Community Physicians Research Articles

A Compassionate Release Pilot in New Orleans.

The prison population is aging and health care costs are rising. Compassionate release for the terminally ill and disabled is underutilized, especially in Louisiana, which is the state with the highest incarceration rate. This article evaluates the utilization of community physicians to improve compassionate release rates. Health care providers at a contract hospital for the Louisiana Department of Public Safety and Corrections collaborated with attorneys, the Louisiana Department of Health, and the Louisiana Department of Public Safety and Corrections to facilitate compassionate release for eligible individuals. A retrospective analysis of patients referred for compassionate release between August 01, 2022 and December 31, 2023 was completed. Outcomes included release rates and underlying conditions. During this time, 18 patients were eligible; most were 56 to 75 years of age, consistent with national trends. Of the 18 eligible patients, four were released, eight died while incarcerated, and six remained incarcerated. This retrospective review shows that a coordinated, multidisciplinary approach can have a significant impact.

Why Are You? Exploring Patients’ Behavior in Selecting Physicians in Online Health Communities

Why Are You? Exploring Patients’ Behavior in Selecting Physicians in Online Health Communities

Peer-led learning: a novel approach to promote rural healthcare interest among medical students.

A persistent maldistribution of medical workforce exists across Canada, with rural areas facing a greater physician shortage. Medical education can be instrumental to increase physicians in rural communities, and medical schools have adapted strategies to generate interest in rural careers among medical students. Many of these efforts occur within formal structured curriculum. This study appraises the effectiveness of peer-led learning (PLL) as a novel approach in rural medical education to provide students with a better understanding of rural life and rural medical practice. This is mixed methods study using a survey and follow-up focus group discussion to evaluate a day-long educational experience organized and led by a medical student to their rural community. Quantitative data were summarized with descriptive statistics. Reflexive thematic analysis was conducted on qualitative insights to describe the students' experiences and perceptions about the educational rural day. Of 54 participants, 50 completed the survey and 13 consented for the follow-up focus group. Most (78%) were female, have non-rural origins (78%), with only 2 having Indigenous status. Majority (61%) have low familiarity with rural medicine. Trustworthiness scores for information about rural life and medical practice were higher for rural-origin peers and rural-origin faculty compared to other sources of information such as government websites, social media, and traditional media. Thematic analysis yielded three main themes: (i) informal teaching facilitated learning, (ii) trust in their peer enabled students to receive information more favorably, and (iii) students gained a better understanding of rural life and medical practice. This study demonstrated that medical students engage differently with peer-led learning activities about rural medical curriculum versus a formal teaching environment. Medical students are cautious about promotional information regarding rural medical education from formal sources but are less skeptical when learning from peers. Information about the way of life and healthcare needs in rural communities may be perceived as more credible and valid if coming from a peer, and hence, is more likely to be received favorably. Thus, when promoting rural education and careers, medical schools should work with rural-origin students, whose messaging may be considered more trustworthy than traditional sources.

Special Topic Burnout: Qualitative verification of machine learning-based burnout predictors in primary care physicians: An exploratory study.

Electronic health record (EHR) usage measures may quantify physician activity at scale and predict practice settings with high risk for physician burnout, but their relation to experiences are poorly understood. To explore the EHR-related experiences and well-being of primary care physicians in comparison to EHR usage measures identified as important for predicting burnout from a machine learning model. Exploratory qualitative study with semi-structured interviews of primary care physicians and clinic managers from a large academic health system and its community physician partners. We included primary care clinics with high burnout scores, low burnout scores, or large changes in burnout scores between 2020 and 2022, relative to all primary care clinics in the health system. We conducted inductive and deductive coding of interview responses using a priori themes related to the machine learning model categories of patient load, documentation burden, messaging burden, orders, and physician distress and fulfillment. Interviews with 16 physicians and 4 clinic managers identified burdens related to 3 dominant themes: 1) Messaging and Documentation Burden are high and require more time than most physicians have available during standard working hours; 2) While EHR-related Burdens are high they also provide patient-care benefits; and 3) Turnover and insufficient staffing exacerbate time-demands associated with patient load. Dimensions that are difficult to quantify, such as a perceived imbalance between job demands and individual resources, also contribute to burnout and were consistent across all themes. EHR-related work burden, largely quantifiable through EHR usage measures, are major sources of distress among primary care physicians. Organizational recognition of this work as well as staffing and support to predict associated work burden may increase professional fulfillment and reduce burnout among primary care physicians.

