The Experts below are selected from a list of 150660 Experts worldwide ranked by ideXlab platform
Monica Krishnan - One of the best experts on this subject based on the ideXlab platform.
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impact of a Clinical Pathway tool on appropriate palliative radiation therapy for bone metastases
Practical radiation oncology, 2017Co-Authors: Lisa S Rotenstein, Alexander O Kerman, J Killoran, Tracy A Balboni, Monica KrishnanAbstract:Abstract Purpose Clinical Pathways increase compliance with treatment guidelines, improve outcomes, and reduce costs. Guidelines recommend single fraction radiation therapy (SFRT) for palliation of uncomplicated bone metastases, but implementation is variable. We examined the effects of a Pathway tool on SFRT rates in an academic radiation oncology practice. Methods and materials Using published literature, Clinical guidelines, and expert input, we designed a Clinical Pathway for bone metastases radiation therapy displayed on a Web-based electronic interface. In March 2016, the Pathway launched on a palliative radiation service at the Dana Farber/Brigham and Women's Cancer Center main campus and at affiliated community sites. Providers were surveyed pre- and postimplementation to assess expectations and elicit feedback. Rates of Pathway utilization, compliance with SFRT recommendations, and reasons for noncompliance were assessed. Results The final Pathway includes 20 endpoints and several validated prognostic scoring systems. It was used in 38% of 723 bone metastases radiation prescriptions, with appropriate SFRT rates rising from 18% before implementation to 48% after launch (P Conclusions Our experience demonstrates the utility of Clinical Pathway decision support for bone metastases radiation in complex academic settings. Next steps include increasing the Pathway's ease of use, refining the Pathway's prognostic abilities, and measuring cost savings related to the Pathway.
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development and implementation of a Clinical Pathway for radiation of bone metastases on a palliative radiation oncology service
Journal of Clinical Oncology, 2016Co-Authors: Lisa S Rotenstein, J Killoran, Tracy A Balboni, Monica Krishnan, Allison Taylor, Neil E MartinAbstract:170 Background: Clinical Pathways increase compliance with treatment guidelines and reduce in-hospital complications. Evidence around treatment of complicated bone metastases is increasingly nuanced and although ASTRO/ACR recommend single fraction radiation therapy for uncomplicated bone metastases, implementation is variable. We sought to determine the effects of a bone metastases-focused Clinical Pathway on the practice patterns of our institution’s palliative radiation oncology service (SPRO), which sees 600 patients yearly and on a rotating basis, involves 23 physicians, 28 residents, 2 nurse practitioners, and 1 fellow. We hypothesized that Pathway implementation would augment data-driven use of palliative radiation for bone metastases, including use of 8 Gy x 1 for uncomplicated metastases. It would also enhance physician efficiency and confidence. Methods: Using published literature, Clinical guidelines, and expert input, we designed a comprehensive Clinical Pathway for bone metastases radiation. T...
Lisa S Rotenstein - One of the best experts on this subject based on the ideXlab platform.
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impact of a Clinical Pathway tool on appropriate palliative radiation therapy for bone metastases
Practical radiation oncology, 2017Co-Authors: Lisa S Rotenstein, Alexander O Kerman, J Killoran, Tracy A Balboni, Monica KrishnanAbstract:Abstract Purpose Clinical Pathways increase compliance with treatment guidelines, improve outcomes, and reduce costs. Guidelines recommend single fraction radiation therapy (SFRT) for palliation of uncomplicated bone metastases, but implementation is variable. We examined the effects of a Pathway tool on SFRT rates in an academic radiation oncology practice. Methods and materials Using published literature, Clinical guidelines, and expert input, we designed a Clinical Pathway for bone metastases radiation therapy displayed on a Web-based electronic interface. In March 2016, the Pathway launched on a palliative radiation service at the Dana Farber/Brigham and Women's Cancer Center main campus and at affiliated community sites. Providers were surveyed pre- and postimplementation to assess expectations and elicit feedback. Rates of Pathway utilization, compliance with SFRT recommendations, and reasons for noncompliance were assessed. Results The final Pathway includes 20 endpoints and several validated prognostic scoring systems. It was used in 38% of 723 bone metastases radiation prescriptions, with appropriate SFRT rates rising from 18% before implementation to 48% after launch (P Conclusions Our experience demonstrates the utility of Clinical Pathway decision support for bone metastases radiation in complex academic settings. Next steps include increasing the Pathway's ease of use, refining the Pathway's prognostic abilities, and measuring cost savings related to the Pathway.
