Clinical Performance of the Xpert® CT/NG Test for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae: A Multicenter Evaluation in Chinese Urban Hospitals

BackgroundWe aimed to evaluate the clinical performance of the GeneXpert® (Xpert) CT/NG assay for the detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) using urine and cervical swabs collected from patients in China.MethodsThis study was conducted from September 2016 to September 2018 in three Chinese urban hospitals. The results from the Xpert CT/NG test were compared to those from the Roche cobas® 4800 CT/NG test. Discordant results were confirmed by DNA sequence analysis.ResultsIn this study, 619 first void urine (FVU) specimens and 1,042 cervical swab specimens were included in the final dataset. There were no statistical differences between the results of the two tests for the detection of CT/NG in urine samples (p > 0.05), while a statistical difference was found in cervical swabs (p < 0.05). For CT detection, the sensitivity and specificity of the Xpert test were 100.0% (95%CI = 96.8–99.9) and 98.3% (95%CI = 96.6–99.2) for urine samples and 99.4% (95%CI = 96.5–100.0) and 98.6% (95%CI 97.5–99.2) for cervical swabs, respectively. For NG detection, the sensitivity and specificity of the Xpert test were 99.2% (95%CI = 94.9–100.0) and 100.0% (95%CI = 99.0–100.0) for urine and 100% (95%CI = 92.8–100.0) and 99.7% (95%CI = 99.0–99.9) for cervical swabs, respectively.ConclusionThe Xpert CT/NG test exhibited high sensitivity and specificity in the detection of CT and NG in both urine and cervical samples when compared to the reference results. The 90-min turnaround time for CT and NG detection at the point of care using Xpert may enable patients to receive treatment promptly.

Association of Socio-Demographic and Climatic Factors with the Duration of Hospital Stay of Under-Five Children with Severe Pneumonia in Urban Bangladesh: An Observational Study

Severe pneumonia is one of the leading contributors to morbidity and deaths among hospitalized under-five children. We aimed to assess the association of the socio-demographic characteristics of the patients and the climatic factors with the length of hospital stay (LoS) of under-five children with severe pneumonia managed at urban hospitals in Bangladesh. We extracted relevant data from a clinical trial, as well as collecting data on daily temperature, humidity, and rainfall from the Meteorological Department of Bangladesh for the entire study period (February 2016 to February 2019). We analyzed the data of 944 children with a generalized linear model using gamma distribution. The average duration of the hospitalization of the children was 5.4 ± 2.4 days. In the multivariate analysis using adjusted estimation of duration (beta; β), extended LoS showed remarkably positive associations regarding three variables: the number of household family members (β: 1.020, 95% confidence intervals (CI): 1.005–1.036, p = 0.010), humidity variation (β: 1.040, 95% Cl: 1.029–1.052, p < 0.001), and rainfall variation (β: 1.014, 95% Cl: 1.008–1.019), p < 0.001). There was also a significant negative association with LoS for children’s age (β: 0.996, 95% Cl: 0.994–0.999, p = 0.006), well-nourishment (β: 0.936, 95% Cl: 0.881–0.994, p = 0.031), and average rainfall (β: 0.980, 95% Cl: 0.973–0.987, p < 0.001). The results suggest that the LoS of children admitted to the urban hospitals of Bangladesh with severe pneumonia is associated with certain socio-demographic characteristics of patients, and the average rainfall with variation in humidity and rainfall.

398. Multicenter Evaluation of Outcomes of SARS-CoV-2 Positive Patients Treated at Rural vs Urban Hospitals in the United States

Background The SARS-CoV-2 pandemic has revealed socioeconomic and healthcare inequities in the US. With approximately 20% of the population living in rural areas, there are limitations to healthcare access due to economic constraints, geographical distances, and provider shortages. There is limited data evaluating outcomes associated with SARS-CoV-2 positive patients treated at rural vs. urban hospitals. The aim of the study was to evaluate characteristics and outcomes of SARS-CoV-2 positive patients treated at rural vs. urban hospitals in the US. Methods This was a multicenter, retrospective cohort analysis of adult (≥ 18 years) hospitalized patients from 241 US acute care facilities with &gt;1 day inpatient admission with a discharge or death between 3/6/20-5/15/21 (BD Insights Research Database [Becton, Dickinson & Company, Franklin Lakes, NJ]), which includes both small and large hospitals in rural and urban areas. SARS-CoV-2 infection was identified by a positive PCR or antigen during or &lt; 7 days prior to hospital admission. Descriptive statistics were completed. P value of ≤0.05 was considered statistically significant. Results Overall, 42 (17.4%) and 199 (82.6%) of hospitals were classified as rural and urban, respectively. A total of 304,073 patients were admitted to a rural hospital with 12,644 (4.2%) SARS-CoV-2 positive. In comparison, a total of 2,844,100 patients were treated at an urban hospital with 132,678 (4.7%) SARS-CoV-2 positive. Patients admitted to rural hospitals were older compared to those treated at an urban hospital (65.2 ± 17.3 vs. 61.5 ± 18.7, P=0.001) (Table 1). Patients treated at an urban facility had significantly higher rates of ICU admission, severe sepsis, and mechanical ventilation. ICU length of stay was significantly longer for patients admitted to an urban hospital compared to a rural hospital (8.1 ± 9.9 vs. 6.1 ±7.2 days, P=0.001) (Table 2). No difference in mortality was observed. Table 1. Characteristics of SARS-CoV-2 positive patients treated at rural vs. urban hospitals. Table 2. Outcomes of SARS-CoV-2 patients treated at rural vs. urban hospitals. *Patients with available data. Conclusion In this large multicenter evaluation of hospitalized patients positive for SARS-CoV-2, there were significant differences in patient characteristics. There was no observed difference in mortality. These findings are important in evaluating the pandemic’s impact on patients in rural and urban healthcare settings. Disclosures Karri A. Bauer, PharmD, Merck & Co., Inc. (Employee, Shareholder) Kalvin Yu, MD, BD (Employee) Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder) Laura A. Puzniak, PhD, Merck & Co., Inc. (Employee)

