Post-Mastectomy Patients in an Urban Safety-Net Hospital: How Do Safety-Net Hospital Breast Reconstruction Rates Compare to National Breast Reconstruction Rates?

2021 ◽  
pp. 000313482110540
Author(s):  
Jason Llaneras ◽  
Jamie M. Klapp ◽  
J. Brian Boyd ◽  
Joaquin Granzow ◽  
Ashkan Moazzez ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Smoking Status ◽  
Medical Center ◽  
Safety Net ◽  
Diverse Population ◽  
Underrepresented Minority ◽  
Hospital System ◽  
National Breast ◽  
Safety Net Hospital ◽  
Rate Type

Background Breast reconstruction (BR) has documented psychological benefits following mastectomy. Yet, racial/ethnic minority groups have lower reported rates of BR. We sought to evaluate the rate, type, and outcome of BR in a racially and ethnically diverse population within a safety-net hospital system. Methods All patients who underwent mastectomy between October 2015 and July 2019 at Harbor-UCLA Medical Center were retrospectively examined. Rates and type of BR were analyzed according to patient characteristics (race/ethnicity, age, and body mass index), smoking status, cancer stage, and presence of diabetes mellitus. Breast reconstruction outcomes were also assessed. Results Of the 259 patients that underwent mastectomy, 87 (33.6%) received BR. Immediate BR was performed in 79 (30.5%) patients and delayed BR in 8 (3.1%). Of the 79 patients with immediate BR, 58 (73.4%) received implant-based BR and 21 (26.5%) autologous tissue. The BR failure rate was 10%, all implant-based. Increasing age and smoking negatively impacted BR rates. Black ( P =.331) and Hispanic ( P =.132) ethnicity were not independent predictors of decreased breast reconstruction. Conclusion This study demonstrated that the rate, type, and quality of BR in this integrated safety-net hospital within a diverse population are comparable to national rates. When made available, historically underrepresented minority patients of Black and Hispanic ethnicity utilize BR.

Abstract 143A: Does Insurance Type Predict Quality of Anticoagulation Care in a Boston Safety Net Hospital System?

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Alok Kapoor ◽  
Nancy R Kressin ◽  
Amresh D Hanchate ◽  
Mengyun Lin ◽  
Chieh Chu ◽  
...  
Keyword(s):  
Medical Center ◽  
Safety Net ◽  
Easy Access ◽  
Uninsured Patients ◽  
Hospital System ◽  
Commercial Insurance ◽  
Safety Net Hospital ◽  
Free Care ◽  
The Impact

Background: Boston Medical Center (BMC) is the primary safety net hospital for Eastern Massachusetts and has a diverse patient population with diverse insurance types. Such types include commercial and public insurance (Medicare and Medicaid) and Free Care, limited coverage funded by money distributed to safety-net institutions to care for uninsured patients. In 2006, the state expanded Medicaid eligibility and began offering Commonwealth Care, comprehensive subsidized coverage with retail pharmacy benefits, for uninsured patients. The impact of these insurance types on individual cardiovascular conditions has not been studied. Venous thromboembolism (VTE), comprised of deep venous thrombosis and pulmonary embolism, is a condition whose clinical course is dependent on high quality anticoagulation care including easy access to medication and providers. Time in the therapeutic range (TTR), the percentage of time a patient spends with INR between 2 and 3, has emerged as the preeminent way to measure quality of anticoagulation care. In this study, we compared quality of anticoagulation among different insurance types. Methods: Using clinical data, we identified adults aged 18 to 64 with a new episode of VTE diagnosed in the years 2003 to 2010 at BMC or its affiliated health centers. To be eligible for inclusion, each patient had to have an ICD-9-CM code for VTE and an INR test in the month following VTE diagnosis. We computed TTR using all INR values from diagnosis to 12 months according to the Rosendaal method. We then measured the mean TTR for each of six insurance categories based on primary insurance at time of diagnosis. Using multiple linear regression, we adjusted measurements for sex, age, race, language preference, area poverty, VTE type, recent surgery, and number of Elixhauser comorbidities. Results: We identified 1099 patients with VTE. Twenty-three percent had commercial insurance, 37% Medicaid, 16% Medicare, 4% Commonwealth care, 18% Free Care, and 2% other. Mean TTR was 39.3%. Patients with Free Care and Commonwealth Care had similar TTR compared to those with commercial insurance. Patients with Medicaid, Medicare or other insurance had significantly lower TTR, compared to those with commercial insurance. Conclusion: Quality of anticoagulation care was low in this population. Residual confounding such as from healthy worker effect may account for higher TTR in patients with commercial insurance. In future work we plan to expand measurement of insurance effects to patients receiving anticoagulation for indications other than VTE and adjust our measurements for temporal bias

