Healthcare Compliance Research Articles

Impact of Covid-19 infection in high-risk coronary patients

BackgroundCoronary artery disease (CAD) has been recognized as a major determinant of Covid-19 vulnerability and severity. We sought to compare demographic characteristics, clinical presentation, and outcomes for Covid-19 in a large cohort of chronic CAD patients living in Strasbourg's cluster region (Fig. 1).MethodsFollow-up was conducted by telephone interviews performed by cardiologists one month after the start of the French lockdown. The primary outcome was the composite of death or hospitalization related to Covid-19 infection. Secondary endpoints included Covid-19 related death, Covid-19 related hospitalization, intensive care unit (ICU) admission, allcause mortality, cardiovascular (CV) mortality and healthcare compliance.ResultsOut of 891 patients included, twenty CAD patients (2.2%) had RT-PCR confirmed Covid-19 infection. Confirmed or suspect cases were evidenced in 48 patients (5.4%). Covid-19 patients showed lower left ventricular ejection fraction, were more frequently obese, less likely to smoke or follow lipid lowering therapy. The composite of death or hospitalization related to Covid-19 was 90%. Mortality rate was 30% among confirmed Covid-19 patients. Drugs’ discontinuation rate was low (1.1%) during the confinement. Reticence to consult a healthcare professional occurred in 6.4%. Postponement or cancellation of non-essential medical visits occurred in 15,7% (Table 1).ConclusionsCoronary patients from a large French cluster of COVID-19 showed a high risk of Covid-19 infection and worse in-hospital outcomes.

A multi-method exploratory study of health professional students\u2019 experiences with compliance behaviours

BackgroundResearch in healthcare, including students as participants, has begun to document experiences with negative compliance, specifically conformity and obedience. There is a growing body of experimental and survey literature, however, currently lacking is a direct measure of the frequency at which health professional students have negative experiences with conformity and obedience integrated with psychological factors, the outcomes of negative compliance, and students’ perceptions.MethodsTo develop empirical knowledge about the frequency of negative compliance and student perceptions during health professional education a multi-methods survey approach was used. The survey was administered to health professional students across ten disciplines at four institutions.ResultsThe results indicated students regularly experience obedience and conformity and are influenced by impression management and displacement of responsibility. Moral distress was identified as a consistent negative outcome. Student self-reported experiences aligned with the empirical findings.ConclusionsThe findings of the present study demonstrate the pervasiveness of experiences with negative compliance during health professional’s education along with some attendant psychological factors. The findings have educational and practical implications, as well as pointing to the need for further integration of social and cognitive psychology in explaining compliance in healthcare. The results are likely generalizable to a population level however replication is encouraged to better understand the true frequency of negative compliance at a health professional population level.

Lumbar Supports for Low Back Pain: Consensus Needed

Low back pain is one of the leading causes of disability worldwide. Nevertheless, there is no consensus regarding recommendations for usage of lumbar supports for patients with low back pain which was demonstrated by asking opinions to different health care specialists. Thus, this confusion decreases trust in health care professionals and compliance of the patients for the treatment. Evidence is scarce and conflicting therefore making it difficult for medical experts to give firm recommendations. We do not have evidence-based answer to what type or material lumbar supports should be used. Nevertheless, manufactures claim that every kind of lumbar supports are safe and effective. In our opinion lumbar supports can be effective if used in conjunction with other treatment modalities especially exercise. Further studies are necessary to develop consensus among health care professionals and restore trust in the eyes of patients.

Effectiveness of Intervention with Health (m-Health) Technology for Health Care Compliance: Literature Review

The integration of cellular technology in healthcare (M-Health) has the potential in coping with the constraints of the medical service system and to become a breakthrough to support the patients’ medication adherence. This review was conducted to compare and evaluate the effectiveness of M-Healthin terms of the patients’ medication adherence.The literature review conducting on PubMed, Cochrane Library, Ebsco Health and Taylor & Francis was confined to the articles published between 2010 and 2019. Fifteen articles relating to medication adherence were reviewed, eleven of which employed RCT methods including quasi-experiment that assessed the effectiveness of M-Health to measure the adherence, while four other researches employed qualitative studies to explore patients’ perceptions.The review showed that the intervention of m-Health is effective to drive the compliance of the treatment in accordance with healthcare promotion efforts as well as the prevention, screening and the management of the diseases. Two studies have shown inconsistent results regarding the prevention of obesity and the management of hypertension patients. The development of such model abd the integration of parallel m-Health and healthcare promotion will improve the long-term medication adherence.
 Index Terms— effectiveness, compliance, M-health, health care

