Patient Healthcare Utilization Research Articles

Healthcare Utilization Following Hemipelvectomy or Hip Disarticulation inthe Military Health System.

Amputations at the hip and pelvic level are often performed secondary to high-energy trauma or pelvic neoplasms and are frequently associated with a prolonged postoperative rehabilitation course that involves a multitude of health care providers. The purpose of this study was to examine the health care utilization of patients with hip- and pelvic-level amputations that received care in the U.S. Military Health System. We performed a retrospective review of all patients who underwent a hip- or pelvic-level amputation in the Military Health System between 2001 and 2017. We compiled and reviewed all inpatient and outpatient encounters during three time points: (1) 3 months pre-amputation to 1 day pre-amputation, (2) the day of amputation through 12 months post-amputation, and (3) 13-24 months post-amputation. Health care utilization was defined as the average number of encounter days/admissions for each patient. Concomitant diagnoses following amputation including post-traumatic stress disorder, traumatic brain injury, anxiety, depression, and chronic pain were also recorded. A total of 106 individuals with hip- and pelvic-level amputations were analyzed (69 unilateral hip disarticulation, 6 bilateral hip disarticulations, 27 unilateral hemipelvectomy, 2 bilateral hemipelvectomies, and 2 patients with a hemipelvectomy and contralateral hip disarticulation). Combat trauma contributed to 61.3% (n = 65) of all amputations. During the time period of 3 months pre-amputation, patients had an average of 3.8 encounter days. Following amputation, health care utilization increased in both the year following amputation and the time period of 13-24 months post-amputation, averaging 170.8 and 77.4 encounter days, respectively. Patients with trauma-related amputations averaged more total encounter days compared to patients with disease-related amputations in the time period of 12 months following amputation (203.8 vs.106.7, P < .001) and the time period of 13-24 months post-amputation (92.0 vs. 49.0, P = .005). PTSD (P = .02) and traumatic brain injuries (P < .001) were more common following combat-related amputations. This study highlights the increased health care resource demand following hip- and pelvic-level amputations in a military population, particularly for those patients who sustained combat-related trauma. Additionally, patients with combat-related amputations had significantly higher rates of concomitant PTSD and traumatic brain injury. Understanding the extensive needs of this unique patient population helps inform providers and policymakers on the requirements for providing high-quality care to combat casualties.

Clinical Outcomes and Health Care Utilization in Patients With Burkitt Lymphoma.

Burkitt lymphoma is an aggressive B-cell lymphoma requiring intensive therapy, which places patients at risk for severe toxicity. However, few studies have described these patients' clinical outcomes and health care utilization, particularly among older adults. We conducted a retrospective analysis of adults 40 years and older with Burkitt lymphoma at Massachusetts General Hospital and Dana-Farber Cancer Institute from February 1999 to December 2020 (N = 97). We abstracted patient characteristics, clinical outcomes, and health care utilization (unplanned hospitalizations, intensive care unit [ICU] admissions) during therapy from the electronic health record. Using univariate logistic regression, we examined factors associated with rates of unplanned hospitalization and ICU admission during therapy. Among evaluable patients (median age, 69 years; 23.7% female; 19.3% with bone marrow involvement), 45.8% (38 of 83) experienced unplanned hospitalization and 23.2% (19 of 82) experienced ICU admission during therapy. Among those 70 years and older, rates of unplanned hospitalization and ICU admission were 36.8% (14 of 38) and 29.0% (11 of 38), respectively. Bone marrow involvement (odds ratio [OR], 3.00; P = .069) was associated with a nonsignificantly greater likelihood of unplanned hospitalization. Older age (OR, 1.06; P = .039), Charlson comorbidity index >0 (OR, 3.14; P = .038), and hypoalbuminemia (OR, 3.22; P = .035) were associated with greater likelihood of ICU admission. Overall, 8.7% (8 of 92) of patients died during treatment, all of whom were 70 years and older. Adults with Burkitt lymphoma experience substantial rates of unplanned hospitalizations and ICU admissions, with older adults at especially high risk for ICU admission and death during treatment. Our findings underscore the need to develop supportive care interventions for patients with Burkitt lymphoma to help improve clinical outcomes and health care utilization.

