Follow-up Calls Research Articles

A Randomized Controlled Trial of Intravenous Haloperidol vs. Intravenous Metoclopramide for Acute Migraine Therapy in the Emergency Department

BackgroundEmergency Department (ED) headache patients are commonly treated with neuroleptic antiemetics like metoclopramide. Haloperidol has been shown to be effective for migraine treatment. Study ObjectiveOur study compared the use of metoclopramide vs. haloperidol to treat ED migraine patients. MethodsA prospective, double-blinded, randomized control trial of 64 adults aged 18–50 years with migraine headache and no recognized risks for QT-prolongation. Haloperidol 5 mg or metoclopramide 10 mg was given intravenously after 25 mg diphenhydramine. Pain, nausea, restlessness (akathisia), and sedation were assessed with 100-mm visual analog scales (VAS) at baseline and every 20 min, to a maximum of 80 min. The need for rescue medications, side effects, and subject satisfaction were recorded. QTc intervals were measured prior to and after treatment. Follow-up calls after 48 h assessed satisfaction and recurrent or persistent symptoms. ResultsThirty-one subjects received haloperidol, 33 metoclopramide. The groups were similar on all VAS measurements, side effects, and in their satisfaction with therapy. Pain relief averaged 53 mm VAS over both groups, with equal times to maximum improvement. Subjects receiving haloperidol required rescue medication significantly less often (3% vs. 24%, p < 0.02). Mean QTcs were equal and normal in the two groups and did not change after treatment. In telephone follow-up, 90% of subjects contacted were “happy with the medication” they had received, with haloperidol-treated subjects experiencing more restlessness (43% vs. 10%). ConclusionsIntravenous haloperidol is as safe and effective as metoclopramide for the ED treatment of migraine headaches, with less frequent need for rescue medications.

Access to Radiology Reports via an Online Patient Portal: Experiences of Referring Physicians and Patients

PurposeFew organizations have reported providing radiology reports to patients via an electronic health record patient portal. The authors describe the process of manual release of reports made by referring physicians, and patients’ and referring physicians’ experiences during the first year that release through the portal was available. MethodsA survey of 508 patients assessed perceived accessibility and importance of portal-released radiology reports, and communications with referring physicians before and after the release. A survey of 48 referring physicians and a group interview assessed the utility of releasing reports, preferences regarding automatic release, and workload impact. Data were analyzed using descriptive statistics and qualitative methods. ResultsA total of 74% (377) of patients found reports easy to access, and 88% (446) reported that the ability to do so was important. In all, 49% (250) of patients were contacted by their referring physician before report release, and 25% (156) contacted their physician for more information after viewing a report. Of the referring physicians, 88% (42) found that releasing reports to patients was useful. Auto-release of x-ray reports, with a 1-week delay, was preferred by 58% (28), but they were more reluctant to auto-release CT and MRI reports. A total of 86% (41) of referring physicians reported that follow-up emails, telephone calls, and office visits were unchanged or had decreased. ConclusionsReferring-physician release of radiology reports via the online portal is important to patients, useful to referring physicians, and does not affect referring-physician workloads. A delay between reporting results to referring physicians and releasing them to patients allows time for needed physician-patient communication.

Developing Volunteer-Assisted Behavioral Activation Teleprograms to Meet the Needs of Chinese Dementia Caregivers

This study aimed to test a model of telephone-assisted behavioral activation (BA) intervention for Chinese dementia caregivers to reduce the level of depressive symptoms among these caregivers. The study compared two telephone interventions using a 4-month longitudinal randomized controlled trial. For the first 4 weeks, all participants received the same psychoeducation program via telephone. Then for the following 4 months, eight biweekly telephone follow-up calls were performed. For these eight follow-up calls, participants were randomized into either one of the two following groups with different conditions. For the Psychoeducation with BA (PsyED-BA) group, participants received eight biweekly sessions of BA practice focused on pleasant event scheduling and improving communications. For the Psychoeducation only (PsyED Only) group, there were eight biweekly sessions of general discussion of psychoeducation and related information. The telephone administration of the BA and general discussion component were administered with the help of senior citizens and also university students engaged as paraprofessionals. A total of 96 family caregivers of persons living with dementia were recruited, and 93 caregivers completed the whole study. As compared to the PsyED Only group, the PsyED-BA group had significantly decreased levels of depressive symptoms. Caregivers who reported longer caregiving hours at baseline were found to benefit more from the intervention. The PsyED-BA group showed an increased frequency in the use of emotional regulation strategies after the BA training. Findings can contribute to the literature by offering some framework for developing accessible, sustainable, and cost-effective interventions for caregivers.

