Gaps In Care Delivery Research Articles

Addressing menopause symptoms in the primary care setting: opportunity to bridge care delivery gaps.

Menopause symptoms affect quality of life and financial well-being but are often unaddressed in primary care clinics. Therefore, we evaluated the extent of menopause symptom documentation in electronic health records (EHRs) by primary health care professionals. We retrospectively reviewed adult women who reported moderate or higher vasomotor symptoms on a Mayo Clinic survey conducted from March 1, 2021, through June 30, 2021. We then assessed adequacy of menopause symptom documentation in the EHRs of these women who had primary care visits during the survey period. We reviewed the percentage of documented vasomotor symptoms from May 1, 2019, through May 1, 2021. In the Mayo Clinic Health System-Northwest Wisconsin Region, 229 women self-reported moderate or higher vasomotor symptoms in the Mayo Clinic survey. Although only 23% of these women had vasomotor symptoms listed in the EHR clinical problem lists, 60% of these women had vasomotor symptoms documented in their clinic notes from the primary care visit. Approximately 6% of women reported hormone therapy use for management of menopause symptoms, and nearly 15% reported use of nonhormone prescription therapies for vasomotor symptoms. A greater proportion of women in our study had EHR documentation of bothersome menopause symptoms than those reported in other studies, but vasomotor symptoms remain generally untreated. We need better methods for identifying midlife women with bothersome menopause symptoms in primary care clinics so that appropriate treatment options, including hormone therapy, can be discussed and offered.

Lessons Learned From a Retrospective Analysis of Medicolegal Risks for Physicians Treated Adolescents and Young Adults With Medical Complexity

PurposeAdolescent and young adult patients occupy a clinically transitional space between pediatric and adult care. Youth with chronic conditions and special healthcare needs may have trouble accessing and receiving appropriate care in this transition, which may lead to patient safety issues and medicolegal risks for physicians. The objectives of this article were to explore patient safety issues and identify medicolegal risks for physicians. MethodsA national repository was retrospectively searched for medicolegal cases (MLCs) involving complaints from youth. The study included MLCs closed at the Canadian Medical Protective Association between 2013 and 2022 involving youth. The study participants were adolescents and young adults aged ≥ 15 and ≤ 21 years with medical complexity. The frequencies and proportions of patient safety events and medicolegal risks for physicians were calculated by exploring factors that contributed to each incident using established frameworks. ResultsA total of 182 eligible MLCs were identified. Of 206 involved physicians, 55 were psychiatrists. The most common reasons for patient complaints were deficient assessment, diagnostic error, and communication breakdown with the patient and/or family. More than half of the cases were related to a harmful incident. Peer experts reviewed the cases and identified factors such as a deficient assessment, a failure to perform a test or intervention, failure to refer the patient, and insufficient provider knowledge/skill as contributing to the patient safety event. DiscussionThe impact of our findings is to identify gaps in care delivery to youth that can inform practitioners of ways to mitigate the gaps and improve patient care and health outcomes.

Addressing cancer survivorship needs in geriatric survivors: Feasibility of a primary care–based survivorship clinic.

