Large Urban Safety-net Hospital Research Articles

Implementation of an Opt-Out Outpatient HIV Screening Program.

Screening rates for Human Immunodeficiency Virus (HIV) remain low despite guidelines by both the CDC and USPSTF recommending that all adolescents and adults be screened at least once. The aim of this quality improvement study was to increase HIV screening among eligible patients. This quality improvement study assessed the impact of interventions to increase HIV screening in an outpatient population at a large urban safety-net hospital. Outcomes were compared from the preintervention (December 2020 to November 2021) to postintervention years (December 2021 to November 2022). Stepwise electronic alerts to prompt HIV screening paired with provider financial incentives were implemented. The proportion of eligible individuals screened for HIV were compared after intervention implementation. Average monthly HIV screening increased from 506 ± 97 to 2484 ± 663 between the pre- and postintervention periods, correlating to a 5.1-fold increase in screening (7.8% to 39.8%, P < .01). Increases were seen across all ages, and those aged 55 to 64 and 65+ had the highest relative increase in screening at 7.5 and 9.3-fold, respectively (P < .01). Screening rates increased for Hispanics (7.9% preintervention vs 43.6% postintervention, P < .01). In the pre- and postintervention periods, 41 patients with new HIV diagnoses were identified (13 preintervention and 28 postintervention) and 85.4% were linked to care within 30 days. Stepwise interventions targeted at primary care clinicians are an effective way to increase HIV screening rates, particularly in older demographics. Earlier HIV diagnosis coupled with linkage to care is an important strategy in ending the HIV epidemic.

Primary Care After Pregnancy Survey: Patient Preferences, Health Concerns, and Anticipated Barriers.

Despite recommendations for ongoing care after pregnancy, many individuals do not see a primary care clinician within the first postpartum year, missing a critical window to engage reproductive-age individuals in primary care. We administered an anonymous, cross-sectional, trilingual survey at a large urban safety-net hospital to assess postpartum individuals' preferences, health concerns, and anticipated barriers to primary care during the year after pregnancy. While 90% of respondents preferred a visit within one year, most individuals - including those with complicated pregnancies - did not recall a primary care recommendation from their pregnancy care team. Respondents reported a variety of primary care-amenable health concerns, and many social and logistical barriers to care. Preference for virtual care increased if self-monitoring tools were hypothetically available, indicating virtual visits may improve primary care access.

Lower Admission Prealbumin and Albumin Levels in Unhoused Burn Patients Is a Marker for Poorer Outcomes.

Unhoused (UH) individuals experience burn injuries at a higher rate than domiciled individuals, and have poorer outcomes following injuries. One such mechanism proposed for worsened outcomes is secondary to poor nutrition. Access to proper nutrition and food insecurity are major barriers. Malnutrition has been shown to decrease wound tensile strength, increase infection rates, and prolong healing. The purpose of this study was to understand if albumin and prealbumin could help determine outcomes in UH patients and identify at-risk patients earlier in their hospital course. A retrospective chart review was conducted of UH patients from 2015 through 2023 at a large urban safety net hospital. Data collected included admission laboratory values including albumin and prealbumin. Outcomes studied included length of stay (LOS), Intensive Care Unit (ICU) days, ventilator days, and mortality. Data analysis for the effect of albumin and prealbumin included a zero-truncated negative binomial model for LOS, a negative binomial hurdle model for ICU LOS and ventilator days, and logistic regression for mortality. Three hundred and eighty-five patients met inclusion criteria and of these, 366 had albumin and 361 had prealbumin information. Adjusting for age, gender, and total body surface area, the fewest days in the hospital and lowest odds of admission to the ICU occurred for those with admission albumin values of approximately 3.4-3.5 g/dL. Each unit (g/dL) decrease in albumin was associated with 3.19 times the odds of death (95% CI: 1.42, 7.69). Each unit (mg/dL) decrease in prealbumin was associated with 1.19 times the odds of death (95% CI: 1.06, 1.35). Decreased admission albumin and prealbumin levels are associated with worse burn outcomes in UH patients. These nutritional biomarkers may aid in determining which UH patients are suffering from food insecurity at injury onset. Obtaining these values on admission may help burn providers target nutritional goals in their most vulnerable patients.

