REFERRAL PATTERN OF INTERVENTIONAL PULMONOLOGY PROCEDURES AT A QUATERNARY MEDICAL CENTER

Abstract

SESSION TITLE: Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Interventional pulmonology (IP) focuses on management of malignant and benign airways and pleural diseases. Access to this specialized care is increasing nationwide, though is largely limited to academic medical centers. We hypothesized a patient’s referral (and subsequent advanced therapies) may be delayed due to access to care, socioeconomic factors, and lack of awareness or understanding of IP’s role in patient care. METHODS: We performed a retrospective analysis of patients who underwent advanced IP procedures in the Operating Room (OR) at our medical center from 7/1/2015 to 12/31/2018 after IRB approval. Procedures included rigid and flexible bronchoscopies for tumor debulking, stent placement, and tissue diagnosis. We obtained demographic data including age, sex, race, primary location of oncologic care, and date of death. We analyzed the distance from patient’s residence to our medical center, reason for referral, and advanced procedures performed. We calculated time intervals, including time to IP referral; to first IP evaluation; to procedure; to IP follow-up; and death. We used a cut-off distance of 51 miles from medical center to identify patients residing “near” versus “far”. Two-tailed Student’s t-test with alpha 0.05 was used for comparison. RESULTS: A total of 277 procedures were performed by IP practitioners on 227 patients during the study period. Forty five percent, (45.4%, 103/227) were female, with an average age of 60.8±11.2 years. The median distance of patient residences were 51 miles from our medical center. Eighty-two percent (188/227) had cancer; 30.3% (57/188) of these malignancies were diagnosed during the IP procedure. Patients residing near our medical center had significantly shorter interval from imaging to IP referral (11.3±18.8 days vs. 17.4±26.6 days, p=0.046). There were no statistically significant differences in days from referral to initial evaluation by IP (p=0.84) or from IP evaluation to time of procedure (p=0.66) between “near” and “far” patients. There was no significant difference in time interval from procedure to first clinic follow-up between the two groups (p=0.14). CONCLUSIONS: Patients residing more than 51 miles from our medical center were associated with an average delay of 6 days for IP referral for necessary intervention when compared to those living within 51 miles. There were no subsequent delays from the date of referral to IP evaluation, nor from date of IP evaluation to IP procedure performed. CLINICAL IMPLICATIONS: IP intervention is delayed for those living away from a quaternary medical center. Appropriate education of referring physicians, community access to IP physicians, and direct communication by telemedicine may be helpful to improve the delay. DISCLOSURES: no disclosure on file for Shaheen Islam; No relevant relationships by Divyesh Mehta, source=Web Response no disclosure on file for Shailesh Pinto; No relevant relationships by Alberto Revelo, source=Web Response No relevant relationships by Virgil Secasanu, source=Web Response No relevant relationships by Harsh Shah, source=Web Response