Comparison of Referral Pathways in Otolaryngology at a Public Versus Private Academic Center

2019 ◽  
Vol 129 (4) ◽  
pp. 369-375
Author(s):  
Caitlin Bertelsen ◽  
Janet S. Choi ◽  
Anna Jackanich ◽  
Marshall Ge ◽  
Gordon H. Sun ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Tertiary Care ◽  
Surgical Care ◽  
Safety Net ◽  
Clinic Visit ◽  
Level Of Evidence ◽  
Sociodemographic Differences ◽  
Academic Center ◽  
Safety Net Hospital ◽  
Type Of Surgery

Objective: Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referral and surgical intervention for index otolaryngologic procedures between a public safety net hospital (PSNH) and tertiary-care academic center (TAC). Methods: Retrospective cohort study of eligible adult patients undergoing one of several general otolaryngologic procedures at a PSNH (n = 216) and a TAC (n = 161) over a 2-year time period. Results: PSNH patients were younger, less likely to have comorbidities and more likely to be female, Hispanic or Asian, and to lack insurance. Time between referral and first clinic visit was shorter at the PSNH than the TAC (Mean 35.8 ± 47.7 vs 48.3 ± 60.3 days; P = .03). Time between referral and surgical intervention did not differ between groups (129 ± 90 for PSNH vs 141 ± 130 days for TAC, P = .30). On multivariate analysis, the TAC had more patient-related delays in care than the PSNH (OR: 3.75, P < .001). Time from referral to surgery at a PSNH was associated with age, source of referral, type of surgery, diagnostic workup and comorbidities, and at a TAC was associated with gender and type of surgery and comorbidities. Conclusions: Sociodemographic differences between PSNH and TAC patients, as well as differences in referral pathways between the types of institutions, influence progression of surgical care in otolaryngology. These differences may be targets for interventions to streamline care. Level of Evidence: 2c

114 Allowing Overlapping Surgery Decreases Length of Stay in an Academic, Safety-Net Hospital

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 224-224
Author(s):  
Anthony Michael DiGiorgio ◽  
Praveen V Mummaneni ◽  
Jonathan Lloyd Fisher ◽  
Adam Podet ◽  
Clifford Crutcher ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Tertiary Care ◽  
Wait Time ◽  
Multivariate Regression Analysis ◽  
Safety Net ◽  
Neurosurgical Procedures ◽  
Urgent Surgery ◽  
Period 2 ◽  
Safety Net Hospital ◽  
The Impact

Abstract INTRODUCTION The practice of surgeons performing overlapping surgery has recently come under scrutiny. We sought to examine the impact of overlapping rooms on surgery wait time and length of stay in patients admitted to a tertiary care, safety-net hospital for urgent neurosurgical procedures. METHODS Our hospital functions as a safety-net, tertiary care, level-1 trauma center in the Southern United States. The neurosurgery service transitioned from routinely allowing one room per day (period 1) to overlapping rooms (period 2), with the second room being staffed by the same attending surgeon. Patients undergoing neurosurgical intervention in each period were retrospectively compared. Case urgency, patient demographics, case type, indication, length of stay and time from admission to surgery were tracked. RESULTS >452 total cases were reviewed (201 in period 1 & 251 in period 2), covering 7 months in each period. 122 of the cases were classified as “urgent” (59 in period 1 and 63 in period 2). In the these patients, length of stay was significantly decreased in period 2 (13.09 days vs 19.52, p = .002) and the time from admission to surgery for urgent cases trended towards a shorter time (5.12 days vs 7.00, p = .084). Insurance status of these patients was 26.2% uninsured, 39.3% Medicaid, 18.9% Medicare, 9% commercial and the remainder workers compensation, liability or prisoner care. Multivariate regression analysis revealed that being in period 1, having Medicare, having trauma as the indication for surgery, and undergoing a non-cranial or non-spinal procedure as significant factors for increased length of stay. CONCLUSION Recent studies suggest overlapping surgeries are safe for patients. In the case of our safety net hospital, allowing the neurosurgery service to run overlapping rooms significantly reduces length of stay in a vulnerable population who is admitted in need of urgent surgery.

