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Purpose: To assess the utility of maintaining and analyzing a quality-management database while investigating a subjectively perceived increase in the incidence of tunneled catheter and port dysfunction in a cohort of oncology outpatients., Materials and Methods: All 152 patients undergoing lytic therapy (2-4 mg alteplase) of a malfunctioning indwelling central venous catheter (CVC) from January through June 2004 at a single cancer center in the United States were included in a quality-management database. Patients were categorized by time to device failure and the initial method of catheter placement (surgery vs interventional radiology). Data were analyzed after 3 months, and areas of possible improvement were identified and acted upon. Three months of follow-up data were then collected and similarly analyzed., Results: In a 6-month period, 152 patients treated for catheter malfunction received a total of 276 doses of lytic therapy. A 3-month interim analysis revealed a disproportionately high rate (34%) of early catheter malfunction (ECM; <30 days from placement). Postplacement radiographs demonstrated suboptimal catheter positioning in 67% of these patients, all of whom had surgical catheter placement. There was a 50% absolute decrease in the number of patients presenting with catheter malfunction in the period from April through June (P < .001). Evaluation of postplacement radiographs in these patients demonstrated a 50% decrease in the incidence of suboptimal positioning (P < .05)., Conclusions: Suboptimal positioning was likely responsible for some, but not all, cases of ECM. Maintenance of a quality-management database is a relatively simple intervention that can have a clear and important impact on the quality and cost of patient care.

Background: Few models for medication reconciliation in ambulatory primary or specialty care have been described, perhaps because of the special challenges posed by this environment., Methods: Dana-Farber Cancer Institute (Boston) created a reconciliation program that was designed as a patient-clinician partnership intervention. Policies that require clinicians to review and update medication lists at regular appointments were augmented. Clinic assistants printed patients' medication lists from the electronic medical record and distributed lists to established patients for review. Patients provided updated lists to their oncology clinicians. Clinicians then entered the information or indicated changes to be entered by a pharmacist., Results: At baseline, 81% of patients' medication lists included at least one error or omission. With medication reconciliation, 90% of incorrect medication lists were updated. In contrast, only 2% of medication lists were corrected among patients who received "usual" care (p < .001)., Discussion: From the program's inception in November 2005 through August 2007, patients and staff reconciled 24,148 medication lists by making 53,040 changes to 168,475 listed drugs, a rate of 31 changes per 100 medications. Implementation required broad staff engagement and ongoing attention to operational issues.

Background: The prognosis of patients with colorectal cancer is related to stages of disease at the time of diagnosis. Ultimately, the goal of fecal occult blood test (FOBT) screening programs is to reduce colorectal cancer mortality., Methods: We reviewed the medical records and pathology reports of all 60 Harvard Community Health Plan (HCHP) members who were diagnosed as having colorectal cancer during the 2 years after our FOBT screening program began. The stage distribution of these 60 cases were compared with that of 76 cases diagnosed at HCHP before the FOBT screening program was started., Results: Eight of 60 colorectal cancers diagnosed after the FOBT screening program was begun (13%) were diagnosed as a result of a positive screening test (Group I). The remaining 52 cases (87%) were diagnosed as a result of symptoms, physical findings, and/or the presence of anemia (Group II). Three of 8 Group I colorectal cancers (38%) were stage A, as compared with 8 of 52 of Group II colorectal cancers (15%). None of the 8 Group I colorectal cancers was stage D (metastatic) at the time of diagnosis, as compared with 11 of 52 Group II colorectal cancers (21%)., Conclusions: We observed a favorable shift in the stage distribution of colorectal cancers diagnosed at HCHP after the FOBT screening program began (p less than .05). The shift was not attributable only to FOBT screening. We believe that the educational components of the program were important to its effectiveness. Our results support continued use of FOBT at HCHP.