Co-Occurrence of Social Risk Factors and Associated Outcomes in Patients With Heart Failure.

Background Among patients with heart failure (HF), social risk factors (SRFs) are associated with poor outcomes. However, less is known about how co-occurrence of SRFs affect all-cause health care utilization for patients with HF. The objective was to address this gap using a novel approach to classify co-occurrence of SRFs. Methods and Results This was a cohort study of residents living in an 11-county region of southeast Minnesota, aged ≥18 years with a first-ever diagnosis for HF between January 2013 and June 2017. SRFs, including education, health literacy, social isolation, and race and ethnicity, were obtained via surveys. Area-deprivation index and rural-urban commuting area codes were determined from patient addresses. Associations between SRFs and outcomes (emergency department visits and hospitalizations) were assessed using Andersen-Gill models. Latent class analysis was used to identify subgroups of SRFs; associations with outcomes were examined. A total of 3142 patients with HF (mean age, 73.4 years; 45% women) had SRF data available. The SRFs with the strongest association with hospitalizations were education, social isolation, and area-deprivation index. We identified 4 groups using latent class analysis, with group 3, characterized by more SRFs, at increased risk of emergency department visits (hazard ratio [HR], 1.33 [95% CI, 1.23-1.45]) and hospitalizations (HR, 1.42 [95% CI, 1.28-1.58]). Conclusions Low educational attainment, high social isolation, and high area-deprivation index had the strongest associations. We identified meaningful subgroups with respect to SRFs, and these subgroups were associated with outcomes. These findings suggest that it is possible to apply latent class analysis to better understand the co-occurrence of SRFs among patients with HF.

Healthcare utilization of patients with hereditary angioedema treated with lanadelumab and subcutaneous C1-inhibitor concentrate.

New hereditary angioedema (HAE) treatments have become available in recent years for the treatment of HAE due to C1-inhibitor (C1-INH) deficiency, including two subcutaneous (SC) options: a monoclonal antibody (lanadelumab) and a plasma-derived C1-INH concentrate (SC-C1-INH). Limited real-world data on these therapies have been reported. The objective was to describe new users of lanadelumab and SC-C1-INH, including demographics, healthcareresource utilization (HCRU), costs, and treatment patterns before and after beginning treatment. This was a retrospective cohort study that used an administrative claims data base. Two mutually exclusive cohorts of adult (ages 18 years) new users of lanadelumab or SC-C1-INH with 180 days of continuous use were identified. HCRU, costs, and treatment patterns were assessed in the 180-day period before the index date (new treatment use) and up to 365 days after the index date. HCRU and costs were calculated as annualized rates. Forty-seven patients who used lanadelumab and 38 patients who used SC-C1-INH were identified. The most frequentlyused on-demand HAE treatments at baseline were the same for both cohorts: bradykinin B2 antagonists (48.9% of the patients on lanadelumab, 52.6% of the patients on SC-C1-INH) and C1-INHs (40.4% of the patients on lanadelumab, 57.9% of the patients on SC-C1-INH). More than 33% of the patients continued to fill on-demand medications after treatment initiation. Annualized angioedema-associated emergency department visits and hospitalizations decreased after initiation of treatment, from 1.8 to 0.6 for the patients on lanadelumab and from 1.3 to 0.5 for the patients on SC-C1-INH. Annualized total healthcare costs after treatment initiation in the database were $866,639 and $734,460 for the lanadelumab and SC-C1-INH cohorts, respectively. Pharmacy costs accounted for >95% of these total costs. Although HCRU decreased after the initiation of treatment, angioedema-associated emergency department visits and hospitalizations and on-demand treatment fills were not completely eliminated. This indicates ongoing disease andtreatment burden despite use of modern HAE medicines.

Long-term health care use and diagnosis after hospitalization for COVID-19: a retrospective matched cohort study.

