Health System Research Articles

Evaluating the Efficacy of Trafficking in Persons Education and Policy Implementation Across Four Acute Care Health Systems

ABSTRACT Background Human Trafficking (HT) victims often seek healthcare for injuries and illnesses without proper screening or support, leading to re-traumatization. Evidence suggests that contributing variables include a lack of organizational protocols and a scarcity of evidence-based, trauma-informed HT education for healthcare providers. Objective This study evaluated the impact of adopting evidence-based HT protocols within health systems and providing trauma-informed education on healthcare professionals’ (HCPs) ability to identify and respond to HT victims. Design/Setting/Participation The study used a quasi-experimental design. Conducted in four large U.S. healthcare systems, the study included 197 participants potentially involved in victim identification within the healthcare setting. Methods Each organization developed and deployed HT policies and procedures, then hosted the HT education intervention, a two-hour evidence-based, trauma-informed, and survivor-informed program. Data analysis was conducted using descriptive and inferential statistical tests. Results The results showed statistically significant improvement in the respondents’ confidence in identifying and responding to potential HT victims in the healthcare setting after adopting organization-specific policies and procedures and attending the HT education program. Conclusion and Implications HT is a global public health crisis and a violation of human rights. This study highlights the importance of adopting trauma-informed, survivor-informed, evidence-based HT organizational protocols and HCP education. The study aligns with the United Nations’ sustainable goals for equitable healthcare, underscoring the significance of HCP education in enhancing the well-being of HT victims and creating an inclusive healthcare system. Global efforts to combat HT must prioritize comprehensive training and policy integration within healthcare systems.

Abstract HUP20: Assessing Social Vulnerability's Effect on Patient Outcomes in Los Angeles County Stroke Patients Among a Health System and Its Impact on Health Disparities

Abstract HUP20: Assessing Social Vulnerability's Effect on Patient Outcomes in Los Angeles County Stroke Patients Among a Health System and Its Impact on Health Disparities

A Multicenter Evaluation of the Impact of Therapies on Deep Learning-based Electrocardiographic Hypertrophic Cardiomyopathy Markers

Artificial intelligence-enhanced electrocardiography (AI-ECG) can identify hypertrophic cardiomyopathy (HCM) on 12-lead ECGs and offers a novel way to monitor treatment response. Although the surgical or percutaneous reduction of the interventricular septum (SRT) represented initial HCM therapies, mavacamten offers an oral alternative. We aimed to assess the use of AI-ECG as a strategy to evaluate biologic responses to SRT and mavacamten. We applied an AI-ECG model for HCM detection to electrocardiography images from patients who underwent SRT across 3 sites: Yale New Haven Health System (YNHHS), Cleveland Clinic Foundation (CCF), and Atlantic Health System (AHS) and to electrocardiography images from patients receiving mavacamten at YNHHS. A total of 70 patients underwent SRT at YNHHS, 100 at CCF, and 145 at AHS. At YNHHS, there was no significant change in the AI-ECG HCM score before versus after SRT (before SRT: median 0.55 [interquartile range 0.24 to 0.77] vs after SRT: 0.59 [0.40 to 0.75]). The AI-ECG HCM scores also did not improve after SRT at CCF (0.61 [0.32 to 0.79] vs 0.69 [0.52 to 0.79]) and AHS (0.52 [0.35 to 0.69] vs 0.61 [0.49 to 0.70]). Of the 36 YNHHS patients on mavacamten therapy, the median AI-ECG score before starting mavacamten was 0.41 (0.22 to 0.77), which decreased significantly to 0.28 (0.11 to 0.50, p <0.001 by Wilcoxon signed-rank test) at the end of a median follow-up period of 237 days. In conclusion, we observed a lack of improvement in AI-based HCM score with SRT, in contrast to a significant decrease with mavacamten. Our approach suggests the potential role of AI-ECG for serial point-of-care monitoring of pathophysiologic improvement after medical therapy in HCM using ECG images.

Net Health System Costs of Parkinson Disease: A Propensity Score-Matched Health Administrative Data Cohort Study in Ontario, Canada.