e13797 Background: The largest segment of the growing population of cancer survivors is at least 65 years of age, a population that is likely to have comorbidities and requires co-management between primary care and specialist physicians. The goal of this study was to characterize care for this patient population in a specialized primary care for cancer survivorship clinic that manages survivorship issues and ongoing primary care in one place. Methods: This study collected demographic and clinical data via electronic chart review of patients aged 65 and over who established care in the Primary Care for Cancer Survivorship clinic at an academic center from November 1, 2021 through November 30, 2023. Results: Out of 228 total patients who established primary care in the clinic, 63 patients were over the age of 65. The mean age of the group was 73, with the range 65 to 90. Seventy-three percent of patients were female, and 27% were male. The most common cancers were breast (38%), lung (10%), leukemia (13%), lymphoma (8%), prostate (8%), and multiple myeloma (6%). Twenty-five patients (40%) had active disease, 37 patients (58%) were post-treatment, and 1 patient was a “previvor” with Li-Fraumeni syndrome. Cancer surveillance was discussed with 81% of patients, and 2 patients (5% of post-treatment patients) were diagnosed with recurrent cancer. Secondary cancer screening was performed in 86% of patients, with no secondary cancers diagnosed. The most common referral sources were medical oncology from the same institution (40%), self-referrals (25%), and hematology (13%). The average number of visits per year was 2.8 with 61% in person and 29% via video. Cardiovascular risk was addressed in 98% of patients; 32% had at least one cardiovascular medication started and 17% were referred to a cardiologist for management. Long term and late effects were addressed in 84% of patients, including mental health (70%), bone health (65%), cognitive function (21%), cancer-related fatigue (13%), and sexual health (11%). Ten percent had end-of-life issues or goals of care addressed. Conclusions: This study demonstrates the feasibility of a primary care-based cancer survivorship clinic to address the ongoing needs of geriatric cancer survivors. Quality review of these patient encounters can identify gaps in care delivery and inform new models of comprehensive care for the growing geriatric cancer survivor population. [Table: see text]

Low back pain management in primary healthcare: findings from a scoping review on models of care

IntroductionModels of care (MoCs) describe evidence-informed healthcare that should be delivered to patients. Several MoCs have been implemented for low back pain (LBP) to reduce evidence-to-practice gaps and increase the...

Applications of artificial intelligence in retinopathy of prematurity

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide, despite the fact that treatment is available, and blindness can be prevented in most cases. There are two key gaps in care delivery. The first is access to care with many parts of the world underserved. The second is subjective diagnosis where the eye exam is challenging, and different clinicians may perceive different levels of severity. Multiple potential indications for use (IFUs) have been proposed for ROP AI algorithms that could impact both gaps in care. In this presentation I will review potential IFUs and the potential translational challenges in implementation.

Unmet Needs and Care Delivery Gaps Among Rural Cancer Survivors.

Community-based healthcare delivery systems frequently lack cancer-specific survivorship support services. This leads to a burden of unmet needs that is magnified in rural areas. Using sequential mixed methods we assessed unmet needs among rural cancer survivors diagnosed between 2015 and 2021. The Supportive Care Needs Survey (SCNS) assessed 5 domains; Physical and Daily Living, Psychological, Support and Supportive Services, Sexual, and Health Information. Needs were analyzed across domains by cancer type. Survey respondents were recruited for qualitative interviews to identify care gaps. Three hundred and sixty two surveys were analyzed. Participants were 85% White (n = 349) 65% (n = 234) female and averaged 2.03 years beyond cancer diagnosis. Nearly half (49.5%) of respondents reported unmet needs, predominantly in physical, psychological, and health information domains. Needs differed by stage of disease. Eleven interviews identified care gap themes regarding; Finding Support and Supportive Services and Health Information regarding Care Delivery and Continuity of Care. Patients experience persistent unmet needs after a cancer diagnosis across multiple functional domains. Access to community-based support services and health information is lacking. Community based resources are needed to improve access to care for long-term cancer survivors.

Challenges in the Care of Patients with AKI Receiving Outpatient Dialysis: AKINow Recovery Workgroup Report.

