Health Care Maintenance Research Articles

Healthcare Maintenance and Safety Policy: Evidence from Port Harcourt Seaport

This study examined the relationship between Healthcare Maintenance and Safety Policy of Maritime Transport Workers in Port Harcourt Seaport. The aim and objectives was to examine if there is any relationship between Healthcare Maintenance and Safety policy of Maritime Transport Workers. Three research questions and null hypotheses were formulated to examine the relationship between Healthcare Maintenance and Safety Policy of Maritime Transport Workers in Port Harcourt Seaport. A sample size of 176 workers was selected from the population of 315 workers in Port Harcourt Seaport using the Taro Yamane sampling procedure. Simple Percentages, Frequency Tables, Bar Charts and Spearman Rank Correlation Coefficient were used as data analysis and techniques. The study found a correlation coefficient of 0.853(rho value) between National Health Insurance Scheme and Safety Policy, 0.755(rho value) between Monitoring/Regulating Healthcare Giver and Safety Policy, and 0.789(rho value) between Healthcare Financing and Safety Policy. From the findings, the study conclude that Healthcare Maintenance have positive and significant relationship with Safety Policy of Maritime Transport Workers in Port Harcourt Seaport. The study, recommends that implementable policies must be put in place to monitor and regulate healthcare givers to avoid ill performance and increase workplace hazard among the maritime transport workers in the seaports. Adequate provisions in financing all healthcare activities in the seaports should be integrated in relevant laws such as the federal government appropriation bills as this will simplify the easy source of financing healthcare projects in the Seaport and there is need for proper management and accountability in healthcare financing in the ports to avoid miss appropriation of healthcare maintenance fund.

Understanding what really helps to ensure access to diagnostic services in the Indian Public Health System: a realist synthesis of the Common Review Mission reports (2007-2021)

Background In India, the National Health Mission (NHM) has been supporting the states in building an integrated public healthcare network across the levels of care. This effort has improved access to, and utilization of, diagnostic services at public healthcare facilities. To continually enhance citizens’ ability to seek and avail quality and affordable services, it is imperative to take stock of various components of the diagnostic ecosystem that may be common or unique to states and understand their influence on equipping the health system. The objective of the study was to understand key health system factors augmenting or limiting access to diagnostic services and outcomes. Methods Common Review Mission (CRM) reports between 2007 and 2021 were selected for the study. Data relevant to diagnostic services were retrieved using defined search terms. The data were segregated for each Indian state and categorized under the pre-determined themes: state-specific practices, key findings, and challenges. Analysis of the data was done iteratively to identify the themes emerging from the reports over the years. Each theme was analysed further to deduce context-specific enablers and barriers influencing access to diagnostic service delivery. Results The major themes that emerged include (i) the approach to health systems strengthening, (ii) efficiency of procurement and distribution systems, (iii) infrastructure, (iv) modes of service delivery, (v) implementation of Free Diagnostic Service Initiative, Comprehensive Primary Health Care and Biomedical Equipment Management and Maintenance Program, and (vi) quality of care , and (vii) diagnostic service outcomes. Conclusions In a complex adaptive system, access to diagnostic services depends on the concurrent strengthening of various health system components across the levels of care. The nation has strategized accessible, affordable and acceptable diagnostic services to achieve universal health coverage and care-continuum pathways. States need to leverage the existing mechanisms, assess their implementation, and arrive at feasible and sustainable solutions to strengthen access to diagnostic services.

An Integrated Review of Carpal Tunnel Syndrome: New Insights to an Old Problem.

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy characterized by pain, numbness, and impaired function of the hand due to compression of the median nerve at the level of the wrist. Although CTS can develop from repetitive strain, injury, or medical conditions, there are also congenital and genetic risk factors that can predispose individuals to the condition. With respect to anatomical factors, some individuals are born with a smaller carpal tunnel, which increases their susceptibility to median nerve compression. Variations in specific genes, such as those encoding proteins involved in extracellular matrix remodeling, inflammation, and nerve function, have also been linked to an increased risk for CTS. CTS is associated with a high cost of health care maintenance and loss of work productivity. Therefore, it is vital that primary care physicians fully understand the anatomy, epidemiology, pathophysiology, etiology, and risk factors of CTS, so they can be proactive in prevention, diagnosing, and guiding proper treatment. This integrated review also provides insights into how biological, genetic, environmental, and occupational factors interact with structural elements to determine who is most likely to acquire and suffer from CTS. Keeping health practitioners abreast of all the factors that could impact CTS should go a long way in decreasing the health care and socioeconomic burden of CTS.

