570. Prioritized Access to COVID-19 Vaccines Among Vulnerable Communities Increases Vaccination Rates

Abstract Background Based on national recommendations,1 Beth Israel Lahey Health (BILH) in Eastern Massachusetts (MA) prioritized vulnerable communities in our distribution of COVID-19 vaccines. We hypothesized that creating prioritized access to appointments for patients in these communities would increase the likelihood vaccination. Methods The BILH health system sent vaccine invitations first to patients of two clinics in vulnerable neighborhoods in Boston (Wave 1), followed by other patients from vulnerable communities (Wave 2) up to 1 day later, and then by all other patients (Wave 3) after up to 1 more day later. To identify whether early access/prioritization increased the likelihood of receipt of vaccine at any site or a vaccine at a BILH clinic, we compared patients in Wave 1 in a single community with high cumulative incidence of COVID-19 (Dorchester) to patients in Wave 2 during a period of limited vaccine access, 1/27/21-2/24/21. Each wave was modeled using logistic regression, adjusted for language and race. By taking the difference between these two differences, we are left with the impact of early vaccination invitation in Wave 1 for a subset of our most vulnerable patients (termed difference-in-differences; Stata SE 16.0). Results In our study of Waves 1 and 2, we offered vaccinations to 24,410 patients. Of those, 6,712 (27.5%) scheduled the vaccine at BILH (Table 1). Patients in Wave 1 were much more likely to be vaccinated at BILH than patients in Wave 2. Patients offered the vaccine in Wave 1 and living in Dorchester were 1.7 percentage points more likely to be vaccinated at all (p=0.445) and 9.4 percentage points more likely to be vaccinated at BILH than another site in MA (p-value = 0.001), relative to patients living outside of Dorchester and offered the vaccine in Wave 2 (Table 2). The coefficient of interest is on Wave1*Dorchester, 0.094. This indicates that residents of Dorchester who were offered the vaccine in Wave 1 were 9.4 percentage points more likely to receive the vaccine at BILH, given that they were vaccinated, relative to patients living outside of Dorchester and offered the vaccine in Wave 2. Conclusion Patients residing in an urban community given prioritized access to vaccination had a higher likelihood of vaccination at our health system, given that they were vaccinated, than patients in other urban communities without prioritized access. We provide an example of a successful effort to move towards equity in access to COVID-19- vaccines, in contrast to larger national trends.2,3 Health systems can use a prioritization approach to improve vaccination equity. Disclosures All Authors: No reported disclosures

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Impact of Louisiana’s HPV Vaccine Awareness Policy on HPV Vaccination Among 13- to 17-Year-Old Females

Health Education & Behavior ◽

10.1177/1090198116684766 ◽

2017 ◽

Vol 44 (4) ◽

pp. 548-558 ◽

Cited By ~ 3

Author(s):

Dudith Pierre-Victor ◽

Mary Jo Trepka ◽

Timothy F. Page ◽

Tan Li ◽

Dionne P. Stephens ◽

...

Keyword(s):

Hpv Vaccine ◽

Hpv Vaccination ◽

Female Adolescents ◽

Physician Recommendation ◽

Vaccination Rates ◽

National Immunization ◽

Before And After ◽

The Difference ◽

Vaccine Information ◽

The Impact

The Advisory Committee on Immunization Practices recommends routine human papillomavirus (HPV) immunization for 11- to 12-year-old adolescents. In 2008, Louisiana required the school boards to distribute HPV vaccine information to parents or guardian of students in Grades 6 to 12. This article investigates the impact of this policy on HPV vaccination among 13- to 17-year-old female adolescents using National Immunization Survey-Teen (NIS-Teen) data. Drawing on the data from the 2008 to 2012 NIS-Teen, we compared the difference in proportions of females who have been vaccinated before and after the policy. Using difference-indifference estimation, we explored the change in vaccination rates before and after the policy implementation in Louisiana compared with Alabama and Mississippi, two states that did not have such a policy in place. The difference-in-differences estimates for HPV vaccination were not significant. Physician recommendation for HPV vaccination was significantly associated with vaccination among females in Louisiana and Alabama (adjusted odds ratio [aOR] = 7.74; 95% confidence interval [CI; 5.22, 11.5]), and for those in Louisiana and Mississippi (aOR = 7.05; 95% CI [4.6, 10.5]). Compared to the proportion of female adolescents who had received physician recommendation in Alabama or Mississippi, the proportion in Louisiana did not increase significantly in the postpolicy period. HPV vaccination rates did not increase significantly in Louisiana compared to Alabama or Mississippi following the implementation of the policy. Despite Louisiana’s policy, physician recommendation remains the key determinant of HPV vaccination. HPV vaccine awareness does not necessarily result in HPV vaccination.

