Differences In Compliance Rates Research Articles

Observational Study on Adherence to modified Clinical and Laboratory Standard Institute H3-A6 Guidelines on Blood Sampling Procedures

Background: The accuracy of clinical laboratory results is paramount for effective patient diagnosis and treatment. However, errors in the pre-analytical phase, particularly during phlebotomy, significantly impact the reliability of laboratory data. With the Clinical and Laboratory Standards Institute (CLSI) guidelines serving as a benchmark for best practices in blood collection, adherence to these standards is crucial for minimizing errors. Objective: This study aimed to assess compliance with modified CLSI guidelines in phlebotomy procedures within a healthcare setting and identify the most prevalent errors in the pre-analytical phase that could compromise patient safety and the integrity of laboratory results. Methods: Conducted at the Combined Military Hospital Lahore from January to March 2023, this observational study scrutinized phlebotomy practices across three distinct healthcare settings: emergency department, outpatient department, and clinical wards. A structured checklist, adapted from the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) guidelines and aligned with local modifications, was employed to evaluate compliance in 20 specific areas of phlebotomy practice. A total of 285 phlebotomies were observed by specialized staff, with data analyzed using SPSS version 25 to compare error frequencies and compliance rates across different settings and among various healthcare professionals. Results: The study revealed an overall compliance rate of 88% for identified request forms, 76% for patient identification according to local guidelines, and 66% for proper hand sanitization. However, significant errors were identified in checking for potential complications of venipuncture (34% compliance), with tubes being clearly under or overfilled (46% compliance), and in verifying that patients were prepared for phlebotomy (46% compliance). The error frequency varied across settings, with the highest discrepancies observed in the emergency department. Differences in compliance rates between laboratory staff and nurses were statistically significant in key areas, including patient identification (p<0.001) and tube labeling (p=0.081). Conclusion: The study highlights a critical need for improving adherence to CLSI guidelines within phlebotomy practices to enhance patient safety and the accuracy of laboratory results. Targeted educational and training interventions are essential for addressing the identified gaps in compliance, particularly in patient identification, sample volume control, and verification of patient preparation for phlebotomy.

Abstract WP48: Prescription Rate for Antihyperglycemic Medication With Proven Cardiovascular Benefit at Discharge in Stroke Patients Not Equal Among Payer Sources

Background: Mortality doubles in stroke patients when Diabetes Mellitus (DM) is present. Target: Type 2 Diabetes SM (TT2DM) is an American Heart Association® (AHA) initiative focused on providing evidence-based guideline (EBG) resources to mitigate risk in hospitalized stroke patients with DM. Participating Get With The Guidelines® (GWTG)-Stroke hospitals track EBG data to improve outcomes. TT2DM initiative has10 EBG data elements related to stroke and the DM subpopulation. The measure  Antihyperglycemic Medication with Proven Cardiovascular (CVD) Benefit at Discharge in Stroke Patients with DM (AMPB) has low compliance. Further data analysis was needed. Methods: GWTG®-Stroke DM reports specific to AMPB were reviewed from Jan.1, 2020-Dec. 21, 2022, from 51 Wisconsin Coverdell Stroke hospitals. Analysis comprised of 5,045 patients with a primary diagnosis of stroke and history of DM or newly identified DM in the denominator. The numerator was satisfied when patients were prescribed a GLP-1 Receptor Agonist or SGLT-2 Inhibitor at discharge. Measure compliance was further delineated according to payment source. Payer sources were identified as: self-pay, Medicaid, Medicare, and Private/HMO. Findings: In the specified timeframe, 11.7% of patients received AMPB. Compliance variation exists across payer source. Only 2.3% identified as self-pay were prescribed AMPB at discharge. Differences in compliance rates were 10% for Medicare, 13.5% Medicaid, and 15.3% with private insurance/HMO. Conclusions: Discharge prescription rate for AMPB has low compliance, further variation exists among patient payer sources. Items for consideration are higher cost of medication and thus payer status are driving factors in prescribing rates. Additional barriers may exist as discharge clinicians may not feel DM management is their responsibility, along with existing medication knowledge gaps. Providing EBC requires shared decision making to ensure proper follow up. Engaging a multidisciplinary approach at discharge to verify insurance coverage, alternate cost options, and follow-up needs may enhance compliance. Future considerations are to assess race “within” payer source to gauge if there is disparate care.