Enhancing Ethics and Combating Corruption: The Role of Compliance Programs in Healthcare

Globally, health is recognized as a second dimension right. However, despite its global relevance, it is not uncommon to hear about the difficulties in fully achieving universal, free, comprehensive, and non-discriminatory access to healthcare. This article aims to present, as its main reflection, the problem rooted in inappropriate practices concerning the use of public health resources. Given the complexity of the topic, the objective is to propose and promote the compliance program as a restorative palliative for the effectiveness of an ethics program and the fight against risks and corrupt acts. Firstly, the historical and legislative framework on the subject will be portrayed, aiming to demonstrate that despite reprehensible behavior, these practices persist over time. In the second chapter, compliance is presented as a means to curb corrupt practices, so that in the end, the third chapter can outline the essential pillars for implementing an effective healthcare compliance program. To obtain results and answers to the problem, the article aims to conduct a literature and legislative review using the deductive method to form new hypotheses given the current nature of the topic.

<p>Comparison Of Expectations For Health Services Between Inpatients From Mental Health Department And Endocrinology Department In China</p>

BackgroundPatient expectations for health services refer to the anticipation or the belief about what should be encountered in the healthcare system. Understanding patient expectations can improve patient satisfaction and healthcare compliance. It is particularly important for patients with mental disorders, as greater healthcare compliance is required for them due to the chronic and relapsing nature of their diseases. However, little is known about expectations among Chinese patients with mental disorders.ObjectiveTo examine expectations for healthcare among patients with mental disorders and to compare them with those of patients with chronic physical diseases.Patients and methodsA cross-sectional survey was conducted among two inpatient groups, consecutively recruited from the Mental Health Department (MHD) and Endocrinology Department (ED) in one tertiary general hospital in Changsha, China. Patient expectations were measured by eight translated and modified vignettes of health system responsiveness. Group differences were compared using Chi-square tests for socio-demographic and clinical characteristics and Z-test for expectation rating. Logistic regression was performed to test whether group differences of expectations remained statistically significant after controlling for socio-demographic and clinical variables.ResultsMost patients from MHD rated scenarios in vignettes on communication, choice of provider, autonomy, and social support as “meeting expectations”, and rated scenarios in vignettes on prompt attention, dignity, confidentiality, and quality of basic amenities as “below expectations”. In comparison, patients from MHD had similar expectations with their counterparts from ED, for prompt attention, dignity, confidentiality, communication, choice of provider, and social support; however, patients from MHD had significantly lower expectations in quality of basic amenities and higher expectations in autonomy, after adjusting for socio-demographic and clinical factors.ConclusionLike their counterparts with physical diseases, patients with mental disorders also expect prompt attention, dignity, confidentiality, communication, choice of provider, and social support in their interaction with the healthcare system. Moreover, extra attention to autonomy is needed for patients with mental disorders to meet their expectations and improve patient satisfaction.

Educating healthcare compliance professionals: Identification of competencies

This study aims to identify business competencies required of healthcare compliance professionals for the purpose of developing university-based curricula for the field. A survey was distributed to members of the Health Care Compliance Association. Information was captured on respondents’ ranking of required competencies for the field. Required competencies fell into four general categories: 1. Specific healthcare compliance knowledge; 2. Skills needed to implement the requirements of the profession; 3. Business leadership skills; and 4. Traditional business skills. The data provide a useful foundation to design and implement a university-based curriculum for the demanding and complex healthcare compliance field.