Approaches towards averting a potential structural shortage of general practitioners: results of a quantitative survey on attitudes, experiences, and ideas from general practitioners in the Federal Republic of Germany

BackgroundSecuring primary care poses a complex set of challenges for policymakers in national healthcare. The risk of a shortage in general practitioners raises the question as to which approach would make an effective contribution towards averting an impending healthcare shortage. There has been a lack of studies shedding light on how general practitioners pview various approaches towards securing long-term primary care, and which measures they support from their own professional experience. The aim of the study was to ascertain the opinions, attitudes, and experiences of general practitioners in securing primary care across the country. We ran a survey to ask GPs about strategies that they saw as promising or particularly pressing, how they viewed the current situation regarding the shortage of general practitioners, and what they saw as causes for any decline they had already seen in primary care.MethodsOur survey conducted online addressed a total of 5,164 general practitioners interviewed between August 2023 and April 2024 (40% response rate). Apart from descriptive analysis, we used Student’s t-test for independent samples to determine significant differences between two groups. We also performed a factor analysis (Varimax rotation).ResultsOur respondents displayed a somewhat negative view of primary care development in Germany. Many general practitioners expressed concerns as to whether primary care would remain secure in the long term. Despite partial progress, respondents saw a great need for countermeasures in the coming years. Nearly half of the respondents at 44% saw a noticeable decrease in general practices in their local area. Physicians in small towns and rural communities were more than twice as likely to experience the healthcare shortage due to a decline in general practitioners compared to their colleagues in medium-sized and large cities (42% versus 19%, p<0.001). More than half at 55% reported declining attractiveness in primary care for young physicians, which they attributed to three problem areas: 1) Position of primary care within the healthcare system, 2) Requirements for foundational and continuing medical education, 3) Working conditions. Respondents especially advocated the following approaches toward securing primary care: Establishing a primary care system (88%), more intense promotion of interest in primary care with points of contact in foundational and continuing medical education, especially in accompanying longitudinal programmes (78%), reinforcing multi-professional outpatient care centres (62%), restructuring curricula (54%) and enrolment criteria for medical study courses (51%), and reforming general medical training (55%).ConclusionsGeneral practitioners have their own proposals and preferences to add to the existing assessments and expert opinions. General practitioners should be involved more consistently than before in planning, implementing, and evaluating measures towards stabilising primary care. Various modes of participation and collaboration exist to this end.

Perceptions and Beliefs About Obesity and Bariatric and Metabolic Surgery Among Black and White Men.

Although metabolic and bariatric surgery (MBS) is a safe and effective procedure to reduce severe obesity and is covered by most health insurance plans, utilization of MBS is significantly lower among men compared to women. This study identifies unique factors that explain men's attitude towards MBS. The study survey (paper/online) included 129 Black and White men with severe obesity from metropolitan communities in Western New York. Bivariate and multivariate analyses were used to evaluate participants' personal and community factors influencing their consideration of MBS. Men willing to undergo MBS had lower education (38% vs. 21% ≤ high school, p < 0.05), were less likely to be satisfied with their body weight (27% vs. 48%, p < 0.05), more likely to have a physician supporting their weight loss efforts (55% vs. 32%, p = 0.03) and discussing MBS treatment (39% vs. 19%, p = 0.02), believed that community role models who underwent MBS "lost weight and looked great" (66% vs. 40%, p = 0.02) and that MBS was safe and effective (40% vs. 13%, p < 0.01), compared to men unwilling to undergo MBS. When adjusted for education level, dissatisfaction with body size (odds ratio, OR = 4.56, 95% confidence interval, CI: 1.16, 18.01) and physician support (OR = 3.71, 95% CI: 1.17, 11.78) remained significantly associated with men's willingness to undergo MBS. Race and BMI were not associated with willingness to undergo MBS. Positive attitude toward MBS among men is influenced by self-perception of excess weight, strong physician support and community role models. Improving patient-provider communication about MBS and awareness from community role models may improve MBS utilization among men.