Impact of the Closure of a Large, Urban Safety-Net Hospital on a Neighboring Academic Center: A Philadelphia Case Study

2020 ◽  
Vol 17 (9) ◽  
pp. 1123-1129
Author(s):  
Sarah I. Kamel ◽  
Adam C. Zoga ◽  
Frederick Randolph ◽  
Vijay M. Rao ◽  
Vishal Desai
Keyword(s):  
Safety Net ◽  
Academic Center ◽  
Safety Net Hospital ◽  
Urban Safety

scholarly journals Risk Factors for Development of Hypocalcemia in Patients With Cancer Treated With Bone-Modifying Agents

2020 ◽  
Vol 18 (4) ◽  
pp. 420-427
Author(s):  
Paul S. White ◽  
Michael Dennis ◽  
Eric A. Jones ◽  
Janice M. Weinberg ◽  
Shayna Sarosiek
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Bone Metastases ◽  
Tertiary Care ◽  
Safety Net ◽  
High Rate ◽  
Close Monitoring ◽  
Patients With Cancer ◽  
Vitamin D Levels ◽  
Safety Net Hospital

Background: This retrospective analysis describes the prevalence of and risk factors associated with the development of hypocalcemia in patients with cancer receiving bone-modifying agents (BMAs) as supportive care. Patients and Methods: Patients with cancer treated with an intravenous or subcutaneous BMA, including pamidronate, zoledronic acid, or denosumab, at a tertiary care/safety net hospital in 2005 through 2015 were included in this retrospective review. We reviewed the medical records for predictive clinical and laboratory parameters and for patient outcomes. Results: A total of 835 patients with cancer received at least one dose of a BMA during the specified time frame; 205 patients (25%) developed hypocalcemia of CTCAE grade ≥1 within 8 weeks of BMA initiation, 18 of whom (8.8%) had grade ≥3, and 3 patients died as a result. Multivariate analysis showed that patients with hematologic malignancy (odds ratio [OR], 1.956; P=.025), bone metastases (OR, 2.443; P=.017), inpatient status (OR, 2.592; P<.001), and deficient baseline vitamin D levels (OR, 2.546; P<.023) were more likely to develop hypocalcemia. Hypercalcemia before BMA administration (OR, 0.474; P=.032) was protective. Conclusions: Certain patient populations, including those with hematologic malignancies and/or bone metastases, warrant closer monitoring of calcium levels while receiving BMAs because of the high rate of hypocalcemia. Low pretreatment vitamin D levels are associated with the development of hypocalcemia. These data support close monitoring of calcium levels in patients with cancer receiving BMAs, in addition to adequate repletion of vitamin D before initiation of BMAs when possible.

scholarly journals Access to Surgical Care for Benign Gallbladder Disease During Covid-19 at a Safety-net Hospital

2021 ◽  
Vol 233 (5) ◽  
pp. S86-S87
Author(s):  
Woon Cho Kim ◽  
Mary Kathryn Abel ◽  
Hope Schwartz ◽  
Marissa Boeck ◽  
Tasce Bongiovanni ◽  
...  
Keyword(s):  
Gallbladder Disease ◽  
Surgical Care ◽  
Safety Net ◽  
Safety Net Hospital

scholarly journals 760. Assessment of DEXA Scan Ordering Among Infectious Disease Providers at a Large Tertiary-Care Urban Academic Center in the Midwest

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S339-S339
Author(s):  
Rebecca Nirmal Kumar ◽  
Mary Clare Masters ◽  
Karen Krueger
Keyword(s):  
Infectious Disease ◽  
Tertiary Care ◽  
Clinic Visit ◽  
Mineral Density ◽  
Osteoporosis Screening ◽  
Academic Center ◽  
Large Tertiary Care ◽  
Care Guidelines ◽  
Prevalence Of Osteoporosis ◽  
Patient Barriers

