Medical Chart Abstraction Research Articles

Abstract 6134: The Latino Colorectal Cancer Consortium: A resource for colorectal cancer disparities research

Abstract Purpose: The Latino Colorectal Cancer Consortium (LC3) was established to fill a gap in representation of the diverse Hispanic/Latino/a/x community in cancer genomic research and to enhance understanding of determinants of disparities in the burden of colorectal cancer (CRC). Methods: The LC3 joins together three established studies with deeply-annotated clinical, epidemiologic, and biologic data available for a heterogenous group of Hispanic/Latino/a/x men and women diagnosed with primary colorectal adenocarcinoma: the Hispanic Colorectal Cancer Study (California), the Total Cancer Care Protocol at Moffitt Cancer Center (Florida), and the Puerto Rico Biobank (southern Puerto Rico). Each contributing study collected data on demographics, medical history, family history, and lifestyle factors. Vital status, cause of death, treatment, and clinical characteristics were obtained through medical chart abstraction and/or linkage to cancer registries. Blood, saliva, or normal colonic tissues were used to extract and genotype germline DNA for a subset of participants. Tumor tissues (snap frozen or formalin-fixed paraffin-embedded) were evaluated by pathologists for diagnosis, tissue content, tumor cellularity, necrosis, immune infiltration, and additional histopathologic characteristics. Results: The LC3 has assembled 2,041 participants across the three studies to date, with recruitment ongoing. Median age at diagnosis is 57 (range: 19-93), 54% of participants are male, and 63% are colon cancer cases (vs. rectal cancer). Participants were diagnosed between 1999 and 2022. The target is to generate comprehensive multi-omic data on 600 LC3 participants. To date, 243 have genome-wide germline genotyping, 323 have paired tumor/normal whole exome sequencing, and 257 have T cell receptor immunosequencing (immunoSEQ, Adaptive Biotechnologies). Further, 206 cases are represented on a set of tissue microarray blocks (target N=281). Bulk RNA-seq data are to be generated on 250 tumors. Conclusions: The LC3 fills an important gap in research infrastructure for the scientific community. Key strengths of this unique consortium are its ability to capture a diversity of Latino CRC patients with respect to nativity and cultural heritage and to represent the spectrum of stages from early to metastatic. Ultimately, research from the LC3 will inform development of equitable precision medicine approaches and predictive models to improve the health of the rapidly-growing, heterogeneous Hispanic/Latino/a population. Citation Format: Nicole C. Loroña, Marco Matejcic, Daniel Sobieski, Nathalie T. Nguyen, Hannah J. Hoehn, Diana B. Diaz, Kritika Shankar, Esther Jean-Baptiste, Domenico Coppola, Clifton Fulmer, Ozlen Saglam, Kun Jiang, Teresita Muñoz-Antonia, Idhaliz Flores, Edna Gordian, José A. Oliveras Torres, Seth I. Felder, Julian A. Sanchez, Jason Fleming, Erin M. Siegel, Douglas Cress, Mariana C. Stern, Jamie K. Teer, Stephanie L. Schmit, Jane C. Figueiredo. The Latino Colorectal Cancer Consortium: A resource for colorectal cancer disparities research [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6134.

Factors Associated With Prolonged Respiratory Virus Detection From Polymerase Chain Reaction of Nasal Specimens Collected Longitudinally in Healthy Children in a US Birth Cohort.

Respiratory viral shedding is incompletely characterized by existing studies due to the lack of longitudinal nasal sampling and limited inclusion of healthy/asymptomatic children. We describe characteristics associated with prolonged virus detection by polymerase chain reaction (PCR) in a community-based birth cohort. Children were followed from birth to 2 years of age in the PREVAIL cohort. Weekly nasal swabs were collected and tested using the Luminex Respiratory Pathogen Panel. Weekly text surveys were administered to ascertain the presence of acute respiratory illnesses defined as fever and/or cough. Maternal reports and medical chart abstractions identified healthcare utilization. Prolonged virus detection was defined as a persistently positive test lasting ≥4 weeks. Factors associated with prolonged virus detection were assessed using mixed effects multivariable logistic regression. From a sub-cohort of 101 children with ≥70% weekly swabs collected, a total of 1489 viral infections were detected. Prolonged virus detection was found in 23.4% of viral infections overall, 39% of bocavirus infections, 33% of rhinovirus/enterovirus infections, 14% of respiratory syncytial virus (RSV) A infections, and 7% of RSV B infections. No prolonged detection was found for influenza virus A or B, coronavirus 229E or HKU1, and parainfluenza virus 2 or 4 infections. First-lifetime infection with each virus, and co-detection of another respiratory virus were significantly associated with prolonged detection, while symptom status, child sex, and child age were not. Prolonged virus detection was observed in 1 in 4 viral infections in this cohort of healthy children and varied by pathogen, occurring most often for bocavirus and rhinovirus/enterovirus. Evaluating the immunological basis of how viral co-detections and recurrent viral infections impact duration of virus detection by PCR is needed to better understand the dynamics of prolonged viral shedding.

Burden of Respiratory Viruses in Children Less Than 2 Years Old in a Community-based Longitudinal US Birth Cohort.

