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Technology resource planning in radiation oncology: application of a needs-based analytic framework to radiosurgery planning in Ontario.

ABSTRACT: With the emergence of radiosurgery as a new radiotherapeutic technique, health care decision makers are required to allocate capital radiotherapy resources to meet both current and future radiosurgery requirements. The goal of this article is to demonstrate the feasibility of applying an explicit, needs-based model to resource planning in radiation oncology.Using an analytic model that relates radiosurgery need to population size, epidemiology, level of service planned, and productivity, the current radiosurgical need for single brain metastases in Ontario was estimated. The model was populated using Ontario-specific data where possible and supplemented with information from the published literature. Multiway sensitivity analyses were performed to calculate the minimum and maximum technology requirements.The calculated number of full-time radiosurgical units required to treat patients with single brain metastases in Ontario was 5.9. Sensitivity analyses performed varying both level of service planned and productivity yielded a range of requirements from 2.5 to 12.2 full-time radiosurgery units.We have shown through the example of single brain metastases in Ontario that it is feasible to perform explicit, needs-based resource planning in radiation oncology. As the availability of new specialized technology increases, health care decision makers may use this approach to ensure the needs of their population are met while maximizing productivity and minimizing opportunity cost.

SUBMITTER: Greenspoon JN

PROVIDER: S-EPMC3500481 | biostudies-other | 2012 Nov

REPOSITORIES: biostudies-other

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Technology resource planning in radiation oncology: application of a needs-based analytic framework to radiosurgery planning in Ontario.

Greenspoon Jeffrey N JN O'Reilly Daria D Wright James R JR Whitton Anthony A Sussman Jonathan J Birch Stephen S

Journal of oncology practice 20120724 6

<h4>Purpose</h4>With the emergence of radiosurgery as a new radiotherapeutic technique, health care decision makers are required to allocate capital radiotherapy resources to meet both current and future radiosurgery requirements. The goal of this article is to demonstrate the feasibility of applying an explicit, needs-based model to resource planning in radiation oncology.<h4>Methods</h4>Using an analytic model that relates radiosurgery need to population size, epidemiology, level of service pl ...[more]

PMID: 23598845

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Project description:BackgroundSocial determinants of health are known to contribute to disparities in health outcomes. Routine screening for basic social needs is not a part of standard care; however, the association of those needs with increased healthcare utilization and poor compliance with guideline-directed care is well established.ObjectiveIn this study, we aimed to assess the prevalence of basic social resource needs identified through a quality improvement initiative in a gynecologic oncology outpatient clinic. In addition, we aimed to identify clinical and demographic factors associated with having basic social resource needs.Study designWe performed a prospective cohort study of women presenting to a gynecologic oncology clinic at an urban academic institution who were screened for basic social resource needs as part of a quality improvement initiative from July 2017 to May 2018. The following 8 domains of resource needs were assessed: food insecurity, housing insecurity, utility needs, financial strain, transportation, childcare, household items, and difficulty reading hospital materials. Women with needs were referred to resources to address those needs. Demographic and clinical information were collected for each patient. The prevalence of needs and successful follow-up interventions were calculated. Patient factors independently associated with having at least 1 basic social resource need were identified using multivariable Poisson regression.ResultsA total of 752 women were screened in the study period, of whom 274 (36%) reported 1 or more basic social resource need, with a median of 1 (range, 1-7) need. Financial strain was the most commonly reported need (171 of 752, 23%), followed by transportation (119 of 752, 16%), difficulty reading hospital materials (54 of 752, 7%), housing insecurity (31 of 752, 4%), food insecurity (28 of 752, 4%), household items (22 of 752, 3%), childcare (15 of 752, 2%), and utility needs (13 of 752, 2%). On multivariable analysis, independent factors associated with having at least 1 basic social resource need were being single, divorced or widowed, nonwhite race, current smoker, nonprivate insurance, and a history of anxiety or depression. A total of 36 of 274 (13%) women who screened positive requested assistance and were referred to resources to address those needs. Of the 36 women, 25 (69%) successfully accessed a resource or felt equipped to address their needs, 9 (25%) could not be reached despite repeated attempts, and 2 (6%) declined assistance.ConclusionBasic social resource needs are prevalent in women presenting to an urban academic gynecologic oncology clinic and can be identified and addressed through routine screening. To help mitigate ongoing disparities in this population, screening for and addressing basic social resource needs should be incorporated into routine comprehensive care in gynecologic oncology clinics.

