Health System Navigation Research Articles

Creation of the Indigenous Support Line for health system navigation and culturally safe access to care: a quality improvement project

Indigenous Peoples face inequities in health and healthcare access due to colonial history and systems. To work towards the Truth and Reconciliation Commission of Canada’s Calls to Action and the...

The impact of socioeconomic inequality on access to health care for patients with advanced cancer: A qualitative study

ObjectiveIn Canada, populations experiencing socioeconomic inequality have lower rates of access to screening and diagnosis and higher mortality rates than people from higher-income areas. Limited evidence exists concerning their experiences when living with advanced cancer. We explored how socioeconomic inequality shapes the experiences of patients with advanced cancer. MethodsWe utilized a qualitative study design that combined tenets of hermeneutic phenomenological inquiry and critical theory. Four individuals with advanced cancer from low-income neighborhoods, three family members, and six cancer care providers were accrued through a tertiary cancer center in a western Canadian city. One-on-one interviews and brief notes were used for data collection. Data were analyzed through thematic analysis. ResultsThree interrelated themes were identified: ‘Lack of access to socioeconomic supports,’ ‘Gaps in access to health care resources and services,’ and ‘Limited access to symptom relief.’ Patients experienced inadequate finances, housing, and transportation. Most patients lived alone and had limited family and social support. Patients reported lack of knowledge of available resources and health system navigation issues, including communication problems with providers and among levels of care. Cancer care providers and patients described issues achieving symptom relief as well as challenges associated with extensive disease. ConclusionsStudy findings suggest that socioeconomic inequality interferes with the ability of persons with advanced cancer to access health care and contributes to less optimal cancer outcomes. Socioeconomic inequality may increase symptom severity. Findings call for the development of tailored interventions for populations with advanced cancer and socioeconomic inequality.

Abstract SY15-02: Health insurance and outcome disparities in adolescents and young adults with cancer

Abstract SY15-02: Health insurance and outcome disparities in adolescents and young adults with cancer

Abstract 998: Pursuing leadership in literacy to ameliorate head and neck cancer disparities

Abstract Overview of Proposed Research. Head and neck cancers are a deadly cancer that ranks among the six most common cancers worldwide. (American Cancer Society, 2021). Studies have shown greater disease burden among minority populations for head and neck cancer, higher mortality rates and lower oral cancer knowledge, but limited evidence has defined the underlying causes of late stage diagnoses and access to the healthcare system (Suzuki et al, 2019). More specifically, in comparison to the national rates, South Carolina is among the top ten for head and neck cancers (Community Outreach, Hollings Cancer Center, MUSC, 2019). Dental and primary care play a critical role delivering quality patient education, prevention, risk reduction and treatment regimes. However, there is a paucity of information published on the value of designing and implementing a health literacy program to prioritize head and neck cancer screening and prevention. Rural communities face unique challenges to achieving optimal oral health, impacted mainly by geographic location and socioeconomic status (IOM&NRC, 2011). More specifically, rural southern states such as SC continues to have a tremendous shortage of primary care providers. SC currently has 44 of 46 counties designated as geographic Primary Care and Dental Health Professional Shortage Areas and approximately 25% of SC citizenry are living in rural areas (HRSA, 2018). Because the vast majority of the state has challenges with availability of primary care and dental providers, this potentially exacerbates access to care inequities for rural and underserved minority populations. To enhance the quality and equity of oral cancer prevention in rural SC, it is critical that we prioritize strategies to elevate the significance of head and neck cancer risks. Therefore, the need to design and deliver innovative strategies to increase opportunities that intersect the healthcare system and community is inevitable. In this regard, we propose PULL A-HEAD, Pursuing Leadership in Literacy to Ameliorate HEAd and neck cancer Disparities. PULL A-HEAD is aimed to develop and implement a community-centered approach design for increasing the health literacy and efficacy of navigating the healthcare system for early detection of head and neck cancers. In this presentation we will share outcome and impact results of a community-centered, health literacy program in collaboration with our Regional Medical Library - Region 2 (RML2), National Library of Medicine partners at the Medical University of South Carolina. The program (i.e. PULL A-HEAD) will emphasize the delivery of health literacy education and health systems navigation tools to improve the early detection of head and neck cancers. Citation Format: Joni D. Nelson, Irene M. Lubker. Pursuing leadership in literacy to ameliorate head and neck cancer disparities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 998.

