Demographic Trends in HCV Testing at an Urban Safety Net Medical Center

OBJECTIVES/SPECIFIC AIMS: The goals of this retrospective cohort study is threefold: 1) to assess how many pregnant women at Boston Medical Center from 2012 to 2017 have had their vitamin D status checked prior to and during pregnancy, 2) determine associations between vitamin D levels, birth outcomes and demographics and 3) assess how many of those found to have lower than satisfactory vitamin D levels (<30ng/mL) received interventions, including receiving vitamin D supplementation and/or being referred to an appropriate specialist such as an endocrinologist or a nutritionist. METHODS/STUDY POPULATION: Our study population is mothers over age 18 who received care at Boston Medical Center during their pregnancy from 2012 to 2017. Our primary outcomes are vitamin D utilization rates and associations between vitamin D levels with clinical outcomes during pregnancy and at birth. Secondary outcomes are demographic predictors of mothers who receive vitamin D testing and those who have complications associated with low vitamin D. We will conduct multiple linear regressions to check for associations between vitamin D levels, birth outcomes and demographic variables. We will adjust vitamin D levels with maternal BMI. De-identified clinical data was gathered from Boston University Medical Center’s (BUMC) Clinical Data Warehouse. This retrospective study was approved with a HIPAA waiver by the BUMC Institutional Data Warehouse. All statistical analysis was completed using SAS version 9.4 and was primarily done by the student PI and reviewed by Dr. Hossein, the co-investigator who is trained as a statistician and geneticist. The team also utilized Boston University’s Biostatistics, Epidemiology & Research Design (BERD) team to check the feasibility of the statistical methods. RESULTS/ANTICIPATED RESULTS: We anticipate that our descriptive demographic data will reflect the medical center’s predominantly black/Hispanic and low-income profile. Based on previous literature, we expect low vitamin D levels to have positive associations with gestational diabetes, pre-eclampsia, and preterm birth. Analyses are currently actively in progress and we expect to have results before the ACTS conference date in March, 2019. DISCUSSION/SIGNIFICANCE OF IMPACT: Vitamin D is an essential part of the human body system. It is well documented in current literature that vitamin D is correlated with bone health, mental health and maternal health. Moreover, there is evidence that maternal vitamin D supplementation prevents vitamin D deficiency in newborns. Previous literature suggests that low vitamin D may be associated with gestational diabetes, pre-eclampsia, and pre-term births. Boston Medical Center is Massachusetts’ largest urban medical center and acts as its only safety-net hospital, serving predominantly low-income and socially marginalized patient populations. There is limited existing research on assessment of maternal vitamin D in urban hospital settings. Pregnant women rarely receive vitamin D screenings as part of their prenatal checkups as current national and regional guidelines do not require pregnant women to be screened for vitamin D deficiency or insufficiency. The results will demonstrate the potential effects vitamin D supplementation, or lack thereof, in expectant mothers living in urban, safety net communities. We hope to inform prenatal care practices and attitudes of vitamin D supplementation in maternal health with the results of our study.

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Race/Ethnicity, Underlying Medical Conditions, Homelessness, and Hospitalization Status of Adult Patients with COVID-19 at an Urban Safety-Net Medical Center — Boston, Massachusetts, 2020

MMWR Morbidity and Mortality Weekly Report ◽

10.15585/mmwr.mm6927a3 ◽

2020 ◽

Vol 69 (27) ◽

pp. 864-869 ◽

Cited By ~ 15

Author(s):

Heather E. Hsu ◽

Erin M. Ashe ◽

Michael Silverstein ◽

Melissa Hofman ◽

Samantha J. Lange ◽

...

Keyword(s):

Medical Center ◽

Safety Net ◽

Adult Patients ◽

Medical Conditions ◽

Urban Safety ◽

Race Ethnicity

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Factors Affecting Compliance With Myringotomy Tube Follow-up Care

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211072293 ◽

2022 ◽

pp. 000348942110722

Author(s):

Helen H. Soh ◽

Katherine R. Keefe ◽

Madhav Sambhu ◽

Tithi D. Baul ◽

Dillon B. Karst ◽

...

