Guideline-compliant Care Research Articles

Association of race and ethnicity with quality of care among head and neck cancer patients in California.

There are significant racial disparities in head and neck cancer (HNC) outcomes. Racial differences in survival may be explained by differential access to high-quality care. The goal of this study was to evaluate the association of race and ethnicity with the quality of the treating hospital, and receipt of guideline-compliant care among HNC patients. Retrospective cohort study of data from the California Cancer Registry dataset linked with discharge records and hospital characteristics. The study cohort included adult patients with HNC diagnosed between January 1, 2010, and December 31, 2019. Outcome measures included the quality of treating hospital, and NCCN guideline-compliant care. Black (OR 0.76, 95% CI 0.67 to 0.85) and Hispanic (OR 0.68, 95% CI 0.63 to 0.74) patients were less likely to be treated in top-quality hospitals compared with non-Hispanic White patients, after adjusting for demographic, and clinical factors. This association disappeared for Black patients, but persisted for Hispanic patients, after additionally adjusting for socioeconomic status and insurance status. Black patients with advanced-stage disease were less likely to be treated with dual-modality therapy (OR 0.82, 95% CI 0.70 to 0.96), however, this association disappeared after adjusting for demographic, and clinical factors, and hospital quality. There are significant racial and ethnic disparities in quality of care for patients with HNC. Our findings suggest that differential access to high-quality care may account for some of the racial disparities in HNC survival, and highlight the need for continued investigation into the drivers of racial disparities in HNC outcomes.

Abstract A090: Comparing baseline knowledge and attitudes towards tobacco use and cessation among providers at substance use treatment centers and medical healthcare centers in rural and/or medically underserved areas of Texas

Abstract Introduction: Tobacco use intervention in healthcare settings is consistent with best practice guidelines and has been shown to facilitate tobacco cessation. Such intervention is particularly important in rural and medically underserved areas (MUAs), where tobacco use is elevated, as is cancer mortality. Providers’ knowledge and attitudes about the danger of tobacco use and their role in mitigating the same may play a role in whether their patients receive guideline-compliant care. This study investigates knowledge and attitudes toward tobacco use and cessation care delivery among providers at substance use treatment centers (SUTCs) and medical healthcare centers (MHCs; e.g., Federally Qualified Health Centers) in rural and/or MUAs of Texas to identify modifiable barriers to effective tobacco cessation treatment. Methods: Providers from healthcare centers (12 SUTCs, 9 MHCs) participating in a tobacco-free workplace program responded to a baseline solicitation assessing, among other things, their interest in receiving tobacco cessation care training and resources. In total, 347 providers from SUTCs (n=174) and MHCs (n=173) serving 49.6% of Texas’ counties responded to face-valid items assessing their knowledge and attitudes about tobacco use and provision of tobacco cessation care. Generalized or linear mixed models were used to analyze differences between SUTCs and MHCs. Results: More SUTC than MHC providers accurately identified that adults with mental health and/or non-nicotine substance misuse disorders are 2x more likely to smoke cigarettes than the general population (69% vs. 57%, p<0.008) and that quitting smoking can improve associated mental health symptomatology/substance misuse (61% vs. 54%, p<0.05), but also that patients’ tobacco product use is a personal decision that does not concern the direct service provider (30% vs. 19%, p<0.03). Conversely, more MHC than SUTC providers agreed that smoking cessation counseling is an important part of their job (66% vs. 41%, p<0.001), that their patients who smoke want to quit (38% vs. 21%, p<0.002), that providers should advise patients to quit even if it is not the reason for the visit (65% vs. 43%, p<0.001), that counseling by a provider motivates tobacco product users to quit (68% vs. 50%, p<0.005), and that providers should make appointments to specifically help patients quit tobacco product use (59% vs. 39%, p<0.003). Overall, only 48.4% of providers felt somewhat or completely prepared to help patients quit (56% MHC vs. 41% SUTCs, p<0.03). Conclusion: Addressing tobacco use in rural and/or MUAs of Texas where patients receive healthcare is critical to cancer prevention and achieving health equity. Responding SUTC and MHC providers evinced a need for training to enhance their understanding of tobacco use and to elevate the importance of cessation care provision. This is particularly the case in SUTCs, where providers primarily treat addiction. Findings will inform workplace interventions and their adaptation for use in each setting to facilitate guideline-compliant care provision. Citation Format: Sriya N. Kakarla, Brian J. Carter, Ammar D. Siddiqi, Maggie Britton, Tzuan A. Chen, Isabel Martinez Leal, Teresa Williams, Kathleen Casey, Hector Sanchez, Lorraine R. Reitzel. Comparing baseline knowledge and attitudes towards tobacco use and cessation among providers at substance use treatment centers and medical healthcare centers in rural and/or medically underserved areas of Texas [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A090.

