Healthcare Information Research Articles

Efficient and Compressed Deep Learning Model for Brain Tumour Classification With Explainable AI for Smart Healthcare and Information Communication Systems

ABSTRACTThe detection of brain tumours presents a significant challenge in the medical domain, where prompt and precise diagnosis is crucial as patient outcomes depend on it. Conventional deep neural networks perform well in carrying out various imaging tasks within the healthcare sector; however, their effectiveness often falls short of expectations in practical applications due to the substantial computational resources required and issues with reliability. In this research, an optimised and effective deep learning model founded on the DenseNet‐169 architecture is introduced for the classification of magnetic resonance imaging brain tumours, which is particularly advantageous for smart healthcare systems and information and communication technology (ICT) settings with limited computational capabilities. The model compression methodologies, including pruning and quantization, have been employed to significantly diminish the dimensions and intricacy of the model while achieving a classification accuracy of 97.07%. Furthermore, this endeavour necessitates the enhancement of the model's interpretability through the utilisation of explainable artificial intelligence methodologies such as Gradient‐weighted Class Activation Mapping (Grad‐CAM) and SHapley Additive exPlanations (SHAP), which will aid clinicians in highlighting crucial areas of the images and validating feature importance concerning the decisions rendered by the model. A comparative performance evaluation is conducted against DenseNet‐169, ResNet‐50 and various other models to delineate the superior efficacy of our model, rendering it exceptionally adept for knowledge‐driven, real‐time brain tumour diagnosis within smart healthcare and ICT systems where resources are constrained.

A Flexible Smart Healthcare Platform Conjugated with Artificial Epidermis Assembled by Three-Dimensionally Conductive MOF Network for Gas and Pressure Sensing

The rising flexible and intelligent electronics greatly facilitate the noninvasive and timely tracking of physiological information in telemedicine healthcare. Meticulously building bionic-sensitive moieties is vital for designing efficient electronic skin with advanced cognitive functionalities to pluralistically capture external stimuli. However, realistic mimesis, both in the skin’s three-dimensional interlocked hierarchical structures and synchronous encoding multistimuli information capacities, remains a challenging yet vital need for simplifying the design of flexible logic circuits. Herein, we construct an artificial epidermal device by in situ growing Cu3(HHTP)2 particles onto the hollow spherical Ti3C2Tx surface, aiming to concurrently emulate the spinous and granular layers of the skin’s epidermis. The bionic Ti3C2Tx@Cu3(HHTP)2 exhibits independent NO2 and pressure response, as well as novel functionalities such as acoustic signature perception and Morse code-encrypted message communication. Ultimately, a wearable alarming system with a mobile application terminal is self-developed by integrating the bimodular senor into flexible printed circuits. This system can assess risk factors related with asthmatic, such as stimulation of external NO2 gas, abnormal expiratory behavior and exertion degrees of fingers, achieving a recognition accuracy of 97.6% as assisted by a machine learning algorithm. Our work provides a feasible routine to develop intelligent multifunctional healthcare equipment for burgeoning transformative telemedicine diagnosis.

Accuracy of natural language processors for patients seeking inguinal hernia information.

NLPs such as ChatGPT are novel sources of online healthcare information that are readily accessible and integrated into internet search tools. The accuracy of NLP-generated responses to health information questions is unknown. We queried four NLPs (ChatGPT 3.5 and 4, Bard, and Claude 2.0) for responses to simulated patient questions about inguinal hernias and their management. Responses were graded on a Likert scale (1 poor to 5 excellent) for relevance, completeness, and accuracy. Responses were compiled and scored collectively for readability using the Flesch-Kincaid score and for educational quality using the DISCERN instrument, a validated tool for evaluating patient information materials. Responses were also compared to two gold-standard educational materials provided by SAGES and the ACS. Evaluations were performed by six hernia surgeons. The average NLP response scores for relevance, completeness, and accuracy were 4.76 (95% CI 4.70-4.80), 4.11 (95% CI 4.02-4.20), and 4.14 (95% CI 4.03-4.24), respectively. ChatGPT4 received higher accuracy scores (mean 4.43 [95% CI 4.37-4.50]) than Bard (mean 4.06 [95% CI 3.88-4.26]) and Claude 2.0 (mean 3.85 [95% CI 3.63-4.08]). The ACS document received the best scores for reading ease (55.2) and grade level (9.2); however, none of the documents achieved the readibility thresholds recommended by the American Medical Association. The ACS document also received the highest DISCERN score of 63.5 (57.0-70.1), and this was significantly higher compared to ChatGPT 4 (50.8 [95% CI 46.2-55.4]) and Claude 2.0 (48 [95% CI 41.6-54.4]). The evaluated NLPs provided relevant responses of reasonable accuracy to questions about inguinal hernia. Compiled NLP responses received relatively low readability and DISCERN scores, although results may improve as NLPs evolve or with adjustments in question wording. As surgical patients expand their use of NLPs for healthcare information, surgeons should be aware of the benefits and limitations of NLPs as patient education tools.