Respiratory viral infections are a major cause of morbidity and hospitalization in young children. Nevertheless, the population burden of respiratory viral infections, especially asymptomatic cases, is not known due to the lack of prospective community-based cohort studies with intensive monitoring. To address this gap, we enacted the PREVAIL cohort, a Centers for Disease Control and Prevention-sponsored birth cohort in Cincinnati, Ohio, where children were followed from 0 to 2 years of age. Weekly text surveys were administered to record acute respiratory illnesses (ARIs), which were defined as the presence of cough or fever (≥38°C). Weekly midturbinate nasal swabs were collected and tested using the Luminex Respiratory Pathogen Panel, which detected 16 viral pathogens. Viral infection was defined as ≥1 positive tests from the same virus or viral subtype ≤30 days of a previous positive test. Maternal report and medical chart abstractions identified healthcare utilization. From 4/2017 to 7/2020, 245 mother-infant pairs were recruited and followed. From the 13 781 nasal swabs tested, a total of 2211 viral infections were detected, of which 821 (37%) were symptomatic. Children experienced 9.4 respiratory viral infections/child-year; half were rhinovirus/enterovirus. Viral ARI incidence was 3.3 episodes/child-year. Emergency department visits or hospitalization occurred with only 15% of respiratory syncytial virus infections, 10% of influenza infections, and only 4% of all viral infections. Regardless of pathogen, most infections were asymptomatic or mild. Respiratory viral infections are common in children 0-2 years. Most viral infections are asymptomatic or non-medically attended, underscoring the importance of community-based cohort studies.

Abstract P3-03-16: A methodology for using real-world data from electronic health records to assess chemotherapy administration in women with breast cancer

Abstract Introduction Chemotherapy administration in real-world cancer care can differ extensively from clinical trials. It is important to understand real-world practice to identify dose reductions, delays, regimen changes and early discontinuations that impact cancer outcomes. Such variables require knowledge of intended regimens, which may not be well-documented in structured data in electronic health records (EHRs). We examined EHR data from the Kaiser Permanente Northern California (KPNC) site of the Optimal Breast Cancer Chemotherapy Dosing (OBCD) study to develop a process to identify each patient’s intended regimen. Methods In this study of women diagnosed and treated with primary stage I-IIIA breast cancer at KPNC from 2006-2019, and ages 18+y at diagnosis, we analyzed treatment patterns using structured EHR data on the drugs, dosages, and dates at which they were administered (from which intervals and total length can be derived). Chemotherapy agents were identified using the NCI’s CANMED database augmented with other sources. We used these data to categorize patients into the 22 drug combinations described in the National Cancer Care Network (NCCN) guidelines for breast cancer treatment. Within these 22 drug combinations, women were then subcategorized into 45 distinct chemotherapy administration schedules, defined as NCCN guideline regimens (NGRs). For this step, algorithms were developed that categorized patients into NGRs if they received the exact regimen described in the guidelines. For the second step, we conducted a manual review of the EHR data for patients who were unable to be categorized. This enabled us to gradually loosen the criteria (in terms of cycle intervals or number of cycles) so patients whose chemotherapy administration aligned closely with NGRs were categorized into each of the 45 NGRs. Clear patterns emerged of regimens that were administered to multiple patients, despite being outside of the NCCN guidelines, which we have defined as non-standard NGRs. For example, in the drug combination TC (cyclophosphamide and docetaxel) the NGR was TC every 21 days for 4 cycles. We found approximately 1 in 10 patients received 6 cycles, which we defined as a non-NGR. For the remaining uncategorized patients, medical chart abstraction was undertaken as a third step, at which point patients were categorized into either existing regimens or new non-NGRs if their intended regimen had not been previously described in the guidelines. Results Among 31,418 women with breast cancer, 12,427 (39.6%) received chemotherapy. We determined the intended chemotherapy regimens for 6,559 (52.8%) receiving the 45 NGRs using EHR data. We further expanded the algorithms through a manual review of the EHR data, which enabled us to categorize 2,977 (24.0%) additional women into their intended regimens. Abstracted medical notes were reviewed for the remaining patients for whom we had not been able to identify the intended regimen. Across both the manual review and abstraction processes, we were able to identify additional non-standard NGR regimens. In total, 9,536 (76.7%) of women were categorized into their intended regimen through the algorithm/manual review process, while 2891 (23.3%) of women underwent medical chart abstraction to identify the intended regimen. Conclusion Here, we describe the challenges and approaches to operationalize complex, real-world data to identify intended chemotherapy regimens at a granularity and scale not seen previously. We are adapting this method at a second OBCD study site, Kaiser Permanente Washington, where all women have undergone medical chart abstraction. We hope this methodology leads to increased feasibility and efficiency of use of large-scale clinical data, in turn improving cancer care delivery, patient outcome evaluation, and other real-world questions. Citation Format: Jenna Bhimani, Kelli O’Connell, Rachael P. Burganowski, Isaac J. Ergas, Marilyn J. Foley, Grace B. Gallagher, Jennifer J. Griggs, Narre Heon, Tatjana Kolevska, Yuriy Kotsurovskyy, Candyce H. Kroenke, Kanichi G. Nakata, Sonia Persaud, Donna R. Rivera, Janise M. Roh, Sara Tabatabai, Emily Valice, Erin J. Bowles, Elisa V. Bandera, Lawrence H. Kushi, Elizabeth D. Kantor. A methodology for using real-world data from electronic health records to assess chemotherapy administration in women with breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-03-16.

