Opening the black box: the impact of an oncology management program consisting of level I pathways and an outbound nurse call system.

PURPOSE: The Innovent Oncology Program aims to improve the value of cancer care delivered to patients. McKesson Specialty Health and Texas Oncology (TXO) collaborated with Aetna to launch a pilot program. The study objectives were to evaluate the impact of Innovent on Level I Pathway compliance, implement the Patient Support Services program, and measure the rate and costs associated with chemotherapy-related emergency room (ER) visits and hospital admissions. PATIENTS AND METHODS: This was a prospective, nonrandomized evaluation of patients enrolled in Innovent from June 1, 2010, through May 31, 2012. Data from the iKnowMed electronic health record, the McKesson Specialty Health financial data warehouse, and Aetna claims data warehouse were analyzed. RESULTS: A total of 221 patients were included and stratified according to disease and age groups; 76% of ordered regimens were on pathway; 24% were off pathway. Pathway adherence improved from TXO baseline adherence of 63%. Of the 221 patients, 81% enrolled in PSS. Within the breast, colorectal, and lung cancer groups, 14% and 24% of patients had an ER visit and in-patient admission (IPA; baseline) versus 10% and 18% in Innovent, respectively; average in-patient days decreased from 2.1 to 1.2 days, respectively. Total savings combined for the program was $506,481. CONCLUSION: Implementation of Innovent positively affected patient care in several ways: Fewer ER visits and IPAs occurred, in-patient days decreased, cancer-related use costs were reduced, and on-pathway adherence increased.

The Nature of Preschool Phonological Processing Abilities and Their Relations to Vocabulary, General Cognitive Abilities, and Print Knowledge.

The development of reading-related phonological processing abilities (PPA) represents an important developmental milestone in the process of learning to read. In this cross-sectional study, confirmatory factor analysis was used to examine the structure of PPA in 129 younger preschoolers (M = 40.88 months, SD = 4.65) and 304 older preschoolers (M = 56.49 months, SD = 5.31). A 2-factor model in which phonological awareness and phonological memory was represented by one factor and lexical access was represented by a second factor provided the best fit for both samples and was largely invariant across samples. Measures of vocabulary, cognitive abilities, and print knowledge were significantly correlated with both factors, but phonological awareness/memory had unique relations with word reading. Despite significant development of PPA across the preschool years and into kindergarten, these results show that the structure of these skills remains invariant.