Artificial intelligence in healthcare facilities asset information management: mixed review

Healthcare facilities are pivotal in ensuring continuous access to services, particularly for individuals with complex health conditions. Effective asset information management (AIM) in these facilities through artificial intelligence (AI) can enhance operational efficiency. The exploratory bibliometric and systematic review assesses the status and trends of AI applications in AIM within healthcare facilities. The findings reveal a significant gap between research findings and practical implementation, highlighting the need for further integration and real-world usage of AI-powered solutions in healthcare facilities settings. This study identified notable gaps, including the need for research on utilising AI to enhance asset management in healthcare, including maintenance scheduling and procurement processes. Involving stakeholders, such as healthcare professionals, facility managers, and patients, in effective facility management using AI requires further investigation. Research is needed to evaluate the economic benefits and develop robust ethical guidelines for responsible AI implementation. Notably, previous research has given limited attention to AI for healthcare AIM, with emerging trends focusing more on AI and infrastructure than the ‘asset’ aspect. Implementing AI-powered solutions tailored to the unique needs of healthcare facilities and evaluating cost-effectiveness will lead to improved asset management practices, enhanced decision-making processes, and, ultimately, more efficient and effective healthcare operations.

Factor Structure and Measurement Invariance of the Cultural Attitudes Toward Healthcare and Mental Illness Questionnaire Among Latino Sexual Minority Men

Mental health disparities among Latino sexual minority men (LSMM) are exacerbated by un(der)treated mental health needs. This study sought to establish the factor structure of the Cultural Attitudes Toward Healthcare and Mental Illness Questionnaire (CAHMIQ) and examine measurement invariance across nativity (born in vs. outside the continental U.S.). Participants included 290 LSMM in South Florida. Confirmatory factor analysis examined the factor structure of CAHMIQ and measurement invariance examined equivalence across LSMM born outside (51.4%) and inside (48.3%) the continental U.S. The second-order factor model showed an acceptable fit (CFI/RMSEA = .91/.03) and consisted of first-ordered factors representing manifest indicators of causes and supports for mental health. Measurement invariance results suggest that the CAHMIQ performs equivalently across nativity groups (∆χ2(18) = 16.941, p = .5272). The CAHMIQ may be used among both nativity groups to understand attitudes toward healthcare and mental illness and inform LSMMs’ engagement in mental health treatment.

Telehealth to increase healthcare access; perspectives of people who use drugs.

