BPI19-018: Cancer Screening Rates and Adherence of Uninsured Cancer Patients in Free Clinics

2019 ◽  
Vol 17 (3.5) ◽  
pp. BPI19-018
Author(s):  
Katherine Robinson ◽  
Amber Todd ◽  
Abu-Sayeef Mirza ◽  
Madeline Macdonald ◽  
Noura Ayoubi ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Chart Review ◽  
Pearson Correlation ◽  
Demographic Data ◽  
Retrospective Chart Review ◽  
Cancer Surveillance ◽  
Screening Colonoscopy ◽  
Smoking History ◽  
Free Clinics ◽  
Uninsured Population

Background: There are limited studies documenting the prevalence of malignancies and the cancer screening practices of the uninsured population. Cancer survivors require continued cancer surveillance and screening for recurrence and second primaries. However, screening may be suboptimal among the uninsured. Our objective was to identify and document the screening rates and adherence to ACS guidelines in our local uninsured community. Methods: Demographic data, cancer history and associated cancer screening measures were extracted from electronic medical records of patients managed in 8 free clinics between January 2016 and December 2017 in the Tampa Bay Area. Frequencies, proportions, and Pearson correlation coefficients were used to describe the population and statistically significant relationships. Using the ACS cancer screening recommendations, the charts were reviewed for appropriate cancer screening. Results: From manual chart review, 6,958 charts were reviewed and 201 (2.89%) patients had a diagnosis of cancer. The average age was 55.58 years and 134 (66.67%) were women. Most common malignancies included breast cancer (49, 24.38%), prostate (18, 8.96%), colorectal (13, 6.47%), leukemia/lymphoma (11, 5.47%), cervical (10, 4.98%), melanoma (10, 4.98%), ovarian (9, 4.48%), thyroid (9, 4.48%), renal (6, 2.99%), bladder (5, 2.49%), and uterine (5, 2.49%). Of the 201 patients diagnosed with cancer, 104 (51.74%) met the guidelines for a screening mammogram; however, only 49 (47.12%) had this completed. 115 (57.21%) met the guidelines for a screening Papanicolaou smear; 28 (24.35%) had it completed. 145 (72.14%) met the guidelines for a screening colonoscopy; 23 (15.86%) had it completed. 39 (19.4%) met the guidelines for prostate screening; 3 (7.69%) had it completed. Of the 201 patients, 14 (6.97%) reported a greater than 30 pack smoking history but no patients were screened with a low-dose CT of the thorax. Of the 10 patients with melanoma, 3 (30%) mentioned having routine skin exams. Conclusions: The uninsured population have many barriers to obtaining health care and appropriate screening for malignancies. This retrospective chart review highlights the need for easier access to screening. Increasing screening rates in the uninsured population will decrease cancer mortality as well as being cost effective to the community. It is important for free clinic providers to emphasize guideline-directed cancer screening at every visit.

Combination Therapies for Hidradenitis Suppurativa: A Retrospective Chart Review of 31 Patients

2019 ◽  
Vol 23 (3) ◽  
pp. 270-276 ◽  
Author(s):  
Meghan L. McPhie ◽  
Alanna C. Bridgman ◽  
Mark G. Kirchhof
Keyword(s):  
Disease Severity ◽  
Hidradenitis Suppurativa ◽  
Chart Review ◽  
Small Sample Size ◽  
Demographic Data ◽  
Severe Disease ◽  
Treatment Protocol ◽  
Retrospective Chart Review ◽  
Small Sample ◽  
Combination Therapies

