Initial Care Research Articles

Screening for Eye Disease in Ebola Virus Disease Survivors: Program Implementation During an Active Outbreak in the North Kivu and Ituri Provinces, Democratic Republic of the Congo.

First identified in the Democratic Republic of the Congo (DRC, formerly Zaire) in 1976, Ebola virus disease (EVD) outbreaks have afflicted thousands of Congolese over the past several decades. The nation's largest outbreak of EVD in 2018-2020 was complicated by security challenges as well as large case numbers across an expansive geographic region. These factors provided challenges for logistical considerations as well as clinical coverage. In conjunction with the EVD survivor care program spearheaded by the Ministry of Health in DRC, the DRC Intitut National de Recherche Biomédicale, (DRC Institut National de Recherche Biomedicale, DRC National Institute of Biomedical Research) and others, we launched a multidimensional effort to provide ophthalmic care to EVD survivors. During the engagement period, 237 EVD survivors were screened, 56% of which were women. The 237 EVD survivors constituted ∼75% of the total EVD survivors who were discharged at the time of the intervention. The mean time from EVD symptom onset to evaluation was 4.6 months ± 1.8 SD (range: 24d to 8.5mo). Ninety-seven (41%) of EVD survivors screened reported ocular symptoms during or after acute illness, such as itchy eyes (49%), eye pain (25%), and tears (24%). Ophthalmic findings, including retinal scarring, active uveitis, dry eye disease, cataracts, and glaucoma, were also identified. The need for continued monitoring and longitudinal care for EVD survivors is evident from the expanding body of literature pertaining to post-acute sequelae, including ophthalmic manifestations. Initiatives for such care should be conducted across and in conjunction with multidisciplinary stakeholders for contextualization and effectiveness.

Improving goal-concordant care via a uniquely collaborative and multi-site PFAC model.

265 Background: Studies reveal a mismatch between the goals of care (GOC) of cancer patients and actual care received. The 10 members of the Alliance of Dedicated Cancer Centers (ADCC) convened the Improving Goal Concordant Care (IGCC) initiative to address system gaps. IGCC was led by palliative care and oncology experts, with guidance from patient and family advisors. Uniquely, the advisors were identified from patient family advisory councils (PFAC) at each center, forming a collaborative Advisory Group (AG) with the lived experience of each center and the knowledge of advocating for the patient/family voice locally. Methods: PFAC members were recruited from each site to serve on the AG. The 19 member AG met quarterly, with minutes shared with the IGCC oversight group, the Implementation Workgroup (IWG). In September 2023, all AG members were surveyed about perceptions of PFAC engagement and local impact of IGCC. In May 2024, 20 IWG members were surveyed about implementation successes and barriers, including items related to PFAC engagement. Results: AG evaluation and recommendations altered IGCC planned core implementation and evaluation actions meaningfully; for example in 1) selection of structured fields in electronic health record (EHR) and universally accessible GOC documentation and in 2) centering patients in the GOC measure set, including incorporating “Heard & Understood” survey into IGCC evaluation. Other AG guidance around direct patient engagement readiness for GOC conversations and implementing patient GOC surveys was left to individual sites to consider with variable adoption. AG Survey: 63% response rate. 80% noted that the GOC program was discussed with their local PFAC and 92% experienced changed routine patient care after GOC implementation. IWG Survey: 100% response rate. 68% agreed that their center sought guidance from their PFAC during GOC implementation and that leadership presented to their PFAC about their GOC implementation. 26% indicated reporting data to their PFAC; of those that did, 80% agreed that this positively impacted their GOC implementation. Conclusions: While PFACs are occasionally included in quality interventions, this model centered the patient/family voice by supporting a PFAC stakeholder feedback loop working collaboratively and locally to support implementation and evaluation of IGCC objectives. While not all AG recommendations were formally integrated into IGCC, all were considered and many adopted at individual centers. Despite ongoing IGCC-level involvement, center-specific engagement of PFACs varied. Future efforts can track this during process evaluation as local PFAC engagement was highly valued. Consensus building for national best practice implementation and evaluation by recruiting local experts including PFAC members into national collaborative efforts is a successful model for local change.