People who use drugs (PWUD) often face restricted healthcare access despite their heightened healthcare needs. Factors such as stigma, mistrust of the healthcare system, competing priorities, and geographical barriers pose significant healthcare access challenges. Telehealth offers an innovative solution to expand healthcare access for better inclusion of underserved populations in healthcare. We aimed to explore PWUDs' perceptions of telehealth as a healthcare delivery modality. We utilized purposive sampling to recruit participants (N = 57) for nine focus group discussions (FGDs) in Athens, Greece. Eligibility criteria required participants to be at least 18years, with current or prior injection drug use, and current internet access. The FGDs followed a semi-structured interview guide, were audio recorded, transcribed verbatim, translated into English, and de-identified. We applied thematic analysis to analyze FGD transcripts. Participants' mean (standard deviation) age was 47.9 (8.9) years, 89.5% (51/57) were male, 91.2% (52/57) were of Greek origin, and 61.4% (35/57) had attended at least 10years of school. Three main themes emerged from the FGDs: (1) high internet utilization for healthcare-related purposes among PWUD, (2) highlighting telehealth benefits despite access obstacles and PWUDs' concerns about diagnostic accuracy, and (3) approaches to overcome access obstacles and build digital trust. Participants extensively used the internet for healthcare-related processes, such as accessing healthcare information and scheduling provider appointments. Despite being telehealth-inexperienced, most participants expressed a strong willingness to embrace telehealth due to its perceived convenience, time-saving nature, and trusted digital environment. Some participants recognized that the inability to conduct physical examinations through telehealth reduces its diagnostic accuracy, while others expressed concerns about digital literacy and technological infrastructure accessibility. Most participants expressed a preference for video-based telehealth encounters over audio-only encounters. To build trust in telehealth and promote patient-centeredness, participants recommended an initial in-person visit, virtual eye contact during telehealth encounters, patient education, and partnerships with PWUD-supportive community organizations equipped with appropriate infrastructure. PWUD frequently use the internet for health-related purposes and suggested several approaches to enhance virtual trust. Their insights and suggestions are practical guidance for policymakers seeking to enhance healthcare access for underserved populations through telehealth. NCT05794984.

Does the development of strategic readiness represent a response to the relationship of strategic competencies and the healthcare information system? Evidence from private hospitals in Jordan

This study introduces a model designed to improve the strategic readiness of private hospitals in Amman by incorporating strategic competencies as an independent variable and using a healthcare information system as a mediator. Targeting private hospitals with over 140 beds, the research included a population of 3263 employees across various managerial levels. Data collection methods involved interviews and electronic questionnaires, resulting in a sample size of 344. Statistical analyses comprised exploratory and confirmatory factor analysis, structural equation modeling, and hypothesis testing with SMART PLS 3.3.3 software. The results indicated medium levels of both strategic competencies and healthcare information systems, while strategic readiness was found to be low. Nevertheless, the proposed model showed a direct positive effect of strategic competencies on strategic readiness, with the healthcare information system acting as a significant partial mediator. Evaluation metrics included the arithmetic mean, standard deviation, and path analysis. This model surpasses traditional methods by effectively linking strategic competencies and information systems to enhance strategic readiness, providing a strong framework for improving hospital responses to crises and dynamic changes. The study suggests focusing on enhancing and developing strategic competencies and integrating a comprehensive healthcare information system to optimize hospital operations and increase readiness.

The role of indigenous healers in treating surgical conditions in the rural Eastern Cape of South Africa.

Indigenous knowledge healers (IKHs) provide alternative healthcare to formal health services in rural South Africa, but there is a gap in knowledge regarding their treatment of surgical conditions. This study evaluated IKH surgical care and described their perspective of the dual health system. A cross sectional survey of IKHs in the Madwaleni Hospital catchment of the Eastern Cape, South Africa was conducted. Topics included the training and experience of IKHs, treatment of nine common surgical conditions, referral patterns, disease origin beliefs, benefits and limitations of care, and collaborative opportunities between the two health systems. Thirty-five IKHs completed the survey. IKHs were consulted by persons with all nine surgical conditions. The most common forms of treatment were application of an ointment on the affected site (88%) and oral medication (82%). Operative treatment was only done for abscess. Referrals to the formal healthcare sector were made for all surgical conditions. IKHs reported that they were limited by their lack of training and resources to perform operations. On the other hand, they perceived the treatment of the spiritual aspect of surgical disease as a benefit of their care. Thirty-five (100%) IKHs were interested in closer collaboration with the formal health sector. IKHs treat surgical conditions but refer to the formal health sector when diagnostic and operative services are needed. More research is needed to determine the potential advantages and disadvantages between the formal health sector and IKH collaboration.

