Comparison Of Practice Patterns Research Articles

Analysis of healthcare provider management of immune-related adverse events and concordance with NCCN Guidelines.

11136 Background: Immune checkpoint inhibitors (ICIs) are a mainstay of treatment for many cancers but can cause immune-related adverse events (irAEs) that require prompt recognition and management. In 2017, we developed an online interactive decision support tool [www.clinicaloptions.com/immuneAEtool] for healthcare providers (HCPs) with case-specific recommendations for managing irAEs from a medical oncology expert. In 2019 and 2023, we updated the tool to offer recommendations from the latest National Comprehensive Cancer Network (NCCN) Guidelines. Here, we report a comparison of self-reported irAE management from HCPs using the 2023 tool vs NCCN recommendations and a comparison of practice patterns between the 2023 and 2019 tools. Methods: To use the online tool, HCPs entered the affected organ system, symptom grade/severity, and their planned management strategy. The tool showed the NCCN management recommendation for that irAE and then asked if the recommendation changed their intended management approach. Results: From July to December 2023, 172 HCPs entered 241 case scenarios into the tool; 53% treated <10 patients/month with ICIs, and 38% of HCPs practiced in the United States. The most common irAEs involved the gastrointestinal (GI)/hepatobiliary (hep)/pancreatic (29% of cases) or dermatologic/oral (19%) systems. Overall, the planned irAE management strategy of HCPs matched the NCCN recommendations in 55% of cases, an increase from the 49% concordance rate in our 2019 analysis. In the current analysis, the lowest concordance was observed for infusion-related reactions (20%), musculoskeletal irAEs (46%), and dermatologic/oral mucosa irAEs (46%; Table). Furthermore, US HCPs had a lower overall concordance rate (46%) than non-US HCPs (66%). Approximately one half (56%) of all HCPs indicated that the NCCN recommendations in the tool changed their management plan. Conclusions: These data suggest that many HCPs are challenged to optimally manage irAEs and are not managing their patients in concordance with NCCN guidelines. A detailed analysis of HCP irAE management vs NCCN recommendations, including by organ system and severity, along with a comparison of 2023 vs 2019 practice patterns, will be presented. [Table: see text]

Management of uncomplicated rhegmatogenous retinal detachments: a comparison of practice patterns and clinical outcomes in a real-world setting.

To investigate practice patterns and clinical outcomes in the repair of uncomplicated rhegmatogenous retinal detachments (RRD) in a real-world setting over a 10-year period. We compared preferences for scleral buckling (SB), pars plana vitrectomy (PPV), PPV/SB, or pneumatic retinopexy (PR) over time, and examined the 1-year single surgery anatomic success (SSAS) and best-corrected visual acuity (BCVA) at a tertiary academic institution from 2008-2018. Eight hundred eight eyes had RRD repair between 2008-2011 (n = 240), 2012-2014 (n = 271), and 2015-2017 (n = 297). Compared to 2008-2011, PPV was preferred over SB in 2012-2014 (OR: 2.93; 95% CI: 1.86-4.63) and 2015-2017 (OR: 5.94; 95% CI: 3.76-9.38), and over PPV/SB in 2012-2014 (OR: 2.74; 95% CI: 1.65-4.56) and 2015-2017 (OR: 3.16; 95% CI: 31.96-5.12). PR was uncommonly utilized (<10%). Younger surgeons (graduating 2010-2017) favored PPV over SB when compared to older surgeons [graduating 1984-2000 (OR: 1.77; 95% CI: 1.18-2.65) and 2001-2009 (OR 1.73; 95% CI: 1.14-2.65)], but similarly selected PPV vs. PPV/SB as their older counterparts (p > 0.05). Compared to PPV, SSAS was higher with SB (OR: 1.53; 95% CI: 1.03-2.26) and PPV/SB (OR: 2.55; 95% CI: 1.56-4.17). One-year BCVA was markedly improved compared to baseline only for eyes that achieved SSAS (p < 0.001). Over the past 10 years, PPV has become the favored approach to repair uncomplicated RRD and this appears to be driven by younger surgeons' preferences. Given the superior long-term SSAS in SB and PPV/SB as compared to PPV, SB and PPV/SB should be more frequently considered when determining the appropriate repair strategy for uncomplicated RRD.

