Illawarra Shoalhaven Cancer and Haematology Network (ISCaHN) has been using an oncology information system (OIS) as a complete electronic record for over 4 years. There has been both considerable and valuable treatment data generated at the point of care. Are we able to rapidly assess the outcomes of our own treatment data, and use this outcome data to help inform the delivery of care to our patients?
Pathways to smoking care for cancer patients (P-SCIP): Stage 1Cancer Institute NSW
As survival from cancer has improved over time, the potential impact of cigarette smoking on cancer patients and survivors is of increasing relevance. In addition to increased risk of chronic disease such as cardiovascular and respiratory disease, continued smoking after a cancer diagnosis increases the risk of second primary cancer, cancer recurrence and is a cause of treatment complications. As well the profound adverse impact of continued smoking on health outcomes in cancer patients, continued smoking among people with cancer incurs significant cost to the health system.
Providing coordinated cancer care: a population-based survey of patients' exp...Cancer Institute NSW
Improving cancer care coordination is a key priority for health services. Understanding the patient experience and who is at risk of receiving poorly coordinated care is crucial to underpin service improvement. However, there is little understanding of the adequacy of care coordination within Australia.
Mapping lung cancer diagnostic pathways: a qualitative study of interviews wi...Cancer Institute NSW
Lung cancer remains the leading cause of cancer death in developed countries. There is growing evidence that earlier diagnosis of lung cancer is an important factor in improving outcomes. Despite this, there is surprisingly little qualitative research that documents lung cancer patients' diagnostic pathway and beyond.
A distributed data mining network infrastructure for Australian radiotherapy ...Cancer Institute NSW
Routine electronic storage of medical records and imaging is becoming standard practice in radiotherapy. There is immense potential to utilise this increasingly diverse data resource as an evidence base for decision support systems for cancer prognosis and subsequent personalised treatment decisions.
Implementing online mental health supports into community-based survivorship ...Cancer Institute NSW
The intersection of developmental vulnerabilities and cancer-related stressors means that adolescents and young adults (AYAs) with cancer show more complex distress relative to other age groups.
Engaging multidisciplinary teams in translational research and quality improv...Cancer Institute NSW
The Sydney West Translational Cancer Research Centre is a five year program grant funded by the Cancer Institute NSW aimed at improving patient outcomes through translational research. Multidisciplinary teams (MDTs) are key to the delivery of cancer care in Australia. There is a lack of knowledge and research into how these MDT teams can best be engaged in translational research from basic science through to implementation science and quality improvement.
Optimising the Model of Care for Patient Management at The Tweed Cancer Care ...Cancer Institute NSW
The document describes the implementation of a morning handover process utilizing the MOSAIQ electronic medical record (EMR) system at the Tweed Cancer Care and Haematology Unit. An evaluation found the EMR handover process improved staff satisfaction, coordination of patient care, and reduced incidents. It was concluded the handover process meets national standards and could benefit other ambulatory care units utilizing EMRs.
Pathways to smoking care for cancer patients (P-SCIP): Stage 1Cancer Institute NSW
As survival from cancer has improved over time, the potential impact of cigarette smoking on cancer patients and survivors is of increasing relevance. In addition to increased risk of chronic disease such as cardiovascular and respiratory disease, continued smoking after a cancer diagnosis increases the risk of second primary cancer, cancer recurrence and is a cause of treatment complications. As well the profound adverse impact of continued smoking on health outcomes in cancer patients, continued smoking among people with cancer incurs significant cost to the health system.
Providing coordinated cancer care: a population-based survey of patients' exp...Cancer Institute NSW
Improving cancer care coordination is a key priority for health services. Understanding the patient experience and who is at risk of receiving poorly coordinated care is crucial to underpin service improvement. However, there is little understanding of the adequacy of care coordination within Australia.
Mapping lung cancer diagnostic pathways: a qualitative study of interviews wi...Cancer Institute NSW
Lung cancer remains the leading cause of cancer death in developed countries. There is growing evidence that earlier diagnosis of lung cancer is an important factor in improving outcomes. Despite this, there is surprisingly little qualitative research that documents lung cancer patients' diagnostic pathway and beyond.
A distributed data mining network infrastructure for Australian radiotherapy ...Cancer Institute NSW
Routine electronic storage of medical records and imaging is becoming standard practice in radiotherapy. There is immense potential to utilise this increasingly diverse data resource as an evidence base for decision support systems for cancer prognosis and subsequent personalised treatment decisions.
Implementing online mental health supports into community-based survivorship ...Cancer Institute NSW
The intersection of developmental vulnerabilities and cancer-related stressors means that adolescents and young adults (AYAs) with cancer show more complex distress relative to other age groups.
Engaging multidisciplinary teams in translational research and quality improv...Cancer Institute NSW
The Sydney West Translational Cancer Research Centre is a five year program grant funded by the Cancer Institute NSW aimed at improving patient outcomes through translational research. Multidisciplinary teams (MDTs) are key to the delivery of cancer care in Australia. There is a lack of knowledge and research into how these MDT teams can best be engaged in translational research from basic science through to implementation science and quality improvement.
Optimising the Model of Care for Patient Management at The Tweed Cancer Care ...Cancer Institute NSW
The document describes the implementation of a morning handover process utilizing the MOSAIQ electronic medical record (EMR) system at the Tweed Cancer Care and Haematology Unit. An evaluation found the EMR handover process improved staff satisfaction, coordination of patient care, and reduced incidents. It was concluded the handover process meets national standards and could benefit other ambulatory care units utilizing EMRs.
Current clinical electronic health record systems do not provide accessible information for quality assurance and research purposes. Furthermore, data entry is limited due to inappropriate and/or insufficient fields.
Secondary Cancers, Health Behaviour and Cancer Screening Adherence in survivo...Cancer Institute NSW
Over 50% of patients undergoing allogeneic BMT can now be expected to become long-term survivors. Unfortunately many survivors experience an increased risk of secondary cancers, infections and chronic diseases.