Abstract 10468: International Classification of Diseases (ICD) Codes for Congenital Heart Defects (CHD) Have Variable and Limited Accuracy for Detecting CHD Cases

Introduction: Administrative data permit analysis of large cohorts but rely on ICD-9-CM and ICD-10-CM billing codes that may not accurately identify CHD cases. Variables that may improve accuracy are unknown, yet improved accuracy will improve CHD surveillance. Methods: We validated 1500 cases with an encounter between 1/1/2010 - 12/31/2019 identified by at least one of 90 CHD codes (41 ICD-9-CM, 49 ICD-10-CM) in 2 healthcare systems (1 adult, 1 pediatric), through medical record review and chart abstraction for presence of a CHD. Inter- and intra-observer reliability exceeded 93%. Results: Positive predictive value (PPV) of ICD codes for CHD (Figure 1) was 68.0% (1020/1500) overall, 95.7% (247/258) for severe codes, 52.8% (371/703) for shunt codes, 75.2% (243/323) for valve codes, 73.2% (120/164) for shunt and valve codes, and 75.0% (39/52) for a select group of 7 codes in ‘other’ category. PPV for cases with > 1 unique CHD code was 73.1% (920/1259) vs. 41.5% (100/241) for cases with only 1 unique CHD code. Characteristics of cases with and without CHD are in Table 1. ICD code 745.5/Q21.1 in isolation was present in 2.2% of cases with confirmed CHD vs. 19.4% of cases without CHD (p< 0.0001). Median number of encounters with a CHD code was higher in cases with CHD (6) vs. without CHD (2), p< 0.0001. Patent foramen ovale was present in 65.8% of false positives (316/480). Conclusion: There is significant variability in the PPV of individual and groups of CHD codes for detection of CHD. The presence of a code for severe CHD is associated with high PPV for true CHD. Use of administrative data for CHD surveillance may require the development of algorithms to improve the accuracy of case detection.

Risk Factors for Acute Gastroenteritis Among Patients Hospitalized in 5 Veterans Affairs Medical Centers, 2016-2019.

In the United States, ∼179 million acute gastroenteritis (AGE) episodes occur annually. We aimed to identify risk factors for all-cause AGE, norovirus-associated vs non-norovirus AGE, and severe vs mild/moderate AGE among hospitalized adults. We enrolled 1029 AGE cases and 624 non-AGE controls from December 1, 2016, to November 30, 2019, at 5 Veterans Affairs Medical Centers. Patient interviews and medical chart abstractions were conducted, and participant stool samples were tested using the BioFire Gastrointestinal Panel. Severe AGE was defined as a modified Vesikari score of ≥11. Multivariate logistic regression was performed to assess associations between potential risk factors and outcomes; univariate analysis was conducted for norovirus-associated AGE due to limited sample size. Among 1029 AGE cases, 551 (54%) had severe AGE and 44 (4%) were norovirus positive. Risk factors for all-cause AGE included immunosuppressive therapy (adjusted odds ratio [aOR], 5.6; 95% CI, 2.7-11.7), HIV infection (aOR, 3.9; 95% CI, 1.8-8.5), severe renal disease (aOR, 3.1; 95% CI, 1.8-5.2), and household contact with a person with AGE (aOR, 2.9; 95% CI, 1.3-6.7). Household (OR, 4.4; 95% CI, 1.6-12.0) and non-household contact (OR, 5.0; 95% CI, 2.2-11.5) with AGE was associated with norovirus-associated AGE. Norovirus positivity (aOR, 3.4; 95% CI, 1.3-8.8) was significantly associated with severe AGE. Patients with immunosuppressive therapy, HIV, and severe renal disease should be monitored for AGE and may benefit from targeted public health messaging regarding AGE prevention. These results may also direct future public health interventions, such as norovirus vaccines, to specific high-risk populations.

Long term outcomes of patients with tuberculous meningitis: The impact of drug resistance.

Little is known about the impact of drug-resistance on clinical outcomes among patients with tuberculosis meningitis (TBM). A retrospective cohort study among patients treated for TBM in Tbilisi, Georgia. We performed medical chart abstraction to collect patient data. Long-term vital status was assessed using the Georgia National Death Registry. We utilized a Cox proportional-hazards model to evaluate the association of drug-resistance and mortality. Among 343 TBM suspects, 237 had a presentation consistent with TBM. Drug resistance was suspected (n = 5) or confirmed (n = 31) in 36 patients including 30 with multidrug- or rifampin-resistance and 6 with isoniazid-resistance. Thirty-four patients had HIV. The median follow-up time was 1331 days (IQR, 852-1767). Overall, 73 of 237 (30%) people died with 50 deaths occurring during and 23 after treatment. The proportion of death was higher among patients with drug-resistant vs. drug-susceptible disease (67% vs. 24%, p<0.001) and with HIV versus no HIV (59% vs 27%, p<0.001). Mortality was significantly higher in patients with drug-resistant TBM after 90 days of treatment (aHR = 7.2, CI95% [3.6-14.3], p < 0.001). Mortality was high among patients with drug-resistant TBM with many deaths occurring post treatment. More effective treatment options are urgently needed for drug-resistant TBM.

#66 Clinical characteristics and outcomes of children with single or co-detected rhinovirus-associated acute respiratory infection in Middle Tennessee

