313 Background: Hospitals accredited by the Joint Commission are required to provide Ongoing Professional Practice Evaluation (OPPE) for all privileged providers. Historically, OPPE reports had been created and completed by a peer review process on a paper-based system, where the data was managed in spreadsheets. The Division of Quality and Safety (DQS) developed an electronic system of collecting clinical and administrative data, with the goal of assessing quality of care in an impartial, modernized, and efficient process. Methods: Electronic implementation of the OPPE process can be divided into three main parts: metric development using electronic medical records (EMR), report automation, and application development for review. We designed queries to extract EMR data to validate the quality measures developed in collaboration with clinical leadership. Data pulls are then automated to populate outcomes to a table, from which the OPPE reports are populated according to selected parameters such as provider’s unique ID and OPPE period. Reports are then accessed by supervisors and providers directly through a web application developed by DQS. After verifying the data, clinicians can sign off in the application to complete the OPPE review process. Results: We have distributed 8,630 electronic OPPE report since 2012, and 1,486 distinct physicians had received reports. We evaluated engagement of the process by looking at engagement rate (number of OPPE signed reports divided by the total number of OPPE reports). The engagement rate varies by department, but the median of engagement rates of the OPPE process is 100%. Conclusions: Moving from paper chart reviews to an electronic process enables the institution to scale, lower the burden on employees, and improve the convenience of OPPE for busy providers. It also provides opportunities to evaluate quality of care on the provider level by analyzing outliers using the OPPE measure outcomes and finding the correlation of engagement rate and the quality outcomes.

e18870 Background: Thirty-day unplanned readmissions are a fundamental indicator of hospital quality. Current models used to predict readmissions perform poorly in cancer patients. We explored how patient-reported satisfaction on the HCAHPS hospital survey correlates with and improves predictive models on 30-day readmissions. Methods: We used data from HCAHPS responses (n = 26,044) between January 2010 and June 2017 from a single, urban comprehensive cancer center. We correlated all HCAHPS questions to readmissions, replicating a previous study’s analysis of 8 HCAHPS questions. Next, we created a prediction model for each HCAHPS questions using binomial logistic regression on clinical variables (MDC, Service, length of stay, number of medications at discharge, history of adverse events, an adverse event on their current visit, hour of discharge, history of readmissions) and satisfaction results. Finally, we performed a factor analysis to determine if latent subscales exist among the highly correlated HCAHPS questions. Results: Among the 21 HCAHPS questions analyzed, 15 had significant associations with readmissions, after controlling for clinical variables. For 14 of these items, patients who selected the top scores on these questions were less likely to be readmitted. For example, patients who selected the top score for the item “Did you have help when you pressed the call button?” were significantly less likely to be readmitted (OR = .69). Non-intuitively, patients who selected the the top score for the item “Did staff talk to you about whether you would have help after you left?” were more likely to be readmitted (OR = 1.31). Our final model accounts for 89.7% of the variance in readmissions when accounting for clinical factors as well as our decided-upon HCAHPS questions. Conclusions: Patient satisfaction ratings offer unique information on the probability that a cancer patient will be readmitted to the hospital. This novel source of data can help improve prediction models and may be considered when designing interventions. As patient satisfaction is increasingly offered in real-time and online, these data could be used to target interventions for cancer patients at high risk of readmissions.

e18775 Background: Hospital culture is the product of multiple factors such as management directives and mission statements which, in turn, can influence individual attitudes and perceptions (Ryan & Deci, 2000). Patient safety culture is important in order to minimize risks to patients and improve outcomes, and can be thought of as containing 3 main factors: psychological, behavioral, and situational. Each affects patient outcomes (Meddings, et al., 2017) and adverse events (Burlison, et al., 2016). To that end, the Agency for Healthcare Research & Quality developed their Patient Safety Culture Survey (PSCS; Nieva & Sorra, 2003) to assess 12 different factors making up safety culture. Our aim was to examine how each of these uniquely relates to reported adverse events in a tertiary academic cancer hospital setting. Methods: Eligible participants were recruited among staff having direct or indirect contact with patients by way of email and hospital home page announcements. The survey itself was administered by the New York State Partnership for Patients. A total of 3,567 staff participated, representing a variety of roles (e.g. physician, nurse, pharmacist) and services (e.g. medicine, surgery, pediatrics). Adverse events in the three months prior to survey administration were recorded to an online reporting system. Staff can record events that cause actual harm ranging from level 0 (a near miss) to level 4 (death). Results: Multiple regressions analyses, including all 12 subscales controlling for each other, suggest that within inpatient floors, higher levels of Organizational Learning (β = -.30) and Overall Perceptions of Safety (β = -.28) were associated with reported adverse events of lowered severity. Greater perceived levels of Teamwork (β = .46) were associated with more severe reported adverse events. Conclusions: Among the 12 subscales of the PSCS, three emerged as uniquely predictive of severity of reported adverse events, with moderate effect sizes. Therefore, assessing and analyzing safety culture may have tangible, beneficial effects for patients. Potential interventions to maintain and improve culture are discussed.