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1536. Impact of Type of Provider on Appropriateness of Treatment for Gonorrhea and Chlamydia in Outpatient Clinics

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1716 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S768-S768

Author(s):

Katherine Sittig ◽

Rossana Rosa Espinoza

Keyword(s):

Health System ◽

Adult Patients ◽

Outpatient Clinics ◽

P Value ◽

Lower Odds ◽

Des Moines ◽

Appropriate Treatment ◽

Integrated Health ◽

Pregnancy Status ◽

The Impact

Abstract Background Patients with sexually transmitted infections (STIs) receive care in a variety of outpatient settings with medical providers of different levels of training and expertise, especially regarding STIs. We aimed to determine the impact of type of provider on the appropriateness of treatment for chlamydia and gonorrhea in a large integrated health system. Methods We conducted a retrospective cohort study of adult patients diagnosed with chlamydia and/or gonorrhea at any outpatient clinic within an integrated health system in Des Moines, Iowa. Nucleic-acid amplification tests were used for diagnosis, and all samples were processed at the same laboratory. Adequate treatment was defined as prescription for appropriate antibiotic, dose and duration within 7 days of the positive test. Logistic regression models with robust standard errors and adjusting for clustering by clinic were built. Results We identified 481 unique patients and a total of 515 unique encounters. Considering unique patients only, the median patient age was 23 years (IQR 20-26), 466/481 (96.9%) were female (96.9%), 15/481 (3.1%) were male, and 79/481 (16.4%) were pregnant. Table 1 shows the patient demographic and provider characteristics by appropriateness of treatment for individual visits. A total of 53 patients had inappropriate treatment, some with multiple errors which are described in Table 2. Provider type, age, type of infection, and pregnancy status were significantly associated with appropriateness of treatment. After adjusting for type of infection, pregnancy status and clustering by clinic, compared to physicians, certified nurse midwives (CNMs) had 33% lower odds of prescribing appropriate treatment (95% CI 0.49-0.91; p-value = 0.010), with no difference in appropriateness of prescribing by mid-level providers (OR 1.61, 95% CI 0.82-3.17; p-value = 0.167). Pregnancy was independently associated with lower odds of appropriate treatment (OR 0.35, 95% CI 0.24-0.52; p-value < 0.001), as was infection with gonorrhea (OR 0.29, 95% CI 0.12-0.68; p-value = 0.004). Table 1. Demographic characteristics of adult patients diagnosed with chlamydia and/or gonorrhea in outpatient clinics by appropriateness of treatment. Des Moines, Iowa, January 1, 2019 to December 31, 2019 Table 2. Type of therapeutic errors encountered among patients diagnosed with chlamydia or gonorrhea Conclusion CNMs had lower odds of prescribing appropriate treatment for STIs. Efforts aimed at improving prescribing by healthcare providers should actively engage with this group. Disclosures All Authors: No reported disclosures

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Effects of Extracorporeal Membrane Oxygenation Initiation on Oxygenation and Pulmonary Opacities

The Journal of Critical Care Medicine ◽

10.2478/jccm-2020-0040 ◽

2021 ◽

Vol 7 (1) ◽

pp. 6-13

Author(s):