Building the bridge from discovery-to-delivery: A Community of Practice in Ca...Cancer Institute NSW
A research breakthrough is said to take approximately 17 years to translate into clinical practice. This time lag can have considerable implications for patients, their carers, health services, and public funds. To address this time lag, the Cancer Institute NSW and the Translational Cancer Research Centres (TCRCs) across the state developed a community of practice (CoP) to increase knowledge, skills, and capacity in implementation science.
Predictors of MDT review and the impact on lung cancer survival for HNELHD re...Cancer Institute NSW
Review by a Multidisciplinary Team (MDT) has been shown to lead to increased rates of surgical resection, radiotherapy, chemotherapy and timeliness of care. Most recently, the Victorian lung cancer patterns of care study have found that MDT review is an independent predictor of lung cancer survival.
The experience of survival following Blood and Marrow Transplant in NSW, Aust...Cancer Institute NSW
Over 50% of patients undergoing allogeneic BMT can now be expected to become long-term survivors. Unfortunately many experience significant late morbidity and mortality.
Weight loss among patients with Head and Neck Cancer at St Vincent's Hospital...Cancer Institute NSW
Patients with Squamous cell carcinoma (SCC) of the Head and Neck (H&N) are often treated with curative intent using treatment protocols placing them at high risk of nutritional decline. Recently released COSA guidelines recommend that prophylactic enteral feeding should be considered for T4 upper aerodigestive tract tumours undergoing concurrent chemoradiotherapy. Evidence is yet to identify optimal method of nutrition intervention and timing across all tumour stages in this population.
Anti-cancer therapy is big business. In Australia alone between 2000 and 2009, cancer-related pharmaceutical expenditure has risen over 200% to over half a billion dollars per annum.
One example of how Clinical Cancer Registry level data can review practice va...Cancer Institute NSW
We examined the possible utility of using Cancer Institute NSW Clinical Cancer Registry data by examining one contentious issue in radiation oncology as an example. Increasing evidence has been published about the safety and efficacy of hypofractionated radiotherapy, in comparison with standard fractionation, in early, node-negative breast cancer.
Given the prevalence and adverse effects of psychological distress on treatment outcomes, particularly the influence of depression on nutritional outcomes, evidence based clinical practice guidelines recommend dietitian screening and referral of head and neck cancer patients for psychosocial distress. However, research suggests that the provision of this care is sub-optimal.
The cancer cup challenge—running an international program in safety and quali...Cancer Institute NSW
Adverse events are a significant quality and safety issue in the hospital setting due to their direct impact on patients. Additionally, such events are often handled by junior doctors due to their direct involvement with patients. As such, it is important for health care organisations to prioritise education and training for junior doctors on identifying adverse events and handling them when they occur. How we make this education relevant and engaging remains a key challenge.
Palliative Patient Journeys—providing services in a regional and rural settingCancer Institute NSW
Griffith is a multicultural city in south-western NSW, with a population of 16,972, with a greater population living in the surrounding rural and remote areas. Palliative Care & End of Life [EOL] Services, were being provided by a wide range of service providers, in both acute and community sectors. Despite Strategic Planning and Model of Care directives, variation in the integration of services and a lack of resources meant that patients and carers were subject to variations in methods of service delivery.
Defining and assessing a delineation uncertainty margin for modern radiotherapyCancer Institute NSW
The implementation of image-guided technology and progressively conformal techniques in modern radiotherapy for the treatment of cancer, ensure the planned distribution of dose is well matched to the clinician-defined target volume. However, this precision relies on the target volume including all malignant tissue, with delineation uncertainty resulting in potential normal tissue toxicities and insufficient dose to the cancer. Methods need to be implemented to minimise delineation uncertainty, and subsequently improve local control and patient outcomes.
The impact of National Bowel Cancer Screening Program in AustraliaCancer Institute NSW
The full rollout of the National Bowel Cancer Screening Program (NBCSP), offering free biennial screening using immunochemical Fecal Occult Blood Test (iFOBT) for 50-74 years is targeted for 2020. In 2013-14, the overall participation rate among Australians who were invited to participate was 36%.
Cancer patients’ experiences in one tertiary referral emergency department (E...Cancer Institute NSW
The demand on Australian EDs has increased by an average of 4.2% each year while the cancer incidence rate has doubled since 1991. Many patients with cancer present to EDs but may be better managed using alternative healthcare models.
An integrated model of psychosocial cancer care: a work in progress…Cancer Institute NSW
Cancer patients are faced with a multitude of stressors, from diagnosis, through treatment, at recurrence, in the stages following treatment completion, and in the terminal phase. Psychosocial care has been highlighted as a critical aspect of providing comprehensive patient-focused care. Specifically, one of the goals of The NSW Cancer Plan 2011-2015 is to improve the quality of life of people with cancer and their carers. This project was initiated to improve the current psychosocial model of care at The Kinghorn Cancer Centre (TKCC), to better reflect an integrated, holistic and comprehensive model of patient-centred care.
Expediting Colonoscopy for Patients with + Faecal Occult Blood Test in a Publ...Cancer Institute NSW
Colon cancer is the commonest cancer in Australia. The Federal Gov. has recently accelerated the rollout of the National Bowel Cancer Screening Program to 2nd yearly after age 50 by 2018. We anticipate up to 1000 extra colonoscopies on the public system at NSLHD.
The Lung Cancer Demonstration Project: Implementation and evaluation of a lun...Cancer Institute NSW
The Royal Prince Alfred Hospital lung MDT was established in 1984. Historically, information about MDT decision making was captured as free text in the electronic medical record, including patient investigation and staging. This information was accessible to clinical staff; however, it was not routinely distributed to GPs involved in the patient's care. We identified a potential gap in the current reporting and communication processes.