1195-P: Improving Diabetes Self-Management with a Mobile App: Results of a Pilot Program at a Safety Net Hospital System

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1195-P
Author(s):  
ROOPA KALYANARAMAN MARCELLO ◽  
JOHANNA DOLLE ◽  
SHARANJIT KAUR ◽  
SAWKIA R. PATTERSON ◽  
NICHOLA DAVIS
Keyword(s):  
Safety Net ◽  
Mobile App ◽  
Self Management ◽  
Pilot Program ◽  
Hospital System ◽  
Safety Net Hospital

scholarly journals An Examination of End-of-Life Care in a Safety Net Hospital System: A Decade in Review

2013 ◽  
Vol 24 (4) ◽  
pp. 1666-1675 ◽  
Author(s):  
Ramona L. Rhodes ◽  
Lei Xuan ◽  
M. Elizabeth Paulk ◽  
Heather Stieglitz ◽  
Ethan A. Halm
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Safety Net ◽  
Life Care ◽  
Hospital System ◽  
System A ◽  
Safety Net Hospital

Diabetes Mellitus Disease Management in a Safety Net Hospital System: Translating Evidence into Practice

2010 ◽  
Vol 13 (6) ◽  
pp. 319-324 ◽  
Author(s):  
Michael K. Butler ◽  
Michael Kaiser ◽  
Jolene Johnson ◽  
Jay Besse ◽  
Ronald Horswell
Keyword(s):  
Diabetes Mellitus ◽  
Disease Management ◽  
Safety Net ◽  
Hospital System ◽  
Safety Net Hospital

scholarly journals 2207. Barriers to HCV Treatment in a Safety-Net Hospital System

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S651-S652
Author(s):  
Sabhi Gull ◽  
Lisa Quirk ◽  
Jennifer McBryde ◽  
Nicole Rich ◽  
Amit Singal ◽  
...  
Keyword(s):  
Safety Net ◽  
Hcv Treatment ◽  
Hospital System ◽  
Safety Net Hospital

Calcium and magnesium infusions for prevention of oxaliplatin-induced peripheral neuropathy.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 387-387
Author(s):  
M. Bupathi ◽  
G. Mahmud ◽  
J. Kovar ◽  
E. Wang ◽  
T. E. O'Brien
Keyword(s):  
Peripheral Neuropathy ◽  
Cumulative Dose ◽  
Medical Center ◽  
Demographic Data ◽  
Performance Status ◽  
Safety Net ◽  
Control Group ◽  
Minority Population ◽  
Tumor Type ◽  
Safety Net Hospital