Donning Sterile Surgical Gloves - A Prospective Clinical Audit of Young Surgeons at a Tertiary Care Hospital of Lahore, Pakistan.

Background Sterilization and aseptic surgical techniques are the most important keys to successful postoperative outcomes. The standard surgical gloving technique causes early wound healing and reduces morbidity and mortality. Objective To assess the standard technique of donning sterile surgical gloves while scrubbing among young surgeons. Material and Methods This two-week prospective audit involved 60 young residents and house officers after ensuring ethical implications. Participants were observed unannounced for donning sterile surgical gloves in the surgical operation theatre (OT) according to the standard criteria set by World Health Organization (WHO) before and after the relevant intervention. The intervention was made through a clinical lecture, live demonstration, and hands-on sessions. After a detailed literature study, a pro forma was generated to record participants' compliance with 14 steps of donning sterile surgical gloves. Data was sent to a statistician for descriptive analysis. Results About 72.14% of the participants followed the standard criteria of donning sterile surgical gloves before intervention. This percentage raised to 90.71% after the intervention, showing marked improvement. Conclusion Pre-intervention and post-intervention observations showed apparent differences in compliance rates for the standard criteria of donning sterile surgical gloves. This scientific study signifies the need for such clinical audits to boost standard surgical practices, especially among newcomers.

Abstract 273: Prescription Rate For Antihyperglycemic Medication With Proven Cvd Benefit At Discharge In Stroke Patients Not Equal Among Payer Sources

Mortality doubles in stroke patient with diabetes mellitus (DM). Target: Type 2 DiabetesSM (TT2DM) is an American Heart Association (AHA) initiative focused on providing evidence-based guideline (EBG) resources to mitigate risk in hospitalized stroke patients with DM. Get With The Guidelines® (GWTG)- Stroke hospitals track EBG data to improve patient outcomes. TT2DM initiative is comprised of 10 EBG data elements related to stroke and DM subpopulation. The measure Antihyperglycemic Medication with Proven CVD Benefit at Discharge in Stroke Patients with DM has low compliance. Methods: GWTG®-Stroke DM reports reviewed from January 1, 2020-June 30, 2021, from 50 Wisconsin Coverdell Stroke Program hospitals. Analysis of 2554 patients with primary diagnosis of stroke with history of or newly identified DM during hospitalization were in the denominator. Numerator met when patients were prescribed GLP-1 Receptor Agonist or SGLT-2 Inhibitor at discharge. Measure compliance was further delineated according to payment source documented. Patient payer source was identified as: Self-Pay, Medicaid, Medicare, and Private. Findings: In specified timeframe, 7.9% of patients received Antihyperglycemic Medication with Proven CVD Benefit at Discharge. Compliance variation exists across payer source. Differences in compliance rates were 2.2% Self-Pay, 6.4% for Medicare, 7.7% Medicaid, and 12.1% for Private. Conclusions: Discharge prescription rate for antihyperglycemic medication with proven CVD benefit at discharge in stroke patients has low compliance, further variation exists among payor sources. Items for consideration are higher cost of medication and thus payor status are driving factors in prescribing rates. Additional barriers may exist as discharge clinicians may not feel DM management is their responsibility, there may be a medication knowledge gap. Providing EBC requires shared decision making among patients and clinicians to ensure proper follow up. Engaging a multidisciplinary approach at discharge to verify insurance coverage, alternate cost options, and follow up needs may enhance compliance. Future considerations are to assess race “within” payor source to gauge if there is disparate care.