Improving parental adherence to a failed vision screening referral in the United States

Vision screening is an important function of the school nurse's role. Parental cooperation after a child's failed vision screening remains a problematic issue for school nurses, as research reveals inconsistent follow-up and a low rate of parental adherence to school nursing screening referral. Using a comparative descriptive design, the purpose of this investigation was to determine if there was an improvement in parental adherence after a failed vision screening referral in school-age children in an urban middle school setting when implementing an approach consisting of a comprehensive informative letter and telephone follow-up versus the use of a standard referral card commonly used in practice. Findings revealed a statistically significant increase in the number of school-age children who received professional eye care services with the use of the informative letter and telephone follow-up calls (P&lt;0.001), as well as an increase in the number of eye care appointments made (P&lt;0.001). Numerous barriers to care were identified. The use of an informative letter and follow-up telephone communication was effective in improving parental adherence to vision screening referral and demonstrates the essential role that school nurses have in promoting child health.

Predicting readmission of heart failure patients using automated follow-up calls.

BackgroundReadmission rates for patients with heart failure (HF) remain high. Many efforts to identify patients at high risk for readmission focus on patient demographics or on measures taken in the hospital. We evaluated a method for risk assessment that depends on patient self-report following discharge from the hospital.MethodsIn this study, we investigated whether automated calls could be used to identify patients who are at a higher risk of readmission within 30 days. An automated multi-call follow-up program was deployed with 1095 discharged HF patients. During each call, the patient reported his or her general health status. Patients were grouped by the trend of their responses over the two calls, and their unadjusted 30-day readmission rates were compared. Pearson’s chi-square test was used to evaluate whether readmission risk was independent of response trend.ResultsOf the 1095 patients participating in the program, 837 (76%) responded to the general status question in at least one of the calls and 515 (47%) patients responded to the general status question in both calls. Out of the 89 patients exhibiting a negative response trend, 37% were readmitted. By contrast, the 97 patients showing a positive trend and the 329 patients showing a neutral trend were readmitted at rates of 16% and 14% respectively. The dependence of readmission on trend group was statistically significant (P < 0.0001).ConclusionsPatients at an elevated risk of readmission can be identified based on the trend of their responses to automated follow-up calls. This presents a simple method for risk stratification based on patient self-assessment.

TELEmedicine for Patients with Inflammatory Bowel Disease (TELE-IBD): Design and implementation of randomized clinical trial

BackgroundInflammatory bowel diseases (IBD), comprised of ulcerative colitis and Crohn's disease, are chronic disorders characterized by worsening of symptoms followed by symptom-free periods. Symptoms have a profound negative impact on quality of life and are associated with increased health care utilization. Despite effective treatments, outcomes are suboptimal secondary to nonadherence, medication intolerance, inconsistent monitoring, poor patient knowledge and limited access to care. ObjectivesCompare disease activity and quality of life over 1year in a randomized trial of IBD patients receiving standard care versus telemedicine. MethodsPatients evaluated at 3 IBD referral centers with worsening symptoms within the last 2years are eligible for randomization to one of two interventions or standard care. The interventions consist of either every other week or weekly assessment of symptoms, side effects, weight and delivery of medication prompts and education via texts to the participant's mobile phone. Individualized alerts and action plans are created on a secure portal. Participants in the standard care group undergo routine and urgent follow-up visits and telephone calls. The primary outcomes group comparisons of changes in disease activity and quality of life scores from baseline to 6 and 12months. ConclusionsMethods such as telemedicine are needed to improve monitoring, adherence, self-efficacy, and patient knowledge in IBD. If effective, telemedicine should decrease symptoms, improve quality of life, and decrease health care utilization. The burden associated with use of telemedicine for patients and providers needs to be assessed. The trial is ongoing and will be completed in July 2016.