Abstract 630: Directly engaging participants in rare cancer research is feasible: the osteosarcoma and leiomyosarcoma projects

Abstract Background and Purpose: Osteosarcoma (OS) and Leiomyosarcoma (LMS) are sarcomas with complex genomes for which there has been limited progress in identifying new treatments and improving outcomes. While slow progress is partially due to insufficient genomic characterization, generating large genomic datasets has been challenging because these are rare cancers. The OS and LMS Projects use various approaches to directly engage pediatric and adult participants with OS and LMS in genomics research. Methods: Working with patients and advocates at the design stage, we created websites (OSProject.org and LMSProject.org) where patients register and consent to participation. Any patient with OS or LMS living in the United States or Canada is eligible. Participant outreach approaches include partnership with advocacy organizations, webinars, social media posts, meeting presentations, stakeholder and physician engagement committees, and direct mailings. Blood and saliva are collected directly from consented participants by mail, archival FFPE tumor samples are obtained from pathology departments and medical records are requested from treating institutions. WES, WGS, DNA panel sequencing and RNASeq of tumor and germline (T/N) is performed. Results are shared with patient, advocacy, physician, and research communities in several ways. Individual participants receive a shared learning report describing the somatic variants identified in their tumor from T/N clinical WES and are offered clinical germline genetic testing and genetic counseling. Results: The study outreach team has participated in or led a total of 33 online and in person events not including social media posts or stakeholder meetings. So far, in 26 months 515 LMS patients (ages 16-83y; median 55) and 145 OS patients (ages 7-74y; median 20) have consented. Thus far, 274 and 76 tumor samples and 555 and 127 germline samples have been obtained from LMS and OS consented participants, respectively. Analysis of the first 20 LMS participants with T/N WGS showed widespread alteration of TP53 (11 pts), RB1 (8 pts), and PTEN (16 pts), concordant with findings in past studies. Likewise, the first 7 OS pts with T/N WGS demonstrated inactivation of TP53 (4 pts) and RB1 (2 pts), as expected from past OS cohorts. Conclusions: Using community partnerships and direct outreach to connect and engage with participants and a virtual consenting process for genomics research in rare cancers is feasible. It is possible to obtain germline samples directly from about half of participants and archival tumor samples from treating pathology departments for about one third of participants consented in direct-to-patient online genomics studies. We have been able to utilize archival tumor samples to identify, with T/N WES/WGS, expected genomic events in complex genome cancers. Recruitment and sequencing are ongoing. Citation Format: Julia M. Wong, David Merrell, Eirian Siegal-Botti, Noorshifa Arssath, Carrie Cibulskis, Evelina Ceca, Alanna Church, Alex Wilson, Lorena Lazo De La Vega, Jill Stopfer, Ellen Sukharevsky, Nia Daley, Anusha Sharma, Sidney Benich, Zachary Kahn, Lauren Fisher, Parker Chastain, Brendan Reardon, Taisha Hendrickson, Colleen Nguyen, Melissa Chiumiento, Melissa Mirick, Noriela Elia, Priscilla Merriam, Eliezer Van Allen, Judy Garber, Riaz Gillani, Chandrajit Raut, Stacey Gabriel, Timothy Rebbeck, Jason L. Hornick, Jennifer Mack, Suzanne George, Diane Diehl, Gad Getz, Katherine A. Janeway. Directly engaging participants in rare cancer research is feasible: the osteosarcoma and leiomyosarcoma projects [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 630.

ShennongAlpha: an AI-driven sharing and collaboration platform for intelligent curation, acquisition, and translation of natural medicinal material knowledge

Natural Medicinal Materials (NMMs) have a long history of global clinical applications and a wealth of records and knowledge. Although NMMs are a major source for drug discovery and clinical application, the utilization and sharing of NMM knowledge face crucial challenges, including the standardized description of critical information, efficient curation and acquisition, and language barriers. To address these, we developed ShennongAlpha, an artificial intelligence (AI)-driven sharing and collaboration platform for intelligent knowledge curation, acquisition, and translation. For standardized knowledge curation, the platform introduced a Systematic Nomenclature to enable accurate differentiation and identification of NMMs. More than fourteen thousand Chinese NMMs have been curated into the platform along with their knowledge. Furthermore, the platform pioneered chat-based knowledge acquisition, standardized machine translation, and collaborative knowledge updating. Together, our study represents the first major advance in leveraging AI to empower NMM knowledge sharing, which not only marks a novel application of AI for science, but also will significantly benefit the global biomedical, pharmaceutical, physician, and patient communities.