Effectiveness of modified pedestrian crossing signs in an urban area

The District of Columbia currently uses the standard pedestrian warning signs and diagonal arrow plaques at a substantial number of uncontrolled crosswalks within the City. However, the widespread use of these measures appears to be ineffective in curbing the incidence of pedestrian involved crashes or pedestrian-vehicle conflicts. To compensate for the perceived lack of effectiveness of the standard pedestrian warning sign the District Department of Transportation developed a new side-of-street crossing sign to improve driver compliance based on pedestrian right-of-way laws. This study was aimed at determining the effectiveness (defined as the proportion of drivers approaching a crosswalk who stop or yield the right of way to a pedestrian in the crosswalk) of the experimental side-of-street pedestrian crossing sign compared to the standard sign, with and without rectangular rapid flashing beacons. Effectiveness of the side-of-street pedestrian sign and standard sign were observed at a total of 32 locations in the District over a one-year period using the “control” and “experimental” comparison approach. Video data for each location was obtained from March 2018 through February 2019 during typical weekdays for the morning and afternoon peak periods. The results of the study showed that the experimental signs with RRFBs provided higher driver compliance rates (yielding to pedestrians) compared to the standard signs for both the morning and afternoon peak periods. However, the differences in compliance rates for the experimental and standard signs were not statistically significant at a 95% confidence interval. Further evaluation of the signs is recommended using the “before” and “after” approach in addition to an assessment of crash statistics at the selected locations.

Difference of compliance rates for the recommendations in Japanese Guideline on Febrile Neutropenia according to respondents\u2019 attributes: the second report on a questionnaire survey among hematology-oncology physicians and surgeons

PurposeThe Japanese Society of Medical Oncology (JSMO) published a guideline (GL) on febrile neutropenia (FN) in 2017. This study aims to identify promoting factors and disincentives for complying with GL recommendations according to attributes of doctors providing chemotherapy.MethodsA questionnaire survey was conducted with SurveyMonkey™ for physician members of the Japanese Association of Supportive Care in Cancer and relevant academic organizations. Each question had four options (always do, do in more than half of patients, do in less than half, do not at all) and a free description form. Responses were analyzed according to the respondents’ attributes.ResultSeven hundred eighty-eight out of retrieved 801 responses were available for analysis. Multivariable analysis demonstrated that the percentage of GL users was higher among women and Japanese Society of Clinical Oncology members. The overall compliance rate was higher among women, JSMO members, and board-certified medical oncologists. Internists emphasized the significance of collecting blood cultures at FN onset, and surgeons stressed the importance of G-CSF prophylaxis. Hematologists were less likely to adhere to recommendations on risk assessment of FN by the Multinational Association of Supportive Care in Cancer score and administration of gammaglobulin products. However, those are acceptable due to the characteristics of their practice. Eight recommendations had no difference in compliance rates between users and non-users, some of whose statements were ambiguous and discretionary.ConclusionWomen were more likely to use and adhere to GL. The recommendations should be developed considering the characteristics of specialty and subspecialty and avoiding ambiguity and discretionary statements.

Factors Associated with the Spectacle Wear Compliance among Primary School Students with Refractive Error in Rural China

ABSTRACT Purpose To study the factors determining spectacle-wear compliance and reasons for non-wear among students in rural China. Methods This study was based on a spectacle intervention trial among 162 schools in rural China. Students with refractive errors were randomly assigned to either a free or voucher group to receive spectacles at baseline. Spectacle-wear compliance was assessed through an unannounced follow-up 7 months after spectacles were distributed. Students not wearing spectacles were also asked their reasons for non-wear. The collected data underwent descriptive, bivariate, and logistic regression analyses. Results A total of 1904 students received spectacles at baseline, 1826 (95.9%) of whom were present at the 7-month follow-up. Among those students, 41.7% wore their spectacles. There was no significant difference in compliance rates between the free and voucher groups. Predictors of wearing spectacles at follow-up included older age (Odds ratio = 1.56, 95% CI: 1.12–2.19), the severity of refractive error (3.68, 2.23–6.07), wearing spectacles before baseline (3.91, 2.53–6.04) and having friends who wore spectacles (1.87, 1.32–2.63). When students could see the blackboard from their seats (0.68, 0.51–0.89) and thought that wearing spectacles was bad looking (0.76, 0.57–1.00), they were reluctant to wear spectacles. The two main reasons for non-wear were the widespread perception that wearing spectacles would weaken eyesight (32.8%) and the inconvenience of wearing spectacles during activities (23.6%). Conclusions The main reason that accounts for the low compliance of spectacle wear was misconceptions around spectacle. School-based spectacle programs should consider enhancing the compliance rates to maximize the benefits of spectacle wear.

