Annual Screening Rates Research Articles

Abstract A139: Patient and provider barriers and facilitators to lung cancer screening: I-STEP 2 Study

Abstract Purpose: While lung cancer is a leading cause of death in the U.S., annual lung cancer screening (LCS) rates remain low. After deployment of an implementation intervention to increase lung cancer screening (LCS) and referral, we used a qualitative approach to identify barriers and facilitators, and recommended supports to increase screening. Methods: Semi-structured interviews were conducted with patients (n=66) and providers (n=59) across 15 BJC Consortium hospitals. Interview domains included perceptions and experiences with LCS referral and completion, barriers and facilitators to LCS, and the impact of the COVID-19 pandemic on these processes. Patients were eligible if they had been referred for LCS. Providers were eligible if they were involved in the LCS decision-making and referral process. Interviews were audio-recorded, de-identified, and transcribed. Deductive and inductive codes were developed separately for patients and providers. Coded data were analyzed to determine themes. Results: Patients cited transportation, uncertainty surrounding insurance coverage for screening, and the COVID-19 pandemic as barriers to accessing LCS. Due to the Medicare and Medicaid requirement of a documented shared decision-making visit prior to providing an LCS referral, providers cited time constraints during patient encounters as a barrier to delivering optimal LCS care. Both patients and providers reported low general awareness of LCS (compared to other preventive screening services) as a barrier to utilization. Patients described many facilitators to LCS including fears regarding cancer risk, knowledge of the benefits of early cancer detection in improving cancer outcomes, provider recommendations, ease of LCS process, and receiving educational materials about LCS. Providers also describe access to evidence-based outreach and education materials regarding LCS, and implementation of clinical decision support tools (e.g. pre-screening for LCS eligibility and insurance authorization, integration of EMR prompts centered around LCS and nodule surveillance) as facilitators for screening. Patients and providers highlighted the importance of LCS navigators in facilitating communication and reducing barriers to LCS and surveillance – specifically, patients found one-on-one support and education with navigators to be encouraging as they underwent LCS. Conclusion: While there are some key barriers related to lung cancer screening and follow-up, there are many facilitators to screening that can be leveraged to increase referrals and enable successful follow-up management after screening. Recommended additions to basic lung screening intervention materials include provider education on how lung cancer screening referral processes are unique in comparison to other screenings, how providers can foster patient understanding of lung nodules, and local support and resources to help patients navigate barriers to lung screening. Citation Format: Amy Ayala, Meera Muthukrishnan, Sydney Beache, Michelle Silver, Courtney Harriss, Graham Colditz, Aimee James. Patient and provider barriers and facilitators to lung cancer screening: I-STEP 2 Study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A139.

The Pattern of Practice in the Management of Early Diabetic Kidney Disease.

Background and objectives Diabetes is a leading cause of kidney failure in various regions worldwide. To detect renal disease in individuals with diabetes, screening typically involves evaluating the glomerular filtration rate and measuring albuminuria. Although there are established guidelines for these screenings, adherence to them varies. This study aims to examine the prevalence of albuminuria screening among adults with diabetes mellitus (DM) and to assess the different practices in managing these patients across primary and tertiary care settings. Methods This cross-sectional observational study involved adult patients with DM attending outpatient clinics in both primary and tertiary care settings. Patient data were gathered using a standardized form, excluding those with established chronic kidney disease (CKD) who were under nephrology care. Results The study included 1,010 patients, with 303 (30%) from primary care clinics and 707 (70%) from tertiary care clinics. The cohort comprised 582 (58%) females, with a median age of 62 years (IQR: 55-70), and approximately 990 (98%) had type 2 DM (T2DM). Annual albumin-to-creatinine ratio (ACR) screening was conducted for 498 out of 1,010 patients (49%) (95% confidence interval {CI}: 46%-52%). Screening compliance was notably higher in primary care settings compared to tertiary care clinics. Older patients (over 60 years) and those with hypertension or cardiac conditions were less likely to undergo screening. Among those screened, 185 of 498 patients (37%) (95% CI: 33%-41%) had abnormal albuminuria (ACR > 3). Conclusion Albuminuria is a significant indicator of progressing renal disease and cardiovascular risk. The annual screening rate for albuminuria in diabetic patients is inadequate. Primary care physicians show better adherence to screening guidelines compared to their tertiary care counterparts. Increasing physician awareness about the importance of screening could improve guideline compliance and mitigate the adverse effects of albuminuria.

Benzathine penicillin G stockouts and other barriers to documented syphilis treatment in pregnancy in Zambia.

