scholarly journals 288. Clinical Variables Associated with COVID-19 Mortality and ICU Admission in a Public Safety-net Hospital in Chicago

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S250-S251
Author(s):  
Ruben A Hernandez-Acosta ◽  
Juan Sarmiento ◽  
Palak Patel ◽  
Michael Hoffman ◽  
Katayoun Rezai
Keyword(s):  
Severe Disease ◽  
Safety Net ◽  
The United States ◽  
Cook County ◽  
Bivariate Analysis ◽  
Care Hospital ◽  
Icu Admission ◽  
Safety Net Hospital ◽  
Hispanic Patients ◽  
Race Ethnicity

Abstract Background The COVID-19 pandemic has disproportionately impacted minorities in the United States. John H. Stroger Jr. Hospital (JSH) is a tertiary care hospital within the safety-net system for Cook County in Chicago, Illinois. In this study we report demographics, clinical characteristics and outcomes of patients admitted with COVID-19 in our hospital during the spring surge of 2020. Methods A retrospective study was done including patients > 18 years of age admitted to JSH with positive PCR for SARS-CoV2 from March 18 to May 30th, 2020. Outcomes, clinical and demographic characteristics were extracted from the electronic medical record. Moderate and severe disease were defined as radiographic evidence of pulmonary infiltrates and SpO2 > 94% on room air or SpO2< 94% on room air, respectively. Bivariate analysis and logistic regression were performed to assess for risk factors for admission to the intensive care unit and mortality. Results 625 patients were included, 424 (68%) were male. Median age was 44 years (44,63). 364 (58%) were Hispanic and 222 (36%) non-Hispanic Blacks. 113 (18%) of patients presented with mild disease, 204 (33%) with moderate disease, 298 (48%) with severe disease. 73 patients (12%) died. 153 (24%) required ICU admission, 84 (13%) required intubation [Table 1]. In bivariate analysis, increasing age and diabetes (DM) were associated with increased mortality and ICU admission (p=0.001, Tables 2 and 3). Race/ethnicity was not associated with increased mortality or ICU admission. In the multivariate analysis, elevated glucose on admission regardless of DM and CKD were associated with mortality (p < 0.001). Conclusion JSH is a safety net hospital that provides care for the most vulnerable population of Chicago. The proportion of Hispanic patients increased in the later weeks of the pandemic until they represented most of the inpatient population and presented with more severe disease (Figure 1). Although race was not associated with mortality or ICU admission, the high prevalence of chronic diseases such as hypertension and DM in our population may explain the higher rate of admissions. Strengthening of preventive medicine and social engagement with minorities must be a crucial effort to decrease the burden of COVID-19 in this population. Graph showing disease severity on admission by Race/Ethnicity (upper). Notice the predominance of severe disease (orange) in Hispanic patients. Graph showing Race/Ethnicity Distribution by Week (lower). Notice the gradual increase and predominance of Hispanic patients (orange) in the later weeks of the study period compared to Black (blue) and White (green) patients. Disclosures All Authors: No reported disclosures

Stage at presentation for medically underserved gastric cancer patients.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 26-26
Author(s):  
M. Alattar ◽  
K. Hahn ◽  
C. J. Wray
Keyword(s):  
Gastric Cancer ◽  
Median Survival ◽  
Proportional Hazards Model ◽  
Safety Net ◽  
The United States ◽  
Cox Proportional Hazards Model ◽  
Age At Diagnosis ◽  
Advanced Stage ◽  
Safety Net Hospital ◽  
Hispanic Patients