Knowledge pertaining to the health and health care utilization of patients after recovery from acute COVID-19 is limited. We sought to assess the frequency of new diagnoses of disease and health care use after hospitalization with COVID-19. We included all patients hospitalized with COVID-19 in Alberta between Mar. 5 and Dec. 31, 2020. Additionally, 2 matched controls (SARS-CoV-2 negative) per case were included and followed up until Apr. 30, 2021. New diagnoses and health care use were identified from linked administrative health data. Repeated measures were made for the periods 1-30 days, 31-60 days, 61-90 days, 91-180 days, and 180 and more days from the index date. We used multivariable regression analysis to evaluate the association of COVID-19-related hospitalization with the number of physician visits during follow-up. The study sample included 3397 cases and 6658 controls. Within the first 30 days of follow-up, the case group had 37.12% (95% confidence interval [CI] 35.44% to 38.80%) more patients with physician visits, 11.12% (95% CI 9.77% to 12.46%) more patients with emergency department visits and 2.92% (95% CI 2.08% to 3.76%) more patients with hospital admissions than the control group. New diagnoses involving multiple organ systems were more common in the case group. Regression results indicated that recovering from COVID-19-related hospitalization, admission to an intensive care unit, older age, greater number of comorbidities and more prior health care use were associated with increased physician visits. Patients recovered from the acute phase of COVID-19 continued to have greater health care use up to 6 months after hospital discharge. Research is required to further explore the effect of post-COVID-19 conditions, pre-existing health conditions and health-seeking behaviours on health care use.

Healthcare utilisation in patients with long-term conditions during the COVID-19 pandemic: a population-based observational study of all patients across Greater Manchester, UK

ObjectivesData on population healthcare utilisation (HCU) across both primary and secondary care during the COVID-19 pandemic are lacking. We describe primary and secondary HCU stratified by long-term conditions (LTCs) and...

Value of embedded palliative care: outpatient palliative care and health care utilization for patients with hematologic malignancies.

Value of embedded palliative care: outpatient palliative care and health care utilization for patients with hematologic malignancies.

Claims data analysis of the health care utilization for patients with coronary heart disease and mental comorbidity

ObjectiveMental disorders (MD) are a common comorbidity in patients with coronary heart disease (CHD) and have a significant impact on morbidity and mortality. The aim of this study was to determine to what extent mental disorders are diagnosed as comorbidity in patients with CHD and whether adequate therapeutic measures are taken. MethodsClaims data from 4435 Cologne citizens with diagnosed CHD and a hospital stay due to CHD in 2015 were examined through a longitudinal analysis. The data were analyzed descriptively with regard to mental disorders, investigating diagnostic examinations performed, prescriptions for psychotropic drugs, and utilization of psychotherapy. We differentiated between pre-existing MD, existing in the year before the CHD-related hospital stay, and incident MD with new onset during or within six months after hospitalization. ResultsPsychodiagnostic examinations for mental disorders occurred very rarely during cardiological hospitalization (0.04%) and psychiatric/psychosomatic consultation sessions rarely (5%). The longitudinal analysis showed a high rate of pre-existing MDs (56%, n = 2490) and a new diagnosis of mental disorders in 7% (n = 302) of the patients. Within one year after inpatient treatment for CHD, psychotropic medication was prescribed in 64–67% of patients with newly diagnosed affective or neurotic, adjustment/somatoform disorder and 10–13% received outpatient psychotherapy. ConclusionThe results indicate low rates of inpatient diagnostic examinations and low rates of adequate treatment of mental disorders in patients from Cologne with CHD and new onset mental disorders. The rate of prescriptions of psychopharmacotherapy after hospitalization due to CHD exceeds that of the utilization of outpatient psychotherapy.

Pain Biomarkers in Fibromyalgia Syndrome: Current Understanding and Future Directions.