Occupational Hazards Among the Agricultural Workers in a Rural Area of South India

Background: Agriculture is one of the most hazardous occupations, employing around 60% of India’s workforce. Agricultural workers face occupational hazards in the form of physical, chemical, biological, mechanical, ergonomic, psychosocial, and so on. This study assessed the physical, chemical, biological, and mechanical health hazards among agricultural workers.Methods: A cross-sectional study was conducted among 400 agricultural workers selected through multistage random sampling in a rural area to assess their occupational hazards.Results: Physical hazards were the most common hazards reported by 390 workers (97.5%), followed by mechanical hazards by 200(50%), and biological hazards by 79(19.7%). Chemical hazards were noted in 136(86.4%) out of 155 participants who used chemicals in the form of pesticides and insecticides.Conclusion: All agricultural workers experience one or the other types of occupational hazards. These hazards have a bearing on the quality of life among the agricultural workers who form the primary workforce in our country and contribute significantly to the economy. It is crucial to ensure a robust health information system to track down and respond to agricultural workers’ various health events, develop and implement a need-based intervention program through the formal healthcare system, and prevent and avert occupational health hazards in this group.

Evaluating the quality and reliability of oncologic breast reconstruction videos on youtube

Oncologic breast reconstruction (OBR) is a complex process that requires consideration of multiple factors, including chemoradiation, extent of cancer treatment, and surgical approach. Patients often feel uncertain about the numerous surgical options and may turn to popular social media platforms like YouTube for information. Thus, this study aims to assess the quality and reliability of YouTube videos related to OBR.We conducted a retrospective, cross-sectional analysis of YouTube videos related to OBR. Search terms were obtained from plasticsurgery.org and Google Trends. The first ten videos for each search term were analyzed. Videos were categorized by source and subject matter and independently reviewed by three evaluators using the DISCERN scale.This study examined 172 YouTube videos. Five video source categories were identified: Health Care Administrations, Physicians, Non-physician Providers, News Organizations, and Patients. Health Care Administration accounts received the highest overall DISCERN score of 3.6 ± 0.51, followed by Physicians at 2.98 ± 0.93, with News Organization accounts scoring the lowest at 2.22 ± 0.60 (p < 0.001). Videos from academic sources (Physicians and Health Care Administrators) had higher DISCERN scores compared to non-academic sources (News Organizations and Patients), 2.98 ± 0.95 versus 2.28 ± 0.77, respectively (p < 0.001).Our findings indicate that videos from academic sources generally exhibit higher DISCERN scores, pointing to a higher content quality and reliability standard. Given the increasing reliance on YouTube for healthcare information, our study underscores the need for healthcare professionals to engage more actively in content creation and dissemination.

A secure blockchain framework for healthcare records management systems

AbstractElectronic health records are one of the essential components of health organizations. In recent years, there have been increased concerns about privacy and reputation regarding the storage and use of patient information. In this regard, the information provided as a part of medical and health insurance, for instance, can be viewed as proof of social insurance and governance. Several problems in the past few decades regarding medical information management have threatened patient information privacy. In intelligent healthcare applications, the privacy of patients' data is one of the main concerns. As a result, blockchain is a severe necessity as it can enhance transparency and security in medical applications. Accordingly, this paper uses the design science method to propose a secure blockchain framework for healthcare records management systems. The proposed framework comprises five components: a blockchain network, smart contracts, privacy key management, data encryption, and integration with healthcare information technology. In the proposed framework, healthcare organizations can manage healthcare information securely and privately. Additionally, a secure storage system for electronic records is proposed to meet these organizations' needs. It provides security and privacy for healthcare organizations, especially when managing healthcare information, and also proposes a secure storage system for electronic records to meet the needs of the organizations.

County-level racial bias is associated with worse care for white and especially black older US adults: a cross-sectional observational study

ObjectiveTo assess the association of county-level bias about black and white people with patient experience, influenza immunisation, and quality of clinical care for black and white older US adults (age...

Clinical Data Flow in Botswana Clinics: Protocol for a Mixed-Methods Assessment.

