Delivery of Quality Oncology Care in a Large, Urban Practice: A Primer.

A comprehensive quality improvement program is critically important for participation in value-based reimbursement models. Seven essential characteristics must be addressed in the development of a cancer-focused quality program. These include leadership, environment, engagement, ethos, metrics, accountability, and sustainability (Q=LE3MAS). This article describes how to address each essential characteristic and provides examples from the experience at Mount Sinai Hospital, a large, urban, academic hospital/health system in New York City.

Implementation of electronic chemotherapy ordering: an opportunity to improve evidence-based oncology care.

PURPOSE: The degree to which electronic health records (EHRs) enhance the quality of patient care depends on use of the system to monitor and improve practice. In planning the transition to Epic's Beacon electronic chemotherapy ordering platform, we saw an opportunity to measure our performance and increase evidence-based practice. METHODS: Advanced planning began 2 years before implementation and included formation of a chemotherapy council charged with reviewing references and approving each chemotherapy protocol; a readiness assessment; design of electronic flow-sheet adherent with Oncology Nursing Society guidelines. To monitor use of evidence-based treatments, we created a novel quality metric: the rate of evidence-based adherence (REBA). RESULTS: A full infusion schedule was maintained through implementation, with a transient 1-month increase in wait time. Our overall REBA of 0.86 significantly exceeded our prespecified goal of 0.80 (P = .001). REBA varied from 0.50 to 0.95 between disease groups. Antiemetic use increased by 20% after Beacon implementation. Provider satisfaction at 8 months ranged from 76% to 80%. CONCLUSION: The transition to electronic chemotherapy ordering offers an institution the chance to develop evidence-based oncology practice, standardize supportive care, and enhance patient safety. The key elements that made our transition so successful were (1) extensive involvement of oncology leadership, (2) use of a chemotherapy council to enforce evidence-based practice, (3) ongoing collaboration between clinical operations and information technology. Finally, the REBA is a powerful tool to monitor adherence to evidence-based chemotherapy prescribing.

Authors' Submission Toolkit: a practical guide to getting your research published.

Biomedical journals and the pharmaceutical industry share the goals of enhancing transparency and expanding access to peer-reviewed research; both industries have recently instituted new policies and guidelines to effect this change. However, while increasing transparency may elevate standards and bring benefits to readers, it will drive a significant increase in manuscript volume, posing challenges to both the journals and industry sponsors. As a result, there is a need to: (1) increase efficiency in the submission process to accommodate the rising manuscript volume and reduce the resource demands on journals, peer reviewers, and authors; and (2) identify suitable venues to publish this research. These shared goals can only be accomplished through close collaboration among stakeholders in the process.In an effort to foster mutual collaboration, members of the pharmaceutical industry and the International Society for Medical Publication Professionals founded a unique collaborative venture in 2008 - the Medical Publishing Insights and Practices initiative (MPIP). At an MPIP roundtable meeting in September 2009,journal editors, publishers and industry representatives identified and prioritized opportunities to streamline the submission process and requirements, and to support prompt publication and dissemination of clinical trial results in the face of increasing manuscript volume. Journal and sponsor participants agreed that more author education on manuscript preparation and submission was needed to increase efficiency and enhance quality and transparency in the publication of industry-sponsored research. They suggested an authors'guide to help bridge the gap between author practices and editor expectations.To address this unmet educational need, MPIP supported development of an Authors' Submission Toolkit to compile best practices in the preparation and submission of manuscripts describing sponsored research.The Toolkit represents a unique collaboration between the pharmaceutical industry and biomedical journals,and reflects both groups' perspectives on how authors can help raise standards and increase efficiency in publishing industry-sponsored studies. The information provided in the toolkit can be useful to help authors navigate the manuscript