Abstract Background Osteoporosis is compromised bone strength that predisposes to fracture. It can be diagnosed by Dual-energy x-ray absorptiometry (DEXA) measurement of bone mineral density (BMD). Persons with HIV (PWH) are at higher risk for the development of osteoporosis. As such, the HIV Medicine Association’s (HIVMA) primary care guidelines recommend DEXA screening for all HIV-infected postmenopausal women and men aged ≥50 years. The purpose of this study was to asses the frequency of DEXA utilization within a tertiary-care urban academic center in the Midwest and to identify prevalence of osteoporosis. Methods A representative sample PWH age ≥50 from our institution’s outpatient infectious disease (ID) clinic were included. All subjects had at least one clinic visit in the last year, were on antiretroviral therapy (ART), and virally suppressed. Unblinded chart review was performed to assess if DEXA was ordered, was DEXA ordered by an ID physician, was DEXA completed, results of DEXA, and whether patients were on a tenofovir disoproxil fumarate (TDF)-containing regimen. Results 225 charts were reviewed. 186 (83%) patients were men, with a median age of 58 (range of 50–85). DEXA scans were ordered on 39 (17%) patients, 9 (23%) of which were ordered by their ID provider. Twenty-eight (72%) DEXA scans were performed. Of scans completed, 11 (39%) diagnosed osteoporosis, 15 (54%) osteopenia, and 2 (7%) showed normal BMD. Of all charts reviewed, 29 (13%) were on TDF-containing regimens. Of those individuals with diagnosed abnormal BMD (26), only 1 (4%) was on a TDF-containing regimen. Conclusion Despite HIVMA’s recommendation for osteoporosis screening in PWH, only 17% of eligible patients with well-controlled HIV in our clinic had been referred for DEXA. Of those who had undergone DEXA screening, nearly all (93%) had abnormal BMD. Further investigation is necessary to explore provider and patient barriers for osteoporosis screening in PWH. Disclosures All authors: No reported disclosures.

DIFFERENTIAL MANIFESTATIONS OF INLAMMATORY BOWEL DISEASE (IBD) BASED ON RAGE AND IMMIGRATION STATUS

2021 ◽  
Vol 27 (Supplement_1) ◽  
pp. S17-S19
Author(s):  
Brooks Crowe ◽  
Ali Khalessi ◽  
Yuhe Xia ◽  
Gregory Rubinfeld ◽  
Jessica Baylor ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Disease Onset ◽  
Intestinal Resection ◽  
Safety Net ◽  
Racial Groups ◽  
Foreign Born ◽  
Single Center ◽  
Immigration Status ◽  
Black Patients ◽  
Safety Net Hospital

Abstract Background The increasing incidence of IBD globally presents an important opportunity to study intrinsic and environmental determinants of disease development. We examined how race and immigration status influence IBD manifestations, treatments, and outcomes in a diverse, tertiary-care public hospital that serves predominantly the uninsured and underinsured. Methods We conducted a single-center retrospective review of all IBD patients treated from 1997–2017. Using logistic regression modeling, we compared disease onset, treatment, and outcomes by race (White, Black, Hispanic, Asian) and immigration status (US-born vs. foreign-born). To assess for the potential confounder of race in analyses of US versus foreign-born subjects, we further evaluated differences in IBD characteristics among foreign-born patients in each of the four racial groups. Results A total of 577 patients were identified, of which 29.8% were White, 27.4% Hispanic, 21.7% Black, and 13.0% Asian. Of these patients, 260 had a confirmed country of birth, with 69.6% being foreign-born. The time between IBD diagnosis and last documented follow up was not statistically different between races, nor by foreign versus US-born status. Asian IBD patients were less likely than White IBD patients to be female (OR 0.38, 95% CI: 0.20, 0.69). Among ulcerative colitis (UC) patients, Asians were more likely than White patients to have isolated proctitis (OR 10.34, 95% CI: 1.58, 203.08). Black patients were less likely to be diagnosed with UC (OR 0.57, 95% CI: 0.36, 0.91) and more likely to undergo IBD-related intestinal resection (OR 2.49, 95% CI: 1.40, 4.50), though the opposite was true in foreign-born Black patients. Overall, foreign-born patients were more likely to be diagnosed with UC (OR 1.77, 95% CI: 1.04, 3.02). They were also less likely to be diagnosed before 16 years of age (OR 0.19, 95% CI: 0.08, 0.41), have undergone intestinal resections (OR 0.39, 95% CI: 0.19, 0.83), or have received biologics (OR 0.43, 95% CI: 0.25, 0.76). No single race accounted for the decreased use of biologics or intestinal resections among foreign-born patients. Conclusions IBD phenotype varies by race, although foreign-born patients of all races show evidence of later onset and milder disease. As our study was performed in a large single-center safety-net hospital, our study design minimized socioeconomic confounders. These findings may aid in disease prognostication and clinical management and furthermore may provide insight into intrinsic and environmental influences on IBD pathogenesis.

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