Low-molecular weight heparin (LMWH) has been the standard of care for treatment of venous thromboembolism (VTE) in patients with cancer. Rivaroxaban was approved in 2012 for the treatment of pulmonary embolism (PE) and deep vein thrombosis (DVT), but no prior studies have been reported specifically evaluating the efficacy and safety of rivaroxaban for cancer-associated thrombosis (CAT). Under a Quality Assessment Initiative (QAI), we established a Clinical Pathway to guide rivaroxaban use for CAT and now report a validation analysis of our first 200 patients. A 200 patient cohort with CAT (PE or symptomatic, proximal DVT), whose full course of anticoagulation was with rivaroxaban, were accrued. In competing risk analysis, primary endpoints at 6 months included new or recurrent PE or symptomatic proximal lower extremity DVT, major bleeding, clinically-relevant non-major bleeding leading to discontinuation of rivaroxaban, or death. In competing risk analysis, the 6 months cumulative incidence of new or recurrent VTE was 4.4 % (95 % CI = 1.4-7.4 %), major bleeding was 2.2 % (95 % CI = 0-4.2 %) and all-cause mortality 17.6 % (95 % CI = 11.7-23.0 %). In this cohort of 200 patients with active cancer and CAT the rates of new or recurrent VTE and major bleeding were comparable to the cancer subgroup analysis from the EINSTEIN studies. The results of our Clinical Pathway provide guidance on Rivaroxaban use for treatment of CAT, and suggest that safety and efficacy is preserved, compared with past-published experience with LMWH.

Rivaroxaban is broadly used for the primary prevention of stroke and systemic embolism in the general population with nonvalvular atrial fibrillation (AF). However, there is little published evidence on the safety and efficacy of rivaroxaban for AF in patients with active cancer. The aim of this study was to assess the safety and efficacy of rivaroxaban in patients with active cancer and AF. The use of rivaroxaban in patients with cancer at the Memorial Sloan Kettering Cancer Center is monitored in the setting of a Quality Assessment Initiative. Patients with active cancer and AF, treated with rivaroxaban from January 1, 2014, to March 31, 2016, are included in this analysis. Clinical end points were defined a priori and assessed through text searches of medical records. A total of 163 evaluable patients were identified. After adjusting for competing risks, the estimated 1-year cumulative incidence of ischemic stroke was 1.4% (95% CI 0% to 3.4%) and major bleeding was 1.2% (95% CI 0% to 2.9%). The risk of clinically relevant nonmajor bleeding leading to discontinuation of anticoagulation at 1 year was 14.0% (95% CI 4.2% to 22.7%). The cumulative incidence of mortality was 22.6% (95% CI 12.2% to 31.7%) at 1 year, reflecting an active cancer population. One patient died after developing an acute ischemic cerebrovascular insult. In conclusion, the safety and efficacy of rivaroxaban treatment for nonvalvular AF in patients with active cancer is comparable to the results of the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF) study in the general population. (C) 2017 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

American Journal of HematologyVolume 92, Issue 1 p. E9-E10 CorrespondenceOpen Access Treatment of central venous catheter-associated deep venous thrombosis in cancer patients with rivaroxaban Eva S. Laube, Eva S. Laube Hematology Service, Memorial Sloan Kettering Cancer Center, New York, New YorkSearch for more papers by this authorSimon Mantha, Simon Mantha Hematology Service, Memorial Sloan Kettering Cancer Center, New York, New YorkSearch for more papers by this authorPatrick Samedy, Patrick Samedy Division of Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, New YorkSearch for more papers by this authorJonathan Wills, Jonathan Wills Data Solution Group, Memorial Sloan Kettering Cancer Center, New York, New YorkSearch for more papers by this authorStephen Harnicar, Stephen Harnicar Pharmacy Department, Memorial Sloan Kettering Cancer Center, New York, New YorkSearch for more papers by this authorGerald A. Soff, Corresponding Author Gerald A. Soff soffg@mskcc.org Hematology Service, Memorial Sloan Kettering Cancer Center, New York, New YorkCorrespondence to: Gerald A. Soff, MD, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065. E-mail: soffg@mskcc.orgSearch for more papers by this author Eva