Abstract Background Rhinovirus (RV) is one of the most common viral etiologies of acute respiratory infection (ARI)—the leading infectious cause of mortality in young children. Multiple respiratory viruses may be detected with RV in children with ARI, but the clinical significance of viral co-detection is unclear. We aimed to compare the clinical characteristics and outcomes of children with ARI associated with RV-only detection or RV co-detection. Method We conducted a prospective viral surveillance study (11/2015–7/2016) in Nashville, Tennessee. Children &amp;lt;18 years old who presented to the emergency department (ED) or were hospitalized with fever and/or respiratory symptoms of &amp;lt;14 days duration were eligible if they resided in one of nine selected counties in Middle Tennessee. Demographics and clinical characteristics were collected by parental interviews and medical chart abstractions. Nasal and/or throat specimens were collected and tested for RV, RSV, metapneumovirus, adenovirus, parainfluenza 1–4, and influenza A–C using real-time reverse transcriptase polymerase chain reaction assays. We compared clinical characteristics and outcomes of children with RV-only detection or RV co-detection using Pearson's χ2 test for categorical variables and linear regression with robust standard errors for continuous variables. Results Of 1,250 children who were enrolled, 904 (72.3%) were positive for at least one virus. RV was detected in 406 virus-positive children (44.9%), of whom 117 (28.8%) had RV co-detection. The most common RV co-detection pair was RV/RSV (n=36). The mean age of children with RV co-detection was lower than those with RV-only detection (2.6 ± 2.7 years vs. 4.3 ± 4.4 years; p&amp;lt;0.001). The signs and symptoms of children with RV-only detection and those with RV co-detection are compared in Table 1. A total of 283 children with RV were discharged from the ED (69.7%), of whom 89 (31.4%) had RV co-detection. Children with RV co-detection who were discharged from the ED were less likely to have a diagnosis of asthma/reactive airway disease (RAD) than those with RV-only detection (10.1% vs. 21.6%; p=0.019) but more likely to be diagnosed with bronchiolitis (18.0% vs. 1.5%; p&amp;lt;0.001). Of the 123 hospitalized children with RV, 28 (22.8%) had RV co-detection. Hospitalized children with RV co-detection were less likely to have an admission diagnosis of asthma/RAD than those with RV-only detection (7.1% vs. 43.2%; p&amp;lt;0.001) but more likely to be diagnosed with bronchiolitis (32.1% vs. 14.7%; p=0.038) and pneumonia (32.1% vs. 8.4%; p&amp;lt;0.001). We did not identify differences in hospitalization, intensive care unit admission, supplemental oxygen use, or length of stay between children with RV-only detection and RV co-detection. Conclusion We did not find evidence that RV co-detection was associated with worse outcomes in children with ARI. However, the clinical presentation of children with RV co-detection differs from that of children with RV-only detection. These distinctions warrant consideration in the diagnostic evaluation and management of RV-positive children. Further studies are needed to describe the distinct clinical presentations of RV/non-RV pairs and RV species.

#65 Respiratory Syncytial Virus Surveillance Among Hospitalized Children in Amman, Jordan

Abstract Background Respiratory syncytial virus (RSV) is a leading cause of acute respiratory infection (ARI) in young children worldwide. In Jordan, RSV has previously been reported as the most frequently detected virus among hospitalized children less than two years. We aimed to compare the demographic and clinical characteristics of RSV-positive and RSV-negative hospitalized children during the peak season in Amman, Jordan. Method Children under two years who presented with fever and/or respiratory symptoms within 72 hours of hospitalization at a government-run hospital were enrolled. We systematically collected demographic and clinical characteristics via parental interviews and medical chart abstractions. Anterior nasal and/or throat swabs were collected and tested for RSV by PCR. Differences in clinical characteristics were evaluated by RSV status using two-sample t- tests allowing for unequal variances for continuous variables and Pearson's Chi-squared test for categorical variables, alpha=0.05. Results From January 8 to March 17, 2020, 531 children were enrolled and tested, of which 57% were male and had a mean age of 5 months. Of those who were tested, 401 (76%) were RSV-positive. Children with RSV were younger and less likely to have an underlying medical condition compared to children without RSV (Table 1). RSV-positive children were more likely to present with cough, shortness of breath, runny nose, nasal congestion, decreased appetite, vomiting, wheezing, and had a higher respiratory rate at admission than RSV-negative children. Compared to RSV-negative children, RSV-positive children were more likely to have an admission diagnosis of pneumonia and bronchiolitis and less likely have the diagnosis of rule out sepsis. Conclusion In our study, more than three-quarters of children hospitalized with ARI had RSV. Additional prevention measures, such as vaccines or antivirals, are needed to effectively reduce the RSV burden among young children in Jordan.

Significance of lymph node fine needle aspiration for the diagnosis of HIV-associated lymphoma in a low-resource setting.

Fine needle aspiration (FNA) is an early step in the work-up of lymphadenopathy in people with HIV (PWH). We set out to characterize the FNA cytology in PWH and report on the time to lymphoma diagnosis through the FNA clinics in the public healthcare system in Johannesburg, South Africa. Retrospective review of laboratory database. A retrospective chart review of patients undergoing FNA through the department of cytopathology at the National Health Laboratory Service (NHLS) was undertaken. Results of FNAs performed between March and May 2018 were reviewed. Medical record chart abstraction included general demographics, HIV status, site and results of FNA, prior history of malignancy and other laboratory data. Five hundred and thirty-nine lymph node FNAs were performed on PWH. Pathological findings included tuberculosis 47% (252), inadequate sampling 14% (75), reactive adenopathy 13% (71), benign disease 12% (63), suspicious for lymphoproliferative neoplasm 8% (45), other malignancy 4% (21) and inflammation 2% ( n = 12). Only 53% (24) of lymphomas were confirmed by biopsy. Those not confirmed had a high mortality (57%) and loss to follow-up rate (29%) over the following year. The median diagnostic interval exceeded 8 weeks from time of FNA to lymphoma diagnosis. FNA is an important screening modality in this high HIV and tuberculosis (TB) burden region. Patients with cytology suggestive for lymphoma, but without biopsy confirmation, have a high mortality rate suggesting undiagnosed lymphoma. A better understanding of the barriers to appropriate diagnostic triage for lymphoma is needed.