Monitoring Thyroid Function Tests in Patients With Type 1 Diabetes Mellitus: Adherence to Recommended Guidelines and Comparison of Practice Patterns in a Health Care System

Abstract Approximately 1.7 million people in the U.S. have type 1 diabetes mellitus. Autoimmune thyroid disease occurs in 17 to 30% of patients with type 1 diabetes. The American Diabetes Association recommends that thyroid function be assessed at diagnosis of type 1 diabetes and repeated every 1 to 2 years thereafter or sooner if clinically indicated. With Centricity, our former electronic medical records (EMR) system, an EMR aid automatically imported key diabetes metrics including the TSH test. Our new EMR system, MedConnect, does not have an EMR aid that imports these metrics. We hypothesized that the screening rate for thyroid dysfunction in type 1 diabetic patients would be higher with the previous EMR system than with the new EMR system. We also hypothesized that the screening rate in patients followed by an endocrinologist would be higher than in those followed by a primary care physician. Methods: We compared practice patterns with Centricity (from June 1, 2013, to May 30, 2016) versus MedConnect (from January 1, 2017, to December 31, 2019) in both primary care and endocrinology clinics. A total of 502 patients (271 Centricity, 231 MedConnect) were identified by chart review with age ≥18 years and ICD 9/10 codes for type 1 diabetes mellitus in outpatient clinics in our multicenter system. Results: Baseline TSH was done in 253 of 271 (93.4%) Centricity patients and in 181 of 231 (78.4%) MedConnect patients. The odds of baseline TSH with Centricity was 3.88 times higher compared to MedConnect (OR = 3.88, 95% CI=2.19,6.88). Of the 214 patients with normal baseline TSH, 135 (63.1%) had repeat TSH done in 1-2 years; and of the 136 MedConnect patients with normal baseline TSH, 86 (63.2%) had repeat TSH done in 1-2 years. Of 434 patients with baseline TSH, 81 (18.6%) had abnormal TSH. Of these patients, 67 (82.7%) had hypothyroidism, 1 (1.2%) had hyperthyroidism, 8 (9.8%) had subclinical hypothyroidism, and 5 (6.1%) had subclinical hyperthyroidism. Of the total 502 patients, 380 (75.7%) were followed by an endocrinologist and 122 (24.3%) were followed by a primary care provider. Among patients followed by an endocrinologist, 348 (91.6%) had a baseline TSH result. Only 86 of 122 (70.5 %) patients followed by a primary care physician had a baseline TSH. Endocrinologists had 4.6 times higher odds of TSH screening at baseline compared with primary care physicians (p &amp;lt;0.0001). Conclusion: Thyroid function was not assessed at baseline in all patients with type 1 diabetes mellitus and was not followed at the recommended intervals per the guidelines. Higher screening rates were seen with an EMR aid. Endocrinologists screened significantly more patients than primary care physicians. Education of providers regarding the guidelines is needed, and addition of an EMR aid may help to improve detecting thyroid dysfunction in patients with type 1 diabetes mellitus.

Comparison of practice patterns and geographic distribution of osteopathic and allopathic dermatologists

To the Editor: During the past decade, osteopathic physicians (doctors of osteopathic medicine [DOs]) have played an increasing role in patient care. In dermatology, the proportion of DOs increased from 4.0% in 2008 to 5.7% in 2017.1 We sought to compare practice patterns of DO and allopathic (doctor of medicine [MD]) dermatologists. This is important because DO physicians have been shown to alleviate health care shortages in other specialties and because major allopathic and osteopathic dermatologic institutions have shared goals of providing accessible dermatologic care.