Kiran Batra ◽

Manish Mohanka ◽

Srinivas Bollineni ◽

Vaidehi Kaza ◽

Prabhakar Rajiah ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

P Value ◽

Limited Data ◽

Hospital Survival ◽

Membrane Oxygenation ◽

Pulmonary Physiology ◽

Before And After ◽

Laboratory Variables ◽

The Difference ◽

The Impact

Abstract Introduction There is limited data on the impact of extracorporeal membrane oxygenation (ECMO) on pulmonary physiology and imaging in adult patients. The current study sought to evaluate the serial changes in oxygenation and pulmonary opacities after ECMO initiation. Methods Records of patients started on veno-venous, or veno-arterial ECMO were reviewed (n=33; mean (SD): age 50(16) years; Male: Female 20:13). Clinical and laboratory variables before and after ECMO, including daily PaO2 to FiO2 ratio (PFR), were recorded. Daily chest radiographs (CXR) were prospectively appraised in a blinded fashion and scored for the extent and severity of opacities using an objective scoring system. Results ECMO was associated with impaired oxygenation as reflected by the drop in median PFR from 101 (interquartile range, IQR: 63-151) at the initiation of ECMO to a post-ECMO trough of 74 (IQR: 56-98) on post-ECMO day 5. However, the difference was not statistically significant. The appraisal of daily CXR revealed progressively worsening opacities, as reflected by a significant increase in the opacity score (Wilk’s Lambda statistic 7.59, p=0.001). During the post-ECMO period, a >10% increase in the opacity score was recorded in 93.9% of patients. There was a negative association between PFR and opacity scores, with an average one-unit decrease in the PFR corresponding to a +0.010 increase in the opacity score (95% confidence interval: 0.002 to 0.019, p-value=0.0162). The median opacity score on each day after ECMO initiation remained significantly higher than the pre-ECMO score. The most significant increase in the opacity score (9, IQR: -8 to 16) was noted on radiographs between pre-ECMO and forty-eight hours post-ECMO. The severity of deteriorating oxygenation or pulmonary opacities was not associated with hospital survival. Conclusions The use of ECMO is associated with an increase in bilateral opacities and a deterioration in oxygenation that starts early and peaks around 48 hours after ECMO initiation.

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Higher COVID-19 vaccination rates are linked to decreased county-level COVID-19 incidence across USA

10.1101/2021.03.05.21252946 ◽

2021 ◽

Author(s):

Arjun Puranik ◽

AJ Venkatakrishnan ◽

Colin Pawlowski ◽

Bharathwaj Raghunathan ◽

Eshwan Ramudu ◽

...

Keyword(s):

Incidence Rate ◽

Vaccine Efficacy ◽

Vaccine Dose ◽

The United States ◽

Vaccination Rate ◽

Incidence Rates ◽

P Value ◽

County Level ◽

Vaccination Rates ◽

The Impact

Real world evidence studies of mass vaccination across health systems have reaffirmed the safety1 and efficacy2,3 of the FDA-authorized mRNA vaccines for COVID-19. However, the impact of vaccination on community transmission remains to be characterized. Here, we compare the cumulative county-level vaccination rates with the corresponding COVID-19 incidence rates among 87 million individuals from 580 counties in the United States, including 12 million individuals who have received at least one vaccine dose. We find that cumulative county-level vaccination rate through March 1, 2021 is significantly associated with a concomitant decline in COVID-19 incidence (Spearman correlation ρ = −0.22, p-value = 8.3e-8), with stronger negative correlations in the Midwestern counties (ρ = −0.37, p-value = 1.3e-7) and Southern counties (ρ = −0.33, p-value = 4.5e-5) studied. Additionally, all examined US regions demonstrate significant negative correlations between cumulative COVID-19 incidence rate prior to the vaccine rollout and the decline in the COVID-19 incidence rate between December 1, 2020 and March 1, 2021, with the US western region being particularly striking (ρ = −0.66, p-value = 5.3e-37). However, the cumulative vaccination rate and cumulative incidence rate are noted to be statistically independent variables, emphasizing the need to continue the ongoing vaccination roll out at scale. Given confounders such as different coronavirus restrictions and mask mandates, varying population densities, and distinct levels of diagnostic testing and vaccine availabilities across US counties, we are advancing a public health resource to amplify transparency in vaccine efficacy monitoring (https://public.nferx.com/covid-monitor-lab/vaccinationcheck). Application of this resource highlights outliers like Dimmit county (Texas), where infection rates have increased significantly despite higher vaccination rates, ostensibly owing to amplified travel as a “vaccination hub”; as well as Henry county (Ohio) which encountered shipping delays leading to postponement of the vaccine clinics. This study underscores the importance of tying the ongoing vaccine rollout to a real-time monitor of spatio-temporal vaccine efficacy to help turn the tide of the COVID-19 pandemic.