Fibromyalgia is a complex and heterogeneous clinical syndrome, mainly characterized by the presence of widespread pain, possibly associated with a variety of other symptoms. Fibromyalgia can have an extremely negative impact on the psychological, physical and social lives of people affected, sometimes causing patients to experience dramatically impaired quality of life. Nowadays, the diagnosis of fibromyalgia is still clinical, thus favoring diagnostic uncertainties and making its clear identification challenging to establish, especially in primary care centers. These difficulties lead patients to undergo innumerable clinical visits, investigations and specialist consultations, thus increasing their stress, frustration and even dissatisfaction. Unfortunately, research over the last 25 years regarding a specific biomarker for the diagnosis of fibromyalgia has been fruitless. The discovery of a reliable biomarker for fibromyalgia syndrome would be a critical step towards the early identification of this condition, not only reducing patient healthcare utilization and diagnostic test execution but also providing early intervention with guideline-based treatments. This narrative article reviews different metabolite alterations proposed as possible biomarkers for fibromyalgia, focusing on their associations with clinical evidence of pain, and highlights some new, promising areas of research in this context. Nevertheless, none of the analyzed metabolites emerge as sufficiently reliable to be validated as a diagnostic biomarker. Given the complexity of this syndrome, in the future, a panel of biomarkers, including subtype-specific biomarkers, could be considered as an interesting alternative research area.

Effect of Telemedicine Use on Medical Spending and Health Care Utilization: A Machine Learning Approach

This study analyzes the effect of telemedicine use on healthcare utilization and medical spending for patients with chronic mental illness. Using the IBM MarketScanResearch database from 2009 to 2018, this study examined the timing of users' first telemedicine use and identified similar periods for non-users by using random forest and random forest proximity matching. A difference-in-differences approach, which tests whether there are differences in the study outcomes before and after the actual/predicted first use among the treated group (users) compared with the control group (non-users), was then used to assess the impact of telemedicine. Analyses were done in 2021. Comparing users with non-users after matching suggested that telemedicine use both increases the number of overall outpatient visits (0.461; 95% CI=0.280, 0.642; p<0.001) related to psychotherapy and evaluation and management services, and decreases the number of in-person visits (0.280; 95% CI= -0.446, -0.114; p=0.001) for patients with chronic mental health diagnoses. Total medical spending was not significantly affected. Additionally, no evidence was found of telemedicine use being associated with an increased probability of an emergency department visit or hospitalization. The study findings suggest that telemedicine use is associated with an increase in outpatient care utilization for patients with chronic mental health diagnoses. No substantive changes in medical spending, the probability of an emergency department visit, or the probability of hospitalization were noted. Results provide insights into the effect of telemedicine use on spending and healthcare utilization for patients with chronic mental illness. These findings may inform research to guide future telemedicine policies and interventions.

Effect of Biologics on the Need for Procedural Interventions, Systemic Medications, and Healthcare Utilization in Patients with Hidradenitis Suppurativa: Real-World Data from the UNITE Registry.

Management of hidradenitis suppurativa (HS) often requires a combined medical/procedural approach. Biologics are frequently reserved for severe cases after irreversible tissue damage has occurred. We evaluated the association between consistent biologic use and the need for procedural interventions, systemic medications, and healthcare utilization. UNITE, a 4-year, global, prospective, observational, HS disease registry, documented the natural history, diagnostic/treatment patterns, and clinical outcomes of HS. Patients aged 12years or more, with active HS were enrolled between October 2013 and December 2015 and evaluated every 6months for 48months at 73 sites across 12 countries (data cutoff December 2019). Proportions of patients requiring different HS procedures, systemic medications, and healthcare utilization were assessed during the 6-month periods before, during, and after biologic initiation for 12weeks or more (i.e., consistent use). There were 63 instances of initiation of consistent biologic use (adalimumab [81%], infliximab [16%], and ustekinumab [3%]) in 57 patients. Patients' mean age was 40years, 58% were female, and 53%/47% had Hurley stageII/III disease, respectively. Fewer patients required surgical/procedural interventions and systemic medications for the 6-month period during/6-month period after biologic initiation versus the 6-month period before biologic initiation, including intralesional corticosteroid injections (22%/14% vs 24%), incision and drainage (I&D) by physician (10%/10% vs 17%), I&D by patient (10%/10% vs 14%), surgical excision (8%/10% vs 11%), deroofing (5%/2% vs 5%), systemic antibiotics (43%/41% vs 54%), and systemic immunosuppressants (10%/6% vs 13%). Fewer patients required hospital admission for HS (17%/13% vs 21%) or emergency department visits for HS (8%/8% vs 16%) during the 6-month periods in which consistent biologics use started and continued versus the 6-month period before consistent biologic use. Following initiation of consistent biologic use (12weeks or more), fewer patients required acute procedural interventions, systemic medications, and healthcare utilization, supporting the importance of early biologic initiation.