387 Background: Oxaliplatin plays an important role in chemotherapy regimens for colorectal and other GI malignancies. Debilitating peripheral neuropathy (PN) often develops with use of this drug. One study (Grothey A et al, ASCO 2009, abst #4025) has shown that pre- and post-oxaliplatin infusions with calcium (Ca) and magnesium (Mg) may reduce this toxicity. To confirm this in an unselected indigent minority population, a retrospective review was performed comparing development of PN in oxaliplatin exposed patients treated with or without Ca/Mg. Methods: Records of patients who received oxaliplatin from 1/2008 to 12/2009 at MetroHealth Medical Center, a large safety net hospital in Cleveland, OH, were reviewed. 47 patients received Ca/Mg + oxaliplatin and 46 oxaliplatin alone. Data collected included age, race, gender, insurance status, performance status, tumor type, stage, concomitant diseases (DM and EtOH), number of cycles and cumulative dose of oxaliplatin. PN was determined using the Common Terminology Criteria of Adverse Events (CTCAE) version 3.0. Patients were followed 6 months after completion of oxaliplatin. Results: Demographic data was similar between the two groups. Colorectal cancer compromised 77% of the treatment group and 85% of control group. Patients who received Ca/Mg had significantly less PN in all three grades (1-3) compared with the control group (grade 1 89.4% vs. 71.7%, grade II 10.6% vs. 19.6%, grade 3 0% vs. 8.7%, respectively). The cumulative dose of oxaliplatin did not differ between the two groups (Ca/Mg median 1,143 range 260-2,169; control median 1,425 range 137-2,635). The combined total grades 2 and 3 in both the treatment and control (10.6% vs. 28.3%, p = 0.038) favored use of Ca/Mg. Conclusions: This small, retrospective study confirms that Ca/Mg infusions reduce the incidence of clinically significant (grade 2/3) PN in pts receiving oxaliplatin. No significant financial relationships to disclose.

Use of palliative care among patients with metastatic breast cancer at a safety net hospital.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 117-117
Author(s):  
Sita Bushan ◽  
Hsiao Ching Li ◽  
Samira K. Syed ◽  
Nisha Unni ◽  
Navid Sadeghi
Keyword(s):  
Breast Cancer ◽  
Palliative Care ◽  
Metastatic Breast Cancer ◽  
Hormone Receptor ◽  
Medical Oncology ◽  
Metastatic Breast ◽  
Safety Net ◽  
Hospital System ◽  
Advanced Directives ◽  
Safety Net Hospital

117 Background: Palliative Care (PC) has been shown to improve quality of life in lung cancer patients, and ASCO recommends it as an adjunct to standard oncologic care. Data regarding the use of PC in other cancers and in disadvantaged populations is scant. We studied the patterns of use of PC in patients with metastatic breast cancer (MBC) at a safety net hospital. Methods: Electronic health records (EHR) of 234 patients who were diagnosed with MBC from 2010 to 2016 at Parkland Health and Hospital System (PHHS) were reviewed, and data on demographics, diagnostics, treatments, and palliative care elements were collected. Results: 105 of 234 (44.8%) patients with MBC were referred to PC, either as outpatients, inpatients, or both. The average time from the first visit with medical oncology to placement of an outpatient referral to PC was 390 days. Of the 79 patients with outpatient referrals to palliative care, we have hormone receptor status on 50. 12 of these patients had triple negative breast cancer; 30 had hormone receptor positive breast cancer. 77 (32% of all patients) patients had formal documentation of advanced directives (AD) in the EHR. Of these, 69 (89.6%) had seen PC. 133 patients have died, and 37 (27.8% of expired patients) died at the Parkland Hospital. Among the 96 patients who did not die in the hospital, 73 (76%) patients had some discussion of hospice prior to death. Conclusions: Less than half of patients with MBC at PHHS were referred to PC, and among those who are, referrals are placed late in the disease course, on average, more than one year after the first medical oncology visit. Lack of a sustained relationship with PC results in truncated goals of care discussions. As a result, most patients do not have formal documentation of AD in the EHR. Furthermore, they do not benefit from discussions with PC that could guide the management of their malignancy while they still have therapeutic options. Instead, patients discuss hospice with their providers toward the end of life, only when they are no longer candidates for cancer directed therapies. Although the use of PC resources at PHHS does not meet clinical guidelines, it is consistent with data from other studies showing inadequate use of PC resources among patients with advanced cancer.

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