S. Laube, Eva S. Laube Hematology Service, Memorial Sloan Kettering Cancer Center, New York, New YorkSearch for more papers by this authorSimon Mantha, Simon Mantha Hematology Service, Memorial Sloan Kettering Cancer Center, New York, New YorkSearch for more papers by this authorPatrick Samedy, Patrick Samedy Division of Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, New YorkSearch for more papers by this authorJonathan Wills, Jonathan Wills Data Solution Group, Memorial Sloan Kettering Cancer Center, New York, New YorkSearch for more papers by this authorStephen Harnicar, Stephen Harnicar Pharmacy Department, Memorial Sloan Kettering Cancer Center, New York, New YorkSearch for more papers by this authorGerald A. Soff, Corresponding Author Gerald A. Soff soffg@mskcc.org Hematology Service, Memorial Sloan Kettering Cancer Center, New York, New YorkCorrespondence to: Gerald A. Soff, MD, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065. E-mail: soffg@mskcc.orgSearch for more papers by this author First published: 20 October 2016 https://doi.org/10.1002/ajh.24588Citations: 32 Conflict of interest: Research support from Janssen Scientific Affairs. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat To the Editor: Central venous catheters (CVC) are an important tool in ongoing cancer therapy. However, central venous catheter-related, upper extremity deep venous thrombosis (CVC-UEDVT) is a common complication in patients with cancer 1. These thromboses often lead to loss of the CVC, which presents an obstacle to ongoing treatment 2. There is little prospective data and limited clinical trials on appropriate anticoagulation management of CVC thrombosis. However, low molecular weight heparin (LMWH) has been recommended and routine removal of the CVC has not been recommended 1-5. There are no data available yet about the use of rivaroxaban for CVC-UEDVT. Since January 1, 2014, all rivaroxaban use at Memorial Sloan Kettering Cancer Center (MSKCC) is being monitored under an Internal Review Board (IRB) approved Quality Assessment Initiative. For this analysis, we have identified all patients with active cancer and a CVC-UEDVT from January 1, 2014 through February 24, 2016, treated with rivaroxaban. A CVC-UEDVT was identified by imaging study (CT, MRI, and/or ultrasound) and related clinical notes. This was a retrospective analysis. The primary endpoint was preservation of line function through 90 days. Secondary endpoints included removal of central line for other medical reason, major bleeding (MB), clinically relevant non-major bleeding leading to discontinuation of rivaroxaban, death, and development of other venous thromboembolic event. Patients were censored if they reached an endpoint, or discontinued rivaroxaban prior to completion of 90 days. All clinical notes were reviewed by a combination of automated text search with predefined terms, followed by review by a study physician. During the study period, we identified a key cohort of 83 patients with active cancer and a CVC-UEDVT, in whom the central line was present and functional at initiation of rivaroxaban. Patients whose CVC had been removed prior to initiation of anticoagulation were not included in this cohort. Table 1 summarizes the baseline characteristics of the 83 patients. Forty one of the CVC-UEDVT events were identified incidentally on routine imaging studies and 42 were identified following symptoms (N = 40) or line dysfunction (N = 2). Most of the thromboses were found in an internal jugular vein (N = 37), the superior vena cava (N = 16), and subclavian vein (N = 10). An indwelling port was the predominant central access device. Table 1. Baseline Characteristics and Outcomes Of Patients With Central Venous Catheter-Associated Thrombosis Treated With Rivaroxaban A. Baseline characteristics Average age 62 years Sex: Male/Female 32/51 CVC-UEDVT, line type: Port 77 PICC 5 Leukapheresis catheter 1 CVC-UEDVT, anatomy: Internal jugular vein 37 Superior vena cava 16 Subclavian vein 10 Other 20 CVC-UEDVT, line type: Port 77 PICC 5 Leukapheresis catheter 1 Presentation: Symptoms of thrombosis 40 Line dysfunction 2 Incidental during routine scan 41 Initiation of rivaroxaban Time since event: Riva started within the first 7 days of diagnosis 60 Rivaroxaban start > 7 days after diagnosis 23 B. Outcomes N Completed 90 days 53 Line Removed <90 days Line removal for dysfunction 3 Line removal