#2705 MEDICAL COST AND HEALTHCARE UTILIZATION IN ADULTS WITH CHRONIC KIDNEY DISEASE AND TYPE 2 DIABETES MELLITUS IN A CHINESE REGIONAL DATABASE

Abstract Background and Aims The presence of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM) leads to elevated medical and economic burden, and with CKD progression, the medical expenditure increases substantially. Information about healthcare utilization and medical expenditures of this patient population is limited in China. This study aims to describe the medical cost and healthcare utilization of patients with CKD and T2DM in a regional database in China. Method A retrospective, regional EHR-based serial cross-sectional study was conducted in Yinzhou Regional Healthcare Database (YRHCD), Ningbo, China. All adult patients (age &amp;gt; = 18 years) with CKD and T2DM were collected between 1st Jan 2017 and 31st Dec 2020, patients were excluded if they did not have serum creatinine (SCr) values or initiated renal replacement therapy. Eligible patients were identified at each calendar year and categorified by CKD stages (G1-G5). Data on demographics, comorbidities and drug prescription were presented for all included patients at baseline and from 2017 to 2020. Annual medical costs and healthcare utilization were described among different CKD stages. Two-part models were built to estimate the medical costs and healthcare utilization in each CKD stage. Results A total of 16,521 patients with CKD and T2DM were included with a substantial increase between 2017 and 2020. Among all patients, the majority of them were classified in CKD stage 1 and 2. Over 70% of patients aged 65 years or older and approximately 55% were female. &amp;gt;90% of patients had hypertension, followed by peripheral vascular diseases, which increased from 69.2% in 2017 to 82.2% in 2020. Renin–angiotensin system inhibitors (RASI) were the most prescribed medication and metformin ranked the second. In general, the age, proportion of having comorbidities and proportion of drug prescription presented an increasing trend from 2017 to 2020. The proportion of eGFR value &amp;gt; = 25 and &amp;lt; = 75 mL/min/1.73m2 in G1 to G4 was 64.4% for baseline and decreased from 58.2% in 2017 to 48.7% in 2020. The general trend of medical costs in all CKD stages increased from 2017 to 2020; for healthcare utilization, the average number of outpatient visits per person per year was over 10.0 times per each CKD stage. The medical cost and healthcare utilization increased substantially in patients with more advanced CKD stages. Mean annual medical costs per patients were 6,084, 8,675, 14,291, 24,971 and 42,580 CNY (908, 1,294, 2,132, 3,726 and 6,353 USD) and the mean length of stay were 2.2, 3.3, 6.2, 12.6 and 16.1 days for G1-5 patients respectively in 2020. Patients in G1 and G2 had more outpatient visits compared with hospitalization, the cost of hospitalization raised dramatically in patients with G4-G5 and became a main contributor of total medical cost. Conclusion Our contemporary study revealed the medical cost and use of healthcare resources increased moderately over time in earlier CKD stages but grew remarkably from G4 stage onwards. The estimates suggested significant correlation between CKD stages and medical costs and healthcare utilization. Our findings further suggest earlier CKD identification and timely treatment may reduce the overall medical and economic burden in this population.

Managed care considerations to improve health care utilization for patients with ALS.

