Center Affiliation Research Articles

Social determinants of health and treatment center affiliation: analysis from the sickle cell disease implementation consortium registry

BackgroundAdults with sickle cell disease (SCD) suffer early mortality and high morbidity. Many are not affiliated with SCD centers, defined as no ambulatory visit with a SCD specialist in 2 years. Negative social determinants of health (SDOH) can impair access to care. Hypothesis: Negative SDOH are more likely to be experienced by unaffiliated adults than adults who regularly receive expert SCD care.MethodsCross-sectional analysis of the SCD Implementation Consortium (SCDIC) Registry, a convenience sample at 8 academic SCD centers in 2017–2019. A Distressed Communities Index (DCI) score was assigned to each registry member’s zip code. Insurance status and other barriers to care were self-reported. Most patients were enrolled in the clinic or hospital setting.ResultsThe SCDIC Registry enrolled 288 Unaffiliated and 2110 Affiliated SCD patients, ages 15-45y. The highest DCI quintile accounted for 39% of both Unaffiliated and Affiliated patients. Lack of health insurance was reported by 19% of Unaffiliated versus 7% of Affiliated patients. The most frequently selected barriers to care for both groups were “previous bad experience with the healthcare system” (40%) and “Worry about Cost” (17%). SCD co-morbidities had no straightforward trend of association with Unaffiliated status. The 8 sites’ results varied.ConclusionThe DCI economic measure of SDOH was not associated with Unaffiliated status of patients recruited in the health care delivery setting. SCDIC Registrants reside in more distressed communities than other Americans. Other SDOH themes of affordability and negative experiences might contribute to Unaffiliated status. Recruiting Unaffiliated SCD patients to care might benefit from systems adopting value-based patient-centered solutions.

PP69 Health Technology Assessment And University Health Center Affiliation Agreement: Current Situation And Potential Developments In Quebec

IntroductionAccording to the Quebec law on health and social services, health technology assessment (HTA) is part of university hospital centers’ mission, together with training, research and care. However, unlike these other functions, HTA is not covered in current affiliation agreements that bind a university with academic health institutions. Université Laval and its affiliated health institutions set up a consultation committee whose mandate is to propose the terms of an agreement to specify collaboration regarding HTA between the university and its affiliated institutions. This study investigates perceptions and needs of stakeholders from Université Laval and its affiliated health institutions with respect to the HTA mission.MethodsSemi-structured interviews were conducted with four types of participants, namely university faculty members, health professionals and managers from institutions with and without HTA units, as well as external partners. Interview guides were developed based on the integrated analysis framework of Greenhalgh et al., and adapted to each group of respondents. Most interviews were conducted in groups and were facilitated by a research associate and a senior investigator. Interviews were recorded and uploaded to NVivo 1.6.2 software for codification and analysis.ResultsA total of 57 people were interviewed (nine group interviews and 35 individual interviews). Three main themes emerged, namely knowledge of HTA, factors related to the relevance of the HTA function, and organizational factors. Results showed that half of the respondents have a vague knowledge of HTA or have never heard of it. Most of the respondents agreed that the HTA function fits well with the mission of a health institution. They would accept getting involved with HTA activities at different levels if all conditions are met. Nevertheless, almost half of respondents believed that others strategies than including HTA into contracts of affiliation should be explored to regulate this function. Finally, organizational obstacles such as the lack of funding, shortage of staff and the lack of well-structured collaborations were highlighted by respondents.ConclusionsDespite recognition of the importance of the HTA function in university health centers, interventions will be required at different levels to support the development of local HTA capacity. In particular, popularization of the HTA function and collaboration networks through specific projects should be developed.

Web-Based Information on the Treatment of Dental Hypomineralization.

To categorise and evaluate the quality and readability of the web-based information about the treatment of the variety of forms of dental hypomineralization. An internet search using two different search terms regarding treating dental hypomineralization was conducted using the Google search engine. The first 100 websites from each search were analysed. Data recorded included DISCERN instrument scores, the Journal of the American Medical Association (JAMA) benchmarks, and the Health on the Net seal (HON). Flesch Reading Ease Scores (FRES), Flesch-Kincaid Grade Level (FKGL), the Simplified Measure of Gobbledygook Index (SMOG), and the Coleman-Liau index were calculated to assess readability. A search for "Treatment of hypomineralized teeth" on Google yielded 48,500 results. After excluding irrelevant websites, only 25 were evaluated based on affiliation with universities/medical centers, non-profit organizations, commercial entities, or government agencies. The majority of the content was medical facts presented as text and visuals such as images and videos. The study found that the scores for questions about the benefits and risks of treatment were low, while alternative treatments had high scores. Only one website met the HON code criteria, and a minority of websites achieved JAMA benchmarks. The readability ratings varied across different tests used in the study. Most websites had university or medical center affiliation but only partially related to the specialty. Two-thirds of websites used images. The online information was inaccurate, poor quality, and hard to read for the average person. Dental professionals should be aware of this information's quality and work to improve it.

