Abstract 112: Statin Utilization in the Outpatient Clinic of a University Based Residency Training Program

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Eric Chang ◽  
Demilade Adedinsewo ◽  
Camille Calcano ◽  
Obiora Egbuche ◽  
Aneese Chaudhry ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Outpatient Clinic ◽  
Patient Population ◽  
Private Insurance ◽  
Safety Net ◽  
Atherosclerotic Cardiovascular Disease ◽  
Specific Patient ◽  
Factors Affecting ◽  
Safety Net Hospital ◽  
National Estimates

Background: Current guidelines released in 2013 recommend statins for five specific patient groups including persons with clinical atherosclerotic cardiovascular disease (ASCVD) and diabetes. National estimates of statin utilization in 2012 report statin use in persons with ASCVD at 58.8% and 63.5% among persons with diabetes. A recent review also showed suboptimal statin prescription rates prior to 2013, with only 23% being prescribed a statin at goal dose. Our goal was to assess statin prescriptions in a large resident run outpatient clinic and identify factors affecting statin prescriptions as potential targets for intervention to improve compliance with the guidelines. Methods: We obtained data from the medical record data warehouse of a primary care outpatient clinic within a large safety-net hospital from Jan–Dec 2015. The clinic is predominantly run by internal medicine residents and supervised by general internal medicine attending physicians. Patients with a diagnosis of ASCVD and diabetes were identified and electronic medical records abstraction was done to identify persons who were prescribed a statin (regardless of dose). Bivariate analyses were conducted to identify potential factors affecting statin prescriptions. Results: Our patient population was predominantly African American, representing more than 70% of our clinic patients. We found 87% of persons with ASCVD and 70% of persons with diabetes were on statin. We found no differences in statin prescriptions by demographic characteristics among persons with ASCVD. Among patients with diabetes, younger age (p<0.01), female sex (p<0.05), non-black race (p<0.05) and private insurance/lack of insurance (p<0.01) were associated with a lower likelihood of being prescribed a statin. Conclusion: Statin prescriptions among patients with ASCVD and diabetes appear to be higher in our patient population compared to prior national estimates, however statin prevalence remains suboptimal. Our next steps are to begin a targeted educational intervention for residents in the continuity clinic and ultimately demonstrate that resident driven intervention is an effective way to increase compliance with the guidelines.

Evaluation of Patterns in Access to Breast Cancer Care and Breast Cancer Presentation in a Safety Net Patient Population

2021 ◽  
pp. 000313482096628
Author(s):  
Erica Choe ◽  
Hayoung Park ◽  
Ma’at Hembrick ◽  
Christine Dauphine ◽  
Junko Ozao-Choy
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Cancer Care ◽  
Patient Population ◽  
Safety Net ◽  
Minority Women ◽  
Breast Cancer Care ◽  
Safety Net Hospital ◽  
Screening Mammograms

Background While prior studies have shown the apparent health disparities in breast cancer diagnosis and treatment, there is a gap in knowledge with respect to access to breast cancer care among minority women. Methods We performed a retrospective analysis of patients with newly diagnosed breast cancer from 2014 to 2016 to evaluate how patients presented and accessed cancer care services in our urban safety net hospital. Patient demographics, cancer stage, history of breast cancer screening, and process of referral to cancer care were collected and analyzed. Results Of the 202 patients identified, 61 (30%) patients were younger than the age of 50 and 75 (63%) were of racial minority background. Only 39% of patients with a new breast cancer were diagnosed on screening mammogram. Women younger than the age of 50 ( P < .001) and minority women ( P < .001) were significantly less likely to have had any prior screening mammograms. Furthermore, in patients who met the screening guideline age, more than half did not have prior screening mammograms. Discussion Future research should explore how to improve breast cancer screening rates within our county patient population and the potential need for revision of screening guidelines for minority patients.

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.

Primary Hip and Knee Arthroplasty in a Safety Net Hospital: Substance Abuse and Other Factors Affecting Short-term Complications

2018 ◽  
Vol 33 (9) ◽  
pp. 3003-3008 ◽  
Author(s):  
Harry E. Jergesen ◽  
Zachary P. Thielen ◽  
Jay A. Roever ◽  
Toure T. Vashon ◽  
Hao-Hua Wu ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Knee Arthroplasty ◽  
Safety Net ◽  
Short Term ◽  
Factors Affecting ◽  
Safety Net Hospital ◽  
Hip And Knee Arthroplasty

scholarly journals Therapeutic Plasma Exchange (PLEX) in Thrombotic Microangiopathy (TMA): Experiences of an Inner-City Hospital over a Decade