Insurance Disparities in Quality of Care Among Patients With Head and Neck Cancer

Significant insurance status disparities have been demonstrated in head and neck cancer (HNC) outcomes. The effects of insurance status on HNC outcomes may be explained by differential access to high-quality care. To evaluate the association of insurance status with the quality of the treating hospital and receipt of guideline-compliant care among patients with HNC. This retrospective cohort study of data from the California Cancer Registry dataset linked with discharge records and hospital characteristics from the California Department of Health Care Access and Information included adult patients with HNC diagnosed between January 1, 2010, and December 31, 2019. Data were analyzed from May 10, 2023, to March 25, 2024. Insurance status: commercial, Medicare, Medicaid, uninsured, other, or unknown. Quality of the treating hospital (tertiles), receipt of National Comprehensive Cancer Network guideline-compliant care, and overall survival. A total of 23 933 patients (mean [SD] age, 64.8 [12.3] years; 75.3% male) met the inclusion criteria. Treatment in top-tertile hospitals (hazard ratio, 0.87; 95% CI, 0.79-0.95) was associated with improved overall survival compared with treatment in bottom-tertile hospitals. Medicare (odds ratio [OR], 0.78; 95% CI, 0.73-0.84), Medicaid (OR, 0.60; 95% CI, 0.54-0.66), and uninsured (OR, 0.38; 95% CI, 0.29-0.49) status were associated with lower likelihood of treatment in high-quality hospitals compared with commercial insurance. Among patients with advanced disease, Medicaid (OR, 0.72; 95% CI, 0.62-0.83) and uninsured (OR, 0.64; 95% CI, 0.44-0.93) patients were less likely to receive dual-modality therapy. Among patients with surgically resected advanced disease, Medicaid coverage (OR, 0.73; 95% CI, 0.58-0.93) was associated with lower likelihood of receiving adjuvant radiotherapy. This study found significant insurance disparities in quality of care among patients with HNC. These findings highlight the need for continued health insurance reform in the US to improve the quality of insurance coverage, in addition to expanding access to health insurance.

Impact of patient, hospital, and operative characteristics relative to social determinants of health: Compliance with National Comprehensive Cancer Network guidelines for colon cancer