Collaboration and growth in a large research cooperative: A network analytic approach

Research networks encourage team science and facilitate collaboration within and across research teams. While many analyses have examined the output of these collaborative networks (e.g., authorship networks, publications, grant applications), less attention has been paid to the formative phases of these initiatives. This article presents analyses of a whole-network survey of investigators participating in a new research initiative, and examines the development of collaborative ties over the network’s first year. In particular, we examine the influence of research center affiliation, seniority, and prior network experience on the number and structure of collaborative ties, including participants’ bridging and broker roles. Such analyses can inform the overall management of the project in purposefully promoting new collaboration opportunities, and may ultimately predict the number of collaborative products generated by the network members.

Assessment of price variation in colorectal cancer screening procedures at US hospitals.

6652 Background: Following the 2021 Hospital Price Transparency Final Rule, US hospitals were mandated to publish their insurer-negotiated prices. We identified factors contributing to price variability of colorectal cancer (CRC) screening procedures across the US. Methods: We compared prices of colonoscopy, flexible sigmoidoscopy, CT colonography, fecal occult blood test, fecal immunochemical test, and Cologuard across U.S. hospitals using the Turquoise dataset (N = 6,378). Psychiatric, rehabilitation, and pediatric hospitals were excluded. Prices in the top and bottom 1% were also excluded to minimize the effect of outliers. Prices were adjusted by the Medicare Geographic Price Index to account for regional variability. We then compared prices across several subgroups, including National Cancer Institute (NCI) designated hospitals, teaching hospitals, and investor owned hospitals. Significance was assessed using the Kruskal-Wallis test. To quantify price variability across insurance plans within a hospital, we defined the within-center-ratio as the 90th percentile rate at a hospital divided by the 10th percentile rate. To quantify variability across hospitals, the across-center-ratio was defined as the 90th percentile median rate across all hospitals divided by the 10th percentile median rate. Results: 1,460 hospitals reported commercial prices for colonoscopy with a median commercial price of $1,867 (IQR: $1,208 - $2,689). For colonoscopy, the within center ratio was 2.5 (IQR: 1.5 – 3.8) and the across-center ratio was 6.2. Prices for other procedures are provided in the table. Compared to non-investor owned hospitals, prices of colonoscopy ($2,082 vs $1,787, P <0.001) and flexible sigmoidoscopy ($2,022 vs $1,289, P <0.001) were significantly higher at investor owned hospitals. Furthermore, across investor classes, hospitals with >5% ownership from private equity firms had the highest median price for both colonoscopy ($2,898), and flexible sigmoidoscopy ($2,697). We did not find significant differences in price by NCI designation, academic teaching center affiliation, overall hospital mortality, overall hospital readmission rate, or urban/rural location. Conclusions: CRC screening procedure prices vary significantly both within and across hospitals. Private equity and other investor owned hospitals had significantly higher prices compared to non-investor owned hospitals. [Table: see text]

The AO spine upper cervical injury classification system: Do work setting or trauma center affiliation affect classification accuracy or reliability?

PurposeTo assess the accuracy and reliability of the AO Spine Upper Cervical Injury Classification System based on a surgeons’ work setting and trauma center affiliation. MethodsA total of 275 AO Spine members participated in a validation of 25 upper cervical spine injuries, which were evaluated by computed tomography (CT) scans. Each participant was grouped based on their work setting (academic, hospital-employed, or private practice) and their trauma center affiliation (Level I, Level II or III, and Level IV or no trauma center). The classification accuracy was calculated as percent of correct classifications, while interobserver reliability, and intraobserver reproducibility were evaluated based on Fleiss’ Kappa coefficient. ResultsThe overall classification accuracy for surgeons affiliated with a level I trauma center was significantly greater than participants affiliated with a level II/III center or a level IV/no trauma center on assessment one (p1<0.0001) and two (p2 = 0.0003). On both assessments, surgeons affiliated with a level I or a level II/III trauma center were significantly more accurate at identifying IIIB injury types (p1 = 0.0007; p2 = 0.0064). Academic surgeons and hospital employed surgeons were significantly more likely to correctly classify type IIIB injuries on assessment one (p1 = 0.0146) and two (p2 = 0.0015). When evaluating classification reliability, the largest differences between work settings and trauma center affiliations was identified in type IIIB injuries. ConclusionType B injuries are the most difficult injury type to correctly classify. They are classified with greater reliability and classification accuracy when evaluated by academic surgeons, hospital-employed surgeons, and surgeons associated with higher-level trauma centers (I or II/III).

