Team huddle, education and infection screening as effective tools in continuing cancer care delivery during the peak of COVID-19 pandemic in 2020 in the Bronx, NY: Experience from a public teaching hospital.

e13500 Background: COVID-19 pandemic has affected healthcare delivery, particularly in the hard-hit areas. During the peak of COVID-19 pandemic crisis in the New York city, our outpatient oncology infusion center, located within a public teaching hospital in the South Bronx remained active. We implemented twice daily team huddle, staff and patient education, and infection screening tools and modified treatment plans based on social, personal and disease related factors. We evaluate the effectiveness of the above strategies in timely delivery of critical oncological care. Methods: Patients treated from the March 1, 2020 to the May 8, 2020 were included. De-identified data from medical charts were analyzed using IBM SPSS Version 27.0. Bivariate logistic regression analysis was applied to identify factors associated with COVID-19. Results: In total, 170 patients were treated in 576 visits. Median age was 60.7 years, 44% Hispanic and 41% Black, median Charlson Comorbidity index (CCI) was 6.6. Fifty percent received cytotoxic chemotherapy, 44% targeted therapies and the remaining received immune-checkpoint inhibitors. Of the 170 patients, six developed severe COVID-19 requiring hospitalization. Their median age was 63 years with average of 10.5 days from infusion center visit to COVID-19 and median CCI score was 9, higher than the rest of the cohort. Two patients died, 3 made complete recovery, 1 enrolled in hospice. Two patients contracted mild COVID-19 managed in the outpatient setting. Diabetes mellitus was associated with severe COVID-19 [OR: 25.9 (95%CI: 1.3-519, p=0.03)]. Age, gender, type of cancer and oncological treatment, smoking, CCI, growth factor support, nursing home residence, statin use were not associated with risk of developing severe COVID-19 Conclusions: Cancer treatment in the outpatient setting using an approach focused on careful patient selection, infection prevention strategies and strong team communication is feasible and allows for continuity of critical oncological care. Receipt of cancer directed therapy was not associated with higher risk for infection compared to risks associated with community-based transmission.. In communities with high community-based transmission, careful selection of patients for oncological based treatment is paramount.

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A Bounded Health Information Technology System Design Approach to Support Community-Based Care Delivery

International Journal of Cloud Applications and Computing ◽

10.4018/ijcac.2015010103 ◽

2015 ◽

Vol 5 (1) ◽

pp. 32-45 ◽

Cited By ~ 2

Author(s):

Liam Peyton ◽

Jaspreet Bindra ◽

Aladdin Baarah ◽

Austin Chamney ◽

Craig Kuziemsky

Keyword(s):

Information Technology ◽

Cloud Computing ◽

System Design ◽

Health Information Technology ◽

Health Information ◽

Care Delivery ◽

Healthcare Delivery ◽

Systems Design ◽

Community Based ◽

Mobile Form

Health information technology (HIT) offers great potential for supporting healthcare delivery, particularly collaborative care delivery that is provided across multiple settings and providers. To date much of HIT design has focused on digitizing data or processes on a departmental or healthcare provider basis. However, this bounded approach has not scaled well for supporting community based care across disparate providers or settings because of the lack of boundaries (e.g. disprate data and processes) that exist in community based care. Cloud computing approaches that leverage mobile form applications for developing integrated HIT solutions have the potential to support collaborative healthcare delivery in the community. However, to date there is a shortage of methods that describe how to develop integrated cloud computing solutions to support community based care delivery. In particular there is a need for methods that identify how to incorporate boundaries into cloud computing systems design. This paper uses a three year case study of the design of the Palliative Care Information System (PAL-IS) to provide system design insight on cloud computing approaches that leverage mobile forms applications to support community care management.