Corporate Health Care Enforcement at a Crossroads: Newly Available Data and the Need for Comprehensive False Claims Act Reform

The Department of Justice (“DOJ”) has a long-stated goal of encouraging companies to engage in what the author refers to as “compliant behaviors” – maintenance of an effective pre-existing compliance program, post-enforcement adoption of an effective compliance program, cooperation with a government investigation, and self-disclosure of misconduct. Substantial DOJ guidance over the past two decades, along with the concrete incentive structure of the United States Sentencing Guidelines, have increasingly made clear to organizations when and how such behaviors will be rewarded in criminal matters. Recently, DOJ has made transparency and clarity regarding the benefit of compliant behaviors a priority in calculating and announcing criminal resolutions. With respect to civil False Claims Act (“FCA”) settlements, however, meaningful formal DOJ guidance on the effect of compliant behavior only arrived in 2019. More significantly, DOJ’s treatment of compliant behavior in civil cases, in contrast to that in the case of criminal resolutions, has appeared inconsistent and certainly opaque. This lack of clear implementation philosophy is particularly problematic in the area of health care, an industry for which the FCA is the primary tool for government action in response to misconduct. While much has been written on the systemic efficiencies – or lack thereof – that DOJ’s enforcement practices bring to the activities of regulated industries, this is the first article to use data to ask whether DOJ has a governing practice with respect to civil settlements, or whether instead its settlement practices fail to match its stated principles. For decades, even as resources devoted by market participants to health care compliance have skyrocketed and DOJ has pressed corporate entities to engage in compliant behaviors, the health care industry and the defense bar have expressed skepticism regarding the actual payoff they might realize by engaging in those behaviors. DOJ’s response has been a series of public statements amounting to, “trust us, they matter.” Until now, the health care industry has been without any mechanism to test those assurances. In response to changes in the tax code, however, DOJ made adjustments in 2018 to its practice of disclosing information regarding FCA settlements – changes which have shaken loose data that provides an opportunity to test DOJ’s claims of rewarding compliant behaviors in civil cases. The author is the first and thus far the only person to have identified and analyzed this newly available data. Examination of this data demonstrates that wide-ranging, structural changes are necessary. The data raises substantial questions about: the quantum of credit given for cooperation; conduct DOJ values in resolving FCA cases; and the degree of consistency in cases settled by U.S. Attorney’s Offices across the country. For example, analysis of the data reveals inconsistent benefits for cooperation. Cases where defendants self-disclosed misconduct or cooperated were often not treated more leniently than cases where defendants did not self-disclose or cooperate, and a review of more than 100 settlements did not find a single instance in which DOJ purported to give an entity a reduction based on its pre-existing compliance program. At the same time, DOJ appears to be greatly rewarding defendants for agreeing to settle – highlighting concerns both with regard to whether DOJ is achieving adequate deterrence and with regard to whether the FCA’s potential penalties are coercing settlements. And the data appears to show significant variation in settlement positions depending on the identity of enforcing DOJ component, with cases handled by DOJ’s Civil Division in Washington, D.C. treated more leniently than cases handled solely by U.S. Attorney’s Offices across the country. With the data now public – and at a moment in time when DOJ is emphasizing transparency and clarity in rewarding compliant behaviors in the resolution of criminal cases – DOJ’s corporate health care enforcement regime is at a crossroads. Without change in this area, DOJ risks undercutting its efforts at encouraging compliant behaviors in one of DOJ’s primary enforcement areas. No longer left in the dark about the impact of compliant behaviors in calculating FCA resolutions, the health care industry may be less likely to continue investing in compliance programs at the same rate, to cooperate with government investigations, and especially to self-disclose misconduct to the government. The analysis reveals that a detailed structure of DOJ’s calculations in FCA settlements, with calculations transparent in each FCA resolution, is needed to accomplish DOJ’s goal of encouraging cooperation and investment in compliance programs, as well as to provide an assurance that like cases are treated alike.

Alarm Compliance in Healthcare: Design Considerations for Actionable Alarms (In Intensive Care Units)

AbstractIntensive care units are technologically advanced environments that are designed to safeguard the patient while their vitals are stabilized for further treatment. Audible and visual alarms are part of the healthcare ecology. However, these alarms are so many that clinicians suffer from a syndrome called ‘alarm fatigue’ and often do not comply with the task alarm is conveying. Measuring compliance with rules in the workspace and determining the success of a system belongs to the field of ergonomics and is based on data collected through task observations and scoring. In this paper, we will explore compliance with critical alarms by not only from their potential success or failure perspective but also from the perspectives of the clinician capacity, needs, and motivations to comply with alarms in critical environments. We will finally, reflect on further possible design strategies to increase compliance in critical care that are beyond following rules per se but through intrinsic motivation.

