DIFFERENTIAL MANIFESTATIONS OF INLAMMATORY BOWEL DISEASE (IBD) BASED ON RAGE AND IMMIGRATION STATUS

2021 ◽  
Vol 27 (Supplement_1) ◽  
pp. S17-S19
Author(s):  
Brooks Crowe ◽  
Ali Khalessi ◽  
Yuhe Xia ◽  
Gregory Rubinfeld ◽  
Jessica Baylor ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Disease Onset ◽  
Intestinal Resection ◽  
Safety Net ◽  
Racial Groups ◽  
Foreign Born ◽  
Single Center ◽  
Immigration Status ◽  
Black Patients ◽  
Safety Net Hospital

Abstract Background The increasing incidence of IBD globally presents an important opportunity to study intrinsic and environmental determinants of disease development. We examined how race and immigration status influence IBD manifestations, treatments, and outcomes in a diverse, tertiary-care public hospital that serves predominantly the uninsured and underinsured. Methods We conducted a single-center retrospective review of all IBD patients treated from 1997–2017. Using logistic regression modeling, we compared disease onset, treatment, and outcomes by race (White, Black, Hispanic, Asian) and immigration status (US-born vs. foreign-born). To assess for the potential confounder of race in analyses of US versus foreign-born subjects, we further evaluated differences in IBD characteristics among foreign-born patients in each of the four racial groups. Results A total of 577 patients were identified, of which 29.8% were White, 27.4% Hispanic, 21.7% Black, and 13.0% Asian. Of these patients, 260 had a confirmed country of birth, with 69.6% being foreign-born. The time between IBD diagnosis and last documented follow up was not statistically different between races, nor by foreign versus US-born status. Asian IBD patients were less likely than White IBD patients to be female (OR 0.38, 95% CI: 0.20, 0.69). Among ulcerative colitis (UC) patients, Asians were more likely than White patients to have isolated proctitis (OR 10.34, 95% CI: 1.58, 203.08). Black patients were less likely to be diagnosed with UC (OR 0.57, 95% CI: 0.36, 0.91) and more likely to undergo IBD-related intestinal resection (OR 2.49, 95% CI: 1.40, 4.50), though the opposite was true in foreign-born Black patients. Overall, foreign-born patients were more likely to be diagnosed with UC (OR 1.77, 95% CI: 1.04, 3.02). They were also less likely to be diagnosed before 16 years of age (OR 0.19, 95% CI: 0.08, 0.41), have undergone intestinal resections (OR 0.39, 95% CI: 0.19, 0.83), or have received biologics (OR 0.43, 95% CI: 0.25, 0.76). No single race accounted for the decreased use of biologics or intestinal resections among foreign-born patients. Conclusions IBD phenotype varies by race, although foreign-born patients of all races show evidence of later onset and milder disease. As our study was performed in a large single-center safety-net hospital, our study design minimized socioeconomic confounders. These findings may aid in disease prognostication and clinical management and furthermore may provide insight into intrinsic and environmental influences on IBD pathogenesis.

Comparison of Referral Pathways in Otolaryngology at a Public Versus Private Academic Center

2019 ◽  
Vol 129 (4) ◽  
pp. 369-375
Author(s):  
Caitlin Bertelsen ◽  
Janet S. Choi ◽  
Anna Jackanich ◽  
Marshall Ge ◽  
Gordon H. Sun ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Tertiary Care ◽  
Surgical Care ◽  
Safety Net ◽  
Clinic Visit ◽  
Level Of Evidence ◽  
Sociodemographic Differences ◽  
Academic Center ◽  
Safety Net Hospital ◽  
Type Of Surgery

Objective: Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referral and surgical intervention for index otolaryngologic procedures between a public safety net hospital (PSNH) and tertiary-care academic center (TAC). Methods: Retrospective cohort study of eligible adult patients undergoing one of several general otolaryngologic procedures at a PSNH (n = 216) and a TAC (n = 161) over a 2-year time period. Results: PSNH patients were younger, less likely to have comorbidities and more likely to be female, Hispanic or Asian, and to lack insurance. Time between referral and first clinic visit was shorter at the PSNH than the TAC (Mean 35.8 ± 47.7 vs 48.3 ± 60.3 days; P = .03). Time between referral and surgical intervention did not differ between groups (129 ± 90 for PSNH vs 141 ± 130 days for TAC, P = .30). On multivariate analysis, the TAC had more patient-related delays in care than the PSNH (OR: 3.75, P < .001). Time from referral to surgery at a PSNH was associated with age, source of referral, type of surgery, diagnostic workup and comorbidities, and at a TAC was associated with gender and type of surgery and comorbidities. Conclusions: Sociodemographic differences between PSNH and TAC patients, as well as differences in referral pathways between the types of institutions, influence progression of surgical care in otolaryngology. These differences may be targets for interventions to streamline care. Level of Evidence: 2c