Background: Although a variety of medical and surgical interventions exist for the treatment of hidradenitis suppurativa (HS), it remains a challenging disease to manage because of its variable presentation and unpredictable clinical course. Apart from the combination of clindamycin and rifampin, the success of other combination therapies is largely unknown. Objectives: The goal of our study was to examine the clinical utility of various combination therapies for the treatment of HS. Methods: We conducted a qualitative retrospective chart review of 31 patients with dermatologist-diagnosed HS who were seen at an academic teaching hospital between 2014 and 2018. Demographic data, disease location, disease severity, and treatment protocol were retrieved for analysis. Hurley stage was used to classify disease severity on initial presentation, and the International Hidradenitis Suppurativa Severity Score System (IHS4) was used to track changes across visits. Results: Of the 31 patients (Mage = 37.7 years; 67.7% female) included in the study, 6 (19.4%), 11 (35.5%), and 14 (45.2%) patients were classified as Hurley stages I, II, and III, respectively. Although no statistical results are provided because of the small sample size, we have identified several drug combinations that show promising clinical response for patients with HS based on their IHS4 score, such as isotretinoin/spironolactone for mild disease, isotretinoin or doxycycline with adalimumab for moderate disease, and cyclosporine/adalimumab for severe disease. Conclusions: This preliminary work demonstrates that HS treatment with combination therapy appears to be a promising method of disease management.

Mo1987 Comparison of Adenoma Detection Rate in Afro-Caribbean and Whites Undergoing First Screening Colonoscopy: A Retrospective Chart Review

2015 ◽  
Vol 148 (4) ◽  
pp. S-760
Author(s):  
Alicia M. Alvarez ◽  
Chau To ◽  
Kinchit Shah ◽  
Kanwarpreet S. Tandon ◽  
Seifeldin Hakim ◽  
...  
Keyword(s):  
Detection Rate ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Adenoma Detection Rate ◽  
Screening Colonoscopy ◽  
Adenoma Detection

Lung cancer: Improving screening in rural clinic.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13060-e13060
Author(s):  
Thuy Thanh Thi Le ◽  
Helen Johnson-wall ◽  
Katherine Hu
Keyword(s):  
Lung Cancer ◽  
North Carolina ◽  
Cancer Screening ◽  
Chart Review ◽  
Lung Cancer Screening ◽  
The United States ◽  
Smoking History ◽  
Study Patient ◽  
Rural Clinic ◽  
Bronchus Cancer

e13060 Background: Lung cancer is the leading cause of overall cancer-related deaths in both men and women in the United States. In 2009, cancer surpassed cardiovascular disease as the leading cause of death in North Carolina. Between 2010-2014, the age-adjusted incidence rate for lung and bronchus cancers in North Carolina was 70 per 100000 persons per year. Between 2010-2014, the age-adjusted mortality rate for lung and bronchus cancers in North Carolina was 50.6 per 100000 persons per year. It is documented that about half of lung and bronchus cancer cases were diagnosed at the distant stage and about 60 percent of deaths occurred in adults ages 65-84. In 2011, 32 percent of cancer death was from lung/bronchus cancer in Robeson County. A chart review in a rural primary care clinic identified patients not being appropriately screened for targeted intervention. Methods: Our retrospective chart review at Lumberton Medical Clinic, a rural outpatient Internal Medicine Clinic, reviewed 91 records from adults aged 55 to 80 years old during the timeframe of September 2017 through August 2018. Patients with a known history of lung cancer were excluded from this study. Patient records were assessed for compliance with USPTF lung cancer screening guidelines. USPTF recommends adults aged 55 to 80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years to have an annual low-dose computed tomography of the chest to screen for lung cancer. Results: The review showed that during the timeframe studied, 42% of patients who qualified received appropriate screening, while 58% of those qualified were found to have no documentation of screening. Following data analysis, intervention to increase screening rates has been initiated. This involves provider education, posters, and individualized letters mailed to patients found deficient during the study. The success of this direct patient outreach effort will be measured over six months. Conclusions: It is the responsibility of providers to emphasize the importance of proper lung cancer screening. This retrospective review found that a large percentage (58%) of adults were not being adequately screened in our rural clinic. Direct outreach is underway to increase compliance rates in this high-risk population served by our rural clinic.