Who, what, where, when, and how: IPOS legacy and future directions

Abstract The International Psycho-Oncology Society (IPOS) has played a pivotal role in the integration and advancement of psychosocial care within oncology. Cancer diagnosis is just one of many stressors for patients, but those with mental health disorders, especially depression or anxiety, struggle disproportionately. Despite evidence for empirically supported psychological treatments and supportive care initiatives, the global visibility of psychosocial oncology is low in countries having the greatest need. Forecasts of cancer incidence and mortality suggest that more than two-thirds of the world's cancers will occur in low-income and middle-income/resource countries (LMRCs) within the next 15 years. Having multiple economic, institutional, and governmental/political barriers, LMRCs have not benefited from extensive research and psychosocial care integration seen in higher resource countries. But importantly, IPOS can leverage its global position and network to lead and support the inclusion of psychosocial care into national LMRC cancer plans and facilitate within-country research development and mentorship. The future requires awareness and leadership to build a global psychosocial infrastructure to improve quality of life for all affected individuals.

Global Health Security in Vision Care: Health Systems Strengthening During Ebola Virus Disease Outbreak Responses.

During the last decade, global health security has been threatened by major Ebola virus disease outbreaks in Western Africa (2014 to 2016) and in eastern Democratic Republic of the Congo (2018 to 2020). Particularly in Western Africa, the outbreak initially overwhelmed health care capacity in already fragile health systems. Thousands of survivors were at risk of newly recognized postacute ocular complications, and their need for urgent ophthalmic care challenged national vision health systems with scarce eye care services. In these unprecedently large outbreaks with implications for global health security, agile eye care responses were challenging, including in regard to decision coordination and requisite logistical needs. In this report, we detail vision care initiatives implemented in response to these outbreaks and highlight the need to include vision care as a critical component of the response to infectious disease outbreaks with eye health implications.

Maternal Prenatal Cannabis Use and Child Autism Spectrum Disorder

Despite an increase in maternal prenatal cannabis use and associations with adverse neonatal outcomes, research on child neurodevelopmental outcomes is limited. To evaluate the association between maternal cannabis use in early pregnancy and child autism spectrum disorder (ASD). This population-based retrospective birth cohort study included children born between 2011 and 2019 to pregnant Kaiser Permanente Northern California members screened for prenatal cannabis use during pregnancy. Statistical analysis was conducted February 2023 to March 2024. Maternal prenatal cannabis use was assessed at entrance to prenatal care (approximately 8- to 10-weeks' gestation) via self-report and/or positive urine toxicology test. Use frequency was assessed. Child ASD was defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis codes ascertained from the electronic health record. Associations between maternal prenatal cannabis use and child ASD were modeled using Cox proportional hazards regression adjusted for maternal sociodemographic, other substance use and disorders, prenatal care initiation, comorbidities, and clustering among maternal siblings. The study cohort included 178 948 singleton pregnancies among 146 296 unique pregnant individuals, including 48 880 (27.3%) Asian or Pacific Islander, 42 799 (23.9%) Hispanic, 9742 (5.4%) non-Hispanic Black, and 70 733 (39.5%) non-Hispanic White pregnancies. The median (IQR) maternal age at pregnancy onset was 31 (6) years; 8486 (4.7%) screened positive for cannabis use, 7054 (3.9%) via urine toxicology testing and 3662 (2.0%) by self-report. In the total study population, the frequency of self-reported use was monthly or less for 2003 pregnancies (1.1%), weekly for 918 pregnancies (0.5%), daily for 741 pregnancies (0.4%), and unknown for 4824 pregnancies (2.7%). ASD was diagnosed in 3.6% of children. After adjustment for maternal characteristics, maternal prenatal cannabis use was not associated with child ASD (hazard ratio [HR], 1.05; 95% CI, 0.84-1.32). When self-reported frequency of use was assessed, no statistically significant associations were observed after confounder adjustment. No sex-specific associations were documented (males: HR, 1.01; 95% CI, 0.77-1.32; and females: HR, 1.19; 95% CI, 0.77-1.85). In this cohort study, maternal cannabis use assessed in early pregnancy was not associated with child ASD. Additional studies are needed to evaluate different patterns of use throughout pregnancy. Given the known adverse neonatal health effects of maternal prenatal cannabis use, clinicians should follow national guidelines and advise against use.