Observational Study of Hand Hygiene Compliance at a Trauma Hospital in Iraqi Kurdistan

Healthcare-associated infections, commonly caused by poor hand hygiene, represent a significant source of disease and economic burden for healthcare systems, especially those in resource-limited settings. The few existing studies on hand hygiene compliance in resource-limited hospital settings suggest that compliance is insufficient. The difference in compliance rates between units in resource-limited trauma hospitals is largely unknown. We aimed to assess hand hygiene compliance rates among healthcare workers at a trauma hospital in Iraqi Kurdistan and compare the levels of compliance between the emergency room (ER), the intensive care unit (ICU), and the acute care ward (ACW). We carried out overt observations in 2018 using the validated World Health Organization ‘five moments for hand hygiene’ observational tool. We observed a total of 622 hand hygiene opportunities performed by 149 healthcare workers. Hand hygiene compliance was defined as handwashing with soap and water or the use of alcohol-based hand rub, in accordance with the ‘five moments for hand hygiene’ concept. Overall, the hand hygiene compliance rate was found to be 6.8% (95% confidence interval 5.0–9.1). Compliance was significantly lower in the ER (1.0%), compared with the ICU (8.1%) (p = 0.0012), and the ACW (11.1%) (p < 0.0001). In all three units, the availability of alcohol-based hand rub and handwashing sinks was insufficient in relation to the number of patient beds. We conclude that the overall level of hand hygiene compliance was low, with the lowest level of compliance in the ER. Our findings call for improved resource allocation and strengthened hand hygiene routines. These relatively simple measures could potentially lower the incidence of healthcare-associated infections and improve the mortality and morbidity of patients in already overburdened healthcare systems.

Graduated compression stockings for the initial treatment of varicose veins in people without venous ulceration.

Graduated compression stockings for the initial treatment of varicose veins in people without venous ulceration.

A Retrospective Comparative Analysis of Use and Rate of Compliance of Hydroxyurea in Sickle Cell Disease Patients at University of Maryland and Barau Dikko Teaching Hospital/Kaduna State University Kaduna, Nigeria: A Global Health Prospective of Sickle Cell Disease Care

Background: Countries of Sub-Saharan Africa, middle east and subcontinent region bear the greatest burden of SCD-associated morbidity and mortality. Hydroxyurea (HU) reduces up to 50% of hospitalizations and blood transfusion rate associated with SCD. HU is being used routinely in high-income countries but still remains a challenge in resource-limited countries. HU is a cost-effective intervention so learning underlying factors associated with HU use can address this problem. There is not any study that compares developing and developed country regarding HU use. There is huge disparity between USA and Nigeria regarding mortality. Hence this study identified factors associated with disparity of care, morbidity & mortality. Methods: Charts of 75 SCD patients treated at UMMC from January 2019 to January 2020 were reviewed. Data of 18 patients who met the eligibility criteria were extracted and charts of 30 patients being treated at Nigerian hospital from same time interval were reviewed and extracted. To identify disparity of care, and difference in morbidity and mortality rate, data were collected regarding heart failure, pain crisis, hospitalization, stroke, HU compliance and acute chest syndrome (ACS). Results: Factors associated with low compliance in USA is treatment none-adherence and insurance issues, whereas in the Nigerian hospital is financial constraints and hydroxyurea availability. Regarding disparity of care, none of the Nigerian patients had any Hemoglobin F, Hemoglobin S percentage documentation, because a diagnosis of SCD is based on alkaline electrophoresis which does not quantify the hemoglobin type. Therefore, the phenotype in Nigerian cohort were not identified. In USA cohort all the patients had HbF percentage tested by high performance liquid chromatography (HPLC) prior to starting HU. There is no significant difference in compliance rate ((Nig 67% VS US 78% P value 0.52). Three patients in Nigerian cohort died prior to age of 35 but none in USA cohort. Fisher exact and chi square tests were used for analysis. P value of all the parameters is >0.05 except the ACS which is 0.0036. Hence findings are not statistically significant except ACS (75% US VS 18% P 0.0036). Conclusion: Sample size is small. Hence it is difficult to make conclusion but, data is showing that there is disparity in terms of mortality, morbidity, health care services (e.g., lab test, blood transfusion resources, screening test) and use of HU between these two counties.