SUN-419 Monitoring Thyroid Function Tests in Patients on Lithium: Adherence to Recommended Guidelines and Comparison of Practice Patterns in a Health Care System

It is well known that Lithium causes various types of thyroid dysfunction. Thus, multiple professional guidelines, for example the American Psychiatry Association, recommend that thyroid function be assessed before starting lithium therapy, within the first 6 months of initiation, and then every 6 to 12 months. We hypothesized that these recommendations are not consistently followed by all types of providers.MethodsA total of 796 patients were identified by chart review with age ≥18 years and ICD 9/10 codes for bipolar disorder or on lithium in outpatient clinics in our multicenter system from January 2013 to December 2017.ResultsLithium start date was known in 472 (59.3%) of 796 patients. Of these 796 patients, 518 (65 %) were followed by psychiatry, 25 (3%) by family medicine, 60 (7.5%) by internal medicine, and 193 (24%) by other specialties including endocrinology and emergency department. Patients with unknown start date were excluded from analysis of baseline and follow-up TSH. Baseline TSH was done in 178 (37%) of patients with known start date. Of these patients, 141 (79%) were followed by psychiatry, 13 (7%) by internal medicine, and 8 (4%) by family medicine. Of the 472 patients, 76 (16%) had 6-month TSH by psychiatry (42; 60.5%), internal medicine (17; 22%), and family medicine (3; 4%). Of the 796 patients on lithium, 568 (71%) had random TSH values, 200 (25%) had abnormal thyroid function tests (TFTs), and only 69 (34%) had baseline TFTs before lithium was started. Of the 200 patients with abnormal TFTs, 90 (45%) developed thyroid disease. The odds of baseline TSH for family practice and internal medicine were not significantly different than for psychiatry, (OR = 1.3 p = 0.6, and OR = 0.7, p = 0.3, respectively). Internal medicine had 5.1 times higher odds of TSH at 6 months compared with psychiatry (p <0.001). The odds of 6-month TSH for family practice were not significantly different than for psychiatry.ConclusionOur findings revealed that TSH was not checked in most patients before starting lithium therapy and TSH values were not followed at recommended intervals. This raises the concern that a large number of patients may have undiagnosed thyroid dysfunction due to inappropriate follow up. Future plans include a quality improvement project to focus on improving practice patterns, such as EMR reminders to prompt providers when TFTs are due and educating providers about the guidelines.

Comparison of practice patterns among Canadian allergists before and after NIAID guideline recommendations

Comparison of practice patterns among Canadian allergists before and after NIAID guideline recommendations

Comparison of Practice Patterns and Outcomes for Recurrent Malignant Pleural Effusions

SESSION TITLE: Pleural Effusions SESSION TYPE: Original Investigation Slide PRESENTED ON: Sunday, October 29, 2017 at 07:30 AM - 08:30 AM PURPOSE: Guidelines for treatment of recurrent malignant pleural effusions (MPE) recommend use of definitive procedures, such as indwelling pleural catheters (IPC) or pleurodesis, over repeat thoracentesis. However, there is a paucity of comparative effectiveness data assessing the impact of practice patterns on outcomes. We hypothesized that many patients receive multiple thoracenteses rather than receiving a definitive procedure as per guidelines and that guideline inconsistent care would result in more pleural procedures and complications. METHODS: Design: Retrospective cohort study of SEER-Medicare data from 2007-2011. The primary outcome was whether patients with rapidly recurring MPE, defined as recurrence within 2 weeks of their first thoracentesis, received guideline consistent care. Secondary outcomes included subsequent pleural procedures, pneumothorax from pleural procedures, location of care, and inpatient days associated with pleural procedures. Setting: Community and academic practices. Participants: Patients age 66-90 diagnosed with their first primary cancer with a MPE that had a thoracentesis were identified using ICD-9 and CPT codes. Thoracentesis for MPE was performed in 23,431 patients. Of these 12,967 (55%) required a second pleural procedure, 8,572 (37%) died without another pleural procedure and 1,892 (8%) were alive without recurrence at last follow-up. Of the 12,967 patients that required a second pleural procedure, 7,565 (58%) had it within 14 days of the first procedure. Exposure variable: Guideline consistent care, defined as a definitive second pleural procedure. RESULTS: Of the 7,565 patients with rapidly recurring MPE’s, only 1,811 (24%) received guideline consistent care. Definitive pleural procedures as compared to repeat thoracentesis for recurrence of MPE resulted in fewer future pleural procedures (0.62 vs. 1.44 procedures per patient respectively, p<0.0001), fewer pneumothoraxes (<0.0037 vs. 0.009 pneumothoraxes per patient, p=0.001), and fewer emergency room procedures (0.02 vs. 0.04 emergency room procedures per patient, p<0.001). However, repeat thoracentesis and IPCs resulted in fewer inpatient days as compared to chest tube or thoracoscopic pleurodesis (0.013 vs. 0.013 vs. 0.085 vs. 0.097 inpatient days per day of life respectively, p<0.001). Factors associated with guidelines consistent care included living in a big metropolitan area, specialists performing the first procedure, having the procedure in the emergency room, younger patient age, and having a diagnosis of lung cancer. CONCLUSIONS: Guideline consistent care using definitive procedures as compared to repeat thoracentesis is associated with fewer future procedures and complications. CLINICAL IMPLICATIONS: Attention to physician training and developing disease management pathways that facilitate prompt follow-up of MPE is needed to address the quality gap observed. DISCLOSURE: The following authors have nothing to disclose: David Ost, Jiangong Niu, Horiana Grosu, Sharon Giordano No Product/Research Disclosure Information