26 Background: Survival disparities in the United States exist for nearly all malignancies. The relationship between stage at presentation and outcome is not well understood. Our hypothesis is that medically un- and underinsured gastric cancer (GC) patients present at advanced stage leading to worse outcomes. Methods: Institutional review board approved review of the departmental gastrointestinal cancer database from 04/08/2000 to 11/18/2008. All patients diagnosed with gastric adenocarcinoma were included; clinicopathologic, treatment and outcome data was recorded. Statistical analysis was performed using STATA 10. Results: A total of 185 patients (108 male, 77 female) were included in this study. Mean age at diagnosis for all patients was 55.3 yrs. The mean age at diagnosis was lower for Hispanics (52.4 years) when compared to other races (ANOVA p = 0.00). The majority of Hispanic patients presented with stage IV disease (55%, chi square p = 0.01). The age range and minimum age at diagnosis was different for Hispanics. Median survival for the entire cohort was 12.3 mo. Although not significant (log rank p = NS), median survival was lowest for African Americans (AA) and Asians. Cox proportional hazards model demonstrated surgical resection and adjuvant therapy (chemoradiation) to be independent predictors of survival. Conclusions: Hispanic patients in medically un- and underinsured populations showed significantly younger age at presentation and more advanced stage of GC. However, median survival for Hispanic GC patients was not significantly shortened compared to other races in this cohort. Survival for AA and Asian patients in a public safety net hospital remains poor and investigation into factors contributing to such disparities is ongoing. [Table: see text] No significant financial relationships to disclose.

Abstract 090: Armenian Ethnicity: An Independent Risk Factor for Positive Exercise Treadmill Tests

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Ara H Rostomian ◽  
Daniel Sanchez ◽  
Jonathan Soverow
Keyword(s):  
Risk Factors ◽  
Los Angeles ◽  
Multivariate Logistic Regression Analysis ◽  
Safety Net ◽  
The United States ◽  
World Health ◽  
Limited Information ◽  
Safety Net Hospital ◽  
Exercise Treadmill ◽  
History Of

Background: Several studies have examined the risk of cardiovascular disease (CVD) among larger racial and ethnic groups such as Hispanics and African-Americans in the United States, but limited information is available on smaller subgroups such as Armenians. According to the World Health Organization, Armenia ranks eighth in CVD rates among all countries however it is unclear if Armenian immigrants living in the US have the same high rates of disease. This study examined whether being of Armenian descent increased the risk of having a positive exercise treadmill test (ETT) among patients treated at a safety net hospital in Los Angeles County. Methods: Data on patients who received an ETT from 2008-2011 were used to conduct a retrospective analysis of the relationship between Armenian ethnicity and ETT result as a surrogate measure for CVD. A multivariate logistic regression analysis was used to estimate the odds ratios (OR) for having a positive ETT among Armenians relative to non-Armenians, adjusting for the following pre-specified covariates: gender, age, diabetes, hypertension, hyperlipidemia, smoking, family history of coronary artery disease (CAD), and patient history of CAD. Results: A total of 5,297 patients, ages 18 to 89, were included. Of these, 13% were Armenian and 46% were male, with an average age of 53 years. Armenians had higher odds of having a positive ETT than non-Armenians (Crude OR=1.30, p=0.037, CI:1.02,1.66). After adjusting for CV risk factors, Armenians were still significantly more likely to have a positive ETT than non-Armenians (OR=1.33, p=0.029, CI:1.03,1.71). CAD (OR 2.02, p<0.001, CI:1.38,2.96), and hyperlipidemia (OR=1.31, p=0.008, CI:1.07,1.60) were also significantly associated with a positive ETT. Conclusion: Armenians have a higher likelihood of having a positive ETT than non-Armenians. This relationship appears to be independent of traditional CV risk factors and suggests a role for cultural and/or genetic influences.