Factors associated with islet yield and insulin independence after total pancreatectomy and islet cell autotransplantation in patients with chronic pancreatitis utilizing off-site islet isolation: Cleveland Clinic experience.

Total pancreatectomy (TP) with islet cell autotransplantation (IAT) can reduce or prevent diabetes by preserving beta cell function and is normally performed with on-site isolation laboratory facilities. We examined factors associated with islet yield and metabolic outcomes in patients with chronic pancreatitis undergoing TP-IAT. We report our experience of TP-IAT with an off-site islet isolation laboratory. Data (August 2008 to February 2014) were obtained from a TP-IAT database which included information from medical records, clinic visits, questionnaires, and follow-up telephone calls. Each patient was assessed with pre- and postoperative 5-hour mixed-meal tolerance tests for metabolic measurements and with serial glycosylated hemoglobin (HbA1c) determinations. Thirty-six patients with a mean age of 38 years (range, 16-72 y) underwent TP-IAT for different etiologies. At a median follow-up time of 28 months (range, 3-66 mo), 12 patients were insulin independent and 24 patients were on at least one insulin injection a day. Postoperatively, C-peptide levels ≥0.3 ng/mL were present in 23/33 (70%) of the patients, with a median fasting C-peptide value of 0.8 ng/mL (range, <0.2-1.5 ng/mL). Those who were insulin independent were more likely to be female (P = .012), have normal morphology on pre-operative pancreatic imaging (P = .011), and have significantly higher median islet yield (6845 islet equivalent numbers [IEQ]/kg, n = 12 vs 3333 IEQ/kg, n = 24; P < .001). IAT after TP performed in our facility with an off-site islet isolation laboratory shows islet yield and rates of insulin independence that are comparable to other large centers with on-site laboratories.

Behavioral activation for dementia caregivers: scheduling pleasant events and enhancing communications.

BackgroundDementia caregiving is often associated with increase in depressive symptoms and strained relationships. This study tested whether telephone-delivered psychoeducation combined with an enhanced behavioral activation (BA) module had a better effect on the well-being of Alzheimer’s caregivers than psychoeducation alone. The focus is on enhancing the competent use of coping skills via BA. The program is delivered by telephone to increase accessibility and sustainability for caregivers. Senior citizens are trained as paraprofessionals to deliver the BA module to increase the potential for sustainability of the program.Methods and subjectsThe study compared two telephone interventions using a 4-month longitudinal randomized controlled trial. For the first 4 weeks, all participants received the same psychoeducation program via telephone. Then for the following 4 months, eight biweekly telephone follow-up calls were carried out. For these eight follow-up calls, participants were randomized into either one of the two following groups with different conditions. For the psychoeducation with BA (PsyED-BA) group, participants received eight biweekly sessions of BA practice focused on pleasant event scheduling and improving communications. For the psychoeducation only (PsyED only) group, participants received eight biweekly sessions of general discussion of psychoeducation and related information. A total of 62 family caregivers of persons living with dementia were recruited and 59 (29 in the PsyED-BA group and 30 in the PsyED only group) completed the whole study.ResultsAs compared to the group with psychoeducation and discussion, the group with enhanced BA had decreased levels of depressive symptoms. The study had a low attrition rate.ConclusionResults suggested that competence-based training could be effectively administered through the telephone with the help of senior citizens trained and engaged as paraprofessionals. Results contribute to the present literature by offering some framework for developing effective, accessible, sustainable, and less costly interventions.

Lessons learned from recruiting socioeconomically disadvantaged smokers into a pilot randomized controlled trial to explore the role of Exercise Assisted Reduction then Stop (EARS) smoking.