Secondary measures of hand hygiene performance in health care available with continuous electronic monitoring of individuals

Hand hygiene (HH) compliance in health care is usually measured against versions of the World Health Organization's "Your 5 Moments" guidelines using direct observation. Such techniques result in small samples that are influenced by the presence of an observer. This study demonstrates that continuous electronic monitoring of individuals can overcome these limitations. An electronic real-time prompting system collected HH data on a musculoskeletal rehabilitation unit for 12 weeks between October 2016 and October 2017. Aggregate and professional group scores and the distributions of individuals' performance within groups were analyzed. Soiled utility room exits were monitored and compared with performance at patient rooms. Duration of patient room visits and the number of consecutive missed opportunities were calculated. Overall, 76,130 patient room and 1,448 soiled utility room HH opportunities were recorded from 98 health care professionals. Aggregate unit performance for patient and soiled utility rooms were both 67%, although individual compliance varied greatly. The number of hand wash events that occurred while inside patient rooms increased with longer visits, whereas HH performance at patient room exit decreased. Eighty-three percent of missed HH opportunities occurred as part of a series of missed events, not in isolation. Continuous collection of HH data that includes temporal, spatial, and personnel details provides information on actual HH practices, whereas direct observation or dispenser counts show only aggregate trends.

Understanding sociodemographic factors related to health outcomes in pediatric obstructive sleep apnea

(1) To examine relationships between socioeconomic status (SES) and successful treatment of pediatric obstructive sleep apnea (OSA) with adenotonsillectomy (T&A). (2) To explore sociodemographic factors and medical comorbidities that separate OSA and refractory OSA populations in children. We retrospectively reviewed pediatric OSA patients (ages 0-18). Patients evaluated for OSA by pediatric otolaryngology between January 2014 and December 2015 were included. OSA was defined as requiring T&A. Refractory OSA (ROSA) was defined as recurring, polysomnography-proven, OSA after T&A, ultimately requiring another intervention, such as a multi-level airway operation. Clinical data were complemented with sociodemographic data. ZIP codes were used to approximate median household income. Our cohort included 105 ROSA and 53 OSA patients. These patients came from similar rates of single parent households and coverage by public insurance. Median household income for OSA patients was $47,086 (IQR $36,395-$60,196), compared to $45,696 (IQR $37,669-$56,203) for ROSA patients. Over 60% of all patients fell below the national household income average. Nearly half of the cohort resided in the three largest metro counties closest to our institution. These patients represented higher rates of single-parent households (p = 0.045) and public insurance (p = 0.002), and trends towards lower rates of ROSA (p = 0.138). Our results identified sociodemographic factors that may influence healthcare compliance and subsequently overall health outcomes. We identified no statistically significant difference in measures of SES between patients with refractory vs non-refractory OSA. Patients living closest to our medical center had lowest rates of ROSA, suggesting that access to care may affect outcomes of pediatric OSA.

Athletic Training Students' Knowledge of Ethical and Legal Practice with Technology and Social Media

Context:Technology, social media, and access to health care continue to grow simultaneously. There is limited research on the knowledge of athletic training students regarding the ethical and legal practice of protected health information using technology and social media.Objective:To explore social media use of athletic training students and to determine their knowledge of patient privacy regulations within social media and technology.Design and Setting:Online survey instrument and knowledge assessment.Patients or Other Participants:A total of 652 athletic training students.Intervention(s):A knowledge assessment of 12 items based on the governance and use of patient privacy compliance in health care within the context of athletic training students' clinical experiences.Main Outcome Measure(s):An instrument of 26 questions, including 14 demographic and 12 knowledge items, was developed and content validated using a Delphi panel of experts in athletic training, health care information technology, and risk management lawyers. Descriptive statistics and independent t tests were calculated.Results:Athletic training students stated they had received previous education (n = 587 of 637, 92.2%) regarding Health Insurance Portability and Accountability Act (HIPAA) regulations, and had an average of 6.81 ± 2.75 active social media accounts. Only 24.2% (n = 154 of 636) of respondents stated their professional athletic training program had a social media policy that was strictly enforced. We identified a lack of knowledge of best practice by athletic training students, with an average knowledge assessment score of 4.92 ± 1.7 out of 13 (37.8%). Total knowledge scores were significantly different (P = .008) if the respondent had previous HIPAA education.Conclusions:The respondents scored poorly on the knowledge assessment despite previous education related to HIPAA regulations. Athletic training educators should seek out strategies to adapt professional or preprofessional curricula to incorporate health care informatics and ethics to adapt to the current culture of technology and social media.