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development and implementation of a Clinical Pathway for radiation of bone metastases on a palliative radiation oncology service
Journal of Clinical Oncology, 2016Co-Authors: Lisa S Rotenstein, J Killoran, Tracy A Balboni, Monica Krishnan, Allison Taylor, Neil E MartinAbstract:170 Background: Clinical Pathways increase compliance with treatment guidelines and reduce in-hospital complications. Evidence around treatment of complicated bone metastases is increasingly nuanced and although ASTRO/ACR recommend single fraction radiation therapy for uncomplicated bone metastases, implementation is variable. We sought to determine the effects of a bone metastases-focused Clinical Pathway on the practice patterns of our institution’s palliative radiation oncology service (SPRO), which sees 600 patients yearly and on a rotating basis, involves 23 physicians, 28 residents, 2 nurse practitioners, and 1 fellow. We hypothesized that Pathway implementation would augment data-driven use of palliative radiation for bone metastases, including use of 8 Gy x 1 for uncomplicated metastases. It would also enhance physician efficiency and confidence. Methods: Using published literature, Clinical guidelines, and expert input, we designed a comprehensive Clinical Pathway for bone metastases radiation. T...
J Killoran - One of the best experts on this subject based on the ideXlab platform.
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impact of a Clinical Pathway tool on appropriate palliative radiation therapy for bone metastases
Practical radiation oncology, 2017Co-Authors: Lisa S Rotenstein, Alexander O Kerman, J Killoran, Tracy A Balboni, Monica KrishnanAbstract:Abstract Purpose Clinical Pathways increase compliance with treatment guidelines, improve outcomes, and reduce costs. Guidelines recommend single fraction radiation therapy (SFRT) for palliation of uncomplicated bone metastases, but implementation is variable. We examined the effects of a Pathway tool on SFRT rates in an academic radiation oncology practice. Methods and materials Using published literature, Clinical guidelines, and expert input, we designed a Clinical Pathway for bone metastases radiation therapy displayed on a Web-based electronic interface. In March 2016, the Pathway launched on a palliative radiation service at the Dana Farber/Brigham and Women's Cancer Center main campus and at affiliated community sites. Providers were surveyed pre- and postimplementation to assess expectations and elicit feedback. Rates of Pathway utilization, compliance with SFRT recommendations, and reasons for noncompliance were assessed. Results The final Pathway includes 20 endpoints and several validated prognostic scoring systems. It was used in 38% of 723 bone metastases radiation prescriptions, with appropriate SFRT rates rising from 18% before implementation to 48% after launch (P Conclusions Our experience demonstrates the utility of Clinical Pathway decision support for bone metastases radiation in complex academic settings. Next steps include increasing the Pathway's ease of use, refining the Pathway's prognostic abilities, and measuring cost savings related to the Pathway.
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development and implementation of a Clinical Pathway for radiation of bone metastases on a palliative radiation oncology service
Journal of Clinical Oncology, 2016Co-Authors: Lisa S Rotenstein, J Killoran, Tracy A Balboni, Monica Krishnan, Allison Taylor, Neil E MartinAbstract:170 Background: Clinical Pathways increase compliance with treatment guidelines and reduce in-hospital complications. Evidence around treatment of complicated bone metastases is increasingly nuanced and although ASTRO/ACR recommend single fraction radiation therapy for uncomplicated bone metastases, implementation is variable. We sought to determine the effects of a bone metastases-focused Clinical Pathway on the practice patterns of our institution’s palliative radiation oncology service (SPRO), which sees 600 patients yearly and on a rotating basis, involves 23 physicians, 28 residents, 2 nurse practitioners, and 1 fellow. We hypothesized that Pathway implementation would augment data-driven use of palliative radiation for bone metastases, including use of 8 Gy x 1 for uncomplicated metastases. It would also enhance physician efficiency and confidence. Methods: Using published literature, Clinical guidelines, and expert input, we designed a comprehensive Clinical Pathway for bone metastases radiation. T...
Tracy A Balboni - One of the best experts on this subject based on the ideXlab platform.