Pre-Incarceration Healthcare Use and Access Barriers among Men with HIV and those at-Risk for Contracting HIV: A Case Study of an Urban Jail.

Approximately 1.5% of incarcerated people live with HIV. Limited information on their pre-incarceration healthcare use which could inform discharge planning efforts to link them to treatment is available. We investigate factors associated with pre-incarceration healthcare use and access barriers for a status-neutral HIV cohort. We collected data via self-report from men with HIV (n = 22) or at-risk of contracting HIV (n = 77) who entered the Washington, DC, Department of Corrections jail from November 2020 to June 2021. We analyzed pre-incarceration hospital, emergency department (ED), physician and mental health visits, and access barriers using t-tests, chi-square tests, and logistic regressions informed by the Anderson Behavioral Model of healthcare utilization. During the year prior to incarceration, more than half of men visited the ED, while less than 20% visited a physician. Over half the sample viewed medical care as too expensive, even though 75% were insured. Depressed men were significantly more likely to report access barriers. Homelessness was the only factor found to be significantly associated with a greater likelihood of urgent and acute care use. Neither HIV status, insurance status, educational level nor race affected healthcare use by type of service. Pre-incarceration men with or at-risk of contracting HIV have limited contact with community physicians who are critical to HIV management. Given the effect of unstable housing on the types of healthcare used, programs to promote HIV treatment and pre-exposure prophylaxis (PrEP) should consider embedding condition-specific discharge planning into an approach addressing a wider array of needs.

Development and Evaluation of an Automated Multimodal Mobile Detection of Oral Cancer Imaging System to Aid in Risk-Based Management of Oral Mucosal Lesions.

Oral cancer is a major global health problem. It is commonly diagnosed at an advanced stage, although often preceded by clinically visible oral mucosal lesions, termed oral potentially malignant disorders, which are associated with an increased risk of oral cancer development. There is an unmet clinical need for effective screening tools to assist front-line healthcare providers to determine which patients should be referred to an oral cancer specialist for evaluation. This study reports the development and evaluation of the mobile detection of oral cancer (mDOC) imaging system and an automated algorithm that generates a referral recommendation from mDOC images. mDOC is a smartphone-based autofluorescence and white light imaging tool that captures images of the oral cavity. Data were collected using mDOC from a total of 332 oral sites in a study of 29 healthy volunteers and 120 patients seeking care for an oral mucosal lesion. A multimodal image classification algorithm was developed to generate a recommendation of "refer" or "do not refer" from mDOC images using expert clinical referral decision as the ground truth label. A referral algorithm was developed using cross-validation methods on 80% of the dataset and then retrained and evaluated on a separate holdout test set. Referral decisions generated in the holdout test set had a sensitivity of 93.9% and a specificity of 79.3% with respect to expert clinical referral decisions. The mDOC system has the potential to be utilized in community physicians' and dentists' offices to help identify patients who need further evaluation by an oral cancer specialist. Prevention Relevance: Our research focuses on improving the early detection of oral precancers/cancers in primary dental care settings with a novel mobile platform that can be used by front-line providers to aid in assessing whether a patient has an oral mucosal condition that requires further follow-up with an oral cancer specialist.

Bridging the gap: Enhancing pharmacist-physiscian collaboration through the provision of comprehensive medication reviews in community pharmacy.