Comparison of adenoma detection rate in Hispanics and whites undergoing first screening colonoscopy: a retrospective chart review

2013 ◽  
Vol 77 (3) ◽  
pp. 430-435 ◽  
Author(s):  
Matthew N. Thoma ◽  
Brenda G. Jimenez Cantisano ◽  
Adrian V. Hernandez ◽  
Alejandro Perez ◽  
Fernando Castro
Keyword(s):  
Detection Rate ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Adenoma Detection Rate ◽  
Screening Colonoscopy ◽  
Adenoma Detection

scholarly journals Secondary prevention among uninsured stroke patients: A free clinic study

2020 ◽  
Vol 8 ◽  
pp. 205031212096532
Author(s):  
Madeline R MacDonald ◽  
Sydney Zarriello ◽  
Justin Swanson ◽  
Noura Ayoubi ◽  
Rahul Mhaskar ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Medical Records ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Free Clinics ◽  
Stroke Patients ◽  
Uninsured Patients ◽  
Patients With Diabetes ◽  
History Of ◽  
Clinic Study

Objectives: Free clinics manage a diversity of diseases among the uninsured. We sought to assess the medical management of stroke in a population of uninsured patients. Methods: A retrospective chart review was conducted to collect chronic disease statistics from 6558 electronic medical records and paper charts at nine free clinics in Tampa, Florida, from January 2016 to December 2017. Demographics and risk factors were compared between stroke patients and non-stroke patients. Medication rates for several comorbidities were also assessed. Results: Two percent (107) of patients had been diagnosed with a stroke. Stroke patients were older (mean (M) = 56.0, standard deviation (SD) = 11.2) than the rest of the sample (M = 43.3, SD = 15.4), p < 0.001 and a majority were men (n = 62, 58%). Of the stroke patients with hypertension (n = 79), 81% (n = 64) were receiving anti-hypertensive medications. Of the stroke patients with diabetes (n = 43), 72% (n = 31) were receiving diabetes medications. Among all stroke patients, 44% were receiving aspirin therapy (n = 47). Similarly, 39% of all stroke patients (n = 42) were taking statins. Conclusions: Uninsured patients with a history of stroke may not be receiving adequate secondary prevention highlighting the risk and vulnerability of uninsured patients. This finding identifies an area for improvement in secondary stroke prevention in free clinics.

Unique perspectives from the transgender community: A retrospective chart review of cancer care needs for transgender patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6566-6566
Author(s):  
Carolyn Moloney ◽  
Margaret Allen ◽  
Deirdre O'Mahony ◽  
Derek Power ◽  
Richard Bambury ◽  
...  
Keyword(s):  
Cancer Care ◽  
Medical Records ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Well Being ◽  
Smoking History ◽  
Desmoid Tumour ◽  
Cancer Support ◽  
Incidence And Mortality ◽  
And Gender

6566 Background: It is estimated that 1% of a population experience some degree of gender non-conformity. There is scant information worldwide on cancer incidence and mortality for this population however due to a lack of investigating large-scale prospective studies. National cancer registries do not hold demographics on this population. Current literature indicates transgender people may face an increased cancer risk. Transgender patients may avoid screening programmes for cancers which are themselves gendered. Transgender patients can feel excluded from gender specific cancer support groups. We set out to identify how cancer services in Ireland can better meet transgender people’s unique needs. Methods: Medical oncology consultants in the South/South-West of Ireland were contacted to identify patients who identified as transgender or gender non-conforming. We carried out a retrospective chart review of the four transgender patients identified. We analysed staging at diagnosis, family supports, smoking history, alcohol use and whether cancer treatment affected gender transitioning treatment and if this had documented effects on mental well-being. We also noted if medical records reflected a new name or change of gender and if not, whether original name and gender used for chemotherapy and blood product administration. Results: All four patients were diagnosed with relatively advanced disease at diagnosis- Stage IIIc high grade ovarian cancer, stage IV gastrointestinal tumour, stage IVb diffuse large B Cell and locally advanced extra-abdominal desmoid tumour. Of the four patients, three had a smoking and alcohol history on diagnosis. All four patient’s recent medical correspondence reflected a name and gender change but the medical records did not reflect this. Three patients had documented depression for which they were attending psychiatry services. It was noted that two patients had gender transitioning treatment postponed due to cancer care. Minimal family support was noted for two patients. Conclusions: The transgender community is a growing population that will continue to integrate into mainstream society. Our retrospective chart review adds to a growing body of evidence which suggests gender minorities may suffer from cancer-related disparities and have an increased need for psychosocial support. As in other studies, it is difficult to identify these individuals. We should identify gender minority individuals and report this data in medical records in order to build much needed epidemiological information.

