79.4% of the sample). From nonpulmonary comorbidities, psychiatric disturbance (42.3%), obesity (24.8%), and diabetes (21.6%) had the highest prevalence. Since pre-transplant patients are frequently anemic (41% had Hb <12 g/dL), adjusting DLCO results for hemoglobin is an important aspect of determining pulmonary disease severity. The HCI-CI recommends the Dinakara method, however the Cotes method has been used in 51.5% of test results in the total sample, and 48.5% were not adjusted for Hb. Cotes equations are favored by the American Thoracic Society/ European Respiratory Society guidelines and routinely chosen for Hb adjustment. Institutional variation in pulmonary function testing and reporting lead to further score discrepancies as 26.8% of assessments were performed at external medical centers, and 77% of these did not report adjusted DLCO. We re-adjusted retrospectively predicted values of patients with pulmonary comorbidity based on DLCO for Hb measured within 30 days before the pulmonary test using the Dinakara method. The individual comorbidity score was reduced in 31.3% of the patients, and the risk category decreased in 19.8%. Conclusion: The efficacy of the HCI-CI for prediction of transplant survival and outcomes has been previously validated in allogeneic and autologous transplants. We will implement a process of DLCO re-adjustment for Hb using Dinakara method for all patients evaluated for blood and marrow transplant to correct the overestimated risk of mortality.
496
Reducing Variability in Blood and Marrow PreTransplant Assessment Based on the Hematopoietic Cell Transplantation-Specific Comorbidity Index Yordanka N. Koleva 1, Michelle P. Zeller 2, Suzette Entwisle 1, Nereida Parada 3, Hana Safah 4. 1 Blood & Marrow Transplant, Tulane University Medical Center, New Orleans, LA; 2 Blood & Marrow Transplant, Tulane Medical Center, New Orleans, LA; 3 Section of Pulmonary, Critical Care and Environmental Medicine, Tulane School of Medicine, New Orleans, LA; 4 Hematology and Medical Oncology, Tulane Medical Center, New Orleans, LA
Designing Electronic Health Record Tools for Efficient CIBMTR Data Management Cindy Kramer 1, Colleen Butcher 1, Michelle Hudspeth 2, Jennifer Joi Jaroscak 2, Robert Stuart 3, Elizabeth J. Williams 1, Leah Judd 1, Saurabh Chhabra 4, Amanda Littleton 1, Valeriy Sedov 1, Juan Carlos Varela 1, Kristy Martin 1, Laura Cole 5, Rebecca Welsh 5, Melinda Cone 5, Yolanda Williams 5. 1 Blood and Marrow Transplant Program, Medical University of South Carolina, Charleston, SC; 2 Pediatric Hematology/Oncology, Medical University of South Carolina, Charleston, SC; 3 Hollings Cancer Center Medical University of South Carolina, Charleston, SC; 4 Medical College of Wisconsin, Charleston, SC; 5 The Medical University of SC, Charleston, SC
Background: Pre-transplant risk assessment of patients with hematologic malignancies includes a comorbidity score based on the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) criteria. The HCT-CI score is used among other factors to predict expected outcomes for both autologous and allogeneic donor transplants. A high comorbidity score of patients transplanted at our center has been observed in multi-institutional comparisons across Sarah Cannon Blood Cancer Network. Objectives: The purpose of this single center study was to determine factors that impacted the comorbidity scores of patients evaluated for blood and marrow transplant.
Background: Blood and Marrow Transplant (BMT) centers must maintain less than an 8% error rate to maintain a good standing with the Center for International Blood and Marrow Transplantation Research (CIBMTR). Creating specific electronic health records (EHR) tools for accurate and efficient data management for CIBMTR is complex. The CIBMTR staging forms in an electronic format can enable efficient and accurate entry of the required patient data during the patients’ visits. Objective: The objective was to design an electronic reporting tool for CIBMTR data and integrate it with the Epic EHR system in order to provide a high quality of accurate and efficient data management for BMT centers.
495