Few estimates of the long-term health system costs of Parkinson disease by phase of disease are available. We estimated 10-year and phase-based net health system costs of Parkinson disease before and after case ascertainment. Using population-based linked administrative databases from Ontario, Canada, we identified 43,149 community-dwelling persons with incident Parkinson disease aged 40 years and older between 2009 and 2018 using a validated algorithm. These individuals were matched 1:1 to controls without Parkinson disease based on demographics and a propensity score. We calculated phase-based, net health system costs from the provincial government perspective during the preascertainment (3 years before index), initial (1 year after index), early continuing (>1-6 years after index), later continuing (>6-10 years after index), and terminal (1 year before death, if applicable) phases (standardized to 2020 $CAD and calculated on an annual basis). By applying survival probabilities to monthly cost estimates, we also determined 10-year net health system costs, stratified by sex and age. Annual mean net costs of Parkinson disease were lowest in the preascertainment phase ($212 CAD, 95% CI [$20-$404]), intermediate in the initial phase ($4,576 (95% CI [$4,217-$4,935]), and higher in the early continuing phase ($7,078, 95% CI [$6,717-$7,438]). The later continuing phase ($12,500, 95% CI [$12,060-$12,940]) and the terminal phase ($13,933, 95% CI [$13,123-$14,743]) showed the highest costs. The 10-year net cost of Parkinson disease was $82,153 (95% CI [$77,965-$86,341]) and was significantly higher in women ($89,773, 95% CI [$83,306-$96,240]) than in men ($76,469, 95% CI [$70,983-$81,953]) and older individuals ($92,197, 95% CI [$87,087-$97,307]), compared with younger individuals ($62,580, 95% CI [$55,346-$69,814]). Over the 10-year period, hospital, nursing home, and home care were the largest contributors to costs of Parkinson disease. Health system costs of Parkinson disease are substantial, particularly in the later phases. Interventions to reduce avoidable use of hospital and nursing home services by persons living with Parkinson disease may provide better quality of life and be cost saving from the health system perspective.

National Implementation of a Crisis Resolution Home Treatment (CRHT) Team in Malta: Insights From the First Two Years of Operation.

Crisis Resolution Home Treatment (CRHT) teams have become a widespread alternative to psychiatric hospitalisation. Despite their popularisation, Malta has only recently introduced a CRHT team. The aims of the current study were to investigate (i) patient characteristics, (ii) factors influencing patients' length of follow-up (LoFU) and (iii) predictors of clinical outcomes. Descriptive and quantitative non-identifiable data were collected and analysed for patients utilising the CRHT service within its first 2 years of operation (n = 643). One-way ANOVA tests investigated influencing factors for LoFU, whereas binary logistic regressions deduced predictive factors for clinical outcomes. Patients without acute psychiatric disorders had the shortest LoFU, indicating that the team received inappropriate referrals. Patients were most likely to have extended LoFU if they were diagnosed with OCD & related disorders and were most likely to be diagnosed with an underlying personality disorder if they were diagnosed with anxiety & phobic disorders. Continuity of care facilitates discharge planning. Patients receiving the CRHT service in Malta are most comparable with health systems that prefer to hospitalise patients with a higher risk profile. The high occurrence of personality disorders necessitates staff to have interdisciplinary knowledge and an appropriate skill mix.

Prevalence and Factors Associated With Depression and Depressive Symptoms Among Chinese Older Persons: An Integrative Review.