760 Wholistic View of Autografting Patients by %TBSA Burned: Medical Chart Abstraction Integrated with Administrative Claims

IntroductionThe current literature of severe burns with autografting is scarce or limited to single data source. This study provides a wholistic view of the clinical and economic characteristics of the inpatient treatment of patients with burns using integrated medical chart abstraction with administrative claims.MethodsPatients with thermal burns undergoing inpatient autografting between July 1, 2010 and November 30, 2019 were identified from large national health plans, representing over 50 million members in the US. The first observed hospitalization with autografting was regarded as the index event. Two hundred hospital patient medical records were abstracted for the clinical characteristics, using a standardized abstraction form, which were integrated with administrative data for economic characteristics. Those with large % TBSA were oversampled. Patients were stratified into three cohorts by %TBSA burned. A Bonferroni correction of alpha 0.017 was performed for post-hoc pairwise tests.ResultsOf 200 patients, 90 were categorized as low TBSA (< 10%), 75 moderate TBSA (10 – 24%), and 35 high TBSA (25+%). Overall, the high %TBSA cohort appeared to be younger, requiring more intensive care, and thereby incurring higher costs of care. The extent of some undocumented critical fields in the medical records was significant, for example (%undocumented): donor size (80%), BMI (31%), mesh ratio (30%), etc. 1 mean (SD) * compared with low TBSA, p< 0.017ConclusionsThis study not only confirmed some conventional understanding of various TBSA cohorts, but also quantified their differences/similarities using multiple data sources. There was considerable incompleteness in many critical fields in the medical records, which limits the ability to generate broader insights. Despite the wide regard of medical records as a “gold standard” for outcomes analyses, future research should be aware of these limitations.

Rates of respiratory syncytial virus (RSV)-associated hospitalization among adults with congestive heart failure-United States, 2015-2017.

BackgroundRespiratory syncytial virus (RSV) can cause severe disease in adults with cardiopulmonary conditions, such as congestive heart failure (CHF). We quantified the rate of RSV-associated hospitalization in adults by CHF status using population-based surveillance in the United States.MethodsPopulation-based surveillance for RSV (RSV-NET) was performed in 35 counties in seven sites during two respiratory seasons (2015–2017) from October 1–April 30. Adults (≥18 years) admitted to a hospital within the surveillance catchment area with laboratory-confirmed RSV identified by clinician-directed testing were included. Presence of underlying CHF was determined by medical chart abstraction. We calculated overall and age-stratified (<65 years and ≥65 years) RSV-associated hospitalization rates by CHF status. Estimates were adjusted for age and the under-detection of RSV. We also report rate differences (RD) and rate ratios (RR) by comparing the rates for those with and without CHF.Results2042 hospitalized RSV cases with CHF status recorded were identified. Most (60.2%, n = 1230) were ≥65 years, and 28.3% (n = 577) had CHF. The adjusted RSV hospitalization rate was 26.7 (95% CI: 22.2, 31.8) per 10,000 population in adults with CHF versus 3.3 (95% CI: 3.3, 3.3) per 10,000 in adults without CHF (RR: 8.1, 95% CI: 6.8, 9.7; RD: 23.4, 95% CI: 18.9, 28.5). Adults with CHF had higher rates of RSV-associated hospitalization in both age groups (<65 years and ≥65 years). Adults ≥65 years with CHF had the highest rate (40.5 per 10,000 population, 95% CI: 35.1, 46.6).ConclusionsAdults with CHF had 8 times the rate of RSV-associated hospitalization compared with adults without CHF. Identifying high-risk populations for RSV infection can inform future RSV vaccination policies and recommendations.

Abstract IA-36: Fragmentation of care among Black women who have breast cancer and multiple comorbidities

Abstract Purpose: Black women newly diagnosed with breast cancer and who have multiple comorbidities at the time of cancer diagnosis require greater care coordination to simultaneously manage cancer care and other chronic conditions. Care coordination may be complicated when multiple clinicians from diverse disciplines are involved in managing care and are located in different health systems, defined as care fragmentation. Given that Black women are disproportionately burdened by comorbidities and breast cancer, we examined the degree of care fragmentation and care coordination experienced by this group from a health system and care team perspective using two population-based cohorts. Methods: We analyzed data from two separate cohorts of Black women diagnosed with breast cancer who had diabetes and/or cardiovascular disease. In the first study we used the Women's Circle of Health Follow-Up Study (n=228) to examine types of practice setting for first primary care visit and primary breast surgery, and, through medical chart abstraction, identified whether care visit was within or outside the same health system. In a separate study, we identified women from the SEER-Medicare database (n=3,420) diagnosed with breast cancer and used encounter claims to examine the complexity and composition of the clinical care team. Results: Care fragmentation was experienced by 79% of Black women in the Women's Circle of Health Follow-Up Study, and individual-level factors (age, health insurance, cancer stage, and comorbidity count) were not associated with care fragmentation (p&amp;gt;.05). In the SEER-Medicare cohort, the most common clinical care team composition was oncology with primary care (45%) followed by oncology, primary care, and medical subspecialty (26%). In the adjusted model, Black women were more likely to have a clinical care team of higher complexity if they had cardiopulmonary disease (OR: 1.74; 95% CI: 1.68, 1.81) or diabetes (OR: 1.69; 95% CI: 1.63,1.75) compared with hypertension only. Women were also less likely to have a complex care team if they were dual Medicaid-Medicare covered (OR: 0.56; 95% CI: 0.48, 0.65) compared with Medicare only, rural residents (OR: 0.54; 95% CI: 0.42, 0.65) compared with urban, or diagnosed with stage III cancer (OR: 0.59; 95% CI: 0.47, 0.75) compared with stage I. Conclusion: The majority of Black breast cancer survivors with comorbidities see multiple clinicians from diverse disciplines and in different health systems, illustrating high care coordination demands and care fragmentation. However, the impact of the health system and care team on care outcomes still need to be assessed, and this includes care transitions into survivorship. To address cancer care disparities experienced by Black women, future research should consider examining clinician's perspectives regarding roles and responsibilities for chronic disease management and cancer care, as well as address care fragmentation across diverse healthcare delivery settings. Citation Format: Michelle Doose, Janeth I. Sanchez, Dana Verhoeven, Veronica Chollette, Joel C. Cantor, Jesse J Plascak, Michael Steinberg, Chi-Chen Hong, Kitaw Demissie, Elisa Bandera, Jennifer Tsui, Sallie J. Weaver. Fragmentation of care among Black women who have breast cancer and multiple comorbidities [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 IA-36.