Correlates of Compliance With COVID-19 Prevention Guidelines: Risk Propensity, Locus of Control, Intolerance of Uncertainty

As the world faces the threat of the coronavirus pandemic it is imperative that people comply with the prevention guidelines provided by the experts. Despite the prevention guidelines in place, the compliance rates among individuals differ. In order to improve voluntary compliance with the COVID-19 prevention guidelines, it is important to examine the personality attributes owing to the individual differences in compliance rates. The objective of this study is to explore the relationship between Compliance with COVID-19 prevention guidelines and Risk Propensity, Locus of Control, and Intolerance of Uncertainty respectively. The study employed a survey method wherein standardized questionnaires were administered to participants from different cities of India. The results indicate that there exists a significant negative correlation between Risk Propensity, External Locus of Control and, Intolerance of Uncertainty and Compliance with COVID-19 prevention guidelines. The results also demonstrate a significant positive correlation between Internal Locus of Control and Compliance with COVID-19 prevention guidelines. The findings suggest the importance of a plurality of messages in communication by the experts and officials. Theoretical and quantitative findings are elaborated in detail.

NCOG-26. IMPACT OF GENDER ON TUMOR TREATING FIELDS COMPLIANCE IN PATIENTS WITH GLIOBLASTOMA

Abstract BACKGROUND Tumor treating fields (TTFields) has emerged as a novel antimitotic modality to treat glioblastoma (GBM). Recently, a positive association was reported between TTFields dose at the tumor bed and survival outcomes in GBM patients. Dose density depends upon power density and compliance rate (cumulative amount of time TTFields therapy is delivered to the patient). Increased compliance with TTFields has been proposed as an independent prognostic factor for improved clinical benefits. There is evidence that females tend to respond better than males to standard therapy. However, the impact of gender and age on TTFields compliance is not fully understood in GBM patients. OBJECTIVE To investigate potential interactions amongst age, gender and TTFields compliance in GBM patients. METHODS A cohort of 16 patients (males =9; females=7; mean-age=60.8±7.6years) with newly diagnosed and recurrent GBM receiving TTFields were analyzed retrospectively. Device usage time was collected from internal log files in each case. The mean duration of TTFields therapy in patients was 4 months. Chi-square and independent sample T-tests were performed to evaluate differences in compliance rates based on patient age and gender and to examine gender-age relationships. Additionally, Pearson correlation analyses were performed to determine associations between gender and compliance rates. The probability (p) value of 0.05 was considered significant. RESULTS A trend (p=0.067) towards greater TTFields compliance was observed in females (80.1±0.11%) versus males (63.0±0.22%). Additionally, there was a strong positive correlation (R=0.73; p=0.058) between age and compliance rates for female patients. There were 6 patients ≥ 65 years and 10 patients < 65 years. However, we did not find significant differences in compliance rate and gender variables between patients ≥ 65 years and < 65 years of age. CONCLUSIONS Our results demonstrate gender influences TTFields compliance amongst GBM patients. However, future studies with larger cohorts are warranted to validate these findings.

Differences in rates of low-dose computed tomography screening for lung cancer amongst various outpatient care centers.