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A Bounded Health Information Technology System Design Approach to Support Community-Based Care Delivery

Oncology ◽

10.4018/978-1-5225-0549-5.ch005 ◽

2017 ◽

pp. 187-202

Author(s):

Liam Peyton ◽

Jaspreet Bindra ◽

Aladdin Baarah ◽

Austin Chamney ◽

Craig E. Kuziemsky

Keyword(s):

Information Technology ◽

Cloud Computing ◽

System Design ◽

Health Information Technology ◽

Health Information ◽

Care Delivery ◽

Healthcare Delivery ◽

Systems Design ◽

Community Based ◽

Technology System

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229. Hospitalists Antimicrobial Scorecard Improves Antibiotic Prescribing at a Community Teaching Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.273 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S116-S116

Author(s):

Julia Sessa ◽

Helen Jacoby ◽

Bruce Blain ◽

Lisa Avery

Keyword(s):

Patient Care ◽

Teaching Hospital ◽

Antimicrobial Stewardship ◽

Rank Order ◽

Antibiotic Use ◽

Outpatient Setting ◽

Antibiotic Prescribing ◽

Full Time ◽

Days Of Therapy ◽

The Impact

Abstract Background Measuring antimicrobial consumption data is a foundation of antimicrobial stewardship programs. There is data to support antimicrobial scorecard utilization to improve antibiotic use in the outpatient setting. There is a lack of data on the impact of an antimicrobial scorecard for hospitalists. Our objective was to improve antibiotic prescribing amongst the hospitalist service through the development of an antimicrobial scorecard. Methods Conducted in a 451-bed teaching hospital amongst 22 full time hospitalists. The antimicrobial scorecard for 2019 was distributed in two phases. In October 2019, baseline antibiotic prescribing data (January – September 2019) was distributed. In January 2020, a second scorecard was distributed (October – December 2019) to assess the impact of the scorecard. The scorecard distributed via e-mail to physicians included: Antibiotic days of therapy/1,000 patient care days (corrected for attending census), route of antibiotic prescribing (% intravenous (IV) vs % oral (PO)) and percentage of patients prescribed piperacillin-tazobactam (PT) for greater than 3 days. Hospitalists received their data in rank order amongst their peers. Along with the antimicrobial scorecard, recommendations from the antimicrobial stewardship team were included for hospitalists to improve their antibiotic prescribing for these initiatives. Hospitalists demographics (years of practice and gender) were collected. Descriptive statistics were utilized to analyze pre and post data. Results Sixteen (16) out of 22 (73%) hospitalists improved their antibiotic prescribing from pre- to post-scorecard (χ 2(1)=3.68, p = 0.055). The median antibiotic days of therapy/1,000 patient care days decreased from 661 pre-scorecard to 618 post-scorecard (p = 0.043). The median PT use greater than 3 days also decreased significantly, from 18% pre-scorecard to 11% post-scorecard (p = 0.0025). There was no change in % of IV antibiotic prescribing and no correlation between years of experience or gender to antibiotic prescribing. Conclusion Providing antimicrobial scorecards to our hospitalist service resulted in a significant decrease in antibiotic days of therapy/1,000 patient care days and PT prescribing beyond 3 days. Disclosures All Authors: No reported disclosures

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Multilevel Pathways of Colorectal Cancer Screening Among Low-Income Vietnamese Americans: A Structural Equation Modeling Analysis

Cancer Control ◽

10.1177/10732748211011077 ◽

2021 ◽

Vol 28 ◽

pp. 107327482110110

Author(s):

Grace X. Ma ◽

Lin Zhu ◽

Timmy R. Lin ◽

Yin Tan ◽

Phuong Do

Keyword(s):

Health Beliefs ◽

Low Income ◽

Self Efficacy ◽

Limited English Proficiency ◽

Structural Equation ◽

Vietnamese Americans ◽

Equation Modeling ◽

Community Based ◽

Related Factors ◽

Crc Screening

Background: Colorectal cancer (CRC) disproportionately affects Vietnamese Americans, especially those with low income and were born outside of the United States. CRC screening tests are crucial for prevention and early detection. Despite the availability of noninvasive, simple-to-conduct tests, CRC screening rates in Asian Americans, particularly Vietnamese Americans, remain suboptimal. The purpose of this study was to evaluate the interplay of multilevel factors – individual, interpersonal, and community – on CRC screening behaviors among low-income Vietnamese Americans with limited English proficiency. Methods: This study is based on the Sociocultural Health Behavior Model, a research-based model that incorporates 6 factors associated with decision-making and health-seeking behaviors that result in health care utilization. Using a community-based participatory research approach, we recruited 801 Vietnamese Americans from community-based organizations. We administered a survey to collect information on sociodemographic characteristics, health-related factors, and CRC screening-related factors. We used structural equation modeling (SEM) to identify direct and indirect predictors of lifetime CRC screening. Results: Bivariate analysis revealed that a greater number of respondents who never screened for CRC reported limited English proficiency, fewer years of US residency, and lower self-efficacy related to CRC screening. The SEM model identified self-efficacy (coefficient = 0.092, P < .01) as the only direct predictor of lifetime CRC screening. Educational attainment (coefficient = 0.13, P < .01) and health beliefs (coefficient = 0.040, P < .001) had a modest significant positive relationship with self-efficacy. Health beliefs (coefficient = 0.13, P < .001) and educational attainment (coefficient = 0.16, P < .01) had significant positive relationships with CRC knowledge. Conclusions: To increase CRC screening uptake in medically underserved Vietnamese American populations, public health interventions should aim to increase community members’ confidence in their abilities to screen for CRC and to navigate associated processes, including screening preparation, discussions with doctors, and emotional complications.