S871 Utilization of Gastrointestinal Procedures Before and After Palliative Care Initiation: A TriNetX Database Analysis

S871 Utilization of Gastrointestinal Procedures Before and After Palliative Care Initiation: A TriNetX Database Analysis

Quality improvement scorecards driving innovation and best practice in a large community oncology practice.

417 Background: Lean Six Sigma Visual Management dashboards, or scorecards, are visual tools designed to drive and improve quality patient care, operationalize best practices, and promote a culture of operational excellence. Practice scorecards create a disciplined problem-solving culture where root causes are identified, and systemic process-based improvements are implemented. Scorecards are created to show full practice data transparency, allowing all employees and sites to see each other’s data. Scorecards are designed so that providers can efficiently review the maximum amount of data, following a Green, Yellow, Red visual cue to signify goal adherence. Methods: Phase 1 (2018 – 2019): Clinical scorecards were created and introduced to all staff on a weekly basis focusing on a few key patient metrics (ex: pain scale, pain care plan, ACP, PHQ-9, teaching/consents, patient portal access). Phase 2 (2020 – 2022): Clinical scorecards were expanded with additional patient care initiatives. New nurse navigator scorecards created (ex: patient teaching and survivorship visits). New physician and APP scorecards created with practice-specific provider metrics. Phase 3 (2023 – 2024): Scorecards updated yearly to match practice quality initiatives. New dashboards for non-clinical employees initiated. Physician and APP compensation changed to include quality metric performance tied to financial incentive. Results: Over the course of 5 years, OHC quality scorecard metrics improved from below national averages (red) to exceeding top-tier threshold goals (green). Scorecard utilization increased across all areas of the business, expanding from one scorecard in 2018 to eight in 2024. Scorecards increased overall practice data transparency leading to increase practice quality metric performance. OHC staff utilize scorecards on a weekly, monthly, and quarterly basis to drive quality improvement adherence. Improved outcomes through full data transparency increased staff participation and ownership in quality metrics and led to achieved shared savings in managed care programs. Example of metrics and results: Patient NCCN Staging 36% (2588/7263) to 96% (10299/10749), Teaching/Consents 37% (423/1147) to 97% (3067/3160), and Oral regimen NCCN entry 69% (586/845) to 98% (1037/1055). Conclusions: Visual Management dashboards or practice scorecards are instrumental in driving and supporting practice change. Scorecards allowed OHC staff to efficiently visualize practice-wide actionable data with eye-catching colors to promote optimal clinical performance. As increased data procurement is on the rise, practices can empower their staff to drive change through data utilization. OHC’s scorecards have proven to bridge the gap to goal, facilitate transparent data sharing, and empower providers and staff toward collaboration and embracing operational excellence.

Patient delay, diagnosis delay, and treatment outcomes among migrant patients with tuberculosis in Shanghai, China, 2018-2020: a mixed-methods study

ObjectivesThis study aimed to examine patient delay, diagnosis delay and treatment performance among patients with tuberculosis (TB) in Shanghai, China in 2018–2020 focusing on disparities between migrant and local patients...