China is the country with the largest population of older persons. Depression is the most common mental health issue among older adults, a trend expected to increase as societies continue to age. With the global increase in depression and depressive symptoms among this demographic, the resulting disease burden poses a significant challenge to health and social care systems in China. To map, summarise and examine the empirical literature on the prevalence and factors associated with depression and depressive symptoms in Chinese older adults, an integrative literature review was conducted informed by the guidelines of Whittemore and Knafl. The literature search encompassed EMBASE, SCOPUS, CINAHL, Web of Science, PubMed, PsycINFO, SocINDEX, China National Knowledge Infrastructure Database and Wanfang Database. The review included 65 studies, 29 in English and 36 in Chinese. The reported prevalence of depression or depressive symptoms in Chinese older adults was 3.78%-84.3%. Based on the biopsychosocial model, the associated factors were clustered as follows: biological factors (physical health, disability, drug effects, gender, age, diets, physical activities), psychological factors (self-esteem, coping skills, trauma, emotions, beliefs, hobbies, lifestyle) and social factors (family relationships, peers, family circumstances, school, residential areas, social support, social structure). This review synthesised research on depression among older adults in China, highlighting varying prevalence across diverse geographical locations. Given the high prevalence among certain older Chinese cohorts, the early identification and assessment of the factors associated with depression is essential to reducing disease burden. The use of the biopsychosocial model provided a theoretical lens to examine depression in this population in an integrative and holistic way. Thus, furthering understanding of the factors that require close consideration in future research and practice innovations on depression in older persons.

Exploring the potential role of financial interventions to improve the health of families impacted by incarceration.

To summarize the impact of financial hardship on children whose parents have been incarcerated, describe both existing cash transfer and guaranteed income programs, and highlight their impact on child and family well being. Emerging data on guaranteed income programs for formerly incarcerated adults indicates that the funds improve recipient health and legal system outcomes and allow participants to spend funds on stabilizing themselves and their families. Guaranteed income programs in the broader population similarly highlight the use of funds to support families' basic needs and improved parent-child relationships, but more data are needed to understand the impact on child health and well being among families impacted by the criminal legal system. Over 5 million children experience parental incarceration, which directly contributes to financial hardship and subsequent negative health outcomes. Cash transfers may assist these families, but policies and administrative burdens limit the ability of existing programs to fully address financial hardship. Guaranteed income programs may therefore serve a unique role in supporting the financial needs of families impacted by incarceration. More longitudinal data focusing on child health outcomes are necessary to fully understand the impact of guaranteed income of children and families impacted by parental incarceration.

Advancing vegetable genetics with gene editing: a pathway to food security and nutritional resilience in climate-shifted environments.

As global populations grow and climate change increasingly disrupts agricultural systems, ensuring food security and nutritional resilience has become a critical challenge. In addition to grains and legumes, vegetables are very important for both human and animals because they contain vitamins, minerals, and fibre. Enhancing the ability of vegetables to withstand climate change threats is essential; however, traditional breeding methods face challenges due to the complexity of the genomic clonal multiplication process. In the postgenomic era, gene editing (GE) has emerged as a powerful tool for improving vegetables. GE can help to increase traits such as abiotic stresstolerance, herbicide tolerance, and disease resistance; improve agricultural productivity; and improve nutritional content and shelf-life by fine-tuning key genes. GE technologies such as Clustered Regularly Interspaced Short Palindromic Repeats/CRISPR-associated protein 9 (CRISPR-Cas9) have revolutionized vegetable breeding by enabling specific gene modifications in the genome. This review highlights recent advances in CRISPR-mediated editing across various vegetable species, highlighting successful modifications that increase their resilience to climatic stressors. Additionally, it explores the potential of GE to address malnutrition by increasing the nutrient content of vegetable crops, thereby contributing to public health and food system sustainability. Additionally, it addresses the implementation of GE-guided breeding strategies in agriculture, considering regulatory, ethical, and public acceptance issues. Enhancing vegetable genetics via GE may provide a reliable and nutritious food supply for an expanding global population under more unpredictable environmental circumstances.

Sir Henry Parkes and the Relationships That Enabled Nightingale Nursing to Advance Mental Healthcare in Nineteenth Century Australia.

This position paper explores famous colonial Australian politician Sir Henry Parkes use of relationships to reform colonial Australian mental healthcare by facilitating the integration of Nightingale-trained nurses into hospitals for the insane in the late nineteenth century. A review of historical sources including primary documents reveals that Parkes exhibited astute political skill by developing relationships with influential healthcare leaders such as Florence Nightingale, Lucy Osburn and Dr. Frederic Norton Manning. As Parkes cultivated friendships with such people, he was able to sow seeds for the deployment of Nightingale nurses including twomembers from the original group of six nurses sent by Nightingale to Australia in 1868, as well as threenurses trained under their supervision (probationers) into hospitals for the insane. This historical account provides evidence that enables current-day nurses to understand ways in which events of the past have contributed to the development of present-day mental health services and systems. Parkes' legacy also encourages contemporary nurses who are interested in change to consider the importance of forging diverse strategic relationships to bring their own visions into reality.