BackgroundDespite an established association with improved patient outcomes, compliance with National Comprehensive Cancer Network (NCCN) guidelines remains suboptimal. We sought to assess the effect of patient characteristics (PCs), operative characteristics (OCs), hospital characteristics (HCs), and social determinants of health (SDoH) on noncompliance with NCCN guidelines for colon cancer. MethodsPatients treated for stage I to III colon cancer from 2004 to 2017 were identified from the National Cancer Database. Multilevel multivariate regression analysis was performed to identify factors associated with receipt of NCCN-compliant care and quantify the proportion of variance explained by PCs, OCs, HCs, and SDoH. ResultsAmong 468,097 patients with colon cancer treated across 1319 hospitals, 1 in 4 patients did not receive NCCN-compliant care (122,170 [26.1%]). On regression analysis, older age (odds ratio [OR], 0.96; 95% CI, 0.96–0.96), female sex (OR, 0.97; 95% CI, 0.96–0.99), Black race (OR, 0.96; 95% CI, 0.94–0.98), higher Charlson-Deyo score (OR, 0.84; 95% CI, 0.82–0.86), tumor stage ≥II (OR, 0.42; 95% CI, 0.40–0.44), and tumor grade ≥ 3 (OR, 0.33; 95% CI, 0.32–0.34) were associated with lower odds of receiving NCCN-compliant care (all P values <.05). Higher hospital volume (OR, 1.02; 95% CI, 1.02–1.03), minimally invasive or robotic surgical approach (OR, 1.26; 95% CI, 1.23–1.29), adequate (≥12) lymph node assessment (OR, 3.46; 95% CI, 3.38–3.53), private insurance status (OR, 1.33; 95% CI, 1.26–1.40), Medicare insurance status (OR, 1.42; 95% CI, 1.35–1.49), and higher educational status (OR, 1.06; 95% CI, 1.02–1.09) were associated with higher odds of receiving NCCN-compliant care (all P values <.05). Overall, PCs contributed 36.5%, HCs contributed 1.3%, and OCs contributed 12.9% to the variation in guideline-compliant care, while SDoH contributed only 3.6% of the variation in receipt of NCCN-compliant care. ConclusionThe variation in NCCN-compliant care among patients with colon cancer was largely attributable to patient- and surgeon-level factors, whereas SDoH were associated with a smaller proportion of the variation.

Differences in receipt of guideline-compliant care and survival for early-onset versus average-onset biliary tract cancers

BackgroundWe examined differences in receipt of guideline-compliant care in patients with early-onset versus average-onset biliary tract cancers (BTC) in localized or metastatic settings. Additionally, we examined associations between guideline compliance and overall survival (OS), stratified by age of onset and clinical stage. MethodsPatients with BTC [intrahepatic cholangiocarcinoma, gallbladder adenocarcinoma, extrahepatic cholangiocarcinoma] were identified within the National Cancer Database (2010–2018). Early onset was defined as diagnosis at < 50 and average onset at ≥ 70 years. Guideline-compliant care was defined as surgical resection ± chemotherapy for localized disease and multi-agent chemotherapy for metastatic disease. ResultsA total of 32,247 patients were identified, of whom 2855 patients (8.9%) had early-onset disease. Early-onset patients were more likely to have metastatic disease at presentation. Early-onset patients were more likely to receive guideline-compliant care in both localized (OR=2.24, 95% CI: 1.93–2.60) and metastatic (OR=4.40, 95% CI: 3.72–5.21) settings. Among patients with localized BTC, guideline compliance was associated with improved OS in both early (median OS: 51.9 vs. 13.5 months; HR=0.31, 95% CI: 0.27–0.37) and average-onset (median OS: 25.9 vs. 6.1 months; HR=0.31, 95% CI: 0.30–0.32) disease. Among patients with metastatic BTC, guideline compliance was associated with improved OS in both early (median OS: 10.1 vs. 3.5 months; HR=0.52, 95% CI: 0.43–0.62) and average-onset (median OS: 8.6 vs. 2.2 months; HR=0.45, 95% CI: 0.43–0.48) disease. ConclusionsEarly-onset BTC is associated with more frequent guideline-compliant care regardless of clinical stage. Guideline compliance is associated with improved OS regardless of age of onset or clinical stage.