Project description:PURPOSE:To assess the optimal structure of an introductory curriculum (IC) for radiation oncology residents, including the perceived utility of a 2-day off-site "boot camp," and evaluate the success of a pilot introductory radiation oncology curriculum (IROC) based on these initial data. METHODS AND MATERIALS:In the first phase, anonymous, web-based surveys were sent to US radiation oncology program directors and residents. Likert-type scores (1, not at all; 5, extremely) are reported as the median and interquartile range. Using the phase 1 results, IROC was developed, piloted, and evaluated. RESULTS:Of the 89 program directors and 697 residents, 47 (53%) and 165 (24%) responded, respectively. Of the 89 program directors, 37 (79%) reported offering a formal IC. However, only 83 residents (50%) reported having a formal IC. Program directors reported resident preparation for clinical training as "moderate" (median 3, interquartile range 2-3) on entering residency and "moderate" (median 3, interquartile range 3-4) after IC completion (P = .03). However, residents only believed they were "slightly" prepared (median 2, interquartile range 1-2) on entering residency and "moderately" (median 3, interquartile range 2-3) prepared after IC completion (P < .01). Program directors believed an off-site boot camp would be of "moderate" utility (median 3, interquartile range 3-4) with participation limited by funding (57%). Residents without an IC reported that having an IC would be "quite" beneficial (median 4, interquartile range 3-5). Residents preferred instruction before the clinical training (49%) and over 1 week (40%). Both program directors and residents rated lectures on radiation emergencies and simulation highly. Using these data, IROC was developed and piloted with incoming residents at 4 institutions. After IROC, residents reported improvement in overall preparedness for clinical training (before: median 1, interquartile range 1-2; vs after: median 3, interquartile range 2-3; P < .01) and among specific practice domains. CONCLUSIONS:Beginning radiation oncology residents frequently lack structured introductory curricula but desire instruction before the clinical training with a focus on practical aspects (emergency management, contouring). Program directors recognize the value of both off-site and on-site boot camps. An on-site IC could mitigate funding barriers. A standardized IC, IROC, piloted at 4 programs, showed promising outcomes.

Project description:ObjectivesTo describe current patterns of practice of radiation oncology peer review within a provincial cancer system, identifying barriers and facilitators to its use with the ultimate aim of process improvement.DesignA survey of radiation oncology programmes at provincial cancer centres.SettingAll cancer centres within the province of Ontario, Canada (n=14). These are community-based outpatient facilities overseen by Cancer Care Ontario, the provincial cancer agency.ParticipantsA delegate from each radiation oncology programme filled out a single survey based on input from their multidisciplinary team.Outcome measuresRated importance of peer review; current utilisation; format of the peer-review process; organisation and timing; case attributes; outcomes of the peer-review process and perceived barriers and facilitators to expanding peer-review processes.Results14 (100%) centres responded. All rated the importance of peer review as at least 8/10 (10=extremely important). Detection of medical error and improvement of planning processes were the highest rated perceived benefits of peer review (each median 9/10). Six centres (43%) reviewed at least 50% of curative cases; four of these centres (29%) conducted peer review in more than 80% of cases treated with curative intent. Fewer than 20% of cases treated with palliative intent were reviewed in most centres. Five centres (36%) reported usually conducting peer review prior to the initiation of treatment. Five centres (36%) recorded the outcomes of peer review on the medical record. Thirteen centres (93%) planned to expand peer-review activities; a critical mass of radiation oncologists was the most important limiting factor (median 6/10).ConclusionsRadiation oncology peer-review practices can vary even within a cancer system with provincial oversight. The application of guidelines and standards for peer-review processes, and monitoring of implementation and outcomes, will require effective knowledge translation activities.

Dataset Information

Technology resource planning in radiation oncology: application of a needs-based analytic framework to radiosurgery planning in Ontario.

Publications

Technology resource planning in radiation oncology: application of a needs-based analytic framework to radiosurgery planning in Ontario.

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