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Counties with Lower Insurance Coverage and Housing Problems Are Associated with Both Slower Vaccine Rollout and Higher COVID-19 Incidence

Vaccines ◽

10.3390/vaccines9090973 ◽

2021 ◽

Vol 9 (9) ◽

pp. 973

Author(s):

Gregory Donadio ◽

Mayank Choudhary ◽

Emily Lindemer ◽

Colin Pawlowski ◽

Venky Soundararajan

Keyword(s):

Socioeconomic Factors ◽

Insurance Coverage ◽

Vaccination Rate ◽

Incidence Rates ◽

P Value ◽

Strongly Correlated ◽

Marginalized Communities ◽

Vaccination Rates ◽

Using Data ◽

The Impact

Equitable vaccination distribution is a priority for outcompeting the transmission of COVID-19. Here, the impact of demographic, socioeconomic, and environmental factors on county-level vaccination rates and COVID-19 incidence changes is assessed. In particular, using data from 3142 US counties with over 328 million individuals, correlations were computed between cumulative vaccination rate and change in COVID-19 incidence from 1 December 2020 to 6 June 2021, with 44 different demographic, environmental, and socioeconomic factors. This correlation analysis was also performed using multivariate linear regression to adjust for age as a potential confounding variable. These correlation analyses demonstrated that counties with high levels of uninsured individuals have significantly lower COVID-19 vaccination rates (Spearman correlation: −0.460, p-value: <0.001). In addition, severe housing problems and high housing costs were strongly correlated with increased COVID-19 incidence (Spearman correlations: 0.335, 0.314, p-values: <0.001, <0.001). This study shows that socioeconomic factors are strongly correlated to both COVID-19 vaccination rates and incidence rates, underscoring the need to improve COVID-19 vaccination campaigns in marginalized communities.

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THE APPLICATION OF AN ENDOGENOUS POVERTY LINE AND ITS RELATIONSHIP WITH THE POVERTY IMPACT OF ECONOMIC SHOCKS: AN EMPIRICAL INVESTIGATION

The Singapore Economic Review ◽

10.1142/s0217590813500057 ◽

2013 ◽

Vol 58 (01) ◽

pp. 1350005 ◽

Cited By ~ 1

Author(s):

TEGUH DARTANTO

Keyword(s):

Computable General Equilibrium ◽

Poverty Line ◽

Poverty Rate ◽

Policy Reforms ◽

Economic Shocks ◽

Percentage Points ◽

Soybean Price ◽

The Difference ◽

Fixed Line ◽

The Impact

Most of the studies on the poverty impact of economic shocks as well as policy reforms assumed the poverty line as a fixed line; thus, the poverty outcome of shocks may underestimate (overestimate) and mislead in policy guidance. This research aims at empirically investigating the difference of poverty outcome between applying a fixed and an endogenous poverty line. Applying computable general equilibrium microsimulation (CGE-MS), this study has empirically proven that, if a fixed poverty line is applied, the poverty impact of economic shocks which significantly increase (decrease) price will always be underestimated (overestimated). This study empirically found that there is a 0.316 percentage point difference in the poverty outcome between applying the endogenous poverty line and the fixed poverty line when analyzing the impact on poverty in Indonesia of a doubling in the imported soybean price. Supposing the fixed poverty line, the poverty rate will increase by 0.167 percentage points, while supposing the endogenous poverty line, the poverty rate will increase by 0.483 percentage points. Therefore, applying either an endogenous or a fixed poverty line will have a different policy implication. This study strongly suggested that the endogenous poverty line should be applied when analyzing the poverty impact of shocks due to the precision in outcomes.