Disparities in guideline-compliant care for patients with pancreatic ductal adenocarcinoma at minority-versus non-minority-serving hospitals

BackgroundWe examined disparities in guideline-compliant care at minority-serving hospitals (MSH) versus non-MSH among patients with localized or metastatic pancreatic adenocarcinoma (PDAC). MethodsPatients with PDAC were identified within the National Cancer Database (2004–2018). Guideline-compliant care was defined as surgery + chemotherapy ± radiation therapy for localized and chemotherapy for metastatic disease. Facilities in the top decile of minority patients treated were considered MSH. ResultsA total of 190,950 patients were identified and most (59.6%) had metastatic disease. Overall, 6.4% of patients with localized and 8.2% of patients with metastatic disease were treated at MSH.Patients treated at MSH were less likely to receive guideline-compliant care (localized: OR = 0.78, 95% CI: 0.67–0.91; metastatic: OR = 0.77, 95% CI: 0.67–0.88). Minority patients were less likely to receive guideline-compliant care at non-MSH (localized: OR = 0.71, 95% CI: 0.67–0.75; metastatic: OR = 0.85, 95% CI: 0.82–0.89) or MSH (localized: OR = 0.85, 95% CI: 0.74–0.98; metastatic: OR = 0.91, 95% CI: 0.82–0.99).Patients treated at non-MSH or MSH who received guideline-compliant care were more likely to have higher OS regardless of stage or race. ConclusionsMSH patients were less likely to receive guideline-compliant care and minority patients were less likely to receive guideline-compliant care regardless of MSH status. Guideline-compliant care was associated with improved OS.

ASO Author Reflections: Disparities in NCCN Guideline-Compliant Care for Patients with Early-Stage Pancreatic Adenocarcinoma at Minority-Serving Versus Non-minority-Serving Hospitals.

ASO Author Reflections: Disparities in NCCN Guideline-Compliant Care for Patients with Early-Stage Pancreatic Adenocarcinoma at Minority-Serving Versus Non-minority-Serving Hospitals.

Disparities in NCCN Guideline-Compliant Care for Patients with Early-Stage Pancreatic Adenocarcinoma at Minority-Serving versus Non-Minority-Serving Hospitals.

Racial/ethnic disparities in pancreatic adenocarcinoma (PDAC) outcomes may relate to receipt of National Comprehensive Cancer Network (NCCN) guideline-compliant care. We assessed the association between treatment at minority-serving hospitals (MSH) and receipt of NCCN-compliant care. Patients who underwent resection of early-stage PDAC between 2006 and 2019 were identified from the National Cancer Database (NCDB). MSH was defined as the top decile of facilities treating minority ethnicities (Black and/or Hispanic). Factors associated with receipt of NCCN-compliant care and its impact on overall survival (OS) were assessed. Among 44,873 patients who underwent resection of PDAC, most were treated at non-MSH (n=42,571, 94.9%), while a smaller subset were treated at MSH (n=2302, 5.1%). Patients treated at MSH were more likely to be at a younger median age (MSH 66 years versus non-MSH 67 years), Black or Hispanic (MSH 58.4% versus non-MSH 12.0%), and not insured (MSH 7.8% versus non-MSH 1.6%). While 71.7% (n=31,182) of patients were compliant with NCCN care, guideline-compliant care was lower at MSH (MSH 62.5% versus non-MSH 72.2%). On multivariable analysis, receiving care at MSH was associated with not receiving guideline-compliant care [odds ratio (OR) 0.63, 95% confidence interval (CI) 0.53-0.74]. At non-MSH, non-white patients had lower odds of receiving guideline-compliant PDCA care (OR 0.85, 95% CI 0.78-0.91). Failure to comply was associated with worse overall survival (OS) [hazard ratio (HR) 1.50, 95% CI 1.46-1.54, all p<0.001]. Patients with PDAC treated at MSH and minorities treated at non-MSH were less likely to receive NCCN-compliant care. Failure to comply with guideline-based PDAC treatment was associated with worse OS.