Barriers to electronic prescribing of controlled substance, especially opioids.

Electronic prescriptions are now the standard of practice for all discharge and outpatient prescriptions. The intention is to increase patient safety, provide a more complete medication record for patients, lessen the burden on prescribers, and shorten the time it takes for medication orders to reach the pharmacy. This cross-sectional questionnaire survey study was conducted between January and August 2022 in three areas of a large urban safety net hospital. A large single academic medical center. Emergency department, inpatient clinicians, and procedural areas. The subjects of the study were trainees, attending physicians, and advance practice providers (APPs) Interventions: Data were collected from the participants using a self-reported questionnaire, including sociodemographic characteristics, ease of use, reliability, and preference. Additionally, the perception of the strengths and limitations associated with electronic prescribing (e-prescribing) were analyzed. The purpose of this study was to evaluate the barriers to e-prescribing of opioids. A total of 121 prescribers completed the survey. The majority trusted that e-prescribing were transmitted successfully (62 percent), saved time (78 percent), and did not interrupt their workflow (78 percent). However, many prescribers indicated that additional improvements are needed, such as updating the patient's preferred pharmacy in the electronic medical record during each visit (52 percent) and having a 24-hour pharmacy readily available (66 percent). Prescribers value the ease of use of e-prescribing and how time efficient the process can be. Nevertheless, there is a need to improve the system's service, design, and usefulness.

Abstract 17034: Outpatient Effort to Improve Medication Uptitration and Maintenance (OPTIMUM)

Introduction: Guideline-directed medical therapy (GDMT) reduces morbidity and mortality for patients with heart failure with reduced ejection fraction (HFrEF) starting as early as 30-days from initiation. Rapid GDMT titration programs have been shown to be effective in clinical trials. We evaluated the feasibility of a rapid GDMT clinical program in a safety-net population with HFrEF. Methods: Patients admitted to a large urban safety net hospital with newly diagnosed HFrEF (LVEF &lt;40%) were eligible for the program. Patients with end-stage renal disease, history of cardiogenic shock, or current homelessness were excluded. The 6-week program consisted of alternating in-person heart failure clinic visits and virtual visits with a multidisciplinary team of pharmacists, nurses, and physicians to adjust medications and to provide heart failure education. Intensities of GDMT prescription at the start of the program and at 3 months were compared using an institutional GDMT score ranging from 0-11 which accounts for drug classes (beta-blocker, ACE/ARB/ARNI, MRA, SGLT2i) and percent of target doses prescribed (Figure, panel A). Results: This pilot enrolled 20 patients (mean age 58.0 +/- 15.6 years, 35% women, 25% Black, 75% Hispanic). At enrollment, patients had an average GDMT score of 5.5 on 2.9 classes of GDMT. At week 6, 15 (75%) patients were prescribed all 4 classes of GDMT with a 2.7 increase in the GDMT score for an average score of 8.2 (Figure, panel B).This was sustained at 3 months. There were no safety events requiring ED visits or hospitalization during the program duration. Conclusions: In a safety-net health system caring for the urban poor, rapid GDMT up titration was feasible and resulted in increased GDMT intensity without clinical adverse events. Our experience supports the development of rapid GDMT titration programs even in clinical settings and patient populations which differ from those enrolled in clinical trials.

PERT era, race-based healthcare disparities in a large urban safety net hospital.