Причины задержки в оказании своевременной медицинской помощи пациентам с синдромом диабетической стопы

Nоwadays diabetes mellitus (DM) and its cоmplicatiоns becоme a glоbal burden, leading tо enоrmоus cоsts оf treatment and time expenditures оn diagnоstics and healing. The mоst cоmmоn symptоm оf DM prоgressiоn is diabetic fооt syndrоme (DFS) and fоrmatiоn оf chrоnic wоunds, fоrcing patients tо attend a surgeоn. Tо evaluate hоw patients respоnd tо early signs оf fооt prоblems and discоver leading delay factоrs оf initial treatment a special questiоnnaire was used in the research. A survey оf patients with DFS was cоnducted at the оutpatient clinic. Each male patient with DM and DFS was оffered tо fill up a fоrm with cоnsecutive questiоns оf his/her present health, chrоnic diseases, undergоne surgeries and оthers. The data оn DM presentatiоn, blооd glucоse level, medical treatment and frequency оf health examinatiоn was alsо cоllected. All data was analysed and systematized. We interviewed 30 male patients. The mean age was 59,43 ± 1,75 years. Almоst all patients had cоncоmitant cardiоvascular disease, such as hypertensiоn – 96,67 % оr ischemic cardiac disease – 63,33 %. Incidence rate оf chrоnic renal disease was 46,67 %. Mean DM duratiоn was 10,13 ± 0,67 years (range 3–17), mean glucоse level – 7,15 ± 0,23 mmоl/l (range 6,1 – 12,3). Cоmpliance tо medical treatment was high – 93,33 % (28 оf 30), thоugh adherence tо regular medical check-up was lоwer than expected – 50 %. Mоstly, chrоnic fооt wоunds have pоlygenic develоpment factоrs, such as arterial оr venоus insufficiency, trauma оr оthers. Factоrs оf late presentatiоn in patients with DFS were: 1) ignоrance оf the disease; 2) misinterpretatiоn оf symptоms; 3) "unexpected" prоgressiоn оf DM; 4) priоrity living circumstances; 5) patient's chоice оf оbservatiоn tactics; 6) refusal оf dоctоr’s help; 7) distance tо medical оrganizatiоns and different cоmbinatiоns оf described factоrs. Cоmbinatiоn оf factоrs can lead tо delays in initial DFS medical care. The identificatiоn оf factоrs оn the part оf the patient and оn the part оf the medical care system and their eliminatiоn can help reduce cоmplicatiоns and amputatiоn rate as well as treatment cоsts.

Does an Inpatient Rehabilitation Admission Via the Community Prevent Hospital Readmissions in Older Adults? An Integrated Care Initiative

Abstract Background Rehabilitation interventions are essential in supporting frail older adult’s recovery following periods of decompensation and preventing future hospitalizations. Previously patients (age > 65 years) could only access inpatient rehabilitation via an inpatient stay in an acute hospital. Within the ICT (Integrated Care Team) in Dublin North West (DNW) a community rehabilitation pathway to two inpatient rehabilitation units exists. We retrospectively evaluated patients that were admitted to rehabilitation units via this pathway and measured their 90-day readmission rate to their local acute hospital. Methods 17 referrals were received from three pathways: Primary Care, the Holly Day clinic and the Frailty Intervention Team (FITT). Clinical frailty score’s (CFS), Falls risk (as per the world falls guidelines) and sarcopenia status as per the European Consensus on the definition of sarcopenia (EWGSOP) were recorded prior to admission. Readmissions within 90 days were collected from the hospital electronic database. Results CFS scores ranged from 5 to 7. All patients were identified as a high risk of falls and sarcopenic. The 90-day readmission rate was 11%. 5.5% of these were due to falls and the other 5.5% was due to the exacerbation of a pre-existing condition. All had CFS score of >6. Conclusion Readmission to acute care is not common in our patient cohort and shows the involvement of the ICT Geriatrician and Physiotherapist in identifying and referring frail older adults for inpatient rehab is successful. Ongoing development of interagency pathways and further referrals is needed to further progress this pathway and measure its efficacy in preventing readmission to an acute hospital. A 90 day and 180 day follow up and falls risk outcome measure pre and post admission would further demonstrate the success of this initiative and help measure the efficacy of this initiative in reducing the risk of preventable hospitalizations in older adults.