Fate of Abstracts Presented at the Saudi Ophthalmology Society Conferences 2015-2018.

The aim of the study was to determine the publication rates of abstracts presented at the annual Saudi Ophthalmology Society (SOS) Conferences from 2015 to 2018. This is a cross-sectional study on abstracts collected from the scientific programs for the SOS meetings from 2015 to 2018. Titles and first authors' names were used in the search process on PubMed. A Chi-square test was conducted to compare between the categorical variables. Kruskal-Wallis test was used for nonnormally distributed variables. A total of 365 abstracts were presented in the SOS Conferences from 2015 to 2018. In the SOS meetings (2015-2018), the publication rate was 45.7%. Seventy-two (43.1%) of the published abstracts were published in journals with an impact factor. The mean impact factor was 1.4 ± 1.9. The median time to publication was 12.0 months (range: 0-60 months). On univariate analysis, basic science (P < 0.001), abstracts on rare diseases (P = 0.003), affiliation with eye hospitals (P < 0.001), and public hospitals (0.007) were associated with a higher publication rate. On multivariate analysis, basic science studies (odds ratio [OR]: 4.23, confidence interval [CI]: 1.77-10.12, P = 0.001), rare topic-related abstracts (OR: 2.03, CI: 1.22-3.38, P = 0.007), and eye center affiliation (OR: 1.67, CI: 1.03-2.68, P = 0.036) were associated with a better publication rate. The factors associated with publication in high impact factor journals were oral abstracts (P = 0.007) and noncase report abstracts (P = 0.023). Basic science studies, rare topic-related abstracts, and first author affiliation with an eye center were all associated with a higher publication rate. Orally presented and noncase report abstracts increased the chance of publication in higher impact factor journals.

Identifying Core Functions of an Evidence-Based Intervention to Improve Cancer Care Quality in Rural Hospitals.

Background:Rural patients experience worse cancer survival outcomes than urban patients despite similar incidence rates, due in part to significant barriers to accessing quality cancer care. Community hospitals in non-metropolitan/rural areas play a crucial role in providing care to patients who desire and are able to receive care locally. However, rural community hospitals typically face challenges to providing comprehensive care due to lack of resources. The University of Kentucky’s Markey Cancer Center Affiliate Network (MCCAN) is an effective complex, multi-level intervention, improving cancer care in rural/under-resourced hospitals by supporting them in achieving American College of Surgeons Commission on Cancer (CoC) standards. With the long-term goal of adapting MCCAN for other rural contexts, we aimed to identify MCCAN’s core functions (i.e., the components key to the intervention’s effectiveness/implementation) using theory-driven qualitative data research methods.Methods:We conducted eight semi-structured virtual interviews with administrators, coordinators, clinicians, and certified tumor registrars from five MCCAN affiliate hospitals that were not CoC-accredited prior to joining MCCAN. Study team members coded interview transcripts and identified themes related to how MCCAN engaged affiliate sites in improving care quality (intervention functions) and implementing CoC standards (implementation functions) and analyzed themes to identify core functions. We then mapped core functions onto existing theories of change and presented the functions to MCCAN leadership to confirm validity and completeness of the functions.Results:Intervention core functions included: providing expertise and templates for achieving accreditation, establishing a culture of quality-improvement among affiliates, and fostering a shared goal of quality care. Implementation core functions included: fostering a sense of community and partnership, building trust between affiliates and Markey, providing information and resources to increase feasibility and acceptability of meeting CoC standards, and mentoring and empowering administrators and clinicians to champion implementation.Conclusion:The MCCAN intervention presents a more equitable strategy of extending the resources and expertise of large cancer centers to assist smaller community hospitals in achieving evidence-based standards for cancer care. Using rigorous qualitative methods, we distilled this intervention into its core functions, positioning us (and others) to adapt the MCCAN intervention to address cancer disparities in other rural contexts.

Improving cancer care locally: Study of a hospital affiliate network model.

