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VHA-Wide Automated Assessment of EGFR Mutation Testing in Advanced Stage, Non-Squamous, Non-Small Cell Lung Cancer (nsNSCLC)
Purpose: To assess feasibility of implementing an automated method to identify patients who should have EGFR testing, and whether they have been tested, as a tool for quality improvement.
Background: Approximately 7% of veterans with metastatic, nsNSCLC have sensitizing mutation of EGFR, which predicts sensitivity to oral EGFR inhibitors. Prior studies have shown under testing for EGFR mutations in this population in VHA.
Methods: An endorsed quality measure (NQF and ASCO) for EGFR testing was utilized. Data to implement the measure were extracted from the cancer registry (ONC RAW), problem and encounter ICD codes, national oncology note template-generated health factors, laboratory test results, National Precision Oncology Program NGS testing, vital status, and pharmacy drug file to populate a SQL database. A dashboard in SharePoint allowed users to retrieve data based on national data access permissions. Descriptive statistics were used.
Results: The initial algorithm implementation was evaluated by comparison to manual review of patient records from one medical center. The second generation algorithm was then evaluated in the same manner at a second medical center (MC2). Among 117 cases identified during 2018, 68 (58%) were identified as having been tested and 49 (42%) not tested (31 living and 18 deceased patients). 48 of the non-tested samples were reviewed: 28 had not been tested, 14 had data documentation or coding problems (11 correctable by using the national note template), 1 correctable limitation of the national note template, and 5 limitations of the algorithm (all but 1 of which has been corrected). For stage 3 and stage VA-wide, there were 871 and 2832 cases, respectively, with documented testing rates of 26% and 36%, and a facility testing rate range of 0% to 100%.
Implications: The EGFR testing dashboard, in conjunction with appropriate structured documentation, has high accuracy of EGFR testing in patients with metastatic nsNSCLC. Current documented testing rates vary widely with a low system-wide rate, that can be improved through utilization of the dashboard.
Purpose: To assess feasibility of implementing an automated method to identify patients who should have EGFR testing, and whether they have been tested, as a tool for quality improvement.
Background: Approximately 7% of veterans with metastatic, nsNSCLC have sensitizing mutation of EGFR, which predicts sensitivity to oral EGFR inhibitors. Prior studies have shown under testing for EGFR mutations in this population in VHA.
Methods: An endorsed quality measure (NQF and ASCO) for EGFR testing was utilized. Data to implement the measure were extracted from the cancer registry (ONC RAW), problem and encounter ICD codes, national oncology note template-generated health factors, laboratory test results, National Precision Oncology Program NGS testing, vital status, and pharmacy drug file to populate a SQL database. A dashboard in SharePoint allowed users to retrieve data based on national data access permissions. Descriptive statistics were used.
Results: The initial algorithm implementation was evaluated by comparison to manual review of patient records from one medical center. The second generation algorithm was then evaluated in the same manner at a second medical center (MC2). Among 117 cases identified during 2018, 68 (58%) were identified as having been tested and 49 (42%) not tested (31 living and 18 deceased patients). 48 of the non-tested samples were reviewed: 28 had not been tested, 14 had data documentation or coding problems (11 correctable by using the national note template), 1 correctable limitation of the national note template, and 5 limitations of the algorithm (all but 1 of which has been corrected). For stage 3 and stage VA-wide, there were 871 and 2832 cases, respectively, with documented testing rates of 26% and 36%, and a facility testing rate range of 0% to 100%.
Implications: The EGFR testing dashboard, in conjunction with appropriate structured documentation, has high accuracy of EGFR testing in patients with metastatic nsNSCLC. Current documented testing rates vary widely with a low system-wide rate, that can be improved through utilization of the dashboard.
Purpose: To assess feasibility of implementing an automated method to identify patients who should have EGFR testing, and whether they have been tested, as a tool for quality improvement.
Background: Approximately 7% of veterans with metastatic, nsNSCLC have sensitizing mutation of EGFR, which predicts sensitivity to oral EGFR inhibitors. Prior studies have shown under testing for EGFR mutations in this population in VHA.