702. Risk Factors for Acute Gastroenteritis Among Patients Hospitalized in 5 Veterans Affairs Medical Centers, 2016–19

BackgroundIn the United States, an estimated 179 million acute gastroenteritis (AGE) episodes occur each year. Identifying factors contributing to AGE susceptibility and severity is important to address the high disease burden of AGE among adults. The primary objective of this analysis was to identify risk factors for all-cause AGE, norovirus-associated AGE and severe AGE among hospitalized adults. MethodsWe analyzed data from 1029 inpatient AGE cases and 624 non-AGE controls enrolled prospectively from December 1, 2016 – November 30, 2019 from 5 Veterans Affairs Medical Centers (Atlanta, Bronx, Houston, Los Angeles, Palo Alto). Standardized patient interviews and medical chart abstractions were conducted to collect demographics, exposure history, and underlying medical conditions. Stool samples from participants were tested for 22 pathogens using the BioFire Gastrointestinal Panel. Severity of AGE was determined using a 20-point modified Vesikari score (MVS) and severe AGE was defined as a MVS score of ≥ 11. Multivariate logistic regression was performed to assess associations between potential risk factors and outcomes. ResultsOf the total AGE cases, 551 (54%) had severe AGE; 44 (4%) were norovirus positive. Risk factors for all-cause AGE vs. non-AGE controls included household contact with a person with AGE in the past 7 days (aOR=2.9, 95% CI:1.3-6.7), severe renal disease (aOR=3.1, 95% CI:1.8-5.2), human immunodeficiency virus (HIV) (aOR=3.9, 95% CI:1.8-8.5), and immunosuppressive therapy (aOR=5.6, 95% CI:2.7-11.7). Factors associated with norovirus positivity by univariate analysis were contact with a person with AGE outside (OR=4.4, 95% CI:1.6-12.0) and within (OR=5.0, 95% CI:2.2-11.5) the household in the past 7 days. Detection of any viral pathogen (aOR=4.0, 95% CI:1.7-9.5) was a risk factor for severe AGE.ConclusionOur findings suggest that inpatients with HIV or severe renal disease, on immunosuppressive therapy, or in contact with a person with AGE within household are at higher risk for all-cause AGE. Patients with these medical conditions should be monitored for AGE related hospitalizations and may benefit from targeted AGE prevention messaging. Disclosures Vincent Marconi, MD, Bayer (Consultant, Scientific Research Study Investigator)Eli Lilly (Consultant, Scientific Research Study Investigator)Gilead Sciences (Consultant, Scientific Research Study Investigator)ViiV (Consultant, Scientific Research Study Investigator)

Treatment Compliance Communications Between Patients with Severe Mental Illness and Treating Healthcare Providers: A Retrospective Study of Documentation Using Healthcare Reimbursement Claims and Medical Chart Abstraction.

IntroductionSuccessful treatment for serious mental illnesses (SMIs) requires a good therapeutic alliance with healthcare providers and compliance with prescribed therapies such as antipsychotic medications. This retrospective study, which utilized administrative claims linked with abstracted medical chart data, addressed a data gap regarding compliance-related discussions between providers and patients.MethodsCommercially insured patients in ambulatory care post-acute (emergency or inpatient) event were eligible. Criteria included age 18–65 years; schizophrenia, bipolar disorder, or major depressive disorder diagnoses; continuous enrollment 6 months before to 12 months after the first acute event claim dated 01/01/2014 to 12/31/2015; and antipsychotic medication prescription. Demographic and clinical data, and patient–provider discussions about treatment compliance were characterized from claims and abstracted medical charts.ResultsNinety patients (62% female, mean age 41 years) were included and 680 visits were abstracted; only 58% had first-visit antipsychotic compliance discussions. Notably, 18% of patients had discussions using the specific terms “compliance,” “persistence,” or “adherence,” whereas half were identified by more general terms. Compliance discussions were observed least often among the patients with schizophrenia, as compared with bipolar or major depressive disorders—a counterintuitive finding.DiscussionCompliance discussions may represent intervention opportunities to optimize treatment, yet their study is a complex endeavor. The results of this study show an opportunity to improve this valuable treatment step.

An Intervention for the Transition From Pediatric or Adolescent to Adult-Oriented HIV Care: Protocol for the Development and Pilot Implementation of iTransition.

