291. Using Individualized Provider Feedback to Improve HCV Screening in a High-Volume Emergency Department

Abstract Background Ending the Hepatitis C Virus (HCV) epidemic requires HCV testing as the critical first step. Busy urban Emergency Rooms are uniquely suited for HCV screening programs but numerous barriers to effective program implementation exist. We describe an emergency room physician champion model that utilizes the feedback intervention theory (FIT) to providers to increase HCV screening rates. Methods Due to the changing epidemiology of HCV in 2017 New York Presbyterian supported one-time universal HCV screening. In September 2018, our physician champion provided an educational session to ED providers about the importance of HCV screening and the proposed study. From the end of September to the end of March 2019, providers received a monthly e-mail from the ED champion and an automated text message with their individual and peer HCV screening rates. The number of HCV tests and percent of individuals with documented HCV testing in the ED was compared pre and post this intervention and to HCV testing in the inpatient and outpatient setting where feedback was not provided. Results On average ED providers evaluated approximately 14,000 patients per month. HCV testing increased 1,600% from an average of 40 tests per month in the 18 months prior to the intervention to an average of 640 tests sent per month during the intervention. tests sent in December. This was compared with stable inpatient and outpatient HCV screening during the same time period. Conclusion Individualized provider feedback paired with an ED physician champion can lead to a significant increase in HCV testing. Ongoing studies will determine if this intervention can lead to long-term behavior change. Disclosures All authors: No reported disclosures.

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1274. Universal HIV and HCV Screening in San Diego Emergency Departments: Implications for Other Settings With a High Density of Free of Charge HIV Screening Programs

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1107 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S388-S388

Author(s):

Martin Hoenigl ◽

Chris Coyne ◽

Jill Blumenthal ◽

Gary Vilke ◽

Susan Little

Keyword(s):

Birth Cohort ◽

San Diego ◽

High Density ◽

Hiv Screening ◽

Newly Diagnosed ◽

Screening Programs ◽

Opt Out ◽

Hiv Test ◽

Hcv Screening ◽

Hcv Testing

Abstract Background While HIV and HCV testing targeted to high-risk groups results in substantially higher proportions of HIV diagnoses, universal HIV and HCV screening in emergency department (ED) settings is expected to reach populations who do not perceive themselves to be at risk or are otherwise less likely to participate in HIV and HCV testing. As a consequence the CDC recommends routine HIV screening for persons 13–64 years of age, and routine HCV screening for the birth cohort (born between 1945–1965). The objective of this analysis was to evaluate the yield of universal opt-out HIV and HCV screening in the two EDs at the University of California San Diego (UCSD). Methods In July 2017, electronic medical record (EMR) based universal opt-out HIV screening (Architect HIV antibody [Ab]/HIV p24 antigen detection) for persons aged 13–64 years (excluding persons known HIV+ or reporteing an HIV test within the last 12 months) was implemented in our EDs. The EMR algorithm also identified HIV+ individuals who had been out of care for >12 months. In March 2018, EMR based universal HCV screening for birth cohort was added in both EDs. Results Over a period of 9 months 7,303 HIV tests were conducted, resulting in 24 (0.3%) new HIV diagnoses, of which 21 were successfully linked to care. In five individuals without HIV infection Architect gave a false-positive result (specificity 99.93%). In addition, the EMR algorithm identified 38 out of care HIV+ individuals of which 21 were successfully relinked to care. During the 1-month HCV birth cohort screening 963 HCV Ab tests were conducted, of which 106 (11%) resulted positive. At the time being 78 of those seropositive individuals had HCV RNA testing, of which 36 (53%) resulted positive (3.7% of all participants). Conclusion In San Diego, a setting with a high density of free-of charge HIV screening programs, 1/300 HIV tests in the ED yielded a new HIV diagnosis and in total 21 newly diagnosed individuals were linked to care. Identification of HIV+ out of care individuals yielded in an equivalent number of individuals relinked to care. The rate of newly diagnosed HCV infections exceeded the rate of newly diagnosed HIV infections by >10-fold outlining the importance of screening for HCV in the ED. Disclosures All authors: No reported disclosures.