The University of Kentucky Markey Cancer Center Affiliate Network (MCCAN) increased access to high-quality cancer care for patients treated in community hospitals across the state by leveraging the American College of Surgeons Commission on Cancer (CoC) standards to improve quality among its member sites. This study describes the network activities and services identified as most helpful or effective to its members, as well as the perceived value of joining MCCAN or pursing accreditation. An independent research team conducted in-depth, semistructured interviews with 18 administrators and clinicians from 10 MCCAN hospitals in 2019. Interviews were transcribed and a thematic analysis was conducted. Network affiliation and CoC accreditation were perceived as helpful to improving quality of care. Having both clinician and administrative champions were key facilitators to achieving CoC standards and made mentoring of member sites a critical activity of the Network. Other components identified as valuable and/or key to the Network's success included providing access to specific CoC-required clinical services (eg, genetic counseling); offering regular performance monitoring and individualized feedback; establishing a culture of quality improvement; and fostering trust within the Network with patient referrals (ie, sending patients back to their local hospital for ongoing care). Quality improvement in community cancer programs is challenging but several strategies were identified by members as valuable and effective. Efforts to disseminate the MCCAN model should focus on identifying the needs of community hospitals, implementing a quality monitoring system, and fostering site-level champions who can be influential drivers of change.

The Use of STS Public Reporting to Guide Referrals in Congenital Heart Surgery: Results of a Survey

BackgroundThe Society of Thoracic Surgeons (STS) public reporting in congenital heart surgery has received considerable attention; however, it is unclear how pediatric cardiac providers use these data to guide surgical referrals. MethodsWe surveyed members of the American Academy of Pediatrics Section on Cardiology and Cardiac Surgery and PediHeartNet members regarding use of STS public reporting. ResultsThere were 155 respondents (90% cardiologist, 7% surgeons) from approximately 800 solicitations (∼19% response rate). While most (83%) felt that STS public reporting is important, 60% are unsure of its accuracy and only 37% find it useful in practice. Most (71%) believe STS public reporting leads to risk aversion. Overall, 92% answered that STS public reporting rarely or never overrides other factors determining referrals. Compared with smaller centers (<300 cases/year), providers in larger centers were more likely to report that STS public reporting data never overrides other factors determining referrals (54% vs 32%, P = .03). Providers using STS public reporting to guide referrals (14% overall) trust the system’s accuracy (P = .03) and believe it presents useful outcomes (P < .01). There was no correlation between use of STS public reporting to guide referrals and practice size, type, location, time in practice, surgical center affiliation, or center volume. ConclusionsProviders believe that public reporting of outcomes is important; however, most do not use the data to guide surgical referrals. Understanding these limitations of the current STS public reporting may enable change and increased usefulness for providers.

Musculoskeletal Urgent Care Centers Restrict Access for Patients with Medicaid Insurance Based on Policy and Location.

As the urgent care landscape evolves, specialized musculoskeletal urgent care centers (MUCCs) are becoming more prevalent. MUCCs have been offered as a convenient, cost-effective option for timely acute orthopaedic care. However, a recent "secret-shopper" study on patient access to MUCCs in Connecticut demonstrated that patients with Medicaid had limited access to these orthopaedic-specific urgent care centers. To investigate how generalizable these regional findings are to the United States, we conducted a nationwide secret-shopper study of MUCCs to identify determinants of patient access. (1) What proportion of MUCCs in the United States provide access for patients with Medicaid insurance? (2) What factors are associated with MUCCs providing access for patients with Medicaid insurance? (3) What barriers exist for patients seeking care at MUCCs? An online search of all MUCCs across the United States was conducted in this cross-sectional study. Three separate search modalities were used to gather a complete list. Of the 565 identified, 558 were contacted by phone with investigators posing over the telephone as simulated patients seeking treatment for a sprained ankle. Thirty-nine percent (216 of 558) of centers were located in the South, 13% (71 of 558) in the West, 25% (138 of 558) in the Midwest, and 24% (133 of 558) in New England. This study was given an exemption waiver by our institution's IRB. MUCCs were contacted using a standardized script to assess acceptance of Medicaid insurance and identify barriers to care. Question 1 was answered through determining the percentage of MUCCs that accepted Medicaid insurance. Question 2 considered whether there was an association between Medicaid acceptance and factors such as Medicaid physician reimbursements or MUCC center type. Question 3 sought to characterize the prevalence of any other means of limiting access for Medicaid patients, including requiring a referral for a visit and disallowing continuity of care at that MUCC. Of the MUCCs contacted, 58% (323 of 558) accepted Medicaid insurance. In 16 states, the proportion of MUCCs that accepted Medicaid was equal to or less than 50%. In 22 states, all MUCCs surveyed accepted Medicaid insurance. Academic-affiliated MUCCs accepted Medicaid patients at a higher proportion than centers owned by private practices (odds ratio 14 [95% CI 4.2 to 44]; p < 0.001). States with higher Medicaid physician reimbursements saw proportional increases in the percentage of MUCCs that accepted Medicaid insurance under multivariable analysis (OR 36 [95% CI 14 to 99]; p < 0.001). Barriers to care for Medicaid patients characterized included location restriction and primary care physician referral requirements. It is clear that musculoskeletal urgent care at these centers is inaccessible to a large segment of the Medicaid-insured population. This inaccessibility seems to be related to state Medicaid physician fee schedules and a center's affiliation with a private orthopaedic practice, indicating how underlying financial pressures influence private practice policies. Ultimately, the refusal of Medicaid by MUCCs may lead to disparities in which patients with private insurance are cared for at MUCCs, while those with Medicaid may experience delays in care. Going forward, there are three main options to tackle this issue: increasing Medicaid physician reimbursement to provide a financial incentive, establishing stricter standards for MUCCs to operate at the state level, or streamlining administration to reduce costs overall. Further research will be necessary to evaluate which policy intervention will be most effective. Level II, prognostic study.

