Gochenour M

Introduction: The National Oncology Program office seeks to provide tools that can electronically capture data elements that can help VA facilities and programs assess the quality of cancer care being provided to veterans. Manual extraction of standards-of-care data from CPRS is resource intensive and difficult to sustain. This is particularly true for data elements embedded in large text fields such as progress notes.

Methods: Nine reminder dialogs were developed: treatment plan, treatment summary, multidisciplinary conference note (breast, prostate, colorectal), breast cancer, colorectal cancer,
symptom management tool, and an interval note. Each reminder dialogs include data elements that can be used to assess quality indicators (e.g., date of diagnosis, stage, performance status,  chemotherapy agents used, radiation therapy sites, start/stop dates, surgery types, and outcomes) that align with the Commission on Cancer guidelines and the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) standards.

To extract the data electronically, distinct health factors are embedded with each of the data elements. Sequential Query Language (SQL) software is used to extract these health factors from the Corporate Data Warehouse. SQL code can be run as a script to update data iteratively (e.g., every 24 hours), thus eliminating manual data extractions.

Results: The reminder dialogs have undergone or will undergo formal usability testing (UT) prior to national release in fall 2016. The UT participants were selected because they are potential end users, and their input is vital to ensuring the dialogs follows current workflow.

Key improvements were made based upon the UT feedback. The breast cancer reminder dialog had additional surgery types added and a section to document why chemotherapy and radiation standards of care were not followed (patient refusal and contraindicated). Every date field in all 9 reminder dialogs was changed to facilitate ease of data entry.

Conclusion: Reminder dialogs provide a standardized documentation tool for QOPI oncology programs. SQL software provides a mechanism for streamlining QOPI data reporting. Both provide a way for VA to monitor cancer quality care in VA.

Introduction: The National Oncology Program office seeks to provide tools that can electronically capture data elements that can help VA facilities and programs assess the quality of cancer care being provided to veterans. Manual extraction of standards-of-care data from CPRS is resource intensive and difficult to sustain. This is particularly true for data elements embedded in large text fields such as progress notes.

Methods: Nine reminder dialogs were developed: treatment plan, treatment summary, multidisciplinary conference note (breast, prostate, colorectal), breast cancer, colorectal cancer,
symptom management tool, and an interval note. Each reminder dialogs include data elements that can be used to assess quality indicators (e.g., date of diagnosis, stage, performance status,  chemotherapy agents used, radiation therapy sites, start/stop dates, surgery types, and outcomes) that align with the Commission on Cancer guidelines and the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) standards.

To extract the data electronically, distinct health factors are embedded with each of the data elements. Sequential Query Language (SQL) software is used to extract these health factors from the Corporate Data Warehouse. SQL code can be run as a script to update data iteratively (e.g., every 24 hours), thus eliminating manual data extractions.

Results: The reminder dialogs have undergone or will undergo formal usability testing (UT) prior to national release in fall 2016. The UT participants were selected because they are potential end users, and their input is vital to ensuring the dialogs follows current workflow.

Key improvements were made based upon the UT feedback. The breast cancer reminder dialog had additional surgery types added and a section to document why chemotherapy and radiation standards of care were not followed (patient refusal and contraindicated). Every date field in all 9 reminder dialogs was changed to facilitate ease of data entry.

Conclusion: Reminder dialogs provide a standardized documentation tool for QOPI oncology programs. SQL software provides a mechanism for streamlining QOPI data reporting. Both provide a way for VA to monitor cancer quality care in VA.

Introduction: The National Oncology Program office seeks to provide tools that can electronically capture data elements that can help VA facilities and programs assess the quality of cancer care being provided to veterans. Manual extraction of standards-of-care data from CPRS is resource intensive and difficult to sustain. This is particularly true for data elements embedded in large text fields such as progress notes.

Methods: Nine reminder dialogs were developed: treatment plan, treatment summary, multidisciplinary conference note (breast, prostate, colorectal), breast cancer, colorectal cancer,
symptom management tool, and an interval note. Each reminder dialogs include data elements that can be used to assess quality indicators (e.g., date of diagnosis, stage, performance status,  chemotherapy agents used, radiation therapy sites, start/stop dates, surgery types, and outcomes) that align with the Commission on Cancer guidelines and the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) standards.

To extract the data electronically, distinct health factors are embedded with each of the data elements. Sequential Query Language (SQL) software is used to extract these health factors from the Corporate Data Warehouse. SQL code can be run as a script to update data iteratively (e.g., every 24 hours), thus eliminating manual data extractions.

Results: The reminder dialogs have undergone or will undergo formal usability testing (UT) prior to national release in fall 2016. The UT participants were selected because they are potential end users, and their input is vital to ensuring the dialogs follows current workflow.

Key improvements were made based upon the UT feedback. The breast cancer reminder dialog had additional surgery types added and a section to document why chemotherapy and radiation standards of care were not followed (patient refusal and contraindicated). Every date field in all 9 reminder dialogs was changed to facilitate ease of data entry.

Conclusion: Reminder dialogs provide a standardized documentation tool for QOPI oncology programs. SQL software provides a mechanism for streamlining QOPI data reporting. Both provide a way for VA to monitor cancer quality care in VA.

Introduction: Cancer patients experience a variety of symptoms, which can be measured and documented using the VSAS (VA Symptom Assessment Scale) in CPRS.We recently developed VAST (VA Symptom Management Tool ) to create and document symptom management plans. We describe 3 VAST templates that address pain, constipation, and distress, and outline initial VAST implementation results.

