We report the case of a 67-year-old woman suffering from Ebstein's disease, who underwent three cardiac operations for bypass, tricuspid prosthesis and pacemaker implantation, and who needed an implantable cardioverter defibrillator for recurrent syncopes related to ventricular tachycardia. Because of the tricuspid prosthesis we chose to implant the defibrillation lead in the inferior vena cava. We collected satisfactory pacing and sensing data and performed a successful defibrillation test during the procedure. This configuration appears to be a safe alternative to conventional implantation in the coronary sinus, as already described in the literature for a few cases.

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200 Background: Treatment of pancreatic adenocarcinoma (PanCa) is complex and requires input from multiple physicians. We developed a unique gastrointestinal (GI) cancer program utilizing a multidisciplinary conference, a multidisciplinary clinic (MDC), a GI nurse navigator (NN) and continuous quality assessment with a nurse clinical auditor. The impact of this program, which requires significant additional resources, on adherence to evidence based cancer treatment for newly diagnosed PanCa patients is unknown. Methods: The GI (NN) interviews patients, coordinates staging and biopsies, physician visits and subsequent adjuvant care in the first year of diagnosis. A clinical quality specialist abstracted all treatment received (surgical, radiation, chemotherapy, palliative), and data was entered into a GI Quality database. Treatment received by patients in first year of diagnosis was compared to NCCN guidelines. Results: From January 2010 to April 2012, 68 patients with newly diagnosed PanCA were evaluated/treated. Overall compliance with NCCN treatment guidelines was 83.4%. Compliance was highest for stage I (almost all underwent surgical resection) and stage IV (none underwent surgery). Utilization of adjuvant therapies was 80% (16/20) for patients with stageI/II disease. Eight patients with stage I/II disease did not undergo surgery, due to comorbidities or disease progression. Conclusions: A novel GI cancer program utilizing a multispecialty MDC and a dedicated GI NN demonstrates very high compliance with evidence based therapy for first line treatment for PanCa patients. Although resource intensive, this level of adherence to evidence-based medicine is encouraging and higher than prior reports for PanCa. The relative contribution of the GI MDC clinic format versus the NN warrants further study. [Table: see text]

272 Background: Patients with newly diagnosed GI cancers require diagnostic studies and evaluations by physicians that may delay initiation of cancer care. Uninsured populations are particularly vulnerable. A Nurse Navigator (NN) can help decrease barriers and improve timeliness of care. This study aims to compare timeliness of cancer care received by patients referred to a GI MDC Program by the patient’s insurance status at the time of referral. Methods: Patients referred to the GI MDC are assigned a NN who evaluates medical history, diagnostic studies, and coordinates further testing and physician evaluations. Timeliness measures assessing milestones in cancer care initiation are collected prospectively. Descriptive statistics are presented and average times for measures are compared by insurance status (insured vs. uninsured) using t-tests, chi-square tests, and the Fisher’s Exact test. Results: 366 patients were evaluated between January 2010 and June 2012. 70% (255/366) were for new cancer diagnoses. Median age of cancer patients was 64 years (range 29-94), 63.1% of patients were male, and 94.1% of patients had insurance. Major cancer diagnosis types were colon/rectal (19.2%), esophageal/gastric (25.1%), hepatobiliary (12.8%) and pancreatic/ampullary/duodenal (35.7%) and 1.6% other. The table describes timeliness and care coordination measures by insurance status. Conclusions: Uninsured cancer patients in our health system appear to receive care in a timely fashion which does not differ from patients with insurance. The impact of a dedicated GI NN in avoiding disparate care for uninsured warrants further study. [Table: see text]

378 Background: Healthcare reform calls for measurements of value in services received. The 2002 IOM report Crossing the Quality Chasm emphasized deficits in efficiency, effectiveness, and patient centeredness. In 2009, a pancreatic cancer panel proposed 43 measures for high quality pancreatic cancer care. We incorporated these composite measures into a unique program of multidisciplinary (MD) care, nurse navigation (NN), and quality monitoring. Methods: A MD gastrointestinal cancer program was initiated in Jan 2010. Key components included a treatment planning conference followed immediately by a MD clinic. A GI NN coordinated staging, clinical evaluation, and treatment initiation. Patients with suspected /newly diagnosed pancreatic or periampullary neoplasms were included. We evaluated our quality of cancer care and outcomes proposed by the pancreatic cancer quality expert panel. Results: A total of 76 patients with pancreatic neoplasms were evaluated over 18 months, 55 subjects had confirmed malignancies. Of these, 20 were clinical Stage I/II, 15 stage III and 20 Stage IV. Quality measures in Table 1 focus on quality measures. 25 patients underwent resection. Mean OR time was 424 min, mean EBL 843 mL, morbidity 30%, mortality 4%, R0 resection rate 76%, mean nodes evaluated 24, and mean hospital LOS 10 days. Complete adherence with guidelines occurred in all 30 non-operative patients and 22 of 25 patients who undergoing resection. Overall compliance for all pancreatic cancer care guidelines was 99.7%. Conclusions: Comprehensive MD pancreatic cancer evaluation and care is feasible in a community cancer. We believe this study establishes new benchmarks of quality and value assessment for pancreatic cancer programs. [Table: see text]