Implementation of Symptom Care Clinic (SCC) for acute symptoms management at outpatient oncology ambulatory centers.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2030-2030
Author(s):  
Han Xiao ◽  
Rosanna Fahy ◽  
Rori Salvaggio ◽  
Maryellen OSullivan ◽  
Desiree Sokoli ◽  
...  
Keyword(s):  
Patient Experience ◽  
Symptom Management ◽  
Cancer Survival ◽  
Care Center ◽  
Urgent Care ◽  
Recidivism Rate ◽  
Time Saving ◽  
Care Clinic ◽  
Acute Symptom ◽  
Ambulatory Oncology

2030 Background: With improved overall cancer survival, increasing number of cancer patients are undergoing active treatment. This, in return, add burden in acute symptom management related to disease and treatment. This has resulted in increasing unplanned emergency room (ER) visits and negatively impacted patients experience and health cost. We establish Symptom Care Clinic (SCC) embedded in suburban ambulatory oncology centers to reduce unplanned ER lists and to improve patient experience. Methods: Together with all stakeholders, we developed six SCCs at regional ambulatory centers in NY and NJ. Clearly defined work flow and algorithm were developed to ensure appropriate patient referral. On-site radiology and laboratory services are available. The SCCs are staffed with combination of Advanced Practice Provided (APP) and physicians or APP alone supported by on site medical oncologist or remote central Urgent Care Center Attendings. We evaluated clinic volumes, reduction ins unplanned ER visits and patient experience. Results: From October 2017 to December 2019, total of 17,542 SCC visits were documented. Total of 17,479 lab and 5,355 radiology tests as well as 3,915 infusions were performed. The top five most common laboratory tests are CBC, blood cultures, CMP, respiratory panel and urine culture. The most common symptoms are fever, nausea/vomiting/dehydration, rash and pain. Among all SCC visits during this period, 83% were discharged home and 17% were transferred to ER or hospitals. During 2019, total 10,736 SCC visits were recored, APP evaluated 73.7% of visits and physicians 16.3% with comaprable recidivism rate, 2.52% and 2.75%, respectively. Conservatively, we estimated that approximately 40% of visits would have been Er visits based on numbers of CBC and other testes performed. Qualitative feedbacks from patients indicated positive experience in convenient access, cohesive care coordination and time saving from traveling to and waiting in ER. Conclusions: We successfully implemented an effective acute symptom management system in busy ambulatory oncology centers that is patient centric. Out data showed that SCC reduced unplanned ER visits and that APP/physician model has low recidivism rate.

Impact of a Dedicated Cancer Urgent Care Center on Acute Care Utilization

2021 ◽  
pp. OP.21.00183
Author(s):  
Bonnie E. Gould Rothberg ◽  
Maureen E. Canavan ◽  
Sophia Mun ◽  
Tannaz Sedghi ◽  
Tracy Carafeno ◽  
...  
Keyword(s):  
Acute Care ◽  
Hospital Admissions ◽  
Clinical Pathways ◽  
Care Center ◽  
Hospitalization Rate ◽  
Urgent Care ◽  
Advanced Practice ◽  
Urgent Care Center ◽  
Care Clinic ◽  
Ed Visits

PURPOSE: Acute care imposes a significant burden on patients and cancer care costs. We examined whether an advanced practice provider-driven, cancer-specific urgent care center embedded within a large tertiary academic center decreased acute care use among oncology patients on active therapy. MATERIALS AND METHODS: We conducted a quasi-experimental study anchored around the Oncology Extended Care Clinic (OECC) opening date. We evaluated two parallel 4-month periods: a post-OECC period that followed a 5-month run-in phase, and the identical calendar period 1 year earlier. Our primary outcomes included all emergency department (ED) presentations and hospital admissions during the 3-month window following the index provider visit. We used Poisson models to calculate absolute pre-OECC v post-OECC rate differences. RESULTS: Our cohort included 2,095 patients in the pre-OECC period and 2,188 in the post-OECC period. We identified 32.6 ED visits/100 patients and 41.2 hospitalizations/100 patients in the pre-OECC period, versus 28.2 ED visits/100 patients and 26.1 hospitalizations/100 patients post-OECC. After adjusting for age, sex, race and ethnicity, and practice location, we observed a significant decrease of 4.6 ED visits/100 patients during the post-OECC period (95% CI, –8.92/100 to –0.28/100; P = .04) compared with the pre-OECC period. There was no significant association between the OECC opening and hospitalization rate (rate difference: –3.29 admissions/100 patients; 95% CI, –8.24/100 to 1.67/100; P = .19). CONCLUSION: Establishing a cancer-specific urgent care center was significantly associated with a modest decrease in emergency room utilization but not with hospitalization rate. Barriers included clinic capacity, patient awareness, and physician comfort with advanced practice provider autonomy. Optimizing workflow and standardizing clinical pathways can create benchmarks useful for value-based payments.