Collaborative practice between physicians and pharmacists is particularly important in the provision of pharmacy services, such as Comprehensive Medication Reviews (CMR), which often require a close coordination between these professionals. Understanding the level and nature of this collaboration can assist in the development of strategies to enhance integrated care. (1) To evaluate the changes in level of collaborative practice between community pharmacists and physicians in the context of a CMR service compared to usual practice, from the perspective of community pharmacists, and (2) to explore the determinants of such collaborative practice. This research was conducted alongside a 12-months prospective longitudinal observational study. Community pharmacists providing CMR and pharmacists providing usual care (nCMR) from six provinces in Spain participated in the study. To measure the level of collaborative practice from the perspective of the community pharmacist, a previously validated tool was used. Collaborative practice was assessed at baseline, 6months and 12months. A multiple regression analysis was undertaken. 323 pharmacists participated in the study. At the 12-month time point there were statistical differences between CMR and nCMR groups for all factors considered in the level of collaborative practice. Determinants which showed positive significant differences between groups included: rural location of the pharmacy, pharmacists being a pharmacy owner, and female gender of the physician. The age of the pharmacist was negatively associated with higher levels of collaborative practice. The study provides novel evidence on the level and nature of the collaborative practice between community pharmacists and physicians.

Family physicians' perspectives on advising patients on an obstetric delivery location: Study from a remote community.

To determine what factors individual physicians in a remote northern Saskatchewan community consider when advising patients on an obstetric delivery location. Semistructured interviews. La Ronge, a remote northern Saskatchewan community. Eleven family physicians providing full-scope care in a remote medical clinic. Each physician at the only medical clinic in the area was sent an email in February 2017 inviting them to be involved in the study. Interviews were conducted between February and April 2017 and were audiorecorded and manually transcribed. The transcribed interviews were returned to participants for their review and additional input. Saturation was reached after 9 interviews, with 2 further interviews being conducted after saturation for a total of 11 interviews. Inductive thematic analysis was undertaken following the interviews. Patient choice was an important factor in the discussion about delivery location. Themes that evolved from physician consideration on delivery location included benefits of local delivery, local resources, selection of low-risk pregnancies, physician and nursing skills, and patient choice. Family physicians should provide patients with all potential options for delivery location and support the decision made with the patient.

Translation, Adaptation, and Validation of the Professional Collaborative Practice Tool for Community Pharmacists and Physicians in Arabic-Speaking Countries.

Translation, Adaptation, and Validation of the Professional Collaborative Practice Tool for Community Pharmacists and Physicians in Arabic-Speaking Countries.

Developing and Evaluating an Interactive, Case-Based, Web-Based Active Learning Tool for Primary Care Physicians (Community Fracture Capture Learning Hub): Protocol for an Acceptability and Engagement Study.

The lack of osteoporosis treatment initiation after fragility fractures is a significant gap, especially in primary care. It is unclear whether barriers for primary care physicians (PCPs) arise from uncertainty about investigations, treatment initiation, or medication side effects. Key questions remain about whether active learning platforms improve treatment initiation rates better than passive methods and how PCP demographics affect learning outcomes. With PCPs increasingly using web-based platforms for continuing professional development due to time constraints and heavy workloads, an interactive community fracture capture (CFC) tool may serve as an effective alternative to in-person learning. Our CFC pilot study tested this new program's design and content, showing promising potential. We aim to evaluate the interactive, case-based, web-based CFC Learning Hub, examining user acceptance and engagement with the platform, focusing on participants' interactions, satisfaction levels, and overall experience. Participating PCPs are recruited through Praxhub, a web-based medical education platform, and provide electronic consent for data use after deidentification. They have been allocated into small groups (12-20 members) and join the CFC Learning Hub, a secure web-based community. This hub includes a web-based discussion forum with participant-contributed case studies and a knowledge repository. Over the 6-week program, participants will receive weekly modules with instructions, resources, discussion threads, and quizzes, along with interactive discussions moderated by experienced PCPs and physicians. The platform also hosts web-based surveys that, in combination with platform analytics, allow assessment of baseline knowledge gaps, level of activity or engagement, and improvements following the course completion. This study protocol demonstrates the creation and proposed evaluation of the CFC Learning Hub, featuring an interactive, case-based, small-group web-based learning platform equipped with flexibly scheduled, tailored modules to address the fracture treatment gap within the community. Both qualitative (via thematic analysis) and quantitative (by using 2-tailed paired t tests, Wilcoxon signed rank tests, and multivariable regression analysis) analyses will be used to assess levels of engagement and acceptance and changes in PCPs' knowledge and confidence after engagement with the CFC Learning Hub. Recruitment of participants started in May 2022. Data collection, analysis, and reporting will be completed following the completion of four 6-week cycles of the program. The study described in this protocol will provide important insights into the function and effectiveness of the CFC Learning Hub. This information will guide the expansion of the program. This initiative offers a simple digital solution for promoting current bone health practices tailored to PCPs' needs and thereafter to expand the rollout of the e-learning hub and implementation of fracture liaison models at a primary care level in Australia and elsewhere. Future applications may extend to other clinical areas and professions. DERR1-10.2196/57511.

