Variations in Medicaid Payment Rates for Radiation Oncology.

Purpose: Interstate variations in Medicaid reimbursements can be significant, and patients who live in states with low Medicaid reimbursements tend to have worse access to care. This analysis describes the extent of variations in Medicaid reimbursements for radiation oncology services across the United States.

Methods And Materials: The Current Procedural Terminology codes billed for a course of whole breast radiation were identified for this study.

Promoting safety mindfulness: Recommendations for the design and use of simulation-based training in radiation therapy.

There is a need to better prepare radiation therapy (RT) providers to safely operate within the health information technology (IT) sociotechnical system. Simulation-based training has been preemptively used to yield meaningful improvements during providers' interactions with health IT, including RT settings. Therefore, on the basis of the available literature and our experience, we propose principles for the effective design and use of simulated scenarios and describe a conceptual framework for a debriefing approach to foster successful training that is focused on safety mindfulness during RT professionals' interactions with health IT.

Toward a better understanding of task demands, workload, and performance during physician-computer interactions.

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).

Quantification of the impact of multifaceted initiatives intended to improve operational efficiency and the safety culture: a case study from an academic medical center radiation oncology department.

Purpose: We have systematically been incorporating several operational efficiency and safety initiatives into our academic radiation oncology clinic. We herein quantify the impact of these initiatives on prospectively collected, clinically meaningful, metrics.

Methods And Materials: The data from 5 quality improvement initiatives, each focused on a specific safety/process concern in our clinic, are presented.

Relating physician's workload with errors during radiation therapy planning.

Purpose: To relate subjective workload (WL) levels to errors for routine clinical tasks.

Methods And Materials: Nine physicians (4 faculty and 5 residents) each performed 3 radiation therapy planning cases. The WL levels were subjectively assessed using National Aeronautics and Space Administration Task Load Index (NASA-TLX).

Quantifying the impact of cross coverage on physician's workload and performance in radiation oncology.

Purpose: To quantitatively assess the difference in workload and performance of radiation oncology physicians during radiation therapy treatment planning tasks under the conditions of "cross coverage" versus planning a patient with whom they were familiar.

Methods And Materials: Eight physicians (3 experienced faculty physicians and 5 physician residents) performed 2 cases. The first case represented a "cross-coverage" scenario where the physicians had no prior information about the case to be planned.

Subjective and objective quantification of physician's workload and performance during radiation therapy planning tasks.

Purpose: To quantify, and compare, workload for several common physician-based treatment planning tasks using objective and subjective measures of workload. To assess the relationship between workload and performance to define workload levels where performance could be expected to decline.

Methods And Materials: Nine physicians performed the same 3 tasks on each of 2 cases ("easy" vs "hard").

Quantitative assessment of workload and stressors in clinical radiation oncology.

Purpose: Workload level and sources of stressors have been implicated as sources of error in multiple settings. We assessed workload levels and sources of stressors among radiation oncology professionals. Furthermore, we explored the potential association between workload and the frequency of reported radiotherapy incidents by the World Health Organization (WHO).