The prevalence of syphilis in Zambia remains high and is a critical public health concern. The Zambian Ministry of Health recommends universal screening and same-day treatment for syphilis in pregnancy, yet the syphilis screening rate is low, and treatment is poorly documented. The goal of this study was to document syphilis treatment rates and associated factors among pregnant women in care in Zambia. This retrospective cohort study included pregnant women diagnosed with syphilis according to rapid plasma reagin (RPR) screening during routine antenatal care (ANC) in Lusaka, Zambia in 2018-2019. The main outcome of interest was lack of documented BPG treatment during pregnancy. Additional information about pregnancy and neonatal outcomes, partner referral for therapy, and facility level stockout data were included. Patient characteristics were compared by treatment status using Pearson Chi-Square Test and logistic regression models were created to estimate the association between individual level-factors, facility type, and lack of BPG treatment. A Cochran-Mantel-Haenszel test was used to evaluate facility-level data with significance set at p<0.05. Among 1,231 pregnant women who screened positive for syphilis at clinic, 643 (52%) lacked documented antibiotic treatment at the facility. BPG was the only antibiotic used to treat syphilis in the cohort and 8% of sex partners had evidence of referral for therapy. Preterm delivery rates were higher in women without documented BPG (43% vs 32%; p = 0.003). In adjusted models, only calendar year and hospital facility type were associated with lack of treatment. At the facility level, annual syphilis screening rates ranged from 37-65% and most (7/10) clinics reported at least one stockout of BPG. Treatment rates for syphilis in pregnancy in Zambia were low and BPG medication stockouts at the facility level were common. A consistent supply of BPG at all ANC facilities is needed to facilitate timely treatment and improve birth outcomes.

Hepatitis C Elimination in Rwanda: Progress, Feasibility, and Economic Evaluation

ObjectivesIn 2018, Rwanda launched a national program to eliminate the hepatitis C virus (HCV). We aim to assess the impact of the program to date and identify strategies to achieve the World Health Organization’s HCV elimination goals by 2030. MethodsWe developed a microsimulation model to simulate Rwanda’s HCV epidemic from 2015 through 2050 and evaluated temporal trends in HCV infection, prevalence, mortality, and the total cost of care for scenarios that could achieve HCV elimination by 2030. ResultsBetween 2018 and 2022, over 7 million people were screened for HCV, and 60 000 were treated. The study projected that Rwanda could achieve HCV elimination as early as 2027. A feasible strategy of an annual screening rate of 15% and a treatment rate of 100% would achieve all World Health Organization elimination goals by 2028, requiring screening an additional 4 million people and treating 23 900 patients by 2030. The elimination strategy costs $25 million for screening and diagnosis and $21 million for treatment from 2015 to 2050. The national program would avert 4900 hepatocellular carcinoma cases and 6700 HCV-related deaths and save the health system $25.33 million from 2015 to 2050. ConclusionsRwanda is poised to become one of the first countries in the world to eliminate HCV. Rwanda’s program serves as a blueprint for other countries in the African region. By rapid screening and treatment scale-up (eg, by leveraging HIV platforms) and by drug price negotiations, HCV elimination is not only feasible but can be cost-saving in low-income settings.

Trends and Barriers in Diabetic Retinopathy Screening: Korea National Health and Nutritional Examination Survey 2016-2021.

The prevalence of diabetes is increasing globally, highlighting the importance of preventive healthcare. This study aimed to identify the diabetic retinopathy (DR) screening rates and risk factors linked to DR screening nonadherence in the Korean population through a nationally representative sample survey. Among the Korea National Health and Nutrition Examination Survey database from 2016 to 2021, participants aged ≥ 40 years with diabetes were included. The weighted estimate for nonadherence to DR screening within a year was calculated. Risk factor analyses were conducted using univariate and multivariate logistic regression. Among the 3,717 participants, 1,109 (29.5%) underwent DR screening within the past year, and this national estimate exhibited no statistically significant difference from 2016 to 2021 (P = 0.809). Nonadherence to annual DR screening was associated with residing in rural areas, age ≥ 80 years, low educational level, self-reported good health, absence of ocular disease, current smoking, lack of exercise and dietary diabetes treatment, and no activity limitation (all P < 0.05). The recent DR screening rate in Korea was relatively low. Factors associated with apathy and complacency towards personal health were associated with the nonadherence to DR screening. Educational interventions have the potential to enhance the annual screening rate for diabetic patients.