Pulmonary embolism (PE) is the third leading cause of cardiovascular death in the United States. Black Americans have higher incidence, greater clot severity, and worse outcomes than White Americans. This disparity is not fully understood, especially in the context of the advent of PE response teams (PERT), which aim to standardize PE-relatedcare. This retrospective single-center cohort study compared 294 Black and 131 White patients from our institution's PERT database. Primary objectives included severity and in-hospital management. Secondary outcomes included length of stay, 30-day readmission, 30-day mortality, and outpatient follow-up. Clot (p = 0.42), acute treatment (p = 0.28), 30-day mortality (p = 0.77), 30-day readmission (p = 0.50), and outpatient follow-up (p = 0.98) were similar between races. Black patients had a lower mean household income ($35,383, SD 20,596) than White patients ($63,396, SD 32,987) (p < 0.0001). More Black patients (78.8%) had exclusively government insurance (Medicare/Medicaid) compared to White patients (61.8%) (p = 0.006). Interestingly, government insurance patients had less follow-up (58.3%) than private insurance patients (79.7%) (p = 0.001). Notably, patients with follow-up had fewer 30-day readmissions. Specifically, 12.2% of patients with follow-up were readmitted compared to 22.2% of patients without follow-up (p = 0.008). There were no significant differences in PE severity, in-hospital treatment, mortality, or readmissions between Black and White patients. However, patients with government insurance had less follow-up and more readmissions, indicating a socioeconomic disparity. Access barriers such as health literacy, treatment cost, and transportation may contribute to this inequity. Improving access to follow-up care may reduce the disparity in PE outcomes.

Accelerated Fentanyl Metabolism During Pregnancy and Impact on Prenatal Drug Testing.

To evaluate the metabolic pattern of illicit fentanyl in a sample of pregnant patients with opioid use disorder. Fentanyl pharmacokinetics during pregnancy are currently understudied yet the interpretation of a fentanyl immunoassay during pregnancy has significant implications on maternal legal custody and child welfare. Through this medical-legal lens, we demonstrate the utility of an emerging metric, the metabolic ratio, for accurate analysis of fentanyl pharmacokinetics during pregnancy. We conducted a retrospective cohort analysis using the electronic medical records of 420 patients receiving integrated prenatal and opioid use disorder care at a large urban safety net hospital. Data related to maternal health and substance use were collected for each subject. The metabolic ratio was calculated for each subject to measure their rate of metabolism. The sample's (n = 112) metabolic ratios were compared with a large non-pregnant sample (n = 4366). The metabolic ratios of our pregnant sample were significantly (p = .0001) higher than the metabolic ratios of our non-pregnant sample, indicating that the rate of conversion to the major metabolite was faster in pregnant people. The effect size for this difference between the pregnant and non-pregnant sample was large (d = 0.86). Our findings characterize the unique metabolic pattern of fentanyl in pregnant people who use opioids, providing guidance for institutional policies around fentanyl drug testing. Additionally, our study warns of misinterpretation of toxicology results and stresses the importance of physician advocacy on behalf of pregnant women who use illicit opioids.

Sociodemographic and clinicopathologic factors of triple negative breast cancer at an academic urban safety-net hospital.

1090 Background: Racial disparities in breast cancer in the United States is a persistent and ongoing problem. Decades of research is derived from large population based data sets and little is published with granular detail of specific, actionable factors to target for interventions. From a large urban safety-net hospital, we evaluate sociodemographic and clinicopathologic factors on survival outcomes of triple negative breast cancer. Methods: We conducted a single-institution retrospective study of patients with invasive breast cancer, diagnosed and treated between January 2010 and December 2021 at an academic safety-net hospital where insurance systems allow for access and treatment for all patients. Demographic, tumor and treatment characteristics were obtained. Chi-square and ANOVA were used to examine associated factors among White, Black, and other races. Survival was analyzed using the Kaplan-Meier estimator and log-rank test. Significant risk factors were identified with Cox regression analysis. Results: 251 women with invasive triple negative breast cancer were diagnosed and treated during the study period. Median age was 58 years, 68.9% were non-white, and 64.9% were publicly insured or uninsured patients. Median time from diagnosis to treatment initiation was 29 days and follow up period was 1392 days. Having a non-English primary language and living in areas with lower socioeconomic indices are observed in non-White patients (P=0.003, 0.033) and predictive of a higher clinical stage at presentation (P=0.011, 0.021). Black patients were diagnosed at higher histologic grade (Black: 82.4%, White: 79.7%; P=0.003) and White patients were more likely to change facility during the treatment course (White: 32.4%, Black: 16.03%; P=0.005). No significant racial disparities were observed in time to treatment, recurrence rate, and overall survival. Among patients indicated for adjuvant therapies, including chemotherapy, immunotherapy, and radiation, rates of recommendation and completion of therapy did not vary by race. Five year survival did not significantly vary by race when adjusted for demographic and clinicopathologic factors. Conclusions: At an academic urban safety-net hospital where access to diagnostic and treatment resources are comparable across patient populations, no racial disparities were seen in treatment, recurrence, and survival outcomes. Further research on racial differences in breast cancer biology and health behaviors may improve understanding of triple negative disease or mitigate later stage diagnosis.