Exploring implementation of intrapartum trial evidence: a qualitative study with clinicians and clinical academics

BackgroundImplementing research evidence into clinical practice is challenging. This study aim was to explore implementation of two intrapartum trials with compelling findings: BUMPES (position in second stage of labour in nulliparous women with epidural), and RESPITE (remifentanil intravenous patient-controlled analgesia). MethodsA qualitative interview study set in UK National Health Service Trusts and Universities. Purposively sampled investigators from RESPITE and BUMPES trials and clinicians providing intrapartum care: midwives, anaesthetists, and obstetricians, were recruited using existing networks and snowball sampling. Semi-structured virtual interviews were conducted. Thematic analysis was underpinned by Capability Opportunity Motivation Behaviour Change Framework.ResultsTwenty-nine interview participants across 19 maternity units: 11 clinical academics, 10 midwives, 4 obstetricians, 4 anaesthetists. Most (25/29) were aware of one or both trials. BUMPES had been implemented in 4/19 units (one original trial site) and RESPITE in 3/19 units (two trial sites). Access to sufficient resources, training, exposure to interventions, support from leaders, and post-trial dissemination and implementation activities all facilitated uptake of interventions. Some clinicians were opposed to the intervention or disagreed with trial conclusions. However competing priorities in terms of staff time and a plethora of initiatives in maternity care, emerged as a key barrier to implementation.ConclusionsCompelling trial findings were not implemented widely, and numerous barriers and facilitators were identified. Large-scale improvement programmes and evidence-based national guidelines may mean single trials have limited potential to change practice. There is a need to examine how intervention implementation is prioritised to optimise safety outcomes in the context of workforce restrictions, limited resources and large arrays of competing priorities including statutory requirements, that have increased in maternity care.

Toddler’s fracture: an updated guide on evaluation and management

Toddler’s fractures are commonly encountered in pediatric healthcare. These injuries are associated with little to no risk of fracture displacement or failure to heal, regardless of treatment modality. The standard treatment for these injuries has historically been several weeks of weightbearing restriction and immobilization in a circumferential cast or posterior splint. Over the last decade, numerous reports comparing clinical outcomes and iatrogenic complication rates between treatment modalities have emerged, revealing a concerning trend of higher rates of skin breakdown in patients treated with traditional management compared to those treated with removable walking boot immobilization or no immobilization. Current management practices for toddler’s fractures vary widely with respect to both initial and follow-up care, reflecting a need for additional guidance on this topic. This review provides an updated, evidence-based review of evaluation and management strategies for the toddler’s fracture.

Clinical Assessment and Management of Acute Spinal Cord Injury.

The information contained in this article is suitable for clinicians practicing in the United States desiring a general overview of the assessment and management of spinal cord injury (SCI), focusing on initial care, assessment, acute management, complications, prognostication, and future research directions. SCI presents significant challenges, affecting patients physically, emotionally, and financially, with variable recovery outcomes ranging from full functionality to lifelong dependence on caregivers. Initial care aims to minimize secondary injury through thorough neurological evaluations and imaging studies to assess the severity of the injury. Acute management prioritizes stabilizing respiratory and cardiovascular functions and maintaining proper spinal cord perfusion. Patients with unstable or progressive neurological decline benefit from timely surgical intervention to optimize neurological recovery. Subacute management focuses on addressing common complications affecting the respiratory, gastrointestinal, and genitourinary systems, emphasizing a holistic, multidisciplinary approach. Prognostication is currently based on neurological assessments and imaging findings, but emerging biomarkers offer the potential to refine outcome predictions further. Additionally, novel therapeutic interventions, such as hypothermia therapy and neuroprotective medications are being explored to mitigate secondary damage and enhance recovery. This paper serves as a high-yield refresher for clinicians for the assessment and management of acute spinal cord injury during index admission.

The impact of delays in transfer to specialist rehabilitation on outcomes in patients with acquired brain injury.