Methods: We retrospectively identified a cohort in the Durham VA Hematology/Oncology clinic. The cohort was limited to patients with moderate to severe symptoms, rated at scores of ≥ 4 (0 – 10 scale with 10 = most severe). We evaluated pain, constipation, and distress VSAS pre- and post-VAST, evaluating mean values and using the paired t-test. A control cohort consisted of patients with VSAS scores of ≥ 4 for the same symptoms, but for which no VAST plan was documented.

Results: Between 11/16/15 and 6/14/16, we identified 78, 36, and 76 Veterans with moderate to severe pain, distress, and constipation, respectively. The mean number of days between the pre-VAST and post-VAST documentation was 36, 29, and 55 for pain, distress, and constipation. Pre-VAST and post-VAST mean scores were 6.42 and 3.82 for pain (P < .0001, 41% reduction), 6.28 and 4.81 for distress (P = .006, 23% reduction), and 6.38 and 3.96 for constipation (P < .0001, 38% reduction). In the control cohort, 542, 243, and 315 Veterans had pain, distress, and constipation scores documented in the same time frame. The mean number of days between the first and second VSAS score documentation were 122, 62, and 119 for pain, distress, and constipation. In the control cohort, pain scores fell from 6.41 to 4.87 (24% reduction), distress scores fell from 6.63 to 4.63 (30% reduction), and constipation scores fell from 6.21 to 4.27 (31% reduction).

Discussion: The VAST is a tool to document and address cancer-related symptom management using a template form, so data can be extracted from the CDW for quality assessment and improvement. VAST may improve the management of and the severity of cancer-related symptoms. Future plans include development of other VAST symptom templates and integration of VAST with nationally used oncology quality measurement tools, such as ASCO QOPI.

Introduction: Cancer patients experience a variety of symptoms, which can be measured and documented using the VSAS (VA Symptom Assessment Scale) in CPRS.We recently developed VAST (VA Symptom Management Tool ) to create and document symptom management plans. We describe 3 VAST templates that address pain, constipation, and distress, and outline initial VAST implementation results.

Methods: We retrospectively identified a cohort in the Durham VA Hematology/Oncology clinic. The cohort was limited to patients with moderate to severe symptoms, rated at scores of ≥ 4 (0 – 10 scale with 10 = most severe). We evaluated pain, constipation, and distress VSAS pre- and post-VAST, evaluating mean values and using the paired t-test. A control cohort consisted of patients with VSAS scores of ≥ 4 for the same symptoms, but for which no VAST plan was documented.

Results: Between 11/16/15 and 6/14/16, we identified 78, 36, and 76 Veterans with moderate to severe pain, distress, and constipation, respectively. The mean number of days between the pre-VAST and post-VAST documentation was 36, 29, and 55 for pain, distress, and constipation. Pre-VAST and post-VAST mean scores were 6.42 and 3.82 for pain (P < .0001, 41% reduction), 6.28 and 4.81 for distress (P = .006, 23% reduction), and 6.38 and 3.96 for constipation (P < .0001, 38% reduction). In the control cohort, 542, 243, and 315 Veterans had pain, distress, and constipation scores documented in the same time frame. The mean number of days between the first and second VSAS score documentation were 122, 62, and 119 for pain, distress, and constipation. In the control cohort, pain scores fell from 6.41 to 4.87 (24% reduction), distress scores fell from 6.63 to 4.63 (30% reduction), and constipation scores fell from 6.21 to 4.27 (31% reduction).

Discussion: The VAST is a tool to document and address cancer-related symptom management using a template form, so data can be extracted from the CDW for quality assessment and improvement. VAST may improve the management of and the severity of cancer-related symptoms. Future plans include development of other VAST symptom templates and integration of VAST with nationally used oncology quality measurement tools, such as ASCO QOPI.

Introduction: Cancer patients experience a variety of symptoms, which can be measured and documented using the VSAS (VA Symptom Assessment Scale) in CPRS.We recently developed VAST (VA Symptom Management Tool ) to create and document symptom management plans. We describe 3 VAST templates that address pain, constipation, and distress, and outline initial VAST implementation results.

Methods: We retrospectively identified a cohort in the Durham VA Hematology/Oncology clinic. The cohort was limited to patients with moderate to severe symptoms, rated at scores of ≥ 4 (0 – 10 scale with 10 = most severe). We evaluated pain, constipation, and distress VSAS pre- and post-VAST, evaluating mean values and using the paired t-test. A control cohort consisted of patients with VSAS scores of ≥ 4 for the same symptoms, but for which no VAST plan was documented.

Results: Between 11/16/15 and 6/14/16, we identified 78, 36, and 76 Veterans with moderate to severe pain, distress, and constipation, respectively. The mean number of days between the pre-VAST and post-VAST documentation was 36, 29, and 55 for pain, distress, and constipation. Pre-VAST and post-VAST mean scores were 6.42 and 3.82 for pain (P < .0001, 41% reduction), 6.28 and 4.81 for distress (P = .006, 23% reduction), and 6.38 and 3.96 for constipation (P < .0001, 38% reduction). In the control cohort, 542, 243, and 315 Veterans had pain, distress, and constipation scores documented in the same time frame. The mean number of days between the first and second VSAS score documentation were 122, 62, and 119 for pain, distress, and constipation. In the control cohort, pain scores fell from 6.41 to 4.87 (24% reduction), distress scores fell from 6.63 to 4.63 (30% reduction), and constipation scores fell from 6.21 to 4.27 (31% reduction).

Discussion: The VAST is a tool to document and address cancer-related symptom management using a template form, so data can be extracted from the CDW for quality assessment and improvement. VAST may improve the management of and the severity of cancer-related symptoms. Future plans include development of other VAST symptom templates and integration of VAST with nationally used oncology quality measurement tools, such as ASCO QOPI.