Abstract 230: Internal Medicine Trainee Understanding and Reaction to Out of Pocket Costs

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Jeffrey P Chidester ◽  
Sandeep R Das ◽  
Rebecca Vigen
Keyword(s):  
Internal Medicine ◽  
Decision Making ◽  
Safety Net ◽  
Cost Of Care ◽  
Care Hospital ◽  
Care Clinic ◽  
Significant Difference ◽  
Safety Net Hospital ◽  
Out Of Pocket Costs ◽  
Clinic Visits

Introduction: Out-of-pocket costs (OOPC) are a significant barrier to care and drive suboptimal medical therapy in ASCVD. Despite this, there is minimal attention paid to these costs in post-graduate education. To define a potential knowledge gap, we surveyed trainee understanding of OOPC. Methods: We surveyed Internal Medicine residents at a large academic program comprised of a large county safety-net hospital, a VA, and a private tertiary care hospital, about knowledge and practices surrounding patient OOPC. Residents rotate on services at all sites and the vast majority have primary care clinic at the county or VA hospital. Participants answered questions considering their most recent inpatient panel and their clinic patient panel. Familiarity was ranked on a 5-point Likert scale, and for the purposes of presentation, was divided into “Poor” and “Moderate or Better”. Non-parametric analysis was used to test differences between outpatients v inpatients and by year of training. Results: Of 159 residents, 106 (67%) responded. Familiarity with patient insurance status was moderate or better in 135 of 159 (85%). Moderate or better understanding of costs associated with medications (52% [83 of 159]), testing (19% [30 of 159]) and clinic visits (30% [48 of 159]) was less common. Respondents had higher familiarity with OOPC for clinic patients compared with their most recent inpatient panel: clinic visits (39% v 21% [62 v 33 of 159 p < 0.005]), testing (25.7% v 12.4% [41 v 20 of 159 p = 0.002]), and medications (62% v 42% [99 v 67 of 159 p <0.005]) Knowledge of cost of care was not an often-considered factor in decision making (27% “Often” or “Always” [43 of 159]). There was no significant difference in response by year of training. Discussion: Our survey demonstrates that trainee familiarity with OOPC was low overall but modestly higher for established clinic patients, perhaps reflecting longitudinal experience with them or the heterogeneity of admitted patient funding status. Familiarity with patient OOPC was not an often-considered factor in decision making and did not significantly improve over years of training. This suggests an important gap in trainee education. Teaching greater familiarity with patient OOPC during residency can increase awareness of the financial realities of patients, enabling more patient-centered care.

Gallstone Pancreatitis: A Benign Disease in Hispanics

2007 ◽  
Vol 73 (10) ◽  
pp. 1071-1074
Author(s):  
Arezou Yaghoubian ◽  
Christian De Virgilio ◽  
Monica El-Masry ◽  
Roger J. Lewis ◽  
Bruce E. Stabile
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Severe Disease ◽  
Disease Process ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Benign Disease ◽  
Gallstone Pancreatitis ◽  
Younger Age ◽  
Hispanic Patients

Little is known about ethnic differences among patients with gallstone pancreatitis in the United States. The purpose of this study was to compare Hispanic and non-Hispanic patients with gallstone pancreatitis with regard to severity of disease, level of care required, length of hospital stay, and clinical outcomes. A retrospective cohort study of 198 consecutive patients with gallstone pancreatitis was performed from 2003 to 2005. Overall, 161 patients were Hispanic and 37 were non-Hispanic. The average age of Hispanic patients was 41 years versus 47.5 years in the non-Hispanic group ( P = 0.02). Only 16 (10%) Hispanic patients had a Ranson score of 2 or greater versus nine (24%) of the non-Hispanic group ( P = 0.03). Only 39 (24%) Hispanic patients were admitted to an intensive care unit or stepdown unit versus 17 (46%) of the non-Hispanic group ( P = 0.01). Hispanic patients underwent cholecystectomy at an average of 5.8 days after admission versus 6.6 days for non-Hispanic patients ( P = 0.07). There was a 4 per cent complication rate and a 2 per cent readmission rate overall with no statistically significant differences between the two groups and no mortality. The majority of Hispanic patients with gallstone pancreatitis have a benign disease process, presenting at a younger age, with less severe disease that infrequently requires intensive care unit admission.

scholarly journals GERM-04. PRIMARY INTRACRANIAL GERM CELL TUMORS ARE MORE PREVALENT AMONG PEDIATRIC PATIENTS OF ASIAN/PACIFIC ISLANDER RACE/ETHNICITY IN THE UNITED STATES