Implementation of Sexual Health Curriculum Series: Educational Initiative to Increase STI Screening and Treatment in Dallas, Texas.

A new monthly virtual education curriculum on sexual healthcare was launched in 2021. This is an analysis of the pilot education series designed to increase primary care providers' knowledge of sexual health best practices including taking thorough sexual histories, STI screening and treatment, and PrEP prescribing. A Sexual Health Curriculum Series was developed as part of a quality improvement initiative at a large urban safety-net hospital in Dallas County, Texas. Didactic sessions were administered to primary care providers and staff via a virtual meeting platform once a month from May 2021 to April 2022. A total of 52 participants completed the pre-series survey, and 21 participants filled out the final post-series survey. 70% of respondents who completed the post-series survey reported that they learned new information that was incorporated into their practice. The average percentage correct on individual pre-session surveys was 60% compared to 63% on individual post-session surveys (p = 0.03). Sexual health education is an important tool to help primary care providers adhere to sexual health best practices. There is a need for ongoing implementation of innovative strategies to improve knowledge and adherence to sexual health best practices. A sexual health curriculum may be effective in helping primary providers recognize patients at increased risk and apply evidence-based guidelines to their practices.

Identifying Populations at Risk for Difficulty Managing Emotions and Social Interactions After Burn Injury.

There has been conflicting data on the relationship between burn severity and psychological outcomes. The present study aims to characterize the baseline psychosocial disposition of adults attending outpatient burn clinic at a large urban safety net hospital, as well as the impact of clinical course on self-reported psychosocial well-being. Adult patients attending outpatient burn clinic completed survey questions from the National Institutes of Health Patient-Reported Outcomes Measurement Information System Managing Chronic Conditions: Self-Efficacy for Managing Social Interactions (SEMSI-4) and Managing Emotions (SEME). Sociodemographic variables were collected from surveys and retrospective chart review. Clinical variables included total body surface area burned, initial hospital length of stay, surgical history, and days since injury. Poverty level was estimated by U.S. census data using patient's home ZIP code. Scores on SEME-4 and SEMSI-4 were compared to the population mean by one-sample T-test, and independent variables evaluated for associations with managing emotions and social interactions by Tobit regression while adjusting for demographic variables. The 71 burn patients surveyed had lower scores in SEMSI-4 (mean = 48.0, P = .041) but not SEME-4 (mean = 50.9, P = .394) versus the general population. Marital status and neighborhood poverty level were associated with SEMSI-4, while length of stay and % total body surface area burned were associated with SEME-4. Patients who are single or from poorer neighborhoods may have difficulty interacting with their environment after burn injury and need extra social support. Prolonged hospitalization and increased severity of burn injury may have more impact on emotional regulation; these patients may benefit from psychotherapy during recovery.

Disparities in presentation and management of chronic hepatitis B among Hispanics in a diverse safety net system.