Medical Gas Systems Maintainability Risks in Healthcare Facilities: A Design Optimization Approach

Medical gas pipeline systems (MGPSs) are crucial for operating healthcare facilities as life-saving systems. The sustainability of MGPSs mandates optimum performance by reducing maintenance and repairs. Since faulty design is inventible, healthcare facilities endure several design-caused maintenance issues that endanger the sustainability of healthcare services and maintenance life cycle costs. These design decisions could have been avoided if proper consideration for maintenance had been applied. Eleven experts participated in semi-structured interviews guided by Staticized Group Techniques to identify and evaluate the maintenance issues. The results included identifying 52 design-related maintenance issues that pose maintainability risks. The findings primarily fall under emergency gas supply availability, future expansion readiness, and accessibility of maintenance. The most critical issue found is the excessive cutting-outs of the pipelines when upgrading the system. For new healthcare facilities, the results of this research provide practical help for designers to avoid MGPS issues. A scarcity of benchmark research and geographical factors are some limitations to this study.

Gaps in care planning and delivery for patients with liver cancer: Baseline assessment for implementation of 4R Oncology model.

e16136 Background: Liver cancer is a complex disease, requiring detailed care planning, patient engagement and delivery of comprehensive care, including supportive and health maintenance care. The 4R Oncology Model for patient facing care planning, patient self-management and team based delivery of complex care has the potential to address these needs. 4R (Right Info/Care/Patient/Time) significantly improves patient self-management and optimizes delivery of supportive and health maintenance care in breast and lung cancer (Trosman JCOOP 2021; Liu JCOOP 2022). The impact of 4R in liver cancer has not been examined. Ochsner Health’s multi-disciplinary live cancer team is implementing and evaluating 4R. Here we describe the baseline assessment of provider practices and patient experience of care planning and delivery of supportive and health maintenance care. Methods: Surveys of providers and patients on current care planning and delivery in liver cancer were conducted Oct 2022 – Jan 2023. We used 3 metrics of care planning and 3 metrics of care delivery (Table). Results: Survey response rates: providers 55% (33/60), patients 43% (27/63). Providers included physicians, advance practitioners, nurses and navigators from Hepatology, Transplant, Interventional Radiology and Medical Oncology. Patients were 56% female, 63% white, 37% black, 56% < 30k income. In care planning, patient experience was reported at a similar rate as provider practices for informed on goal of care, but significantly higher than providers for informed on next steps in care and receiving a detailed care plan (Table). In care delivery, patient experience and provider referral practices for social and supportive care were similarly low. Rates of patients’ receiving primary care and substance abuse assistance were significantly higher than respective rates of provider referrals. Among providers, 73% give patients a verbal care plan and 27% a hand written plan. The current process to create care plans is satisfactory to 54% of providers. Conclusions: We found substantial gaps in care planning and referrals to supportive and health maintenance care. Higher rates of patients reporting receipt of care planning and services suggest that many patients may resort to their own devices in these aspects of care. Ochsner Health aims to address these gaps by implementing the 4R Oncology model in liver cancer and will share results when available. [Table: see text]

RWD2 A Retrospective Cohort Study of Patients with Venous Thromboembolism (VTE): An Analysis from a Healthcare Maintenance Organization (HMO) Perspective in Brazil

VTE, that includes deep vein thrombosis (DVT) and pulmonary embolism (PE), affects 10 million people/year worldwide, being the second most common medical complication and a cause of excess length of hospital stay. Its incidence and economic burden are expected to increase as the population ages. This study examined the cost of patients care from an HMO perspective.