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Adrenoleukodystrophy Newborn Screening in California Since 2016: Programmatic Outcomes and Follow-Up

International Journal of Neonatal Screening ◽

10.3390/ijns7020022 ◽

2021 ◽

Vol 7 (2) ◽

pp. 22

Author(s):

Jamie Matteson ◽

Stanley Sciortino ◽

Lisa Feuchtbaum ◽

Tracey Bishop ◽

Richard S. Olney ◽

...

Keyword(s):

Newborn Screening ◽

Program Implementation ◽

Screening Program ◽

Birth Prevalence ◽

Variant Of Uncertain Significance ◽

Implementation Challenges ◽

Screening Programs ◽

Uncertain Significance ◽

Long Term Follow Up

X-linked adrenoleukodystrophy (ALD) is a recent addition to the Recommended Uniform Screening Panel, prompting many states to begin screening newborns for the disorder. We provide California’s experience with ALD newborn screening, highlighting the clinical and epidemiological outcomes observed as well as program implementation challenges. In this retrospective cohort study, we examine ALD newborn screening results and clinical outcomes for 1,854,631 newborns whose specimens were received by the California Genetic Disease Screening Program from 16 February 2016 through 15 February 2020. In the first four years of ALD newborn screening in California, 355 newborns screened positive for ALD, including 147 (41%) with an ABCD1 variant of uncertain significance (VUS) and 95 males diagnosed with ALD. After modifying cutoffs, we observed an ALD birth prevalence of 1 in 14,397 males. Long-term follow-up identified 14 males with signs of adrenal involvement. This study adds to a growing body of literature reporting on outcomes of newborn screening for ALD and offering a glimpse of what other large newborn screening programs can expect when adding ALD to their screening panel.

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Relationship of hospital volume on outcomes in patients with acute pulmonary embolism: Analysis of a 70,000 patient database

Vascular Medicine ◽

10.1177/1358863x20970263 ◽

2020 ◽

pp. 1358863X2097026

Author(s):

Mark Finkelstein ◽

Mario A Cedillo ◽

David C Kestenbaum ◽

Obaib S Shoaib ◽

Aaron M Fischman ◽

...

Keyword(s):

New York ◽

Pulmonary Embolism ◽

Length Of Stay ◽

New York State ◽

Multivariable Analysis ◽

High Volume ◽

Categorical Variables ◽

Patient Database ◽

Very High ◽

Total Charges

Positive relationships between volume and outcome have been seen in several surgical and medical conditions, resulting in more centralized and specialized care structures. Currently, there is a scarcity of literature involving the volume–outcome relationship in pulmonary embolism (PE). Using a state-wide dataset that encapsulates all non-federal admissions in New York State, we performed a retrospective cohort study on admitted patients with a diagnosis of PE. A total of 70,443 cases were separated into volume groups stratified by hospital quartile. Continuous and categorical variables were compared between cohorts. Multivariable regression analysis was conducted to assess predictors of 1-year mortality, 30-day all-cause readmission, 30-day PE-related readmission, length of stay, and total charges. Of the 205 facilities that were included, 128 (62%) were labeled low volume, 39 (19%) medium volume, 23 (11%) high volume, and 15 (7%) very high volume. Multivariable analysis showed that very high volume was associated with decreased 30-day PE-related readmission (OR 0.64; 95% CI, 0.55 to 0.73), decreased 30-day all-cause readmission (OR 0.84; 95% CI, 0.79 to 0.89), decreased 1-year mortality (OR 0.85; 95% CI, 0.80 to 0.91), decreased total charges (OR 0.96; 95% CI, 0.94 to 0.98), and decreased length of stay (OR 0.94; 95% CI, 0.92 to 0.96). In summary, facilities with higher volumes of acute PE were found to have less 30-day PE-related readmissions, less all-cause readmissions, shorter length of stay, decreased 1-year mortality, and decreased total charges.