Addressing Gender Disparity: Increase in Female Leadership Increases Gender Equality in Program Director and Fellow Ranks.

Women make up 15% of the total number of practicing gastroenterology (GI) physicians in the US. Despite this disparity, only 33% of the current GI fellows are female. Increasing female GIs is a major goal of all four GI societies. It is known that gender disparity exists in the field of gastroenterology, and women are underrepresented in the leadership ranks and trainee level at academic programs. Whether an increase in female leadership in academic medicine is associated with an increase in female program directors and trainees is unknown. The aim of this study was to assess this relationship in GI. Data were collected via a standardized protocol from all 173 US gastroenterology fellowship programs up until October 2018 from program websites and supplemented by online surveys completed by program coordinators. Any missing information was collected by calling the program coordinators. Data were collected on gender and academic rank of the program director, associate program director, division chief, chair of medicine, program size, academic center affiliation, number, and academic rank of female faculty and geographic region. The association was assessed using a Chi-square test or independent samples t test. In leadership positions, men were listed as comprising 86% of chairs, 82% of division chiefs, 76% of program directors and 63% of associate program directors. Forty-three percent of programs did not have female representation at any leadership level. The presence of a female program director or female associate program director was associated with an increase in the number of female fellows (4.03 vs 3.20; p = 0.076; 4.26 vs 3.36; p = 0.041), respectively. Overall, the presence of a female in any leadership position led to an increase in the number of female fellows (4.04 females vs 2.87 females; p = 0.007) enrolled in a program. If a GI division chief was male, the program director was more likely to be male as well (81% male vs. 18.8% female). Conversely, having a female division chief was likely to lead to a more equitable program director representation, 54% female to 48% male (p value < 0.0001, OR 5.03 95% CI 2.04-12.3). Furthermore, if either the internal medicine department chair or GI chief was female, the proportion of female program directors increased to 41% as compared to 19% if both were male (p value < 0.0001, OR 2.99 95% CI 1.34-6.6). Women are significantly underrepresented in the number of practicing gastroenterologists, at all levels of leadership in GI fellowship programs, and at the fellow level. Increasing the number of women in fellowship leadership positions is associated with an increase in female program directors and trainees. Per our knowledge, this is the first study to examine the relationship between female leadership in fellowship programs and the gender of trainees. Increasing female representation in leadership positions would not only address current gender disparity, but it may also increase the number of female future GI trainees.

Placental Pathology in COVID-19: Case Series in a Community Hospital Setting.

ObjectiveTo report the histopathologic findings in the placentas of pregnant women with coronavirus disease-19 (COVID-19).MethodsPregnant women with COVID-19 delivering between April 2020 to June 2020 were identified. A retrospective study of placentas from COVID positive women received in the Department of Pathology, Monmouth Medical Center affiliate of Robert Wood Johnson Barnabas Health were examined and compared to control cohort of placentas from COVID negative women. The mothers were tested for coronavirus through nasopharyngeal swab upon admission to labor and delivery. The placentas from mothers who tested negative for the virus were sent to Pathology for examination based on the obstetrician’s clinical judgment.ResultsFifty surgical specimens (49 placentas and one product of conception) from patients positive for COVID-19 were examined and compared with fifty placentas from women with negative COVID-19 test results, who delivered during the same period. Most of the neonates had Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores of 9 and 9 at 1 and 5 minutes, respectively. Increased incidence of the COVID-19 positivity was noted in individuals with Rh-positive blood group A and Jewish heritage. Compared to the control group, the COVID-19 positive placentas showed increased features of malperfusion (microcalcifications, fibrin thrombi, syncytial knotting, and villous agglutination). However, there was no significant dysregulation in other variables, such as inflammation or coagulation. There was no case of maternal or fetal death (greater than eight weeks) or evidence of worse fetal outcomes noted due to a mother's positive COVID-19 status. ConclusionsThe COVID-19 positive placentas showed an increased prevalence of microcalcifications and fibrin thrombi, which may reflect an underlying hypercoagulable state induced by COVID-19 infection or could be due to excessive syncytiotrophoblast injury.