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Medicaid Expansion and Not-For-Profit Hospitals’ Financial Status: National and State-Level Estimates Using IRS and CMS Data, 2011-2016

Medical Care Research and Review ◽

10.1177/10775587211009720 ◽

2021 ◽

pp. 107755872110097

Author(s):

Tatiane Santos ◽

Simone Singh ◽

Gary J. Young

Keyword(s):

Hospital Costs ◽

State Level ◽

Medicaid Expansion ◽

Financial Status ◽

For Profit ◽

Not For Profit ◽

Percentage Points ◽

The Difference ◽

Using Data ◽

The Impact

Several studies have shown that Medicaid expansion has improved hospital financial performance. All of these studies have either used data from the Internal Revenue Service (IRS) or the Centers for Medicare and Medicaid Services (CMS), and none of them has examined the state-level impact of expansion on hospital finances. Using data for not-for-profit hospitals from both IRS and CMS for 2011-2016, we described the difference in costs related to uncompensated care and Medicaid shortfalls. We then estimated the impact of Medicaid expansion on hospitals’ financial status nationally and by state. Nationally, the estimated net effect of expansion reduced not-for-profit hospital costs by 2 percentage points based on IRS data and 0.83 percentage points based on CMS data. Across expansion states, the estimated net effects varied widely with approximately a 10-fold difference for hospitals based on IRS data and a 2-fold difference based on CMS data. Future studies should further explore the differences across IRS and CMS data.

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Peranan Kadar Feritin Serum terhadap Kejadian Preeklampsia

Jurnal Kesehatan Andalas ◽

10.25077/jka.v4i3.364 ◽

2015 ◽

Vol 4 (3) ◽

Author(s):

Mega Ulfah ◽

Masrul Masrul ◽

Arni Amir

Keyword(s):

Serum Level ◽

Early Stage ◽

Serum Levels ◽

Total Sample ◽

Normal Pregnancy ◽

P Value ◽

Excess Iron ◽

The Difference ◽

The Impact ◽

Biomedical Laboratory

Abstrak Preeklampsia merupakan penyebab utama kematian maternal dan perinatal diseluruh dunia. Peningkatan kadar serum besi dan feritin memiliki potensi untuk digunakan secara diagnostik untuk memperingatkan preeklampsia tahap awal. Tujuan penelitian ini adalah untuk menentukan peranan kadar serum feritin terhadap kejadianpreeklampsia. Penelitian ini merupakan penelitian analitik observasional dengan desain case-control. Penelitian dilakukan dari Agustus 2013 hingga Juli 2014, bertempat di RS dr. M. Djamil, RS dr. Reksodiwiryo dan Laboratorium Biomedik UNAND Padang. Jumlah sampel yang diteliti adalah 40 responden dimana sampel terdiri dari 2 kelompok,masing-masing terdiri dari 20 sampel. Pemeriksaan serum feritin dilakukan dengan metode ELISA. Perbedaan rerata kadar feritin serum antara kelompok preeklampsia dan kehamilan normal dianalisa dengan mengunakan independen ttest. Hasil penelitian diperoleh rerata kadar serum feritin pada kelompok preeklampsia dan kehamilan normal adalah50,46+4,37 ng/ml dan 17,64+1,6 ng/ml, dengan nilai p=0,004. Kadar feritin pada kedua kelompok masih dalam batas normal dan tidak ditemukan indikasi adanya kelebihan besi sebagai faktor resiko preeklampsia. Kesimpulan penelitian ini yaitu kadar serum feritin tidak memiliki peranan terhadap kejadian preeklampsia. Kata kunci: preeklampsia, hipertensi dalam kehamilan, serum feritin Abstract Preeclampsia is a major cause of worldwide maternal and prenatal mortality. The increase in iron serum and ferritin can be used as a diagnosis to warn of the early stage of preeclampsia. The objective of this study was to determine the impact of ferritin serum levels on preeclampsia. This study was an observational analytic study withcase-control design. It has been done from August 2013 to Juli 2014, in RS dr. M. Djamil, RS dr. Reksodiwiryo and Biomedical Laboratory of Andalas University Padang. Total sample evaluated was 40 samples. The sample consist of two groups, each group consist of 20 respondents. Ferritin serum level was examined by using ELISA method. The difference of ferritin serum level between preeclampsia and normal pregnancy analyzed by using independen t test.The result of this study shows that the avarage of ferritin serum levels in preeclampsia group and normalpregnancy is 50,46+4,37 ng/ml and 17,64+1,6 ng /ml, with a p-value 0,004. The ferritin serum level in both groups is normal and didn’t find that excess iron as a risk factor for preeclampsia. It can be concluded that ferritin serum level has no role on preeclampsia. Keywords: preeclampsia, hypertension in pregnancy, ferritin serum

