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Browsing by Author "Haggstrom, David"
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Item Cancer reporting: timeliness analysis and process reengineering(2015-11-09) Jabour, Abdulrahman M.; Jones, Josette; Dixon, Brian; Haggstrom, David; Davide, BolchiniIntroduction: Cancer registries collect tumor-related data to monitor incident rates and support population-based research. A common concern with using population-based registry data for research is reporting timeliness. Data timeliness have been recognized as an important data characteristic by both the Centers for Disease Control and Prevention (CDC) and the Institute of Medicine (IOM). Yet, few recent studies in the United States (U.S.) have systemically measured timeliness. The goal of this research is to evaluate the quality of cancer data and examine methods by which the reporting process can be improved. The study aims are: 1- evaluate the timeliness of cancer cases at the Indiana State Department of Health (ISDH) Cancer Registry, 2- identify the perceived barriers and facilitators to timely reporting, and 3- reengineer the current reporting process to improve turnaround time. Method: For Aim 1: Using the ISDH dataset from 2000 to 2009, we evaluated the reporting timeliness and subtask within the process cycle. For Aim 2: Certified cancer registrars reporting for ISDH were invited to a semi-structured interview. The interviews were recorded and qualitatively analyzed. For Aim 3: We designed a reengineered workflow to minimize the reporting timeliness and tested it using simulation. Result: The results show variation in the mean reporting time, which ranged from 426 days in 2003 to 252 days in 2009. The barriers identified were categorized into six themes and the most common barrier was accessing medical records at external facilities. We also found that cases reside for a few months in the local hospital database while waiting for treatment data to become available. The recommended workflow focused on leveraging a health information exchange for data access and adding a notification system to inform registrars when new treatments are available.Item Communicating Critical Information to Cancer Survivors: an Assessment of Survivorship Care Plans in Use in Diverse Healthcare Settings(Springer, 2021) Lyson, Helena C.; Haggstrom, David; Bentz, Michael; Obeng-Gyasi, Samilia; Dixit, Niharika; Sarkar, Urmimala; Medicine, School of MedicinePurpose: Survivorship care plans (SCPs) serve to communicate critical information needed for cancer survivors’ long-term follow-up care. The extent to which SCPs are tailored to meet the specific needs of underserved patient populations is understudied. To fill this gap, this study aimed to assess the content and communication appropriateness of SCPs collected from diverse health care settings. Methods: We analyzed collected SCPs (n=16) for concordance with Institute of Medicine (IOM) recommendations for SCP content and for communication appropriateness using the Suitability Assessment of Materials (SAM) instrument. Results: All plans failed to incorporate all IOM criteria, with the majority of plans (n=11) incorporating less than 60% of recommended content. The average reading grade level of all the plans was 14, and only one plan received a superior rating for cultural appropriateness. Conclusion: There is significant variation in the format and content of SCPs used in diverse hospital settings and most plans are not written at an appropriate reading grade level nor tailored for underserved and/or minority patient populations. Implications for Cancer Survivors: Co-designing SCPs with diverse patient populations is crucial to ensure that these documents are meeting the needs and preferences of all cancer survivors.Item Contribution of patient, physician, and environmental factors to demographic and health variation in colonoscopy follow-up for abnormal colorectal cancer screening test results(Wiley, 2017-09-15) Partin, Melissa R.; Gravely, Amy; Burgess, James F., Jr.; Haggstrom, David; Lillie, Sarah E.; Nelson, David B.; Nugent, Sean; Shaukat, Aasma; Sultan, Shahnaz; Walter, Louise C.; Burgess, Diana J.; Medicine, School of MedicineBACKGROUND: Patient, physician, and environmental factors were identified, and the authors examined the contribution of these factors to demographic and health variation in colonoscopy follow-up after a positive fecal occult blood test/fecal immunochemical test (FOBT/FIT) screening. METHODS: In total, 76,243 FOBT/FIT-positive patients were identified from 120 Veterans Health Administration (VHA) facilities between August 16, 2009 and March 20, 2011 and were followed for 6 months. Patient demographic (race/ethnicity, sex, age, marital status) and health characteristics (comorbidities), physician characteristics (training level, whether primary care provider) and behaviors (inappropriate FOBT/FIT screening), and environmental factors (geographic access, facility type) were identified from VHA administrative records. Patient behaviors (refusal, private sector colonoscopy use) were estimated with statistical text mining conducted on clinic notes, and follow-up predictors and adjusted rates were estimated using hierarchical logistic regression. RESULTS: Roughly 50% of individuals completed a colonoscopy at a VHA facility within 6 months. Age and comorbidity score were negatively associated with follow-up. Blacks were more likely to receive follow-up than whites. Environmental factors attenuated but did not fully account for these differences. Patient behaviors (refusal, private sector colonoscopy use) and physician behaviors (inappropriate screening) fully accounted for the small reverse race disparity and attenuated variation by age and comorbidity score. Patient behaviors (refusal and private sector colonoscopy use) contributed more to variation in follow-up rates than physician behaviors (inappropriate screening). CONCLUSIONS: In the VHA, blacks are more likely to receive colonoscopy follow-up for positive FOBT/FIT results than whites, and follow-up rates markedly decline with advancing age and comorbidity burden. Patient and physician behaviors explain race variation in follow-up rates and contribute to variation by age and comorbidity burden. Cancer 2017;123:3502-12. Published 