Abstract 16413: The Development of Care Curves Following the Stage 1 Palliation: A Comparison of Intensive Care Among Five Centers

Introduction: Comparisons of care among centers is currently limited to major endpoints, such as mortality, length of stay, or complication rates. Hypothesis: We hypothesized that comparing individual elements of intensive care over time using classical statistics and “care curves” may highlight important modifiable differences among centers. Methods: We retrospectively reviewed data of key elements of postoperative care after stage-1-palliation (S1P) among 5 US centers during 2009-2018. Minimum mandatory ventilation rate (MMVR), opioid total daily dose (TDD) and fluid balance (FB) were computed from postoperative day (POD) 0 to 28. Cox regression, mixed random effect models and growth chart-like care curves were used to analyze data variability and trajectory over time. Results: During the study period, 502 patients underwent S1P (median age 5 [IQR 3-6] days). Patients were weaned from MMV by POD 8 (IQR 5-16), with significant differences among centers (P&lt;0.001). Opioid administration peaked on POD 2 (3.7 [IQR 1.5-7.5] mg morphine equivalents/kg/day), and freedom from opioids was achieved in a median of 13 (IQR 8-25) days (P&lt;0.001 among centers). After adjusting for patient-level characteristics, center affiliation was independently predictive of time to freedom from MMV and from opioids. The median daily FB per patient was +23 (IQR -3 to +39) ml/kg/day (P&lt;0.001 among centers). Center affiliation was independently predictive of both trajectories over time and daily variation in MMVR, opioid TDD, and FB. Growth chart-like care curves can be used to visualize variation in elements over time (Fig1). Conclusions: Both “care curves” and classical statistics highlighted important modifiable differences in the elements of care among centers. MMVR, opioid TDD, and FB following S1P significantly differ even after adjusting for patient and operative factors. Care curves may be used to guide collaborative quality improvement initiatives in the intensive care unit.

Improving the Quality of Cancer Care in Community Hospitals.

Cancer patients treated in community hospitals receive less guideline-recommended care and experience poorer outcomes than those treated in academic medical centers or National Cancer Institute-Designated Cancer Centers. The Markey Cancer Center Affiliate Network (MCCAN) was designed to address this issue in Kentucky, the state with the highest cancer incidence andmortalityrates in the U.S. Using data obtained from the Kentucky Cancer Registry, the study evaluated the impact of patients treated in MCCAN hospitals on four evidence-based Commission on Cancer (CoC) quality measures using a before-and-after matched-cohort study design. Each group included 13 hospitals matched for bed size, cancer patient volume, community population, and region (Appalachian vs. non-Appalachian). Compliance with quality measures was assessed for the 3years before the hospital joined MCCAN (T1) and the 3years afterward (T2). In T1, the control hospitals demonstrated greater compliance with two quality measures than the MCCAN hospitals. In T2, the MCCAN hospitals achieved greater compliance in three measures than the control hospitals. From T1 to T2, the MCCAN hospitals significantly increased compliance on three measures (vs. 1 measure for the control hospitals). Although most of the hospitals were not accredited by the CoC in T1, 92% of the MCCAN hospitals had achieved accreditation by the end of T2 compared with 23% of the control hospitals. After the MCCAN hospitals joined the Network, their compliance with quality measures and achievement of CoC accreditation increased significantly compared with the control hospitals. The unique academic/community-collaboration model provided by MCCAN was able to make a significant impact on improvement of cancer care. Future research is needed to adapt and evaluate similar interventions in other states and regions.