Up to one third of survivors of AKI that required dialysis (AKI-D) during hospitalization remain dialysis dependent at hospital discharge. Of these, 20%-60%, depending on the clinical setting, eventually recover enough kidney function to stop dialysis, and the remainder progress to ESKD. To describe the challenges facing those still receiving dialysis on discharge, the AKINow Committee conducted a group discussion comprising 59 participants, including physicians, advanced practitioners, nurses, pharmacists, and patients. The discussion was framed by a patient who described gaps in care delivery at different transition points and miscommunication between care team members and the patient. Group discussions collected patient perspectives of ( 1 ) being often scared and uncertain about what is happening to and around them and ( 2 ) the importance of effective and timely communication, a comfortable physical setting, and attentive and caring health care providers for a quality health care experience. Provider perspectives included ( 1 ) the recognition of the lack of evidence-based practices and quality indicators, the significant variability in current care models, and the uncertain reimbursement incentives focused on kidney recovery and ( 2 ) the urgency to address communication barriers among hospital providers and outpatient facilities. The workgroup identified key areas for future research and policy change to ( 1 ) improve communication among hospital providers, dialysis units, and patients/care partners; ( 2 ) develop tools for risk classification, subphenotyping, and augmented clinical decision support; ( 3 ) improve education to providers, staff, and patients/care partners; ( 4 ) identify best practices to improve relevant outcomes; ( 5 ) validate quality indicators; and ( 6 ) assess the effect of social determinants of health on outcomes. We urge all stakeholders involved in the process of AKI-D care to align goals and work together to fill knowledge gaps and optimize the care to this highly vulnerable patient population.

Addressing Provider-Dependent Gaps in Sickle Cell Disease Care

Sickle cell disease (SCD) affects around 100,000 Americans and presents numerous health-related challenges thus necessitating effective management strategies. Educational initiatives on evidence-based intervention are known to play a crucial role in improving patient-related outcomes (PRO) and enhancing the quality of life (QOL) for individuals with SCD. Community-based hospitals face challenges in managing SCD patients. Patients who are unaffiliated with a comprehensive sickle cell center have increased healthcare utilization, readmissions, and patient dissatisfaction due to limited access to specialized services and discrepancies in care delivery. Addressing these disparities and expanding access to care is crucial in optimizing SCD management. The purpose of this exploratory observational study was to identify provider-related gaps in a community-based tertiary center. The survey assessed internal medicine trainees' and hospitalists' baseline knowledge and comfort level at a tertiary care center with a total of 304 yearly adult admissions related to SCD management. The survey was distributed through an online platform. Data was analyzed to identify trends and gaps in internal medicine providers. Our survey had a total of 30 respondents, the response rate was 39%. Most respondents (90%) had prior experience with SCD patients; however, many gaps were identified [Table 1]. 70-75% of physicians felt comfortable managing acute pain and chronic illnesses, yet only half of these providers were comfortable with managing SCD patients. While our study sample is small, similar results were noted in a study conducted in another community-based hospital in the Chicagoland area. Our study shows a similar provider-related gap in SCD care delivery. Dr. Kanter proposed a model of care delivery which is known as the “hub and spoke” model. It offers a promising solution, creating a networked system of care with a central hub and secondary spokes providing more limited services. Community-based hospital settings can serve as spokes, bringing specialized SCD care closer to patients in local areas. Hence, we propose that this model can be further modified to include provider education. This equips non-sickle cell specialists at various spokes with the necessary knowledge and skills through targeted education by sickle cell specialists at a centralized hub. Targeting provider gaps may significantly improve PRO. Our residency program hopes to establish an affiliation with the University of Illinois (UI) Health Sickle Cell Center (SCC) to help with educating trainees on SCD. The UI Health SCC was one of eight sites participating in the National Sickle Cell Disease Implementation Consortium (SCDIC) with the goal of helping patients access longitudinal care, increase hydroxyurea utilization when appropriate, and provide proper pain management in ED. They are also part of the Recruitment and Engagement in Care to Impact Practice Enhancement (RECIPE) project which focuses on patients with SCD that are unaffiliated with care centers and attempts to understand and eliminate their barriers to care. Future efforts should include implementing targeted provider education, within the context of a hub and spoke model. This may help bridge the gap in care delivery and ultimately enhance outcomes for SCD patients.

Models of care and the advanced practice nurse role in caring for children and adolescents with a cancer predisposition syndrome: a scoping review protocol.

