J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 8, Number 9, September 2016, pages 633-640

Improving Clinical Practice Using a Novel Engagement Approach: Measurement, Benchmarking and Feedback, A Longitudinal Study

**Table 1.** List of CPV Cases
Set A	Set B
Atypical ductal hyperplasia	Atypical ductal hyperplasia
Invasive ductal CA, stage I	Invasive ductal CA, stage I
Invasive lobular CA, stage II CHF	Invasive lobular CA, stage II CHF
Invasive ductal CA, stage II	Invasive ductal CA, stage IIB in pregnancy
Invasive ductal CA, stage III	Invasive ductal CA, stage III
Recurrent stage IIIB with bone metastasis	Recurrent stage IIIB with solitary CNS metastasis
Recurrent stage II invasive ductal CA	Isolated axillary recurrence, invasive ductal CA
Stage IIIB with recurrent disease to brain, liver	Local recurrence of stage IIIB invasive ductal CA
Multifocal breast cancer, stage II	Bilateral breast CA, stage IIIA (left), stage I (right)
Diffuse large B cell NHL, stage IIIAE. No breast CA	Ductal carcinoma in situ
Hyperparathyroidism from adenoma. No progression of breast CA	Inflammatory breast CA stage IIIB
Dense breasts	Primary stage IV breast CA with bone metastasis

Table 1. List of CPV Cases

Set A

Set B

Atypical ductal hyperplasia

Invasive ductal CA, stage I

Invasive lobular CA, stage II CHF

Invasive ductal CA, stage II

Invasive ductal CA, stage IIB in pregnancy

Invasive ductal CA, stage III

Recurrent stage IIIB with bone metastasis

Recurrent stage IIIB with solitary CNS metastasis

Recurrent stage II invasive ductal CA

Isolated axillary recurrence, invasive ductal CA

Stage IIIB with recurrent disease to brain, liver

Local recurrence of stage IIIB invasive ductal CA

Multifocal breast cancer, stage II

Bilateral breast CA, stage IIIA (left), stage I (right)

Diffuse large B cell NHL, stage IIIAE. No breast CA

Ductal carcinoma in situ

Hyperparathyroidism from adenoma. No progression of breast CA

Inflammatory breast CA stage IIIB

Dense breasts

Primary stage IV breast CA with bone metastasis

**Table 2.** Provider Characteristics, Overall and by Site
	Overall	Site 1	Site 2	Site 3	Site 4
N	81	31	22	18	10
Average age (years)	46.4	47.5	45.0	45.6	47.6
Provider type
Medical oncologist	34	7	12	7	8
Radiation oncologist	11	3	6	-	2
Surgeon	13	6	2	5	-
Other (other MD, PharmD)	10	10	-	-	-
APP (PA, APRN)	13	5	2	6	-
Breast cancer patients (%)	46.4	47.0	29.1	83.4	16.0
Time spent teaching (%)	14.2	18.2	12.0	17.2	1.5
Average years of experience	11.6	10.8	11.4	12.0	13.7
Average case load per week (all)	20.6	21.4	13.2	33.6	10.8

Table 2. Provider Characteristics, Overall and by Site

Overall

Site 1

Site 2

Site 3

Site 4

Average age (years)

46.4

47.5

45.0

45.6

47.6

Provider type

Medical oncologist

Radiation oncologist

Surgeon

Other (other MD, PharmD)

APP (PA, APRN)

Breast cancer patients (%)

46.4

47.0

29.1

83.4

16.0

Time spent teaching (%)

14.2

18.2

12.0

17.2

1.5

Average years of experience

11.6

10.8

11.4

12.0

13.7

Average case load per week (all)

20.6

21.4

13.2

33.6

10.8

**Table 3.** Average Overall and Domain CPV Scores and Standard Deviation (SD) at Baseline and Subsequent Rounds
	Baseline	Round	P-value
Number of CPVs	149	151	149	130
Overall score	56.6 (12.6)	60.0 (14.4)	69.2 (13.2)	70.5 (16.8)	< 0.01
Domain score
History	69.5 (13.1)	70.9 (15.7)	80.5 (16.8)	85.4 (15.0)	< 0.01
Physical	83.1 (20.6)	81.5 (21.8)	89.4 (18.9)	84.8 (19.9)	< 0.01
Workup	40.0 (20.8)	48.9 (22.3)	57.7 (24.1)	63.4 (20.6)	< 0.01
Diagnosis-treatment	45.6 (20.8)	51.4 (20.7)	61.9 (19.5)	57.6 (18.6)	< 0.01

Table 3. Average Overall and Domain CPV Scores and Standard Deviation (SD) at Baseline and Subsequent Rounds

Baseline

Round

P-value

Round 4 vs. baseline

Number of CPVs

149

151

149

130

Overall score

56.6 (12.6)

60.0 (14.4)

69.2 (13.2)

70.5 (16.8)

< 0.01

Domain score

History

69.5 (13.1)

70.9 (15.7)

80.5 (16.8)

85.4 (15.0)

< 0.01

Physical

83.1 (20.6)

81.5 (21.8)

89.4 (18.9)

84.8 (19.9)

< 0.01

Workup

40.0 (20.8)

48.9 (22.3)

57.7 (24.1)

63.4 (20.6)

< 0.01

Diagnosis-treatment

45.6 (20.8)

51.4 (20.7)

61.9 (19.5)

57.6 (18.6)

< 0.01

**Table 4.** Comparison of Baseline to Latest Round of CPV Scores by Areas of Care
Area of care	Site 1	Site 2	Site 3	Site 4
Surgery	85%	81%	52%	74%	40%	83%	69%	80%
Axillary management	62%	81%	39%	32%	50%	67%	31%	80%
Radiation therapy	58%	65%	57%	73%	50%	100%	83%	50%
Chemotherapy	38%	77%	50%	31%	50%	75%	40%	42%
Hormonal therapy	60%	81%	71%	72%	60%	75%	79%	67%

Table 4. Comparison of Baseline to Latest Round of CPV Scores by Areas of Care

Area of care

Site 1

Site 2

Site 3

Site 4

Baseline

Round 4

Baseline

Round 4

Baseline

Round 4

Baseline

Round 4

Surgery

85%

81%

52%

74%

40%

83%

69%

80%

Axillary management

62%

81%

39%

32%

50%

67%

31%

80%

Radiation therapy

58%

65%

57%

73%

50%

100%

83%

50%

Chemotherapy

38%

77%

50%

31%

50%

75%

40%

42%

Hormonal therapy

60%

81%

71%

72%

60%

75%

79%

67%