Kristen McNiff

University of Texas MD Anderson Cancer Center, Houston, Texas, United States

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Publications (22)131.62 Total impact

  • Kristen K McNiff, Joseph O Jacobson
    Journal of Oncology Practice 11/2014; 10(6):339-44. DOI:10.1200/JOP.2014.001305
  • Journal of Clinical Oncology 09/2014; DOI:10.1200/JCO.2014.56.8899 · 17.88 Impact Factor
  • Journal of Oncology Practice 05/2014; 10(3):203-5. DOI:10.1200/JOP.2014.001399
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    Journal of Oncology Practice 04/2014; DOI:10.1200/JOP.2014.001423
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    ABSTRACT: Most cancer quality measures focus on individual cancers, assess specific providers, and evaluate processes of care. Although important, these efforts are not sufficient. A more comprehensive measure set is needed to address gaps in care, focus on patients rather than providers, and assess the cross-cutting aspects of care that are relevant to all patients with cancer throughout the trajectory of their illness. With the long-term goal of developing a more comprehensive oncology measure set, the American Society of Clinical Oncology (ASCO) organized a collaborative measure summit that used an iterative consensus approach to identify priorities for the development of new cancer quality measures. The summit, which included professional societies and patient/consumer advocacy organizations, was held during the ASCO Quality Care Symposium in December 2012. This effort, which brought together 12 diverse stakeholders, identified 10 high-priority topics for cancer quality measure development that cross-cut cancer diagnoses and care settings and addressed patient-centered concerns. Topics of particular interest included planning and counseling before therapy, interdisciplinary and multidisciplinary coordinated care, comprehensive symptom assessment, patient experience of care, and use of palliative care and hospice services. This is an important first step in the development of patient-centered, cross-cutting cancer quality measures. Addressing the high-priority topics identified by this effort will help fill the gaps left by existing cancer quality measures, including care coordination and transitions, quality of life, safety, experience of care, and outcomes. More work will be needed to specify, implement, and validate measures based on these topics.
    Journal of Oncology Practice 02/2014; DOI:10.1200/JOP.2013.001240
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    ABSTRACT: There is growing interest in incorporating routine collection of patient-reported outcomes (PROs) into cancer care. Practicing oncologists are a stakeholder group whose views are not well characterized. We developed an interview guide after literature review and in-depth interviews with leaders in the field. We conducted 45-minute semistructured interviews with a diverse sample of medical oncologists identified through affiliation with the Quality Oncology Practice Initiative or a minority-based Community Clinical Oncology Program until thematic saturation. Multiple analysts independently reviewed and thematically coded verbatim transcripts. Seventeen interviews were conducted with oncologists from 15 states. Emergent themes included variable understanding and experience with PROs. There was enthusiasm for the potential of PROs to improve the efficiency and thoroughness of the patient encounter. Fundamental concerns included information overload, possibility of identifying problems without access to intervention, depersonalization of the physician-patient encounter, cost, and inefficiency. Barriers identified included the need for buy-in from other stakeholders in the practice, lack of appropriate referral resources, staffing needs, and technology concerns. Few identified patient compliance, data sharing/privacy, or medical liability as a major barrier to implementation. Practicing oncologists had variable understanding of the details of PROs but, when introduced to the concept, recognized utility in improving the efficiency and thoroughness of the patient encounter if implemented properly. The time is right to begin pilot testing such measures with community oncologists so they can lend their expertise to national discussions on which measures to use and how best to use them.
    Journal of Oncology Practice 08/2013; DOI:10.1200/JOP.2012.000823
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    ABSTRACT: In 2009, the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) published standards for the safe use of parenteral chemotherapy in the outpatient setting, including issues of practitioner orders, preparation, and administration of medication. In 2011, these were updated to include inpatient facilities. In December 2011, a multistakeholder workgroup met to address the issues associated with orally administered antineoplastics, under the leadership of ASCO and ONS. The workgroup participants developed recommended standards, which were presented for public comment. Public comments informed final edits, and the final standards were reviewed and approved by the ASCO and ONS Boards of Directors. Significant newly identified recommendations include those associated with drug prescription and the necessity of ascertaining that prescriptions are filled. In addition, the importance of patient and family education regarding administration schedules, exception procedures, disposal of unused oral medication, and aspects of continuity of care across settings were identified. This article presents the newly developed standards.
    Oncology Nursing Forum 05/2013; 40(3):225-33. DOI:10.1188/13.ONF.40-03AP2 · 1.91 Impact Factor