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3691-3691
Author(s):  
Aakash Putta ◽  
Hafeez Shaka ◽  
Shristi Upadhyay Banskota ◽  
Sunny R K Singh ◽  
Sindhu Malapati ◽  
...  
Keyword(s):  
Inner City ◽  
Validation Studies ◽  
Patient Population ◽  
Final Diagnosis ◽  
Safety Net ◽  
Inclusion Criteria ◽  
Safety Net Hospital ◽  
Study Population ◽  
Time Of Presentation

Introduction: There are multiple mechanisms of occurrence of TMA. Some of the etiologies are associated with high morbidity and mortality, but there are very subtle differences in presentation. A high index of suspicion is recommended for thrombotic thrombocytopenic purpura (TTP) due to the time sensitive nature of treatment initiation and poor outcomes associated with delay in treatment. Due to this, treatment with PLEX is often initiated empirically before diagnostic test results are available. We aim to report the management and outcomes of TMA along with the predictive value of the PLASMIC score in our patient population, over a 10-year period in an inner-city safety net hospital. Methods: This is a single center observational study including patients who underwent PLEX for a diagnosis of TMA, due to concern for TTP between January 2009 and May 2019 at an inner-city safety net hospital. Patients were identified from blood bank records and data was collected by review of electronic medical record. We excluded patients &lt;18 years old and who received PLEX for indications other than that described previously. Data was collected until death or last follow-up. Statistical analysis was done using STATA. Results: A total of 40 patients met the inclusion criteria. Of these, 57.5% (n=23) were male, 17.5% (n=7) had a known malignancy and 15% (n=6) had human immunodeficiency virus infection. Study population was predominantly African American and Hispanic- comprising 75% (n=30) and 17.5% respectively- which differentiates our study from other validation studies for the PLASMIC score. Symptoms at presentation to emergency department, time to initiation of PLEX from presentation, and lab parameters before and after PLEX are shown in the attached table. ADAMTS13 activity level is available in 65% (n=26) patients, 57.7% of which were sent before initiation of PLEX. Average number of PLEX sessions during the admission was 9.4 (range: 2-30). As part of treatment, 85% (n=34) received steroids and 17.5% (n=7) received hemodialysis. 5 patients received rituximab and 2 received eculizumab. Final diagnoses included TTP in 62.5% (n=25), complement mediated TMA in 5% (n=2), drug induced TMA in 10% (n=4), TMA from sepsis or rheumatological condition in 15% (n=6), bone marrow suppression due to chemotherapy in 5% (n=2) and unsure in 2.5% (n=1). Average length of stay was 22.2 days (range: 6-85 days). Of the total 40 patients, 7.5% (n=3) died on the same admission, 10% (n=4) died after discharge and 3 were readmitted for repeat PLEX. Duration of follow-up after discharge ranged from 9 to 3319 days (mean 1102.6 days). We retrospectively estimated the PLASMIC score at the time of presentation for all the patients. Amongst the patients eventually diagnosed with TTP, 50% had a PLASMIC score of &gt;5 and 70.83% had a score ≥5 at the time of presentation. Among non-TTP TMA, 25% had a score of &gt;5 and 62.5% had a score ≥5. The sensitivity, specificity and positive predictive value of PLASMIC score for prediction of final diagnosis of TTP was calculated for all patients who met inclusion criteria and is shown in the attached table. Of those who underwent PLEX in the setting of TMA for the concern of TTP, only about a third were started on PLEX within 24 hours. Conclusion:Among our study population, only about a third were started on PLEX within 24 hours which is concerning and highlights the need for quality improvement initiatives to increase provider awareness and decrease time to PLEX. Final diagnosis of TTP was made in 62.5% of the patients but notably, the performance of PLASMIC score in our patient population was inferior compared to prior validation studies. One possible explanation for this could be the difference in baseline patient demographics, with our patients belonging mostly to minority groups. There is a need for further studies with derivation and validation cohorts in this patient population to derive a scoring system that is more predictive. Table Disclosures No relevant conflicts of interest to declare.

scholarly journals Factors affecting the rates of adherence to surveillance recommendations for incidental pancreatic cystic lesions in a large urban safety net hospital

2020 ◽  
Vol 7 (1) ◽  
pp. e000430
Author(s):  
Andrew Canakis ◽  
Asaf Maoz ◽  
Jaroslaw N Tkacz ◽  
Christopher Huang
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Safety Net ◽  
Multivariate Logistic Regression Model ◽  
Cystic Lesions ◽  
Factors Affecting ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Access To Primary Care