BackgroundResearch is needed on what influences recruitment to smoking reduction trials, and how to increase their reach. The present study aimed to i) assess the feasibility of recruiting a disadvantaged population, ii) examine the effects of recruitment methods on participant characteristics, iii) identify resource requirements for different recruitment methods, and iv) to qualitatively assess the acceptability of recruitment. This was done as part of a pilot two-arm trial of the effectiveness of a novel behavioral support intervention focused on increasing physical activity and reducing smoking, among disadvantaged smokers not wishing to quit.MethodsSmokers were recruited through mailed invitations from three primary care practices (62 participants) and one National Health Stop Smoking Service (SSS) database (31 participants). Six other participants were recruited via a variety of other community-based approaches. Data were collected through questionnaires, field notes, work sampling, and databases. Chi-squared and t-tests were used to compare baseline characteristics of participants.ResultsWe randomized between 5.1 and 11.1% of those invited through primary care and SSS, with associated researcher time to recruit one participant varying from 18 to 157 minutes depending on time and intensity invested.Only six participants were recruited through a wide variety of other community-based approaches, with an associated researcher time of 469 minutes to recruit one participant. Targets for recruiting a disadvantaged population were met, with 91% of the sample in social classes C2 to E (NRS social grades, UK), and 41% indicating mental health problems. Those recruited from SSS were more likely to respond to an initial letter, had used cessation aids before, and had attempted to quit in the past year. Overall, initial responders were more likely to be physically active than those who were recruited via follow-up telephone calls. No other demographics or behaviour characteristics were associated with recruitment approach or intensity of effort. Qualitative feedback indicated that participants had been attracted by the prospect of support that focused on smoking reduction rather than abrupt quitting.ConclusionsMailed invitations, and follow-up, from health professionals was an effective method of recruiting disadvantaged smokers into a trial of an exercise intervention to aid smoking reduction. Recruitment via community outreach approaches was largely ineffective.Trial registrationISRCTN identifier: 13837944, registered on 6 July 2010

Community Pharmacy-Based Adherence Programs and the Role of Pharmacy Technicians: A Review.

Objective: To increase pharmacy technician awareness of medication nonadherence enabling them to identify opportunities to participate in the provision of community pharmacy-based adherence programs. Data Sources: Articles were identified through searches of MEDLINE/PubMed (1950 through December 2014) using the following search terms: "adherence," "role of technicians," "community adherence programs," "adherence and technician's role," "medication synchronization," "retail pharmacy adherence programs," and "CMS Star Ratings." Additionally, resources on adherence programs were used from the American Society of Health-System Pharmacists, the American Pharmacists Association, and the Food and Drug Administration. Study Selection and Data Extraction: Articles describing community pharmacy adherence programs, the role of pharmacy technicians in providing these services, and medication synchronization were included. Data Synthesis: Nonadherence to medications creates a burden in terms of patient health and leads to high health care costs to the patients, providers, and insurers. Initiatives on pharmacist-led adherence programs have proven to reduce these overall health care-related costs. Pharmacy technicians can have an active role in the management of these adherence programs to reduce the burden on community pharmacists who are running adherence programs. Pharmacy technicians can be responsible for gathering medication histories, organizing patient medication lists, making appointment calls to schedule patients, collecting patient demographic history, conducting follow-up calls, and in promoting the program overall. Conclusions: Pharmacy technicians are a valuable asset to the community pharmacists in the process of running adherence programs, and they can work with the pharmacists to coordinate and promote community pharmacy-based medication adherence programs.

Acceptability and non-compliance in a family-led weight-management programme for obese Pacific children.

To explore factors influencing participation and attrition in a family-led weight-management programme for obese Pacific children. Qualitative study used bilingual in-depth interviews at exit and end of an 8-week weight-management programme. New Zealand. Forty-two parents/primary caregivers of obese children who were randomised in the intervention weight-management programme. Programmatic factors that enhanced retention included: simultaneous delivery to both children and parents as participants; delivery of the programme in small group settings at local community venues; enabling trustworthy and accountable relationships; providing resources for travel to venues and regular telephone/text messaging follow-up calls reinforcing programme goals; and day and time scheduling. Suggested programme improvements included having ethnic-specific Island-language delivery and practical sessions like cooking classes and shopping expeditions at local food stores. The research found that unpredictable external life crises like extended family deaths, a change in job shift, family illnesses (both acute and those requiring chronic management) and long-term family visitations affected participation and momentum. A loss of momentum through managing life crises was often difficult to overcome for participants, leading them to drop out of the weight-management programme. Most drop-out participants preferred to defer their programme participation with hopes of re-committing to future programmes at another time. In order for weight-management programmes to be effective, participants must be able to complete them. Identifying factors that predict participation and attrition may serve as a basis for programme improvement.

