PURPOSE: Financial toxicity of cancer treatment is well described in the literature, including characterizations of its risk factors, manifestations, and consequences. There is, however, limited research on interventions, particularly those at the hospital level, to address the issue. METHODS: From March 1, 2019, to February 28, 2022, a multidisciplinary team conducted a three-cycle Plan-Do-Study-Act (PDSA) process to develop, test, and implement an electronic medical record (EMR) order set to directly refer patients to a hospital-based financial assistance program. The cycles included an assessment of the efficacy of our current practice in connecting patients experiencing financial hardship with assistance, the development and piloting of the EMR referral order, and the broad implementation of the order set across our institution. RESULTS: In PDSA cycle 1, we found that approximately 25% of patients at our institution experienced some form of financial hardship, but most patients were not connected to available resources because of our referral mechanism. In PDSA cycle 2, the pilot referral order set was deemed feasible and received positive feedback. Over the 12-month study period (March 1, 2021-February 28, 2022) of PDSA cycle 3, 718 orders were placed for 670 unique patients across interdisciplinary providers from 55 treatment areas. These referrals resulted in at least $850,000 in US dollars (USD) in financial aid in 38 patients (mean = $22,368 USD). CONCLUSION: The findings from our three-cycle PDSA quality improvement project demonstrate the feasibility and efficacy of interdisciplinary efforts to develop a hospital-level financial toxicity intervention. A simple referral mechanism can empower providers to connect patients in need with available resources.
This paper briefly describes a new biosphere model, ERMYN, that was developed to characterize biosphere processes for radionuclides released fiom the proposed high-level radioactive waste geologic repository at Yucca Mountain (YM). Biosphere modeling for YM is conducted independently for two radionuclide release modes and resulting exposure scenarios, groundwater release and volcanic release. This paper focuses on the model for groundwater release. The groundwater release exposure scenario addresses the case in which the geosphere-biosphere interface is well extraction of contaminated groundwater.
The Nuclear Waste Policy Act of 1982 established the obligations of and the relationship between the U.S. Environmental Protection Agency (EPA), the U.S. Nuclear Regulatory Commission (NRC), and the U.S. Department of Energy (DOE) for the management and disposal of high-level radioactive wastes. In 1985, the EPA promulgated regulations that included a definition of performance assessment that did not consider potential dose to a member of the general public. This definition would influence the scope of activities conducted by DOE in support of the total system performance assessment program until 1995. The release of a National Academy of Sciences (NAS) report on the technical basis for a Yucca Mountain-specific standard provided the impetus for the DOE to initiate activities that would consider the attributes of the biosphere, i.e. that portion of the earth where living things, including man, exist and interact with the environment around them.The evolution of NRC and EPA Yucca Mountain-specific regulations, originally proposed in 1999, was critical to the development and integration of biosphere modeling and analyses into the total system performance assessment program. These proposed regulations initially differed in the conceptual representation of the receptor of interest to be considered in assessing performance. The publication in 200 1 of final regulations in which the NRC adopted standard will permit the continued improvement and refinement of biosphere modeling and analyses activities in support of assessment activities.
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