BackgroundPancreatic cystic lesions (PCLs) are a heterogenous group of lesions with varying degrees of malignant potential. PCLs are often incidentally detected on imaging. Management for patients without an immediate indication for resection or tissue sampling entails radiographic surveillance to assess for features concerning for malignant transformation. This study aims to determine the rates of adherence to surveillance recommendations for incidental PCLs, and identify factors associated with adherence or loss of follow-up.MethodsWe conducted a single-centre retrospective study of patients at a tertiary safety net hospital with incidentally discovered asymptomatic PCLs. Follow-up was defined as having undergone repeat imaging as recommended in the radiology report. Data were analysed using logistic regression.ResultsWithin our cohort (n=172), 123 (71.5%) subjects completed follow-up imaging. Attending a gastroenterology appointment was most strongly associated with completing follow-up for PCLs and remained significant (p=0.001) in a multivariate logistic regression model. Subjects without a documented primary care provider were less likely to have follow-up (p=0.028). Larger cyst size was associated with completion of follow-up in univariate only (p=0.067).ConclusionWe found that follow-up of an incidentally discovered PCLs was completed in the majority of our subjects. Incomplete follow-up for PCLs occurred in up to one in three to four patients in our cohort. Access to primary care and utilisation of subspecialty gastroenterology care are associated with completion of follow-up for PCLs. If validated, our findings can guide potential interventions to improve follow-up rates for PCLs.

Factors Affecting Compliance With Myringotomy Tube Follow-up Care

2022 ◽  
pp. 000348942110722
Author(s):  
Helen H. Soh ◽  
Katherine R. Keefe ◽  
Madhav Sambhu ◽  
Tithi D. Baul ◽  
Dillon B. Karst ◽  
...  
Keyword(s):  
Medical Center ◽  
Private Insurance ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Safety Net ◽  
Tube Placement ◽  
Factors Affecting ◽  
Urban Safety

Objective: Myringotomy and tube insertion is a commonly practiced procedure within pediatric otolaryngology. Though relatively safe, follow-up appointments are critical in preventing further complications and monitoring for improvement. This study sought to evaluate the factors associated with compliance of post-myringotomy follow-up visits in an urban safety-net tertiary care setting. Methods: This study is a retrospective chart review conducted in outpatient otolaryngology clinic at an urban, safety-net, tertiary-care, academic medical center. All patients from ages 0 to 18 who received myringotomy and tube placement between February 3, 2012, to May 30, 2018 at the aforementioned clinic were included. Results: A total of 806 patients had myringotomy tubes placed during this period; 190 patients were excluded due to no visits being scheduled within 1 and 6 month visit windows post-operatively, leaving 616 patients included for analysis. Of 616 patients, 574 patients were seen for the 1-month visit, (42 patients did not have follow-up visits within the 1-month window), and 356 patients were examined for the 6-month visit (260 patients did not schedule follow-up visits within the 6-month window). For the 1-month follow-up visits post-procedure, only race/ethnicity type “Other” was associated with lower no-show rates (OR = 0.330, 95% CI: 0.093-0.968). With the 6-month follow-up visits, having private insurance (OR = 0.446, 95% CI: 0.229-0.867) and not having a 1-month visit scheduled (OR = 0.404, 95% CI: 0.174-0.937) predicted lower no-show rates. Conclusion: No meaningful factors studied were significantly associated with compliance of short-term, 1-month visits post-myringotomy. Compliance of longer-term, 6-month post-operative visits was associated with insurance type and previous visit status.

scholarly journals Relationship Between Hepatitis C Clinical Testing Site and Linkage to Care

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Sabrina A. Assoumou ◽  
Wei Huang ◽  
C. Robert Horsburgh ◽  
Mari-Lynn Drainoni ◽  
Benjamin P. Linas
Keyword(s):  
Hepatitis C ◽  
Private Insurance ◽  
Linkage To Care ◽  
Safety Net ◽  
Hcv Rna ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Control And Prevention ◽  
Multivariable Regression ◽  
Testing Site