Methods: An endorsed quality measure (NQF and ASCO) for EGFR testing was utilized. Data to implement the measure were extracted from the cancer registry (ONC RAW), problem and encounter ICD codes, national oncology note template-generated health factors, laboratory test results, National Precision Oncology Program NGS testing, vital status, and pharmacy drug file to populate a SQL database. A dashboard in SharePoint allowed users to retrieve data based on national data access permissions. Descriptive statistics were used.
Results: The initial algorithm implementation was evaluated by comparison to manual review of patient records from one medical center. The second generation algorithm was then evaluated in the same manner at a second medical center (MC2). Among 117 cases identified during 2018, 68 (58%) were identified as having been tested and 49 (42%) not tested (31 living and 18 deceased patients). 48 of the non-tested samples were reviewed: 28 had not been tested, 14 had data documentation or coding problems (11 correctable by using the national note template), 1 correctable limitation of the national note template, and 5 limitations of the algorithm (all but 1 of which has been corrected). For stage 3 and stage VA-wide, there were 871 and 2832 cases, respectively, with documented testing rates of 26% and 36%, and a facility testing rate range of 0% to 100%.
Implications: The EGFR testing dashboard, in conjunction with appropriate structured documentation, has high accuracy of EGFR testing in patients with metastatic nsNSCLC. Current documented testing rates vary widely with a low system-wide rate, that can be improved through utilization of the dashboard.
Use of the Community Needs Assessment (CNA) to Identify Barriers and Improve Access to Cancer Care for Veterans
Purpose: To disseminate information regarding The American College of Surgeons Commission on Cancer (ACOS COC) requirements of Patient Navigation that can be used across VAMCs.
Background: The ACOS COC requires that each facility determine a patient navigation process. The process must focus on a barrier to care identified within a Community Needs Assessment (CNA) that is administered at least every 3 years. From the results of the CNA, a patient navigation process can be developed to address patient, provider, or system barriers to care. These results are also presented to the Cancer Committee (CC) to compile a report summarizing the findings and implementing a plan to improve the quality of cancer care delivered.
Methods: A CNA questionnaire was reviewed by an interdisciplinary group consisting of oncology social worker, oncology psychologist, medical oncologist, survivorship advanced practice nurse, 3 oncology nurse care coordinators and the Cancer Center Program Administrator. The questionnaire was formatted for ease of reading and comprehension. The group presented the CNA questionnaire to the CC for review and approval. The questionnaire was distributed and completed by Veteran’s at varying stages along the cancer trajectory.
Data Analysis: The questionnaire was distributed and completed by 50 Veterans from Feb 2014-Sept 2014. The questionnaires were distributed and collected in the chemotherapy infusion clinic, during outpatient clinic visits, and during the Louis Stokes Cleveland VAMC (LSCVAMC) annual Cancer Fair.
Results: The top rated concern was found to be travel. According the National Cancer Data Base (NCDB) generated in May 2015 shows that from the years of 2007-2012, 34% of Veterans receiving their care at the LSCVAMC traveled between 50-99 miles to receive their cancer care. The data were presented to the CC, and plans were made to further look at travel resources and community services available to our Veterans. A comprehensive report addressing resources was compiled and presented to the CC.
Implications: Identifying and breaking down barriers to transportation is vital to improving access to Veteran’s cancer care.
Purpose: To disseminate information regarding The American College of Surgeons Commission on Cancer (ACOS COC) requirements of Patient Navigation that can be used across VAMCs.
Background: The ACOS COC requires that each facility determine a patient navigation process. The process must focus on a barrier to care identified within a Community Needs Assessment (CNA) that is administered at least every 3 years. From the results of the CNA, a patient navigation process can be developed to address patient, provider, or system barriers to care. These results are also presented to the Cancer Committee (CC) to compile a report summarizing the findings and implementing a plan to improve the quality of cancer care delivered.
Methods: A CNA questionnaire was reviewed by an interdisciplinary group consisting of oncology social worker, oncology psychologist, medical oncologist, survivorship advanced practice nurse, 3 oncology nurse care coordinators and the Cancer Center Program Administrator. The questionnaire was formatted for ease of reading and comprehension. The group presented the CNA questionnaire to the CC for review and approval. The questionnaire was distributed and completed by Veteran’s at varying stages along the cancer trajectory.