This scoping review will examine the literature describing models of care, barriers and facilitators of care, and gaps in care delivery for children and adolescents with a cancer predisposition syndrome (CPS). It will also explore how advanced practice nurses contribute to the delivery of care for children and adolescents with a CPS. Cancer remains a leading cause of death in children and adolescents. Pediatric CPS clinics proactively aim for early diagnosis or prevention of cancer in children and adolescents with a CPS. Additionally, the holistic well-being of individuals requires a multidisciplinary team, including advanced practice nurses, to manage their complex health care needs. This review will consider both published and unpublished literature exploring aspects of models of care and the role of the nurse in pediatric CPS clinics. Literature published in English from 1991 onward will be considered. This scoping review will follow the JBI methodology for scoping reviews. The review will include searches in MEDLINE, Embase, and CINAHL Complete. Gray literature searches will be conducted in OAIster and Social Science Research Network, as well as websites of hospitals in the USA and the UK with large pediatric cancer centers. Two reviewers will screen titles, abstracts, and full-text articles. An extraction table will be used to extract relevant data from all included articles and facilitate data analysis. Results will be presented in narrative and tabular format. Open Science Framework osf.io/axkp7/.

ASCO Patient-Centered Cancer Care Certification (APC4) pilot: Assessing and improving care delivery gaps.

67 Background: APC4 is a comprehensive oncology care delivery certification built on oncology medical home (OMH) standards developed by ASCO and COA. APC4 consists of 7 domains supported by 39 specific standards, including the chemotherapy safety domain, which incorporates the existing ASCO QOPI Certification Program. To test the standards and assess the feasibility of a vigorous certification process, ASCO embarked on a two-year pilot with twelve oncology practices. All twelve practices achieved certification, although each practice had to address gaps. We present the results of the gap assessment as determined by both onsite survey and practice self-assessment. Methods: The APC4 process involves an onsite survey, followed by cycles of monitored improvement. Certification is awarded after a practice has satisfactorily met all standards. We report here on the 17 care delivery standards not included in QCP. Onsite survey teams consisting of qualified oncology professionals evaluated practice performance against the standards. The final scoring was reviewed and agreed upon by a governance committee. In the final phase of the pilot, practices were surveyed to determine which standards required practices to adopt new procedures or to improve existing care processes to meet certification requirements. Results: At the initial site survey none of the twelve practices met 100% of the 17 standards. Combining the experience of all 12 practices – 68% of the care delivery standards were met (# total standards met by 12 practices / 17 standards X 12 practices) (range 47-82%). Following recalibration of care through implementing new or modified processes of care all 17 standards were met resulting in certification. For example, 85-95% of the practices had to implement new or improve existing processes to meet advanced care planning & goals of care standards; and 90% to deal with the health equity standard (notably 5 of the 12 practices developed completely new equity initiatives). Conclusions: The APC4 pilot was deemed to be feasible and is now being expanded. The presented pilot data suggest that even among oncology practices experienced in the implementation of therapy administration safety (10/12 were already QOPI certified) and practice transformation (11/12 participated in OCM) there is significant room for improvement to meet the standards of APC4 certification. The pilot also demonstrated that practices could identify and rectify gaps through a continued quality improvement focus. [Table: see text]

Enhancing Transsectoral Interdisciplinary Patient-Centered Care for Patients With Rare Cancers: Protocol for a Mixed Methods Process Evaluation.