Abstract Background.  The Centers for Disease Control and Prevention recommends one-time hepatitis C virus (HCV) testing of the population born between 1945 and 1965 with follow-up RNA testing for those with reactive serology. To increase the rate of diagnosis, testing may be considered in settings other than outpatient clinics (OC), such as inpatient wards (IP) or emergency department (ED). Methods.  We used electronic medical records to create a retrospective cohort with reactive HCV serology between 2005 and 2010 at an urban safety net hospital. We determined factors associated with linkage to HCV care as measured by HCV RNA testing, and we evaluated the rate of linkage to care according to diagnosis location (OC, IP, or ED). Results.  Individuals, 37 828, were tested and 5885 (16%) were reactive. Seropositivity was similar across all sites. Of the 4466 patients who met inclusion criteria, 3400 (76%) were diagnosed in the OC, whereas 967 (22%) and 99 (2%) were tested in the IP and the ED, respectively. A total of 2135 (48%) underwent HCV RNA testing. Using multivariable regression modeling, the following factors were independently associated with HCV RNA testing: diagnosis in the OC (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.42–1.90); age at diagnosis in decades (OR, 0.98; 95% CI, 0.98–0.99); private insurance (OR, 1.17; 95% CI, 1.01–1.34); and ≥10 visits after diagnosis (OR, 2.15; 95% CI, 1.89–2.44). Conclusion.  There is an opportunity to increase HCV diagnosis by testing in sites other than the OC, but this opportunity needs to be coupled with robust initiatives to improve linkage to care.

scholarly journals The Impact of Payer Status on Hospital Admissions: Evidence from an Academic Medical Center

2021 ◽  
Author(s):  
Yanying Zhao ◽  
Ioannis Ch. Paschalidis ◽  
Jianqiang Hu
Keyword(s):  
Access To Care ◽  
Low Income ◽  
Hospital Admissions ◽  
Medical Center ◽  
Conditional Logistic Regression ◽  
Private Insurance ◽  
Academic Medical Center ◽  
Safety Net ◽  
Safety Net Hospital ◽  
The Impact

Abstract Background: Inequity exists in accessing to care for patients with different payer statuses. However, there are few studies on the difference of hospital admissions. This study aims to examine how the payer status affects patients hospitalization from the perspective of a safety-net hospital. Methods: We extracted all patients with visiting record in this medical center between 5/1/2009-4/30/2014, and then linked the outpatient and inpatient records three year before target admission time to patients. We conduct a retrospective observational study using a conditional logistic regression methodology. To control the illness of patients with different diseases in training the model, we construct a three-dimension variable with data stratification technology. The model is validated on a dataset distinct from the one used for training. Results: Payer status is strongly associated with a patient’s admission. Patients covered by private insurance or uninsured are less likely to be admitted than those totally or partially insured by government. For uninsured patients, inequity in access to hospitalization is observed. Among all non-clinical influential factors considered in our study, payer status is a significant important factor. Conclusion: Attention is needed on improving the access to care for vulnerable (low-income) patients, for example, by actively advertising free care programs, reaching out to community organizations with better access to these individuals, or offering assurances that access to care is not linked to immigration procedures. Also, in order to reduce preventable admissions, basic preventive care services should be enhanced.

Abstract P167: Inconsistency in the Application of National Institutes of Health Stroke Scale Scores (NIHSS) Between Neurologist and Emergency Room Nurses During Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michele Glidden ◽  
Evan Templeton ◽  
Stephanie Bartlett ◽  
Lynn DCruz ◽  
Abbie McNew ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Retrospective Chart Review ◽  
Safety Net ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Factors Affecting ◽  
Nihss Score ◽  
Score Difference ◽  
Safety Net Hospital ◽  
Scale Scores

Background: The National Institutes of Health Stroke Scale (NIHSS) score is the gold standard for assessing stroke severity. One 2006 study demonstrated research nurses had better interrater reliability in clinical trials than neurologists, but little is known about NIHSS score consistency between neurologists and registered nurses in clinical practice. Consistent baseline NIHSS scoring by neurologists and nurses is crucial to determine stroke acuity, deliver evidence-based treatment, and optimize patient outcomes. The purpose of this study was to determine whether a difference existed between healthcare providers’ NIHSS scores and determine factors affecting inconsistencies in scores. Methods: A retrospective chart review of patients treated at a single Comprehensive Stroke Center safety net hospital compared the initial NIHSS scores given to the same patient by neurologists and emergency department nurses from January 2018 to December 2019. Of the 588 charts reviewed, 438 met inclusion criteria. Patients were divided into two cohorts based on score differences between neurologists and nurses: clinically meaningful score difference ≥2 (n= 152, 34.70%) and non-meaningful score difference <2 (n= 286, 65.30%,). Results: Only two variables were significantly associated with greater score inconsistencies: higher NIHSS score (p = <.01) and patients presenting with aphasia (p =<.01). Clinically meaningful score inconsistencies were 44% more likely to occur in aphasic stroke patients. Conclusions: Although overall NIHSS scores are similar between physicians and nurses, patients with aphasia and more severe strokes were more likely to be scored inconsistently. Neurologists and nurses have different training and certification requirements with nurses required to certify annually while neurologists are not. Implementing a policy that requires all providers to undergo the same training in specific areas of the NIHSS may eliminate disparity and ensure patients are given the interventions needed for best outcomes.

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