title: Quality management of potential chemotherapy-induced neutropenic complications: evaluation of practice in an academic medical center.
abstract: OBJECTIVE
  Management of the risk of potential chemotherapy-induced neutropenic complications such as febrile neutropenia (FN) and severe neutropenia (SN) is a quality of care priority. How frequently does care at our institution conform to established guidelines?
  
  
  METHODS
  This retrospective chart review study included a random sample of 305 cancer patients receiving care at a single US academic medical center. Abstracted data included demographics, risk factors, and outcome variables (e.g., development of FN/SN, administration of myeloid growth factors). To evaluate quality of care, we assessed conformance between actual practice and established clinical practice guidelines for the use of myeloid growth factors from the National Comprehensive Cancer Network (NCCN).
  
  
  RESULTS
  Of the 305 cases reviewed, 8% were classified as low risk (<10%), 48% as intermediate risk (10-20%), and 44% as high risk (>20%), using the risk classifications in the NCCN guidelines modified to accommodate illness and other risk factors. Thirty-four percent received prophylactic administration of myeloid growth factors. Half of the cases had adequate documentation of mid-cycle absolute neutrophil count to determine whether FN/SN developed. Among these cases with adequate documentation, 21% developed FN/SN. Use of growth factors did not conform to established quality guidelines. Overall, 77 of 133 (58%) high-risk cases received myeloid growth factors, whereas six of 25 (24%) low-risk cases received myeloid growth factors.
  
  
  CONCLUSIONS
  Routine clinical practice in this academic oncology setting was poorly aligned with established guidelines; there is substantial opportunity to standardize clinical strategies and increase conformance with evidence-based guidelines.
authors.affiliation: Department of Medicine, Division of Medical Oncology, Duke University Medical Center (DUMC), Box 3436, Durham, NC 27710, USA. amy.abernethy@duke.edu
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
authors.forename: Sally Y
authors.initials: SY
authors.lastname: Barbour
authors.forename: Hope
authors.initials: H
authors.lastname: Uronis
authors.forename: S Yousuf
authors.initials: SY
authors.lastname: Zafar
authors.forename: April
authors.initials: A
authors.lastname: Coan
authors.forename: Krista
authors.initials: K
authors.lastname: Rowe
authors.forename: Mary Ruth
authors.initials: MR
authors.lastname: Pupa
authors.forename: Jane L
authors.initials: JL
authors.lastname: Wheeler
authors.forename: James E
authors.initials: JE
authors.lastname: Herndon
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003115:Colony-Stimulating Factors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D003115:Colony-Stimulating Factors