Standard precaution knowledge and adherence: Do Doctors differ from Medical Laboratory Scientists?

Doctors and laboratory scientists are at risk of infection from blood borne pathogens during routine clinical duties. After over 20 years of standard precautions, health care workers knowledge and compliance is not adequate. This study is aimed at comparing adherence and knowledge of standard precautions (SP) among Medical Laboratory Scientists (MLSs) and doctors. It was a cross sectional study done at University of Nigeria Teaching Hospital, ItukuOzalla. A semi structured pre-tested questionnaire was the study instrument. General knowledge of SP was high,76.2% in doctors and 67.6% in MLSs although there were differences between the two groups on the knowledge of components of SP. Safe injection practices, use of personal protective equipment as well as safe handling of contaminated equipment or surfaces was higher amongst doctors. Even though more than half of respondents in both groups, 53.1 % among doctors and 58.1% among MLSs had received training on standard precautions, this did not reflect in the practice. MLS reported more use of personal protective equipment such as gloves and coveralls (100% in MLS and 35% of doctors), P<0.001. Recapping of syringes was higher amongst doctors (63.6%) than MLS (55.1%).The doctors practiced better hand hygiene than MLS (P<0.001). Constraints that affected SP included non-availability of PPEs and emergency situations for both groups. SP knowledge and practice are still low, and as such, there is a need to train doctors and MLS on the components of SP. Policies on SP need to be enforced and facilities for practice regularly supplied.

Concordance in healthcare by means of the intersubjective negotiation of a joint commitment

Health care compliance has a very important influence on the final outcome of clinical treatment. Accordingly, the fulfilment/failure of compliance is mainly attributed to the patients’ role in doing what clinicians have indicated instead of an agreement negotiation between the patient and the clinician’s treatment objectives. In the paper, we define how the clinical colloquium can be a space of intentional sharing, in which both patients and health professionals can be involved to arrive at mutually agreed goals. Therefore, we introduced the deontic normative of joint commitments and discuss it in terms of clinical concordance. In the last section of the paper, we present various possibilities of an intersubjective negotiation of concordance during a dyadic conversation, which is detectable from a social ethology approach in the observation of bodily-centred signals.

Assessment of Knowledge and Practices of Health Team Toward Radiation Hazards and it's Safety Measures at Assuit University Hospitals

Radiation is a threat to health in work place and in general environment. Workers in radiation therapy department are exposed to a variety of occupational hazards. Health care and safety measures compliance may decrease the health sequences of hazards occurrence. The study aimed to assess knowledge and practice of health care team about radiation hazards and it‟s safety measures. A descriptive design was used in this study. It was conducted at the Main Assuit University hospital and South Egypt Cancer Institute. A convenient sample (300) from heath team workers from the previous setting. Two tools was used (1) Self administrative and interview questionnaire. (2) Health team observation check list. Results: There were significant statistical differences in relation between health team knowledge and their performance. The study concluded that health team had poor knowledge about radiation hazards and most of them had satisfactory practice about safety measures. It recommend that hospitals must be provide radiation departments with adequate personal protective equipment to reduce exposure of health system from radiation hazards and establish plans for periodical safety training courses and educational programs for health team members in radiation setting to help in improving their practice and update their knowledge.

A nationwide covert observation study using a novel method for hand hygiene compliance in health care.

Evaluation and feedback is a core hand hygiene (HH) improvement strategy. The covert observation method avoids observation bias inherent to the overt method. The aim of the study was to observe HH compliance by a novel covert method in a real-world setting. We conducted a 2-year, nationwide, prospective, observational study in teaching hospitals across Taiwan. Medical students and students who may have contact with patients in their careers were recruited as participants. A novel, shorthand notation method for covert observation was used. Observation results were reported through a study website. There were a total of 25,379 HH opportunities covertly observed by 93 observers. Overall HH compliance was 32.0%. Health care workers had the highest HH compliance for indication 4 (42.6%), and the lowest for indication 5 (21.7%). Overall handrubbing percentage was high, reaching 83.6%. The HH compliance increased significantly with an increase in the number of indications within 1 HH opportunity (P < .001). The overall HH compliance by the covert observation method was low. An innovative shorthand notation method facilitated covert observation, and website reporting was demonstrated to be feasible for large-scale observation.