Botswana has made significant investments in its health care information infrastructure, including vertical programs for child health and nutrition, HIV care, and tuberculosis. However, effectively integrating the more than 18 systems in place for data collection and reporting has proved to be challenging. The Botswana Health Data Collaborative Roadmap Strategy (2020-24) states that "there exists parallel reporting systems and data is not integrated into the mainstream reports at the national level," seconded by the Botswana National eLearning strategy (2020), which states that "there is inadequate information flow at all levels, proliferation of systems, reporting tools are not synthesized; hence too many systems are not communicating." The objectives of this study are to (1) create a visual representation of how data are processed and the inputs and outputs through each health care system level; (2) understand how frontline workers perceive health care data sharing across existing platforms and the impact of data on health care service delivery. The setting included a varied range of 30 health care facilities across Botswana, aiming to capture insights from multiple perspectives into data flow and system integration challenges. The study design combined qualitative and quantitative methodologies, informed by the rapid assessment process and the technology assessment model for resource limited settings. The study used a participatory research approach to ensure comprehensive stakeholder engagement from its inception. Survey instruments were designed to capture the intricacies of data processing, sharing, and integration among health care workers. A purposive sampling strategy was used to ensure a wide representation of participants across different health care roles and settings. Data collection used both digital surveys and in-depth interviews. Preliminary themes for analysis include perceptions of the value of health care data and experiences in data collection and sharing. Ethical approvals were comprehensively obtained, reflecting the commitment to uphold research integrity and participant welfare throughout the study. The study recruited almost 44 health care facilities, spanning a variety of health care facilities. Of the 44 recruited facilities, 27 responded to the surveys and participated in the interviews. A total of 75% (112/150) of health care professionals participating came from clinics, 20% (30/150) from hospitals, and 5% (8/150) from health posts and mobile clinics. As of October 10, 2023, the study had collected over 200 quantitative surveys and conducted 90 semistructured interviews. This study has so far shown enthusiastic engagement from the health care community, underscoring the relevance and necessity of this study's objectives. We believe the methodology, centered around extensive community engagement, is pivotal in capturing a nuanced understanding of the health care data ecosystem. The focus will now shift to the analysis phase of the study, with the aim of developing comprehensive recommendations for improving data flow within Botswana's health care system. DERR1-10.2196/52411.

The Role of Community Beliefs and Practices on the Spread of Ebola in Uganda, September 2022.

On September 20, 2022, Uganda declared an Sudan Virus Disease (SVD) outbreak in Mubende District. Another eight districts were infected September-November 2022. We examined how Ugandan community beliefs and practices spread Sudan Ebola Virus (SUDV) in 2022. A qualitative study was conducted in Mubende, Kassanda, and Kyegegwa districts in February 2023. Nine focus group discussions and six key informant interviews were held. We investigated whether community beliefs and practices contributed to spreading Sudan Ebola Virus (SUDV). Interviews were recorded, translated, transcribed, and thematically analyzed. The community deaths, later found to be due to Sudan Virus Disease(SVD), were often attributed to witchcraft or poisoning. Key informants reported that SVD patients often sought traditional healers or spiritual leaders before or after formal healthcare failed. They also found that traditional healers treated SVD patients without precautions. Religious leaders praying for SVD patients and their symptomatic contacts, SVD patients hiding in friends' homes, and exhuming SVD patients from safe and dignified burials to allow traditional burials were other themes. Diversity in community beliefs and culture likely contributed to spreading the 2022 Ugandan SVD outbreak. Public health systems, traditional healers, and religious leaders can help Uganda control ebolavirus outbreaks by identifying socially acceptable and scientifically supported infection control methods.

Provision of digital health interventions for young people with ADHD in primary care: findings from a survey and scoping review