Expedited patient-centered outcome measurement development for cancer careCancer Institute NSW
The need for real-time access to outcomes data is well-recognized. However, providers, payers, and patients lack access to timely and relevant outcomes data to support informed decision-making and comparisons across providers and over time. To help address these gaps, MD Anderson initiated a project to develop patient-centered outcome measures and to integrate data collection within the electronic health record (EHR) in 2014.
With almost half of oncology studies failing due to a lack of patient retention, there is a critical need to develop more efficient and patient focused strategies. Jessica Thilaganathan at CRF Health sits down with International Clinical Trials to explain why electronic clinical outcome solutions could be the answer. (Published with permission of International Clinical Trials).
This document discusses the increasing pressure on healthcare providers to adhere to clinical guidelines and quality metrics. It outlines challenges in implementing clinical decision support systems and electronic medical records to help providers meet these demands. Key points include the need for provider buy-in, reliable guideline-based decision support, and creating a culture where metrics are accepted and do not cause anger or fear.
Current clinical electronic health record systems do not provide accessible information for quality assurance and research purposes. Furthermore, data entry is limited due to inappropriate and/or insufficient fields.
Secondary Cancers, Health Behaviour and Cancer Screening Adherence in survivo...Cancer Institute NSW
Over 50% of patients undergoing allogeneic BMT can now be expected to become long-term survivors. Unfortunately many survivors experience an increased risk of secondary cancers, infections and chronic diseases.
Building the bridge from discovery-to-delivery: A Community of Practice in Ca...Cancer Institute NSW
A research breakthrough is said to take approximately 17 years to translate into clinical practice. This time lag can have considerable implications for patients, their carers, health services, and public funds. To address this time lag, the Cancer Institute NSW and the Translational Cancer Research Centres (TCRCs) across the state developed a community of practice (CoP) to increase knowledge, skills, and capacity in implementation science.
Predictors of MDT review and the impact on lung cancer survival for HNELHD re...Cancer Institute NSW
Review by a Multidisciplinary Team (MDT) has been shown to lead to increased rates of surgical resection, radiotherapy, chemotherapy and timeliness of care. Most recently, the Victorian lung cancer patterns of care study have found that MDT review is an independent predictor of lung cancer survival.
The experience of survival following Blood and Marrow Transplant in NSW, Aust...Cancer Institute NSW
Over 50% of patients undergoing allogeneic BMT can now be expected to become long-term survivors. Unfortunately many experience significant late morbidity and mortality.
Weight loss among patients with Head and Neck Cancer at St Vincent's Hospital...Cancer Institute NSW
Patients with Squamous cell carcinoma (SCC) of the Head and Neck (H&N) are often treated with curative intent using treatment protocols placing them at high risk of nutritional decline. Recently released COSA guidelines recommend that prophylactic enteral feeding should be considered for T4 upper aerodigestive tract tumours undergoing concurrent chemoradiotherapy. Evidence is yet to identify optimal method of nutrition intervention and timing across all tumour stages in this population.
Anti-cancer therapy is big business. In Australia alone between 2000 and 2009, cancer-related pharmaceutical expenditure has risen over 200% to over half a billion dollars per annum.
One example of how Clinical Cancer Registry level data can review practice va...Cancer Institute NSW
We examined the possible utility of using Cancer Institute NSW Clinical Cancer Registry data by examining one contentious issue in radiation oncology as an example. Increasing evidence has been published about the safety and efficacy of hypofractionated radiotherapy, in comparison with standard fractionation, in early, node-negative breast cancer.
Given the prevalence and adverse effects of psychological distress on treatment outcomes, particularly the influence of depression on nutritional outcomes, evidence based clinical practice guidelines recommend dietitian screening and referral of head and neck cancer patients for psychosocial distress. However, research suggests that the provision of this care is sub-optimal.
The cancer cup challenge—running an international program in safety and quali...Cancer Institute NSW
Adverse events are a significant quality and safety issue in the hospital setting due to their direct impact on patients. Additionally, such events are often handled by junior doctors due to their direct involvement with patients. As such, it is important for health care organisations to prioritise education and training for junior doctors on identifying adverse events and handling them when they occur. How we make this education relevant and engaging remains a key challenge.
Palliative Patient Journeys—providing services in a regional and rural settingCancer Institute NSW
Griffith is a multicultural city in south-western NSW, with a population of 16,972, with a greater population living in the surrounding rural and remote areas. Palliative Care & End of Life [EOL] Services, were being provided by a wide range of service providers, in both acute and community sectors. Despite Strategic Planning and Model of Care directives, variation in the integration of services and a lack of resources meant that patients and carers were subject to variations in methods of service delivery.
Defining and assessing a delineation uncertainty margin for modern radiotherapyCancer Institute NSW
The implementation of image-guided technology and progressively conformal techniques in modern radiotherapy for the treatment of cancer, ensure the planned distribution of dose is well matched to the clinician-defined target volume. However, this precision relies on the target volume including all malignant tissue, with delineation uncertainty resulting in potential normal tissue toxicities and insufficient dose to the cancer. Methods need to be implemented to minimise delineation uncertainty, and subsequently improve local control and patient outcomes.
The impact of National Bowel Cancer Screening Program in AustraliaCancer Institute NSW
The full rollout of the National Bowel Cancer Screening Program (NBCSP), offering free biennial screening using immunochemical Fecal Occult Blood Test (iFOBT) for 50-74 years is targeted for 2020. In 2013-14, the overall participation rate among Australians who were invited to participate was 36%.
Cancer patients’ experiences in one tertiary referral emergency department (E...Cancer Institute NSW
The demand on Australian EDs has increased by an average of 4.2% each year while the cancer incidence rate has doubled since 1991. Many patients with cancer present to EDs but may be better managed using alternative healthcare models.