Establishing Mental Wellness Screening As Standard of Care in Pediatric Sickle Cell Patients

Sickle cell disease (SCD) is an inherited hemoglobinopathy characterized with multi-organ involvement and frequent pain crises. Somatic complaints can give rise to neuropsychiatric disorders, among which anxiety and depression are the most common. Although mental health plays an important role in health outcomes, there is not a standardized approach to screen sickle cell patients for depression at most sickle cell centers across the country and at Texas Children's Hospital (TCH). The long-term goal of this project is to screen sickle cell patients over the age of 12 for depression across TCH hospitals: TCH-West Campus (TCH-WC), TCH-Woodlands (TCH-WL) and TCH-Medical Center (TCH-MC). Over the past two years, we successfully implemented depression screening at TCH-WC as standard of care through a series of PDSA cycles. The focus of this quality improvement project is to implement depression screening at TCH-WL. At TCH-WC, all sickle cell patients aged 12 years of greater are screened for depression using the Patient Health Questionnaire-9 modified for Adolescents (PHQ-A) . From October 2022 to July 2023, 71% of the patients that qualified for screening identified low risk, 16% identified mild risk and 12% identified moderate to severe risk of depression. Eleven percent endorsed suicidality. Psychology/Social Work (SW) saw 77.4% of patients with moderate to severe depression and 100% who screened positive for suicidality on the same day as screening. Now that our depression screening protocol is standard of care at TCH-WC, we extended this screening to TCH-WL in February 2023. Our goal is to increase the annual depression screening rate from 0 to 50% in English/Spanish speaking patients aged 12 years and older with sickle cell disease who present for follow-up care to the TCH-WL. During our first PDSA cycle at TCH-WL, one hematologist administered the PHQ-A to sickle cell patients &amp;gt; 12 years. No intervention was needed if patient scored 0-6 on the PHQ-A. Psychological resources were provided via handout if patient scored 7-9. SW referral was placed and patient was preferably seen same day if patient scored &amp;gt; 10 on the PHQ-A. If unable to be seen same day, SW followed-up via phone call. If patient screened positive for suicidality, an urgent SW referral was made and patient was seen in clinic the same day. Three sickle cell patients &amp;gt;12 years presented for follow up with the assigned provider. Two-thirds (67%) of patients were given the PHQ-A; half (50%) screened positive. During the second PDSA cycle at TCH-WL, all patients with SCD over the age of 12 who presented to TCH-WL Hematology Clinic were screened. The patients were given the PHQ-A by the Medical Assistant/nurse prior to the start of the appointment and then they followed the outlined and detailed algorithm listed above based on score.Forty-five patients were eligible for screening. Forty-two percent (19/45) were given the PHQ-A; 73% endorsed mild risk of depression; 26% endorsed moderate to severe risk; 22% endorsed suicidal ideation. 80% of patients with moderate to severe risk received same day SW assessment; 100% of patients with suicidal ideation received same day SW assessment. Over the course of our project, we have been able to maintain our goals at TCH-WC and came close to achieving our goal of screening 50% of eligible patients for depression at TCH-WL. We are working with staff and providers at TCH-WL to determine barriers and optimize clinic flow in order to achieve &amp;gt;50% screening. In the future, we plan to expand our project to our largest sickle cell clinic, TCH-Medical Center, and for depression screening to become standard of care for all sickle cell patients at Texas Children's Hospital.

2669. Improving Trichomoniasis Screening Among Cis- and Transgender Women with HIV

Abstract Background In 2020, the Primary Care Guidance for Persons with HIV added the recommendation for annual trichomoniasis screening. We identified a low trichomoniasis annual screening rate among cis- and transgender female patients living with HIV at the Institute for Advanced Medicine – Morningside Clinic, a New York State Designated AIDS Center with over 1200 patients with HIV in the Mount Sinai Health System in Manhattan. The primary aim of this prospective quality improvement pilot project was to increase the clinic’s annual trichomoniasis screening rate to 25% over the six-month intervention period. Methods A gap analysis identified lack of efficient workflow as the major reason for low trichomoniasis screening. We developed and implemented an intervention as outlined in Figure 1. The intervention began on October 15, 2022. The data was reviewed on April 19, 2023 after the intervention period ended. Results At baseline, there were 423 cis- and transgender women with HIV engaged in care at the Morningside Clinic eligible for annual sexually transmitted infection screening, including trichomoniasis. Pre-intervention screening for trichomoniasis was low at 13.7% (n=58). During the six-month intervention period, there were 280 cis- and transgender women with HIV who required annual trichomoniasis screening and seen at least once for a clinic visit with a primary care provider. Of these 280 eligible patients, 178 were tested for trichomoniasis, a significantly increased screening rate of 63.6%. Conclusion The intervention successfully increased the clinic’s annual trichomoniasis screening rate from 13.7% to 63.6% among women with HIV. The observed increase within six months was above our goal and demonstrates the effectiveness of a low-intensity and highly sustainable intervention to improve annual trichomoniasis screening rates among women with HIV. Despite the intervention, there are still a number of patients who remain unscreened for trichomoniasis as well as other sexually transmitted infections such as gonorrhea, chlamydia and syphilis. We will continue this intervention longitudinally and further identify and address barriers to sexually transmitted infection screening among people living with HIV. Disclosures All Authors: No reported disclosures