Rare cancers account for approximately 24% of all new cancers. The category of rare tumor diseases includes almost 200 different entities. In particular, the treatment of patients with extensive care needs requires cooperation between service providers, both between sectors (outpatient and inpatient) and within sectors (eg, between different medical disciplines). The treatment pathway is associated with a high need for coordination and information sharing between providers. When crossing sectoral boundaries in the German health care system, interface problems between the outpatient and inpatient sectors can lead to gaps in care delivery. The multicomponent program Trans-sectoral Personalised Care Concept for Patients with Rare Cancers aims to optimize transsectoral cooperation and coordination of care to enhance patient involvement and the medical care coordination of patients with rare cancers. This process evaluation will contribute to answering questions about intervention fidelity and the implementation of transsectoral communication, identifying and describing the intended and nonintended effects of the intervention, and exploring the barriers to and facilitators of the implementation. We will include patients who participate in the intervention phase; all persons and staff involved in the development and implementation of the intervention (Onco Coach, psychologists, physicians on the contact platform, IT staff, and staff of the Bavarian Association of Statutory Health Insurance Physicians); physicians from the Ludwig-Maximilians-University Hospital Munich and the hospital of the Technical University Munich who are involved in the treatment of patients during the course of the project; and participating office-based hematologists and oncologists. Data collection will be conducted at the beginning, during, and at the end of the intervention using mixed methods. Data will be collected from questionnaires, document analyses, semistructured interviews, and structured observations and will cover different aspects of process evaluation. These include examining the context to explore existing patterns, changes in patterns, attitudes, and interactions; analyzing the implementation of intervention elements; and exploring the complex causal pathways and mediators of the intervention. Qualitative data will be analyzed using thematic analysis. The data will then be combined using between-methods triangulation. This project received funding on March 1, 2022. The intervention phase and recruitment for the process evaluation began on March 1, 2023, and the recruitment is expected to end on September 30, 2025. At the time of protocol submission in June 2023, a total of 8 doctors from hematology and oncology practices were enrolled. Data collection began on March 14, 2023. The Trans-sectoral Personalised Care Concept for Patients with Rare Cancers project is a complex intervention that is to be implemented in an equally complex health care context. The process evaluation will help understand the influence of contextual factors and assess the mechanisms of change. ISRCTN registry ISRCTN16441179; https://doi.org/10.1186/ISRCTN16441179. DERR1-10.2196/49731.

Pancreatic Adenocarcinoma: Real World Evidence of Care Delivery in AccessHope Data.

Pancreatic adenocarcinoma is an aggressive disease and the delivery of comprehensive care to individuals with this cancer is critical to achieve appropriate outcomes. The identification of gaps in care delivery facilitates the design of interventions to optimize care delivery and improve outcomes in this population. AccessHope™ is a growing organization that connects oncology subspecialists with treating providers through contracts with self-insured employers. Data from 94 pancreatic adenocarcinoma cases (August 2019-December 2022) in the AccessHope dataset were used to describe gaps in care delivery. In all but 6% of cases, the subspecialist provided guideline-concordant recommendations anticipated to improve outcomes. Gaps in care were more pronounced in patients with non-metastatic pancreatic cancer. There was a significant deficiency in germline testing regardless of the stage, with only 59% of cases having completed testing. Only 20% of cases were receiving palliative care or other allied support services. There was no difference in observed care gaps between patients receiving care in the community setting vs. those receiving care in the academic setting. There are significant gaps in the care delivered to patients with pancreatic adenocarcinoma. A concurrent subspecialist review has the opportunity to identify and address these gaps in a timely manner.

Care Delivery for Patients with Leiomyomas: Failures, Real-Life Experiences, Analysis of Barriers, and Proposed Restorative Remedies.

In this narrative review, we describe historical and contemporary influences that prevent patients with fibroids from getting appropriate medical care. Using patient stories as examples, we highlight how misogyny on all levels hurts patients and prevents medical teams from doing their best. Importantly, inequity and disparities result in massive gaps in care delivery. We suggest that we, as gynecologists and surgeons, must join public discourse on this topic to highlight the inadequacies of care delivery and the reasons behind it, suggest potential solutions, and join patients and communities in formulating and implementing remedies.