An integrated model of psychosocial cancer care: a work in progress…Cancer Institute NSW
Cancer patients are faced with a multitude of stressors, from diagnosis, through treatment, at recurrence, in the stages following treatment completion, and in the terminal phase. Psychosocial care has been highlighted as a critical aspect of providing comprehensive patient-focused care. Specifically, one of the goals of The NSW Cancer Plan 2011-2015 is to improve the quality of life of people with cancer and their carers. This project was initiated to improve the current psychosocial model of care at The Kinghorn Cancer Centre (TKCC), to better reflect an integrated, holistic and comprehensive model of patient-centred care.
Expediting Colonoscopy for Patients with + Faecal Occult Blood Test in a Publ...Cancer Institute NSW
Colon cancer is the commonest cancer in Australia. The Federal Gov. has recently accelerated the rollout of the National Bowel Cancer Screening Program to 2nd yearly after age 50 by 2018. We anticipate up to 1000 extra colonoscopies on the public system at NSLHD.
The Lung Cancer Demonstration Project: Implementation and evaluation of a lun...Cancer Institute NSW
The Royal Prince Alfred Hospital lung MDT was established in 1984. Historically, information about MDT decision making was captured as free text in the electronic medical record, including patient investigation and staging. This information was accessible to clinical staff; however, it was not routinely distributed to GPs involved in the patient's care. We identified a potential gap in the current reporting and communication processes.
Expedited patient-centered outcome measurement development for cancer careCancer Institute NSW
The need for real-time access to outcomes data is well-recognized. However, providers, payers, and patients lack access to timely and relevant outcomes data to support informed decision-making and comparisons across providers and over time. To help address these gaps, MD Anderson initiated a project to develop patient-centered outcome measures and to integrate data collection within the electronic health record (EHR) in 2014.
With almost half of oncology studies failing due to a lack of patient retention, there is a critical need to develop more efficient and patient focused strategies. Jessica Thilaganathan at CRF Health sits down with International Clinical Trials to explain why electronic clinical outcome solutions could be the answer. (Published with permission of International Clinical Trials).
This document discusses the increasing pressure on healthcare providers to adhere to clinical guidelines and quality metrics. It outlines challenges in implementing clinical decision support systems and electronic medical records to help providers meet these demands. Key points include the need for provider buy-in, reliable guideline-based decision support, and creating a culture where metrics are accepted and do not cause anger or fear.
Module 5 (week 9) - InterventionAs you continue to work on your .docxroushhsiu
This document provides guidance for a week 9 assignment on recommending an evidence-based practice change. It instructs students to identify a current problem from their week 2 assignment, propose an intervention derived from literature reviewed in previous assignments, and present this as an 8-9 slide PowerPoint. The document reviews what content should be drawn from past assignments and what will be new. It directs students to review full assignment details and offers assistance for any questions.
Research studies show thatevidence-based practice(EBP) leads t.docxronak56
This annotated bibliography summarizes 6 research articles on learning and development challenges facing first-generation college students. The articles address topics like social and academic integration, the impact of family support, and factors influencing persistence. A critical analysis compares the studies' populations, settings, strategies, and conclusions. Overall, the research highlights both opportunities and barriers first-generation students face in their transition to college. Recommendations from this research will inform strategies to design an educationally effective environment for this student group.
Cadth symposium 2015 d3 pro presentation apr 2015 - for debCADTH Symposium
This document summarizes a presentation on implementing patient reported outcomes (PROs) to improve patient-centered care. It discusses collecting PRO data through distress screening tools and patient satisfaction surveys, analyzing the data, and using it to select and evaluate quality improvement initiatives. PROs are outcomes that patients report on issues like symptoms, experience of care, and quality of life. The presentation outlines the benefits of PROs, Saskatchewan Cancer Agency's implementation including two PRO tools and progress to date, and lessons learned around using a phased approach and technology to gather and apply PRO evidence to enhance care.
Week 5 Lab 3· If you choose to download the software from http.docxcockekeshia
Week 5 Lab 3
· If you choose to download the software from http://www.easyphp.org, use the installation guide provided here to install the EasyPHP.
Lab 3: XAMPP and MySQL Setup
Due Week 5 and worth 75 points
· Install XAMPP and MySQL and take a screen shot that shows the MySQL prompt on your screen. (screen shot optional)
· Research the capabilities of MySQL.
Write a one to two (1-2) page paper in which you:
1. Describe your experiences related to your setup of MySQL. Include any difficulties or issues that you had encountered during the installation.
1. Based on your post-installation research, describe the main capabilities of MySQL.
1. Describe the approach that you would take to go from a conceptual or logical model that you created to the implementation of that database structure in MySQL. Determine the additional information that you will need to implement the database design in a database management system.
Your assignment must follow these formatting requirements:
. Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
. Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.
Research studies show thatevidence-based practice(EBP) leads to higher qual-
ity care, improved patient out-
comes, reduced costs, and greater
nurse satisfaction than traditional
approaches to care.1-5 Despite
these favorable findings, many
nurses remain inconsistent in their
implementation of evidence-based
care. Moreover, some nurses,
whose education predates the in-
clusion of EBP in the nursing cur-
riculum, still lack the computer
and Internet search skills neces-
sary to implement these practices.
As a result, misconceptions about
EBP—that it’s too difficult or too
time-consuming—continue to
flourish.
In the first article in this series
(“Igniting a Spirit of Inquiry: An
Essential Foundation for Evidence-
Based Practice,” November 2009),
we described EBP as a problem-
solving approach to the delivery
of health care that integrates the
best evidence from well-designed
studies and patient care data,
and combines it with patient
preferences and values and nurse
expertise. We also addressed the
contribution of EBP to improved
care and patient outcomes, de-
scribed barriers to EBP as well as
factors facilitating its implementa-
tion, and discussed strategies for
igniting a spirit of inquiry in clin-
ical practice, which is the founda-
tion of EBP, referred to as Step
Zero. (Editor’s note: although
EBP has seven steps, they are
numbered zero to six.) In this
article, we offer a brief overview
of the multistep EBP process.