Amyotrophic lateral sclerosis (ALS) is a fatally progressive degenerative disease, with many patients succumbing to the condition within 3 to 5 years after diagnosis. It is a rare, orphan disease with an estimated US prevalence of 25,000 patients. Patients with ALS and their caregivers are faced with a substantial financial burden as a result of the condition, as ALS has an estimated national financial burden of $1.03 billion. A significant driver of the patient financial burden includes the continued need for caregiver support as the weakening of muscles progresses to dysphagia and dyspnea, making it difficult to complete activities of daily living as the disease progresses. Caregivers also experience financial burdens, as well as feelings of anxiety, depression, and decreased quality of life. In addition to needed caregiver support, patients with ALS and their families also incur substantial nonmedical costs including travel expenses, home modifications such as ramps, and indirect costs such as productivity loss. Due to the wide range of clinical symptoms that patients may exhibit when first presenting with ALS symptoms, diagnosis is often delayed, which negatively affects patient outcomes and impacts missed opportunity for clinical trial recruitment aimed at developing new disease-modifying therapies. Additionally, delay in diagnosis and referral to ALS treatment centers results in increased overall health care costs. Telemedicine may be a tool used to promote timely care from an ALS treatment center in addition to clinical trial participation for those patients who cannot overcome mobility barriers for care. Currently, 4 therapies are approved for the treatment of ALS. Riluzole has demonstrated modest improvement in survival. Other recently approved therapies include oral edaravone, a combination therapy of sodium phenylbutyrate and taurursodiol (PB/TURSO), and tofersen, which is administered intrathecally and approved under an accelerated approval. Long-term studies have shown PB/TURSO to have a dual benefit on survival and function. The Institute for Clinical and Economic Review (ICER) 2022 Evidence Report for ALS does not value the high price points of edaravone and PB/TURSO as cost-effective based on the current evidence, despite valuing the need for new treatment options for this patient population.

RWD166 Comparative Real-World Retrospective Data Analysis of Comorbid Conditions and Healthcare Utilization for Patients with Myotonic Dystrophy over a 5-Year Timeframe

Myotonic dystrophy (DM) types 1 and 2 are rare, dominantly inherited, multisystem diseases that cause progressive muscle weakness and myotonia, along with variable cardiopulmonary, gastrointestinal, and neurological manifestations. Long-term data on patients with DM are limited. This research describes the management of DM patients compared with matched controls (MCs) in the five-years post-diagnosis.

Electronic frailty index to assess post-operative healthcare utilization in veterans with non-metastatic colon cancer.

e15642 Background: Frailty is a measure of physiologic reserve and is associated with adverse perioperative outcomes in patients with cancer. Existing surgical frailty measures, such as the 11-factor and 5-factor modified frailty index, may not be routinely utilized due to time constraints. Electronic Frailty Index (EFI) serves as an efficient and automated alternative. There is limited data for the use of EFI in assessment of post-operative healthcare utilization in patients with non-metastatic colon cancer. Methods: We performed a retrospective cohort study using VA administrative files from 2016 -2020 and VA Central Cancer Registry. EFI was calculated based on the Veterans Affairs-FI (VA-FI), a validated 31-item cumulative deficit FI, to define three groups: robust (≤ 0.1), prefrail (0.1 - 0.2), and frail ( &gt; 0.2). Cox proportional hazard analyses were conducted to evaluate survival. Logistic regression analyses were performed to examine healthcare utilization. All models were adjusted for age, gender, race, stage, and Charlson Comorbidity Index. Confidence intervals (CI) were calculated as 95%. Results: Among 2,861 patients (median age 70.7 ± 9.1 years) with stage I – III colon cancer who underwent surgery, 42.5% were robust, 36.6% were prefrail, and 20.8% were frail. The cohort was comprised of stage I (32.9%), stage II (34.9%), and stage III (32.2%) cases. Prefrail patients were at increased odds of emergency room (ER)/urgent care (UC) use at one year (adjusted odds ratio [aOR] 1.41, CI 1.09 – 1.83) compared to robust patients. Frail patients had an increased odds of ER/UC visits at 30 days (aOR 1.95, CI 1.19 - 3.20), 60 days (aOR 2.18, CI 1.42 - 3.34), and one year (aOR 2.79, CI 2.06 - 3.78). Increased risk of death was found in prefrail (adjusted hazard ratio [aHR] 1.34; CI 1.12 - 1.59) and frail (aHR 2.38; CI 1.97 - 2.86) patients when compared to robust patients. Conclusions: EFI was significantly associated with higher ER/UC utilization among frail patients with colon cancer who received curative intent surgery, independent of stage. Pre-frail and frail patients had worse survival outcomes compared to robust patients. Further work is needed to develop EFI as a risk-stratification tool in curative intent patients with colon cancer prior to surgery.

Patient- and clinician-directed implementation strategies to improve serious illness communication for high-risk patients with cancer: A cluster-randomized pragmatic trial.