Chronic hepatitis B (HBV) prevalence is highest in foreign-born Asian and African individuals in the US, though Hispanics make up the largest proportion of the immigrant population. Differences in the diagnosis and management of chronic HBV in Hispanics might exist due to the lower awareness of risk. We aim to examine racial/ethnic disparities in the diagnosis, presentation, and immediate management of chronic HBV in a diverse safety net system enriched for Hispanics. In a large urban safety-net hospital system, we retrospectively identified patients with chronic HBV by serological data and categorized them into mutually exclusive self-identified racial/ethnic groups: Hispanics, Asians, Blacks, and Whites. We then examined differences in screening, disease phenotype and severity, follow-up testing, and referral by race/ethnicity. Among 1063 patients, 302 (28%) were Hispanics, 569 (54%) Asians, 161 (15%) Blacks, and 31 (3%) Whites. More Hispanics (30%) were screened in the acute setting (defined as inpatient or emergency department encounters) than Asians (13%), Blacks (17%), or Whites (23%) (p<0.01). Hispanics also had lower rates of follow-up testing after HBV diagnosis than Asians including HBeAg status (43% vs. 60%, p<0.01) and HBV DNA levels (42% vs. 58%, p<0.01) and lower rates of linkage to specialty care (32% vs. 55%, p<0.01). Among those with available testing, however, the presence of immune-active chronic HBV was infrequent and similar across racial/ethnic groups. 25% of Hispanics had cirrhosis at initial presentation, proportionally higher than other groups (p<0.01). Our results underscore the importance of raising chronic HBV awareness and increasing both screening and linkage to care among Hispanic immigrants in addition to the existing risk groups, with the goal of mitigating downstream liver-related complications.

Race and Ethnicity Influences Outcomes of Adult Burn Patients.

Outcomes of burn survivors is a growing field of interest; however, there is little data comparing the outcomes of burn survivors by ethnicity. This study seeks to identify any inequities in burn outcomes by racial and ethnic groups. A retrospective chart review of an ABA Certified burn center at a large urban safety net hospital identified adult inpatient admissions from 2015 to 2019. A total of 1142 patients were categorized by primary ethnicity: 142 black or African American, 72 Asian, 479 Hispanic or Latino, 90 white, 215 other, and 144 patients whose race or ethnicity was unrecorded. Multivariable analyses evaluated the relationship between race and ethnicity and outcomes. Covariate confounders were controlled by adjustment of demographic, social, and prehospital clinical factors to isolate differences that might not be explained by other factors. After controlling for covariates, black patients had 29% longer hospital stays (P = .043). Hispanic patients were more likely to be discharged to home or to hospice care (P = .005). Hispanic ethnicity was associated with a 44% decrease in the odds of discharge to acute care, inpatient rehabilitation, or a ward outside the burn unit (P = .022). Black and Hispanic patients had a higher relative chance of having publicly assisted insurance, versus private insurance, than their white counterparts (P = .041, P = .011 respectively). The causes of these inequities are indeterminate. They may stem from socioeconomic status not entirely accounted for, ethnic differences in comorbidity related to stressors, or inequity in health care delivery.

Improving access to minimally invasive gynecologic surgery: trends in route of hysterectomy and clinical outcomes at a large urban safety-net hospital

Improving access to minimally invasive gynecologic surgery: trends in route of hysterectomy and clinical outcomes at a large urban safety-net hospital

Prepregnancy Cardiovascular Disease Risk Factors and Adverse Pregnancy Outcomes in a Safety-Net Hospital.

Background: Many adverse pregnancy outcomes (APOs) are associated with elevated cardiovascular disease (CVD) risk. However, APO data in the context of pre-existing CVD risk factors, and from diverse populations, are limited. We assessed the occurrence of APOs among individuals with and without prepregnancy CVD risk factors, overall and by race/ethnicity. Methods: We conducted a retrospective study using electronic medical record data from a large urban safety-net hospital. Individuals with prenatal care and delivery between 2016 and 2018 at the hospital were included, and data from prenatal intake through the delivery hospitalization were captured. The exposure, prepregnancy CVD risk factors (hypertension, diabetes, tobacco use, and obesity), and the outcome, APOs (hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, low birth weight, and stillbirth), were identified from electronic medical records. Results: We identified 3760 unique delivering individuals, of whom 55.1% self-identified as Black non-Hispanic and 17% as Hispanic. Prepregnancy CVD risk factor prevalence was 45.6%, most commonly obesity (26.6%). APO prevalence was 35.6%, most commonly a hypertensive disorder of pregnancy (20.1%). Overall, 45.7% of APOs occurred in the absence of recognized prepregnancy CVD risk factors, representing 16.3% of the total sample. Among individuals without prepregnancy CVD risk factors, APO prevalence was 30.0% and did not vary by race/ethnicity. Conclusions: In this racially and ethnically diverse hospital-based sample, APOs were present in one in three parous individuals without prepregnancy CVD risk factors-a group with potentially elevated CVD risk who might otherwise be missed by traditional CVD risk factor screening.