Future articles will elaborate on
each of the EBP steps, using
the context provided by the
Cas.
Assessing Adherence to Treatment: A Partnershipicapclinical
This document summarizes a presentation on assessing adherence to HIV treatment. It defines adherence to care and treatment, describes various methods to measure adherence including patient recall, pill counts, and qualitative assessments. Program examples from Swaziland, South Africa, and Mozambique are provided. Visual, qualitative, and partnership-based approaches aim to facilitate patient understanding and ongoing monitoring to support optimal adherence. Barriers to and facilitators of adherence are identified to guide interventions.
Assessing Adherence to Treatment: A Partnershipicapclinical
This document summarizes a presentation on assessing adherence to HIV treatment. It defines adherence to care and treatment, describes various methods to measure adherence including patient recall, pill counts, and qualitative assessments. Program examples from Swaziland, South Africa, and Mozambique are provided. Visual, qualitative, and partnership-based approaches aim to facilitate patient understanding and ongoing monitoring to support optimal adherence. Barriers to implementation include staff time constraints and ensuring clinical interpretation and follow-up on assessment results.
Primer in quality improvement in radiology departmentAhmed Bahnassy
This document provides guidance on developing and implementing a quality improvement plan for a radiology department. It discusses identifying areas for improvement, collecting relevant data, setting targets, developing a work plan, implementing changes, monitoring results, and continually refining the process. Key aspects of quality improvement covered include using tools like fishbone diagrams and SWOT analyses to identify root causes of issues, applying the PDSA (Plan-Do-Study-Act) cycle of testing changes, and developing standardized reporting templates to improve consistency and communication. Examples of specific quality improvement projects focused on areas like lumbar spine MRI reporting and management of indeterminate pulmonary nodules are also provided.
Patient Blood Management: Impact of Quality Data on Patient OutcomesViewics
Patient blood management (PBM) has been proven to improve patient outcomes and save hospitals millions of dollars. Ensuring the quality of your data is central to decision making and critical to having a strong PBM program.
Would you like to learn how your organization can improve patient outcomes by implementing a PBM program based on accurate data?
If so, view this presentation by blood management expert Lance Trewhella. Lance presents how to develop a successful, evidence-based, multidisciplinary PBM program aimed at optimizing the care of patients who might need transfusion.
You’ll learn:
• Current recommendations for blood transfusion utilization
• The impact of quality data on PBM programs
• Best data practices in PBM
The document discusses the patient centered medical home model and its implications. It begins with an overview of problems with the current US healthcare system based on international comparisons. It then outlines the rationale for patient centered medical homes, describing their core principles of being patient-centered, comprehensive, coordinated, accessible, and committed to quality and safety. Key aspects discussed include the use of care teams, standards for medical home recognition from NCQA, and the shift towards population health, quality-based reimbursement, and around the clock access. The implications discussed are that truly patient-centered care requires personal and practice transformation, appropriate support and resources, and a long-term transition away from fee-for-service models.
Grand rounds are a teaching methodology where physicians present clinical cases to colleagues, residents, and medical students. During grand rounds, physicians discuss a patient's medical history, presentation of symptoms, diagnostic testing and imaging results, treatment plans, and learning objectives. The goal is to enhance medical education and support collaborative care across specialties. Modern grand rounds also use data-driven approaches and technology to continuously improve patient outcomes and healthcare value.
Patient profiling disaggregating the datanhsnwHELP
The document discusses patient profiling data, which involves collecting key demographic information from patients to understand diversity and advance equality. It describes the types of data that should be collected, such as age, gender, disability status and more. The document outlines best practices for collecting high quality data, including using self-declaration, explaining the purpose of collection, and training staff. It notes barriers to collection like outdated IT systems and provides examples of how disaggregated data can be analyzed to identify potential equality issues and inform areas like service design.
Delivering Quality Through eHealth and Information TechnologyNHSScotlandEvent
The document summarizes several presentations on using eHealth and information technology to improve quality in healthcare delivery. It discusses tools like the Lanarkshire Quality Improvement Portal that allow clinicians to easily enter and access data to monitor quality measures and drive improvements. It also describes how systems like TrakCare and the Emergency Care Summary can help with tasks like medicines reconciliation across care settings. Accessing the Emergency Care Summary provided additional clinical information for management in 10% of cases studied.
Clinical Audit is a method of confirming the quality of clinical services and identify the need for improvement. A skill hospital administrator should learn and practice.
Structure and development of a clinical decision support system: application ...komalicarol
Clinical decision requires to infer great, diverse and not suitably
organized quantity of information and having low time to decide.
The therapeutic choice is fundamental to formulate a strategy to
avoid complications and to achieve favorable results, being more
important in some specialties. In addition, medical decision-makers are overloaded with clinical tasks, have an intense work rate and
are subject to a great demand, and are prone to greater tiredness.
In this sense, computer tools can be extremely useful, as can deal
with a lot of information in much less time than decision-makers.
Thus, the existence of a tool that assists them in decision-making
is of crucial importance
Health IT Summit Houston 2014 - Case Study "EHR Optimization for Organizational Value in a Changing Healthcare Environment"
Luis Saldana, MD, MBA, FACEP
CMIO
Texas Health Resources
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.
This document describes a study that evaluated a new framework for end-of-life care and withdrawal of treatment on an intensive care unit. Staff completed questionnaires before and after the introduction of the framework to assess changes in knowledge, quality of care, and satisfaction. Results showed improvements in staff knowledge, increased confidence that patients' comfort needs were being met, and greater satisfaction with end-of-life care processes after implementing the framework. The study concludes the framework was associated with enhanced end-of-life care delivery and communication on the ICU.