It takes a Village to Care for the Mechanical Circulatory Support Device Patient throughout the Care Environment

Purpose Over 23,000 mechanical circulatory support (MCS) devices have been implanted since 2006. Survival for patients with MCS at 3 years is approximately 60%. In the hospital environment, there are an increasing number of patients with devices from both index admissions, readmissions and non-device related admissions. Frequently patients in the Progressive and Acute Care settings are required to travel off the unit requiring nurses to leave their other patients while accompanying the MCS patient. Our urban, academic medical center needed a way to support these patients and the team members caring for them. Objectives Creating a safe environment for patients to receive care is of utmost importance in a complex patient population with essential life sustaining equipment. Empowering knowledge to our team members allows for smoother transitions throughout the practice areas and a shared ownership for their safety. Methods A class was developed for support team members and taught by CT Surgery Clinical Nurse Specialists and VAD Coordinators. Transporters, care partners, occupational therapists, physical therapists, speech therapists, nurses in procedural/ambulatory areas, and others attended the educational class. The 2 hour class consisted of introduction to MCD devices - Heart Mate II, III / HeartWare and Total Artificial Hearts devices. Opportunities for hands on learning allowed for greater comfort with handling the equipment during everyday care or an emergency. This annual required education was offered monthly. Results Stable ventricular assist device patients are able to travel off the Progressive and Acute care units without a nurse or VAD coordinator due to this collaborative effort. There has not been any serious safety events related to VADs being transported off the units since this practice was implemented in 2013. Conclusions It takes a village to care for patients with Mechanical Circulatory Support and this organization welcomes them throughout the care environment. Non licensed team members in additional to nurses in ambulatory areas can safely care for patients when leaving their primary inpatient units, allowing for greater awareness of the special needs of this complex population. Table/Image: Table/Image: Primary Author Registrant ID: 5632540 First Name: Kimberly Last Name: Nelson Phone Number: (540) 226-7533 E-mail: [email protected] Credentials DNP, RN-BC, ACNS-BC, CHFN, CCPC, CCRP, RDCS Affiliation Name: VCU Medical Center Affiliations Address 1: 22 Brown Circle Address 2: City: Fredericksburg State: VA Zip Code: 22405 Over 23,000 mechanical circulatory support (MCS) devices have been implanted since 2006. Survival for patients with MCS at 3 years is approximately 60%. In the hospital environment, there are an increasing number of patients with devices from both index admissions, readmissions and non-device related admissions. Frequently patients in the Progressive and Acute Care settings are required to travel off the unit requiring nurses to leave their other patients while accompanying the MCS patient. Our urban, academic medical center needed a way to support these patients and the team members caring for them. Creating a safe environment for patients to receive care is of utmost importance in a complex patient population with essential life sustaining equipment. Empowering knowledge to our team members allows for smoother transitions throughout the practice areas and a shared ownership for their safety. A class was developed for support team members and taught by CT Surgery Clinical Nurse Specialists and VAD Coordinators. Transporters, care partners, occupational therapists, physical therapists, speech therapists, nurses in procedural/ambulatory areas, and others attended the educational class. The 2 hour class consisted of introduction to MCD devices - Heart Mate II, III / HeartWare and Total Artificial Hearts devices. Opportunities for hands on learning allowed for greater comfort with handling the equipment during everyday care or an emergency. This annual required education was offered monthly. Stable ventricular assist device patients are able to travel off the Progressive and Acute care units without a nurse or VAD coordinator due to this collaborative effort. There has not been any serious safety events related to VADs being transported off the units since this practice was implemented in 2013. It takes a village to care for patients with Mechanical Circulatory Support and this organization welcomes them throughout the care environment. Non licensed team members in additional to nurses in ambulatory areas can safely care for patients when leaving their primary inpatient units, allowing for greater awareness of the special needs of this complex population.

Introducing and testing an advanced quantitative methodological approach for the evaluation of research centers: a case study on sustainability science

AbstractWith the growing complexity of societal and scientific problems, research centers have emerged to facilitate the conduct of research beyond disciplinary and institutional boundaries. While they have become firmly established in the global university landscape, research centers raise some critical questions for research evaluation. Existing evaluation approaches designed to assess universities, departments, projects, or individual researchers fail to capture some of the core characteristics of research centers and their participants, including the diversity of the involved researchers, at what point in time they join and leave the research center, or the intensity of their participation. In addressing these aspects, this article introduces an advanced approach for the ex post evaluation of research centers. It builds on a quasi-experimental within-group design, bibliometric analyses, and multilevel statistics to assess average and individual causal effects of research center affiliation on participants along three dimensions of research performance. The evaluation approach is tested with archival data from a center in the field of sustainability science. Against a widely held belief, we find that participation in research centers entails no disadvantages for researchers as far as their research performance is concerned. However, individual trajectories varied strongly.