245 Background: Despite low-dose computed tomography (LDCT) screening for lung cancer recommended by the United States Preventive Services Task Force (USPSTF) demonstrating a relative reduction in mortality, there remains low rates of testing nationwide. Yet studies are limited regarding specific differences in screening rates amongst various outpatient care settings. Methods: We performed retrospective chart reviews of patients followed by resident providers within an academic internal medicine residency program who met USPSTF guidelines for lung cancer screening between 2015-2020. This was conducted at three separate outpatient clinic sites including a state-funded academic institution, inner city community health center, and veteran affairs medical center. Data collection included patient demographic and smoking histories as well as rates of ordered and completed LDCT screening. Results: A total of 832 patients were identified as current or former smokers between the ages of 55 and 80 years: 320 from Hartford Hospital Community Health Center (HHCHC), 262 from University of Connecticut Health Center (UCHC), and 250 from the Veteran Affairs (VA) Medical Center. 85 (27%) of these patients from HHCHC, 84 (32%) from UCHC, and 56 (22%) from the VA met USPSTF eligibility criteria for LDCT screening. Overall compliance rates of screening were found to be 44% at HHCHC, 59.5% at UCHC, and 51.8% at the VA. Results are outlined in Table. Conclusions: Screening rates for lung cancer with LDCT remain low but have been steadily improving throughout the United States following new recommendations and increased awareness provided by multiple medical organizations. We sought to compare differences in compliance rates amongst various outpatient clinics within the same internal medicine residency program at University of Connecticut. Our findings demonstrate significant differences in LDCT screening for lung cancer between the program’s community health center versus its state and federally funded outpatient clinics. Automatic reminders to providers can potentially improve rates of lung cancer screening. Patients should also be educated about the importance of screening to improve adherence with imaging. [Table: see text]

Compliance with Smoke-Free Policy and Challenges in Implementation: Evidence from Bengkulu, Indonesia.

Background:Smoking is among the top contributors to deaths and disability-adjusted life years in Indonesia, particularly among males. In 2012, a presidential decree encouraged provinces and districts to implement a smoke-free policy (SFP). This study aims to evaluate compliance and explore the challenges in the implementation. Methods:Through a mixed-methods design, we used quantitative methods to examine the compliance with six criteria including signage, no active smoking, no selling, no advertisement, no smoke, and no ashtray at SFP facilities in Bengkulu city. We observed SFP compliance at 105 facilities, including health/educational facilities, places of worship, workplaces, and indoor/outdoor public facilities. We also used a qualitative method to explore challenges in the implementation through interviews with the government and legislators. Results:The compliance rate to all six criteria was 38% overall, ranging from 17% at outdoor public facilities to 67% at health facilities. We found no spatial patterning, as shown by non-significant differences in compliance rates between SFP facilities inside and outside of 1-kilometer around the provincial and city health offices. Implementation challenges included lack of sensitization, lack of coordination, and limited budget. Conclusion:The compliance was relatively low due to several challenges, which could serve as a tobacco control policy lesson in a lower-middle-income country.

Medication Adherence: Assess Compliance and Associated Factors among Hypertensive Patients

Background: Health care decision-makers require more information on differences in compliance rates associated with antihypertensive drugs and the implications of these differences for health care utilization and costs. This community- based prospective study was conduct to Assess hypertensive patients’ compliance with their prescribed regimen. Method: This is a cross-sectional community- based prospective study. Four hundred hypertensive patients were selected from OPD of tertiary care center hospital Delhi. Data were collect through a structured questionnaire and then analyzed by SPSS. Results: The finding of this study shows that the majority of the selected patients belonged to the old age group. Females were slightly more than males. . A total of 56% of patients were fully compliant with their antihypertensive treatments. Two factors were identified to be independently associated with compliance: gender (P=0.51), Age (P=1.10).educational status (P=0.028) were found to have significant effects on compliance Conclusion: Patients’ compliance need to improve for that we need pharmacists adhere to their new role that requires proper dispensing practices. There is persistence and improvement in compliance to antihypertensive medications after an education of the patients about hypertension and its complications. Education about hypertension knowledge should be strengthened for patients Patient compliance need to improve for that we need to make a guideline for pharmacists adhere to their new role that requires proper dispensing practices.