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Are Communities Willing to Transition Into Learning Health Care Communities? A Community-Based Participatory Evaluation of Stakeholders’ Receptivity

Qualitative Health Research ◽

10.1177/1049732321998643 ◽

2021 ◽

pp. 104973232199864

Author(s):

Nabil Natafgi ◽

Olayinka Ladeji ◽

Yoon Duk Hong ◽

Jacqueline Caldwell ◽

C. Daniel Mullins

Keyword(s):

Health Care ◽

Health Care Delivery ◽

Health Care Professionals ◽

Care Delivery ◽

Lessons Learned ◽

Community Members ◽

Community Based ◽

Care Community ◽

Care Experience ◽

National Initiative

This article aims to determine receptivity for advancing the Learning Healthcare System (LHS) model to a novel evidence-based health care delivery framework—Learning Health Care Community (LHCC)—in Baltimore, as a model for a national initiative. Using community-based participatory, qualitative approach, we conducted 16 in-depth interviews and 15 focus groups with 94 participants. Two independent coders thematically analyzed the transcripts. Participants included community members (38%), health care professionals (29%), patients (26%), and other stakeholders (7%). The majority considered LHCC to be a viable model for improving the health care experience, outlining certain parameters for success such as the inclusion of home visits, presentation of research evidence, and incorporation of social determinants and patients’ input. Lessons learned and challenges discussed by participants can help health systems and communities explore the LHCC aspiration to align health care delivery with an engaged, empowered, and informed community.

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COVD-27. THE COVID-19 PANDEMIC AND NEURO-ONCOLOGICAL PATIENTS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.108 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii26-ii26

Author(s):

Sofya Norman ◽

Rupa Juthani

Keyword(s):

New York ◽

Brain Tumor ◽

Patient Outcomes ◽

Care Delivery ◽

Tumor Control ◽

Oncology Patient ◽

Term Survival ◽

Oncological Care ◽

Oncological Patients ◽

Significant Difference

Abstract INTRODUCTION The Coronavirus disease 2019 (COVID-19) pandemic has uprooted healthcare systems worldwide, disrupting care and increasing dependence on alternative forms of health care delivery. It is yet to be determined how the pandemic affected neuro-oncology patient outcomes, given that the majority of even “elective” neurosurgical oncology procedures are time-sensitive. This study quantifies changes in neuro-oncological care during the height of the pandemic in New York City and investigates patient outcomes in 2020 compared to a historical control. METHODS We performed a retrospective review of patients with brain tumor diagnoses (primary or secondary) who were seen at the Weill Cornell Brain and Spine Center between March 13, 2020 and May 1, 2020. A control cohort from the corresponding time period in 2019 was also reviewed. Alterations in care, including shift from in-person to telehealth, delays in evaluation and intervention, and treatment modifications were evaluated. These variables were analyzed with respect to brain tumor control and mortality. RESULTS 114 patients from 2020 and 171 patients from 2019 were included, with no significant difference in baseline demographics between the groups. There was no significant difference in outcomes between the cohorts, despite significantly more treatment delays (p= 0.0154) and use of telehealth (p< 0.0001) in 2020. For patients treated during the pandemic in 2020, patients who experienced delays in care did not suffer from worse outcomes compared to those without delays. Patients who utilized telehealth visits had significantly more stable tumor control (P = 0.0027), consistent with appropriate use of in-person visits for patients with progression. CONCLUSION Our study showed that use of telehealth and selective alterations in neuro-oncological care during the COVID-19 pandemic did not lead to adverse patient outcomes. This suggests that adaptive physician-led changes during the pandemic were successful and effective. Further studies are needed to evaluate impact on long-term survival.