Comparison of practice patterns between inpatient cardiology pharmacists with and without added qualifications in cardiology.

There is a paucity of data comparing practice patterns between board-certified specialists with added qualifications in cardiology (AQCV) and cardiovascular pharmacists without these credentials. The purpose is to characterize differences in practice between inpatient pharmacists with and without AQCV. We conducted a multicenter, retrospective, cross-sectional, case-controlled survey. An AQCV pharmacist list was extracted from the Board of Pharmacy Specialties Web site. Hospitals with AQCV pharmacists comprised the case group. Hospitals were excluded if the AQCV pharmacists did not provide direct patient care, practiced in the outpatient setting, or were in a Veterans Affairs hospital. Each case hospital was matched to hospitals without an AQCV pharmacist in a 1:3 ratio (case:control) by region, cardiovascular discharges, and teaching hospital status. Institutions completed a survey characterizing their pharmacy services. Fifty-six hospitals completed the survey (21 AQCV, 35 non-AQCV). More AQCV pharmacists participated on rounds (100% vs 82.9%, P = .04) and devoted more time performing administrative tasks (20.5% ± 15.3% vs 11.1% ± 8.1%, P = .001) than non-AQCV pharmacists. Conversely, AQCV pharmacists spent less time providing clinical care (52.4% ± 14.5% vs 66.2% ± 19.8%, P = .007), were less involved with drug protocol management (71.4% vs 91.4%, P = .05), and performed less order verification than non-AQCV pharmacists. Practice patterns differ between inpatient pharmacists with and without AQCV. Further research is needed to determine whether AQCV credentialing improves patient outcomes and to delineate what specific tasks performed by inpatient cardiology pharmacists may improve patient outcomes.

Comparison of Practice Patterns Between Inpatient Cardiology Pharmacists With and Without Added Qualifications in Cardiology

There is a paucity of data comparing practice patterns between board-certified specialists with added qualifications in cardiology (AQCV) and cardiovascular pharmacists without these credentials.The purpose is to characterize differences in practice between inpatient pharmacists with and without AQCV.We conducted a multicenter, retrospective, cross-sectional, case-controlled survey. An AQCV pharmacist list was extracted from the Board of Pharmacy Specialties Web site. Hospitals with AQCV pharmacists comprised the case group. Hospitals were excluded if the AQCV pharmacists did not provide direct patient care, practiced in the outpatient setting, or were in a Veterans Affairs hospital. Each case hospital was matched to hospitals without an AQCV pharmacist in a 1:3 ratio (case:control) by region, cardiovascular discharges, and teaching hospital status. Institutions completed a survey characterizing their pharmacy services.Fifty-six hospitals completed the survey (21 AQCV, 35 non-AQCV). More AQCV pharmacists participated on rounds (100% vs 82.9%, P = .04) and devoted more time performing administrative tasks (20.5% ± 15.3% vs 11.1% ± 8.1%, P = .001) than non-AQCV pharmacists. Conversely, AQCV pharmacists spent less time providing clinical care (52.4% ± 14.5% vs 66.2% ± 19.8%, P = .007), were less involved with drug protocol management (71.4% vs 91.4%, P = .05), and performed less order verification than non-AQCV pharmacists.Practice patterns differ between inpatient pharmacists with and without AQCV. Further research is needed to determine whether AQCV credentialing improves patient outcomes and to delineate what specific tasks performed by inpatient cardiology pharmacists may improve patient outcomes.