Optimising Maintenance Workflows in Healthcare Facilities: A Multi-Scenario Discrete Event Simulation and Simulation Annealing Approach

Healthcare systems in low-resource settings need effective methods for managing their scant resources, especially people and equipment. Digital technologies may provide means for circumventing the constraints hindering low-income economies from improving their healthcare services. Although analytical and simulation techniques, such as queuing theory and discrete event simulation, have already been successfully applied in addressing various optimisation problems across different operational contexts, the literature reveals that their application in optimisation of healthcare maintenance systems remains relatively unexplored. This study considers the problem of maintenance workflow optimisation with respect to labour, equipment availability and cost. The study aims to provide objective means for forecasting resource demand, given a set of task requests with varying priorities and queue characteristics that flow from multiple queues, and in parallel, into the same maintenance process for resolution. The paper presents how discrete event simulation is adopted in combination with simulated annealing to develop a decision-support tool that helps healthcare asset managers leverage operational performance data to project future asset-performance trends objectively, and thereby determine appropriate interventions for optimal performance. The study demonstrates that healthcare facilities can achieve efficiency in a cost-effective manner through tool-generated maintenance strategies, and that any future changes can be expeditiously re-evaluated and addressed.

Risk Stratification Model for Severe COVID-19 Disease: A Retrospective Cohort Study.

Risk stratification models have been developed to identify patients that are at a higher risk of COVID-19 infection and severe illness. Objectives To develop and implement a scoring tool to identify COVID-19 patients that are at risk for severe illness during the Omicron wave. This is a retrospective cohort study that was conducted in Israel's second-largest healthcare maintenance organization. All patients with a new episode of COVID-19 between 26 November 2021 and 18 January 2022 were included. A model was developed to predict severe illness (COVID-19-related hospitalization or death) based on one-third of the study population (the train group). The model was then applied to the remaining two-thirds of the study population (the test group). Risk score sensitivity, specificity, and positive predictive value rates, and receiver operating characteristics (ROC) were calculated to describe the performance of the model. A total of 409,693 patients were diagnosed with COVID-19 over the two-month study period, of which 0.4% had severe illness. Factors that were associated with severe disease were age (age > 75, OR-70.4, 95% confidence interval [CI] 42.8-115.9), immunosuppression (OR-4.8, 95% CI 3.4-6.7), and pregnancy (5 months or more, OR-82.9, 95% CI 53-129.6). Factors that were associated with a reduced risk for severe disease were vaccination status (patients vaccinated in the previous six months OR-0.6, 95% CI 0.4-0.8) and a prior episode of COVID-19 (OR-0.3, 95% CI 0.2-0.5). According to the model, patients who were in the 10th percentile of the risk severity score were considered at an increased risk for severe disease. The model accuracy was 88.7%. This model has allowed us to prioritize patients requiring closer follow-up by their physicians and outreach services, as well as identify those that are most likely to benefit from anti-viral treatment during the fifth wave of infection in Israel, dominated by the Omicron variant.

Assessing the risk of endogeneity bias in health and mortality inequalities research using composite measures of multiple deprivation which include health-related indicators: A case study using the Scottish Index of Multiple Deprivation and population health and mortality data.

The inclusion of health-related indicators in composite measures of multiple deprivation introduces a risk of endogeneity bias when using the latter in health inequalities research. This bias may ultimately result in the inappropriate allocation of healthcare resources and maintenance of preventable health inequalities. Mitigation strategies to avoid this bias include removing the health-related indicators or using single constituent domains (such as income or employment class) in isolation. These strategies have not been widely validated. This study used population-level health and mortality data with a contemporary composite measure of multiple deprivation (Scottish Index of Multiple Deprivation; SIMD) to assess these mitigation strategies. The differences between deprivation methods (original, health excluded, and income domain) were negligible. The results of quantitative research on health inequalities are unlikely to be affected by endogeneity bias.

Colorectal Cancer Screening Decisions From Student-Led Telemedicine Initiative During COVID-19.