Abstract TP143: Improving CT imaging in Non-Fatal strangulation Domestic Violence Victims

Introduction: The incidence of domestic violence (DV) can vary from 2 to 4 million in a year. Domestic violence can be broad in definition and not limited to physical assault. The role of the medical provider in caring for these patients can be difficult; studies suggest that less than 10% of these cases are diagnosed correctly in the emergency room. In collaboration with Brooklyn District Attorney office, we examined and designed a quality improvement study to look at the performance of CT imaging in non-fatal strangulation DV in the emergency department from 8/1/2021 to 3/31/2024 of all NYC Health and Hospitals System (NYCHH). The timely identification of arterial dissection can potentially lead to a decrease risk of stroke. Methods: We developed a non-fatal strangulation pathway in the emergency department for DV patients. We examined the use of CT head and CTA head and neck. The utilization of CT was monitored every quartile. Cases were abstracted with diagnoses of DV and asphyxiation. Strategies were employed to encourage and improve the utilization of pathway. Results: In total, 2163 domestic violence cases were abstracted from electronic medical records. 63% (n=1363) female 5.2% (113) male 31.7% (n=687) did not select for sex (NOA) The percentage of CT performance during 8/1/2021 through 3/31/2024 was 5.5% (116/2163). Upon further evaluation, the percentage of female cases imaged was 5.5% (75/116); by contrast, male cases were imaged at 24.8% (28/116), and NOA 1.9% (13/116). The odds ratio of CT performances in noted cases was 4.5 [95% CI 2.8016-7.2381], 13.0946 [6.5861-26.0349], 2.9 [1.6024-5.277], Male to female cases, male to NOA, and Female to NOA, respectively. Discussion: The literature on domestic violence range in incidence from 2 million to 4 million in a year. The identification of stroke risk factors from a domestic violence incident is a novel approach and has not been fully elucidated. Non-fatal strangulation is known to decrease cerebral perfusion; the risk of developing an arterial dissection is known. Arterial dissection is an independent risk factor for ischemic stroke. In this study, we have observed a low utilization of imaging to rule out dissection; there is a suggestion of disparity among the sexes in diagnosis. Conclusion: The observation from this study involving all hospitals in the NYCHH system reveals a need to better educate and improve diagnosis of domestic violence. This can lead to prompt intervention and medical stabilization.

The prebiopsy photo: A tool to improve patient safety and outcomes.

This article reviews the reasons to take a prebiopsy photograph and the consequences that can ensue when one is not taken. Electronic medical record systems compatible with mobile devices can record clinical photographs that comply with patient privacy regulations, making them the method of choice for dermatologic photo documentation. Correct photographic documentation technique also is critical and is reviewed with examples.

A qualitative exploration of the early adoption of an electronic medical record system for type 1 diabetes management in Rwanda.

Delivering adequate quality care remains a challenge in many low-and middle-income countries (LMICs), especially for people living with type 1 diabetes (T1D), requiring a complex treatment regimen. Digital health solutions, including electronic medical record (EMR) systems, have shown potential to improve delivery and quality of care but still require a successful implementation. To analyze the adoption of a newly implemented EMR system in Rwanda from the perspectives of individuals with T1D, health care providers, and experts. A qualitative study was conducted using the Diffusion of Innovation (DoI) theory to guide the focus of the analysis. A data triangulation strategy was used to gain multi-dimensional insights, involving in-depth interviews and participant observations with T1D individuals, EMR system users, and experts (with varying levels of acquaintance with the EMR system). Experiences of early adoption of the EMR system were explored through thematic analysis guided by the DoI theory. In general, all the participant groups had a positive attitude towards the EMR system, believed to increase the likelihood of a successful implementation. The system was described as user-friendly and improved workflows, data quality, and patient care. The main concerns to successful adoption were related to the maintenance and long-term sustainability of the system. The EMR system showed great potential, was valued by users, and was positively believed to have potential to improve care and outcomes for patients. However, sustainability aspects must not be overlooked when assessing the adoption and use of an EMR system.