for other reasons. (completion of therapy, infection, thrombocytopenia,) 9 Major bleed 2 CRNMB leading to discontinuation of rivaroxaban 1 Death 6 New thrombosis in other blood vessel 3 Rivaroxaban discontinuation for medical reason other than endpoint 4 Transfer of care to other hospital 2 TOTAL 83 In 55 patients rivaroxaban was the sole anticoagulant and 5 additional patients received less than 7 days of LMWH prior to transition to rivaroxaban. The remaining patients transitioned to rivaroxaban after initial anticoagulation with LMWH. In three patients, the CVC-UEDVT developed in patients already on another anticoagulant for either atrial fibrillation or a previous thromboembolic event, and the patients were transitioned to rivaroxaban when the new CVC-UEDVT was identified. The majority of patients were in an advanced cancer stage; 60% stage IV and 13% stage III. Our analysis focused on the 90-day period after the thrombosis. Within the 90-day period, in only three patients was the CVC line removed due to development of line dysfunction. These three patients developed inability to aspirate from a Port type central line on day 15, 20, and 36 of rivaroxaban anticoagulation. Fifty-three patients (64%) completed a follow-up time of 90 days without the removal of their central line, or reaching another endpoint (Table 1). In addition, nine other patients had their CVC lines removed within the 90-day period, but not due to line failure. These were for end of cancer treatment (N = 6), infection (N = 1), thrombocytopenia (N = 1), and patient preference (N = 1). Other primary endpoints of note are listed in Table 1(B), including six deaths, three new VTE at other sites, two major bleeds, and one clinically relevant non-major bleeding leading to discontinuation of rivaroxaban. In this single institutional experience, rivaroxaban appears to be a good choice for treatment of a CVC-UEDVT. The failure rate at three months of treatment with rivaroxaban in this cohort is low, with only 3 patients out of 83 (3.6%) requiring CVC line removal due to development of line dysfunction. The overall rate of CVC line removal for any cause in our rivaroxaban cohort was 12 of 83 (14%). Our cohort study does not lend itself to direct comparisons with previous reports. With that limitation in mind, in the previously published Catheter Study of LMWH followed by warfarin, the overall rate of CVC line removal was 43% 3. The safety profile of rivaroxaban use for CVC-UEDVT was encouraging. Major bleeding events occurred in two patients treated with rivaroxaban, with an estimate of 2.4%. In The Catheter Study and the upper-Extremity DVT arm of the RIETE trial, major bleeding was reported in 10.9% and 2.1%, respectively 3, 6. Overall the safety and efficacy of rivaroxaban use in patients with active cancer for treatment of central venous catheters associated upper extremity deep venous thrombosis is very favorable in this single institutional cohort. Nevertheless, randomized controlled trials are needed to confirm these results. Eva S. Laube,1 Simon Mantha,1 Patrick Samedy,2 Jonathan Wills,3 Stephen Harnicar,4 and Gerald A. Soff1* 1Hematology Service; 2Division of Quality and Safety; 3Data Solution Group; 4Pharmacy Department, Memorial Sloan Kettering Cancer Center, New York, New York References 1Debourdeau P, Farge D, Beckers M, et al. International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer. J Thromb Haemost 2013; 11: 71– 80. 2Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol 2003; 21: 3665– 3675. 3Kovacs MJ, Kahn SR, Rodger M, et al. A pilot study of central venous catheter survival in cancer patients using low-molecular-weight heparin (dalteparin) and warfarin without catheter removal for the treatment of upper extremity deep vein thrombosis (The Catheter Study). J Thromb Haemost 2007; 5: 1650– 1653. 4Kucher N. Clinical practice. Deep-vein thrombosis of the upper extremities. N Engl J Med 2011; 364: 861– 869. 5Lee AY, Levine MN, Baker RI, et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003; 349: 146– 153. 6Munoz FJ, Mismetti P, Poggio R, et al. Clinical outcome of patients with upper-extremity deep vein thrombosis: Results from the RIETE Registry. Chest 2008; 133: 143– 148. Citing Literature Volume92, Issue1January 2017Pages E9-E10 ReferencesRelatedInformation