Leveraging Technology and Workflow Optimization for Health-Related Social Needs Screening: An Improvement Project at a Large Health System

The collection of health-related social needs (HRSN) data at one large health system has historically been inconsistent. This project was aimed to increase annual HRSN screening rates by standardizing data collection in the electronic health record (EHR) through optimized clinical workflows. The authors designed a standard screening questionnaire in alignment with the Accountable Health Communities model, and they conducted interviews with eleven US-based health systems and one medical center on best practices for ambulatory HRSN screening and interventions, which identified five possible methods to administer the questionnaire. After testing, the authors opted to send questionnaires to patients through the patient portal three days prior to an ambulatory visit. For inpatients, in-person interviews were implemented. Staff implementing the updated processes included registered nurses, social workers, preventive health coordinators, and community health workers. The annual screening rate for all active ambulatory patients increased from 0.4% to 15.9% (p < 0.001), and 10.7% of all patients had at least one health-related social need. The annual screening rate for inpatients was estimated to be zero at baseline and increased by 66 percentage points (p < 0.001). The most prevalent health-related social need in both settings was financial resource strain, followed closely by food insecurity. Well-designed interventions and technology support were effective in achieving improved screening and data collection. Leadership support, building interventions within preexisting workflows, and ensuring standard data capture in the EHR were key factors leading to successful process improvement.

Impact of a modified screening approach during the COVID-19 pandemic on the diagnosis and outcomes of gestational diabetes mellitus: A population-level analysis of 90,518 pregnant women.

To provide real-world evidence on the uptake of and outcomes associated with the modified gestational diabetes mellitus (GDM) screening approach offered during the COVID-19 pandemic compared with the standard screening approach. All pregnancies between 01 January 2020 and 31 December 2021, in Alberta, Canada, were included in the study. We examined GDM screening and diagnosis rates, and large-for-gestational-age (LGA) outcomes. Annual GDM screening rates were > 95% during the study time period. Overall, 84.7%, and 11.6% of the 92,505 pregnancies underwent standard and modified screening for GDM, respectively. The use of modified screening was the highest among deliveries in August 2020 (49.8%) which corresponded to the early first wave of the pandemic. GDM diagnosis rate was lower in the modified screening (7.4%) than in the standard screening (12.3%, p < 0.001) group. The LGA rates in the modified screening with GDM and the standard screening with GDM groups were 24.8% and 12.6%, respectively (p < 0.001). Women in the modified screening with GDM group were at a higher risk of having an LGA infant (adjusted odds ratio: 3.46; 95% confidence interval: 2.93, 4.08) compared to the standard screening with no GDM group. The COVID-19 epidemic had no impact on screening for GDM. Women who underwent modified screening, based on HbA1c/random plasma glucose, had lower rates of GDM cases.

Comparative study of factors influencing cytological screening for cervical cancer attendance in Hungary among Roma and non-Roma population, in relation to Slovak and Romanian results

To the present day, the prevalence and incidence of cervical cancer remains very significant. For disadvantaged groups such as the Roma, screening for the disease should be given increased attention, as members of this minority have lower access to health care and lower average health literacy. The aim of our study was to assess the prevalence of cytological screening for cervical cancer among Hungarian-speaking Roma and non-Roma populations in Hungary, Romania and Slovakia, in relation to the possible influencing factors. We also investigated respondents' perceptions of the importance of cervical cancer screening and HPV vaccination. In this paper, we focus on presenting the data from Hungary in relation to the results from the other two countries. The study sample size was 1366. Data were presented as mean ± SD and proportion. To compare Roma and non-Roma samples, the independent samples t-test was used. Cross tabulation with Pearson's chi-square test with calculating phi/Cramér's V effect size (p<0.05) was used to reveal association between ethnicity and studied variables. In Hungary, a higher proportion of Roma women (p = 0.004) did not attend cytological screening for cervical cancer compared to non-Roma women, a difference confirmed in the other two countries. Non-Roma women attached greater importance to attendance at cervical cancer screening (p = 0.022). The Roma population aged 18-65 years had lower rates of annual cytological screening for cervical cancer compared to non-Roma in all age groups, while the annual screening rate decreased with age, regardless of ethnicity. Further health promotion to prevent cervical cancer in the Roma and non-Roma population would be necessary, regardless of national borders, specifically to address risk factors in all age groups, with a focus on young people, who are less aware of the risk, and older age groups, who mostly believe that the disease does not affect them due to their age. Orv Hetil. 2023; 164(36): 1416-1425.