1514 Background: Early serious illness conversations (SICs) elicit patients’ values, goals, and care preferences and have been shown to improve outcomes and reduce end-of-life healthcare utilization for patients with cancer. However, most patients with cancer die without a documented SIC. Given prior evidence that strategies informed by behavioral economics (“nudges”) increase SIC rates, our objective was to test the independent and additive effects of clinician- and patient-directed nudges to increase SIC completion. Methods: We conducted a 2 × 2 factorial, cluster-randomized pragmatic trial (NCT04867850) to test the effects of nudges to clinicians, patients, or both, compared to usual care, on SIC completion. Usual care was an active control consisting of clinician-directed text messages sent before routine clinic sessions, identifying patients at high risk of 6-month mortality as predicted by a validated machine-learning prognostic algorithm. The clinician nudge additionally included weekly peer comparisons on clinician-level SIC completion rates. The patient nudge consisted of a patient-facing message sent electronically before an index clinic visit, asking a 3-question survey designed to prime patients for an SIC with their oncology team. Participants included medical/gynecologic oncologists and advanced practice providers (APPs) within a large academic health system and their high-risk patients. We independently randomized oncologist/APP clusters and patients to receive nudges vs. usual care. The primary outcome was a documented SIC in the electronic health record within 6 months of enrollment. Using a Cox proportional hazards model with cluster robust standard errors, we performed a time-to-event analysis and tested for heterogeneity of effect across prespecified subgroups. Results: From September 2021 to March 2022, the study accrued 4,450 patients (median age 67, 52.9% female, 17.3% Black, 2.7% Hispanic) seen by 166 clinicians across 4 hospitals and 6 community sites, randomized to clinician nudge (n=1,179), patient nudge (n=997), both (n=1,270), or active control (n=1,004). Overall patient-level rates of 6-month SIC completion were: 11.5% (clinician nudge), 11.5% (patient nudge), 14.1% (both), and 11.2% (active control). Compared to the active control, participants in the combination nudge arm were more likely to engage in SICs (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.00-2.40), whereas those in the clinician (HR 0.95, 95% CI 0.64-1.41) and patient (HR 0.99, 95% CI 0.73-1.33) nudge arms were not. There was no effect heterogeneity across age and race subgroups. Conclusions: Clinician- and patient-directed nudges may be synergistic in promoting serious illness communication at scale and equitably in routine cancer care. Effects on end-of-life care among decedents are forthcoming. Clinical trial information: NCT04867850 .

Role of social disparity in 30-day readmissions and healthcare utilization in patients with history of sickle cell crisis in United States: Cross-sectional analysis from US national database.

e18666 Background: Factors like age, mental status, spirituality, financial security, and clinic attendance affect hospital admissions/readmissions in sickle cell disease patients. To further understand the predisposing factors associated with increased readmissions in sickle cell disease patients, this study examined the relationship between readmission rates and socioeconomic status of Sickle cell patients in the US. Methods: All adult hospitalized patients in the Nationwide Readmission Database (NRD) for the year 2019 were captured. The sample population included all patients with primary diagnosis of Sickle cell crisis, identified using ICD-10 codes (International Classification of Diseases, tenth edition). We used the Wilcoxon rank sum test to compare continuous variables and chi square test for categorical variables. Predictors of readmission were analyzed using multivariate logistic regression models. We used StataCorp LLC MP4 17 version to perform statistical analysis. Results: The sample size included 48,715 patients admitted with sickle cell crisis, of which 55.12% were females and 44.88% were males. The mean age of presentation was 32.84 years. The rate of all cause 30-day readmission in patients admitted with Sickle cell crisis was 27.19%. The total hospital charges for these readmitted patients during the year 2019 was 507 million dollars and total length of stay was 69,418 days (about 190 years). The most common causes of readmissions were Sickle cell crisis including Acute chest syndrome and splenic sequestration crisis, followed by sepsis due to MRSA and femoral fractures. After adjusting for confounders on multivariate analysis, compared to patients belonging to income category 1 ( &lt; $46,000), patients in category 2 ($46,000-$58,999) had 11% lower risk (p-value 0.018) and category 3 had 16% lower risk (p-value 0.008) of 30-day readmission. However, there was no increased risk of death based on socioeconomic status (OR 1.03, p-value 0.875). Conclusions: Our study concludes that socioeconomically deprived Sickle cell crisis patients are at higher risk of readmissions. Factors like poor living situation, lack of means for transportation, potential lower level of education leading to decreased medication compliance and clinic follow ups could be attributed to these findings. Interventions targeting this population can help reduce healthcare burden and patient morbidity significantly. [Table: see text]