Quality Assessment and Validation of a Direct Observation Hand Hygiene Program

<h3>Background</h3> Hand hygiene (HH) is a critical infection prevention practice to prevent transmission of microorganisms in healthcare settings. Direct overt HH observation programs provide opportunities for direct feedback, but face concerns over potential Hawthorne effect. We sought to compare our overt HH program to covert observations and perform quality assessments. <h3>Methods</h3> During May-July 2019, covert HH observations were conducted on inpatient units of healthcare personnel (HCP) in direct contact with patients and patient surroundings. An observer was trained to perform observations using the World Health Organization's Five Moments for HH. Electronic data collection included time, unit, HCP role, moments of HH and compliance. Quality metrics included duration of alcohol-based hand rub (ABHR), hand areas missed and compliance with nail policy. Observations included varying times and days covering all shifts and roles. Data was excluded if the observer was unable to fully visualize HH or if staff became aware of observations. Simultaneously, the institutional HH overt observations continued. <h3>Results</h3> During the study period, 189 covert observations were obtained, compared to 1826 overt observations on study units. We found no significant difference (p=0.217) between the rate of compliance of overt HH observations (99%, n=1804) and covert HH observations (95%, n=179). The majority of staff were nurses (77%). The median ABHR was 6 seconds (range: 2-15 seconds), with 10% of HCP completing the recommended 15 second hand rub. Most commonly missed areas (n=48) included the fingertips (65%, n=31) and between the fingers (65%, n=31). Staff were compliant with our nail policy (98%). <h3>Conclusions</h3> We describe the validation of a direct, overt HH program. The Hawthorne Effect did not make a statistically significant difference in compliance rates and HCP maintained high compliance (>95%) whether or not they knew they were observed. Quality metrics including appropriate duration of AHBR and coverage of hands were identified as opportunities for improvement.

Chapter-7: Complex Systems Challenges: Epidemics, the Welfare-State and the Constitution

During the last four hundred years, different types of Epidemics have wreaked havoc on the health, psyche, politics and economies of regions, nations and continents. Epidemics are major Geopolitical Risks because: i) They can have significant negative social, economic, psychological, political and environmental consequences (as clearly illustrated by the COVID-19 Epidemic of 2019-present, and other Epidemics). ii) There are significant differences in compliance rates around the world (compliance with public health standards and statutes/regulations for emergencies). iii) Countries and even states/regions respond differently to Epidemics. iv) There are significant differences in regulation and new legislation around the world and that is sometimes a function of the existing political system in the country. v) There can be different rates of mutation of viruses/bacteria around the world. vi) The impact on infrastructure and critical systems varies dramatically around the world and is sometimes a function of the existing political system in the country. vii) There are or there can be significant differences in the reactions of stock, bond, currency and commodity markets to Epidemics in various countries. viii) Only the fear, uncertainty and anxiety causes by an Epidemic is sufficient to crash stock markets, bond markets and exchange rates, as illustrated by the COVID-19 Epidemic of 2020.

Trends of Follow-Up Recommendations Made on Musculoskeletal MRI Reports.

OBJECTIVE. The purpose of this article was to analyze trends in follow-up recommendations made on musculoskeletal MRI reports. MATERIALS AND METHODS. An IRB-approved retrospective study identified 790 musculoskeletal MRI reports from our database between January 1, 2016, and January 1, 2018, containing follow-up recommendations made by the interpreting radiologist. Metadata were automatically extracted and classification of the recommendations was performed by manual review. Clinical outcome data were collected from the electronic health record. After exclusion criteria were applied, 654 reports were included in the study. Descriptive statistics, Fisher exact tests, and chi-square tests were used for analysis. RESULTS. Clinicians acknowledged 83% and followed 73% of the recommendations. Follow-up compliance varied with the type of recommendation made: 98% for clinical intervention versus 67% for additional imaging (p < 0.001). Subspecialties acknowledged and followed recommendations at different rates: 92% and 85% for internists versus 76% and 64% for orthopedists (p < 0.001 and p < 0.001), respectively. Patient age, practice setting, radiologist experience, recommendation conditionality, and specified follow-up time intervals made no difference in compliance rate (all p > 0.05). There was no difference in compliance rate among various pathologic findings of concern (p = 0.995). Compliance rate increased significantly after direct communication between the radiologist and clinician compared with when there was no direct communication (93% vs 71%, p < 0.001). Concern for neoplasm comprised the greatest number of unacknowledged recommendations (73%). CONCLUSION. Musculoskeletal MRI recommendations are followed independent of the finding of concern and compliance is lowest for requests of additional imaging. Direct communication improves compliance and may be particularly helpful for orthopedic referrers.