2021 ◽  
Vol 23 (Supplement_1) ◽  
pp. i16-i17
Author(s):  
Nayan Lamba ◽  
Bryan Iorgulescu
Keyword(s):  
Pediatric Patients ◽  
Pacific Islander ◽  
Germ Cell Tumors ◽  
The United States ◽  
Asian Pacific Islander ◽  
Intracranial Germ Cell Tumors ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
Asian Pacific ◽  
The U.S

Abstract Introduction Primary intracranial germ cell tumors (GCTs) appear to be more prevalent among pediatric patients in eastern Asia than in the U.S. Herein we use cancer registry data to evaluate whether GCT prevalence differs by race/ethnicity among U.S. pediatric patients. Methods Pediatric patients (age≤14) presenting between 2004–2017 with a primary intracranial GCT were identified by ICD-O-3 histological and topographical coding from the National Cancer Database (comprising &gt;70% of cancers newly-diagnosed cancers in the U.S.), and categorized by NICHD age stages. Patients’ age, sex, race/ethnicity, and overall survival, and tumor location and size were evaluated. Results 889 pediatric patients with primary intracranial GCTs were identified, which were overwhelmingly male (64.8%) and pure germinomas (64.0%). Non-germinomatous (24.5%) and mixed (11.5%) tumor types were in the minority. Overall, primary GCTs comprised 4.9% of intracranial tumors in pediatric males and 2.9% of intracranial tumors in pediatric females. Asian/Pacific Islander pediatric patients in the U.S. had a notably higher prevalence of GCTs: among Asian/Pacific Islander males, 10.6% of all brain tumors were GCTs, compared to only 4.5% in White non-Hispanic patients, 2.8% in Black non-Hispanic patients, and 6.0% in Hispanic patients. Despite the much lower prevalence of GCTs among female patients overall, this predominance also persisted for Asian/Pacific Islander females, among whom 7.5% of brain tumors were GCTs, compared to only 2.5% in White non-Hispanic patients, 2.4% in Black non-Hispanic patients, and 4.1% in Hispanic patients. Overall, 9.4% of pediatric primary intracranial GCTs occurred in patients of Asian/Pacific Islander race/ethnicity, in contrast to 4.0% of diffuse astrocytic/oligodendroglial tumors, 2.8% of other astrocytic tumors, or 4.6% of embryonal tumors. Conclusions Primary intracranial GCTs affect a substantially larger proportion of both male and female pediatric patients of Asian/Pacific Islander race/ethnicity in the United States.

scholarly journals Racial and Ethnic Enrollment Disparities and Demographic Reporting Requirements in Acute Leukemia Clinical Trials

2021 ◽  
Author(s):  
Andrew Hantel ◽  
Marlise R. Luskin ◽  
Jacqueline S Garcia ◽  
Wendy Stock ◽  
Daniel J DeAngelo ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Native American ◽  
Acute Leukemia ◽  
Race And Ethnicity ◽  
Disease Incidence ◽  
The United States ◽  
Reporting Requirements ◽  
Number Of Patients ◽  
Hispanic Patients ◽  
Race Ethnicity