Antibiotic Prescribing in Adults Presenting with Pharyngitis Pre- and Post-Implementation of a Rapid Group A Streptococcus Test

2021 ◽  
pp. 001857872110323
Author(s):  
Preeyaporn Sarangarm ◽  
Timothy A. Huerena ◽  
Tatsuya Norii ◽  
Carla J. Walraven
Keyword(s):  
Group A Streptococcus ◽  
Intervention Group ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Care Clinic ◽  
Rapid Antigen Detection Test ◽  
Appropriate Prescribing ◽  
Icd 10 ◽  
Group A

Background: Group A Streptococcus (GAS) pharyngitis is the most common bacterial cause of acute pharyngitis and is often over treated with unnecessary antibiotics. The purpose was to evaluate if implementation of a rapid antigen detection test (RADT) for GAS would reduce the number of inappropriately prescribed antibiotics for adult patients presenting with symptoms of pharyngitis. Methods: This was a retrospective cohort study of adult urgent care clinic patients pre- and post-implementation of a GAS RADT. We included patients who had a diagnosis of GAS identified via ICD-10 codes and either a throat culture, GAS RADT, or antibiotic prescribed for GAS. Antibiotic prescribing was assessed as appropriate or inappropriate based on testing and IDSA guideline recommendations. Thirty-day follow-up visits related to pharyngitis or the prescribed antibiotics was also evaluated. Results: A total of 1734 patients were included; 912 and 822 in the pre- and post-implementation groups, respectively. Following implementation of the GAS RADT, there was an increase in the number of antibiotics prescribed for GAS (43.4% vs 59.1%, P < .001) as well as an increase in appropriate prescribing (67.6% vs 77.5%, P < .001). More 30-day pharyngitis-related follow-up visits were seen in the pre-intervention group (12.5% vs 9.3%, P = .03). Conclusion: Implementation of a RADT for GAS pharyngitis was associated with an increase in both the overall number of antibiotic prescriptions for GAS and the proportion of appropriately prescribed antibiotics. There was also a reduction in follow up visits related to GAS pharyngitis, however educational efforts to further increase appropriate prescribing is needed.

scholarly journals 594. Characteristics of an At-Risk Patient Population Presenting to a Philadelphia Student-Run Free Clinic within 30 Days of Hospital Visit

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S360-S360
Author(s):  
Kaitlyn Thomesen ◽  
Matthew Lipow ◽  
Tess S Munoz ◽  
Sara K Schultz
Keyword(s):  
At Risk ◽  
Patient Population ◽  
Urgent Care ◽  
Risk Patient ◽  
Syringe Exchange ◽  
Hospital Visit ◽  
Readmission Rates ◽  
Care Clinic ◽  
Medical Needs ◽  
Clinic Visits

Abstract Background 30-day readmission rates are the parameter that hospitals and insurance companies use to measure clinical quality of care and set reimbursement levels for care (McCormack, et al., 2013). The 2019 readmission rate for United States hospitals was 14.9%; however, reported readmission rates vary in accuracy due to exclusion of at-risk populations or patients who seek care outside the hospital network (America’s Health Rankings, 2020; Gupta, et al., 2018). As coordinators of a student-run urgent care clinic operating within a Philadelphia syringe exchange and harm-reduction social services organization, we serve an at-risk patient population that includes a large portion of individuals who are transiently housed, people who engage in sex work, and people who use drugs (PWUD). We sought to determine our at-risk population’s impact on current readmission rates and the ability of hospitalization to meet their unique medical needs. Methods We conducted a retrospective review of 607 electronic charts for patients who sought care at our student run clinic associated with a syringe exchange in Kensington, Philadelphia from January 2017 to January 2020, and identified patients who visited our clinic within 30 days of self-reported hospitalization. We identified time since hospitalization, purpose for hospitalization, and reason for clinic visit. Results Of 607 visits, 100 (16.5%) self-reported hospitalization within 30 days clinic presentation. Of these 100 clinic visits, 64% presented with the same chief complaint as their reason for hospitalization, and 21% presented with a complication related to their hospital visit. 33% of visits associated with previous hospitalization were from infections associated with IV drug use, including abscess, cellulitis, and osteomyelitis. On average, patients presented 7.5 days following hospital departure. Conclusion We identified a high incidence of clinic visits for medical needs associated with recent hospitalization, particularly injection-related infection, which suggests insufficient hospital care for this at-risk population. The number of readmissions for this population is underestimated due to their ability to seek medical care outside of the hospital network. Disclosures All Authors: No reported disclosures

scholarly journals Evaluation of Patient Experience During Virtual and In-Person Urgent Care Visits: Time and Cost Analysis