Patient perspectives on the vital primary care role of community pharmacists in Nova Scotia, Canada: qualitative findings from the PUPPY Study.

Community pharmacists play an important role in primary care access and delivery for all patients, including patients with a family physician or nurse practitioner ("attached") and patients without a family physician or nurse practitioner ("unattached"). During the COVID-19 pandemic, community pharmacists were accessible care providers for unattached patients and patients who had difficulty accessing their usual primary care providers ("semi-attached"). Before and during the pandemic, pharmacist services expanded in several Canadian provinces. The aim of this qualitative study was to explore patient experiences receiving care from community pharmacists, and their perspectives on the scope of practice of community pharmacists. Fifteen patients in Nova Scotia, Canada, were interviewed. Participant narratives pertaining to pharmacist care were analyzed thematically. Attached, "semi-attached," and unattached patients valued community pharmacists as a cornerstone of care and sought pharmacists for a variety of health services, including triaging and system navigation. Patients spoke positively about expanding the scope of practice for community pharmacists, and better optimization of pharmacists in primary care. System decision-makers should consider the positive role community pharmacists can play in achieving primary care across the Quintuple Aim (population health, patient and provider experiences, reducing costs, and supporting equity in health).

Conceptualizing care partners' burden, stress, and support for reintegrating Veterans: a mixed methods study.

People who support Veterans as they transition from their military service into civilian life may be at an increased risk of psychological distress. Existing studies focus primarily on paid family caregivers, but few studies include spouses and informal non-family "care partners." We sought to identify key challenges faced by care partners of Veterans with invisible injuries. Semi-structured interviews were conducted with 36 individuals involved in supporting a recently separated US military Veteran enrolled in a 2-year longitudinal study. CPs completed validated measures on perceived stress, caregiving burden, quality of their relationship, life satisfaction, and flourishing. Independent t-tests were used to compare cases in these groups on caregiving burden, quality of their relationship, life satisfaction, and flourishing. Care partners were categorized as reporting high and low levels of stress. Exemplar cases were used to demonstrate divergences in the experiences of CPs with different levels of stress over time. Care partners reported shifts in self-perception that occurred from supporting a Veteran, emphasizing how they helped Veterans navigate health systems and the processes of disclosing health and personal information in civilian contexts. Exemplar cases with high and low burdens demonstrated divergent experiences in self-perception, managing multi-faceted strain, and coping with stress over time. Case studies of specific care partners illustrate how multi-faceted strain shifted over time and is affected by additional burdens from childcare, financial responsibilities, or lack of education on mental health issues. Findings suggest the unique needs of individuals who support military Veterans with invisible injuries, highlighting variations and diachronic elements of caregiving. This sample is younger than the typical caregiver sample with implications for how best to support unpaid care partners caring for Veterans in the early to mid-period of their use of VA and civilian health services.

Where are the links? Using a causal loop diagram to assess interactions in healthcare coordination for youth experiencing homelessness in Toronto, Canada

BackgroundYouth experiencing homelessness (YEH) suffer from poorer physical and mental health outcomes than stably housed youth. Additionally, YEH are forced to navigate fragmented health and social service systems on their own, where they often get lost between systems when transitioning or post-discharge. Inevitably, YEH require support with health system navigation and healthcare coordination. The aim of this study is to understand interactions within and between the emergency youth shelter (EYS) and health systems that affect healthcare coordination for YEH in Toronto, Canada, and how these interactions can be targeted to improve healthcare coordination for YEH.MethodsThis study is part of a larger qualitative case study informed by the framework for transformative systems change. To understand interactions in healthcare coordination for YEH within and between the EYS and health systems, we developed a causal loop diagram (CLD) using in-depth interview data from 24 key informants at various levels of both systems. Open and focused codes developed during analysis using Charmaz’s constructivist grounded theory methodology were re-analysed to identify key variables, and links between them to create the CLD. The CLD was then validated by six stakeholders through a stakeholder forum.ResultsThe CLD illustrates six balancing and one reinforcing feedback loop in current healthcare coordination efforts within the EYS and health systems, respectively. Increasing EYS funding, building human resource capacity, strengthening inter and intra-systemic communication channels, and establishing strategic partnerships and formal referral pathways were identified among several other variables to be targeted to spiral positive change in healthcare coordination for YEH both within and between the EYS and health systems.ConclusionsThe CLD provides a conceptual overview of the independent and integrated systems through which decision-makers can prioritize and guide interventions to strengthen healthcare coordination within and between the EYS and health systems. Overall, our research findings suggest that key variables such as streamlining communication and improving staff–youth relationships be prioritized, as each of these acts interdependently and influences YEH’s access, quality and coordination of healthcare.