Learning About Spirituality Improves Competency

A “process” approach allowing residents to reflect on their own responses to the subject matter appears to be crucial.

Results of the Chronic Heart Failure Intervention to Improve MEdication Adherence study: A randomized intervention in high-risk patients

BackgroundPoor adherence to evidence-based medications in heart failure (HF) is a major cause of avoidable hospitalizations, disability, and death. To test the feasibility of improving medication adherence, we performed a randomized proof-of-concept study of a self-management intervention in high-risk patients with HF.MethodsPatients with HF who screened positively for poor adherence (<6 Morisky Medication Adherence Scale 8-item) were randomized to either the intervention or attention control group. In the intervention group (n=44), a nurse conducted self-management training prior to discharge that focused on identification of medication goals, facilitation of medication-symptom associations, and use of a symptom-response plan. The attention control group (n=42) received usual care; both groups received follow-up calls at 1 week. However, the content of follow-up calls for the attention control group was unrelated to HF medications or symptoms. General linear mixed models were used to evaluate the magnitude of change in adherence and symptom-related events at 3-, 6-, and 12-month follow-up clinic visits. Efficacy was measured as improved medication adherence using nurse-assessed pill counts at each time point.ResultsPooled over all time points, patients in the intervention group were more likely to be adherent to medications compared with patients in the attention control group (odds ratio [OR] 3.92, t=3.51, p=0.0007).ConclusionsA nurse-delivered, self-care intervention improved medication adherence in patients with advanced HF. Further work is needed to examine whether this intervention can be sustained to improve clinical outcomes.

Evaluation and costs of volunteer telephone cessation follow-up counseling for Veteran smokers discharged from inpatient units: a quasi-experimental, mixed methods study.

BackgroundThe Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate the volunteer telephone smoking cessation counseling follow-up program implemented as part of the inpatient Tobacco Tactics intervention in a Veterans Affairs (VA) hospital.MethodsThis was a quasi-experimental, mixed methods design that collected data through electronic medical records (EMR), observations of telephone smoking cessation counseling calls, interviews with staff and Veterans involved in the program, and intervention costs.ResultsReach: Of the 131 Veterans referred to the smoking cessation telephone follow-up program, 19% were reached 0–1 times, while 81% were reached 2–4 times. Effectiveness: Seven-day point-prevalence 60-day quit rates (abstracted from the EMR) for those who were reached 2–4 times were 26%, compared to 8% among those who were reached 0–1 times (p = 0.06). Sixty-day 24-hour point-prevalence quit rates were 33% for those reached 2–4 times, compared to 4% of those reached 0–1 times (p < 0.01). Adoption and Implementation: The volunteers correctly followed protocol and were enthusiastic about performing the calls. Veterans who were interviewed reported positive comments about the calls. The cost to the hospital was $21 per participating Veteran, and the cost per quit was $92. Maintenance: There was short-term maintenance (about 1 year), but the program was not sustainable long term.ConclusionsQuit rates were higher among those Veterans that had greater participation in the calls. Joint Commission standards for inpatient smoking with follow-up calls are voluntary, but should these standards become mandatory, there may be more motivation for VA administration to institute a hospital-based, volunteer telephone smoking cessation follow-up program.Trial registrationClinicalTrials.Gov NCT01359371.

Cerebral performance category at hospital discharge predicts long-term survival of cardiac arrest survivors receiving targeted temperature management*.