Increasing immunization compliance among schools and day care centers: Evidence from a randomized controlled trial

This paper reports on the results of a randomized controlled trial in which researchers collaborated with a department of health in a mid-size city to evaluate the effectiveness of targeted communications highlighting descriptive social norms to increase immunization compliance across 700 schools. Schools were randomly selected to receive a twice-annual immunization compliance report card reporting in detail their compliance rates compared to other schools of the same school type; the comparison rates reported included the school-type average, average compliance among the top 10% of performers, and the city target of 98% compliance. Shifts in immunization compliance are tracked in a city-wide administrative vaccine registry. The results suggest that there was no significant difference in compliance rates between treatment and control schools six months post-treatment. To our knowledge, it is the first randomized controlled trial evaluating the use of descriptive social norms in increasing immunization compliance rates in a school-based setting. In addition, it serves as an example of embedding a behaviorally-informed experiment in a government program utilizing high-quality administrative data.

Abstract P1-12-12: Bubble packaging of adjuvant endocrine therapy:updated analysis of compliance and survival

Abstract Introduction: Adherence to endocrine therapy is a long recognized problem despite efficacy of these drugs with reported compliance rates of 89% in first year and 50% in fourth year. Most of our knowledge of noncompliance is observational and retrospective. This final analysis of the Bubble Study reports the compliance rate of adjuvant endocrine therapy among women with early stage breast cancer using “bubble” packaging. We previously reported adherence rates of 97% with bubble packaging. This updated analysis includes disease free survival (DFS) and overall survival (OS) at 5 years. Methods: The Bubble study is a non-blinded, prospective observational cohort study, which enrolled 86 patients between August 2012 and April 2014. Demographic and clinical data were collected prospectively including age, race, insurance, duration of therapy, stage, treatment, comorbidities, recurrence and survival. Duration of therapy was divided into 3 cohorts: &amp;lt;12 months, 12-36 months, and 37-60 months. All patients received routine prescriptions in a “bubble” pack or daily blister pack. Patients returned all used bubble packs at follow up appointments for review and kept a diary of missed doses for analysis. DFS and OS data were obtained at 78 months. Compliance was defined as &amp;gt;90% adherence. We calculated institutional DFS and OS for breast cancer patients treated within a similar time frame from the tumor registry. Results: 53 patients were included in the analysis. The remaining patients withdrew from the study prior to data collection or were deemed ineligible. The overall compliance rate was 97%; however, only 72% of enrolled patients were continued in the analysis. None of the variables examined (race, age, insurance status and stage) had an impact on compliance. Only duration of endocrine therapy had a marginal effect on compliance (p value = 0.06). The latest cohort (duration of therapy 37-60 months) was least likely to be compliant at 89.53%. Our 5-year DFS is 92% and 5-year OS is 96%. There is no statistically significant difference in DFS and OS between patients with compliance&amp;gt;90% and &amp;lt;90%. For ER+ breast cancer patients treated during similar timeframe at our institution outside the trial, 5-year DFS is 94% and 5-year OS is 90%. Conclusion: There was no difference in OS or DFS based on compliance to oral anti-estrogens. Given the high overall compliance rate in this small patient population, the lack of OS and DFS difference is not surprising. However, the compliance rate of bubble packaging (&amp;gt;90%) is higher than expected based on current literature. Although this may suggest improved compliance with bubble packaging, more studies are necessary to confirm this given small sample size and high trial dropout rate. Trial withdrawal likely altered analysis of adherence rates as it selects for a largely compliant group of patients.This bias may also explain the lack of difference in compliance rate among race, insurance status and/ or age, which contradicts our current knowledge of high-risk groups.There was a trend towards lower DFS in the bubble cohort, but overall better survival when comparing to institutional rate. Studies are ongoing to confirm bubble packaging adherence rates and compare this to established strategies to improve adherence. Citation Format: Bhandari S, Ngo PT, Mandadi M, Wu X, Brown C, Rai S, Riley EC. Bubble packaging of adjuvant endocrine therapy:updated analysis of compliance and survival [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-12.