Adherence to screening mammogram guidelines in the transgender/non-binary population.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 120-120
Author(s):  
Natalie Luehmann ◽  
Mona Ascha ◽  
Emily Chwa ◽  
Caitlin Stockslager ◽  
Paige Hackenberger ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Screening Mammogram ◽  
Provider Education ◽  
Hospital System ◽  
Screening Guidelines

120 Background: Data is limited regarding rates of breast cancer and mammography screening within the transgender/non-binary (TGNB) population. Screening recommendations vary and there is no global consensus. TGNB patients face unique challenges that may preclude screening and risk assessment, such as barriers to accessing healthcare, lack of provider education, and limited data regarding hormonal impacts on risk. This study aims to address adherence to current screening mammogram recommendations within the TGNB population at a single hospital system. Methods: A retrospective chart review was performed using ICD codes, sexual orientation and gender identity data, and key words to identify TGNB patients that had contact with the Northwestern Hospital system between March 2019 and February 2021. Patients designated female at birth (DFAB) and age ≥ 40 with breasts at time of screening eligibility were included as well as patients designated male at birth (DMAB) and age ≥ 50 with ≥ 5 years of hormone therapy (HT). Rates of screening mammogram were evaluated along with analysis of demographic factors that may predict for or against adherence to recommendations. ASBrS and USPSTF guidelines, screening mammograms starting at age 40 and 50, respectively, were applied to patients DFAB. UCSF Center for Transgender Health and Fenway Health guidelines (screening mammogram at age 50 and ≥ 5 years of HT) were applied to patients DMAB. Results: The table illustrates screening adherence rates according to guidelines with two definitions of adherence. We evaluated patients who had screening mammogram “on-time” which was defined at age 40 or 50 with a two year grace period. We also defined adherence as having had a screening mammogram within the two year study period regardless of age. Univariate analysis and multivariate analysis evaluating for insurance status, employment status, level of education, and hormone use did not identify any factors associated with likelihood of adhering to screening guidelines in either the DFAB or DMAB population. Conclusions: Adherence to screening mammogram recommendations among the TGNB population at Northwestern Hospital system is low across all sub-groups. In contrast, the ACO rate of adherence to screening mammogram (within the last two years) at our institution for all-comers (age ≥ 50-74) in 2019 was 77.33%. Demographic data failed to elucidate any association with likeliness to undergo appropriate breast cancer screening. This disparity demands the development of initiatives aimed at increasing breast cancer screening rates for the Northwestern TGNB population.[Table: see text]

Abstract 290: Comparison of Lipid Control in Patients with Coronary versus Peripheral Arterial Disease

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Suresh Sharma ◽  
Rashmi Thapa ◽  
Taylor Myers ◽  
Casper Hu ◽  
Michael Brimacombe ◽  
...  
Keyword(s):  
Chart Review ◽  
Demographic Data ◽  
Retrospective Chart Review ◽  
Arterial Disease ◽  
Lipid Levels ◽  
Established Coronary Artery Disease ◽  
Cardiovascular Morbidity And Mortality ◽  
Artery Disease ◽  
Lipid Control ◽  
Peripheral Arterial