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impact of a Clinical Pathway tool on appropriate palliative radiation therapy for bone metastases
Practical radiation oncology, 2017Co-Authors: Lisa S Rotenstein, Alexander O Kerman, J Killoran, Tracy A Balboni, Monica KrishnanAbstract:Abstract Purpose Clinical Pathways increase compliance with treatment guidelines, improve outcomes, and reduce costs. Guidelines recommend single fraction radiation therapy (SFRT) for palliation of uncomplicated bone metastases, but implementation is variable. We examined the effects of a Pathway tool on SFRT rates in an academic radiation oncology practice. Methods and materials Using published literature, Clinical guidelines, and expert input, we designed a Clinical Pathway for bone metastases radiation therapy displayed on a Web-based electronic interface. In March 2016, the Pathway launched on a palliative radiation service at the Dana Farber/Brigham and Women's Cancer Center main campus and at affiliated community sites. Providers were surveyed pre- and postimplementation to assess expectations and elicit feedback. Rates of Pathway utilization, compliance with SFRT recommendations, and reasons for noncompliance were assessed. Results The final Pathway includes 20 endpoints and several validated prognostic scoring systems. It was used in 38% of 723 bone metastases radiation prescriptions, with appropriate SFRT rates rising from 18% before implementation to 48% after launch (P Conclusions Our experience demonstrates the utility of Clinical Pathway decision support for bone metastases radiation in complex academic settings. Next steps include increasing the Pathway's ease of use, refining the Pathway's prognostic abilities, and measuring cost savings related to the Pathway.
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development and implementation of a Clinical Pathway for radiation of bone metastases on a palliative radiation oncology service
Journal of Clinical Oncology, 2016Co-Authors: Lisa S Rotenstein, J Killoran, Tracy A Balboni, Monica Krishnan, Allison Taylor, Neil E MartinAbstract:170 Background: Clinical Pathways increase compliance with treatment guidelines and reduce in-hospital complications. Evidence around treatment of complicated bone metastases is increasingly nuanced and although ASTRO/ACR recommend single fraction radiation therapy for uncomplicated bone metastases, implementation is variable. We sought to determine the effects of a bone metastases-focused Clinical Pathway on the practice patterns of our institution’s palliative radiation oncology service (SPRO), which sees 600 patients yearly and on a rotating basis, involves 23 physicians, 28 residents, 2 nurse practitioners, and 1 fellow. We hypothesized that Pathway implementation would augment data-driven use of palliative radiation for bone metastases, including use of 8 Gy x 1 for uncomplicated metastases. It would also enhance physician efficiency and confidence. Methods: Using published literature, Clinical guidelines, and expert input, we designed a comprehensive Clinical Pathway for bone metastases radiation. T...
Ilana Waynik - One of the best experts on this subject based on the ideXlab platform.
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Reducing Invasive Care for Low-risk Febrile Infants Through Implementation of a Clinical Pathway
Pediatrics, 2019Co-Authors: Kathryn E. Kasmire, Eric C. Hoppa, Pooja P. Patel, Kelsey N. Boch, Tina Sacco, Ilana WaynikAbstract:BACKGROUND AND OBJECTIVES: Significant variation in management of febrile infants exists both nationally and within our institution. Risk stratification can be used to identify low-risk infants who can be managed as outpatients without lumbar puncture (LP) or antibiotics. Our objective was to reduce invasive interventions for febrile infants aged 29 to 60 days at low risk for serious bacterial infection (SBI) through implementation of a Clinical Pathway supported by quality improvement (QI). METHODS: The evidence-based Clinical Pathway was developed and implemented by a multidisciplinary team with continuous-process QI to sustain use. Low-risk infants who underwent LP, received antibiotics, and were admitted to the hospital were compared pre- and postPathway implementation with SBI in low-risk infants and appropriate care for high-risk infants as balancing measures. RESULTS: Of 350 included patients, 220 were pre- and 130 were postPathway implementation. With Pathway implementation in July 2016, invasive interventions decreased significantly in low-risk infants, with LPs decreasing from 32% to 0%, antibiotic administration from 30% to 1%, and hospital admission from 17% to 2%. Postimplementation, there were 0 SBIs in low-risk infants versus 29.2% in high-risk infants. The percentage of high-risk patients receiving care per Pathway remained unchanged. Improvement was sustained for 12 months through QI interventions, including order-set development and e-mail reminders. CONCLUSIONS: Implementation of a Clinical Pathway by using QI methods resulted in sustained reduction in invasive interventions for low-risk febrile infants without missed SBIs. Clinical Pathways and QI can be key strategies in the delivery of evidence-based care for febrile infants.