Chapter 4 Knowledge Discovery, Data Mining, and Practice-Based Evi.docxchristinemaritza
Chapter 4 Knowledge Discovery, Data Mining, and Practice-Based Evidence
Mollie R. Cummins
Ginette A. Pepper
Susan D. Horn
The next step to comparative effectiveness research is to conduct more prospective large-scale observational cohort studies with the rigor described here for knowledge discovery and data mining (KDDM) and practice-based evidence (PBE) studies.
Objectives
At the completion of this chapter the reader will be prepared to:
1.Define the goals and processes employed in knowledge discovery and data mining (KDDM) and practice-based evidence (PBE) designs
2.Analyze the strengths and weaknesses of observational designs in general and of KDDM and PBE specifically
3.Identify the roles and activities of the informatics specialist in KDDM and PBE in healthcare environments
Key Terms
Comparative effectiveness research, 69
Confusion matrix, 62
Data mining, 61
Knowledge discovery and data mining (KDDM), 56
Machine learning, 56
Natural language processing (NLP), 58
Practice-based evidence (PBE), 56
Preprocessing, 56
Abstract
The advent of the electronic health record (EHR) and other large electronic datasets has revolutionized efficient access to comprehensive data across large numbers of patients and the concomitant capacity to detect subtle patterns in these data even with missing or less than optimal data quality. This chapter introduces two approaches to knowledge building from clinical data: (1) knowledge discovery and data mining (KDDM) and (2) practice-based evidence (PBE). The use of machine learning methods in retrospective analysis of routinely collected clinical data characterizes KDDM. KDDM enables us to efficiently and effectively analyze large amounts of data and develop clinical knowledge models for decision support. PBE integrates health information technology (health IT) products with cohort identification, prospective data collection, and extensive front-line clinician and patient input for comparative effectiveness research. PBE can uncover best practices and combinations of treatments for specific types of patients while achieving many of the presumed advantages of randomized controlled trials (RCTs).
Introduction
Leaders need to foster a shared learning culture for improving healthcare. This extends beyond the local department or institution to a value for creating generalizable knowledge to improve care worldwide. Sound, rigorous methods are needed by researchers and health professionals to create this knowledge and address practical questions about risks, benefits, and costs of interventions as they occur in actual clinical practice. Typical questions are as follows:
•Are treatments used in daily practice associated with intended outcomes?
•Can we predict adverse events in time to prevent or ameliorate them?
•What treatments work best for which patients?
•With limited financial resources, what are the best interventions to use for specific types of patients?
•What types of indi ...
Similar to ISCaHN Treatment Dashboard: Providing clinician decision support with data generated at the point of care (20)
Cervical screening – taking care of your health flipchart (Farsi)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to Farsi women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Khmer)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to Khmer women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Dari)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to Dari women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Nepali)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to Nepalese women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Nepali)
Cervical screening – taking care of your health flipchart (Turkish)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to Turkish women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Thai)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to Thai women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Korean)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to Korean women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Arabic)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to women of a Arabic background, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Vietnamese)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to women of a Vietnamese background, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Thai)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to women of a Thai background, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Bengali))Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to women from different cultural backgrounds, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Tibetan)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to women from different cultural backgrounds, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
This document provides information for users of a flipchart about cervical cancer screening. It discusses topics like what cervical cancer is, its causes, prevention methods, who should get screened and how often, the screening procedure, possible results, and where to find more information. The flipchart is intended to help bilingual health workers educate community members from different cultural backgrounds about cervical cancer screening.
This document provides information about cervical cancer screening in Australia. It discusses the topics of cancer and the cervix, causes of cervical cancer, preventing cervical cancer through vaccination and screening, the cervical screening test process including who should get it and potential results, and where to find more information. The intended audience is bilingual health workers who can use this flipchart to educate community members from culturally diverse backgrounds about cervical cancer screening.
The document provides information about cervical cancer screening and prevention. It discusses:
1) The causes of cervical cancer, which is almost always caused by HPV infection. HPV is common and passed through sexual contact.
2) How cervical cancer can be prevented through HPV vaccination and regular cervical screening tests every 5 years for women aged 25-74 who are or have been sexually active.
3) What the cervical screening test involves, including that it looks for HPV and cell changes, replaces the Pap test, and involves a similar examination to the Pap test.
The document provides information about cervical cancer screening. It discusses:
- Cervical cancer screening is important to detect cell changes early that could lead to cancer.
- The Cervical Screening Test checks the health of the cervix and looks for HPV and cell changes. It is recommended every 5 years for women aged 25-74 who are or have been sexually active.
- The test involves collecting a few cells from the cervix using a soft brush. It is a simple procedure that takes a few minutes and aims to detect cell changes early before they develop into cancer.
The document provides information for users of a flipchart on cervical cancer and cervical screening for different cultural communities. It includes topics such as what cancer and the cervix are, the causes of cervical cancer, how cervical cancer can be prevented through vaccination and screening, details on the cervical screening test procedure and results, and where to find more information. The flipchart is intended to be used by bilingual health workers to educate community members from different cultures about cervical screening.
The Cervical Screening Test involves a doctor or nurse inserting a lubricated plastic speculum to gently open the vagina, then using a soft brush to collect a few cells from the cervix which are placed in liquid and sent to a laboratory for testing to check for HPV and cell changes.
Staying well and preventing cancer: Community education flipchartCancer Institute NSW
One in three cancers can be prevented through healthy living behaviours.
The Cancer Institute NSW developed the Staying well and preventing cancer flipchart to support health or community workers/educators working with multicultural communities.