2021 ◽  
Vol 8 ◽  
pp. 237437352098148
Author(s):  
Saif Khairat ◽  
Xi Lin ◽  
Songzi Liu ◽  
Zhaohui Man ◽  
Tanzila Zaman ◽  
...  
Keyword(s):  
Patient Experience ◽  
Care Delivery ◽  
Turnaround Time ◽  
Cross Sectional Study ◽  
Emergency Department Visits ◽  
Urgent Care ◽  
Cross Sectional ◽  
Significant Difference ◽  
Virtual Visits ◽  
One Year

Urgent care (UC) is one of the fastest growing venues of health care delivery for nonemergent conditions. This study compared the patient experience during virtual and in-person urgent care visits. We conducted a cross-sectional study of patients with the same diagnosis during Virtual Urgent Care (VUC) and in-person UC visits with the same diagnosis with regard to time and cost over a period of one year. We recorded and analyzed 16 685 urgent care visits: In-person UC (n = 14 734), VUC (n = 1262). Significant differences were found in the average total time for a visit in an in-person UC (70.89 minutes), and VUC (9.38 minutes). The average total cost of VUC ($49) and in-person UC ($142.657) differed significantly. Significant difference was found between UC turnaround time and VC turnaround time (Dependent variable (DV): 53.77, P < .01). We found significant differences in cost and time between in favor of virtual visits. Our findings suggest additional policy reform to expand the use of virtual care among target populations to improve access, reduce costs, meet the needs of patients, and reduce emergency department visits.

scholarly journals Increase in Urgent Care Center Visits for Sexually Transmitted Infections, United States, 2010–2014

2017 ◽  
Vol 23 (2) ◽  
pp. 367-369 ◽  
Author(s):  
William S. Pearson ◽  
Guoyu Tao ◽  
Karen Kroeger ◽  
Thomas A. Peterman
Keyword(s):  
United States ◽  
Sexually Transmitted Infections ◽  
Care Center ◽  
Urgent Care ◽  
Urgent Care Center ◽  
Sexually Transmitted

scholarly journals Notes from the Field: Group A Streptococcal Pharyngitis Misdiagnoses at a Rural Urgent-Care Clinic — Wyoming, March 2015

2016 ◽  
Vol 64 (50-51) ◽  
pp. 1383-1385 ◽  
Author(s):  
Alexia Harrist ◽  
Clayton Van Houten ◽  
Stanford T. Shulman ◽  
Chris Van Beneden ◽  
Tracy Murphy
Keyword(s):  
Streptococcal Pharyngitis ◽  
Urgent Care ◽  
Care Clinic ◽  
Group A ◽  
Urgent Care Clinic

scholarly journals Retrospective Study Evaluating Effect of Voxelotor Treatment on Acute Care Utilization during the Peak of COVID-19

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4179-4179
Author(s):  
Shivani Rao ◽  
Nicole K. Yun ◽  
James L. Coggan ◽  
Peter Wu ◽  
Teresa O'Brien ◽  
...  
Keyword(s):  
Acute Care ◽  
Statistical Significance ◽  
Advisory Board ◽  
Urgent Care ◽  
Care Utilization ◽  
Novel Therapies ◽  
Care Clinic ◽  
Acute Care Utilization ◽  
Urgent Care Clinic ◽  
Acute Medical Care