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Individual and healthcare supply-related barriers to treatment initiation in HIV-positive patients enrolled in the Cameroonian antiretroviral treatment access programme

Health Policy and Planning ◽

10.1093/heapol/czaa153 ◽

2020 ◽

Author(s):

Pierre-Julien Coulaud ◽

Camélia Protopopescu ◽

Khadim Ndiaye ◽

Maël Baudoin ◽

Gwenaëlle Maradan ◽

...

Keyword(s):

Antiretroviral Treatment ◽

Cox Model ◽

Task Shifting ◽

Hiv Positive ◽

Treatment Access ◽

Community Based ◽

Related Factors ◽

Hiv Services ◽

Community Based Organizations ◽

Art Initiation

Abstract Increasing demand for antiretroviral treatment (ART) together with a reduction in international funding during the last decade may jeopardize access to ART. Using data from a cross-sectional survey conducted in 2014 in 19 HIV services in the Centre and Littoral regions in Cameroon, we investigated the role of healthcare supply-related factors in time to ART initiation in HIV-positive patients eligible for ART at HIV diagnosis. HIV service profiles were built using cluster analysis. Factors associated with time to ART initiation were identified using a multilevel Cox model. The study population included 847 HIV-positive patients (women 72%, median age: 39 years). Median (interquartile range) time to ART initiation was 1.6 (0.5–4.3) months. Four HIV service profiles were identified: (1) small services with a limited staff practising partial task-shifting (n = 4); (2) experienced and well-equipped services practising task-shifting and involving HIV community-based organizations (n = 5); (3) small services with limited resources and activities (n = 6); (4) small services providing a large range of activities using task-shifting and involving HIV community-based organizations (n = 4). The multivariable model showed that HIV-positive patients over 39 years old [hazard ratio: 1.26 (95% confidence interval) (1.09–1.45), P = 0.002], those with disease symptoms [1.21 (1.04–1.41), P = 0.015] and those with hepatitis B co-infection [2.31 (1.15–4.66), P = 0.019] were all more likely to initiate ART early. However, patients in the first profile were less likely to initiate ART early [0.80 (0.65–0.99), P = 0.049] than those in the second profile, as were patients in the third profile [association only significant at the 10% level; 0.86 (0.72–1.02), P = 0.090]. Our findings provide a better understanding of the role played by healthcare supply-related factors in ART initiation. In HIV services with limited capacity, task-shifting and support from community-based organizations may improve treatment access. Additional funding is required to relieve healthcare supply-related barriers and achieve the goal of universal ART access.

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Big Data Analytics in Healthcare

BioMed Research International ◽

10.1155/2015/370194 ◽

2015 ◽

Vol 2015 ◽

pp. 1-16 ◽

Cited By ~ 178

Author(s):

Ashwin Belle ◽

Raghuram Thiagarajan ◽

S. M. Reza Soroushmehr ◽

Fatemeh Navidi ◽

Daniel A. Beard ◽

...

Keyword(s):

Big Data ◽

Data Analytics ◽

Care Delivery ◽

Healthcare Delivery ◽

Big Data Analytics ◽

Healthcare Systems ◽

Medical Data ◽

Unstructured Data ◽

Process Of Care ◽

Multimodal Data

The rapidly expanding field of big data analytics has started to play a pivotal role in the evolution of healthcare practices and research. It has provided tools to accumulate, manage, analyze, and assimilate large volumes of disparate, structured, and unstructured data produced by current healthcare systems. Big data analytics has been recently applied towards aiding the process of care delivery and disease exploration. However, the adoption rate and research development in this space is still hindered by some fundamental problems inherent within the big data paradigm. In this paper, we discuss some of these major challenges with a focus on three upcoming and promising areas of medical research: image, signal, and genomics based analytics. Recent research which targets utilization of large volumes of medical data while combining multimodal data from disparate sources is discussed. Potential areas of research within this field which have the ability to provide meaningful impact on healthcare delivery are also examined.