Expanded or Risk Factor-Based Annual Screening for Hepatitis C Virus (HCV) Among Persons With HIV: Which Is the Best Approach?

Introduction. Universal one-time screening for hepatitis C virus (HCV) is recommended for all adults. For persons with HIV (PWH), guidelines recommend HCV screening at entry into care and annually in men who have unprotected sex with other men (MSM) and persons who inject drugs (PWID). Public health experts recommend expanded annual screening in all PWH given concerns for undiagnosed new HCV diagnoses when risk factors are not assessed. Electronic medical record (EMR) with clinical decision support using a Best Practice Advisory (BPA) tool can aid HCV risk factor assessment. We conducted a prospective study among three HIV clinics to compare the two screening approaches. Methods. Two clinics implemented the EMR-triggered risk factor-based screening; one clinic used the expanded screening approach. We evaluated BPA uptake and compared HCV testing and positivity rates from August 12, 2019 to March 12, 2020. Results. In the risk factor-based screening clinics, of 1,343 PWH, 239 tests were performed with 139 attributed to the BPA (testing rate 10%). At the expanded screening site, among 434 patients, 237 HCV tests were performed (testing rate 55%). The risk factor-based screening sites were less likely to test for HCV (odds ratio [OR] = 0.0884, p < .01) and identify positive cases (OR = 0.55, p = .025). Conclusions. An EMR-based clinical-decision support tool was successfully implemented for HCV risk factor-based screening resulting in a lower HCV annual screening rate compared with an expanded approach. Although in this group of HIV clinics with limited longitudinal follow-up, no previously undiagnosed HCV cases were detected, additional work is needed to guide the design of the best approach.

Temporal and Racial Trends in Prostate Specific Antigen Screening for US Men With Family History of Prostate Cancer.

Limited data exists on trends in prostate-specific antigen (PSA) screening in men with family history of prostate cancer (PCa). 1) to study age-stratified temporal trends in PSA screening from 2000-2018 for men with a family history of PCa and black men with family history of PCa; and 2) identify determinants associated with receipt of PSA screening in aforementioned groups. We identified men aged ≥40 without prior history of PCa using data from National Health Institution Survey (NHIS) 2000-2018 who self-reported PSA testing in the last 12 months. Age-stratified temporal trends and weighted multivariable logistic regression analyses were assessed. PSA screening increased for men with a family history of prostate cancer between NHIS 2000 (28.9%) and 2005 (41.9%), with stable rates for the following years. Black men with family history of PCa showed no significant change in PSA screening rates regardless of age. Controlling for socio-demographics and access to healthcare provider, younger age (40-54) and later survey years (2013-2018) were associated with a lower likelihood of PSA screening overall and for black men, but not for those with positive family history. Data from nationally representative study of US men indicated that the annual PSA screening rates for men with a family history of PCa was higher than reported for the overall male population. We believe this represents the first study on trends and determinants of PSA screening in US men with a family history of PCa.

1264-P: Trends in Incidence and Prevalence of CFRD from the U.S. Cystic Fibrosis Foundation Patient Registry (CFFPR)

Intro: The US CFFPR includes data from ~30,000 individuals with cystic fibrosis (CF). We aimed to examine trends in incidence and prevalence alongside screening rates of cystic fibrosis related diabetes (CFRD) from 2003-2018. Methods: Prevalence of CFRD was defined as the percent of patients with CFRD in the registry in a given year. Annual incidence of CFRD was calculated as the number of new diagnoses per 1,000 person-years. Annual screening rates were defined as the percent of individuals without CFRD who underwent an oral glucose tolerance test (OGTT). Individuals &amp;lt;10 years were excluded, and data were grouped by age decade. Results: (Table 1) CFRD screening rates increased from 2003-2018, particularly in 10-18 yr olds. Although screening rates increased in adults as well, overall rates remain low. In 10-18 yr olds, the incidence of CFRD did not increase, and incident cases in adults decreased. The prevalence of CFRD is gradually increasing in adults. Conclusions: Despite increased screening, the incidence of CFRD is stable or declining. CFRD prevalence is steadily rising in older adults. Screening rates and trends in CFRD incidence support a need for revised and potentially targeted screening algorithms. With increasing longevity in people with CF and rising prevalence of CFRD, there is great need for more specialists trained to care for a growing population of adults with CFRD. Disclosure C.L.Kohler: None. T.B.Vigers: None. C.Sakamoto: None. A.Moran: Advisory Panel; Abata Therapeutics, Dompé, Other Relationship; Novo Nordisk, Research Support; Abbott Diabetes. S.Sagel: None. C.L.Chan: None.