Online Educational Resources for Youth Living With Type 1 Diabetes Transitioning to Adult Care: An Environmental Scan of Canadian Content

ObjectivesThere are many educational resources for adolescents and young adults living with type 1 diabetes; however, it is unknown whether they address the breadth of topics related to transition to adult care. Our aim in this study was to collect educational resources relevant to Canadian youth and assess their quality and comprehensiveness in addressing the knowledge necessary for youth to prepare for interdependent management of their diabetes. MethodsWe conducted an environmental scan, a systematic assessment and analysis, of online education resources in English and French relevant to Canadian youth living with type 1 diabetes. Resources were screened using an open education resource evaluation grid and relevant resources were mapped to the Readiness for Emerging Adults with Diabetes Diagnosed in Youth, a validated diabetes transition readiness assessment tool. ResultsFrom 44 different sources, 1,245 resources were identified and, of these, 760 were retained for analysis. The majority were webpages (50.1%) and downloadable PDFs (42.4%), and 12.1% were interactive. Most resources covered Diabetes Knowledge (46.0%), Health Behaviour (23.8%), Insulin and Insulin Pump Management (11.8% and 8.6%, respectively), and Health-care System Navigation (9.7%). Topic areas with the fewest resources were disability accommodations (n=5), sexual health/function (n=4), and locating trustworthy diabetes resources (n=3). ConclusionsThere are many resources available for those living with type 1 diabetes preparing to transition to adult care, with the majority pertaining to diabetes knowledge and the least for navigation of the health system. Few resources were available on the topics of substance use, sexual health, and reproductive health. An interactive presentation of these resources, as well as a central repository to house these resources, would improve access for youth and diabetes care providers during transition preparation.

Why Liver Cancer Hits Home: Bridging Healthcare Disparities in the Asian American and Pacific Islander Community.

Asian Americans and Pacific Islanders have an increased risk of developing liver cancer and higher risk of death compared to non-Hispanic White individuals. The role of individual-level risk factors, social determinants of health, and barriers navigating health systems present unique challenges in obtaining liver cancer care for these patients. Additionally, the Asian American and Pacific Islander population is a heterogenous group originating from several different countries and speaking various languages, and they are often underrepresented in cancer clinical trial populations. This article describes the challenges faced by Asian American and Pacific Islander patients with liver cancer from the clinician, research, and patient advocacy perspectives and proposes targeted solutions to reduce healthcare disparities in this group.

Patient and family experiences of lysosomal storage diseases in Canada: A qualitative interview study.