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P14.123 Neurological complications related to checkpoints inhibitors

Neuro-Oncology ◽

10.1093/neuonc/noz126.358 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii97-iii98

Author(s):

I Esparragosa ◽

R Valenti-Azcarate ◽

D Moreno-Ajona ◽

J Gallego Perez de Larraya

Keyword(s):

Cerebrospinal Fluid ◽

Checkpoint Inhibitors ◽

Early Recognition ◽

Oral Prednisone ◽

Fatal Outcome ◽

Case Series ◽

Neurological Complications ◽

Ovarian Adenocarcinoma ◽

Inflammatory Myositis ◽

Oncological Treatment

Abstract BACKGROUND Currently, immunotherapy is part of the therapeutic arsenal for oncological treatment. Indeed, the need for new medications has led to the development of immune checkpoint inhibitors. Despite favourable oncological outcomes, these treatments have been associated with immune-related adverse events. Although infrequent, neurological toxicities have been reported. Early recognition is crucial for improvement of functional outcome and requires a multidisciplinary approach. OBJECTIVE To describe a case series of patients with neurological complications related to checkpoint inhibitors. PATIENTS AND METHODS We identified six oncological patients who presented immunomediated neurological complications, derived from the use of checkpoints inhibitors. Five cases were men. Ages ranged from 58 to 73 years. Nivolumab, alone or combined, was the most commonly associated drug (4/6). Underlying diseases included lung carcinoma (2/6), melanoma (2/6), renal carcinoma (1/6) and ovarian adenocarcinoma (1/6). An acute demyelinating sensory-motor polyneuropathy and an acute axonal sensory polyneuropathy were documented in two and one case, respectively. In these, the cerebrospinal fluid analysis revealed albuminocytologic dissociation. All three cases improved after treatment with intravenous immunoglobulins (0.4 g/Kg a day for five days). The latter and another case were diagnosed of aseptic meningitis after cerebrospinal fluid lymphocytic pleocytosis was found. High fever was also associated with lower extremities areflexia, weakness and ataxia. Methylprednisolone (1g/day for five days) was administered. One case of necrotizing inflammatory myositis with high levels of creatine kinasa, confirmed by muscular biopsy, involving cervical weakness and ptosis, was effectively treated with Methylprednisolone (1g/day for five days) follow by oral prednisone tapering. An anti-Yo related pancerebellar syndrome was the only case with a fatal outcome despite treatment. CONCLUSION The increasingly frequent use of immunotherapy in the treatment of cancer may lead to an increase in neurological complications. These include a broad spectrum of syndromes with peripheral nervous system predominantly susceptible. Early identification of these and appropriate management of drug-related toxicity are required. Immune-modulating therapies are particularly beneficial.

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Factors Associated with the Patient’s Decision to Avoid Healthcare during the COVID-19 Pandemic

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182413239 ◽

2021 ◽

Vol 18 (24) ◽

pp. 13239

Author(s):

Patrícia Soares ◽

Andreia Leite ◽

Sara Esteves ◽

Ana Gama ◽

Pedro Almeida Laires ◽

...

Keyword(s):

Health Services ◽

Healthcare Delivery ◽

System Response ◽

Healthcare Use ◽

Health Services Use ◽

Community Based ◽

Societal Costs ◽

Factors Associated ◽

The Government ◽

Services Use

The COVID-19 pandemic has resulted in changes in healthcare use. This study aimed to identify factors associated with a patient’s decision to avoid and/or delay healthcare during the COVID-19 pandemic. We used data from a community-based survey in Portugal from July 2020 to August 2021, “COVID-19 Barometer: Social Opinion”, which included data regarding health services use, risk perception and confidence in health services. We framed our analysis under Andersen’s Behavioural Model of Health Services Use and utilised Poisson regression to identify healthcare avoidance associated factors. Healthcare avoidance was high (44%). Higher prevalence of healthcare avoidance was found among women; participants who reported lower confidence in the healthcare system response to COVID-19 and non-COVID-19; lost income during the pandemic; experienced negative emotions due to physical distancing measures; answered the questionnaire before middle June 2021; and perceived having worse health, the measures implemented by the Government as inadequate, the information conveyed as unclear and confusing, a higher risk of getting COVID-19, a higher risk of complications and a higher risk of getting infected in a health institution. It is crucial to reassure the population that health services are safe. Health services should plan their recovery since delays in healthcare delivery can lead to increased or worsening morbidity, yielding economic and societal costs.

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