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Shared-Task Worklists Improve Clinical Trial Recruitment Workflow in an Academic Emergency Department

Applied Clinical Informatics ◽

10.1055/s-0041-1727153 ◽

2021 ◽

Vol 12 (02) ◽

pp. 293-300

Author(s):

Kevin S. Naceanceno ◽

Stacey L. House ◽

Phillip V. Asaro

Keyword(s):

Clinical Trial ◽

Emergency Department ◽

Clinical Trials ◽

Clinical Research ◽

Substantial Reduction ◽

Text Message ◽

High Volume ◽

Text Messages ◽

Shared Task ◽

Clinical Research Coordinators

Abstract Background Clinical trials performed in our emergency department at Barnes-Jewish Hospital utilize a centralized infrastructure for alerting, screening, and enrollment with rule-based alerts sent to clinical research coordinators. Previously, all alerts were delivered as text messages via dedicated cellular phones. As the number of ongoing clinical trials increased, the volume of alerts grew to an unmanageable level. Therefore, we have changed our primary notification delivery method to study-specific, shared-task worklists integrated with our pre-existing web-based screening documentation system. Objective To evaluate the effects on screening and recruitment workflow of replacing text-message delivery of clinical trial alerts with study-specific shared-task worklists in a high-volume academic emergency department supporting multiple concurrent clinical trials. Methods We analyzed retrospective data on alerting, screening, and enrollment for 10 active clinical trials pre- and postimplementation of shared-task worklists. Results Notifications signaling the presence of potentially eligible subjects for clinical trials were more likely to result in a screen (p < 0.001) with the implementation of shared-task worklists compared with notifications delivered as text messages for 8/10 clinical trials. The change in workflow did not alter the likelihood of a notification resulting in an enrollment (p = 0.473). The Director of Research reported a substantial reduction in the amount of time spent redirecting clinical research coordinator screening activities. Conclusion Shared-task worklists, with the functionalities we have described, offer a viable alternative to delivery of clinical trial alerts via text message directly to clinical research coordinators recruiting for multiple concurrent clinical trials in a high-volume academic emergency department.

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The Science, Industry and Business Library of the New York Public Library: A High-Technology Research Centre for High-Volume Public Use

Alexandria The Journal of National and International Library and Information Issues ◽

10.1177/095574909801000103 ◽

1998 ◽

Vol 10 (1) ◽

pp. 39-62

Author(s):

Kristin McDonough

Keyword(s):

New York ◽

Customer Service ◽

Information Service ◽

Public Library ◽

High Technology ◽

High Volume ◽

Research Centre ◽

Technology Research ◽

York Public Library ◽

New York Public Library

In 1996, its centenary year, the New York Public Library opened its Science, Industry and Business Library (SIBL) in a former department store in mid-town Manhattan, occupying 160,000 square feet of usable floor space. The building, which has received six awards, is designed to be both attractive and highly functional. The $100 million project was funded by a combination of private and government funds. The concept is of a specialized high technology research centre with unparallelled older and current print collections (1.2 million books and serials) and access to electronic resources, which also incorporates a 50,000-item circulating library of popular print, audiovisual and multimedia materials. All of the resources are available to the public at no charge. Much of the collection is on open access. There are several professionally staffed information service points. The provision of extensive training sessions is proving to be an outstanding success, more than 20,000 people having registered since SIBL opened. A three-year grant from the W.K. Kellogg Foundation has enabled SIBL to train information professionals in the three crucial areas of technological competence, customer service and professional development.

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Reference Mode Preferences of Community College (Two-Year) and Four-Year College Students: A Comparison Study

Evidence Based Library and Information Practice ◽

10.18438/b8vw40 ◽

2017 ◽

Vol 12 (1) ◽

pp. 50 ◽

Cited By ~ 2

Author(s):

John Carey ◽

Ajatshatru Pathak

Keyword(s):