Content-based medical retrieval systems with evidence-based diagnosis for enhanced clinical decision support

Content-based medical retrieval systems with evidence-based diagnosis for enhanced clinical decision support

Disparities in Utilization of Outpatient Telemedicine for Neurologic Care.

To characterize outpatient telemedicine utilization for neurologic conditions and identify potential disparities. All outpatient visits conducted by neurology clinicians at an academic medical health care system for patients aged 18 years or older from January 2019 to July 2022 were included. All telemedicine visits were synchronous audio-visual. Patients completing in-person visits alone were compared with patients completing telemedicine visits. Utilization of telemedicine was compared across 3 time frames: prepandemic (before March 2020), early-pandemic (March-June 2020), and late-pandemic (July 2020-July 2022). Generalized linear mixed-effects models were used to evaluate whether the odds of a visit being telemedicine vs in-person differed based on the time frame and to predict likelihood of telemedicine vs in-person visit in late pandemic time frame. In total, 242,273 patients (mean age 55.9 years, 58.2% female, 81.9% White, 12.5% Black, 3.4% Hispanic, 39.2% Medicare) completed 752,174 visits during the study time frame. There was a significant difference in telemedicine utilization between the time frames, with the highest utilization being in the early pandemic (p 0.01). In the late pandemic time frame, odds of a telemedicine visit were significantly lower for individuals who were older (odds ratio [OR] 0.97), Black (OR 0.84), Hispanic (OR 0.70), a higher Area Deprivation Index (20%-40%: OR 0.85, 40%-60%: OR 0.80, 60%-80%: OR 0.78, ≥80%: OR 0.65), with nonprivate insurance (Medicaid OR 0.78; Medicare OR 0.84; self-pay OR 0.60), and non-English preferred language (OR 0.61) (p < 0.01 for all). Odds of a telemedicine visit were significantly higher for individuals who were female (OR 1.25) and lived outside of the greater Cleveland area (other Ohio OR 2.33; out of state OR 3.32) (p < 0.01). Visits completed by rural patients did not differ significantly from metropolitan patients (OR 0.95, p = 0.09). Disparities in telemedicine persist with lower use in individuals who were older, Black, Hispanic, non-English preferred language, and lower socioeconomic status. These disparities improved initially but were accentuated later in the pandemic. The equal utilization of telemedicine by rural and urban patients in this study suggests the potential of telemedicine to improve access disparities for rural patients. The implementation of equitable health care delivery will require a better understanding of barriers, preferences, and legislation needed to support equitable telemedicine access.

Collaboration of Clustering and Classification Techniques for better Prediction of Severity of Heart Stroke using Deep Learning

Our research aims to present a comprehensive study of machine learning algorithms and deep learning advancements in medical field systems for decision making. Present study examines the idea of extracting most important risk factors from given medical data, which has major impact in the increase of severity condition of heart stroke. Three experimental prediction models are developed when k-means clustering is collaborated with classification which includes machine learning algorithms like Naïve Bayes, Decision Tree and a deep learning algorithm Artificial Neural Network. A detailed comparison analysis is done by evaluating performance metrics like sensitivity, specificity, accuracy, and AUC-ROC scores. Out of the three, k-means with Artificial Neural Network model outperformed with sensitivity 0.89, specificity 0.89, and accuracy of 0.90 in comparison with machine learning classifiers. The challenges of perfect balancing of sensitivity and specificity is achieved by AUC-ROC score of 0.96, which is the best possible result till now.

Immigration of medical personnel from Ukraine to Poland - Context, regulations, and trends.