Assessing changes in cancer-related financial support needs across three waves of the COVID-19 pandemic.

e18584 Background: Cancer-related financial hardship is well-documented and associated with treatment/medication nonadherence and poor outcomes. Family Reach is a national nonprofit that aims to remove financial barriers to cancer treatment through education, resource navigation, financial coaching, and direct financial assistance. We sought to evaluate variation in patient financial support needs throughout three waves of the COVID-19 pandemic: March-December 2020 (Wave 1), January-December 2021 (Wave 2), and January-June 2022 (Wave 3). Methods: Applications for Family Reach services were evaluated. Descriptive statistics and univariate tests characterized responses, and multivariable analysis, considering age, race/ethnicity, insurance, gender, insurance, % of federal poverty level (FPL), and children < 18 in the home, assessed associations between pandemic wave and self-reported financial and essential needs concerns. Results: From 3/2020-6/2022, 10679 applications were processed: 39% in 2020, 38% in 2021, and 24% in 2022. When relationship to the patient was specified (62%, n = 6647), most applications were submitted by a parent (53%) or the patient (28%). Common diagnoses included leukemia (26%), breast cancer (16%), sarcoma (8%), and lymphoma (7%). Patients were a median age of 30 years (IQR: 11-46); racial/ethnic identity included 41% Non-Hispanic White, 24% Non-Hispanic Black, 21% Hispanic patients; 53% had a child < 18 years at home. Median %FPL was 123.2 (IQR: 68.3-207.6): 54% reported losing income because of the pandemic, with a greater than expected proportion experiencing income loss in the Wave 2 (Wave 1: 49%, Wave 2: 59%, Wave 3: 54%; χ2= 67.0, df = 2, p < .001). Financial concerns across the entire sample included medical expenses (50%), nonmedical expenses (61%), childcare costs (17%), and food insecurity (42%). One-third (33%) were at risk of utility shut off within the past 90 days. In multivariable analyses, concerns about medical expenses were higher in Wave 2 (OR = 1.8, 95% CI: 1.5-2.1, p < .001) and Wave 3 (OR = 3.2, 95% CI: 2.7-3.9, p < .001), when compared to Wave 1. Past 90-day-risk of utility shut off (Wald = 26.0, p < .001), food insecurity (Wald = 46.7, p < .001), and childcare concerns (Wald = 26.0, p < .001) were higher in Wave 1 when compared to Waves 2 and 3. General nonmedical needs were consistent across all three waves of the pandemic (Wald = 1.28, p = .53). Conclusions: Although the early months of the COVID-19 pandemic led to high rates of immediate essential needs in patients with cancer, nonmedical financial concerns remained consistent, and medical financial concerns rose over time. Given ongoing financial gaps in care delivery for the most vulnerable, financial assistance and other services through programs like Family Reach will continue to be a key resource for patients and families, but structural and policy-focused interventions are needed for sustainable change.

Principles for task shifting hypertension and diabetes screening and referral: a qualitative study exploring patient, community health worker and healthcare professional perceptions in rural Uganda

BackgroundA shortage of healthcare workers in low- and middle-income countries (LMICs) combined with a rising burden of non-communicable diseases (NCDs) like hypertension and diabetes mellitus has resulted in increasing gaps in care delivery for NCDs. As community health workers (CHWs) often play an established role in LMIC healthcare systems, these programs could be leveraged to strengthen healthcare access. The objective of this study was to explore perceptions of task shifting screening and referral for hypertension and diabetes to CHWs in rural Uganda.MethodsThis qualitative, exploratory study was conducted in August 2021 among patients, CHWs and healthcare professionals. Through 24 in-depth interviews and ten focus group discussions, we investigated perceptions of task shifting to CHWs in the screening and referral of NCDs in Nakaseke, rural Uganda. This study employed a holistic approach targeting stakeholders involved in the implementation of task shifting programs. All interviews were audio-recorded, transcribed verbatim, and analyzed thematically guided by the framework method.ResultsAnalysis identified elements likely to be required for successful program implementation in this context. Fundamental drivers of CHW programs included structured supervision, patients’ access to care through CHWs, community involvement, remuneration and facilitation, as well as building CHW knowledge and skills through training. Additional enablers comprised specific CHW characteristics such as confidence, commitment and motivation, as well as social relations and empathy. Lastly, socioemotional aspects such as trust, virtuous behavior, recognition in the community, and the presence of mutual respect were reported to be critical to the success of task shifting programs.ConclusionCHWs are perceived as a useful resource when task shifting NCD screening and referral for hypertension and diabetes from facility-based healthcare workers. Before implementation of a task shifting program, it is essential to consider the multiple layers of needs portrayed in this study. This ensures a successful program that overcomes community concerns and may serve as guidance to implement task shifting in similar settings.