Abstract Introduction In sickle cell disease (SCD), the polymerization of deoxygenated HbS fundamentally alters the structure of the erythrocyte, producing the sickle cell that is characteristic of the disease. Clinical manifestations often perceived in patients suffering from SCD include vaso-occlusion, anemia, and hemolysis. Due to these sequelae, patients frequent the emergency room (ER), urgent care clinic, and hospital. Voxelotor, an oral medication approved by the Food and Drug Administration (FDA) in 2019 for the treatment of SCD, directly targets the pathophysiology of SCD by inhibiting deoxygenated HbS polymerization. Results of the Phase III HOPE trial indicate that the drug can increase hemoglobin levels and reduce markers of hemolysis as well as the incidence of worsening anemia in patients with SCD (Vichinsky et al. N Engl J Med 2019). The COVID-19 pandemic has posed several challenges for patients with SCD in 2020. Amid the pandemic, patients continued to seek out acute medical care, including care in the ER, urgent care clinics, and hospital. The aim of this study was to determine whether utilization of acute medical care differed for patients who received voxelotor before and after therapy in 2020. We also evaluated the utilization of healthcare through telemedicine platforms to facilitate access to novel therapies such as voxelotor for patients with SCD. Methods 13 patients (≥18 years of age as of January 1, 2020) with SCD who had begun treatment with voxelotor between January 1, 2020 and December 31, 2020 were included in the initial analysis. Six patients were excluded from final analysis: three discontinued treatment due to side effects, one was noncompliant with treatment, and two were lost to follow-up. Acute care utilization, measured by the number of times each patient visited the ER, urgent care clinic, and hospital was compared for each patient in the period six months prior to their first dose of voxelotor and in the period six months after their last dose of the drug in 2020 using paired t-tests and Wilcoxon matched-pairs signed rank tests. Demographic information and the type of visit at which patients agreed to proceed with voxeletor was recorded for each patient. Simple linear regressions and multiple regressions controlled for covariates, defined as sex, BMI, age, type of insurance coverage, and duration of treatment. Results All seven (100%) patients discussed voxelotor treatment with their provider during a telehealth video visit. In the period before initiating treatment, patients frequented the ER an average of 2.71 (SD=6.75) times. In the six months after their last dose, patients visited the ER less than they had in the period prior to treatment, on average 0.57 (SD=0.79) times. This difference did not achieve statistical significance (p&gt;0.9999). The mean number of visits to the urgent care clinic in the six months before treatment was 2.71 (SD=6.75) compared to 2 (SD=4) in the period after patients' last dose in 2020. This finding was not statistically significant (p&gt;0.9999). Hospitalizations, on average, decreased significantly from 5.14 (SD=2.34) in the six months before starting treatment to 1.57 (SD=0.98) after ending therapy for 2020 (p=0.0015). Covariates did not have an effect on the differences in acute care utilization before treatment and after last treatment in 2020. Conclusions The findings of this study imply that treatment with voxelotor was associated with a decrease in the frequency of hospitalizations for the seven patients analyzed. This finding can potentially be attributed to the efficacy of voxelotor in improving anemia and reducing complications associated with SCD. While the difference between ER visits and urgent care visits before treatment and after the last dose in 2020 did not achieve statistical significance, likely due to small sample size, the data does suggest a reduction in both outcomes. In addition, the observation that all visits in which patient and provider discussed and initiated treatment were virtual support the use of telemedicine technology to improve access to multidisciplinary care and novel therapies for SCD patients. The impact of voxelotor treatment will continue to be assessed in SCD patients at our institution, and more data from clinical encounters will lead to a greater understanding of the efficacy of voxelotor. Figure 1 Figure 1. Disclosures Jain: GBT: Speakers Bureau; Novartis: Speakers Bureau; Sanofi: Other: advisory board; Argenx: Other: advisory board; DOVA: Other: advisory board.

scholarly journals Deep Learning of COVID-19 Chest X-Rays: New Models or Fine Tuning?

2020 ◽  
Author(s):  
Tuan Pham
Keyword(s):  
Deep Learning ◽  
High Performance ◽  
Data Augmentation ◽  
Dominant Role ◽  
Care Center ◽  
Characteristic Curve ◽  
Fine Tuning ◽  
Urgent Care ◽  
X Rays ◽  
Training Time

Chest X-rays have been found to be very promising for assessing COVID-19 patients, especially for resolving emergency-department and urgent-care-center overcapacity. Deep-learning (DL) methods in artificial intelligence (AI) play a dominant role as high-performance classifiers in the detection of the disease using chest X-rays. While many new DL models have been being developed for this purpose, this study aimed to investigate the fine tuning of pretrained convolutional neural networks (CNNs) for the classification of COVID-19 using chest X-rays. Three pretrained CNNs, which are AlexNet, GoogleNet, and SqueezeNet, were selected and fine-tuned without data augmentation to carry out 2-class and 3-class classification tasks using 3 public chest X-ray databases. In comparison with other recently developed DL models, the 3 pretrained CNNs achieved very high classification results in terms of accuracy, sensitivity, specificity, precision, F1 score, and area under the receiver-operating-characteristic curve. AlexNet, GoogleNet, and SqueezeNet require the least training time among pretrained DL models, but with suitable selection of training parameters, excellent classification results can be achieved without data augmentation by these networks. The findings contribute to the urgent need for harnessing the pandemic by facilitating the deployment of AI tools that are fully automated and readily available in the public domain for rapid implementation.

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