2017. This article is a US Government work and is in the public domain in the USA.Item Integrating Clinical Decision Support into Workflow(2011) Doebbeling, Bradley N.; Saleem, Jason; Haggstrom, David; Militello, Laura; Flanagan, Mindy; Arbuckle, Nicole; Kiess, Chris; Hoke, Shawn; Dexter, Paul; Linder, Jeff; Sarbah, Steedman; Burgo, LucillePurpose: The aims were to (1) identify barriers and facilitators related to integration of clinical decision support (CDS) into workflow and (2) develop and test CDS design alternatives. Scope: To better understand CDS integration, we studied its use in practice, focusing on CDS for colorectal cancer (CRC) screening and followup. Phase 1 involved outpatient clinics of four different systems—120 clinic staff and providers and 118 patients were observed. In Phase 2, prototyped design enhancements to the Veterans Administration’s CRC screening reminder were compared against its current reminder in a simulation experiment. Twelve providers participated. Methods: Phase 1 was a qualitative project, using key informant interviews, direct observation, opportunistic interviews, and focus groups. All data were analyzed using a coding template, based on the sociotechnical systems theory, which was modified as coding proceeded and themes emerged. Phase 2 consisted of rapid prototyping of CDS design alternatives based on Phase 1 findings and a simulation experiment to test these design changes in a within-subject comparison. Results: Very different CDS types existed across sites, yet there are common barriers: (1) lack of coordination of “outside” results and between primary and specialty care; (2) suboptimal data organization and presentation; (3) needed provider and patient education; (4) needed interface flexibility; (5) needed technological enhancements; (6) unclear role assignments; (7) organizational issues; and (8) disconnect with quality reporting. Design enhancements positively impacted usability and workflow integration but not workload. Conclusions: Effective CDS design and integration requires: (1) organizational and workflow integration; (2) integrating outside results; (3) improving data organization and presentation in a flexible interface; and (4) providing just-in time education, cognitive support, and quality reporting.Item Managing Health Care After Cancer Treatment: A Wellness Plan(Frontline Medical Communications, 2014-05-01) Moye, Jennifer; Langdon, Maura; Jones, Janice M.; Haggstrom, David; Naik, Aanand D.; Department of Medicine, IU School of MedicineMany patients and health care providers lack awareness of both the existence of, and treatments for, lingering distress and disability after treatment. A cancer survivorship wellness plan can help ensure that any referral needs for psychosocial and other restorative care after cancer treatment are identified.Item Oncologists' perspectives on post-cancer treatment communication and care coordination with primary care physicians(Wiley, 2017-07) Klabunde, Carrie N.; Haggstrom, David; Kahn, Katherine L.; Gray, Stacy W.; Kim, Benjamin; Liu, Benmei; Eisenstein, Jana; Keating, Nancy L.; Medicine, School of MedicinePost-treatment cancer care is often fragmented and of suboptimal quality. We explored factors that may affect cancer survivors' post-treatment care coordination, including oncologists' use of electronic technologies such as e-mail and integrated electronic health records (EHRs) to communicate with primary care physicians (PCPs). We used data from a survey (357 respondents; participation rate 52.9%) conducted in 2012-2013 among medical oncologists caring for patients in a large US study of cancer care delivery and outcomes. Oncologists reported their frequency and mode of communication with PCPs, and role in providing post-treatment care. Seventy-five per cent said that they directly communicated with PCPs about post-treatment status and care recommendations for all/most patients. Among those directly communicating with PCPs, 70% always/usually used written correspondence, while 36% always/usually used integrated EHRs; telephone and e-mail were less used. Eighty per cent reported co-managing with PCPs at least one post-treatment general medical care need. In multivariate-adjusted analyses, neither communication mode nor intensity were associated with co-managing survivors' care. Oncologists' reliance on written correspondence to communicate with PCPs may be a barrier to care coordination. We discuss new research directions for enhancing communication and care coordination between oncologists and PCPs, and to better meet the needs of cancer survivors post-treatment.Item Promoting common ground in a clinical setting: the impact of designing for the secondary user experience(2016-07-27) Tunnell, Harry D., IV; Bolchini, Davide; Faiola, Anthony; Doebbeling, Bradley; Haggstrom, DavidPrimary users can create a user experience (UX) for others—secondary users— when interacting with a system in public. Common ground occurs when people have certain knowledge in common and each knows that they have this shared understanding. This research investigates how designing for a secondary UX improves common ground during a patient-provider first encounter. During formative work, patients and providers participated in telephonic interviews and answered online questionnaires so that their respective information requirements for clinical encounters could be understood. The outcome of the formative work was a smartphone application prototype to be used as the treatment in an experimental study. In a mixed methods study, with a patient role-player using the prototype during a simulated clinical encounter with 12 providers, the impact of the prototype upon secondary user satisfaction and common ground was assessed. The main finding was that the prototype was capable of positively impacting secondary user satisfaction and facilitating common ground in certain instances. Combining the notions of human-computer interaction design, common ground, and smartphone technology improved the efficiency and effectiveness of providers during the simulated face-to-face first encounter with a patient. The investigation substantiated the notion that properly designed interactive systems have the potential to provide a satisfactory secondary UX and facilitate common ground.