Living with Cancer: an Educational Intervention in Cancer Patients Can Improve Patient-Reported Knowledge Deficit.

A cancer diagnosis requires significant information to facilitate health care decision making, understand management options, and health care system navigation. Patient knowledge deficit can decrease quality of life and health care compliance. Surveys were distributed to attendees of the Mayo Clinic "Living with and Surviving Cancer" patient symposium January 2015. Follow-up survey was sent to participants 3months after the symposium. Surveys included demographic data and patient-reported disease comprehension, symptom burden, desired information, and quality-of-life assessment. Demographics: 113 patients completed the pre-intervention survey. Average age was 64.7years. Disease types included hematologic (N=50) and solid malignancies (N=77). Most patients self-reported adequate baseline understanding of their disease (80%), screening tests (74%), and monitoring tools (72%). Lowest knowledge topics were legal issues (13%) and pain management (35%). Pre- and post-analysis: 79 of the initial 113 participants completed both surveys. In the post-symposium setting, durable knowledge impact was noted in disease understanding (pre 80% vs post 92%), treatment options (pre 60% vs post 76%), nutrition (pre 68% vs post 84%), and legal issues (pre 15% vs post 32%). Most patients desired increased understanding regarding disease, screening tests, nutrition, and stress and fatigue management. The level of desired information for these topics decreased in the post-symposium setting, statistically significant decrease noted in 4 of 5 topics assessed. Knowledge needs and deficit in cancer care range from disease-specific topics, social stressors, and health care navigation. A cancer patient-centered symposium can improve patient-reported knowledge deficit, with durable responses at 3months, but patient needs persist.

Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research

Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided.

Impact of Health Care Funding on Compliance and Survival in Patients with Chronic Myeloid Leukemia in the Era of Tyrosine Kinase Inhibitors: A Single Institution Experience

Abstract Background: Health care funding has been shown to have an effect on the outcomes of several hematological malignancies. There hasn't been enough data on the impact of health care funding and compliance on the outcomes of chronic myeloid leukemia (CML) in the era of Tyrosine kinase inhibitors (TKIs). Methods: We conducted a retrospective review of patients diagnosed with CML between January 1, 2000 and June 30, 2014. Several factors such as age, sex, race, health care funding, distance traveled to access health care facility (less than or greater than 100 miles), compliance with medications and clinic visits, white blood cell count at the time of diagnosis, time to response and dates of death or last follow up were collected by review of electronic health records. Impact of compliance with medications and clinic visits, and health care funding status on overall survival were the main outcomes of the study. Chi-Square or fisher's exact test were used where appropriate to assess the association among variables and multivariate cox regression model was used to assess the effect of variables on survival of these patients. Results: A total of 93 patients were included in the review, most recent follow up being in June 2015. Median age of the patients at diagnosis was 50 years. In a multivariate cox regression analysis, compared to patients with Medicaid, those with Medicare (HR=0.311, 95% CI: 0.11-0.89) and private health care funding (HR=0.32, 95% CI: 0.32-0.99) had an increased survival where as lack of funding had no impact on survival (HR=0.52, 95% CI: 0.2-1.36). White blood cell count (WBC) of less than 80,000/microL at diagnosis predicted an increased survival (HR=0.43, 95% CI: 0.20-0.91) as compared to patients with WBC greater than 80,000/microL, whereas age at diagnosis, sex, race, achievement of major molecular response, compliance with oral TKIs or clinic visits had no impact on survival. There was a trend towards increased compliance with TKIs in patients with Medicare and private funding when compared to those with Medicaid and no health care funding (p=0.09). Patients with Medicaid and private funding were more compliant with their clinic visits (84% and 62% respectively) when compared to those with Medicare and no funding (51.6% and 37% respectively, p=0.02). Patients who traveled less than 100 miles to reach health care facility were more compliant with oral chemotherapy (TKI) than those who had to travel farther, (62.5% vs. 55%, p=0.46) whereas patients who traveled far to access health care were more compliant with clinic visits (64% vs. 53%, p=0.26). However, neither of these findings was statistically significant. Conclusion: Health care funding and WBC at diagnosis seem to have a significant impact on overall survival in patients with CML. There seems to be a trend towards increased compliance with TKIs in patients with Medicare and private funding as compared to those with Medicaid and no funding. Equal access to health care through patient assistance programs could probably explain the non-inferior survival in patients with no funding. Further studies are needed to validate these findings in a larger patient population. Disclosures No relevant conflicts of interest to declare.