Patient and Provider Experience with Artificial Intelligence Screening Technology for Diabetic Retinopathy in a Rural Primary Care Setting.

The development of autonomous artificial intelligence for interpreting diabetic retinopathy (DR) images has allowed for point-of-care testing in the primary care setting. This study describes patient and provider experiences and perceptions of the artificial intelligence DR screening technology called EyeArt by EyeNuk during implementation of the tool at Western Maine Primary Care in Norway, Maine. This non-randomized, single-center, prospective observational study surveyed 102 patients and 13 primary care providers on their experience of the new screening intervention. All surveyed providers agreed that the new screening tool would improve access and annual screening rates. Some providers also identified initial challenges in incorporating the tool into the primary care visit (31%). Patients expressed a favorable view of the service, sharing an openness to being screened more regularly (75%) and a desire to have screenings performed at Western Maine Primary Care going forward (81%). Patients were generally favorable about their experience with the new DR screening technology. Providers indicated challenges due to the limited availability of trained medical assistant photographers during the initial implementation of DR screening, as well as timing issues in coordinating screening with regular office appointments. This study supports further investigation of this technology in primary care, particularly in areas with challenges to care access. The potential benefits of this innovative tool in caring for people with diabetes includes improving access to retinopathy screenings and supporting wider detection of vision-threatening retinopathy.

Advance directive screening among veterans with incident heart failure: Comparisons among people aging with and without HIV

BackgroundHeart failure (HF) is common among people aging with HIV (PWH) and without HIV (PWoH). Despite the poor prognosis for HF, advance directives (AD) completion is low but has not been compared among PWH and PWoH. ObjectivesDetermine the prevalence and predictors of AD screening among PWH and PWoH with incident HF. MethodsWe included Veterans with an incident HF diagnosis code from 2013–2018 in the Veterans Aging Cohort Study (VACS) without prior AD screening. Health records were reviewed for AD screening note titles within -30 days to 1-year post-HF diagnosis. Analyses were stratified by HIV status. Trends in annual AD screening were evaluated with the Cochran-Mantel-Haenszel test. The associations of AD screening with demographics, disease severity (Charlson Comorbidity Index, VACS 2.0 Index), and healthcare encounters (cardiology, palliative care, hospitalization) were evaluated with Cox proportional hazards regression. ResultsHF was diagnosed in 4516 Veterans (28.2% PWH, 71.8% PWoH). Annual AD screening rates increased in both groups (Ptrend<0.0001) and aggregate rates were higher among PWH than PWoH (53.5% vs. 48.2%, p=.001). In both groups, the likelihood of AD screening increased with greater disease severity, palliative care contact, and hospitalization (HR range=1.04–3.32, all p≤.02) but not with cardiology contact (p≥.53). ConclusionsAD screening rates after incident HF remain suboptimal but increased over time and were higher in PWH. Future quality improvement and implementation efforts should aim for universal AD screening with incident HF diagnosis, initiated by providers skilled in discussing AD, including in the cardiology subspecialty setting.

Hepatitis C Virus Screening among Baby Boomers: The Positive Benefits of Health Education and Outreach during the COVID-19 Pandemic.

In 2019, 2020, and 2021, Sendero Health Plans, an ACA health insurance company, implemented Hepatitis C Virus (HCV) health education and outreach screening campaigns. Chi-square goodness-of-fit and tests of independence were performed to assess and compare the uptake of HCV screening among baby boomers in 2019, 2020, and 2021. In 2019, 2020, and 2021, 17.9% (308/1,718), 10.9% (93/852), and 8.5% (37/435) of eligible members were screened, respectively. Individuals were more likely to be screened for HCV in 2019 than in 2020 and 2021 (p < 0.0001). In 2019, 2020, and 2021, 39.9%, 26.9%, and 48.6% of annual screenings occurred during the health campaign months, respectively. Annual HCV screening rates were lower during the COVID-19 pandemic period than in the pre-pandemic cohort. However, screening rates during the months of outreach and education contributed to nearly 50% of annual screenings in the pandemic year 2021, thus representing a positive impact on preventive screening uptake despite the pandemic. Missed screening opportunities affect HCV transmission, diagnosis, and treatment. Yet, health education and outreach continue to work, even during a pandemic.