Multidisciplinary Model of Cervical Cancer Management in Botswana: Benchmarking the Care Cascade to Identify the Impact of Delays

<h3>Purpose/Objective(s)</h3> Timely access to and completion of radiation therapy (RT) are crucial for optimizing clinical outcomes of patients with locally advanced cervical cancer. The cascade of cancer care comprises the steps between initial presentation and treatment initiation. It is unknown which of these steps if any contribute to delay and downstream survival. Multi-disciplinary management has been shown to enhance the likelihood of successful care coordination and delivery across this cascade, but when implemented in limited resource settings it is unknown if multi-disciplinary management initiatives can adequately identify care delivery gaps. This study sought to examine care delivery metrics and outcomes from a newly established multi-disciplinary team clinic (MDT) in a limited resource setting. The analysis benchmarked the timing of steps between diagnosis and RT initiation in patients with locally advanced cervical cancer in Botswana to determine if delay impacted survival. <h3>Materials/Methods</h3> Between January 2016 and July 2018, 230 patients with biopsy-proven cervical cancer were enrolled in Gaborone, Botswana and followed until November 2019. The number of days between biopsy, pathology, MDT consult, RT consult, simulation, and treatment start were calculated based on dates of care delivery. The association of delay with survival was evaluated using the Kaplan-Meier estimates and multivariable Cox proportional hazards models. <h3>Results</h3> After diagnosis, 187 (81.3%) patients ultimately received treatment. Times between various steps of the care cascade are detailed in Table 1. Untreated patients had a median of one-month additional delay between biopsy and pathology result (57 vs. 25 days, p=0.003). Univariate analysis showed patients treated with curative intent (EQD2 >65 Gy) had worse overall survival when delay between simulation and RT start was > 12 days (p=0.048). Median survival was 2 vs. 4.6 years for patients with and without delay >12 days, respectively. This association trended toward but did not meet statistical significance on multivariate analysis after controlling for HIV status and stage (HR 2.35, 95% CI 0.95 – 5.85, P=0.07). HIV status was not associated with delay at any point. <h3>Conclusion</h3> Treatment delay exists in all steps of the care cascade for patients with cervical cancer in Botswana. Delay of >12 days between radiation simulation and initiation was found to negatively impact survival in patients treated with curative intent. This study also demonstrates the feasibility of utilizing the resources of an MDT care model to quantify care delivery benchmarks in a low-resource setting, resulting in identification of actionable targets to improve care delivery and outcomes.

Palestinian Dependence on External Health Services: De-development as a Tool of Dispossession

Abstract Through multiple mechanisms, armed conflict degrades and destroys health systems, leaving significant gaps in care delivery that lead to worse health outcomes. Civilian populations are often left at the mercy of multiple stakeholders to attain health care. Often, they are unable to meet their needs within their own territory. This has been documented as the case throughout the occupied Palestinian territories for decades. In this paper, I argue that the destruction and de-development of the Palestinian health system is not just a side effect of conflict, but is part of a broader effort of dispossession, disconnecting Palestinians from their land and from each other. I focus on the multiple ways Palestinians are forced to depend on external actors to seek needed care due to the limitations of blockade and occupation, the drivers of these pathways, and the outcomes of this dependence. Lastly, I provide recommendations for refocusing health efforts internally.

Quality gaps in care delivery among emerging adults with type 1 diabetes: A retrospective cohort study.

Quality gaps in care delivery among emerging adults with type 1 diabetes: A retrospective cohort study.

What’s missing? Diagnostic workup for breast cancer in Sudan.