Living with Cancer: An Educational Intervention in Cancer Patients Can Improve Knowledge Deficit

Abstract Background: A diagnosis of cancer leads to significant information requirements to facilitate health care decision making, understand management options, and health care system navigation. Many patients demonstrate a knowledge deficit that can lead to decreased quality of life and poor health care compliance. This study sought to evaluate the impact of a patient centered cancer symposium on knowledge level, symptom burden, and desired information in a broad population of cancer patients. Methods: Surveys were distributed to attendees of the Mayo Clinic "Living with and Surviving Cancer" patient symposium in January 2015. A follow up survey was sent to participants 3 months after the symposium. Surveys included demographic data, questionnaire evaluating disease comprehension, symptom burden, desired information and quality of life. Results: Demographics: 113 patients completed the pre-intervention survey. Average age of participants was 64.7 years. Disease types represented included hematologic malignancies (N=50), specifically multiple myeloma (N=24), lymphoma (N=17), leukemia (N=6), MPN/MDS (n=3), as well as solid tumor malignancies (N=77). Highest knowledge topics were disease (80%), screening tests (74%), and monitoring tools (72%). Lowest knowledge topics were financial management (13%), legal issues (13%), and pain management (35%). Pre and Post Analysis: Of the 113 initial participants, 79 patients completed the pre- and post-symposium surveys. In the post-symposium setting significant improvement was noted in understanding of disease (pre 80% vs post 92%), treatment options (pre 60% vs post 76%), nutrition (pre 68% vs post 84%) and legal issues (pre 15% vs post 32%). Non-significant knowledge improvement was noted in areas of risk factors and symptoms, screening/monitoring tools, disease side effects, managing stress/fatigue, end of life decision making and health care navigation. Most patients desired increased understanding regarding disease, screening tests, nutrition, and stress and fatigue management. The level of patient reported desire for information of these topics decreased in the post-symposium setting, statistically significant decrease noted in 4 of 5 topics assessed. In hematology patients who completed pre and post surveys (N=36), a higher level of baseline knowledge was reported regarding disease understanding (89%), tools monitoring response (83%) and recurrence (75%), symptoms (83%), relapse symptoms (64%) and treatment options (72%). In this group the decrease in desire for information was less prominent in the post-symposium setting. Discussion: This data demonstrates improved patient reported understanding on a variety of topics with durable response at 3 months. A majority of patients reported adequate baseline knowledge of many topics prior to the symposium but also a desire of increased cancer specific information. Knowledge deficit in cancer care includes disease specific topics, social stressors and health care navigation. The percentage of participants reporting a high desire for more information remained high but did decrease, suggesting decreased knowledge deficit in the post-symposium setting. Patient education should strive to be accessible, all-inclusive and reactive to patient needs. Table 1.Reported "quite a bit" or "very much" understanding and desired information regarding cancer carePrePostP-valueN=79(%)N=79(%)I understand…How to manage financial considerations of my disease/treatment39(51)41(53)0.85How to manage my pain24(34)23(32)0.81Risk factors that can lead to my disease37 (49)42 (56)0.56How to navigate the health care system43(55)47(60)0.56How to manage fatigue38(50)43(56)0.54Process of making end of life decisions33(47)41(53)0.52Screening tests60 (76)63 (81)0.5Symptoms associated with relapse35(45)42(54)0.27Disease symptoms54(70)60(76)0.2Tools monitoring recurrence49(62)56 (72)0.19Tools monitoring response56(71)63(81)0.15How to manage stress46(60)56(71)0.12Legal issues of my disease11(15)24(32)&lt;0.05Treatment options47(60)60(76)&lt;0.05What to eat49(68)66(84)&lt;0.05My disease62(80)71(92)&lt;0.05I desire increased understanding…Of my disease59(77)53(70)0.4Of managing stress50(65)35(51)&lt;0.05Regarding nutrition64(84)54(70)&lt;0.05Of the screening tests62(79)43(57)&lt;0.05How to manage fatigue54(72)42(54)&lt;0.05 Disclosures Tibes: TetraLogic Pharmaceuticals: Research Funding. Mesa:Novartis. Research- incyte, Gilead, cti, Genentech, promedior, NS Pharma: Consultancy.