With the onset of the COVID-19 pandemic, there has been a significant decrease in colorectal cancer (CRC) screening leading to delayed diagnoses and increased cancer deaths. To mitigate these burgeoning gaps in care, we developed a medical student-led service learning project aimed at improving rates of colorectal cancer screening at the Farrell Health Center (FHC), a primary care practice within the Ambulatory Care Network (ACN) at New York-Presbyterian Hospital. A cohort of 973 FHC patients aged 50-75 years were identified as possibly overdue for screening. Student volunteers reviewed patient charts to confirm screening eligibility and then contacted patients to offer colonoscopy or stool DNA test. Following the patient outreach intervention, medical student volunteers completed a questionnaire to assess the educational value for the service-learning experience. Fifty-three percent of identified patients were due for CRC screening; 67.8% of eligible patients were reached by volunteers. Among the patients reached, 47.0% were referred for CRC screening. No statistical significance was observed between likelihood of CRC screening acceptance and patient age or sex; 87% of medical student volunteers felt that the service-learning project was a valuable educational experience. The student-led patient telehealth outreach program is an effective model for identifying and referring patients overdue for CRC screening and an enriching educational experience for preclinical medical students. The structure provides a valuable framework to address gaps in health care maintenance.

Smoking quit rates among patients receiving pharmacotherapy who received general practitioner counselling versus intensive counselling: a retrospective cohort study

BackgroundBehavioral treatments can augment the success of pharmacotherapy in smoking cessation. The aim of this study was to compare smoking quit rates between patients receiving individual counseling with their general practitioner during office visits or intensive counselling with behavioral support, both augmented by varenicline.MethodsA nationwide retrospective cohort study conducted in a large Healthcare Maintenance Organization in Israel. We selected randomly patients who filled a prescription for varenicline and received either individual consulting by their general practitioner or intensive counselling with behavioural support, and asked them to answer a questionnaire. The outcome variables were smoking cessation 26–52 weeks following the beginning of treatment and satisfaction with the process.Results870 patients were contacted and 604 agreed to participate (a response rate of 69%); 301 patients in the general practitioner group, 300 in the intensive counselling group and 3 were excluded due to missing date. The quit rate was 36.5% in the general practitioner group and 42.3% in the intensive counselling group (P = 0.147). In a logistic regression analysis, controlling for age, gender, socioeconomic status, ischemic heart disease, chronic obstructive pulmonary disease, pack years and duration of varenicline consumption, the adjusted OR for quitting in the general practitioner group was 0.79 (95% CI 0.56,1.13). The adjusted OR was higher in the group with the highest socioeconomic status at 2.06 (1.39,3.07) and a longer period of varenicline consumption at 1.30 (1.15,1.47). Age, gender and cigarette pack-years were not associated with quit rate. In the general practitioner group 68% were satisfied with the process, while 19% were not. In the intensive counselling group 64% were satisfied and 14% were not (P = 0.007).ConclusionWe did not detect a statistically significant difference in smoking quit rates, though there was a trend towards higher quit rates with intensive counselling.

Emotion-focused communication training online: Development and evaluation of acceptability

ABSTRACT Emotion-focused communication can improve the delivery of care for long-term care recipients, especially individuals’ living with dementia. The purpose of this manuscript is to describe the process of translating the Emotion-Focused Communication Training (EFCT) for long-term care staff from an in-person workshop to an online program and evaluate its acceptability and impact on knowledge of emotion-focused communication and perceived self-efficacy for utilizing emotion-focused communication. The online course was developed following the ADDIE (Analysis, Design, Development, Implementation, Evaluation) Model. The program teaches participants to better identify and manage their own emotions and others’ emotions in care. Pre- and post-training t-test comparisons on data collected from 247 caregivers across disciplines in long-term care (direct care workers, life-enrichment/activities staff, health care providers, case managers, health educators, students, administrators, ombudsmen, dietary, housekeeping, or maintenance staff, human resources employees, family care partners, and others) indicated a significant increase in level of knowledge of emotion-focused communication and confidence in applying the learned knowledge and skills in care (increased self-efficacy). Participants also reported high levels of program acceptability. Overall, findings indicate the benefits of translating an in-person training opportunity for caregivers into an interactive online experience; implications for caregivers and care recipients are discussed.