110 Background: In Sudan, healthcare access may limit diagnostic workup for breast cancer. This study evaluates the relationship between geography and ethnicity and completeness of documentation of diagnostic workup (staging and receptor testing) in Sudan. Methods: This retrospective study used data abstracted from patients with breast cancer receiving cancer care at Sudan’s largest cancer center (Radiation and Isotopes Center Khartoum [RICK]) in 2017. The patient’s age at diagnosis, sex, breast cancer stage, ethnic subgroup (further categorized as Arab and non-Arab), regions of origin and residence (Central, Northeastern, Western, and Khartoum [where RICK is located]), and receptor status from pathology reports were abstracted from paper medical records. Complete diagnostic workup was defined as having both receptor testing and staging. Descriptive statistics were calculated using frequencies and percentages for categorical variables and median and interquartile range (IQR) for continuous variables. Odds ratios (OR) and 95% confidence intervals (CI) were estimated to evaluate complete diagnostic workup on ethnic group, origin, and residence using binomial logistic regression models (excluding non-Sudanese patients and those with missing demographics). Results: Of 240 patients included, 237 were female, median age was 53 (IQR 43-62). Most often patients were Arab (68%), originated from Northeastern and Khartoum regions (both 28%) and lived in the Khartoum region (53%). Overall, 49% patients were missing receptor testing and/or staging, with modest differences by geographic region and ethnicity (Table). In adjusted analyses, non-Arab patients had similar odds of having complete diagnostic workup when compared to Arab patients (OR 1.22; 95% CI 0.70-2.10). Patients originating from and residing in regions outside the Khartoum region had similar odds of complete diagnostic workup when compared to patients originating from and residing in the Khartoum region. Conclusions: Almost half of breast cancer patients had incomplete diagnostic workup, regardless of region of origin, region of residence, and ethnic group. This highlights a substantial systems-based quality gap in care delivery, warranting efforts to improve completeness in diagnostic workup for all patients with breast cancer in Sudan.[Table: see text]

Increasing research to address cancer care disparities in an NCI-sponsored community oncology network.

176 Background: Improving the delivery and outcomes of cancer care should be informed by research that aims to reduce disparities among underserved populations and those underrepresented in clinical studies. The NCI Community Oncology Research Program (NCORP), a community-based clinical trials network, conducts such research. In this analysis, we aimed to identify opportunities to develop a robust program of disparities-relevant cancer care delivery research (CCDR). Methods: We reviewed NCORP CCDR studies approved between August 2014-May 2022. Any study with at least one aim addressing care delivery in NIH-health disparity or underrepresented populations was deemed disparities-relevant. Studies were categorized as: primary if they were focused exclusively on cancer disparities within populations of interest; secondary if they had a disparities-related aim in a broader study; and exploratory if the aim assessed differences by race, ethnicity, income, insurance status, or practice-level characteristics. For each CCDR protocol, study and disparities-related characteristics were abstracted by two reviewers, who resolved any disagreements by discussion. Descriptive statistics are summarized. Results: Of 23 CCDR studies, a majority had at least one disparities-relevant aim: 4 primary, 3 secondary, and 10 exploratory. Studies with primary and secondary aims focused on racial/ethnic minorities, rural residents, older adults, adolescent/young adults and socioeconomically disadvantaged populations. Cancer care delivery gaps addressed by these studies included shared decision making, guideline adherence, case management, healthcare expenditures, and healthcare accessibility. Most studies focused on patients undergoing active treatment and included multilevel interventions. Only one of the disparities-relevant studies was available to non-English speaking patients. Conclusions: The inclusion of disparities-relevant aims in most of the care delivery studies is encouraging. The fact that most studies with a primary or secondary aim included an intervention demonstrates strong interest in generating evidence that will support improved cancer care delivery. Studies also addressed several distinct disparity populations across a range of care delivery gaps. These results represent opportunities for targeted network efforts to increase the disparities research portfolio and may inform strategies to optimize equitable care delivery that meets the needs of diverse cancer patient/survivor populations.