BackgroundPeople with attention-deficit hyperactivity disorder (ADHD) are at risk of negative health outcomes, with risks reduced through evidence-based treatments. Therefore, ensuring continued access to treatment for young people with ADHD, especially as they transition from child to adult services, is a priority. Currently many young people with ADHD are unable to access adequate care, with negative consequences for patients and their communities. Preliminary evidence suggests digital health interventions (DHIs) may act as an effective adjunct to usual care, helping overcome barriers to access, and improving outcomes by increasing understanding of ADHD as a long-term condition. The aim of this mixed methods study is to explore the healthcare information preferences of people with lived experience of ADHD in the primary care context and considers these in the light of the emerging body of literature on DHIs for ADHD. To explore this, a descriptive summary of cross-sectional survey responses was compared and discussed in the context of DHIs identified in a scoping review.ResultsDigital apps, followed by support groups, were deemed the most useful information resource types by survey respondents, but were the least currently used/provided. Over 40% participants indicated a preference for signposting to all resource types by their general practitioner (GP), suggesting that GPs are credible sources for ADHD healthcare information. The scoping review identified nine studies of DHI for ADHD, consisting of games, symptom monitoring, psychoeducation, and medication reminders, with limited evidence of effectiveness/implementation.ConclusionsPeople with ADHD state a preference for digital apps as an adjunct to usual care. However, these are currently the least provided information resource in primary care, indicating a key area for future development. The limited evidence base on DHIs for ADHD suggests combining digital apps and support networks, and utilising multimodal delivery methods may also enhance the delivery of healthcare information.

Enhancing Healthcare Information Systems in Ethiopian Hospitals: Exploring Challenges and Prospects of a Cloud-based Model for Smart and Sustainable Information Services

Hospitals are the primary hubs for healthcare service providers in Ethiopia; however, hospitals face significant challenges in adopting digital health information systems solutions due to disparate, non-interoperable systems and limited access. Information technology, especially via cloud computing, is crucial in healthcare for efficient data management, secure storage, real-time access to critical information, seamless provider communication, enhanced collaboration, and scalable IT infrastructure. This study investigated the challenges to standardizing smart and green healthcare information services and proposed a cloud-based model for overcoming them. We conducted a mixed-methods study in 11 public hospitals, employing quantitative and qualitative approaches with diverse stakeholders (N = 103). The data was collected through surveys, interviews, and technical observations by purposive quota sampling with the Raosoft platform and analyzed using IBM SPSS. Findings revealed several shortcomings in existing information systems, including limited storage, scalability, and security; impaired data sharing and collaboration; accessibility issues; no interoperability; ownership ambiguity; unreliable data recovery; environmental concerns; affordability challenges; and inadequate policy enforcement. Notably, hospitals lacked a centralized data management system, cloud-enabled systems for remote access, and modern data recovery strategies. Despite these challenges, 90.3% of respondents expressed interest in adopting cloud-enabled data recovery systems. However, infrastructure limitations, inadequate cloud computing/IT knowledge, lack of top management support, digital illiteracy, limited innovation, and data security concerns were identified as challenges to cloud adoption. The study further identified three existing healthcare information systems: paper-based methods, electronic medical catalog systems, and district health information systems2. Limitations of the paper-based method include error-proneness, significant cost, data fragmentation, and restricted remote access. Growing hospital congestion and carbon footprint highlighted the need for sustainable solutions. Based on these findings, we proposed a cloud-based model tailored to the Ethiopian context. This six-layered model, delivered as a Software-as-a-Service within a community cloud deployment, aims to improve healthcare services through instant access, unified data management, and evidence-based medical practices. The model demonstrates high acceptability and potential for improving healthcare delivery, and implementation recommendations are suggested based on the proposed model.

Development and validation of an instrument to evaluate the perspective of using the electronic health record in a hospital setting

BackgroundEvaluating healthcare information systems, such as the Electronic Health Records (EHR), is both challenging and essential, especially in resource-limited countries. This study aims to psychometrically develop and validate an instrument (questionnaire) to assess the factors influencing the successful adoption of the EHR system by healthcare professionals in Moroccan university hospitals.MethodsThe questionnaire validation process occurred in two main stages. Initially, data collected from a pilot sample of 164 participants underwent analysis using exploratory factor analysis (EFA) to evaluate the validity and reliability of the retained factor structure. Subsequently, the validity of the overall measurement model was confirmed using confirmatory factor analysis (CFA) in a sample of 368 healthcare professionals.ResultsThe structure of the modified HOT-fit model, comprising seven constructs (System Quality, Information Quality, Information technology Service Quality, User Satisfaction, Organization, Environment, and Clinical Performance), was confirmed through confirmatory factor analysis. Absolute, incremental, and parsimonious fit indices all indicated an appropriate level of acceptability, affirming the robustness of the measurement model. Additionally, the instrument demonstrated adequate reliability and convergent validity, with composite reliability values ranging from 0.75 to 0.89 and average variance extracted (AVE) values ranging from 0.51 to 0.63. Furthermore, the square roots of AVE values exceeded the correlations between different pairs of constructs, and the heterotrait-monotrait ratio of correlations (HTMT) was below 0.85, confirming suitable discriminant validity.ConclusionsThe resulting instrument, due to its rigorous development and validation process, can serve as a reliable and valid tool for assessing the success of information technologies in similar contexts.