Data regarding racial and ethnic enrollment diversity for acute myeloid (AML) and lymphoid leukemia (ALL) clinical trials in the United States (US) are limited, and little is known about the effect of federal reporting requirements instituted in the late 2000s. We examined demographic data reporting and enrollment diversity for US ALL and AML trials from 2002-2017 as well as changes in reporting and diversity after reporting requirements were instituted. Of 223 AML and 97 ALL trials with results, 68 (30.5%) and 51 (52.6%) reported enrollment by both race and ethnicity. Among trials that reported race and ethnicity (AML N=6,554; ALL N=4,149), non-Hispanic (NH)-Black, NH-Native American, NH-Asian, and Hispanic patients had significantly lower enrollment compared to NH-white patients after adjusting for race-ethnic disease incidence (AML odds: 0.68, 0.31, 0.75, and 0.83; ALL: 0.74, 0.27, 0.67, and 0.64; all p≤0.01). The proportion of trials reporting race increased significantly after the reporting requirements (44.2 to 60.2%; p=0.02), but race-ethnicity reporting did not (34.8 to 38.6%; p=0.57). Reporting proportions by number of patients enrolled increased significantly after the reporting requirements (race: 51.7 to 72.7%, race-ethnicity: 39.5 to 45.4%; both p&lt;0.001), and relative enrollment of NH-Black and Hispanic patients decreased (AML odds: 0.79 and 0.77; ALL: 0.35 and 0.25; both p≤0.01). These data suggest that demographic enrollment reporting for acute leukemia trials is suboptimal, changes in diversity after the reporting requirements may be due to additional enrollment disparities that were previously unreported, and enrollment diversification strategies specific to acute leukemia care delivery are needed.

scholarly journals Interim Analysis of Risk Factors for Severe Outcomes among a Cohort of Hospitalized Adults Identified through the U.S. Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET)

2020 ◽  
Author(s):  
Lindsay Kim ◽  
Shikha Garg ◽  
Alissa O'Halloran ◽  
Michael Whitaker ◽  
Huong Pham ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Invasive Mechanical Ventilation ◽  
The United States ◽  
Surveillance Network ◽  
Adjusted Risk ◽  
Factors Associated ◽  
Icu Admission ◽  
Male Sex ◽  
Race Ethnicity

Background: As of May 15, 2020, the United States has reported the greatest number of coronavirus disease 2019 (COVID-19) cases and deaths globally. Objective: To describe risk factors for severe outcomes among adults hospitalized with COVID-19. Design: Cohort study of patients identified through the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network. Setting: 154 acute care hospitals in 74 counties in 13 states. Patients: 2491 patients hospitalized with laboratory-confirmed COVID-19 during March 1-May 2, 2020. Measurements: Age, sex, race/ethnicity, and underlying medical conditions. Results: Ninety-two percent of patients had at least 1 underlying condition; 32% required intensive care unit (ICU) admission; 19% invasive mechanical ventilation; 15% vasopressors; and 17% died during hospitalization. Independent factors associated with ICU admission included ages 50-64, 65-74, 75-84 and 85+ years versus 18-39 years (adjusted risk ratio (aRR) 1.53, 1.65, 1.84 and 1.43, respectively); male sex (aRR 1.34); obesity (aRR 1.31); immunosuppression (aRR 1.29); and diabetes (aRR 1.13). Independent factors associated with in-hospital mortality included ages 50-64, 65-74, 75-84 and 85+ years versus 18-39 years (aRR 3.11, 5.77, 7.67 and 10.98, respectively); male sex (aRR 1.30); immunosuppression (aRR 1.39); renal disease (aRR 1.33); chronic lung disease (aRR 1.31); cardiovascular disease (aRR 1.28); neurologic disorders (aRR 1.25); and diabetes (aRR 1.19). Race/ethnicity was not associated with either ICU admission or death. Limitation: Data were limited to patients who were discharged or died in-hospital and had complete chart abstractions; patients who were still hospitalized or did not have accessible medical records were excluded. Conclusion: In-hospital mortality for COVID-19 increased markedly with increasing age. These data help to characterize persons at highest risk for severe COVID-19-associated outcomes and define target groups for prevention and treatment strategies.