College Students ◽

Community College ◽

New York ◽

Academic Library ◽

Text Message ◽

Online Chat ◽

Face To Face ◽

Reference Services ◽

Academic Level ◽

Reference Service

Abstract Objective – The purpose of this study was to examine the reference service mode preferences of community college (two-year) and four-year college students. Methods – The researchers administered a paper-based, face-to-face questionnaire at two institutions within the City University of New York system: Hunter College, a senior college, and Queensborough Community College, a two-year institution. During the summer of 2015, the researchers surveyed 79 participants, asking them to identify their most and least preferred mediums for accessing library reference services. Results – Nearly 75% of respondents expressed a preference for face-to-face reference, while only about 18% preferred remote reference services (online chat, e-mail, text message, and telephone). Close to 84% of the participants cited remote reference services as their least preferred modes and slightly more than 10% said this of face-to-face. The data reveal a widespread popularity of face-to-face reference service among all types of participants regardless of institutional affiliation, age, gender, academic level, field of study, and race or ethnicity. Conclusion – This study suggests that given the opportunity academic library users will utilize face-to-face reference service for assistance with research assignments. Academic libraries at both two-year and four-year institutions might consider assessing user views on reference modes and targeting support toward services that align with patron preferences.

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340 Trends and Disparities in Cervical Spine Fusion Procedure Utilization in the New York State

Neurosurgery ◽

10.1093/neuros/nyx417.340 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 276-276

Author(s):

Rui Feng ◽

Mark Finkelstein ◽

Eric Karl Oermann ◽

Michael Palese ◽

John M Caridi

Keyword(s):

New York ◽

African American ◽

Cervical Spine ◽

New York State ◽

High Volume ◽

Spine Fusion ◽

York State ◽

High Volume Hospital ◽

Low Volume ◽

Cervical Spine Fusion

Abstract INTRODUCTION There has been a steady increase in spinal fusion procedures performed each year in the US, especially cervical and lumbar fusion. Our study aims to analyze the rate of increase at low-, medium-, and high-volume hospitals, and socioeconomic characteristics of the patient populations at these three volume categories. METHODS We searched the New York State, Statewide Planning and Research Cooperative System (SPARCS) database from 2005 to 2014 for the ICD-9-CM Procedure Codes 81.01 (Fusion, atlas-axis), 81.02 (Fusion, anterior column, other cervical, anterior technique), and 81.03 (Fusion, posterior column, other cervical, posterior technique). Patients' primary diagnosis (ICD-9-CM), age, race/ethnicity, primary payment method, severity of illness, length of stay, hospital of operation were included. We categorized all 122 hospitals high-, medium-, and low-volume. We then described the trends in annual number of cervical spine fusion surgeries in each of the three hospital volume groups using descriptive statistics. RESULTS >African American patients were significantly greater portion of patients receiving care at low-volume hospitals, 15.1% versus 11.6% at high-volume hospital. Medicaid and self-pay patients were also overrepresented at low-volume centers, 6.7% and 3.9% versus 2.6% and 1.7% respectively at high-volume centers. In addition, Compared with Caucasian patients, African American patients had higher rates of post-operative infection (P = 0.0020) and post-operative bleeding (P = 0.0044). Compared with privately insured patients, Medicaid patients had a higher rate of post-operative bleeding (P = 0.0266) and in-hospital mortality (P = 0.0031). CONCLUSION Our results showed significant differences in racial distribution and primary payments methods between the low- and high-volume categories, and suggests that accessibility to care at high-volume centers remains problematic for these disadvantaged populations.

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Exploring Inmate Reentry in a Local Jail Setting

Crime & Delinquency ◽

10.1177/0011128708327033 ◽

2008 ◽

Vol 58 (1) ◽

pp. 124-146 ◽

Cited By ~ 20

Author(s):

Michael D. White ◽

Jessica Saunders ◽

Christopher Fisher ◽

Jeff Mellow

Keyword(s):

New York ◽

New York City ◽

Program Implementation ◽

York City ◽

Developmental Trajectories ◽

Target Population ◽

Program Completion ◽

Local Jail ◽

Research And Policy

Although prisoner reentry has taken center stage in correctional research and policy discussions, there has been little emphasis on reentry among jail populations. This paper examines a jail-based reentry program in New York City that begins while individuals are incarcerated and includes 90 days of postrelease services. This article explores these assumptions through an evaluation of a jail-based reentry program in New York City that begins while individuals are incarcerated and includes 90 days of postrelease services. To determine program impact, the authors compare samples of participants with nonparticipants and program completers with noncompleters. The groups are matched using developmental trajectories derived from group-based trajectory modeling, in addition to propensity score matching. Findings show that participants perform no better than nonparticipants over a 1-year follow-up, but those who stay engaged for at least 90 days of postrelease services experience significantly fewer (and slower) returns to jail. The findings regarding program completion are tempered by several methodological concerns, however. The article concludes with a discussion of how the study may offer insights for program implementation and operation with this target population.