Abstract B018: A community intervention for increasing screening through engaging primary care providers (I-STEP)

Abstract Background: While lung cancer is a leading cause of death in the U.S., annual lung cancer screening (LCS) rates remain low at 12.7%. The WUSTL research group began a community intervention to increase LCS called I-STEP (Increasing Screening Through Engaging Primary Care Providers) to address this quality gap. A customizable Toolkit was administered to a collaborative of six hospital systems in Missouri and Illinois, encompassing LCS eligibility and follow up guidelines, navigating LCS referral, and smoking cessation. The COVID-19 pandemic prompted brief suspension of screening, with lingering effects on LCS delivery and I-STEP implementation. Methods: This was a step-wedged cluster randomized control trial from January 2019 – March 2021. Six hospital systems sequentially entered a three-month training phase, followed by I-STEP implementation into primary care settings. Primary outcomes were mean number of screenings and mean percent change in LCS from baseline. Data were collated into a dashboard. Analyses compared outcomes within I-STEP sites pre- and post- intervention. To investigate whether I-STEP sites recovered screening numbers during the pandemic, we compared I-STEP sites to six comparator hospitals within the collaborative that did not participate in the intervention. Results: Mean LCS increased by 63% amongst I-STEP sites (130.8 to 212). Mean screenings increased significantly from pre- to post-intervention phases within I-STEP sites (p = 0.0272). Across I-STEP sites and comparator hospitals, mean LCS increased significantly following emergence of the pandemic in March 2020 (p = 0.0002, LSM difference -72.0, 95% CI [-100.9, -43]) - data adjusted for the three-month period in which LCS was suspended. Findings were similar for mean percent change in LCS. There was no difference in outcomes between I-STEP and comparator sites. Conclusion: I-STEP implementation successfully increased mean LCS from pre-intervention baseline. Findings suggest a possible effect of the I-STEP intervention in promoting increased LCS amidst the pandemic. Citation Format: Sydney Beache, Michelle Silver, Jingxia Liu, Aimee James, Graham Colditz, Courtney Harriss. A community intervention for increasing screening through engaging primary care providers (I-STEP) [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B018.

The effect of screening on the health burden of chlamydia: An evaluation of compartmental models based on person-days of infection.

Sexually transmitted diseases (STDs) are detrimental to the health and economic well-being of society. Consequently, predicting outbreaks and identifying effective disease interventions through epidemiological tools, such as compartmental models, is of the utmost importance. Unfortunately, the ordinary differential equation compartmental models attributed to the work of Kermack and McKendrick require a duration of infection that follows the exponential or Erlang distribution, despite the biological invalidity of such assumptions. As these assumptions negatively impact the quality of predictions, alternative approaches are required that capture how the variability in the duration of infection affects the trajectory of disease and the evaluation of disease interventions. So, we apply a new family of ordinary differential equation compartmental models based on the quantity person-days of infection to predict the trajectory of disease. Importantly, this new family of models features non-exponential and non-Erlang duration of infection distributions without requiring more complex integral and integrodifferential equation compartmental model formulations. As proof of concept, we calibrate our model to recent trends of chlamydia incidence in the U.S. and utilize a novel duration of infection distribution that features periodic hazard rates. We then evaluate how increasing STD screening rates alter predictions of incidence and disability adjusted life-years over a five-year horizon. Our findings illustrate that our family of compartmental models provides a better fit to chlamydia incidence trends than traditional compartmental models, based on Akaike information criterion. They also show new asymptomatic and symptomatic infections of chlamydia peak over drastically different time frames and that increasing the annual STD screening rates from 35% to 40%-70% would annually avert 6.1-40.3 incidence while saving 1.68-11.14 disability adjusted life-years per 1000 people. This suggests increasing the STD screening rate in the U.S. would greatly aid in ongoing public health efforts to curtail the rising trends in preventable STDs.

Breaking Down Barriers and Addressing Mental Wellness in Pediatric Sickle Cell Patients