Access to Care After Autism Diagnosis During the COVID-19 Pandemic: A Quality Improvement Project.

The aim of this study was to identify barriers and improve access to services for children diagnosed with autism spectrum disorder (ASD) during the COVID-19 pandemic. Sixty-two patients diagnosed with ASD between March 23 and June 30, 2020, at a large urban safety net hospital were identified by chart review. Patients were called from January to March 2021 and queried regarding access to services. Brief interventions were provided as part of a modified Plan-Do-Study-Act approach. A second chart review was conducted between April and May 2021 to determine whether families accessed any additional services. At the time of initial evaluation, 12 patients (19%) had been able to access all recommended services, 32 (52%) had been able to access some recommended services, and 9 (15%) were not able to access any services. Service levels for 9 families (15%) were undetermined. Sixteen patients (26%) lacked any follow-up with their developmental behavioral pediatrician since their initial evaluation. Thirty patients (48%) reported changes to their individualized educational program or early intervention services, and 17 patients (27%) were receiving in-home applied behavior analysis. After the brief intervention, 13 patients had accessed new services, and 9 patients previously lost to follow-up had completed an appointment. Patients diagnosed with ASD in the spring of 2020 had significant difficulty accessing community services. The transition to telemedicine exacerbated this hospital's difficulty contacting patients for follow-up. Additional research is needed to fully characterize the disruptions to services experienced by patients diagnosed with ASD during the pandemic and to increase accessibility and equity of care.

S73 Effect of Substance Abuse on Cholangiocarcinoma Outcomes and Screening in a Large Urban Safety-Net Hospital