Canadian patients and families affected by rare genetic lysosomal storage diseases (LSDs) suffer from numerous challenges related to disease management, including issues navigating healthcare and social support services, access to orphan drugs, and intensive treatment regimens. These challenges significantly impact people's quality of life, yet they remain obscure and have not been the subject of comprehensive analysis. Thus, we conducted qualitative interviews with Canadian patients and caregivers living with LSDs to advance current understanding of their experiences with rare-disease (RD) management and health systems navigation to support patient-focused RD policies and programs and improve the health outcomes of the 2.8 million Canadians affected by RDs. This study employed a qualitative descriptive research design with inductive thematic analysis. The study data were collected using semi-structured interviews. Thirty Canadian participants were interviewed in person or remotely via video chat to allow for an interactive discussion and the acquisition of rich data related to the insights and perceptions of people with LSDs. Between April and November 2019, 30 participants (16 patients and 14 caregivers) with experiences with nine types of LSDs and living in seven Canadian provinces were interviewed. Five themes were identified using comprehensive thematic analysis. These themes were the complexity of the diagnosis process; navigation of healthcare systems; psychological, social, and financial implications of LSDs; access to social support services; and access to orphan drugs. Our findings reveal that patients' access to appropriate healthcare and social services is subject to significant delays and lacks care coordination. The process of accessing orphan drugs in Canada is extremely complex and convoluted. The study results also illuminate experiences of RD stigma when navigating healthcare and social support systems. Our study offers new insights into the complex nature and extensive needs of Canadians with LSDs that are currently unmet. The management of these complex diseases requires holistic patient care and support beyond having access to orphan drugs. Our findings highlight the importance of bridging existing gaps between health and social care for RD patients. Policymakers should utilize these results when developing the forthcoming national RD strategy.

#NavigatingHealth - Building a Global Movement Empowering Patients to Navigate Health Systems

Background: Whilst health reports talk about health systems shifts from reactive “one size fits all” to proactive personalised health care, the current reality is that health systems are challenging for patients and carers to navigate. Patients frequently experience gaps and barriers in healthcare. We talk about patient-centred care, but we do not have patient centred systems. The challenges are not new and patient navigation was extensively research by Professor Harold Freeman in the US over 30 years ago. 
 Audience: This presentation is for a multidisciplinary audience of patients, health professionals, policy managers and politicians focused on enabling patient-centred at a systems level. 
 Who did you involve and engage with? What was the approach and process undertaken? 
 Patients, professionals and policy makers in Australia and globally have been involved in what started as a national Community of Practice in Australia “Mind the Gap: #NavigatingHealth”. 
 The approach was tested for audience interest with a series of two webinars in September 2021 to set the scene of navigating health across a life journey of patient and provider experiences with a solutions focused approach on how to tackle the many challenges.
 Following the success and interest of the webinars and as part of a focused advocacy and change management approach we developed a bimonthly Community of Practice. This is open to all those in Australia. Our focus in the first year was to make visible the many solutions being developed to support patients and to develop an engaged participatory community and build connection. 
 Further to the success in the first year, we have now expanded the approach at a global level running our first global webinar in November 2022 with speakers from Australia, the United States of America, Canada and the United Kingdom providing a connected approach across a life journey. This included lived experience of patients as well as presentations from non-governmental, medical and government organisations interweaving micro, meso and macro approaches (for example included American Cancer Society, NHS England). 
 What is the learning for the international audience? Problems that patients face navigating health systems in countries are common and consistent. Collaborating across disease and functional areas both within and across countries allows the opportunity to take a “big-picture” view to take a systems focused approach. This allows the solutions being developed to be coalesced at a systems level, remove duplication and leverage resources to benefit both patients, providers and policy makers to focus on a person-centred value-based healthcare approach across a life journey. 
 What are the next steps? Our next steps are to consolidate the learnings and scale. Whilst our initial focus has been high income countries we will be expanding the approach in 2023 to low and middle income countries using the same methodology.

CARE PARTNERS OF PERSONS WITH DEMENTIA USE OF SHARED ACCESS TO THE PATIENT PORTAL

Abstract The patient portal plays a significant and growing role in health system navigation, and most patient portals offer shared access for care partners. Care partners are at the forefront of dementia care, yet little is known about their use of the portal through shared access. We conducted an observational cohort study of patient portal utilization for a 5-year period (10/3/2017-10/2/2022) at an academic health system. The cohort consisted of 49,382 patients ages 65+ with 2+ visits in 24 months. More than half (57.34%) of the cohort was female and white (67.19%) and the average age was 76.56 (SD 8.60). We operationalized diagnosed dementia from ICD10 codes and problem lists. Shared access use was defined as activity happening through “proxy” credentials. We operationalized the patient portal activity metric as the ratio of portal sessions in relation to number of clinical encounters. Older adults with (versus without) diagnosed dementia were similarly likely to be registered for the patient portal (71.20% versus 71.51%, p=0.16) but more likely to have a shared access user (10.41% vs. 3.31%; p<0.001). Among patients with dementia, those who had a shared access user, compared to those who did not, had 341.32 versus 164.33 patient portal sessions, sent 47.56 versus 27.42 messages, and had a 19.22 versus 11.22 patient portal activity metric over the 5-year period (p<0.001 all contrasts). Policy initiatives and organizational efforts that encourage use of shared access may benefit care quality of persons with dementia and their care partners.