Abstract Background: Low-molecular weight heparin (LMWH) has been the standard of care for treatment of venous thromboembolism (VTE) in patients with cancer. LMWH injections are painful and costly. Rivaroxaban, an oral direct factor Xa inhibitor, was FDA approved in 2012 for treatment of pulmonary embolism (PE) and deep vein thrombosis (DVT), but there has been a knowledge gap for its use in patients with cancer-associated thrombosis (CAT). Under a Quality Assurance Initiative (QAI), we established a Clinical Pathway to guide rivaroxaban use for CAT, and began to offer rivaroxaban as an alternative to enoxaparin, in January 2014, for patients who met appropriate clinical criteria. We are tracking all cancer patients with PE or symptomatic proximal DVT, whose full course of anticoagulation is with rivaroxaban (allowing up to 3 days of initial parenteral anticoagulation). We now report the characteristics of the first 200 patients, and an outcome analysis of our first 100 patients, who have been treated for at least 6 months or otherwise reached an endpoint. Materials and Methods: The Clinical Pathway guidelines will be available on request, pending publication. Patients were not treated with rivaroxaban if they had active gastrointestinal or genitourinary lesions, or had undergone gastric resection due to anticipated excess bleeding risk or reduced absorption. This excluded under 5% of patients. The Pathway provided dosing guidelines in the setting of thrombocytopenia, advanced age, transient renal, or hepatic dysfunction. Primary endpoints include new or recurrent PE, symptomatic proximal lower extremity DVT, major bleeding (ISTH definition), clinically-relevant non-major bleeding leading to discontinuation of rivaroxaban, or death. Considering those outcomes as competing risks, the cumulative incidence of each event type was calculated using R 3.2.0 for Windows and package "Survival". Results: The characteristics of our first 200 patients are in Table 1. 70% of the patients had PE. Of the solid tumor patients, 65.6% had metastatic disease. The first 100 patients have completed at least 6 months of rivaroxaban anticoagulation or otherwise reached a primary endpoint. At 6 months, the cumulative incidence of death was 14.4% (95% CI=6.8-21.4%), new or recurrent VTE was 4.3% (95% CI=0.1-8.4%), major bleeding was 1.1% (95% CI=0-3.1%), and clinically relevant non-major bleeding leading to rivaroxaban discontinuation was 7.9% (95% CI=2.1-13.3%). Conclusions: In the analysis of the first 100 patients entered into our QAI program, the rates of major bleeding, and new or recurrent VTE compare favorably to two published studies of LMWH for treatment of cancer associated thrombosis. In the CLOT study (Lee et al, NEJM, 2003) and the Daltecan study (Francis et al, JTH, 2015), the 6-month rates of new or recurrent VTE were approximately 9%, and the rates of major bleeding were 6% and 9.5% respectively. Our final analysis awaits the completion of 6 months follow-up on 200 patients, to be completed in December 2015. But the rates of major bleeding and recurrent VTE at this point suggest safety and efficacy to be at least non-inferior to LMWH, with the advantage of reduced patient burden, and support the ongoing use of our Clinical Pathway. Our low rate of major bleeding likely is influenced by the exclusion of patients with active GI or GU lesions, who would be expected to have a high bleeding risk with an oral direct anticoagulant. However, we estimate this excluded less than 5% of cancer patients with VTE. Further, we anticipated reduced drug clearance in the elderly, and used a reduced dose for patients greater than 75 years of age. This appeared to be associated with no loss in efficacy, and helped maintain a low rate of major bleeding. A randomized trial is the optimal approach to establish non-inferiority or superiority of rivaroxaban to LMWH for cancer associated thrombosis. However, our QAI Clinical Pathway provides guidance and reassurance for rivaroxaban use until a randomized trial is conducted. Table. Baseline Characteristics of Patients Characteristic Number of Individuals Gender Male 82 Female 118 Event Type PE, with or without DVT 140 Proximal, Symptomatic Lower extremity DVT 60 Cancer Type Solid Tumor 186 Hematologic Malignancy 14 Cancer Stage (Of Solid Tumors) No Evidence of Disease (Post-Cancer Surgery) 11 (5.9%) 1 1 (0.5%) 2 4 (2.2%) 3 16 (8.6%) 4 122 (65.6%) Unknown 32 (17.2%) Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

