Effect of the establishment of a hematological multidisciplinary oral chemotherapy clinic at a community hospital on the number of emergency department visits.
Bibliographic record
Abstract
50 Background: Oral chemotherapy is an efficacious albeit toxic treatment of Malignant Hematological diseases. Multidisciplinary oral chemotherapy clinics (MOCC) have been proven to improve care in patients with solid tumors such as prostate and gastrointestinal cancer but there is little data in the Hematological setting. A MOCC was formed to determine if it would lead to a 20% decrease in emergency department (ED) visits and hospital admission over a 10-month period after implementation in patients with Malignant hematological disease on oral chemotherapy. Methods: A chart review of patients on oral Hematological drugs was performed for baseline data. A MOCC consisting of a nurse and a pharmacist was established, with physician backup. Checklists that were drug and disease specific were created for 5 different drugs (Lenalidomide, Ibrutinib, Dasatinib, Nilotinib and Idelalisib) for treatment initiation, follow-up and monitoring and incorporated into the electronic health record. This model was piloted and outcomes were measured to determine improvements in medicine reconciliation, documentation of adverse events, dose modification, patient compliance, unscheduled MD assessments and ED visits. Qualitative interviews were performed with patients and nurses to assess satisfaction with this team approach. Results: 30 patients with Hematological malignancies were enrolled sequentially during the 10-month period. After a median follow up of 7 months, there was 100% medicine reconciliation and 92% compliance with treatment protocols; 47% of patients had interventions requiring dose modifications that would not previously have been documented or addressed. There was a 20% increase in unscheduled MD assessments and a 33% decrease in ED visits and hospital admission from baseline. Both patients and nursing staff were satisfied with the team approach. Conclusions: In a community setting, the implementation of MOCC resulted in early recognition of AE and reduced ED visits. In addition, the new model lead to improved patient and staff satisfaction.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.028 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".