DEMENTIA CARE PARTNER ACTIVATION PROGRAM FOR FILIPINO AMERICANS

Abstract This study aims to enhance the quality of life and health outcomes for individuals with Alzheimer’s Disease and Related Dementia (ADRD) and their care partners through a culturally tailored support program. Specifically focusing on the unique challenges Filipino and Filipino American (FA) caregivers face, we seek to address disparities in access to care and develop strategies for effective health system navigation. The research employs a multifaceted approach, combining surveys, focus groups, observational techniques, and interviews to assess the caregiving experience comprehensively. Our primary objectives include evaluating the impact of caregiving burden, socio-emotional support, and health literacy on emergency department visits and hospital admissions for ADRD patients. Preliminary results highlight the significance of culturally sensitive interventions. FA caregivers often encounter difficulties due to cultural beliefs, knowledge gaps about ADRD, and limited support networks. This study outlines the development and testing of a specialized program designed to empower FA caregivers with the skills needed for proficient care management and emergency response. By engaging these caregivers in participatory action research, the program aims to foster active involvement and enhance their caregiving capabilities. The study’s outcomes emphasize the potential for improved quality of life and health outcomes for individuals with ADRD and their caregivers. By addressing FA caregivers’ unique challenges in the context of disparity populations, our research contributes to enhancing health system navigation behaviors and promoting culturally attuned care practices. This initiative promises to reduce emergency department visits and hospital admissions, benefiting ADRD patients and their dedicated care partners.

Qualitative exploration of the early experiences of opioid use disorder patients from private clinics after Russia's invasion of Ukraine in five major cities in Ukraine.

Following the full-scale invasion of Ukraine by the Russian Federation on 24 February 2022, over 6,000 patients were at risk of potential disruptions in treatment with medications for opioid use disorder (MOUD) in Ukraine. Before 2022, privatized MOUD clinics had emerged, partly driven by restrictive governmental policies and practices in state-funded facilities. Nevertheless, scant information exists regarding their operation and the patient's experiences, especially during crises. This study seeks to elucidate the initial lived experiences of patients utilizing private MOUD clinics, integrating these insights with an analysis of the responding health system during war. The findings are derived from 20 qualitative semi-structured interviews conducted between March and June 2022, engaging participants from five major Ukrainian cities: Kharkiv, Kyiv, Odesa, Poltava, and Zaporizhzhya. Employing a rapid analysis procedure, we examined the data through descriptive and analytical summaries aligned with the domains of the data collection instrument. Emergent themes encompassed stress and uncertainty following the invasion's onset, challenges accessing MOUD, and consequent perceptions concerning state-funded versus private clinics. The study identified disruptions in the operation of private MOUD clinics across most cities examined. Issues pertaining to MOUD medication availability were linked to dosage reductions at state-funded clinics or pharmacy medication shortages or closures. Despite varied experiences at different MOUD clinics and cities, most participants continued their treatment. This qualitative exploration provides a perspective on lived experiences with MOUD treatment at private clinics amidst the initial months of the invasion, illuminating how the early days' stress, access challenges, varied responses from private MOUD clinics, and precarious conditions informed or altered preferences regarding MOUD treatment options. Moreover, these findings corroborate previously documented efforts by myriad stakeholders to mitigate war-related disruptions to MOUD delivery. These insights contribute to the international understanding of health system navigation and resilience during major crises, offering valuable lessons for preparedness development.