e17583 Background: Patients with limited English proficiency (LEP) are increasing in number in the US. Language barriers make it difficult for patients to communicate their symptoms and may lead to higher readmission rates. It is unknown whether this risk is observed in LEP cancer patients. Methods: We performed a cross sectional study to assess readmission rates for cancer patients admitted to Memorial Sloan Kettering Cancer Center. Data were collected from December 1, 2010 to August 31, 2013 (n = 64445; n = 4429 (7%) reported LEP). We evaluated differences in readmissions by service and analyzed a subset of patients admitted to the Gastrointestinal Oncology (GI) Service for the top 3 admission diagnoses: fever, abdominal pain, and nausea with vomiting. We calculated 30-day readmission rates and conducted logistic regression analyses to evaluate the difference in readmission rates between LEP and English speakers. Results: Compared to English speaking patients, LEP patients were 27% more likely to be readmitted (p < 0.001). LEP patients admitted to the breast surgery (n = 2356, OR 3.61, 95% CI 1.05-12.46, p = 0.042), GI (n = 4629, OR 1.28, 95% CI 1.01-1.62, p = 0.042), lymphoma (n = 980, OR 1.55, 95% CI 1.05-2.28, p = 0.028), and orthopedic (n = 1302, OR 2.81, 95% CI 1.15-6.86, p = 0.023) services were more likely to be readmitted than English speakers. A total of 1,197 patients were admitted to the GI service with fever (n = 512), abdominal pain (n = 432), or nausea with vomiting (n = 253) during the study period, 10.6% with LEP. Compared to English-speaking patients, LEP patients with fever were twice as likely to be readmitted (OR 2.13, 95% CI 1.15-3.95, p = 0.016). There were no differences in the readmission rates for patients admitted with abdominal pain (OR 0.98, 95% CI 0.45-2.11, p = 0.9) or nausea with vomiting (OR 0.89, 95% CI 0.32-2.46, p = 0.8). Conclusions: Overall, LEP patients were more likely to be readmitted than English speaking patients, particularly on the breast surgery, GI onc, lymphoma, and orthopedic services. LEP patients with gastrointestinal cancers initially admitted for fevers were more likely to be readmitted than English-speaking patients with fever. Studies are needed to understand the role that LEP plays in hospital readmissions.

34 Background: Research and quality improvement studies often involve an extensive amount of manual review of medical records. The effective management of this process is critical to the consistent, accurate, and cost effective collection and timely dissemination of quality data. Methods: The purpose of this paper is to introduce “OpenQA”, a data management tool designed specifically to help organize, track, and communicate data related to quality improvement studies. OpenQA is designed with ease of chart abstraction, efficiency of data collection, and data transparency as a goal, while providing reporting that support a range of activities related to data management tasks common to hospital quality management departments. The basic method behind OpenQA is to: (1) Provide a centralized online repository for measure related metadata; (2) automatically identify retrospective and prospective encounters that meet specified study inclusion/exclusion criteria; (3) extract key details from structured and unstructured data sources and then combine them to help quality auditors make compliance decisions; (4) provide a workflow engine that supports work lists, alerting and a feedback mechanism for metric stakeholders; (5) provide audit tracking to enable measurability of data collection efforts. Results: Favorable effects were realized post implementation across all measures of performance despite an increase in case volume. Results indicate a decrease in median audit turnaround time, defined as the time between the patient encounter and a decision is made by the auditor, by 23 days (85%). Results also indicate a decrease in the audit reporting turnaround time, defined as the time between the patient encounter and the compliance decision is made and reported. Both reductions were significant at a p value of < 0.05. Conclusions: We suggest that a tool designed to help streamline and standardize the quality improvement data collection process may offer the advantage of minimizing the resource utilization associated with data collection while improving data integrity and shortening the feedback loop.