Despite recent advancements in post-cardiac arrest resuscitation, the optimal measurement of postarrest outcome remains unclear. We hypothesized that Cerebral Performance Category score can predict the long-term outcome of postarrest survivors who received targeted temperature management during their postarrest hospital care. Retrospective chart review. Two academic medical centers from May 2005 to December 2012. The medical records of 2,417 out-of-hospital and in-hospital patients post cardiac arrest were reviewed to identify 140 of 582 survivors who received targeted temperature management. None. The Cerebral Performance Category scores at hospital discharge were determined by three independent abstractors. The 1-month, 6-month, and 12-month survival of these patients was determined by reviewing hospital records and querying the Social Security Death Index and by follow-up telephone calls. The association of unadjusted long-term survival and adjusted survival with Cerebral Performance Category was calculated. Of the 2,417 patients who were identified to have undergone cardiac arrest, 24.1% (582/2,417) were successfully resuscitated, of whom 24.1% (140/582) received postarrest targeted temperature management. Overall, 42.9% of patients (60/140) were discharged with Cerebral Performance Category 1, 27.1% (38/140) with Cerebral Performance Category 2, 18.6% (26/140) with Cerebral Performance Category 3, and 11.4% (16/140) with Cerebral Performance Category 4. Cerebral Performance Category 1 survivors had the highest long-term survival followed by Cerebral Performance Categories 2 and 3, with Cerebral Performance Category 4 having the lowest long-term survival (p < 0.001, log-rank test). We found that Cerebral Performance Category 3 (hazard ratio = 3.62, p < 0.05) and Cerebral Performance Category 4 (hazard ratio = 12.73, p < 0.001) remained associated with worse survival after adjusting for age, gender, race, shockable rhythm, time to targeted temperature management initiation, total duration of resuscitation, withdrawal of care, and location of arrest. Patients with different Cerebral Performance Category scores at discharge have significantly different survival trajectories. Favorable Cerebral Performance Category at hospital discharge predicts better long-term outcomes of survivors of cardiac arrest who received targeted temperature management than those with less favorable Cerebral Performance Category scores.

Integrative medicine for subacute stroke rehabilitation: a study protocol for a multicentre, randomised, controlled trial

IntroductionMany patients with stroke receive integrative medicine in China, which includes the basic treatment of Western medicine and routine rehabilitation, in conjunction with acupuncture and Chinese medicine. The question of...

Lessons learned for follow-up phone booster counseling calls with substance abusing emergency department patients

BackgroundPost-visit “booster” sessions have been recommended to augment the impact of brief interventions delivered in the emergency department (ED). This paper, which focuses on implementation issues, presents descriptive information and interventionists' qualitative perspectives on providing brief interventions over the phone, challenges, “lessons learned”, and recommendations for others attempting to implement adjunctive booster calls. MethodAttempts were made to complete two 20-minute telephone “booster” calls within a week following a patient's ED discharge with 425 patients who screened positive for and had recent problematic substance use other than alcohol or nicotine. ResultsOver half (56.2%) of participants completed the initial call; 66.9% of those who received the initial call also completed the second call. Median number of attempts to successfully contact participants for the first and second calls were 4 and 3, respectively. Each completed call lasted an average of about 22minutes. Common challenges/barriers identified by booster callers included unstable housing, limited phone access, unavailability due to additional treatment, lack of compensation for booster calls, and booster calls coming from an area code different than the participants' locale and from someone other than ED staff. ConclusionsSpecific recommendations are presented with respect to implementing a successful centralized adjunctive booster call system. Future use of booster calls might be informed by research on contingency management (e.g., incentivizing call completions), smoking cessation quitlines, and phone-based continuing care for substance abuse patients. Future research needs to evaluate the incremental benefit of adjunctive booster calls on outcomes over and above that of brief motivational interventions delivered in the ED setting.

Effect of early palliative care on depression and survival in patients with advanced cancer.