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    ABSTRACT: In 2009, ASCO and the Oncology Nursing Society (ONS) published standards for the safe use of parenteral chemotherapy in the outpatient setting, including issues of practitioner orders, preparation, and administration of medication. In 2011, these were updated to include inpatient facilities. In December 2011, a multistakeholder workgroup met to address the issues associated with orally administered antineoplastics, under the leadership of ASCO and ONS. The workgroup participants developed recommended standards, which were presented for public comment. Public comments informed final edits, and the final standards were reviewed and approved by the ASCO and ONS Boards of Directors. Significant newly identified recommendations include those associated with drug prescription and the necessity of ascertaining that prescriptions are filled. In addition, the importance of patient and family education regarding administration schedules, exception procedures, disposal of unused oral medication, and aspects of continuity of care across settings were identified. This article presents the newly developed standards.
    Journal of Oncology Practice 03/2013; 9(2 Suppl):5s-13s. DOI:10.1200/JOP.2013.000874
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    Kristen McNiff
    Journal of Oncology Practice 11/2012; 8(6):363-4. DOI:10.1200/JOP.2012.000791
  • Allen S. Lichter, Kristen McNiff
    Community Oncology 09/2011; 8(9):408–409. DOI:10.1016/S1548-5315(12)70088-8
  • Kristen McNiff
    Journal of Clinical Oncology 02/2010; DOI:10.1200/JCO.2009.27.1015 · 17.88 Impact Factor
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    ABSTRACT: More than a decade ago, the Institute of Medicine created the National Cancer Policy Board and identified a need to assess national quality of cancer care, generating a cascade of projects, including ASCO's QOPI.
    Journal of Oncology Practice 11/2009; 5(6):270-6. DOI:10.1200/JOP.091045
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    ABSTRACT: Standardization of care can reduce the risk of errors, increase efficiency, and provide a framework for best practice. In 2008, the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) invited a broad range of stakeholders to create a set of standards for the administration of chemotherapy to adult patients in the outpatient setting. At the close of a full-day structured workshop, 64 draft standards were proposed. After a formal process of electronic voting and conference calls, 29 draft standards were eliminated, resulting in a final list of 35 draft measures. The proposed set of standards was posted for 6 weeks of open public comment. Three hundred twenty-two comments were reviewed by the Steering Group and used as the basis for final editing to a final set of standards. The final list includes 31 standards encompassing seven domains, which include the following: review of clinical information and selection of a treatment regimen; treatment planning and informed consent; ordering of treatment; drug preparation; assessment of treatment compliance; administration and monitoring; assessment of response and toxicity monitoring. Adherence to ASCO and ONS standards for safe chemotherapy administration should be a goal of all providers of adult cancer care.
    Oncology Nursing Forum 11/2009; 36(6):651-8. DOI:10.1188/09.ONF.651-658 · 1.91 Impact Factor
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    ABSTRACT: Over the past 5 years, the American Society of Clinical Oncology (ASCO) has supported the development of a Web-based quality-reporting tool in response to a recognized need to provide medical oncologists the opportunity to demonstrate the quality of care that they are providing to patients. The development of quality measures, their basis in the literature, and the descriptions and organizational structure of the measures are discussed. Specific results are the property of practices and are not shared outside of the practices except in aggregate. The system allows collection of information concerning a wide range of quality measures in a short period of time. In the last data collection period in the fall of 2008, information was submitted concerning 81 measures of quality divided into one required and six optional modules from over 250 practices concerning 15,000 patients. The timely collection of information on a wide range of quality measures regarding cancer patients can be efficiently collected using a Web-based data collection tool allowing for practice self-examination and comparison with other practices.
    Cancer control: journal of the Moffitt Cancer Center 10/2009; 16(4):312-7. · 2.66 Impact Factor
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    ABSTRACT: The Quality Oncology Practice Initiative (QOPI) is a voluntary program developed by the American Society of Clinical Oncology (ASCO) to aid oncology practices in quality self-assessment. Few academic cancer centers have been QOPI participants. We implemented the QOPI process at the University of Michigan Comprehensive Cancer Center, a large, hospital-based academic cancer center, and report our experience with five rounds of data collection. Patient medical records were selected using QOPI-specified procedures and abstracted locally; results were entered into an ASCO-maintained database and analyzed. Abstractors who were not directly involved with patient care required an average of 62.3 minutes per medical record (4.7 minutes per data element) to abstract data. We found that compliance with quality measures was uniformly high when measures were structured into our electronic medical record. Results from other measures, including those measuring chemotherapy administration in the last 2 weeks of life, were initially markedly different from those reported by other QOPI participants. Our practice changed toward the QOPI national practice norm after a presentation of the results at a faculty research conference. We found that other measures were consistently greater than 90%, including disease-specific diagnosis and treatment measures. Measuring and showing performance data to physicians was sufficient to change some aspects of physician behavior. Improvement in other measures requires structural practice changes. QOPI, an oncologist-developed system, can be adapted for use in practice improvement at an academic medical center.