Barriers in Health and Social Care Access and Systems Navigation among Older Adults without Advocates: A Scoping Literature Review and Framework Synthesis

Barriers in Health and Social Care Access and Systems Navigation among Older Adults without Advocates: A Scoping Literature Review and Framework Synthesis

An integrative review of adult cancer patients’ experiences of nursing telephone and virtual triage systems for symptom management

PurposeTelephone and virtual triage services are becoming increasingly common in ambulatory oncology settings. Few studies have evaluated their implementation from the perspective of service users. This study aims to evaluate the experiences of engaging with nurse-delivered telephone and virtual triage systems for symptom management among people undergoing cancer treatment. MethodsAn integrative review was undertaken. MEDLINE, CINAHL, PsycInfo, Academic Search Complete and Scopus were systematically searched. Twelve publications met the inclusion criteria, and data related to cancer patients’ perceptions of the triage process were extracted and analysed. ResultsTelephone-based (n=7), app-based (n=5) and video-based teleconferencing (n=2) triage systems were evaluated positively overall, enhancing ease of health system navigation, avoidance of emergency department for consultation, and the information, reassurance and support provided to support self-management of symptoms. However, several factors influenced the users’ engagement with triage services, including confidence to articulate symptoms, limited opening hours, waiting times for initial triage or follow-up and digital literacy. Collectively, these factors contributed to delayed reporting or under-reporting of symptoms, undermining the potential impact of services. Studies included variable reporting of intervention characteristics, including the qualification of nurses delivering and leading services. ConclusionsFuture evaluations of triage services must give greater consideration to the characterisation of interventions to ensure transferability, including nursing roles and qualifications. To ensure effective intervention and optimal supportive care for symptom management, patients must be prepared to engage triage services early. Future evaluations must ensure the impact of digital literacy on engagement with, and experience of, virtual triage is investigated.

Enterprise Healthcare Physician Services in Canada: An Environmental Scan.

Employers in Canada are increasingly offering physician services to their employees through third-party "enterprise" virtual care platforms. In our environmental scan, we identified nine enterprise healthcare companies offering physician services tomillions of Canadian employees via enterprise platforms. All platforms offered rapid access to virtual physician services. Some offered in-person visits, access to specialists, health system navigation and sharing of information with an employee's regular care provider. Almost half shared aggregate or de-identified health data with employers. These platforms provide rapid and convenient access to physician services but also disrupt the continuity of care, pose risks to employee privacy and expand two-tiered healthcare.

Adult Inpatient Services in Pediatric Hospitals: A National Mixed Methods Study.

Some pediatric institutions have developed adult inpatient services to enable quality care of hospitalized adults. Our objectives were to understand the characteristics of these adult inpatient services in pediatric hospitals, barriers and facilitators to their creation and sustainability, and patient and system needs they addressed. An explanatory mixed methods study was conducted using a distribution of an electronic survey followed by targeted semi-structured interviews of directors (or designates) of adult inpatient services in US pediatric hospitals. The survey identified institutional demographics, service line characteristics, and patient populations. An interview guide was created to explore survey findings and facilitators and barriers in the creation of adult inpatient services. Interviews were conducted after survey completion. A codebook was created using an inductive thematic approach and iteratively refined. Final themes were condensed, and illustrative quotes selected. Ten institutions identified as having an adult inpatient service. Service staffing models varied, but all had dually trained internal medicine and pediatrics physicians. All participants voiced their respective pediatric institutions valued that these services filled a clinical care gap for hospitalized adults adding to whole-person care, patient safety, and health system navigation. Adult inpatient services in pediatric institutions have been present for >15 years. These services address clinical care gaps for adults hospitalized in pediatric institutions and use specialized internal medicine and pediatrics knowledge. Demonstrating return on investment of these services using a traditional fee for service model is a barrier to creation and sustainability.

217-OR: The Supporting Emerging Adults with Diabetes (SEAD) Program—An Adult-Based Clinical Model That Improves Glycemic Control and Diabetes Technology Uptake in Underserved Young Adults (YA) with Type 1 Diabetes (T1D)