Introduction: Patients with substance use disorders are at an increased risk of viral hepatitis and alcohol-related liver disease and, consequently, at higher risk of developing cholangiocarcinoma (CCA). Further, patients with substance abuse are often less compliant with healthcare screening strategies. We performed a retrospective study to evaluate the association of substance use disorders with CCA screening and outcomes. Methods: A manual chart review was performed for all patients diagnosed with CCA at a large urban safety-net hospital from 2010-2019. Patients were divided into two cohorts, CCA patients with and without a history of substance abuse. Patient characteristics, liver disease etiology, and radiologic screening intervals were recorded. CCA outcomes such as mortality rate, disease metastasis, and treatment decision at tumor board were noted. Statistical analyses were performed using Statistical Product and Service Solutions version 26.9 (SPSS, Inc., Chicago, Illinois). Qualitative and quantitative differences between groups were analyzed by Chi-squared or Fisher’s exact tests for categorical variables and t-test for continuous variables. Results: A total of 46 patients were identified with CCA. Among them, 11 patients (23.9%) had a history of substance abuse, while 35 patients (76.1%) did not have a history of substance abuse. CCA patients with a history of substance abuse were significantly younger (mean age 60 vs. 65) at diagnosis (Table). There were no significant differences in the adequacy of screening in CCA patients with or without a history of substance abuse. While not statistically significant, compared to those without substance abuse, patients with CCA and substance abuse trended toward a higher mortality rate (72.7% vs. 54.3%) and were more likely to be recommended a palliative approach at tumor board (72.7% vs. 57.1%) (Figure). Conclusion: Notably, those patients with substance abuse were diagnosed with CCA at a significantly younger age. Therefore, cirrhotic patients with substance abuse may benefit from earlier referral to specialist care with hopes of more adherence to screening exams. There is suggestion of worse outcomes in those with substance abuse, as they had higher deaths in follow up and higher likelihood of referral to palliative care upon diagnosis. Overall, this study emphasizes the need for more multidisciplinary linkage to care for this vulnerable patient population.Figure 1.: Screening adequacy and disease outcome in Cholangiocarcinoma patients with and without substance abuse. Legend: 1Therapeutic treatment options include resection, transplantation, ablation, or Transarterial chemoembolization. 2 Palliative treatment options include chemotherapy and hospice. Table 1. - Baseline characteristics of Cholangiocarcinoma patients with and without substance abuse CCA Total (n=46) Substance Abuse (n=11) No substance abuse (n=35) P-value Age (mean +/- sd) 64.4 +/- 11.1 60.9 +/- 5.4 65.5 +/- 12.2 0.0278 Gender Male 22 (47.8%) 8 (72.7%) 14 (40.0%) 0.0485 Female 24 (52.2%) 3 (27.7%) 21 (60.0%) Race African Americans 14 (30.4%) 2 (18.2%) 12 (34.3%) 0.2064 White 25 (54.3%) 7 (63.6%) 18 (51.4%) Asian 1 (2.2%) 0 (0%) 1 (2.9%) Ethnicity Hispanic 5 (10.9%) 2 (18.2%) 3 (8.6%) 0.2626 Non-Hispanic 41 (89.1%) 9 (81.8%) 32 (91.4%) Insurance Medicaid 14 (30.4%) 4 (36.4%) 10 (28.6%) 0.8376 Medicare 15 (32.6%) 4 (36.4%) 11 (31.4%) Financial Assistance 1 (2.2%) 0 (0%) 1 (2.9%) Private 9 (19.6%) 1 (9.1%) 8 (22.9%) No insurance 7 (15.2%) 2 (18.2%) 5 (14.3%) Liver disease HCV 11 (23.9%) 6 (54.5%) 5 (14.3%) 0.3049 Alcohol 7 (15.2%) 5 (45.5%) 2 (5.7%) NASH 3 (6.5%) 0 (0%) 3 (8.6%) HCV treatment HCV treated 1 (9.1%) 1 (16.7%) 0 (0%) 0.5455 HCV not treated 10 (90.9%) 5 (83.3%) 5 (100%) Abbreviations: HCV hepatitis C virus, NASH = Non-alcoholic steatohepatitis

S1321 Federal Mandates and Trends in Acetaminophen-Opioid Combination Product Supratherapeutic Ingestions at a Large Urban Safety-Net Hospital From 2011-2020

S1321 Federal Mandates and Trends in Acetaminophen-Opioid Combination Product Supratherapeutic Ingestions at a Large Urban Safety-Net Hospital From 2011-2020

Racial equity in linkage to inpatient opioid use disorder treatment in patients that received emergency care.

Opioid use disorder (OUD) is a national epidemic, and Black and Hispanic patients are less likely to receive treatment when compared to white patients. In this study, race was used as a proxy to assess potential effects of racism on the referral process for OUD treatment. Our primary aim was to examine whether Black or Hispanic patients experienced increased barriers to inpatient OUD detoxification (detox) placement at a community-integrated, substance use disorder support program based in an emergency department (ED). Our secondary aim was to determine if Black and Hispanic patients were more likely to have >3 referrals. This retrospective cohort study was conducted at a large urban safety-net hospital and included patients seen in the ED from July 2018 to September 2019 with ICD-10 codes for an opioid-related visit and who sought placement to inpatient detox. A generalized linear mixed model controlling for multiple visits, age, sex, insurance, time, day of week, and time of year was used to assess the association between race/ethnicity and hypothesized barriers to placement. The proportion of patients with >3 visits for referral to inpatient detox was compared between Black and Hispanic patients and white patients using a chi-squared test. We identified 1733 encounters from 782 unique patients seeking connection to inpatient detox for OUD. Of the 1733 encounters, 45% were among Black and Hispanic patients. Hispanic and Black men had significantly lower odds of having a barrier to inpatient OUD detox than white men (OR = 0.734, 95% CI 0.542-0.995). No significant difference was found for Hispanic and Black women (OR = 1.212, 95% CI 0.705-2.082). More Black and Hispanic patients experienced >3 referrals to inpatient detox compared to white patients (19.2% vs 12.9%, p = 0.016). This study suggests in the context of near-universal health insurance coverage, an ED-based OUD support program staffed by diverse community members can mitigate inequities in access to inpatient detox. However, the increased number of ED visits for OUD detox placement by Black and Hispanic patients suggests racial inequities in OUD treatment exist after linkage to care. Additional research should explore the causes, specifically structural and interpersonal racism, and determine solutions to address racial inequities in detox placement as well as maintenance in treatment programs.