Assessing the Impact of Community Health Workforce on the Efficiency and Accessibility of Healthcare Delivery

The role of Community Health Workers (CHWs) in improving healthcare delivery, particularly in low- and middle-income countries (LMICs), has garnered increased attention due to their ability to bridge the gap between formal health systems and underserved communities. This study assesses the impact of CHWs on healthcare accessibility, efficiency, and quality. CHWs have been instrumental in expanding healthcare access, especially in rural and remote areas, by providing primary care, maternal and child health services, and chronic disease management. Additionally, CHWs enhance health system efficiency by alleviating the burden on overworked health professionals, enabling them to focus on more specialized care. However, challenges remains regarding the sustainability of CHW programs, including inadequate training, compensation, and integration into formal healthcare systems, which can affect the quality of care. Addressing these challenges through sustained investment, political support, and better integration is critical for maximizing the potential of CHWs to transform healthcare delivery, reduce health disparities, and promote health equity.

6989 Novel Use of Dual GIP/GLP-1 Receptor Agonist in HNF4A-MODY

Abstract Disclosure: A. Mehdi: None. M.C. Foss de Freitas: Advisory Board Member; Self; PTC Pharmaceuticals. Other; Self; Scientific presenter in a symposium funded by Amryt Pharmaceuticals. C.L. Martin: None. B.E. Gregg: None. N. Nachawi: None. E. Frontera: None. E.A. Oral: Consulting Fee; Self; Amryt Pharmaceuticals, Akcea Therapeutics, Ionis Pharmaceuticals Inc., Regeneron Pharmaceuticals. Grant Recipient; Self; Amryt Pharmaceuticals (now part of Cheisi, manufacturer of metreleptin), Akcea Therapeutics, Ionis Pharmaceuticals Inc., Regeneron Pharmaceuticals, Novo Nordisk, Rhythm Pharmaceuticals, Fractyl Laboratories, GI Dynamics (now Morfic Medical. Other; Self; Royalty rights from the use of Metreleptin in lipodystrophy. W.H. Herman: Advisory Board Member; Self; Member of the Data Safety and Monitoring Board for Merck Sharp &amp; Dohme, LLC, Memer of the Data Safety and Monitoring Board for Rivus Pharmaceuticals. Other; Self; Chair for the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) Workgroup. D.T. Broome: Consulting Fee; Self; Tayco, Inc. Research Investigator; Self; Novo Nordisk, Fractyl Laboratories, Rhythm Pharmaceuticals, Inc. HNF4A-MODY (formerly MODY-1) is an autosomal dominant form of diabetes caused by a mutation in the transcription factor HNF4A[1],2. Affected patients are initially very sensitive to the anti-hyperglycemic effect of sulfonylureas, but become unresponsive to sulfonylureas at a rate of 1-4% per year3. Recently, the efficacy of glucagon-like peptide-1 receptor agonists has been demonstrated in HNF4A-MODY2, but there have been no reports on the use of dual gastric inhibitory polypeptide/glucagon-like peptide-1 receptor agonists (dual GIP/GLP-1 RA) in HNF4A-MODY. This report describes a patient with HNF4A-MODY who was treated with a dual GIP/GLP-1 RA. A 42-year-old White male with a pathogenic heterozygous mutation in Q268X was diagnosed with HNF4A-MODY at the age of 10 years (part of the RW pedigree)3. He was diagnosed with diabetes at age 20, treated with metformin from age 20 to age 30, and had glipizide extended release added at age 30. His dose of glipizide was titrated over 9-years to the maximum therapeutic dose. At the age of 40, when his HbA1c was no longer controlled, dulaglutide 1.5 mg once weekly was added. Thereafter, his HbA1c was well controlled between 5.5-7.0%, until it increased to 7.7%. He was then transitioned from dulaglutide to tirzepatide 5 mg once weekly for 4 weeks, 7.5 mg once weekly for 4 weeks, then 10 mg once weekly. He has been maintained on tirzepatide 10 mg once weekly, glipizide extended release 10 mg once daily, and metformin 1,000 mg twice daily without significant side effects. His HbA1c improved from 7.7% to 5.8% and he lost 7 lbs since transitioning from dulaglutide to tirzepatide (while on tirzepatide for 4 months in total). During his recent visit, he was without significant hyper- or hypoglycemia and his BMI was 31.2 kg/m2. (down from 32.32 kg/m2). To our knowledge, this is the first case report demonstrating preliminary efficacy of dual GIP/GLP-1 receptor agonist in HNF4A-MODY. While it is known that GIP and GLP-1 can cause glucose stimulated insulin secretion, and the mechanism of GLP-1 was previously described in MODY4, the differential effects and/or predominance of GIP or GLP-1 in MODY requires further investigation.