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Addressing Auditory Health with a Medical Student-Run Screening Program in an Urban, Underserved Minority Population

Scholar: Pilot and Validation Studies ◽

10.32778/spvs.71366.2020.9 ◽

2020 ◽

Vol 1 (2) ◽

pp. 2-7

Author(s):

Justin Chin ◽

Patrick O’Toole ◽

Jun Lin ◽

Julie Lavalliere ◽

Grace Huang ◽

...

Keyword(s):

New York ◽

Hearing Loss ◽

Medical Student ◽

Screening Program ◽

Training Session ◽

Pilot Project ◽

Minority Population ◽

Underserved Communities ◽

Screening Programs ◽

Health Fairs

Abstract Background: Introduction: 1 in 6 Americans has or will have a sensory or communication disorder in their lifetime. In New York, approximately 12.6% of the population is affected by some degree of hearing loss or vestibular dysfunction. Osteopathic medical student auditory screenings have the potential to positively impact communities in screening for auditory disorders. The aim of this study is to argue for the importance of incorporating auditory screening programs into osteopathic student-run health fairs to positively impact underserved communities. Methods: Osteopathic medical students developed an auditory screening protocol and training session to detect auditory pathologies in health fair participants. Screenings included patient intake, hearing loss risk factor discussion questions, and audiological testing such as the whispered voice and turning fork tests. Participants of Touro College of Osteopathic Medicine’s fall and spring health fairs were invited to undergo the screening from September 2017 to March 2018 in New York City, New York. Results: During the inaugural health fairs, 28 participants were screened for auditory pathologies. 6 participants (21%) were referred for additional testing due to abnormal or inconclusive results. Median age of participants was 60 with 19 females and 9 males, IQR 5. Participants primarily self-identified as African American/Black (54%, n=15) or Hispanic (29%, n=8). Conclusion: The results of this pilot project underscore the benefits of effective auditory screening programs at osteopathic student-run health fairs, especially in urban, underserved communities.

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JAMAICA BAY HURRICANE BARRIER

Coastal Engineering Proceedings ◽

10.9753/icce.v12.125 ◽

1970 ◽

Vol 1 (12) ◽

pp. 125

Author(s):

Frank L. Panuzio

Keyword(s):

New York ◽

Mathematical Models ◽

High Volume ◽

Beach Erosion ◽

High Peak ◽

Flood Protection ◽

Rainfall Runoff ◽

Design Storm ◽

Jamaica Bay ◽

Ecological Objectives

A 12 4 mile beach erosion control and hurricane flood protection project includes Jamaica Bay and the Rockaway Inlet in the southwest corner of Long Island, New York«i The project would provide 6 1 miles of beach fill and floodwalls along the Atlantic Ocean shore and 6 3 miles of inland structures to tie back to high ground, including a 0 9 mile barrier across the inlet The barrier, with a 300 foot gated opening and a 300 foot ungated opening, would permit suppression of the design hurricane surge so as to eliminate the need of flood protection works within the bay Linear mathematical models were used to determine these openings Because of the limitation of these models to produce adequate data m the bay pertinent to environmental and ecological considerations, three hydraulic models were utilized General conclusions drawn from the hydraulic model test data are that the results of the mathematical models were upheld, a design storm with high peak is critical for determining the height of protection, a design storm with high volume rather than high peak plus rainfall runoff is critical in determining ungated openings and suppression of bay levels, and there is a combination of gated and ungated openings that would meet the flood protection, navigation, environmental and ecological objectives.

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