Institutional factors associated with global health education across US pharmacy schools

IntroductionThe objective of this study is to explore the relationship between institutional factors and offerings of global health education opportunities in pharmacy schools. MethodsData for this project came from a review of international advanced pharmacy practice experiences (APPEs) and global course offerings for US pharmacy schools conducted between February 1 and March 31, 2014. These data were merged with data on institutional factors which may influence a school's offering of APPEs or courses. Institutional factors included tuition, class size, academic medical center affiliation, year established, and others. Multivariable regression models were used to evaluate the relationship between individual institutional factors and APPEs and global courses. ResultsIn multivariable adjusted models, older and more established schools had a larger percent of the graduating class with an international APPE (9.5% vs. 2.6%, p < 0.01) and a larger number of international APPEs (3.8 vs. 1.4, p < 0.01) than schools founded after 1980. Schools with higher tuition (>$25,000/year) had, on average, a larger percent of their graduating class with an international APPE (7.9% vs. 3.1%, p < 0.05), a larger number of international APPEs (3.7 vs. 1.5, p < 0.01), and more interprofessional international APPEs (3.1 vs. 0.7, p < 0.001). There were more course offerings at older schools (1.1 vs. 0.4, p < 0.05) and those with higher tuition (1.3 vs. 0.4, p < 0.01). ConclusionsMore established schools and those with higher tuition appeared to have more robust global offerings. Schools can consider local opportunities to provide global experiential and didactic experiences, which may reduce the financial burden of global programs.

The association of continuity of care and cancer centre affiliation with outcomes among patients with cancer who require emergency department care.

Patients with cancer have complex care requirements and frequently use the emergency department. The purpose of this study was to determine whether continuity of care, cancer expertise of an institution or both affect outcomes in patients with cancer in the emergency setting. We conducted a retrospective cohort study using administrative databases from Ontario, Canada, involving records of patients aged 20 years and older who received chemotherapy or radiation in the 30 days before a cancer-related visit to the emergency department between 2006 and 2011. Patients seen in an emergency department at an alternative hospital (not the site where cancer treatment was given) were matched based on propensity score to patients who visited their original hospital (site where cancer treatment was given). Next, patients seen at an alternative emergency department that was in a general hospital (i.e., not a cancer centre) were matched to patients who visited their original hospital or a cancer centre. Outcomes were admission to hospital at the index visit to the emergency department, 30-day mortality, having imaging with computed tomography and return visits to the emergency department. We found 42 820 patients who were eligible for our study. Patients seen in the emergency departments at alternative hospitals were less likely to be admitted to hospital (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.74-0.83) and had higher hazards of return visits to the emergency department than matched patients at original hospitals (hazard ratio [HR] 1.06, 95% CI 1.03-1.11). In comparison, patients at alternative general hospitals also had lower odds of admission to hospital (OR 0.83, 95% CI 0.79-0.88) and higher hazards of return visits to the emergency department (HR 1.07, 95% CI 1.03-1.11) compared with matched counterparts; however, these patients had higher 30-day mortality (OR 1.13, 95% CI 1.05-1.22) and lower odds of having CT imaging (OR 0.74, 95% CI 0.69-0.80). Cancer expertise of an institution rather than continuity of care may be an important predictor of outcomes following emergency treatment of patients with cancer.

Clinical Presentation and Long-Term Outcomes of Systemic Sclerosis Portuguese Patients from a Single Centre Cohort: A EUSTAR Registration Initiative.

Systemic sclerosis is a complex disorder that requires systematic screening. Our objective is to report the EuropeanScleroderma Trials and Research group centre affiliation and its impact in our clinical practice. The European Scleroderma Trials and Research group affiliation process, database update and current patientevaluation, with respect to demographic and clinical features. Cumulative mortality was analysed. We identified 19 female patients (which met all the American College of Rheumatology/ European League Against Rheumatism2013 criteria for systemic sclerosis) under current follow-up, divided according to the LeRoy classification into diffuse cutaneous (n= 5), limited cutaneous (n = 11) and limited (n = 3) types, followed for a median period of 5, 12 and 6 years, respectively. Raynaud´sphenomenon and abnormal nailfold capillaries were universally present. Interstitial lung disease was absent in the limited cutaneousform but present in 100% of the diffuse subtype. Pitting scars were more common in the diffuse form. Active disease was also morefrequent in the diffuse form, and most patients with active disease were treated with anti-endothelin receptor antagonists. Over 21 years(from 1994 to 2015) the mortality rate was 55% (n = 23/42). Age at time of death was significantly lower in the diffuse subtype. Our single centre cohort shares many features with larger and international reports and more specifically is in accordancewith patient characteristics described in the European Scleroderma Trials and Research group registries. The European Scleroderma Trials and Research group registration motivated our systematic patient characterization andmay be used as a tool for homogenous disease registries.