The migration of healthcare professionals is common phenomenon and shows upwards trends. Poland, which used to be a source country with marginal immigration, has in the past few years received more immigrants due to the simplified access to the labour market for professionals from outside the European Union. We aimed to analyse the immigration of healthcare workforce to Poland with an emphasis on legislative changes regarding the right to practice of medical personnel from outside the EU (mainly from Ukraine). This analysis included the description of legislative changes in the recognition of qualifications of doctors, dentists, nurses, and midwives. Data on the number of non-EU citizens who took up employment in Poland were analysed concerning three periods reflecting these changes: (1) before 2020, (2) during the Covid-19 pandemic (2020-2022), and (3) after the Russian invasion of Ukraine (since February 2022). Also, the medical education systems in Poland and Ukraine were compared. The number of Ukrainian health workers seeking employment in Poland has increased significantly in recent years, mainly due to the geopolitical context of the war in Ukraine. This has been supported by the simplification of legal regulations for obtaining a licence to practice. It is necessary to implement a comprehensive adaptation process for migrant health workers to maintain the quality of provided services and patient safety.

Correlation of the clinical rating scale for tremor with a global assessment.

The Fahn-Tolosa-Marín Clinical Rating Scale for Tremor (CRST) includes three parts (tremor severity, motor task performance, functional disability) and a separate global assessment of impairment completed by both the patient and examiner. Although the CRST is used to determine tremor severity and the efficacy of treatments for tremor, the instrument may not sufficiently capture the patient's perspective. The objective of this study was to determine the association of the CRST subpart and total scores with the global assessment. This cross-sectional study included patients with essential tremor who completed a CRST within a tertiary health system electronic health record from 2013 to 2023. The global assessment was rated on a 0-100 % (most severe impairment) scale. 116 patients were included. The total CRST score was significantly associated with the examiner-reported global assessment (Spearman's correlation coefficient (ρ) 0.63, 95 % confidence interval (CI) 0.51 - 0.73, p < 0.001) but not the patient-reported global assessments (ρ 0.15, 95 % CI -0.04 - 0.33, p = 0.13). There were no significant associations between Part A, B, or C sub-scores and the patient-reported global assessments. CRST scores have a stronger association with the examiner-reported global assessment than the patient-reported global assessment. The impact of tremor may be determined by functional detriments not readily measured with the CRST. By using the global assessments as a standard for comparison, our findings call into question the relevance of the CRST total scores and sub-scores as an accurate patient-centered outcome metric.

Projections of future heat-related emergency hospitalizations for asthma under climate and demographic change scenarios: a Japanese nationwide time-series analysis

There is growing concern about climate impacts on human health. However, empirical evidence is lacking regarding future projections of heat-related asthma hospitalizations. This study aimed to project excess emergency hospitalizations for heat-related asthma exacerbation in Japan. Using Japanese nationwide administrative data from 2011 to 2019, we conducted an ecological time-series quasi-Poisson regression analysis to estimate the heat-related relative risk of emergency hospitalization for asthma over a lag of 0-3 days during the warm season (June to September). Heat exposure was defined as the region-specific daily mean temperature exceeding the locally defined minimum morbidity temperature percentile (MMP). Heat-related excess hospitalizations for asthma were projected under future climate and demographic change scenarios based on Shared Socioeconomic Pathways (SSPs). We identified 75,829 emergency hospitalizations for asthma. The heat-related relative risk of hospitalization was 1.22 (95% confidence interval (CI): 1.12-1.33) at the 99th percentile temperature relative to the MMP, with the highest estimates for cases aged 0-14 years. Heat-related excess hospitalizations were projected to increase by 6.78 (95%CI: 5.84-7.67) times in 2091-2099 versus 2011-2019 along SSP5-8.5 when constant population structure was assumed. The increasing trend persisted even when the future population decline was considered (4.19 (95%CI: 3.53-4.85) times in 2091-2099 versus 2011-2019 under SSP5-8.5). Future heat-related impacts on asthma exacerbation are expected to increase in Japan toward the end of this century, even when the future demographic change is considered. Our projections will contribute to resilient health systems adapting to ongoing climate change.