To determine the effect of time waiting for admission to inpatient neurorehabilitation following acquired brain injury on rehabilitation outcomes. A retrospective observational case series. A specialist brain injury inpatient rehabilitation service. Consecutive 235 admissions to specialist brain injury rehabilitation following acutely-acquired brain injury between 2019 and 2022. Waiting time from the point of injury to admission, diagnostic category, admission complexity (patient categorisation tool), functional status (functional independence measure/functional attainment measure), care needs (Northwick Park Care Needs Assessment), change in functional status and care needs over duration of admission (efficiency). Subgroup analysis was performed for patients with a tracheostomy, enteral feeding, anticonvulsant treatment and prior neurosurgery. There was no relationship between admission wait and initial complexity (rs = 0.006; p = 0.923), functional status (rs = -0.070; p = 0.284) or care needs (rs = 0.019; p = 0.768). Longer waiting times were significantly associated with reduced efficiency of rehabilitation (rs = -0.240; p = 0.0002) and change of care needs (rs = -0.246; p = 0.0001). Longer waits were associated with reduced rehabilitation efficiency for patients prescribed anticonvulsants (n = 115; rs = -0.243; p = 0.009), with a tracheostomy (n = 46; rs = -0.362; p = 0.013), requiring enteral nutrition (n = 137; rs = -0.237; p = 0.005) or having had intracranial surgery (n = 97; rs = -0.344; p = 0.0006). There was a negative association between waiting times and reduction in care needs for patients admitted on anticonvulsants (rs = -0.319; p = 0.0005) and requiring enteral nutrition (rs = -0.269; p = 0.001). Longer wait for transfer to rehabilitation following brain injury is associated with reduced improvement in functional status and care needs over time. Attention should be given to ensuring rapid transfer into inpatient rehabilitation services.

Current Advances in Patient-Perceived Quality Assessment Within Romanian Healthcare.

The global healthcare landscape is shifting toward patient-centered care, emphasizing the integration of patient feedback into service delivery. Romania, aligning with this trend, has implemented patient-perceived quality assessment tools to enhance healthcare services and better meet patient needs and expectations. This study aims to review comprehensively the implementation and impact of these tools in Romania, focusing on their role in improving healthcare quality. By examining key assessment instruments such as the Patient Satisfaction Questionnaire (PSQ), the Service Quality (SERVQUAL) model, and the Romanian Healthcare Quality Assessment Survey (RHQAS), the research seeks to understand how these tools have been used to identify areas for improvement and drive advancements in patient care. Employing a comprehensive review methodology, the study will conduct a thorough literature search to identify relevant studies, reports, and publications, analyzing the PSQ, SERVQUAL, and RHQAS in detail to understand their measurement domains, psychometric properties, and application within Romania. Additionally, qualitative data from interviews with healthcare providers and patients may be collected to offer further insights into the use and effectiveness of these tools. The study's findings are expected to provide valuable insights into the role of patient-perceived quality assessment tools in enhancing healthcare in Romania, identifying strengths, weaknesses, and opportunities for improvement. The results will highlight the effectiveness of combining international methodologies with localized adaptations to address the specific needs of the Romanian healthcare system, ultimately contributing to the ongoing efforts to improve patient satisfaction and health outcomes by informing the development and refinement of patient-centered care initiatives in Romania.

The Effect of Baby Friendly Neonatal Intensive Care Initiative on Exclusive Breastfeeding Rates following Discharge in Very Preterm Infants.

We aimed to investigate the effect of "Baby Friendly NICU" practice on exclusive breastfeeding rates following discharge in very preterm infants. The Baby-Friendly Hospital Initiative (BFHI) is a global program launched by the World Health Organization (WHO) and UNICEF. The feeding technique, type of nutrition (breastfeeding, formula, mixed) and anthropometric measurements of the very preterm infants (≤32 gestational weeks) were recorded for every month following discharge up to corrected 6months of age. Exclusive breastfeeding rates were compared between 2 periods before "Baby Friendly NICU" practice (group 1) and after (group 2). Data of 252 infants, 135 in group 1 and 117 in group 2 were analyzed. Exclusive formula feeding rates decreased by 6months age in group 2 (46 vs. 32%, P =.02); however, exclusively breastfeeding rates did not changed significantly (20% vs. 29%, P =.14). Baby friendly NICU practices significantly decreased formula feeding rates at 6months; however, it did not have an effect on exclusive breastfeeding rates at any time point during follow-up probably due to small sample size.