Background: Underserved YA with T1D transitioning from pediatric to adult care experience adverse outcomes, which stem from simultaneously unmet social, glycemic, and health system navigation needs. We developed a multidisciplinary clinical program called SEAD to address these challenges. In this analysis, we compared outcomes in YA with TID who were enrolled in SEAD to comparable YA in non-SEAD usual care. Methods: The SEAD model was integrated into routine adult diabetes care at Montefiore in 2019, offering equal access to all YA with T1D aged 18-35 years old. SEAD provides YA-centered care, ongoing T1D education, diabetes technology support, psychological focus, and equity-based social need screening and referrals. We collected data prospectively on YA receiving care in SEAD vs. non-SEAD at Montefiore from 2019-2022 for a priori program evaluation, using multivariate linear regression to compare primary glycemic outcomes and Kaplan-Meier analysis for secondary technology outcomes, adjusted for age, sex, race/ethnicity, DKA, and complications. Results: We included 416 YA with T1D (SEAD n=244, non-SEAD n=172): mean age 23 ± 4y, 49% F, 35% Black, 47% Hispanic, 73% Medicaid-insured (no baseline differences, p>0.05). Compared to non-SEAD care, YA in SEAD care experienced double the HbA1c improvement with a cumulative effect size of -0.9% vs. -0.45% over the 3-year study period [SEAD: -0.30%/yr (-0.43, -0.18); non-SEAD: -0.15%/yr (-0.27, 0.04)], and had higher likelihood of accepting insulin pump (HR 1.96, [1.24, 3.12]) and CGM therapy (HR 1.63, [0.97, 2.72]). Conclusion: Integration of the SEAD model into adult diabetes care to offer YA-centered T1D and social needs support improved glycemic control and diabetes technology uptake for underserved YA with T1D, compared to usual care. Cumulative effects over time could change YA trajectories into adulthood. Disclosure S.Agarwal: Advisory Panel; Medtronic, Consultant; Beta Bionics, Inc., Research Support; Abbott Diabetes, Dexcom, Inc. P.M.Mathias: None. C.Schechter: None. M.Greenberg: None. M.Finnan: None. J.A.Long: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896-05)

Real-world healthcare resource utilization amongst non-small cell lung cancer (NSCLC) patients tested with a host immune classifier (HIC).

e21210 Background: The HIC is a blood-based proteomic test that measures immune response in patients with NSCLC. The test stratifies patients into two groups, HIC-H and HIC-C which helps evaluate patient prognosis and response to treatment. While clinical validity of the HIC test has been published, no real-world studies have described healthcare resource utilization (HCRU) amongst patients who have been tested with the HIC. This claims analysis describes HCRU amongst patients with NSCLC tested with the HIC. Methods: MarketScan Commercial and Medicare Supplemental Databases linked to Biodesix data files of HIC test results were retrospectively queried to identify patients who were age 18 and older on index date (date of HIC testing), underwent a HIC proteomic test, were continuously enrolled in the MarketScan database for the 6-months before index (pre-index period) and one month post-index, and had at least one non-diagnostic medical claim of lung cancer during the pre-index period. Data utilized was between January 1, 2016 to June 30, 2021. HCRU was measured per patient per month (PPPM) during the pre-index and post-index period and compared between HIC-H and HIC-C cohorts. Results: Of the 328 included patients, 260 patients were HIC-H and 68 were HIC-C. On index, 178 patients had non-metastatic lung cancer and 150 patients had metastatic lung cancer. When examining HCRU in all patients prior to the HIC test, significantly more HIC-C patients had an outpatient visit with an oncologist (40% vs 27%, P < 0.05) or a primary care physician (71% vs 56%, P < 0.05). When assessing only patients with metastatic lung cancer prior to index, significantly more HIC-C patients had inpatient admissions (57% vs 37%, P < 0.05) and more outpatient visits with a primary care physician (73% vs 50%, P < 0.05). When examining HCRU in patients after the HIC test, metastatic patients had significantly more prescriptions (4.6 vs 3.6, P < 0.05). Metastatic HIC-H patients also had significantly more visits to the emergency room (64% vs 43%, P < 0.05). Conclusions: Patients who are identified as HIC-C tend to have higher HCRU earlier in their lung cancer diagnosis and treatment course (prior to HIC testing). In the post-index period, metastatic HIC-H patients had higher HCRU with respect to prescriptions and emergency visits. Other post-index HCRU metrics such as primary care utilization and inpatient admissions were similar among HIC-C and HIC-H patients. Earlier identification of HIC-C and HIC-H patients may help identify those most likely to benefit from additional health system navigation support.