The flipchart uses simple text and illustrations to provide information about cancer prevention and healthy living behaviours.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
3. Aim
To describe the development of a treatment dashboard at
Illawarra Shoalhaven Cancer and Haematology Network
(ISCaHN)
4. Treatment Dashboard
The aim of the dashboard is to present data extracted in
real time from our Oncology Information System (OIS) that
is accessible and actionable for clinicians
This data can then be used to inform and support treatment
decisions
7. Foundation - RLS
Etheredge defined a rapid learning health care model as
one that generates as rapidly as possible the evidence
needed to deliver quality patient care 1
Users learn as much as possible as soon as possible
through the collection of data at the point of care that can
then be used to inform clinical care and service delivery
Whilst this model has been developed around the concept
of “big data”, it is also possible to apply it at a localised
level to achieve similar outcomes
1. Abernethy et al, 2010
9. Challenges for Big Data and RLS
Data correctness
Data completeness
Data consistency
Data storage
10.
11.
12. Development
Dashboard not developed in isolation
Result of experience from multiple extraction projects
including:
– CINSW Enhanced Medical Oncology Reporting Project
– Oncology Day Care Enhanced Scheduling Project
– Activity Based Funding Extract
– PROMPT care pilot project
13. Development
From lessons learnt in extract projects we were able to
develop an extract with relevant clinical data
This data is then displayed in a dashboard for clinicians to
access in a readable and accessible form
14.
15. Intake Data
You can only pull out what you've put in
Ensure quality and completeness of data
– Use of manual and automated QA's
– Regular staff training, education and support
Data needs to be accessible and actionable for clinicians
16.
17. Data Transformation and Aggregation
Treatment dashboard
Chemotherapy protocols – different protocols dependent
upon diagnosis, stage, co-morbidities
Gold standards in curative disease, greater variability in
palliative setting
Dash board not solely a tool for clinicians, we aim to
develop an option for patient viewing, so that they can be
walked through treatment options, empowering them in
their own treatment decision
24. Carboplatin/Gemcitabine in NSCLC
D1 or D8 Carboplatin?
Carboplatin combined with Gemcitabine has an established
role in the treatment of advanced NSCLC
In 2009 Crombie et al evaluated Two 21 day gemcitabine-
carboplatin schedules
Phase II study where 40 patients were given Gemcitabine
on D1 and Day 8 of a 21 day cycle, with patients being
randomized to having Carboplatin on either D1 or D8 of
their treatment
Results of the study showed that Carboplatin administered
on D8 resulted in lower dose intensity and more dose
delays
25. Carboplatin/Gemcitabine in NSCLC
D1 or D8 Carboplatin?
Based on the results of the Crombie study, eviQ
superseded their Carbo/Gem (D8 Carbo) protocol in July
2013, and left only the Carbo/Gem (D1 Carbo) protocol
approved
At ISCaHN, we had also made a similar change in practice
From January 2011 to March 2013 patients were
prescribed the Carboplatin/Gemcitabine protocol with D8
Carboplatin
From March 2013 the majority of patients were prescribed
Carboplatin/Gemcitabine, with carboplatin being delivered
on D1
27. Demographics
Carbo D1 Carbo D8
Carbo
D1
Carbo
D8
Sex Male % 70 45
Sex Female % 30 55
Stage III % 15 30
Stage IV % 85 70
Crombie et al
28. Results
Progressive disease on treatment comparison is possible
Average patients delayed per cycle comparison is possible
Crombie et al ISCaHN
D1 Carbo
n = 20 (%)
D8 Carbo
n = 20 (%)
D1 Carbo
n = 83 (%)
D8 Carbo
n = 97 (%)
7 (35) 8 (40) 33 (40) 38 (39%)
Crombie et al ISCaHN
D1 Carbo
n = 20 (%)
D8 Carbo
n = 20 (%)
D1 Carbo
n = 83 (%)
D8 Carbo
n = 97 (%)
2 (10) 4.75 (24) 23 (27) 40.7 (42)
29. Results
Toxicity comparison will be possible, still working on bugs
in the report and display of these
Unable to provide comparison for response rates as this is
currently poorly and/or not uniformly documented in day to
day clinical practice
Survival rates/time currently not calculated, but will be
possible in future
30. Dashboard Difficulties
Similar to large scale difficulties
– Incomplete data entry
– Inconsistent data entry
– Incorrect data entry
Survival outcomes, particularly for positive prognostic early
stage dx (breast, colon etc), requires lengthy time for
measurement of PFS rates and OS rates
31. Conclusion
Able to extract, aggregate and analyse data generated at
point of care to inform and optimise patient care
Ability to identify and measure patterns and trends in real
time
Visualisation of data enables rapid hypothesis generation
Possible to quickly compare treatment data with that from
published clinical trials
32. Conclusion
There are holes in the data – requires continued audit and
QA
Engage with staff, make the data presentable and
actionable, giving a reason for complete and correct data
entry
34. References
Abernethy AP, Etheredge LM, Ganz PA et al. Rapid-Learning System for Cancer Care.
Journal of Clinical Oncology. 2010;28(27): 4268-4274
Crombie C, Burns WI, Karapetis C, Lowenthal RM et al. Randomized phase II trial of
gemcitabine and either day 1 or day 8 carboplatin for advanced non-small-cell lung cancer: Is
thrombocytopenia predictable? Asia-Pacific Journal of Clinical Oncology 2009;5: 24-31
Editor's Notes
1
Treatment dashboard still at development stage – but feel it provides a good example of rapid learning, and hopefully gives people food for thought on some of the possibilities that this rapid learning/data visualisation may provide.
In conjunction with clinical trials and published literature
Today I’ll look to briefly discuss the foundation for the development of the dashboard
Then discuss development of the dashboard
Finally we’ll view the dashboard and view a few examples of how it can be utilised
So, at the foundation we have the framework of a rapid learning system, and the source of our data, where it’s all stored, the OIS
Etheredge defined….
So, uploading point of care data from multiple locations in large numbers to a central knowledge base
Aggregating data from multiple health records with clinical trials and published guidelines
Whilst this model has been developed around the concept of “big data”, it is also possible to apply it at a localised level to achieve similar outcomes
7
Whilst this shows great potential, I believe there are still real challenges for big data
Data correctness
Completeness
Consistency - Clinical trials have the ability to report strictly on tight definitions with additional staff and funding resources – this is not the norm in day to day clinical practice
Data storage - different locations in the same software at different sites, making multilateral data extraction time consuming and challenging
It is possible to mitigate these issues using computer intelligence, but issues remain
There are also other challenges for big data..