Clinical practice selectively follows acute appendicitis guidelines

IntroductionAcute appendicitis is a common surgical emergency, and the standard approach to diagnosis and management has been codified in several practice guidelines. Adherence to these guidelines provides insight into independent surgical practice patterns and institutional resource constraints as impediments to best practice. We explored data from the recent ESTES SnapAppy observational cohort study to determine guideline compliance in contemporary practice to identify opportunities to close evidence-to-practice gaps.MethodsWe undertook a preplanned analysis of the ESTES SnapAppy observational cohort study, identifying, at a patient level, congruence with, or deviation from WSES Jerusalem guidelines for the diagnosis and management of acute appendicitis and the Surviving Sepsis Campaign in our cohort. Compliance was then correlated with the incidence of postoperative complications.ResultsFour thousand six hundred and thirteen (4613) consecutive adult and adolescent patients with acute appendicitis were followed from date of admission (November 1, 2020, and May 28, 2021) for 90 days. Patient-level compliance with guideline elements allowed patients to be grouped into those with full compliance (all 5 elements: 13%), partial compliance (1–4 elements: 87%) or noncompliance (0 elements: 0.2%). We identified an excess postoperative complication rate in patients who received noncompliant and partially compliant care, compared with those who received fully guideline-compliant care (36% and 16%, versus 7.3%, p < 0.001).ConclusionsThe observed diagnostic and treatment practices of the participating institutions displayed variability in compliance with key recommendations from existing guidelines. In general, practice was congruent with recommendations for preoperative antibiotic surgical site infection prophylaxis administration, time to surgery, and operative approach. However, there remains opportunities for improvement in the choice of diagnostic imaging modality, postoperative antibiotic stewardship to timely discontinue prophylactic antibiotics, and the implementation of ambulatory treatment pathways for uncomplicated appendicitis in the healthy young adult.

Guideline compliance for pancreatic adenocarcinoma at minority- vs. non-minority-serving hospitals

Background: We examined the disparities in the receipt of guideline-compliant care at minority-serving hospitals (MSH) versus non-MSH among patients with localized or metastatic pancreatic adenocarcinoma (PDAC). In addition, we investigated associations between guideline compliance and overall survival (OS).

Trends in Adjuvant Chemotherapy Use Among Stage III Colon Cancer in Non-Elderly and Low Comorbidity Patients

BackgroundAdjuvant chemotherapy for stage III colon cancer is underutilized in the United States. The aim of this study was to assess the use of adjuvant chemotherapy in younger and medically fit patients and analyze the socioeconomic factors associated with its utilization. MethodsUsing the National Cancer Database from 2004 to 2015, we selected stage III colon cancer patients between age 18 to 65, Charlson-Deyo Comorbidity Index (CDCI) of 0 or 1, and those that survived at least 12 months after surgery. We then compared patients that underwent surgery only with those that received adjuvant chemotherapy. Multivariable logistic regression analysis was performed to identify variables associated with adjuvant chemotherapy use in the population. Overall survival was estimated by Kaplan-Meier curves. ResultsOf the 48,336 patients that met inclusion criteria, 43,315 (90%) received adjuvant chemotherapy. The utilization of adjuvant chemotherapy increased from 87% in 2004 to 91% in 2015. On multivariable regression analysis, the use of adjuvant chemotherapy was lower among males, Non-Hispanic Blacks and Hispanics, low-grade cancer, left-sided tumors, CDCI 1, those who travel ≥ 50 miles, yearly income < $40,227, and uninsured patients. The most common reason for the omission of adjuvant chemotherapy was the patient or caregiver's choice (40% between 2013 and 2015). The 5-year and 10-year overall survival rates were 76.7% and 63.8% respectively, in those who received adjuvant chemotherapy as compared to 65.1% and 49.3% in those who underwent surgery only (P < .001). ConclusionIn young and medically fit stage III colon cancer patients, most patients received guideline-compliant care in the United States. However, socioeconomic disparities adversely impacted the use of adjuvant chemotherapy. The patient or caregiver's decision was the most common reason for non-adherence to adjuvant chemotherapy and lead to poor survival outcomes. Emphasis should be placed on developing patient-centered strategies to improve adherence to chemotherapy in all patients.