PD35 Mortality And Risk Factors Associated With Dialysis Patients With COVID-19 In A Brazilian Supplementary Health Service

IntroductionPatients with chronic kidney disease (CKD) and COVID-19 are at high risk of adverse outcomes due to the presence of comorbidities. However, it is still unclear whether dialysis therapy is associated with a worse prognosis in patients infected with SARS-CoV-2. The objectives were to assess mortality and risk factors associated with a worse prognosis of these patients (e.g., age, sex, comorbidities, Intensive Care Admission [ICU] admission, and need for invasive mechanical ventilation [IMV]).MethodsAn observational, descriptive, retrospective study was conducted in the private healthcare maintenance organization (Unimed-BH) of Belo Horizonte and 33 surrounding cities in Brazil. We used data collected from the organization’s database. We included adult inpatients with CKD on previous dialysis therapy who tested positive for COVID-19, from February 2020 to June 2021.ResultsDuring the period, 16182 patients were admitted to Unimed-BH with a diagnosis of COVID-19. Of these, 333 (2%) had dialysis CKD. Male patients were 180 (54%), age ranged from 22.85 to 95.75 years and the mean was 60.91 years. Of the 333 patients, 109 (32.7%) were admitted to the ICU, and 56 (16.8%) required IMV. Among the 14 comorbidities analysed, the mean number of comorbidities was 6, with 93 (27.9%) dyslipidaemia, 74 (22%) diabetic, 270 (81%) hypertensive, 25 (7.5%) asthmatic, 42 (12.6%) with chronic pulmonary disease (CPD) and 122 (36.6%) with congestive heart failure (CHF). There were 66 (19.8%) deaths, 29 (43.9%) were male, the mean age was 60.8 years, and 23 patients (34.8%) were elderly (>60 years). Among the patients who died, 55 (83.3%) were in the ICU and 46 (69.7%) on IMV. The mean number of comorbidities was 9.27 being 16 (24.2%) dyslipidaemia, 44 (66.6%) diabetic, 60 (90.9%) hypertensive, 5 (7%) asthmatic, 10 (15%) with CPD and 32 (48.5%) with CHF.ConclusionsDialysis patients appear more susceptible to unfavourable outcomes than the general population. Our findings are similar to those reported in the world literature which is still scarce. It is important to conduct more studies on this population.

E - Health Centre Maintenance System using PHP with MySQL and XAMPP Web Server

The Health Care Maintenance System is designed for any Hospital to replace their existing manual paper-based system. The new system is to operate the following information; patient information, employees information, accounts, inventory, medical reports, laboratory and employee payrolls. These services are to be provided in an efficient, cost-effective manner, with the goal of reducing the time and resources currently required for such tasks. It aims at standardizing data, consolidating data, ensuring data integrity and reducing inconsistencies.Evidently, this project contains an admin panel with an employee/doctor panel. In an overview of this web application, a doctor can simply log into the system using his/her doctor id and password. He/she can manage patients, pharmacy, and laboratory records. Additionally, the employee/doctor can view and manage inventories too. This project uses PHP as the front-end software which is object-oriented programming and has connectivity with MySQL. Additionally, XAMPP is a free cross platform web server which help developers to create and test their programs on a local web server.

Fluctuations in Pediatric Acute Otitis Media Burden During the First Two COVID-19 Years in Israel.

To study pediatric acute otitis media (AOM) burden fluctuations before and during the first two COVID years, which were characterized by measures to reduce the spread of airborne diseases. We used urinary tract infection (UTI) as a comparison infection. This was a cross-sectional study encompassing three pre-COVID years (March 1, 2017-February 29, 2020) and the first two COVID years (March 1, 2020-February 28, 2021, and March 1, 2021-February 28, 2022). Records were retrieved from the Clalit Health Services database, Israel's largest healthcare maintenance organization. Children 0-15 years with AOM and UTI episodes were categorized according to age (1>, 1-4, 5-15 years). We collected demographics, seasonality, AOM complications, antibiotic prescriptions, and recent COVID-19 infections. The average AOM/UTI rates of the three pre-COVID years vs. two COVID years were used to calculate the incidence rate ratios (IRRs). We identified 1,102,826 AOM and 121,263 UTI episodes. The median age at AOM diagnosis was 2.0 years (IQR, 1.1-4.1). Male predominance, age at presentation, and the dominant age group of 1-4 years did not change during the COVID years. While UTI episode rates decreased during the COVID years (IRR 0.76, 95% CI, 0.68-0.84, P < 0.001), the reduction in AOM episode rates was >2-fold (IRR 0.46, 95% CI, 0.34-0.63, P < 0.001). The largest decrease was observed among children 1-4 years old during the first COVID year (β=-1,938 AOM episodes/100,00 children, 95% CI, -2,038 to -1,912, P < 0.001). Recent COVID-19 infection was associated with low AOM morbidity (IRR 0.05, 95% CI 0.05-0.05, P < 0.001). AOM burden substantially decreased during the first COVID year but almost reached pre-pandemic levels during the second year.