When and why does motor preparation arise in recurrent neural network models of motor control?

During delayed ballistic reaches, motor areas consistently display movement-specific activity patterns prior to movement onset. It is unclear why these patterns arise: while they have been proposed to seed an initial neural state from which the movement unfolds, recent experiments have uncovered the presence and necessity of ongoing inputs during movement, which may lessen the need for careful initialization. Here, we modeled the motor cortex as an input-driven dynamical system, and we asked what the optimal way to control this system to perform fast delayed reaches is. We find that delay-period inputs consistently arise in an optimally controlled model of M1. By studying a variety of network architectures, we could dissect and predict the situations in which it is beneficial for a network to prepare. Finally, we show that optimal input-driven control of neural dynamics gives rise to multiple phases of preparation during reach sequences, providing a novel explanation for experimentally observed features of monkey M1 activity in double reaching.

Abstract B132: Access to palliative care for individuals with cancer experiencing homelessness

Abstract Introduction Persons experiencing homelessness (PEH) face significant disparities in health outcomes and access to healthcare, including cancer-related and end-of-life care. PEH are less likely to receive age-appropriate cancer screening, more likely to be diagnosed with cancer at later stages, and more likely to die secondary to cancer compared to the general population. Qualitative research has demonstrated that PEH and the providers who care for them perceive gaps in access to palliative care, largely due to a lack of palliative care programs that cater to the specific needs of PEH. However, less is known about how medical providers’ referral patterns affect access to care. Providers may be less likely to refer PEH to palliative care services because of these known gaps in access, exacerbating existing disparities. The purpose of this study was to quantify the rates of palliative care referrals and outpatient palliative care visits along with time to initial palliative care referral and ambulatory palliative care visit. We hypothesized that PEH would be referred to palliative care at lower rates and have longer intervals to palliative care follow-up as compared to their housed counterparts. Methods A retrospective analysis was performed on patients with cancer admitted to an academic center’s medical oncology service between July 2022 and June 2023. Patients were stratified into two groups based on their housing status: housed and PEH. A comparative quantitative analysis was conducted between these groups. Results 1166 patients with cancer were admitted to the medical oncology service during the one-year study period. The mean age of the cohort was 61.0 years and 46.7% were female. Seventeen (1.4%) PEH and 1149 (98.6%) patients who were housed were identified. Among PEH, five (29.4%) were referred to ambulatory palliative care or received an inpatient consult to palliative care. Among patients who were housed, 362 (31.5%) were referred to ambulatory palliative care or received an inpatient consult to palliative care. Two (11.8%) PEH attended an ambulatory palliative care appointment compared to 183 (15.9%) patients who were housed. The mean number of days to first palliative care or hospice referral/consult was 25.5 in PEH and 43.9 in patients who were housed. The mean number of days to first ambulatory palliative care visit was 131 in PEH and 83.7 in patients who were housed. Conclusion The frequency of inpatient and ambulatory palliative care referrals was comparable between the two groups, suggesting that PEH are appropriately referred to palliative care. However, PEH had longer intervals from cancer diagnosis to first outpatient palliative care visit, suggesting that additional supports may be needed to ensure PEH can access outpatient follow-up. While this quantitative study is underpowered to detect statistically significant differences, it highlights a potential area for further study to develop interventions to better support PEH to achieve timely follow-up with ambulatory palliative care and hospice services after referral. Citation Format: Brandon A. Bellen, Katarina Leyba, Amanda V. Johnson, Eric Grimm, Erin Bredenberg. Access to palliative care for individuals with cancer experiencing homelessness [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 B132.