Data Analysis: The questionnaire was distributed and completed by 50 Veterans from Feb 2014-Sept 2014. The questionnaires were distributed and collected in the chemotherapy infusion clinic, during outpatient clinic visits, and during the Louis Stokes Cleveland VAMC (LSCVAMC) annual Cancer Fair.
Results: The top rated concern was found to be travel. According the National Cancer Data Base (NCDB) generated in May 2015 shows that from the years of 2007-2012, 34% of Veterans receiving their care at the LSCVAMC traveled between 50-99 miles to receive their cancer care. The data were presented to the CC, and plans were made to further look at travel resources and community services available to our Veterans. A comprehensive report addressing resources was compiled and presented to the CC.
Implications: Identifying and breaking down barriers to transportation is vital to improving access to Veteran’s cancer care.
Purpose: To disseminate information regarding The American College of Surgeons Commission on Cancer (ACOS COC) requirements of Patient Navigation that can be used across VAMCs.
Background: The ACOS COC requires that each facility determine a patient navigation process. The process must focus on a barrier to care identified within a Community Needs Assessment (CNA) that is administered at least every 3 years. From the results of the CNA, a patient navigation process can be developed to address patient, provider, or system barriers to care. These results are also presented to the Cancer Committee (CC) to compile a report summarizing the findings and implementing a plan to improve the quality of cancer care delivered.
Methods: A CNA questionnaire was reviewed by an interdisciplinary group consisting of oncology social worker, oncology psychologist, medical oncologist, survivorship advanced practice nurse, 3 oncology nurse care coordinators and the Cancer Center Program Administrator. The questionnaire was formatted for ease of reading and comprehension. The group presented the CNA questionnaire to the CC for review and approval. The questionnaire was distributed and completed by Veteran’s at varying stages along the cancer trajectory.
Data Analysis: The questionnaire was distributed and completed by 50 Veterans from Feb 2014-Sept 2014. The questionnaires were distributed and collected in the chemotherapy infusion clinic, during outpatient clinic visits, and during the Louis Stokes Cleveland VAMC (LSCVAMC) annual Cancer Fair.
Results: The top rated concern was found to be travel. According the National Cancer Data Base (NCDB) generated in May 2015 shows that from the years of 2007-2012, 34% of Veterans receiving their care at the LSCVAMC traveled between 50-99 miles to receive their cancer care. The data were presented to the CC, and plans were made to further look at travel resources and community services available to our Veterans. A comprehensive report addressing resources was compiled and presented to the CC.
Implications: Identifying and breaking down barriers to transportation is vital to improving access to Veteran’s cancer care.
The Veteran Symptom Assessment Screen (VSAS) as an Alternate for the National Comprehensive Cancer Network (NCNDT) Distress Thermometer
Purpose: To utilize a distress screening tool that can be used across VAMCs that fulfills cancer center requirements and accreditation standards.
Background: The American College of Surgeon’s (ACOS) Commission on Cancer (COC), Standard 3.2 Distress Screening requires all new cancer diagnoses be screened at diagnosis and at pivotal points across the cancer care continuum. The Louis Stokes Cleveland VAMC (LSCVAMC) used the NCCN DT from May 2012 through March 2016. Collaborating with the Durham VAMC, the LSCVAMC began to pilot the VSAS screening tool in place of the NCCN DT. This initiative was an attempt to use 1 tool that could satisfy both ACOS COC accreditation standards as well as the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) Certification.
Methods: An interdisciplinary team composed of an oncology social worker, oncology psychologist, medical oncologist, survivorship advanced practice nurse and the Cancer Center Program Administrator gathered to compare elements of both the NCCN DT and the VSAS tool. Social elements of distress related to transportation, housing and insurance deemed important to our veteran population were incorporated into the existing VSAS tool.
Data Analysis: During March through June 2016 there have been 47 VSAS tools completed on 47 unique patients. Nursing staff administer, document, and order applicable consults for the screening process. The time required to complete the screen is approximately 2-4 minutes depending on the complexity of the patient. Preliminary data regarding specific elements of the VSAS will be forthcoming at the time of poster presentation.