Social determinants of health, workforce diversity, and financial toxicity: A review of disparities in cancer care

Disparities in cancer care and outcomes between racial and ethnic groups, urban and rural populations, and socioeconomic classes are well documented and represent one of the greatest forms of injustice throughout the United States. Despite the development of increasingly efficacious treatments, survival disparities have widened over time, with known impacts based on both medical factors and social determinants of health including education, neighborhood, factors, and access to care, among others. In this review, we discuss current state of inequities in access to cancer services, treatment-related financial toxicity, and disparities within the oncology workforce, all of which significantly impact the ability of clinicians to provide high quality, equitable, and guideline-compliant care for all people with cancer.

CGK4PM: Towards a Methodology for the Systematic Generation of Clinical Guideline Process Models and the Utilization of Conformance Checking

In the context of improving clinical treatments and certifying clinics, guideline-compliant care has become more important. However, verifying the compliance of treatment procedures with Clinical Guidelines remains difficult, as guidelines are mostly available in non-computer interpretable form and previous computer-interpretable approaches neglect the process perspective with its potential to gain medical insight. In this paper, we present our transformation framework CGK4PM, which addresses the procedural nature of treatment processes and which guides the transformation of clinical explicit and implicit guideline knowledge into process models. The procedural representation enables the use of process mining techniques such as conformance checking to verify guideline compliance and the opportunity to gain insights from complex clinical treatment processes. In collaboration with physicians from Münster University Hospital, the practical applicability of the framework is demonstrated in a case study by transforming the guideline for the treatment of malignant melanoma. The case study findings demonstrate the need for structured and guided transformation and highlight the difficulties in developing a guideline-based process model.

SLEEP WELL

BackgroundThe standard treatment of obstructive sleep apnea (OSA) is nocturnal positive airway pressure (PAP) therapy, which only has positive effects on symptoms and sequelae with regular and long-term use. Interface problems in existing care lead to incorrect treatment and long waiting times in the diagnostics and therapy, which are aggravated by the pandemic.ObjectiveBased on the existing structures a cross-sectoral care treatment model for the diagnostics and therapy of OSA will be evaluated. The central goals are a timely, needs-oriented care with optimized quality and efficiency. Furthermore, treatment adherence and thus quality of life should be improved as well as the cross-sectoral collaboration. The SLEEP WELL project is funded by the G-BA Innovation Fund (funding reference 01NVF20020).Material and methodsThe evaluation will be carried out based on a prospective, randomized, controlled, multicenter study in North Rhine-Westphalia, Germany, in which 4448 patients with suspected OSA receive guideline-compliant care with telemedicine (telemedicine group) or without telemedicine (control group). The 1:1 randomization takes place after initial suspicion by the primary physician. The two groups are compared in terms of quality of life (primary endpoint), PAP therapy adherence, and medical resource use (secondary outcomes).Results and discussionQuantitative data collation occurs at 5 time points. In an intention to treat analysis the results are analyzed using statistical evaluation methods. Patient and provider satisfaction will be assessed using qualitative methods. The cost-benefit relation is examined on the basis of routine health insurance data. In addition, remuneration concepts for standard care will be developed. Project completion is planned for September 2025.

Quality assurance and improvement in oncology using guideline-derived quality indicators – results of gynaecological cancer centres certified by the German cancer society (DKG)

PurposeBased on the example of Gynaecological Cancer Centres (GCCs) certified by the German Cancer Society, this study evaluates the results of medical-guideline-derived quality indicators (QIs) for cervical cancer (CC) and ovarian cancer (OC), examines the development of indicator implementation over time as well as the status of guideline-compliant care and identifies improvement measures.MethodsQI results for patients with CC and OC treated in GCCs between 2015 and 2019 are analysed. The median, overall proportion and standard deviation of each QI were calculated. Two-sided Cochran-Armitage tests were applied.ResultsQIs are divided into two categories: process-organization (PO-QIs) and treatment-procedures (TP-QIs), to allow a differentiated analysis for identifying improvement measures.PO-QIs that reflect the implementation of processes and structures show a high degree of application. PO-QIs have a tremendous influence on the quality of care and are easy to implement through SOPs.TP-QIs report on treatments that are performed in the GCC. TP-QIs that report on systemic therapies reach a plateau where the guideline is known, but patient-related-factors meaningfully prevent further increase. TP-QIs that report on surgical interventions fluctuate. The most relevant factors are practitioners’ personal skills. Besides the discussion of results amongst peers during the audit, improvement measures could include surgical courses or coaching.ConclusionThe analysis shows that a combination of different measures is necessary to anchor quality sustainably in health care and thus improve it.