5 Background: We previously demonstrated improved depression and survival in advanced cancer patients participating in two palliative care (PC) RCTs: ENABLE II (EII; N=322) compared intervention vs. usual care, and ENABLE III (EIII; N=207) compared immediate vs. delayed intervention. The interventions were identical, except in EIII, the intervention included support for family caregivers and the delayed group began the intervention 12 weeks after enrollment. Both EII and EIII included an in-person PC consultation, weekly phone sessions facilitated by a nurse coach, and monthly follow-up calls. The Center for Epidemiologic Studies-Depression (CES-D) scale was collected at baseline and every 6 weeks until death or study completion. Our aim was to examine the moderating effects of baseline depression on the intervention effect and on survival outcomes in both RCTs. Methods: After combining data from the two RCTs the sample consisted of 529 patients. We conducted Cox proportional hazard analyses to examine the effect of the intervention (as a time-varying covariate) and baseline depression scores on subsequent survival. Results: The intervention significantly reduced mortality risk in this sample (Hazard Ratio [HR]= 0.78, CI: 0.63-0.98, p=.029). Adding baseline CES-D scores and the interaction of the intervention and CES-D scores as predictor variables yielded a significant interaction (HR= 0.97, p =.035) that remained after controlling for cancer type. Following this analysis, patients were classified as clinically depressed (baseline CES-D 16) or not, and Cox analyses were conducted using the intervention as the sole predictor within each depression group. Receiving the intervention significantly reduced mortality risk among clinically depressed patients (HR = 0.65, CI: 0.44-0.95, p =.029), but not among non-depressed patients (HR = 0.89, CI: 0.65-1.21, p &gt;.45). Conclusions: The ENABLE intervention improved survival in this combined sample of advanced cancer patients. The intervention effect on survival was moderated by baseline depression levels, such that patients who were depressed at baseline and received the intervention had a longer survival compared with non-depressed intervention patients.

Abstract A84: Do patient follow-up improvements, at hospitals caring for medically underserved patients, impact no-show rates

Abstract Background: In Chicago Black women are 62% more likely to die from breast cancer than White women. Previous data from 39 Chicago hospitals suggested the existence of significant variation in mammography quality across facilities (Chicago Breast Cancer Quality Consortium, 2010). We developed process improvement recommendations for sites that participated in our care process assessment (Weldon CB, et al, ASCO-Abstract-6120-2012). This study was funded through a generous grant from the Susan G. Komen for the Cure Foundation. Appointment reminder calls and follow-up calls to patients that do not attend their appointments are effective in increasing breast cancer screening and diagnosis completion rates of (Goel A, et al, JHCPU 2008). We provided technical assistance to implement breast imaging care process improvements and compared pre and post process improvement appointment no-show rates and follow-up call rates at 14 sites. Procedures: Using Deming's PDCA cycle for continuous improvement, we created care process improvement recommendations for 27 Chicago institutions with the patient base averaging more than 50% medically underserved patients (22 community, 3 academic and 2 public hospitals), 17 of the sites are safety net institutions. Recommendations were based on analysis across sites, literature, and input from institution staff. We provided 14 of the sites with technical assistance to implement “rapid cycle” care process improvements (RCI sites). Sites were selected for technical assistance based on their need and their commitment to improving breast imaging care processes. Thematic and statistical analyses were performed using simple frequencies, and McNemar's test. Summary of Results: Detailed results are shown in the table below. Technical assistance was utilized by 14 of 17 safety net sites (RCI sites) to which it was offered. 10 sites adjusted their processes to conduct appointment reminder calls to patients. 12 sites implemented processes to conduct follow up phone calls with patients who missed an appointment, with a focus on answering patient questions and to schedule a new appointment. 6 sites adjusted their processes to conduct phone calls to inform patients of abnormal breast screening results (BIRADS 0, 4, 5) in addition to sending each patient a letter (MQSA requires at least a letter). Working with the 14 sites resulted in an improvement in no-show rates from 29% to 21%. Appointment reminder call: baseline 48% (13/27) all sites, 21% (3/14) RCI sites post-improvement 85% (23/27) all sites, 93% (13/14) RCI sites pvalue = 0.0044, Chi squared: 8.100 w 1 degree of freedom Call no-show patients : baseline 19% (5/27) all sites, 0% (0/14) RCI sites post-improvement 63% (17/27) all sites, 86% (12/14) RCI sites pvalue = 0.0015, Chi squared: 10.083 w 1 degree of freedom Call to follow up with patients who have abnormal results: baseline 56% (15/27) all sites, 50% (7/14) RCI sites post-improvement 78% (21/27) all sites, 93% (13/14) RCI sites pvalue = 0.0412, Chi squared: 4.167 w 1 degree of freedom No show rate for screening mammograms baseline 22% all sites, 29% RCI sites : post-improvement 18% all sites, 21% RCI sites Conclusions: Conducting phone calls to remind patients about appointments improves no-show rates at sites that care for the medically underserved. Further analysis may show a reduction in loss-to-follow-up for sites that implement follow up phone calls to patients who miss appointments and to patients who need additional diagnostic assessment. Findings from this study have generalizable application to health facilities beyond breast imaging sites. Given persistent and growing disparities in health outcomes for vulnerable populations and the limited resource availability; these findings suggest that implementation of basic patient tracking strategies have substantial benefit to improve patient outcomes and health care quality. Citation Format: Christine B. Weldon, Teena L. Francois, Julia R. Trosman, Betty Roggenkamp, Danielle M. Dupuy, Jimmie T. Knight, David A. Ansell, Anne Marie Murphy. Do patient follow-up improvements, at hospitals caring for medically underserved patients, impact no-show rates. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A84. doi:10.1158/1538-7755.DISP13-A84