Abstract B135: Association of residential economic and racial segregation with metastatic disease at diagnosis in pediatric patients with solid tumors

Abstract Background: Disparities in pediatric cancer outcomes by race and ethnicity may be influenced by neighborhood characteristics, particularly residential economic and racial segregation. Prior to a new cancer diagnosis, pediatric patients are vulnerable to structural barriers embedded in their neighborhoods. In particular, residential economic and racial segregation may impede access to initial care for early cancer detection, increasing the likelihood of presenting with distant metastatic disease at diagnosis that can translate to excess morbidity and mortality. This study assesses the association of residential economic and racial segregation as measured by the Index of Concentration at the Extremes (ICE) with the likelihood of presenting with distant metastatic disease (as compared to local or locoregional disease) among children newly diagnosed with cancer. Methods: We studied a cohort of pediatric patients diagnosed with solid tumors at Children’s Healthcare of Atlanta between 2010 and 2016. Patients’ ZIP codes were linked to the ICE, which was constructed at the ZIP code level using American Community Survey 2012-2016 five-year estimates. The ICE was categorized into tertile 1 (most deprived) through tertile 3 (most privileged). Multivariable logistic regression models were used to assess the association between residential economic and racial segregation, defined by tertiles of the ICE, and the likelihood of presenting with distant metastatic disease, as determined by initial cancer staging. All models adjusted for patient- and disease-level covariates, including age, sex at birth, health insurance type, and cancer type. Results: Among 829 patients identified in our analytic sample, 27.6% had distant metastatic disease at diagnosis. Living in the most deprived (ICE tertile 1) versus the most privileged (ICE tertiles 2/3) neighborhoods was significantly associated with a higher likelihood of presenting with distant metastatic disease at diagnosis (adjusted odds ratio [OR] = 1.46; 95% confidence interval [CI] = 1.03 to 2.07; p=0.03). Additionally, non-Hispanic Black patients living in the most deprived neighborhoods were more likely to have distant metastatic disease at diagnosis compared to non-Hispanic White patients living in the most privileged neighborhoods (adjusted OR = 1.83; 95% CI = 1.15 to 2.92; p=0.002). Conclusion: This study provides new insights into how residential economic and racial segregation is associated with metastatic disease at diagnosis among children presenting with a new solid tumor. Our findings highlight the need for geographically targeted interventions to improve community care, resource allocation and investment, and public policies aimed at supporting this vulnerable patient population. Citation Format: Alexandra Cathcart, Sharon M. Castellino, Lu Zhang, Karen Wasilewski-Masker, Andrew L. Hong, Heeju Sohn, Xu Ji. Association of residential economic and racial segregation with metastatic disease at diagnosis in pediatric patients with solid tumors [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 B135.

Culture, tradition and healthcare: exploring the Kisiizi Community Health Insurance scheme

In southwestern Uganda, a custom of health and social support has been managed through collective organizations known as engozi for centuries. Subscribers advanced help for those who were not able to provide for themselves and their households. Participants pooled financial and food resources, offered emotional assistance, and aided in transporting patients to hospitals. The institution of “free government health amenities” caused the decline of the engozi custom. However, with an insufficient annual health sector budget allocation, the state health services cannot satisfactorily meet the needs. The Kisiizi neighborhood, while depending on the engozi practice, arrived at a CHI system in 1996 as a self-help innovation to eliminate financial obstacles and enhance access to quality health amenities. Numerous studies on CHI have examined the structure, registration and memberships, health-related advantages, and monetary-related benefits, but little has been documented on how cultural beliefs and customs have affected its application. This study aimed to identify the role of culture and customs in tackling healthcare disparities via a CHI strategy. This study adopted a case study methodology and qualitative methods. The study utilizes Woolcock’s social capital theory and Cultural competence theory as the analytical framework. It identifies Brotherhood, Solidarity, Belonging, Cooperation, Volunteering, Reciprocity, and Respect for Authority and Leaders as key values upheld by the engozi tradition, strengthening social capital and laying a solid foundation for successful CHI. This study also identified that societal values and traditions have significantly impacted the implementation of the Kisiizi CHI scheme, as evidenced by the influence on CHI leadership and governance, collecting premium fees from subscribers, mobilization and registration of participants, and information dissemination. Lastly, the study identified that CHI has positively affected healthcare challenges within the community, evidenced by increased utilization of healthcare services, improved access to antenatal care, health promotion and disease prevention initiatives, and improved quality of services due to user feedback.