Keyword(s):

Medical Center ◽

Private Insurance ◽

Academic Medical Center ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Safety Net ◽

Tube Placement ◽

Factors Affecting ◽

Urban Safety

Objective: Myringotomy and tube insertion is a commonly practiced procedure within pediatric otolaryngology. Though relatively safe, follow-up appointments are critical in preventing further complications and monitoring for improvement. This study sought to evaluate the factors associated with compliance of post-myringotomy follow-up visits in an urban safety-net tertiary care setting. Methods: This study is a retrospective chart review conducted in outpatient otolaryngology clinic at an urban, safety-net, tertiary-care, academic medical center. All patients from ages 0 to 18 who received myringotomy and tube placement between February 3, 2012, to May 30, 2018 at the aforementioned clinic were included. Results: A total of 806 patients had myringotomy tubes placed during this period; 190 patients were excluded due to no visits being scheduled within 1 and 6 month visit windows post-operatively, leaving 616 patients included for analysis. Of 616 patients, 574 patients were seen for the 1-month visit, (42 patients did not have follow-up visits within the 1-month window), and 356 patients were examined for the 6-month visit (260 patients did not schedule follow-up visits within the 6-month window). For the 1-month follow-up visits post-procedure, only race/ethnicity type “Other” was associated with lower no-show rates (OR = 0.330, 95% CI: 0.093-0.968). With the 6-month follow-up visits, having private insurance (OR = 0.446, 95% CI: 0.229-0.867) and not having a 1-month visit scheduled (OR = 0.404, 95% CI: 0.174-0.937) predicted lower no-show rates. Conclusion: No meaningful factors studied were significantly associated with compliance of short-term, 1-month visits post-myringotomy. Compliance of longer-term, 6-month post-operative visits was associated with insurance type and previous visit status.

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Lean methods to improve operating room elective first case on-time starts in a large, urban, safety net medical center

The American Journal of Surgery ◽

10.1016/j.amjsurg.2018.05.002 ◽

2018 ◽

Vol 216 (2) ◽

pp. 194-201 ◽

Cited By ~ 8

Author(s):

Charles Coffey ◽

Edward S. Cho ◽

Eric Wei ◽

Allison Luu ◽

Maria Ho ◽

...

Keyword(s):

Operating Room ◽

Medical Center ◽

Safety Net ◽

First Case ◽

Urban Safety ◽

Improve Operating Room ◽

Lean Methods ◽

Improve Operating

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Validation of a Crisis Standards of Care Model for Prioritization of Limited Resources During the Coronavirus Disease 2019 Crisis in an Urban, Safety-Net, Academic Medical Center

Critical Care Medicine ◽

10.1097/ccm.0000000000005155 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Albert Nadjarian ◽

Jessica LeClair ◽

Taylor F. Mahoney ◽

Eric H. Awtry ◽

Jasvinder S. Bhatia ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Safety Net ◽

Limited Resources ◽

Standards Of Care ◽

Care Model ◽

Academic Medical ◽

Urban Safety

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Neurologic findings among inpatients with COVID-19 at a safety-net US hospital

Neurology Clinical Practice ◽

10.1212/cpj.0000000000001031 ◽

2020 ◽

pp. 10.1212/CPJ.0000000000001031

Author(s):

Pria Anand ◽

Lan Zhou ◽

Nahid Bhadelia ◽

Davidson H. Hamer ◽

David M. Greer ◽

...

Keyword(s):

Low Income ◽

Medical Center ◽

Altered Mental Status ◽

Safety Net ◽

Nasopharyngeal Swab ◽

Neurologic Complications ◽

Safety Net Hospital ◽

Urban Safety ◽

Record Review ◽

Neurologic Findings

ObjectiveTo characterize the breadth of neurologic findings associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in a diverse group of inpatients at an urban, safety-net US medical center.MethodsPatients were identified through an electronic medical record review from April 15, 2020, until July 1, 2020, at a large safety-net hospital in Boston, MA, caring primarily for underserved, low-income, and elderly patients. All hospitalized adult patients with positive nasopharyngeal swab or respiratory PCR testing for SARS-CoV-2 during their hospitalization or in the 30 days prior to admission who received an inpatient neurologic or neurocritical care consultation or admission during the study period were enrolled.ResultsSeventy-four patients were identified (42/57% male, median age 64 years). The majority of patients self-identified as Black or African-American (38, 51%). The most common neurologic symptoms at presentation to the hospital included altered mental status (39, 53%), fatigue (18, 24%), and headache (18, 18%). Fifteen patients had ischemic strokes (20%). There were 10 in-hospital mortalities, with moderately severe disability among survivors at discharge (14%, median modified Rankin Scale score of 4).ConclusionsNeurologic findings spanned inflammatory, vascular pathologies, sequelae of critical illness and metabolic derangements, possible direct involvement of the nervous system by SARS-CoV-2, and exacerbation of underlying neurologic conditions, highlighting a broad range of possible etiologies of neurologic complications in patients with coronavirus disease 2019 (COVID-19). Further studies are needed to characterize the infectious and post-infectious neurologic complications of COVID-19 in diverse patient populations.

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