Comparison of Practice Patterns in Total Ankle Replacement and Ankle Fusion in the United States

Although tibiotalar fusion has historically been considered the gold standard treatment for end-stage arthritis of the ankle, the performance of total ankle replacement appears to be gaining favor as improved outcomes have been observed with new implant designs and surgical techniques. The purpose of this study was to compare trends and demographics in the performance of ankle fusion and total ankle replacement in the United States. The Current Procedural Terminology (CPT) codes of patients undergoing ankle fusion and total ankle replacement were searched using the PearlDiver Patient Record Database, a national database of orthopaedic patients. The CPT codes for open ankle arthrodesis (27870), arthroscopic ankle arthrodesis (29899), and total ankle replacement (27700, 27702) were searched for the years 2004 to 2009 to identify relative changes in the performance of ankle fusion and replacement over time. The performance of ankle fusion was unchanged during the 6-year study period. In contrast, an increase in total ankle replacement was observed, from 0.63 cases per 10 000 patients searched in 2004 to 0.99 cases per 10 000 patients in 2009 (P < .05). Both ankle fusion and total ankle replacement were performed most commonly in patients aged 60 to 69 years (P < .05). Although an even gender distribution was observed in patients undergoing total ankle replacement, open and arthroscopic fusion were more commonly performed in males (P < .05). With regard to regional distribution, open and arthroscopic fusion were most commonly performed in the western region of the United States, whereas total ankle replacement was performed most frequently in the Midwest (P < .001). In the population studied, the performance of total ankle replacement increased 57% from 2004 to 2009 and was performed equally in male and female patients when compared to ankle fusion, which was more often performed in males and was unchanged with time. Level IV, cross-sectional study.

P.7.c.009 Management of ADHD among children in Europe: a comparison of practice patterns across countries

P.7.c.009 Management of ADHD among children in Europe: a comparison of practice patterns across countries

Current Status of the European Association for Cardio-Thoracic Surgery and The Society of Thoracic Surgeons Congenital Heart Surgery Database

After utilizing separate congenital databases in the early 1990s, the Society of Thoracic Surgeons (STS) and the European Association for Cardio-Thoracic Surgery (EACTS) collaborated on several joint database initiatives. In 1998, the joint EACTS-STS International Congenital Heart Surgery Nomenclature and Database Project Committee was created and a common nomenclature and common core minimum database dataset were adopted and published by the STS and the EACTS. In 1999, the joint EACTS-STS Aristotle Committee was created and the Aristotle Score was adopted and published as a method to provide complexity adjustment for congenital heart surgery. Collaborative efforts involving the EACTS and STS are underway to develop mechanisms to verify data completeness and accuracy. Since 1998, this nomenclature, database, and methodology of complexity adjustment have been used by both the STS and EACTS to analyze outcomes of over 40,000 patients. A huge amount of data have been generated which allow comparison of practice patterns and outcomes analysis between Europe and North America. The aggregate data from the first 5 years of data collection not only make for interesting comparison but also allow examination of regional difference in practice patterns. For example, in the EACTS, out of 4,273 neonates, 885 (20.7%) underwent arterial switch procedures and 297 (6.95%) underwent Norwood stage 1 procedures. In the STS, out of 3,988 neonates, 472 (11.8%) underwent arterial switch procedures and 575 (14.4%) underwent Norwood stage 1 procedures. This analysis of the EACTS-STS multi-institutional outcomes database confirms that in both Europe and North America, case complexity and mortality is highest among neonates, then infants, and then children. Regional differences in practice patterns are demonstrated, with the overall goal being the continued upgrade in the quality of surgery for congenital heart disease worldwide.