Procedure Cost Comparison of Outpatient and Inpatient Shoulder Arthroplasty and Lower-Extremity Arthroplasty Within a Managed-Care Organization.

Introduction The authors sought to evaluate cost differences between shoulder arthroplasties and lower-extremity joint replacements in the outpatient and inpatient setting within a large health-maintenance organization. Methods A cross-sectional study of 100 total hip arthroplasties (THA), 100 total knee arthroplasties (TKA), and 100 shoulder arthroplasties (50 anatomical total shoulder arthroplasties and 50 reverse shoulder arthroplasties [RTSA]) was performed at a single regional health care center within an integrated health care maintenance organization. A time-driven activity-based costing methodology was used to obtain total cost of each episode for outpatient (vs) inpatient surgery. Results are presented by procedure type. Results Compared to their respective inpatient procedure, outpatient surgery was less expensive by 20% for RTSA, 22% for total shoulder arthroplasties, 29% for THA, and 30% for TKA. The cost of implants was the highest proportion of cost for all joint procedures across inpatient and outpatient settings, ranging from 28% of the total cost for inpatient THA to 63% of the cost for outpatient RTSA. Discussion Although many factors influence the total cost for arthroplasty surgery, including rate of hospitalization, duration of stay, operative time, complexity of cases, patient factors, equipment, and resource utilization, the implant cost remains the most expensive factor, with hospital bed admission status being the second costliest contribution. Conclusion Outpatient total arthroplasty substantially reduced procedure expenses in a managed-care setting by 20%-30%, although savings for outpatient shoulder arthroplasty was lower than savings for THA or TKA. Implant costs remain the largest portion of shoulder arthroplasty procedure expenses.

Care across the gender spectrum: A transgender health curriculum in the Obstetrics and Gynecology clerkship

BackgroundA lack of undergraduate medical curricula on providing healthcare to transgender and gender diverse (TGD) patients has contributed to significant health disparities for TGD communities. To address this gap, we designed and evaluated a novel curriculum to train Obstetrics and Gynecology (OB/GYN) clerkship students in caring for TGD patients.MethodsFollowing Kern’s 6-step method for curriculum development, we created a two-part curriculum on TGD healthcare topics – an online module on gender-affirming care, followed by a series of interactive cases on TGD-specific health topics. Undergraduate medical students completing their core OB/GYN clerkships at a university academic medical center (January-December 2021) were invited to complete this curriculum. Participants completed pre/post assessment surveys to assess their experience caring for TGD patients, as well as a scored knowledge assessment before and after completing the curriculum.ResultsSixty-five students participated in this curricular assessment. Prior to completing the module, 45% agreed that they had received adequate TGD health training. Following module completion, students reported increased comfort in caring for transgender patients (49.2% vs. 81.5%; p < .001) and endorsed an improved fund of knowledge of both healthcare maintenance for TGD patients (61.5% vs. 100%; p < .001) and gender affirming medical therapies (60.0% vs. 96.9%; p < .001). Knowledge scores increased from a mean of 9.65 (1.81) to 12.5 (2.20) out of 15 (p < .001). In post-assessment surveys, 95% of participants agreed that the module was helpful for their learning. Qualitatively, students suggested longitudinal integration of TGD-topics into the pre-clinical curriculum, and expanded opportunities to practice patient counseling.ConclusionThe findings of this study support the need for student education on TGD health. Integration of interactive, case-based TGD-care curricula into clinical training may increase medical students’ knowledge and comfort in caring for TGD patients. Ongoing efforts to integrate TGD health training into undergraduate medical student curricula are necessary.