114 Allowing Overlapping Surgery Decreases Length of Stay in an Academic, Safety-Net Hospital

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 224-224
Author(s):  
Anthony Michael DiGiorgio ◽  
Praveen V Mummaneni ◽  
Jonathan Lloyd Fisher ◽  
Adam Podet ◽  
Clifford Crutcher ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Tertiary Care ◽  
Wait Time ◽  
Multivariate Regression Analysis ◽  
Safety Net ◽  
Neurosurgical Procedures ◽  
Urgent Surgery ◽  
Period 2 ◽  
Safety Net Hospital ◽  
The Impact

Abstract INTRODUCTION The practice of surgeons performing overlapping surgery has recently come under scrutiny. We sought to examine the impact of overlapping rooms on surgery wait time and length of stay in patients admitted to a tertiary care, safety-net hospital for urgent neurosurgical procedures. METHODS Our hospital functions as a safety-net, tertiary care, level-1 trauma center in the Southern United States. The neurosurgery service transitioned from routinely allowing one room per day (period 1) to overlapping rooms (period 2), with the second room being staffed by the same attending surgeon. Patients undergoing neurosurgical intervention in each period were retrospectively compared. Case urgency, patient demographics, case type, indication, length of stay and time from admission to surgery were tracked. RESULTS >452 total cases were reviewed (201 in period 1 & 251 in period 2), covering 7 months in each period. 122 of the cases were classified as “urgent” (59 in period 1 and 63 in period 2). In the these patients, length of stay was significantly decreased in period 2 (13.09 days vs 19.52, p = .002) and the time from admission to surgery for urgent cases trended towards a shorter time (5.12 days vs 7.00, p = .084). Insurance status of these patients was 26.2% uninsured, 39.3% Medicaid, 18.9% Medicare, 9% commercial and the remainder workers compensation, liability or prisoner care. Multivariate regression analysis revealed that being in period 1, having Medicare, having trauma as the indication for surgery, and undergoing a non-cranial or non-spinal procedure as significant factors for increased length of stay. CONCLUSION Recent studies suggest overlapping surgeries are safe for patients. In the case of our safety net hospital, allowing the neurosurgery service to run overlapping rooms significantly reduces length of stay in a vulnerable population who is admitted in need of urgent surgery.

Communication of Urgent Public Health Messages to Urban Populations: Lessons From the Massachusetts Water Main Break

2011 ◽  
Vol 5 (3) ◽  
pp. 235-241 ◽  
Author(s):  
C. Jason Wang ◽  
Alison A. Little ◽  
Jaime Bruce Holliman ◽  
Chun Y. Ng ◽  
Alejandra Barrero-Castillero ◽  
...  
Keyword(s):  
Public Health ◽  
Safety Net ◽  
Personal Networks ◽  
Contaminated Water ◽  
Foreign Born ◽  
Public Officials ◽  
Cellular Telephone ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Water Main

ABSTRACTObjective: To study when and how an urgent public health message about a boil-water order reached an urban population after the Massachusetts water main break.Methods: In-person surveys were conducted in waiting areas of clinics and emergency departments at a large urban safety net hospital within 1 week of the event.Results: Of 533 respondents, 97% were aware of the order; 34% of those who lived in affected cities or towns were potentially exposed to contaminated water. Among those who were aware, 98% took action. Respondents first received the message through word of mouth (33%), television (25%), cellular telephone calls (20%), landline calls (10%), and other modes of communication (12%). In multivariate analyses, foreign-born respondents and those who lived outside the city of Boston had a higher risk of exposure to contaminated water. New modes (eg, cellular telephones) were used more commonly by females and younger individuals (ages 18 to 34). Individuals who did not speak English at home were more likely to receive the message through their personal networks.Conclusions: Given the increasing prevalence of cellular telephone use, public officials should encourage residents to register landline and cellular telephone for emergency alerts and must develop creative ways to reach immigrants and non–English-speaking groups quickly via personal networks.(Disaster Med Public Health Preparedness. 2011;5:235–241)

scholarly journals Risk Factors for Development of Hypocalcemia in Patients With Cancer Treated With Bone-Modifying Agents

2020 ◽  
Vol 18 (4) ◽  
pp. 420-427
Author(s):  
Paul S. White ◽  
Michael Dennis ◽  
Eric A. Jones ◽  
Janice M. Weinberg ◽  
Shayna Sarosiek
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Bone Metastases ◽  
Tertiary Care ◽  
Safety Net ◽  
High Rate ◽  
Close Monitoring ◽  
Patients With Cancer ◽  
Vitamin D Levels ◽  
Safety Net Hospital