BackgroundIn the United States, adolescents and young adults are disproportionately affected by HIV and have poorer HIV-related health outcomes than adults. Health care transition (HCT) from pediatric or adolescent to adult-oriented HIV care is associated with disruptions to youths’ care retention, medication adherence, and viral suppression. However, no evidence-based interventions exist to improve HCT outcomes for youth living with HIV.ObjectiveThere are 2 phases of this project. Phase 1 involves the iterative development and usability testing of a Social Cognitive Theory–based mobile health (mHealth) HIV HCT intervention (iTransition). In phase 2, we will conduct a pilot implementation trial to assess iTransition’s feasibility and acceptability and to establish preliminary efficacy among youth and provider participants.MethodsThe iterative phase 1 development process will involve in-person and virtual meetings and a design team comprising youth living with HIV and health care providers. The design team will both inform the content and provide feedback on the look, feel, and process of the iTransition intervention. In phase 2, we will recruit 100 transition-eligible youth across two clinical sites in Atlanta, Georgia, and Philadelphia, Pennsylvania, to participate in the historical control group (n=50; data collection only) or the intervention group (n=50) in a pilot implementation trial. We will also recruit 28 provider participants across the pediatric or adolescent and adult clinics at the two sites. Data collection will include electronic medical chart abstraction for clinical outcomes as well as surveys and interviews related to demographic and behavioral characteristics; Social Cognitive Theory constructs; and intervention feasibility, acceptability, and use. Analyses will compare historical control and intervention groups in terms of HCT outcomes, including adult care linkage (primary), care retention, and viral suppression (secondary). Interview data will be analyzed using content analysis to understand the experience with use and acceptability.ResultsPhase 1 (development) of iTransition research activities began in November 2019 and is ongoing. The data collection for the phase 2 pilot implementation trial is expected to be completed in January 2023. Final results are anticipated in summer 2023.ConclusionsThe development and pilot implementation trial of the iTransition intervention will fill an important gap in understanding the role of mHealth interventions to support HCT outcomes for youth living with HIV.International Registered Report Identifier (IRRID)DERR1-10.2196/24565

Respiratory Virus Surveillance in Infants across Different Clinical Settings

We aimed to evaluate the distribution, clinical presentations and severity of common acute respiratory infections (ARI) viruses in infants across 3 clinical settings. In a prospective virus surveillance study, infants under 1year with fever and/or respiratory symptoms were enrolled from outpatient, emergency department, and inpatient settings from December 16, 2019 through April 30, 2020. Demographic and clinical characteristics were collected through parent/guardian interviews, medical chart abstractions, and follow-up surveys. Nasal swabs were collected and tested for viruses using quantitative reverse-transcription polymerase chain reaction. We enrolled 366 infants and tested nasal swabs on 360 (98%); median age was 6.3months, 50% male. In total, 295 (82%) had at least 1 virus detected; rhinovirus/enterovirus (RV/EV; 42%), respiratory syncytial virus (RSV; 34%), and influenza (15%) were the most common. RSV was the most frequently detected virus in the inpatient (63%) and emergency department (37%) settings, and RV/EV was most frequently detected virus in the outpatient setting (54%). RSV-positive infants had a lower median age (4.9months) and were more likely to have respiratory distress, and RV/EV-positive infants were less likely to have respiratory distress. Influenza-positive infants had a higher median age (8months) and were more likely to have systemic symptoms. RSV infection and younger age were associated with higher odds of hospitalization in multivariable logistic regression. Across 3 clinical settings, and combining virologic, patient, and health-system information, our results highlight the burden of viral ARI among infants. Overall, RSV, RV/EV, and influenza were most commonly detected, with RSV having the highest disease severity.

Nutritional status and TB treatment outcomes in Addis Ababa, Ethiopia: An ambi-directional cohort study

Remaining underweight during Tuberculosis (TB) treatment is associated with a higher risk of unsuccessful TB treatment outcomes and relapse. Previous studies conducted in Ethiopia found that bodyweight not adjusted for height at the start of treatment is associated with poor treatment outcomes. However, the association of body mass index (BMI) and weight change during treatment with treatment outcomes has not been studied. We aimed to investigate the association of BMI at the time of diagnosis and after two months of treatment and TB treatment outcomes. Using an ambi-directional cohort study design (retrospective and prospective), a total of 456 participants were enrolled among 30 randomly selected public health centers residing within six sub-cities of Addis Ababa, Ethiopia. Data were collected using medical chart abstraction and face to face interviews. We compared TB treatment outcomes in persons with a body mass index (BMI) <18.5kg/m2 (underweight) versus persons with BMI ≥18.5kg/m2 (normal or overweight) at treatment initiation and after two months of treatment. Treatment was classified as successful in persons who were free of symptoms and had a negative sputum smear for acid-fast bacilli at the end of the 6-month treatment course. We analysed outcomes using univariable and multivariable logistic regression with 95% CI and p value< 0.05. Of enrolled study participants, 184 (40.4%) were underweight and 272 (59.6%) were normal or overweight. Body mass index (BMI ≥18.5kg/m2) at the start and second month of treatment were independent predictors for successful treatment outcome (AOR = 2.15; 95% CI: 1.05, 4.39) and (AOR = 3.55; 95% CI: 1.29, 9.73), respectively. The probability of treatment success among patients with BMI≥18.5kg/m2 at the start and second month of treatment was 92.9% and 97.1%, respectively versus 86.5% and 91.7% in patients with BMI<18.5kg/m2. Bodyweight not adjusted for height and change in the bodyweight after the second and sixth months of treatment were not significantly associated with treatment success. In persons treated for TB disease, being underweight at baseline and after two months of treatment was a predictor for unsuccessful treatment outcomes. Nutritional assessment, counselling, and management are important components of TB treatment programs with the potential to improve treatment outcomes.