Results: Patients with a new diagnosis of cancer were asked to complete the form at their initial visit. Initial results from the team piloting the VSAS found that the tool actually allowed providers to hone in on more of the areas that were causing the Veteran the most distress. Whereas, with DT only having 1 thermometer made narrowing down what was causing the most distress more difficult.
Implications: Finding tools that can be implemented across VA facilities for both COC and QOPI initiatives will streamline processes and allow for multicenter data collection benefiting the VA as a whole and decreasing variability in cancer care between facilities.
Purpose: To utilize a distress screening tool that can be used across VAMCs that fulfills cancer center requirements and accreditation standards.
Background: The American College of Surgeon’s (ACOS) Commission on Cancer (COC), Standard 3.2 Distress Screening requires all new cancer diagnoses be screened at diagnosis and at pivotal points across the cancer care continuum. The Louis Stokes Cleveland VAMC (LSCVAMC) used the NCCN DT from May 2012 through March 2016. Collaborating with the Durham VAMC, the LSCVAMC began to pilot the VSAS screening tool in place of the NCCN DT. This initiative was an attempt to use 1 tool that could satisfy both ACOS COC accreditation standards as well as the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) Certification.
Methods: An interdisciplinary team composed of an oncology social worker, oncology psychologist, medical oncologist, survivorship advanced practice nurse and the Cancer Center Program Administrator gathered to compare elements of both the NCCN DT and the VSAS tool. Social elements of distress related to transportation, housing and insurance deemed important to our veteran population were incorporated into the existing VSAS tool.
Data Analysis: During March through June 2016 there have been 47 VSAS tools completed on 47 unique patients. Nursing staff administer, document, and order applicable consults for the screening process. The time required to complete the screen is approximately 2-4 minutes depending on the complexity of the patient. Preliminary data regarding specific elements of the VSAS will be forthcoming at the time of poster presentation.
Results: Patients with a new diagnosis of cancer were asked to complete the form at their initial visit. Initial results from the team piloting the VSAS found that the tool actually allowed providers to hone in on more of the areas that were causing the Veteran the most distress. Whereas, with DT only having 1 thermometer made narrowing down what was causing the most distress more difficult.
Implications: Finding tools that can be implemented across VA facilities for both COC and QOPI initiatives will streamline processes and allow for multicenter data collection benefiting the VA as a whole and decreasing variability in cancer care between facilities.
Purpose: To utilize a distress screening tool that can be used across VAMCs that fulfills cancer center requirements and accreditation standards.
Background: The American College of Surgeon’s (ACOS) Commission on Cancer (COC), Standard 3.2 Distress Screening requires all new cancer diagnoses be screened at diagnosis and at pivotal points across the cancer care continuum. The Louis Stokes Cleveland VAMC (LSCVAMC) used the NCCN DT from May 2012 through March 2016. Collaborating with the Durham VAMC, the LSCVAMC began to pilot the VSAS screening tool in place of the NCCN DT. This initiative was an attempt to use 1 tool that could satisfy both ACOS COC accreditation standards as well as the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) Certification.
Methods: An interdisciplinary team composed of an oncology social worker, oncology psychologist, medical oncologist, survivorship advanced practice nurse and the Cancer Center Program Administrator gathered to compare elements of both the NCCN DT and the VSAS tool. Social elements of distress related to transportation, housing and insurance deemed important to our veteran population were incorporated into the existing VSAS tool.
Data Analysis: During March through June 2016 there have been 47 VSAS tools completed on 47 unique patients. Nursing staff administer, document, and order applicable consults for the screening process. The time required to complete the screen is approximately 2-4 minutes depending on the complexity of the patient. Preliminary data regarding specific elements of the VSAS will be forthcoming at the time of poster presentation.
Results: Patients with a new diagnosis of cancer were asked to complete the form at their initial visit. Initial results from the team piloting the VSAS found that the tool actually allowed providers to hone in on more of the areas that were causing the Veteran the most distress. Whereas, with DT only having 1 thermometer made narrowing down what was causing the most distress more difficult.
Implications: Finding tools that can be implemented across VA facilities for both COC and QOPI initiatives will streamline processes and allow for multicenter data collection benefiting the VA as a whole and decreasing variability in cancer care between facilities.