Care with allergen immunotherapy for allergic respiratory diseases in Germany-Predictors and deficits.

Allergen immunotherapy (AIT) represents the only possibility of causal therapy for allergic respiratory diseases. Although the prevailing high prevalence of allergic diseases and restrictions in the daily lives of patients, AIT is offered to a suboptimal number of patients in Germany. Insured patients with documented allergic respiratory disease of one of the largest statutory health insurances in Germany, 'DAK-Gesundheit', were contacted by postal mail and asked to participate in the study. In case of written consent, primary and secondary data of patients were collected and analysed. Patient characteristics, predictors of being offered AIT, predictors of performing AIT and guideline-compliant care were analysed. 2505 subjects were included in the VerSITA study. Allergy to tree pollen and native speaking were identified as predictors, which increase the probability of being offered AIT. The probability was significantly decreased by the characteristics allergic rhinitis only, allergic asthma only, age in years, non-German citizenship, no graduation and lower secondary qualification. Significant positive predictors for an AIT to be actually performed were: Allergy to tree pollen and male sex. Predictors that decrease the likelihood that AIT is performed were: only allergic asthma, current smoker, former smoker, age and non-German citizenship. Furthermore, it was possible to identify characteristics in which guideline-compliant patients differed significantly from the rest of the study population. Based on statutory health insurance data and patient survey data, the VerSITA study provides a broad and in-depth overview of the care situation with regard to AIT in Germany and identifies deficits.

Health service nutrition practices and associations with clinical outcomes in patients undergoing resection for upper gastrointestinal cancer: Results from the multi-centre NOURISH point prevalence study.

The present study aimed to investigate health service nutrition practices of sites providing care to patients undergoing surgery for upper gastrointestinal cancer within Australia, including the provision of perioperative nutrition support services and outpatient clinics, as well as the use of evidence-based nutrition care pathways/protocols. Secondary aims were to investigate associations between the use of a nutrition care pathway/protocol and patient outcomes. Principal investigator dietitians for the sites (n = 27) participating in the NOURISH point prevalence study participated in a purpose-built site-specific survey regarding perioperative nutrition practices and protocols. Data from the 200 patients who participated in the study (including malnutrition prevalence, preoperative weight loss and receipt of dietetics intervention, intraoperative feeding tube insertions, provision of nutrition support day 1 post surgery, length of stay, and complications) were investigated using multivariate analysis to determine associations with the sites' use of a nutrition care pathway/protocol. The majority of sites (>92%) reported having dietetics services available in chemotherapy/radiotherapy. Eighty-five percent of sites reported having some form of outpatient clinic service; however, a routine service was only available at 26% of sites preoperatively and 37% postoperatively. Most preoperative services were embedded into surgical/oncology clinics (70%); however, this was reported for only 44% of postoperative clinics. Only 44% had a nutrition care pathway/protocol in place. The use of a nutrition care pathway/protocol was associated with lower rates of malnutrition, as well as higher rates of preoperative dietetics intervention, intraoperative feeding tube insertions, and European Society of Clinical Nutrition and Metabolism (ESPEN) guideline compliant care day 1 post surgery. The results of the present study demonstrate varied perioperative outpatient nutrition services in this high-risk patient group. The use of nutrition care pathways and protocols was associated with improved patient outcomes.