Mortality Variations of COVID-19 from Different Hospital Settings During Different Pandemic Phases: A Multicenter Retrospective Study

Introduction: Diverse coronavirus disease 2019 (COVID-19) mortalities have been reported but focused on identifying susceptible patients at risk of more severe disease or death. This study aims to investigate the mortality variations of COVID-19 from different hospital settings during different pandemic phases. Methods: We retrospectively included adult (≥18 years) patients who visited emergency departments (ED) of five hospitals in the state of Texas and who were diagnosed with COVID-19 between March–November 2020. The included hospitals were dichotomized into urban and suburban based on their geographic location. The primary outcome was mortality that occurred either during hospital admission or within 30 days after the index ED visit. We used multivariable logistic regression to investigate the associations between independent variables and outcome. Generalized additive models were employed to explore the mortality variation during different pandemic phases. Results: A total of 1,788 adult patients who tested positive for COVID-19 were included in the study. The median patient age was 54.6 years, and 897 (50%) patients were male. Urban hospitals saw approximately 59.5% of the total patients. A total of 197 patients died after the index ED visit. The analysis indicated visits to the urban hospitals (odds ratio [OR] 2.14, 95% confidence interval [CI], 1.41, 3.23), from March to April (OR 2.04, 95% CI, 1.08, 3.86), and from August to November (OR 2.15, 95% CI, 1.37, 3.38) were positively associated with mortality. Conclusion: Visits to the urban hospitals were associated with a higher risk of mortality in patients with COVID-19 when compared to visits to the suburban hospitals. The mortality risk rebounded and showed significant difference between urban and suburban hospitals since August 2020. Optimal allocation of medical resources may be necessary to bridge this gap in the foreseeable future.

Health care ethics programs in U.S. Hospitals: results from a National Survey

Background As hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking. Methods Based on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs. Results Among 372 hospitals whose informants responded to an online survey, 97% of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents’ strategies for managing challenges include staff training and additional funds. Conclusions While this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs.

“A Tale of Two Hospitals”: The Role of Place-Based Sensemaking in COVID-19 Communication for Rural and Urban Texas Hospitals

Rural and urban hospitals must respond differently to crises such as the COVID-19 pandemic, given their unique situations. In this study, we performed a rhetorical analysis of press releases from rural and urban hospitals in Texas to better understand the crisis communication strategies of the two hospital systems. Following previous literature on narrative sensemaking, place-based storytelling, and pre-crisis management, we found that the examined press releases used setting details to ground their health-related information in their specific communities. Such a strategy made the information accessible and attainable, but potentially reinforced place-based tensions and inequalities. Our study has implications for preventative sensemaking research as well as for crisis communicators attempting to better reach specific communities during a long-term, developing crisis.

The analysis of patients’ revisits intention factors in sub-urban hospital

Revisit intention is a very important topic in a marketing context. However, previous literature is still rarely linked together with trust, satisfaction and two types of service, namely medical and non-medical with the hospital as the subject. Hospitals have the task of providing complete individual health services. This study aims to analyze the relationship between the quality of medical services and the quality of non-medical services on satisfaction, trust and revisit intention on the sub-urban hospitals. This research is a quantitative study using primary data from distributing questionnaires to 250 patients of the sub-urban hospitals. The data in this study were analyzed using the SEM (Structural Equation Model) method with AMOS 24 software. The results of this study indicate that the quality of medical services and the quality of non-medical services have a positive and significant effect on satisfaction. Meanwhile, patient satisfaction has a positive and significant effect on trust and revisit intention. However, trust was found to have a positive but insignificant effect on revisit intention. This research recommends several implications to the management of sub-urban hospitals. The managers of the sub-urban hospital are advised to pay more attention to and emphasize medical services, non-medical services, and patient satisfaction because it has been empirically proven to increase Revisit Intention

Factors associated with the extent of information technology use in Ontario hospitals

Patients, providers and society are demanding more from health care systems worldwide. As health systems evolve, the use of health information technology is one method to deliver safer, more efficient, and more effective patient care. This paper presents analysis that explores whether location, hospital type, hospital size are factors in determing the extent that IT is used in Ontario hospitals.The results show that urban hospitals use IT more extensively than non-urban hospitals. Hospital type does not have an effect on the relative extent that IT is used. Larger hospitals are likely to use IT more than smaller hospitals. Key implications for having location and size determine a hospital's use of IT are the increasing divide between urban and non-urban hospitals and the proliferation of smaller "have not" hospitals in Ontario.