Assessment of Oropharyngeal and Laryngeal Cancer Treatment Delay in a Private and Safety Net Hospital System

Objective To examine the impact of treatment setting and demographic factors on oropharyngeal and laryngeal cancer time to treatment initiation (TTI). Study Design Retrospective case series. Setting Safety net hospital and adjacent private academic hospital. Subjects and Methods Demographic, staging, and treatment details were retrospectively collected for 239 patients treated from January 1, 2014, to June 30, 2016. TTI was defined as days between diagnostic biopsy and initiation of curative treatment (defined as first day of radiotherapy [RT], surgery, or chemotherapy). Results On multivariable analysis, safety net hospital treatment (vs private academic hospital treatment), initial diagnosis at outside hospital, and oropharyngeal cancer (vs laryngeal cancer) were all associated with increased TTI. Surgical treatment, severe comorbidity, and both N1 and N2 status were associated with decreased TTI. Conclusion Safety net hospital treatment was associated with increased TTI. No differences in TTI were found when language spoken and socioeconomic status were examined in the overall cohort.

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

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a143a ◽

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

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

Diabetes ◽

10.2337/db20-1195-p ◽

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

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Impact of insurance status on overall survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

Pleura and Peritoneum ◽

10.1515/pp-2020-0105 ◽

2020 ◽

Vol 5 (3) ◽

Author(s):

Ravi J. Chokshi ◽

Jin K. Kim ◽

Jimmy Patel ◽

Joseph B. Oliver ◽

Omar Mahmoud

Keyword(s):

Overall Survival ◽

Neoadjuvant Chemotherapy ◽

Abdominal Wall ◽

Intraperitoneal Chemotherapy ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Safety Net ◽

Insurance Status ◽

Gynecologic Malignancies ◽

Safety Net Hospital ◽

The Impact

AbstractObjectivesThe impact of insurance status on oncological outcome in patients undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is poorly understood.MethodsRetrospective study on 31 patients having undergone 36 CRS-HIPEC at a single institution (safety-net hospital) between 2012 and 2018. Patients were categorized as insured or underinsured. Demographics and perioperative events were compared. Primary outcome was overall survival (OS).ResultsA total of 20 patients were underinsured and 11 were insured. There were less gynecologic malignancies in the underinsured (p=0.02). On univariate analysis, factors linked to poor survival included gastrointestinal (p=0.01) and gynecologic malignancies (p=0.046), treatment with neoadjuvant chemotherapy (p=0.03), CC1 (p=0.02), abdominal wall resection (p=0.01) and Clavien–Dindo 3-4 (p=0.01). Treatment with neoadjuvant chemotherapy and abdominal wall resections, but not insurance status, were independently associated with OS (p=0.01, p=0.02 respectively). However, at the end of follow-up, six patients were alive in the insured group vs. zero in the underinsured group.ConclusionsIn this small, exploratory study, there was no statistical difference in OS between insured and underinsured patients after CRS-HIPEC. However, long-term survivors were observed only in the insured group.

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Impact of Pathological Stratification on the Clinical Outcomes of Advanced Well-Differentiated/Dedifferentiated Liposarcoma Treated with Trabectedin

Cancers ◽

10.3390/cancers13061453 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1453

Author(s):

Chiara Fabbroni ◽

Giovanni Fucà ◽

Francesca Ligorio ◽

Elena Fumagalli ◽

Marta Barisella ◽

...

Keyword(s):

Clinical Outcomes ◽

Proportional Hazards ◽

Case Series ◽

Progression Free Survival ◽

Cox Proportional Hazards ◽

Low Grade ◽

High Grade ◽

Retrospective Case ◽

Well Differentiated ◽

The Impact

Background. We previously showed that grading can prognosticate the outcome of retroperitoneal liposarcoma (LPS). In the present study, we aimed to explore the impact of pathological stratification using grading on the clinical outcomes of patients with advanced well-differentiated LPS (WDLPS) and dedifferentiated LPS (DDLPS) treated with trabectedin. Patients: We included patients with advanced WDLPS and DDLPS treated with trabectedin at the Fondazione IRCCS Istituto Nazionale dei Tumori between April 2003 and November 2019. Tumors were categorized in WDLPS, low-grade DDLPS, and high-grade DDLPS according to the 2020 WHO classification. Patients were divided in two cohorts: Low-grade (WDLPS/low-grade DDLPS) and high-grade (high-grade DDLPS). Results: A total of 49 patients were included: 17 (35%) in the low-grade cohort and 32 (65%) in the high-grade cohort. Response rate was 47% in the low-grade cohort versus 9.4% in the high-grade cohort (logistic regression p = 0.006). Median progression-free survival (PFS) was 13.7 months in the low-grade cohort and 3.2 months in the high-grade cohort. Grading was confirmed as an independent predictor of PFS in the Cox proportional-hazards regression multivariable model (adjusted hazard ratio low-grade vs. high-grade: 0.45, 95% confidence interval: 0.22–0.94; adjusted p = 0.035). Conclusions: In this retrospective case series, sensitivity to trabectedin was higher in WDLPS/low-grade DDLPS than in high-grade DDLPS. If confirmed in larger series, grading could represent an effective tool to personalize the treatment with trabectedin in patients with advanced LPS.

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

Journal of Health Care for the Poor and Underserved ◽

10.1353/hpu.2013.0179 ◽

2013 ◽

Vol 24 (4) ◽

pp. 1666-1675 ◽

Cited By ~ 14

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

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

Population Health Management ◽

10.1089/pop.2009.0078 ◽

2010 ◽

Vol 13 (6) ◽

pp. 319-324 ◽

Cited By ~ 2

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

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

Neurosurgery ◽

10.1093/neuros/nyx417.114 ◽

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.

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