Analysis of Stroke Care Among 2019-2020 National Emergency Medical Services Information System Encounters

ObjectivesEmergency Medicine Service (EMS) providers play a pivotal role in early identification and initiation of treatment for stroke. The objective of this study is to characterize nationwide EMS practices for suspected stroke and assess for gender-based differences in compliance with American Stroke Association (ASA) guidelines. Materials and MethodsUsing the 2019-2020 National Emergency Medical Services Information System (NEMSIS) Datasets, we identified encounters with an EMS designated primary impression of stroke. We characterized patient characteristics and EMS practices and assessed compliance with eight metrics for “guideline-concordant” care. Multivariable logistic regression modeled the association between gender and the primary outcome (guideline-concordant care), adjusted for age, EMS level of service, EMS geographical region, region type (i.e. urban or rural), and year. ResultsOf 693,177 encounters with a primary impression of stroke, overall compliance with each performance metric ranged from 18% (providing supplemental oxygen when the pulse oximetry is less than 94%) to 76% (less than 90sec from incoming call to EMS dispatch). 2,382 (0.39%) encounters were fully guideline-concordant. Women were significantly less likely than men to receive guideline-concordant care (adjusted OR 0.82, 95% CI 0.75-0.89; 0.36% women, 0.43% men with guideline-concordant care). ConclusionsA minority of patients received prehospital stroke care that was documented to be compliant with ASA guidelines. Women were less likely to receive fully guideline-compliant care compared to men, after controlling for confounders, although the difference was small and of uncertain climical importance. Further studies are needed to evaluate the underlying reasons for this disparity, its impact on patient outcomes, and to identify potential targeted interventions to improve prehospital stroke care.

Disparities in NCCNGuidelineCompliant Care for Resectable Cholangiocarcinoma at Minority-Serving Versus Non-Minority-Serving Hospitals.

Racial/ethnic disparities in cancer outcomes may relate to variations in receipt of National Comprehensive Cancer Network (NCCN)guidelinecompliant care. Patients undergoing resection of cholangiocarcinoma (CCA) between 2004 and 2015 were identified using the National Cancer Database (NCDB). Institutions treating Black and Hispanic patients within the top decile were categorized as minority-serving hospitals (MSH). Factors associated with receipt of NCCN-compliant care, and the impact of NCCN compliance on overall survival (OS), were evaluated. Among 16,108 patients who underwent resection of CCA, the majority of patients were treated at non-MSH (n=14,779, 91.8%), while a smaller subset underwent resection of CCA at MSH (n=1329, 8.2%). Patients treated at MSH facilities tended to be younger (MSH: 65 years versus non-MSH: 67 years), Black or Hispanic (MSH: 59.9% versus non-MSH: 13.4%), and uninsured (MSH: 11.6% versus non-MSH: 2.2%). While overall compliance with NCCN care was 73.0% (n=11,762), guideline-compliant care was less common at MSH (MSH: 68.8% versus non-MSH: 73.4%; p<0.001). On multivariable analyses, the odds of receiving non-NCCNcompliant care remained lower at MSH (OR 0.76, 95% CI 0.65-0.88). While white patients had similarodds of NCCN-compliant care withminority patients when treated at MSH (OR 0.98, 95% CI 0.75-1.28), minority patients had lower odds of receiving guideline-compliant care when treated at non-MSH (OR 0.85, 95% CI 0.75-0.96). Failure to comply with NCCN guidelines was associated with worse long-term outcomes (HR 1.60, 95% CI 1.52-1.69). Patients treated at MSH had decreased odds to receive NCCN-compliant care following resection of CCA. Failure to comply with guideline-based cancer care was associated with worse long-term outcomes.

ASO Author Reflections: Minority-Serving Hospitals are Associated with Lower Likelihood of Providing NCCN Guideline Compliant Care to Patients with Resectable Cholangiocarcinoma.

ASO Author Reflections: Minority-Serving Hospitals are Associated with Lower Likelihood of Providing NCCN Guideline Compliant Care to Patients with Resectable Cholangiocarcinoma.