Control of Pulse Pressure and Factors Affecting it among the Geriatric Population Suffering from Hypertension within the Community.

To explore the impact of employing the Knowledge, Attitude, and Practice (KAP) model within a unified community physician intervention aimed at managing pulse pressure among elderly individuals with hypertension in Shenyang, along with its associated influencing variables. 2660 hypertensive patients were recruited in the community of Shenyang City in January 2020. After a 1-year KAP intervention by a unified community physician, KAP changes and pulse pressure levels were compared before and after the intervention. Meanwhile, the relevant influences affecting pulse pressure control were explored. Descriptive analysis and multifactorial logistic regression were used. A significant decrease in pulse pressure by 10.71 mmHg (95% CI: 10.09, 11.33 mmHg) was noted among elderly individuals with hypertension in the community after undergoing a rigorous one-year intervention program (t = 33.79, p < 0.05). Pulse pressure control increased from 32.59% at baseline to 64.92% (χ2 = 556.43, p < 0.01). Compared to pre-intervention, knowledge about hypertension, awareness of prevention, medication and behavioural adherence improved significantly. A multifactorial logistic regression analysis revealed that the risk factors for pulse pressure control were female sex, a history of comorbid diabetes mellitus and poor adherence to medication due to forgetfulness. Unified community physician interventions can change the perceptions of elderly hypertensive patients, improve medication adherence, and improve poor lifestyle habits, thereby improving pulse pressure control in the geriatric population with hypertension residing in local communities.

The roadmap to integrate diversity, equity, and inclusion in hematology clinical trials: an American Society of Hematology initiative.

Clinical trial design for classical hematologic diseases is difficult because samples sizes are often small and not representative of the disease population. The American Society of Hematology initiated a roadmap project to identify barriers and make progress to integrate diversity, equity, and inclusion into trial design and conduct. Focus groups of international experts from across the clinical trial ecosystem were conducted. Eight issues identified include (1) harmonization of demographic terminology; (2) engagement of lived experience experts across the entire study timeline; (3) awareness of how implicit biases impede patient enrollment; (4) the need for institutional review boards to uphold the justice principle of clinical trial enrollment; (5) broadening of eligibility criteria; (6) decentralized trial design; (7) improving access to clinical trial information; and (8) increased community physician involvement. By addressing these issues, the hematology community can promote accessible and inclusive trials that will further inform research, clinical decision-making, and care for patients.

Challenges in Implementing the Competency-Based Medical Education Curriculum in Pharmacology: Impact of Shortened Duration and Reduced Teaching Hours.