Multidisciplinary Team Utilizing Pharmacists in Multimodal, Bundled Care Reduce Chronic Obstructive Pulmonary Disease Hospital Readmission Rates

2019 ◽  
pp. 089719001988944 ◽  
Author(s):  
Anthony J. Gentene ◽  
Maria Rose Guido ◽  
Brittany Woolf ◽  
Amber Dalhover ◽  
Timmi Anne Boesken ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Multidisciplinary Team ◽  
Safety Net ◽  
The United States ◽  
Care Bundle ◽  
Chronic Obstructive ◽  
Readmission Rates ◽  
Obstructive Pulmonary Disease ◽  
Safety Net Hospital

Background: Chronic obstructive pulmonary disease (COPD) is a major contributor of morbidity and mortality in the United States resulting in high hospitalization and readmission rates. For health systems, identifying an effective strategy to reduce COPD readmissions has remained difficult. Multiple COPD care bundles have been developed with varying degrees of success. Bundles that were multidisciplinary and included pharmacists were successful in reducing readmissions. Objective: To describe and assess a multidisciplinary, 5-element, COPD care bundle that was implemented in an academic, urban safety-net hospital to reduce COPD readmissions and the role of pharmacists in bundle implementation. Methods: A multidisciplinary team collaborated to develop a 5-element COPD care bundle that met unmet patient needs. The bundle elements included the following, with pharmacy responsible for the first two: optimization of COPD inhalers, 30-day supply of insurance-compatible inhalers, individualized patient inhaler teaching, provision of standardized discharge instructions, and scheduling of a 15-day discharge follow-up appointment. Bundle was implemented with multiple Plan-Do-Study-Act (PDSA) cycles to develop intra- and interdepartment processes. Results: Prior to bundle implementation, the health system COPD readmission rates were 22.7%. Reliable implementation of the bundle reduced readmissions to 14.7% over a 6-month period. Pharmacy adherence to completion of the bundle was over 95% over 2 years of bundle use. Conclusion: Pharmacists have a crucial role in hospital-based transitions of care to reduce COPD readmissions.

Interest and use of alternative/holistic therapies amongst cancer patients at a large urban safety-net hospital.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18289-e18289
Author(s):  
Bartlomiej Posnik ◽  
Romy Jose Thekkekara ◽  
Sushma Bharadwaj ◽  
Barbara Yim ◽  
Shweta Gupta
Keyword(s):  
Cancer Patients ◽  
Conventional Medicine ◽  
Safety Net ◽  
Cook County ◽  
Cook County Hospital ◽  
Alternative Treatments ◽  
Number Of Patients ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Holistic Therapies

e18289 Background: Patient interest in alternative/holistic therapies during cancer treatment is common in oncology. Studies have shown that 1 in 3 cancer patients in Europe turn to alternative therapies in combination with conventional medicine. Observational studies have shown some benefit of herbal medications in treating chemotherapy-associated complications; however, there remains skepticism in clinical practice. This study was undertaken to evaluate the interest and use of alternative treatments amongst cancer patients at a large urban safety-net hospital. Methods: An anonymous optional survey was offered in a random fashion to malignant hematology/oncology patients at Cook County Hospital in downtown Chicago. Results: One hundred seventy patients completed the survey comprised of 51% men, 78% being over age 50, and 67% with a high school or higher level of education. Responses included 35% African Americans, 34% Hispanics, and 25% Caucasians. At the time of the survey 16% of patients were currently using alternative treatments, while another 12% were planning to. Eighty-seven percent stated that they believed alternative treatments were very/somewhat beneficial, 77% expressed being very/somewhat interested in their use, and 77% stated they were very/somewhat likely to use such treatments. The treatments of interest included herbal supplements/oils in 40%, meditation/prayer in 29%, and cleanses/diets in 26%. Media and internet were the primary sources of information for 41% patients, while 36% heard about these treatments from family/friends. Although 51% of patients described having some safety concerns of such therapies, 77% had not discussed with their doctor. Conclusions: Our data showed that 28% of patients were either already taking or planning to take alternative/holistic therapies in conjunction with conventional medicine for their cancer care. Data also shows that an even larger number of patients are interested in such options and perceive them to be beneficial; however, there is a general reluctance to discuss it with the treating physician. The use of complementary therapies needs to be more openly discussed in order to better guide patients and assure safety.[Table: see text]

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