    Journal of Clinical Oncology 07/2009; 27(23):3802-7. DOI:10.1200/JCO.2008.21.6770 · 17.88 Impact Factor
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    Journal of Oncology Practice 11/2008; DOI:10.1200/JOP.0866002
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    ABSTRACT: We provide a brief review of the use of quality measures to assess supportive care in the medical oncology office. Specifically, we discuss the development and implementation of supportive care measures in the Quality Oncology Practice Initiative (QOPI), a voluntary quality measurement and improvement program of the American Society of Clinical Oncology. QOPI has demonstrated that medical oncologists voluntarily engage in self-assessment and often select measures related to supportive care for measurement and improvement. Results to date have demonstrated that there is room for improvement in this domain. Because supportive care measures appropriate for use through structured chart review in the outpatient oncology setting are not generally available in the published literature, measures have been developed and tested through the program. Additional measures are in development for implementation in QOPI in 2008.
    Journal of Clinical Oncology 09/2008; 26(23):3832-7. DOI:10.1200/JCO.2008.16.8674 · 17.88 Impact Factor
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    ABSTRACT: The National Cancer Policy Board recommended the creation of quality measures and a national reporting system in 1999. Representatives from the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) collaborated to create metrics suitable for national performance measurement. Content and methodology experts nominated by ASCO and NCCN met to select and refine metrics for breast, colon, and rectal cancer based on National Initiative for Cancer Care Quality and NCCN measures and NCCN and ASCO guidelines. Measures were selected based on their impact on disease free and overall survival, the degree to which opportunities for improvement exist, and the feasibility of data collection. Three breast cancer measures and four colorectal cancer measures were chosen. Measures for breast cancer included adjuvant hormone therapy for hormone receptor-positive tumors, chemotherapy for hormone receptor-negative cancer, and radiation after lumpectomy. Colorectal measures included adjuvant radiation and chemotherapy for rectal cancer, and adjuvant chemotherapy for colon cancer. All but one were recommended as accountability measures and one for quality improvement (removal and examination of 12 or more lymph nodes in colon cancer). Specifications were developed for each measure using tumor registries as the data source. ASCO/NCCN measures can be implemented by health systems, provider groups or payors for improvement or accountability using local tumor registries to furnish data on staging and treatment.
    Journal of Clinical Oncology 07/2008; 26(21):3631-7. DOI:10.1200/JCO.2008.16.5068 · 17.88 Impact Factor
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    ABSTRACT: The Quality Oncology Practice Initiative (QOPI) became available to all American Society of Clinical Oncology member physicians in 2006 as a voluntary medical oncology practice-based quality measurement and improvement project. QOPI assesses practice performance for a series of evidence- and consensus-based process measures, relying on practices to complete structured chart reviews and submit data via a secure Web-based portal. This analysis focused on the 71 practices that participated in both the March and September 2006 data collections (7,624 charts abstracted in March and 10,240 in September). Among 33 measures common to both collections, five measures were closely correlated, and 28 are included in the final analysis. Composite scores were created for six different domains of care. Statistical significance was tested on both absolute changes and relative changes (relative failure reduction) of quality measures from baseline to follow-up and between the lower quartile and all other quartiles. Practice performance on individual measures varied between 18.8% and 98.6%. Mean overall performance as measured by a composite score increased from 78.7% in March to 82.3% in September (P < .05). Improvement was most marked among practices originally performing in the bottom quartile. Using a composite score, the absolute and relative performance for the bottom quartile improved by 27% and 35%, respectively, statistically superior to that of all others. Practices that participated in QOPI demonstrated improved performance in self-reported process measures, with the greatest improvement demonstrated in initially low-performing practices.
    Journal of Clinical Oncology 04/2008; 26(11):1893-8. DOI:10.1200/JCO.2007.14.2992 · 17.88 Impact Factor
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    Kristen McNiff
    Journal of Oncology Practice 01/2006; 2(1):26-30. DOI:10.1200/JOP.2.1.26

Publication Stats

454 Citations
131.62 Total Impact Points

Institutions

  • 2014
    • University of Texas MD Anderson Cancer Center
      Houston, Texas, United States
  • 2013–2014
    • Dana-Farber Cancer Institute
      Boston, Massachusetts, United States
    • Gateway-Vanderbilt Cancer Treatment Center
      Clarksville, Tennessee, United States
  • 2009–2014
    • American Society of Clinical Oncology
      Alexandria, Virginia, United States
  • 2008
    • North Shore Medical Center
      Salem, Massachusetts, United States
  • 2005
    • University of Cincinnati
      Cincinnati, Ohio, United States