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Octreotide LAR dosage and survival among elderly patients with distant-stage neuroendocrine tumors.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.392 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 392-392

Author(s):

Chan Shen ◽

Ya-Chen T. Shih ◽

Ying Xu ◽

James C. Yao

Keyword(s):

Elderly Patients ◽

Neuroendocrine Tumors ◽

Dosage Level ◽

Population Based ◽

Rank Test ◽

P Value ◽

Octreotide Lar ◽

The Difference ◽

Long Acting ◽

The Impact

392 Background: Octreotide long-acting repeatable (LAR) is approved for the management of symptoms due to carcinoid syndrome and may delay tumor progression among patients with neuroendocrine tumors (NETs). It is unknown whether dosage of octreotide LAR has an impact on survival. The current analysis evaluates the impact of initial octreotide LAR dosage on survival of elderly patients with NETs. Methods: Distant stage NET patients diagnosed between 1/1999 and 12/2009 who had received octreotide LAR treatment within 12 months of diagnosis were identified from the SEER-Medicare database. Those under age 65, enrolled in HMOs, or without continuous enrollment in Medicare Parts A and B were excluded. We compared the five-year survival of NET patients based on dose per 28 days averaged over the initial 3 months: Group A, <= 20 mg; B, 21 to 30 mg; C, > 30 mg. Kaplan-Meier estimations and Cox proportional hazard modeling were used to examine the association between octreotide LAR dose and survival. Results: Among 214 distant stage patients (mean and median age at 74 years old) with octreotide LAR treatment, 73 (34%) received <= 20 mg, 82 (38%) received 21 – 30 mg, while 59 (28%) received >30 mg. Median survival for patients who received low, medium and high dosage levels were 20.8 (95% CI: 13.2 – 31.5), 32.6 (95% CI: 20.5 – 51.1), and 36.3 (95% CI: 24.8 – N/A) months respectively. The log rank test had a p-value of 0.006. Multivariate analyses showed that higher octreotide LAR dosage levels were associated with significant survival improvement for distant stage patients. Compared to patients with the low dosage level, patients with medium dosage (HR=0.52, P=0.002) and patients with high dosage (HR=0.48, P=0.004) had better five-year survival. The difference in survival between Groups B and C was not statistically significant. Conclusions: This population-based study suggests potential survival benefits for octreotide LAR 30 mg dosage level among elderly distant stage NET patients.

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COVID-19 Vaccination Mandates and Vaccine Uptake

10.21203/rs.3.rs-1146923/v1 ◽

2021 ◽

Author(s):

Alexander Karaivanov ◽

Dongwoo Kim ◽

Shih En Lu ◽

Hitoshi Shigeoka

Keyword(s):

Time Series ◽

Time Series Analysis ◽

Vaccine Uptake ◽

Difference In Differences ◽

Vaccination Rates ◽

Series Analysis ◽

Percentage Points ◽

Canadian Provinces ◽

The Impact ◽

Approach Time

Abstract We evaluate the impact of government mandated proof of vaccination requirements for access to public venues and non-essential businesses on COVID-19 vaccine uptake. We find that the announcement of a mandate is associated with a rapid and significant surge in new vaccinations (more than 60% increase in weekly first doses) using the variation in the timing of these measures across Canadian provinces in a difference-in-differences approach. Time-series analysis for each province and for France, Italy and Germany corroborates this finding, and we estimate cumulative gains of up to 5 percentage points in provincial vaccination rates and 790,000 or more first doses for Canada as a whole as of October 31, 2021 (5 to 13 weeks after the provincial mandate announcements). We also find large vaccination gains in France (3 to 5 mln first doses), Italy (around 6 mln) and Germany (around 3.5 mln) 11 to 16 weeks after the proof of vaccination mandate announcements.JEL codes: I18, I12, C23

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