Abstract TP130: Identifying Facilitators and Barriers to Positive Illness Perceptions in Younger Stroke Survivors during Acute Hospitalization

Background: Despite increasing stroke incidence in US adults younger than 44 years, little is known about their illness perceptions, which have been shown to impact stroke recovery and possibly secondary prevention. This study’s objective is to identify facilitators and barriers to positive illness perception of stroke survivors and their caregivers during acute hospitalization. Methods: Stroke survivors and caregivers participated in virtual focus group sessions with structured interview guides assessing perceptions of hospitalization and general wellbeing. Sessions were recorded and transcribed using NVivo software. Framework method was used for analysis; three independent coders developed a comprehensive codebook from transcripts. Framework matrices were used to identify recurrent themes, which were then determined to be facilitators or barriers to positive illness perception during acute hospitalization. Results: Stroke survivors and caregivers (n=12) participated in seven focus group sessions. Younger survivors (n=4; 3 male, 1 female survivors) were aged 25 to 44, compared with older survivors (n=8; 3 female survivors, 5 female caregivers) aged 45 to 84. Across each phase of acute hospitalization, five themes related to illness perceptions emerged: (1) symptom recognition and health system navigation; (2) communication of diagnosis and management; (3) presence of a champion; (4) clinician bias; (5) psychological distress. Figure 1 shows how stroke survivors, based on their age, experienced the acute hospitalization and how illness perception was shaped by these themes. Clinician bias, psychological distress, and the inability to recognize stroke symptoms emerged as unique barriers for younger stroke survivors. Conclusion: Despite a similar diagnosis, illness perceptions of younger stroke survivors were distinct compared to older counterparts. Younger survivors experienced bias and psychological distress, exposing differential treatment in care. A facilitator to positive illness perception among both populations was the presence of a champion; in younger survivors, advocacy of a partner was crucial for diagnosis, suggesting the importance of symptom recognition in younger populations. Future studies are required to explore the transferability of our findings and to investigate clinician recognition of stroke in younger populations.

Provider perspectives on non-medical barriers to GI cancer care at a regional cancer center.

807 Background: Disparities in care for patients with gastrointestinal (GI) cancers are well-documented, but solutions remain elusive. Understanding the barriers faced by healthcare providers is essential to improving care equity. This study explored the perceptions of healthcare providers at a regional academic health system regarding barriers to care for GI cancer patients. Methods: A cross-sectional survey was conducted among healthcare providers, including physicians, advanced care providers (APPs), nurses, dietitians, social workers, care coordinators, and physical/occupational therapists who directly care for patients with GI malignancies. Survey items assessed specific barriers encountered in clinical practice and suggestions for improving care. Descriptive statistical analysis evaluated the quantitative data from the closed-ended questions across professional roles. A thematic analysis was performed on open-response items and assessed to further identify key barriers to care based on respondents' clinical roles and experiences. Results: Seventy-nine healthcare providers responded to the survey. Initial treatment planning was consistently identified as the phase with the most significant barriers across all disciplines. Health literacy was cited as the most critical barrier to diagnosis, while insurance coverage, financial constraints, geographic location, lack of transportation, and social support were the primary obstacles to treatment. The importance of these barriers varied by profession: physicians noted geographic and transportation limitations, while nurses and social workers emphasized gaps in health literacy, insurance, and social support. Systemic issues such as limited access to specialized care and healthcare personnel shortages were also noted. Notably, 55% of physicians spent 10-30% of their time addressing non-medical barriers to treatment, while 38% of nurses spent 30-50%. Care coordination across disciplines was commonly cited as a challenge, with many calling for improved communication and establishing multidisciplinary clinics. Food insecurity, housing stability, and language/cultural barriers were less prominent concerns at this institution. Conclusions: Oncology providers at a large regional cancer center spend significant time addressing non-medical barriers to treatment for GI cancer patients, particularly during initial treatment planning. The most common challenges reported were insurance, transportation, health literacy, and social support. We will use these findings to guide in-depth provider and patient interviews and develop a team-based, equity-focused intervention. These efforts aim to improve care delivery at our institution and serve as a model enhancing GI cancer care in broader healthcare settings.