NON-ORAL POSTER 19: Comparison of Practice Patterns When Using the Minimally Invasive Sling

NON-ORAL POSTER 19: Comparison of Practice Patterns When Using the Minimally Invasive Sling

Comparison of practice patterns and treatment techniques for regional nodal irradiation with breast conservation vs. postmastectomy in stage I-II breast cancer

Comparison of practice patterns and treatment techniques for regional nodal irradiation with breast conservation vs. postmastectomy in stage I-II breast cancer

Comparison of practice patterns and treatment techniques for regional nodal irradiation with breast conservation vs. postmastectomy in stage I-II breast cancer

Comparison of practice patterns and treatment techniques for regional nodal irradiation with breast conservation vs. postmastectomy in stage I-II breast cancer

A comparison of practice patterns and a model continuum of ambulatory behavioral health services.

guished from each other by service characteristics and patient characteristics. Service characteristics include function, presence of scheduled programming, structure, milieu, availability of crisis services, involvement of medical personnel, accessibility, responsibility, and control. Patient characteristics include psychiatric symptoms, level of functioning, level of risk and dangerousness, presence of support, and commitment to treatment (2). Descriptions of the three levels of care illustrate their clinical applicability. While the prototype for level 1 is the traditionally defined partial hospital program, this level also describes other intensive hospital diversion services that provide crisis stabilization and acute symptom reduction. Level 1 provides access to care within 24 hours and incorporates a high degree of medical input and an organized system of crisis back-up for patients with unstable, disabling symptoms. Level 2 services provide treatment for patients with moderate to severe disorders who require interventions focused on improved level of func tioning, skill building, and disease management. Intensive outpatient programs, characterized by coordinated, multimodal treatment with structured program activities, are most frequently categorized as level 2.

Comparison of Practice Patterns and Job Satisfaction of Entry Level PharmD and BS Level Graduates in Hospital and Community Practice

Comparison of Practice Patterns and Job Satisfaction of Entry Level PharmD and BS Level Graduates in Hospital and Community Practice

A Comparison of Practice Patterns and Job Satisfaction of California and Non-California PharmD Graduates: Some Implications for the Entry Level PharmD Issue

A Comparison of Practice Patterns and Job Satisfaction of California and Non-California PharmD Graduates: Some Implications for the Entry Level PharmD Issue

Lawyers and Localities: The Interaction of Community Context and Professionalism

Most studies of the legal profession, done in metropolitan settings, have indicated that the profession is characterized by deep divisions associated with varying practice patterns, professional status, and orientation. But the sources of division within the bar include more than the specialization and stratification that are typical of the bar in metropolitan settings. Community context also appears to be a source of division. It determines not only the character of a lawyer's cases and clients but also the manner in which practice is conducted. This comparison of practice patterns in Missouri of rural lawyers with those in a middle-sized city (Springfield) revealed that while the small town context protects the bar from the centrifugal forces of stratification found in larger settings, it also has elements that challenge the professional independence of the practitioner. The small town or rural practitioner is very much a part of the local life, and thus local opinion and values have a salience for practice patterns not typical of larger settings. In addition, these rural lawyers are less likely to be engaged exclusively in law practice.Overall, the data suggest that the legal profession is divided not only by specialization and its attendant internal stratification but also by the size and character of the local context. In contrast to the view that the profession is a homogeneous professional subculture, we found that the bar may better be thought of as a rather loose-knit group with tenuous collegial ties whose professionalism is under constant challenge from the community in which law practice occurs.

Lawyers and Localities: The Interaction of Community Context and Professionalism

Most studies of the legal profession, done in metropolitan settings, have indicated that the profession is characterized by deep divisions associated with varying practice patterns, professional status, and orientation. But the sources of division within the bar include more than the specialization and stratification that are typical of the bar in metropolitan settings. Community context also appears to be a source of division. It determines not only the character of a lawyer's cases and clients but also the manner in which practice is conducted. This comparison of practice patterns in Missouri of rural lawyers with those in a middle-sized city (Springfield) revealed that while the small town context protects the bar from the centrifugal forces of stratification found in larger settings, it also has elements that challenge the professional independence of the practitioner. The small town or rural practitioner is very much a part of the local life, and thus local opinion and values have a salience for practice patterns not typical of larger settings. In addition, these rural lawyers are less likely to be engaged exclusively in law practice.Overall, the data suggest that the legal profession is divided not only by specialization and its attendant internal stratification but also by the size and character of the local context. In contrast to the view that the profession is a homogeneous professional subculture, we found that the bar may better be thought of as a rather loose-knit group with tenuous collegial ties whose professionalism is under constant challenge from the community in which law practice occurs.