Abstract PO-085: A mixed-methods study of minority recruitment for cancer genomics research at a large urban safety net hospital

Abstract Background: Racial and ethnic minorities are underrepresented in cancer genomics research, and advancements in personalized medicine without inclusion of minority groups is likely to further exacerbate disparities in care and treatment outcomes. Prior research has demonstrated successful recruitment of minority populations for biospecimen donation through community-based approaches, physician engagement, culturally appropriate education, and on-site services. However, there is a significant gap in the literature regarding practical, low-cost interventions to maximize enrollment in biospecimen research studies at hospitals serving a diverse patient population. Objective: This study surveys eligible participants for cancer biospecimen research and aims to intervene on barriers to enrollment. Methods: Between January 2021 and June 2021, participants eligible for four different genomics studies were surveyed regarding reasons for consenting to biospecimen donation as well as barriers to participating among those who declined. The survey consists of six multi-part questions for a total of thirteen questions and requires an average of five minutes to complete. Results: Preliminary results include survey responses from 30 participants. Fourteen participants self-identified as Black or African American, twelve as White, two as Asian, and two as other. One participant self-identified as Hispanic. The majority of participants (73%) consented to biobank specimen collection including 50% of Black participants, 92% of White participants, and 100% of Asian and other participants. Of the eight participants who did not consent to donation, seven were Black. Among nine participants who reported that the study was recommended by their provider, all but one consented to donation. The majority of participants who consented to biospecimen collection reported contributing important information to medical science (73%) and potentially helping others with similar conditions in the future (68%) as reasons for donation. One participant who declined biospecimen donation reported that he would have felt less anxious if clinical staff had been present to explain the study. Two participants recommended including family members and other caregivers in the consent process, especially for older adults. One participant indicated difficulty reading through the consent form while another reported desire for more information “on the type of research” that would be conducted on the biospecimens. Conclusion: Our findings suggest that a majority of patients will consent to biospecimen collection, however Black patients are more likely to decline, and provider engagement is helpful. We found that our consent process can be improved with greater physician engagement, inclusion of family members and caregivers, and concise, patient-oriented presentation of information. Future work will involve implementation of interventions based on these findings. Citation Format: Tina Zhang, Nina Modanlo, David Li, Kiana Mahdaviani, Naomi Ko. A mixed-methods study of minority recruitment for cancer genomics research at a large urban safety net hospital [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-085.

The Inpatient Experience of Emerging Adults: Transitioning From Pediatric to Adult Care.

The pediatric-to-adult care transition has been correlated with worse outcomes, including increased mortality. Emerging adults transitioning from child-specific healthcare facilities to adult hospitals encounter marked differences in environment, culture, and processes of care. Accordingly, emerging adults may experience care differently than other hospitalized adults. We performed a retrospective cohort study of patients admitted to a large urban safety net hospital and compared all domains of patient experience between patients in 3 cohorts: ages 18 to 21, 22 to 25, and 26 years and older. We found that patient experience for emerging adults aged 18 to 21, and, to a lesser extent, aged 22 to 25, was significantly and substantially worse as compared to adults aged 26 and older. The domains of worsened experience were widespread and profound, with a 38-percentile difference in overall experience between emerging adults and established adults. While emerging adults experienced care worse in nearly all domains measured, the greatest differences were found in those pertinent to relationships between patients and care providers, suggesting a substantial deficit in our understanding of the preferences and values of emerging adults.