Abstract B82: Beyond October: A multisite breast care patient navigation program

Abstract Background: Insufficient access to mammography and early detection are contributing factors to the racial disparity in breast cancer mortality in Chicago (Chicago Breast Cancer Quality Consortium, 2010). Patient navigators provide information, support, and guidance that can help remove barriers to care and improve the quality of disease management for underserved patients (Vargas et al, 2008). The Metropolitan Chicago Breast Cancer Task Force developed a patient navigation program called Beyond October to provide free mammograms to uninsured and underserved women throughout Metropolitan Chicago. Our goal is to develop a replicable and effective means for patient navigation across multiple sites. Through navigation from Task Force staff, these women received timely and managed care through the screening, and if necessary, diagnostic and treatment processes. Methods: Nine facilities in various locations throughout Chicago donated free mammograms in order to meet our program's goal of 800 mammograms completed from November 1, 2012 to October 31, 2013. Participants were identified through community events, online applications, personal referrals, and referrals from other hospitals and organizations. To be eligible participants were over 40 years of age, uninsured and without symptoms. Eligible participants received culturally sensitive navigation throughout the screening and, if needed, diagnostic process from bilingual staff navigators. A staff navigator (4 navigators in total) verified the patient's eligibility prior to the patient completing intake and HIPAA authorization forms necessary to receive an appointment. Participants were navigated to a facility that was most convenient to their home address and received a packet of site-specific forms, as well as a voucher, to take to their appointment. Each patient received reminder and follow-up calls to assure appointment attendance. If the initial appointment was missed, a patient would receive one more attempt at attending the appointment. Navigators ensured appointments were scheduled, prior mammogram films were requested and obtained. After the appointment, results were communicated effectively and the necessary follow-up imaging and procedures were scheduled. Any patients requiring follow-up imaging and/or biopsies who did not receive their initial mammogram at a site that donated diagnostic mammograms, were referred to an IBCCP (state funded) facility. Women diagnosed with breast cancer received free treatment through the Treatment Act. Results: Based on preliminary data, a total of 662 mammograms were completed across nine Chicago facilities. From this pilot, successful outcomes were observed in the areas of client recruitment, communication of results, and care management for each woman. The program identified economic, language, and administrative /health system barriers as the main challenges faced by women. These barriers were addressed by: 1) providing access to free screening and diagnostic breast health care, 2) providing translation assistance for Spanish speaking clients, and 3) obtaining PCP orders and prior medical information to reduce health system barriers. Developing site specific protocols, providing patients with site specific forms, and having designated facility contacts decreased scheduling times and increased the rate of completion of the specific care plan for each participant. Delays occurred when medical information had to be sent across multiple sites, requests for prior medical history were not properly documented, and patients had a high number of forms to complete. Conclusion: A multi-site, culturally sensitive navigation program that takes into account both patient and facility needs can reduce screening barriers and increase access to quality breast health care for uninsured women. Citation Format: Jimmie Knight, III, Teena L. Francois. Beyond October: A multisite breast care patient navigation program. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B82. doi:10.1158/1538-7755.DISP13-B82