6687 Indicators of Diabetes Management: Predicting Unplanned Healthcare Utilization and Mortality in a Suburban Integrated Delivery Network

Abstract Disclosure: K.M. Barton: None. J.Y. Yip: None. K.C. Geckeler: None. A. Popelka: None. D.J. Ramsey: None. Purpose: To explore whether patients with diabetes mellitus (DM) who met Comprehensive Diabetes Care Healthcare Effectiveness Data and Information Set (HEDIS) metrics had a reduced likelihood of experiencing unplanned emergency department (ED) visits, hospitalizations, or mortality. Introduction: The prevalence of DM among U.S. adults is approximately 15% and continues to rise. To enhance care for individuals with DM, Comprehensive Diabetes Care HEDIS quality measures have been established. These measures encompass criteria such as blood pressure control, hemoglobin A1c (HbA1c) levels, and the completion of an annual eye examination. However, the connection of these metrics to health outcomes remains insufficiently studied. Methods: This study comprised a retrospective, cross-sectional exploratory analysis of established patients aged 18 years or older with DM receiving primary care within a suburban integrated delivery network (IDN). Multivariate logistic regression was used to analyze patient characteristics, including demographics, sociomedical factors, and biometrics. Outcome variables encompassed one or more unplanned ED visits (including urgent care), one or more unplanned hospitalizations, or mortality within the one-year study period. Results: Out of 28,929 patients with DM, 5293 (18.3%) had ≥1 ED visit, 3725 (12.9%) had ≥1 hospital admission, and 614 (2.1%) died during 2022. After controlling for available demographic and sociomedical factors, patients with poor HbA1c control (considered HbA1c &amp;gt; 9.0) in the year prior were more likely to experience an ED visit in the study year (adjusted odds ratio [aOR] = 1.292, 95% CI, 1.121-1.489, p &amp;lt; 0.001). Patients who achieved HbA1c control (considered HbA1c &amp;lt; 8.0) in the year prior were less likely to experience an ED visit (aOR = 0.845, 95% CI, 0.763-0.936, p = 0.001) and less likely to experience a hospitalization in the study year (aOR = 0.878, 95% CI, 0.779-0.989, p = 0.032). Patients who completed an eye exam in the year prior were less likely to experience a hospitalization (aOR = 0.913, 95% CI, 0.847-0.984, p = 0.017) or die (aOR = 0.694, 95% CI, 0.579-0.831, p &amp;lt; 0.001) in the study year. Finally, patients who completed microalbumin testing in the year prior were less likely to experience an ED visit (aOR = 0.902, 95% CI, 0.84-0.968, p = 0.004), or die (aOR = 0.464, 95% CI, 0.389-0.554, p &amp;lt; 0.001). Conclusion: Achieving HbA1c control in the previous year is linked to decreased likelihood of experiencing an unplanned ED visit or hospitalization. An eye exam in the year prior was associated with decreased likelihood of hospitalization or death. Further research into interventions aimed at enhancing DM management and reducing associated complications may have potential to enhance patient health outcomes while reducing health care costs. Presentation: 6/3/2024