Background: This retrospective analysis describes the prevalence of and risk factors associated with the development of hypocalcemia in patients with cancer receiving bone-modifying agents (BMAs) as supportive care. Patients and Methods: Patients with cancer treated with an intravenous or subcutaneous BMA, including pamidronate, zoledronic acid, or denosumab, at a tertiary care/safety net hospital in 2005 through 2015 were included in this retrospective review. We reviewed the medical records for predictive clinical and laboratory parameters and for patient outcomes. Results: A total of 835 patients with cancer received at least one dose of a BMA during the specified time frame; 205 patients (25%) developed hypocalcemia of CTCAE grade ≥1 within 8 weeks of BMA initiation, 18 of whom (8.8%) had grade ≥3, and 3 patients died as a result. Multivariate analysis showed that patients with hematologic malignancy (odds ratio [OR], 1.956; P=.025), bone metastases (OR, 2.443; P=.017), inpatient status (OR, 2.592; P<.001), and deficient baseline vitamin D levels (OR, 2.546; P<.023) were more likely to develop hypocalcemia. Hypercalcemia before BMA administration (OR, 0.474; P=.032) was protective. Conclusions: Certain patient populations, including those with hematologic malignancies and/or bone metastases, warrant closer monitoring of calcium levels while receiving BMAs because of the high rate of hypocalcemia. Low pretreatment vitamin D levels are associated with the development of hypocalcemia. These data support close monitoring of calcium levels in patients with cancer receiving BMAs, in addition to adequate repletion of vitamin D before initiation of BMAs when possible.

scholarly journals Healthcare disparities in cardio oncology: patients receive same level of surveillance regardless of race at a safety net hospital

2020 ◽  
Author(s):  
Crystal Chen ◽  
Raj Dalsania ◽  
Eman A Hamad
Keyword(s):  
Breast Cancer ◽  
Ejection Fraction ◽  
Statistical Difference ◽  
Safety Net ◽  
Referral Rate ◽  
Cancer Type ◽  
Racial Groups ◽  
Receptor Antagonists ◽  
Her2 Receptor ◽  
Safety Net Hospital

Abstract Background: Cardiotoxicity remains a dreaded complication for patients undergoing chemotherapy with human epidermal growth factor (HER)-2 receptor antagonists and anthracyclines. Though many studies have looked at racial disparities in heart failure patients, minimal data is present for the cardio-oncology population. Methods: We queried the echocardiogram database at a safety net hospital, defined by a high proportion of patients with Medicaid or no insurance, for patients who received HER2 receptor antagonists and/or anthracyclines from January 2016 to December 2018. Patient demographics, clinical characteristics, and treatment outcomes were collected. Based on US census data in 2019, home ZIP codes were used to group patients into quartiles based on median annual household income. The primary end point studied was referral rate to cardiology for patients undergoing chemotherapy. Results: We identified 149 patients who had echocardiograms and also underwent treatment with HER2 receptor antagonists and/or anthracyclines, of which 70 (47.0%) were referred to the cardio-oncology program at our institution. Basic demographics were similar, but white patients were more likely to live in ZIP codes with higher income quartiles (p<0.00001). Comparing between racial groups, there was no statistical difference in the percentage of patients that had a reduction in ejection fraction (EF) (p=0.75). There was no statistical difference between racial groups in the number of cardiology or oncology appointments attended, number of appointments cancelled, average number of echocardiograms received, additional cardiac imaging received. Black patients were more likely to receive ACEI/ARB post chemotherapy (p=0.047). A logistic regression model was created using race, age, gender, insurance, income quartile by home ZIP code, comorbidities (hypertension, hyperlipidemia, coronary artery disease, arrhythmia, diabetes mellitus, smoking, family history, age >65), procedures (coronary stents, cardiac surgery), medications pre-chemotherapy, cancer type, cancer stage, and chemotherapy. This model found that there was an increased referral rate among patients from higher income quartiles (p=0.017 for quartile 3, p=0.049 for quartile 4), patients with a history of hypertension (p<0.0001), and patients with breast cancer (p=0.02). Conclusions: The results of this study suggest that patients of our cardio-oncology population at a safety net hospital receive the same level of surveillance and treatment, and develop drop in ejection fraction at similar rates regardless of their race. However, patients that reside in ZIP codes associated with higher income quartiles, with hypertension, and with breast cancer, are associated with increased rate of referral.

Sign in / Sign up

Export Citation Format

Share Document