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Purpose To evaluate the association between functional status based on a geriatric assessment (GA) and outcomes of tolerance to treatment in patients with lung or head and neck cancer receiving radiation therapy (RT) or chemoradiation (CRT). Methods and Materials A prospective cohort study was conducted in patients aged ≥65 years with head and neck cancer or lung cancer undergoing curative intent RT or CRT. Pretreatment GA, health-related quality of life (HRQoL), and patient-reported outcomes (PRO) were obtained. Questionnaires were repeated biweekly during RT and at 6 weeks after treatment. Dysfunction was defined as scores 3-day treatment delay, change in RT or CRT regimen, or death. Associations of dysfunction with tolerance to radiation therapy, HRQoL changes, and PRO ratings were evaluated. Results Of the 50 patients accrued, 46 had evaluable data. Mean age was 72.5 years (range, 65-92 years). At baseline, 37% had dysfunction. Poor tolerance to RT or CRT occurred in 39%. There was no association between dysfunction and tolerance. Patients with dysfunction had lower baseline HRQoL scores. From baseline to end of RT, those with baseline dysfunction had less of a decline in Role Functioning (P=.01) and Global Health Score (P=.04) domains. However, from end of RT to 6-week follow-up, those with dysfunction were more likely to continue to drop in the Physical, Role Functioning, and Social domains (all P

The objective of this pilot study was to assess the inter-rater reliability of a newly developed A3 Quality Assessment (QA) rubric to evaluate the quality of completed Plan-Do-Study-Act (PDSA) projects that used an A3 Thinking Tool (A3) for problem solving. One A3 was independently reviewed by 7 PDSA experts using 5 main levels and 22 sublevels. Evaluations were compared and coded for agreement and used for statistical analysis. Fleiss’ kappa statistics was performed to test for inter-rater reliability between experts across 5 main and 22 sublevels. Preliminary results suggest that the A3 QA rubric meets reliability criteria with a moderate level of agreement beyond chance alone (κ = 0.44) and it is applicable to measure progress on problem solving abilities spearheaded via PDSA cycles. Additional verification testing is needed across multiple A3 improvement projects completed in multiple A3 Thinking templates.

Objective To assess the relationship between (1) task demands and workload, (2) task demands and performance, and (3) workload and performance, all during physician-computer interactions in a simulated environment.Methods Two experiments were performed in 2 different electronic medical record (EMR) environments: WebCIS ( n = 12) and Epic ( n = 17). Each participant was instructed to complete a set of prespecified tasks on 3 routine clinical EMR-based scenarios: urinary tract infection (UTI), pneumonia (PN), and heart failure (HF). Task demands were quantified using behavioral responses (click and time analysis). At the end of each scenario, subjective workload was measured using the NASA-Task-Load Index (NASA-TLX). Physiological workload was measured using pupillary dilation and electroencephalography (EEG) data collected throughout the scenarios. Performance was quantified based on the maximum severity of omission errors.Results Data analysis indicated that the PN and HF scenarios were significantly more demanding than the UTI scenario for participants using WebCIS ( P < .01), and that the PN scenario was significantly more demanding than the UTI and HF scenarios for participants using Epic ( P < .01). In both experiments, the regression analysis indicated a significant relationship only between task demands and performance ( P < .01).Discussion Results suggest that task demands as experienced by participants are related to participants' performance. Future work may support the notion that task demands could be used as a quality metric that is likely representative of performance, and perhaps patient outcomes.Conclusion The present study is a reasonable next step in a systematic assessment of how task demands and workload are related to performance in EMR-evolving environments.

Purpose To present our approach and results from our quality and safety program and to report their possible impact on our culture of patient safety. Methods and materials We created an event learning system (termed a "good catch" program) and encouraged staff to report any quality or safety concerns in real time. Events were analyzed to assess the utility of safety barriers. A formal continuous quality improvement program was created to address these reported events and make improvements. Data on perceptions of the culture of patient safety were collected using the Agency for Health Care Research and Quality survey administered before, during, and after the initiatives. Results Of 560 good catches reported, 367 could be ascribed to a specific step on our process map. The calculated utility of safety barriers was highest for those embedded into the pretreatment quality assurance checks performed by physicists and dosimetrists (utility score 0.53; 93 of 174) and routine checks done by therapists on the initial day of therapy. Therapists and physicists reported the highest number of good catches (24% each). Sixty-four percent of events were caused by performance issues (eg, not following standardized processes, including suboptimal communications). Of 31 initiated formal improvement events, 26 were successfully implemented and sustained, 4 were discontinued, and 1 was not implemented. Most of the continuous quality improvement program was conducted by nurses (14) and therapists (7). Percentages of positive responses in the patient safety culture survey appear to have increased on all dimensions ( p Conclusions Results suggest that event learning and continuous quality improvement programs can be successfully implemented and that there are contemporaneous improvements in the culture of safety.

Le but de cette etude etait de mesurer subjectivement et objectivement la charge de travail et le niveau de performance parmi des radiooncologues realisant une tache informatisee, avant et apres l’administration d’une session de neurofeedback. Huit participants ont ete recrutes pour cette etude pilote. La charge de travail etait evaluee subjectivement en utilisant le questionnaire NASA Task-Load-Index (NASA-TLX), et objectivement en utilisant l’analyse de donnees par electroencephalographie. Les performances ont ete evaluees subjectivement en utilisant un questionnaire d’etat de « flow », et objectivement en se basant sur le temps de completion du test et la performance basee sur les erreurs. Les differences statistiques entre les scores de la periode pre- et post-intervention du i) NASA-TLX, du temps de completion du test et de la performance basee sur les erreurs ont ete evalue en utilisant des test t pour des echantillons apparies ; ii) la performance percue telle que quantifiee par le questionnaire d’etat de flow a ete evaluee en utilisant le test de rangs signes de Wilcoxon ; iii) et les changements EEG pre- et post-intervention dans les lobes temporaux, acquis tout au long de la realisation de la tâche, ont ete mesures par l’analyse de variance (ANOVA). Les analyses ont indique une reduction significative dans le NASA-TLX (p=0.01) ; un accroissement significatif de la puissance spectrale Theta (p 0.05). Une future recherche est necessaire pour quantifier davantage l’impact du neurofeedback sur la charge de travail et la performance des radiooncologues.

e20534 Background: Comprehensive geriatric assessments (CGA) have been shown to predict for toxicity from chemotherapy (CT) and surgery. This study’s purpose is to evaluate associations between CGA components and poor tolerance to radiotherapy (RT) or Chemoradiotherapy (CRT) in patients with lung or head and neck cancer (HNC). Methods: From 2012 to 2014, consent was obtained on 50 patients undergoing curative intent RT or CRT for this prospective, institutionally approved study. Patients completed a pre-treatment CGA. During treatment and 4-8 weeks post treatment, quality of life and toxicity measures were obtained. Poor tolerance to treatment was defined by hospitalization, > 3 day treatment delay, change in RT or CT regimen, and death. The primary outcome was to assess the association between instrumental activities of daily living (I-ADL) scores and poor tolerance to treatment. Associations of other patient variables were also evaluated. Fisher’s exact test was used to test associations. Results: Of th...