22. Description of Hospitalized Patients with Influenza Vaccine Failure

BackgroundDespite influenza vaccination, some patients develop illness and require hospitalization. Many factors contribute to vaccine failure, including mismatch of the vaccine and circulating strains, waning immunity, timing of influenza season, age and patient comorbidities such as immune function. This study compared vaccinated, hospitalized patients with and without influenza.MethodsThis study used 2015–2019 Tennessee data from the US Hospitalized Adult Influenza Vaccine Effectiveness Network database. Enrolled patients were ≥ 18 years vaccinated for the current influenza season and admitted with an acute respiratory illness. Patient or surrogate interviews and medical chart abstractions were performed, and influenza vaccinations were confirmed by vaccine providers. Influenza PCR testing was performed in a research lab. Statistical analyses were performed with STATA and R using Pearson’s chi-squared, Kruskal-Wallis and Wilcoxon rank-sum tests and multivariate logistic regression.Results1236 patients met study criteria, and 235 (19%) tested positive for influenza. Demographics, vaccines and comorbidities were similar between the two groups (Table 1) except for morbid obesity, which was more common in influenza negative patients (13% vs 8%, p = 0.04), and immunosuppression, which was more common in the influenza positive (63% vs 54%, p = 0.01). Logistic regression analysis demonstrated older patients (OR 1.47, 95% CI 1.03–2.10) and immunosuppressed patients (OR 1.56, 1.15–2.12) were at increased risk for influenza (Table 2 and Figure 1). Immunosuppression also increased the risk for influenza A/H3N2 (OR 1.86, 95% CI 1.25–2.75). A sensitivity analysis was performed on patients who self-reported influenza vaccination for the current season without vaccine verification and demonstrated increased risk of influenza in older adults (OR 1.66, 95% CI 1.16–2.39).Table 1: Demographics of influenza positive versus influenza negative patients in influenza vaccinated, hospitalized patients. Table 2: Logistic regression analyses of vaccinated, hospitalized influenza positive patients; vaccinated, hospitalized patients with influenza A subtypes and self-reported vaccinated, hospitalized influenza positive patients. Figure 1: Predicted Probability of Hospitalization with Influenza, Influenza A/H1N1 and Influenza A/H3N2 in Vaccinated Patients by Age. ConclusionOur study demonstrated an increased risk of influenza vaccine failure in older patients and immunosuppressed patients. These groups are also at increased risk for influenza complications. To improve protection of these patients against future influenza illnesses, more effective vaccines are needed, and more research on ring vaccination should be pursued.Disclosures All Authors: No reported disclosures

128. Characteristics and Outcomes of Pregnant Women Hospitalized with Influenza in the United States, Flusurv-net, 2010–2019

BackgroundPregnant women are at high-risk for influenza-associated hospitalization. We used data from the U.S. Influenza Hospitalization Surveillance Network (FluSurv-NET) to characterize pregnant women hospitalized with influenza.MethodsWe included pregnant women (15–44 years) residing within a FluSurv-NET catchment area and hospitalized with laboratory-confirmed influenza between October 1 and April 30, during the 2010–19 influenza seasons. Clinical data were obtained on cases through medical chart abstraction. We examined trends in vaccination coverage and antiviral treatment using the Cochran-Armitage test for trend and characterized maternal interventions and maternal and fetal outcomes during hospitalization.ResultsOf 9,652 women aged 15–44 years hospitalized with influenza, 2,697 (28%) were pregnant. Median maternal age was 28 years and median gestational age was 32 weeks; 36% were non-Hispanic white, 29% non-Hispanic black, and 20% Hispanic. Underlying conditions were present in 35% (n=931), with asthma (n=613; 22.7%) and chronic metabolic disease (n=204; 7.6%) as the most common; 12% (n=299) were current smokers. Vaccination coverage and antiviral receipt varied by season and age [Figures 1 and 2]. Overall, 31% (n=846) were vaccinated and 89% (n=2,408) received antivirals. Five percent (n=132) had intensive care unit admission, 2% (n=52) required mechanical ventilation, 6% (n=165) developed pneumonia and 0.3% (n=9) died; median length of hospital stay was 2 days (IQR 1–3). The most common symptoms at admission included cough (68%) and fever (66%) [Figure 3]. At discharge, most women (70%; n=1865) were still pregnant while 28% (n=758) were no longer pregnant and 2% (n=44) had unknown pregnancy status. Among women who were no longer pregnant at discharge, 96% (n=726) had pregnancies resulting in live births, 3% (n=25) had pregnancies resulting in loss of the fetus or neonate, and 1.0% (n=7) had unknown birth outcome.Figure 1. Vaccination coverage among pregnant women hospitalized with laboratory-confirmed influenza by season and by age group, FluSurv-NET 2010–2019 Figure 2. Antiviral treatment among pregnant women hospitalized with laboratory-confirmed influenza by season and by age group, FluSurv-NET 2010–2019 Figure 3. Symptoms at admission among pregnant women hospitalized with laboratory-confirmed influenza by age group, FluSurv-NET 2010–2019 ConclusionOver 9 influenza seasons, nearly one-third of women aged 15–44 years and hospitalized with influenza were pregnant. Severe maternal and fetal outcomes were rare. While most women received antivirals, fewer than one-third received current season influenza vaccine.DisclosuresSue Kim, MPH, Council of State and Territorial Epidemiologists (CSTE) (Grant/Research Support) Melissa Sutton, MD, MPH, CDC funding (Emerging Infections Program) (Grant/Research Support)