S1431 Hepatitis B Vaccination Rates in Ambulatory Patients With Chronic Liver Disease Before and After the Onset of the COVID-19 Pandemic

Introduction: Hepatitis B (HBV) is one of the most prevalent infectious diseases worldwide. It is preventable with vaccination and experts recommend screening for HBV immunity in all patients with chronic liver disease. The 2019 novel coronavirus (COVID-19) pandemic disrupted ambulatory care clinics throughout the United States, interfering with normal vaccination screening and administration. In the subsequent years after the pandemic began, clinicians and patients alike have had to play catch up on healthcare maintenance. This study was done to determine if the rate of screening and vaccination of patients with chronic liver disease for Hepatitis B changed in the subsequent years after the onset of the COVID-19 pandemic at our single institution. Methods: A retrospective study was performed from January 2000 to January 2019 and from February 2022 to April 2022 on patients seen in the ambulatory clinic of our community-based hospital. The criteria to be vaccinated for Hepatitis B was patients with chronic liver disease (defined as cirrhosis, nonalcoholic fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and transaminitis (ALT or AST >2x ULN) not immune to HBV. Seven-hundred-and-ninety patients were selected from the first period and eighty-six patients were selected from the second period. Results: We found that there were increases in the rate of screening for HBV immunity as well as the rate of vaccination against HBV in the post-COVID onset years compared to the pre-COVID onset years. (Table) Conclusion: We believe that the increases in both screening rates and subsequent vaccination are due to both patient and physician driven motives. Our patients are requesting re-evaluation of vaccination history with increased compliance in vaccination course. We have also noticed a more thorough review of patient history by our physicians, focusing on what was missed during the years since the onset of the pandemic. Further studies qualifying these observations are underway, however, we believe it is important to present these results now to demonstrate that we can continue to improve the care we provide in the outpatient setting despite the pandemic. In fact, the COVID-19 pandemic itself may have improved the overall care we provide for patients. Table 1. - Rates of Screening and Subsequent Vaccination Against Hepatitis B Virus in Patients With Chronic Liver Disease Before and After the Onset of COVID-19 Pre-COVID Onset Post-COVID Onset Percent Change Screening for HBV Immunity 88.5% 94.2% +6.4% Rate of 1st HBV Vaccine Given 46.1% 63.5% +37.7% Rate of 2nd HBV Vaccine Given 37.5% 48.3% +28.8% Rate of 3rd HBV Vaccine Given 27.5% 28.8% +4.7%

S342 A Quality Improvement Project on Colorectal Cancer Screening and Follow-Up Through Utilization of Healthcare Maintenance Forms Among Average Risk Active Patients in Resident Run Primary Care Clinics

S342 A Quality Improvement Project on Colorectal Cancer Screening and Follow-Up Through Utilization of Healthcare Maintenance Forms Among Average Risk Active Patients in Resident Run Primary Care Clinics

BIM-based repair and maintenance for hospital work order management

Work order management in hospitals that are dynamic and high-pressured environments is a significant challenge. Healthcare Repair and Maintenance (R&M) managers need to plan work orders precisely, quickly, and cost-effectively according to technical and administrative aspects and resource limitations. This paper develops a new framework to optimize R&M schedules in hospitals by minimizing direct and indirect costs (personnel, travel, and delay costs), considering managers' preferences and constraints. The proposed framework integrates Building Information Modeling (BIM), Genetic Algorithm (GA), and Discrete Event Simulation (DES) to discover the optimum plan for R&M tasks and employs BIM and Augmented Reality (AR) to support on-site activities by navigating and retrieving information. The proposed framework enables healthcare managers to reduce the time and costs of R&M plans and utilize personnel more efficiently. Implementing this system on an actual case study proves its capabilities in basing a good foundation to provide personnel's visualized work packages automatically.