Background The Competency-Based Medical Education (CBME) curriculum was introduced by the Medical Council of India in 2019 to enhance the quality of Indian medical graduates (IMGs). Its goal is to produce IMGs who possess the knowledge, skills, attitudes, and values needed to serve as competent community physicians while remaining globally relevant. The curriculum incorporates new elements and refined assessment methods. However, the duration of the second-year MBBS course was reduced from 18 months to 12 months, and pharmacology teaching hours were cut from 300 to 230. These changes have raised concerns about the challenges of implementation and the adequacy of training. This study seeks to identify the obstacles faced by pharmacology faculty in implementing the CBME curriculum, particularly focusing on the effects of the shortened course duration, reduced teaching hours, and faculty-related challenges while proposing actionable solutions for effective implementation. Materials and methods This nationwide cross-sectional study, conducted between September and October 2023, surveyed 52 pharmacology faculty members from eight states and one union territory in India. Following Institutional Ethics Committee (IEC) approval number IEC-43/2022, data were collected using a structured questionnaire designed to capture faculty experiences and opinions on the CBME curriculum. Key areas of focus included course duration, teaching hours, new curriculum elements, faculty adequacy, and training status. The questionnaire, validated by internal and external experts, underwent a pilot study prior to its distribution via Google Forms (Google LLC, Menlo Park, California, USA) for purposive sampling. Responses, comprising closed-ended and Likert scale items, were analyzed using Microsoft Excel (Microsoft Corporation, Redmond, Washington, USA), with the chi-square test applied for significance. An open-ended section was included to gather additional insights for enhancing CBME implementation. Results Thirteen (25%) of the study participants had not undergone the Curriculum Implementation Support Program (CISP) even three years after the CBME curriculum was introduced. A majority, 37 (71.2%), felt that the reduction of the second-year MBBS duration from 18 months to 12 months and the decrease in theory hours from 100 to 80 were insufficient for effective syllabus completion. However, nearly the same percentage of faculty expressed satisfaction with the allocation of 150 practical hours, compared to the 200 hours in the pre-CBME curriculum. Notably, 45 (87%) of the faculty reported significant challenges in conducting self-directed learning, small group discussions, seminars, tutorials, and similar activities. Furthermore, all participants unanimously agreed that the inability to appoint additional assistant professors in a department, as restricted by the National Medical Commission (NMC) guidelines, to compensate for the shortage of tutors had negatively impacted the implementation of the CBME curriculum. Conclusions The CBME curriculum marks a significant breakthrough in the Indian medical education system. However, it is crucial to identify and assess the barriers to its effective implementation and establish a systematic feedback mechanism to ensure that the CBME curriculum, as outlined in the NMC document, is successfully put into practice.

Electronic Health Record Use Patterns Among Well-Being Survey Responders and Nonresponders: Longitudinal Observational Study.

Physician surveys provide indispensable insights into physician experience, but the question of whether responders are representative can limit confidence in conclusions. Ubiquitously collected electronic health record (EHR) use data may improve understanding of the experiences of survey nonresponders in relation to responders, providing clues regarding their well-being. The aim of the study was to identify EHR use measures corresponding with physician survey responses and examine methods to estimate population-level survey results among physicians. This longitudinal observational study was conducted from 2019 through 2020 among academic and community primary care physicians. We quantified EHR use using vendor-derived and investigator-derived measures, quantified burnout symptoms using emotional exhaustion and interpersonal disengagement subscales of the Stanford Professional Fulfillment Index, and used an ensemble of response propensity-weighted penalized linear regressions to develop a burnout symptom prediction model. Among 697 surveys from 477 physicians with a response rate of 80.5% (697/866), always responders were similar to nonresponders in gender (204/340, 60% vs 38/66, 58% women; P=.78) and age (median 50, IQR 40-60 years vs median 50, IQR 37.5-57.5 years; P=.88) but with higher clinical workload (median 121.5, IQR 58.5-184 vs median 34.5, IQR 0-115 appointments; P<.001), efficiency (median 5.2, IQR 4.0-6.2 vs median 4.3, IQR 0-5.6; P<.001), and proficiency (median 7.0, IQR 5.4-8.5 vs median 3.1, IQR 0-6.3; P<.001). Survey response status prediction showed an out-of-sample area under the receiver operating characteristics curve of 0.88 (95% CI 0.77-0.91). Burnout symptom prediction showed an out-of-sample area under the receiver operating characteristics curve of 0.63 (95% CI 0.57-0.70). The predicted burnout prevalence among nonresponders was 52%, higher than the observed prevalence of 28% among responders, resulting in an estimated population burnout prevalence of 31%. EHR use measures showed limited utility for predicting burnout symptoms but allowed discrimination between responders and nonresponders. These measures may enable qualitative interpretations of the effects of nonresponders and may inform survey response maximization efforts.

Influence of data review on community physicians’ treatment preferences in frontline esophageal cancer (EC).