CO218 Characteristics and Healthcare Utilization of Patients with Myasthenia Gravis Who Developed Exacerbation

Our study aimed to describe the characteristics of patients with myasthenia gravis (MG) who developed exacerbation (MG-E) and compare their healthcare utilization (HRU) to those with MG who did not experience exacerbation (MG-O).

EE186 Healthcare Utilization of Patients with Hypereosinophilic Syndrome in Europe

Hypereosinophilic syndrome (HES) is a rare group of blood disorders characterized by prolonged eosinophilia leading to tissue and organ damage. Healthcare resource utilization (HCRU) in patients with HES is not well characterized, and clinical trial data may not be representative of the real-world population. This analysis aimed to describe real-world HES-related HCRU in European patients.

Healthcare utilization among individuals diagnosed with hereditary breast-ovarian cancer syndrome through a universal germline genetic testing program.

10604 Background: Most individuals with Hereditary Breast-Ovarian Cancer Syndrome (HBOC) are unaware of their risk. Criteria-based testing will not close this gap as it fails to identify ~50% of mutation carriers. Universal germline testing (GT) in oncology stands to identify more mutation carriers and advance cancer control. However, the clinical utility of universal germline testing is unknown. Methods: The City of Hope INSPIRE study offers all consented patients GT for cancer susceptibility (155 genes) and actionable disorders (59 genes). We used an informatics approach to evaluate healthcare utilization for patients found to have BRCA1/ BRCA2 mutations. We queried codified data in our electronic data warehouse before and after GT (post testing interval: 1-29 months). We binned care as possibly related/ not related to HBOC based on NCCN guidelines. Results: Of 10,814 patients who had GT, 217 (2%) had a pathogenic/ likely pathogenic mutation in either BRCA1 or BRCA 2. The demographic distribution of mutation carriers was: white (n = 162, 75%), Asian (n = 28, 13%), Hispanic (n = 65, 30%); female (n = 184, 85%); the mean age was 54 yrs. Eighty-four percent (n = 182) had cancer, including 64% with cancers associated with HBOC (breast 40%, ovarian 13%, pancreatic 3%, 5% prostate, and 0.5% melanoma) and 18% with cancers that are not associated with HBOC. Eighty-three percent of patients had procedures, imaging, and/or therapy potentially related to the BRCA mutation. Eighty-six percent of cancer patients had potentially related care. As expected, use of breast MRI, mammography, MRCP, mastectomy, and bilateral salpingo-oophorectomy (BSO) occurred both before and after testing, with most utilization occurring prior to GT and likely related to cancer staging and treatment. The exception was MRCP which occurred more often following GT (0.6% before vs 1.2% after). Fifty-one (28%) cancer patients received PARP inhibitors. In the unaffected cohort, 67% of patients received possibly related care. Use of mammography was higher prior to GT (7% vs 2%). Consistent with the fact that some unaffected patients were likely known mutation carriers prior to consent, mastectomy was higher prior to GT (5% vs 0%) and BSO was equivalent before and after GT (1.8%). Use of breast MRI (9% vs 15%), MRCP (1.8% vs 3%) and transvaginal US (5% vs 7%) were all higher after GT. Conclusions: We found high levels of relevant healthcare utilization for BRCA mutation carriers in the context of universal GT. However, this initial informatics approach is limited because key information on prior GT and motivations for surgery (e.g., therapeutic vs prophylactic mastectomy) are not adequately captured in codified data. Codified EHR queries will need to be augmented by text mining and/or manual chart review to fully capture care and assess the clinical utility of system-wide genetic care delivery interventions.