Like how he is going to step over this building without crushing innocent bystanders.
Here we have a Schema based on an ASCO CancerLinq slide on a RLS, and today I’d like to structure the development and production section of the talk around this
Firstly, I’d like to speak to the development or transformation and aggregation of data, and in particular, the visualisation of data
Then observe how the data visualisation facilitates the analysis of data
So what I’ll show you are basically pivot charts viewed in a dashboard. Perhaps they’re not that innovative. The novel step here is not in the presentation of the data. The novel step is the data extraction…..
Requires a broad skill set – an analyst/programmer with knowledge of the db and reporting nous; plus a clinician with extensive knowledge of clinical practice/process (click) and how this practice is recorded in the eMR software
So, with rapid learning as a foundation and an extract developed to provide us with the required data, what are some of the issues around development of a locally based RLS?
Age old adage garbage in, garbage out.
How do we ensure quality of data entered?
Manual and automated QA’s
Regular staff training
Most importantly, the data needs to accessible and actionable for the clinicians so that they can see the outcomes of their data entry
As Data from the Goonies proved, size in itself doesn’t matter – what matters is having the data, of whatever size, to assist in solving a problem or addressing a question we have
Combining our framework with our data intake, ISLHD cancer service have looked to use our data, routinely generated in delivery of care, to inform clinical care and service development
This has culminated in the development of the treatment dashboard
Whilst in it’s early stages, I believe it truly exhibits the potential that RLS holds at a local level
Chemotherapy is delivered in a set protocol….
Example of our clinical dashboard
Currently at proof of concept stage
Example of a relatively new drug for melanoma – Ipilimumab, and I think provides a good example of how the dashboard can be utilised
Drug showed promise for pts with stage 3 and 4 melanoma where treatment options were limited
(click) On the left hand side we have the number of patients (as a percentage) on the y axis – 39 patients delivered 1st cycle (with 4 unknown), and number of cycles on the x.
(click) In the middle with have toxicity grading
(click) On the right here we have demographics including Dx stage, Pt Age, Pt Gender and ECOG performance status
Ipilumumab is given for a total 4 cycles, every 3 weeks;
Ipilimumab costs $30,000 each cycle – at $157 per mg – To put that in perspective, that’s approximately 4,000 times the cost of gold….
In the real world PALLIATIVE setting (not the strict clinical trial setting, with strict guidelines on who can receive the drug), we felt anecdotally that there were:
High rates of toxicity and cessation of treatment due to toxicity;
Significant disease progression on treatment (with a high mortality rate);
The dashboard validated this (click). If we follow “delivered” treatment colours, we see the dramatic attrition rate, with a decreasing trend in the number of patients receiving treatment (39 pts in C1 to 18 pts in C4), and (click) an increasing number of discontinued treatments (just over 25%), with an unfortunately high mortality rate (just over 25%)
Exploring the dashboard further…
(click) On the left we can see in more detail the toxicity grading 0-3, with each column representing the grade of toxicity each cycle (this is still a work in progress)
(click) Can see N/A column which is to some extent, the level of incomplete data
(click) We can see some of the data aggregation where demographic data is used to filter to a specific patient, and this filters on both the assessments and treatment details
We also aim to introduce Patient Reported Side Effects/Outcomes - having different views dependent upon the individual accessing the information
Here is an example where we’ve aggregated the data to see only stage 4, male patents, aged between 60-69
So there are a few aspects of this data visualisation that I believe can play a role in clinical decision support.
1. We have treatment data from patients treated in the real life setting that can assist in guiding clinician judgement on perhaps who to treat and when to treat
2. Can we display the results differently for patient’s to view? Ask patients what they want to see, what would assist them in making a treatment decision.
3. Is there a trend to the subset of patients deceased during treatment that warrants further examination? Can we identify these patients earlier and perhaps palliate them more appropriately?
I’ve just mentioned data analysis. Now that we’ve seen the transformation and aggregation of data, let’s observe how the dashboard assists in data analysis
The next care plan I want to discuss in the dashboard setting is Carboplatin and Gemcitabine in Non Small Cell Lung Cancer.
The change in practice not only gave us an ability to compare the two treatment care plans, it also gave us the opportunity to compare with the published literature
The dashboard gives us an ability to quickly assess our own treatment details in comparison to published literature
In comparison to the literature (20 patients in each arm), here we have 83 patients receiving D1 Carboplatin and 97 patients receiving D8 carboplatin
You can also see that we have some data entry issues with unknown patients representing approximately 15% of total entries
There are also the issues around patients not being randomized and the analysis being retrospective, however, we have a much larger population of patients to analyse
Here we are able to compare the Crombie article demographics with our own
Genders are more evenly represented in both arms
Staging is different, particularly as a result of incomplete diagnosis data entry (i.e. the diagnosis staging was not completed)
We are able to quickly compare results between the literature and our own data
We have similar rates of progressive disease treatment
However, our average number of patients delayed is significantly higher in both arms – could be that the study had a much higher use of blood products to address neutropenia and thrombocytopenia
Contributing factors: staff workload, unintuitive software, lack of clinician buy in, data entry errors
Rapid learning requires choosing the correct outcomes to learn from (shorter outcomes – not long term)
Optimisation of patient care includes time, resources, and clinical decisions (e.g. number of staff required for clinical trials)
Anecdotal theories can quickly be visualised to determine if there is a trend worth investigating
Will never replace clinical trials, but can be used to support treatment decisions alongside clinical trial
Holes in data, but I believe we’ve proved that it can still be done despite weaknesses
Dashboard can be plugged into other sites with MOSAIQ OIS