501 Background: EC remains a global health challenge with a rising incidence and poor prognosis despite advancements in treatment modalities. Standard therapies include surgery, chemotherapy (CT), radiation therapy, and recently, targeted and immunotherapy. The PD-L1 inhibitors pembrolizumab (pembro) and nivolumab (nivo) received FDA approval for frontline treatment in EC in March and May 2021, respectively, based in part on the KEYNOTE-590 (KN590) and CheckMate 648 trials. In this study, we aimed to uncover rationale in physician preference for PD-L1 inhibitors in EC. Methods: US-based oncologists convened at two in-person meetings in April 2024 to discuss clinical and real-world data presented at the 2024 ASCO GI Cancers Symposium. Among data discussed included the KN590 5-year update. Survey questions were fielded at the meeting to capture participants’ impressions. Demographics were captured via an online survey ahead of the meeting. Responses from participants who manage EC and responded to all survey questions were aggregated. Results: 86 participants qualified; and, collectively, are 76% community physicians with 18 years average in clinical practice, see 18 patients median on clinic days, and spend 83% of their time in direct patient care on average. ECOG PS status (50%), tumor histology (52%), and location/stage (48%) were reported as critical factors in treatment decision-making; only 14% said PD-L1 status was a major factor. Participants were queried on a hypothetical patient case of esophageal squamous cell and adenocarcinoma before and after reviewing the KN590 data. Prior to reviewing KN590, physician preferences in the squamous cell 1L setting were split between nivo+CT and pembro+CT; following data review, pembro+CT was favored nearly 3:1. In the adenocarcinoma 1L setting, preference shifted from 60/40 nivo+CT to 60/40 pembro+CT, see Table. The cohort were most impressed with the overall survival (87%) and objective response rates (40%), and 55% would consider pembro+CT for both squamous cell and adenocarcinoma disease while 37% would consider it for PD-L1 CPS&gt;10 squamous cell disease only. Conclusions: Our study showed PD-L1 status was not a major factor in clinical decisions. The shift in treatment preference toward pembro+CT for both patient cases following KN590 data review suggests an impact for data review to influence physician behavior. This highlights the importance of educational initiatives to disseminate clinical updates to providers. It is still to be determined the optimal platform and length for these initiatives, and to quantify their effectiveness. 65-year-old male patient with advanced EC;PD-L1 CPS ≥10;ECOG PS of 1 Squamous cell disease Adenocarcinoma Before After Before After Fluoropyrimidine (FP) + platinum (P)-based CT 1% 1% 1% 0% FP +P-based CT + nivo 55% 27% 60% 36% FP + P-based CT + pembro 43% 71% 38% 63% Nivo + ipilimumab 1% 1% 0% 1% None of the above 0% 0% 0% 0%

Exploring implementation of interventions to facilitate integration in fragmented healthcare systems

AbstractIntroductionStanford Medicine is working to better coordinate care across the Stanford healthcare system, as well as improve patient and provider experiences in seeking and receiving care. This study aimed to explore the complexities of moving from a fragmented to an integrated academic healthcare system and to identify and explain factors (e.g., facilitators and barriers) of the implementation of three interventions meant to improve patient experience, reduce staff burden, and integrate health care systems across faculty and community settings.MethodsWe conducted qualitative semi‐structured interviews via Zoom with faculty and community physicians. Interviews were audio‐recorded, professionally transcribed, and analyzed using the Consolidated Framework for Implementation Research (CFIR) and open coding. Using consensus coding approaches, researchers met regularly to discuss themes and adaptations to CFIR.ResultsWe analyzed transcripts from interviews with physicians (n = 26). Factors impacting integration included the following: (1) physicians supported the interventions, promoting mission alignment; (2) physicians were motivated for change, reporting the existing system was intolerable; (3) physicians reported different priorities between clinics: faculty versus community and primary care versus specialty; (4) physicians prioritized interpersonal versus system solutions; (5) specialists were wary of unintended consequences of integration, specifically inappropriate bookings or patients being redirected to other clinics. Broadly speaking, facilitator factors 1–2 focused on the openness to, and tension for, change; and barrier factors 3–5 promoted or sustained variation across specialties and faculty/community clinics.ConclusionsOur results illustrate the challenges and opportunities of moving from a fragmented to an integrated healthcare system and emphasize the importance of building shared culture, collaboration, and coordinated actions across and within an integrated healthcare network.