Sickle cell disease is an inherited hemoglobinopathy that is characterized with multi-organ involvement and frequent pain crises. Over the last two decades, a growing body of clinical evidence has pointed out that these somatic complaints can give rise to neuropsychiatric disorders, among which anxiety and depression are the most common, that worsen the health-related quality of life of these patients. Mood disorders can in turn increase fatigue and pain through a psychosomatic component. Although mental health is deemed to play an important role in their health outcomes, at this time, we don't have standardized approach to screening sickle cell patients for depression at most sickle cell centers across the country and at Texas Children's Hospital(TCH). The objective of this Quality Improvement (QI) study is to increase the annual depression screening rate from 0 to 50% in English/Spanish speaking patients who are 12 years and older with an established diagnosis of Sickle Cell Disease (SCD) who present for follow-up care to the Texas Children's Hospital - West Campus (TCH-WC). Our QI project consisted of three distinct PDSA cycles. Prior to the start of the first PDSA cycle, we did not have a streamlined approach for depression screening. The physician team would verbally screen for depression and Social Work was consulted as needed. During our first PDSA cycle, a clinical psychologist was integrated into our monthly Hematology-Pulmonary Joint Clinic and all patients with SCD who presented to Joint Clinic were assessed for depression by the psychologist as part of the psychological evaluation. During the second PDSA cycle, all patients with SCD over the age of 12 who presented to Joint Clinic (with psychologist present) were given the Patient Health Questionnaire-9 modified for Adolescents (PHQ-A) by the Medical Assistant prior to the start of the medical appointment. After the physician team completed their visit, the psychologist addressed concerns raised on the PHQ-A, completed the psychological evaluation and provided appropriate intervention. During the third and final PDSA cycle, the PHQ-A was given to all patients with SCD above the age of 12 who presented to hematology clinic (including those outside of Joint Clinic during which the psychologist was not present). During this cycle, the MA gave the patient the PHQ-A at the start of the visit. The MA then followed an outlined and detailed algorithm. If patient scored 0-6 on the PHQ-A, no intervention was performed. If patient scored 7-9 on the PHQ-A, psychological resources were provided via handout. If patient scored > 10 on the PHQ-A, Social Work referral was placed and patient was preferably seen same day. If patient screened positive for suicide, an urgent Social Work referral was made and patient was seen same day prior to leaving clinic for further evaluation. During our first PDSA cycle, 19 patients above the age of 12 presented to Joint Clinic. Seventeen patients were seen by the psychologist. Twenty-four percent (4/17) of patients were given the PHQ-A; 50% of patients screened positive. Twenty-four percent (4/17) of patients were referred for outpatient follow-up with psychology. During our second PDSA cycle, 14 patients above the age of 12 presented to Joint Clinic. Ninety-three percent (13/14) of patients were given the PHQ-A; 7% (1/14) of patients screened positive for depression. Twenty-one percent (3/14) of patients were referred for outpatient follow-up with psychology. During our third PDSA cycle, 54 patients above the age of 12 presented to Hematology Clinic. Eighty percent (43/54) of eligible patients were given the PHQ-A. Fourteen percent of patients endorsed mild symptoms of depression; 23% of patients endorsed moderate to severe symptoms of depression; 23% of patients endorsed suicidal ideation. Eighty percent of patients with moderate to severe depression received same day Social Work Assessment. One hundred percent of patients with suicidal ideation received same day Social Work assessment. During the first three PDSA's cycle of our project, we achieved our goal of screening greater than 50% of eligible patients with SCD and providing same day intervention. In the future, we will need to examine if there are any downstream effects that negatively impact the clinic flow while administering the questionnaire. We also hope to expand screening for all patients with SCD over the age of 12 across Texas Children's Hospital campuses.

Cervical cancer screening and outcomes for women under 25 years of age in Belgium: a 10-year nationwide study.

The aim of the study was to describe trends in cervical cancer screening and outcomes for women under 25 years of age in Belgium between 2010 and 2019 in response to a changed reimbursement policy. We used the databases of the National Health Insurance Institute (RIZIV/INAMI) and the Belgian Cancer Registry (BCR) for a nationwide description of cervical screening, subsequent diagnostic procedures and outcomes for women younger than 20 years and women aged 20-25 years between 2010 and 2019. Over a 10-year period, the number of cytology screening tests and annual screening rates in women younger than 25 years have been reduced by 50%, but no increases in invasive cervical cancer or high-grade intraepithelial lesion diagnoses were observed. The major determinant of this decreased overscreening has been the limitation of reimbursement in 2013 to once every 3 years instead of once every 2 years. In women aged 25-29 years, there is no increase in invasive cervical cancer diagnoses after decreased screening of women younger than 25 years. To detect 29 invasive cervical cancers in women younger than 25 during the 10-year study period, a total of 5606 conizations were performed and 43 million EUR of Belgian health insurance budget was spent. Since the cost of hospitalization, sickness leave and negative psychological impact were not included in our estimation, these costs are underestimated. Incidence of cervical cancer in women under 25 years remains low and screening is not effective in preventing cervical cancer, although there is clear evidence of potential reproductive harm and financial cost. We state that restricting reimbursement of cervical cancer screening before the age of 25 will improve guideline adherence and decrease healthcare expenditures without negatively impacting the health of the population.