Objectives: Patients with Peripheral artery disease (PAD) have similar cardiovascular morbidity and mortality as those with established coronary artery disease (CAD). Thus the recommended LDL goal is < 100 mg/dl for both CAD and PAD patients. This study assesses the degree of lipid control and statin drug use in CAD and PAD patients in current clinical practice. Methods: We did a retrospective chart review of patients with a diagnosis of PAD, CAD and both PAD and CAD seen at our institution between Jan 2009 to March 2012. Demographic data, lipid levels and statin use were compared between CAD, PAD and PAD & CAD groups. To enable comparison of the doses of various statins, we used statin potency unit where 1 potency unit = 10mg of Simvastatin. Results: There were a total of 11498 subjects in the chart review (CAD-9879, PAD-623, both PAD & CAD -996). PAD patients were younger with more females & lower BMI compared to CAD and both PAD & CAD groups (Table 1). Mean LDL level in the PAD group was 93.4±35.5 mg/dL, CAD group was 82.7±33.1 mg/dL and both PAD & CAD group was 80.5±31.0 mg/dL. Although all groups had a mean LDL of < 100mg/dL, significantly fewer number of PAD patients achieved target LDL <100 mg/dl and LDL <70 mg/dl, as compared to CAD and combined group (Table 1). The PAD group had significantly higher mean total cholesterol and mean LDL levels as compared to the CAD group and combined PAD & CAD group (Table 1). The mean HDL and mean triglyceride (TG) levels in PAD group were significantly higher than the CAD and combined PAD & CAD group. The PAD patients had significantly greater use of less potent statins than the CAD and PAD & CAD groups which was not compensated for by a higher mean dose of the lower potency statins (Table 1). PAD patients were receiving significantly lower mean potency unit of statins as compared to PAD and combined CAD and PAD group (Table 1). Conclusion: Even though both PAD and CAD groups had mean LDL < 100mg/dL, we found that lipid control assessed by absolute mean lipid levels were significantly better in patients with CAD and combined PAD & CAD group. Thus, our study indicates that physicians tend to be more aggressive with lipid control in patients with a diagnosis of CAD when compared to patients with PAD alone.

Burden of Chronic Conditions among Patients from Free Clinics: A Retrospective Chart Review of 2015

2018 ◽  
Vol 29 (3) ◽  
pp. 1011-1026 ◽  
Author(s):  
Shams Rahman ◽  
Abu-Sayeef Mirza ◽  
Jennifer Stenback ◽  
Shikerria Green ◽  
Yeshuwa Mayers ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Free Clinics

Women screened for breast cancer are dying from lung cancer: An opportunity to improve lung cancer screening in a mammography population

2021 ◽  
pp. 096914132110130
Author(s):  
Kim L Sandler ◽  
Diane N Haddad ◽  
Alexis B Paulson ◽  
Travis J Osterman ◽  
Carolyn C Scott ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Natural Language Processing ◽  
Cancer Screening ◽  
Natural Language ◽  
Language Processing ◽  
Chart Review ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Lung Screening

Objective Lung cancer is the leading cancer killer in women, resulting in more deaths than breast, cervical and ovarian cancer combined. Screening for lung cancer has been shown to significantly reduce mortality, with some evidence that women may have a greater benefit. This study demonstrates that a population of women being screened for breast cancer may greatly benefit from screening for lung cancer. Methods Data from 18,040 women who were screened for breast cancer in 2015 at two imaging facilities that also performed lung screening were reviewed. A natural language-processing algorithm followed by a manual chart review identified women eligible for lung cancer screening by U.S. Preventive Services Task Force (USPSTF) criteria. A chart review of these eligible women was performed to determine subsequent enrollment in a lung screening program (2016–2019), current screening eligibility, cancer diagnoses and cancer-related outcomes. Results Natural language processing identified 685 women undergoing screening mammography who were also potentially eligible for lung screening based on age and smoking history. Manual chart review confirmed 251 were eligible under USPSTF criteria. By June 2019, 63 (25%) had enrolled in lung screening, of which three were diagnosed with screening-detected lung cancer resulting in zero deaths. Of 188 not screened, seven were diagnosed with lung cancer resulting in five deaths by study end. Four women received a diagnosis of breast cancer with no deaths. Conclusion Women screened for breast cancer are dying from lung cancer. We must capitalize on reducing barriers to improve screening for lung cancer among high-risk women.

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