Healthcare Network Research Articles

Factors influencing delay in cancer diagnosis: a qualitative study in Chile, Colombia and Ecuador

Abstract Background Although the greatest delays in cancer diagnosis in Latin America occur in the provider interval, little is known about related factors. This study, part of EquityCancer-LA, aims to analyse the factors influencing access to cancer diagnosis from key stakeholders’ perspective in healthcare networks of Chile, Colombia, and Ecuador. Methods A qualitative, descriptive-interpretative study was conducted in two networks per country in 2023, using semi-structured individual interviews (n = 114) with a criterion sample of primary care (PC) (n = 40) and secondary/tertiary hospitals (n = 44) health/administrative professionals, managers, and policy makers (n = 30). Thematic analysis was performed, segmented by country. Results The analysis revealed interacting factors that cause cumulative delays, with differences between countries. In all, participants identified networks structural characteristics (deficits in diagnostic resources; geographical accessibility), organizational factors (long waiting times, especially after referral), and limited knowledge of PC doctors, which all lead to delayed referral. In Chile and Colombia, barriers related to care rationing/prioritization policies hampered access to tests, and in Chile, increased delays for non-prioritized conditions. Barriers related to the health system organization also emerged: in Chile, problems related to private services subcontracting and the voucher system for using them; in Colombia, the management of care by insurers (authorizations; fragmented and short-term contracting of providers); and in Ecuador, health system underfunding. The barriers mostly affected the elderly, those with low socioeconomic status, limited social support networks, and rural areas residents. Conclusions The results reveal significant barriers in access to timely cancer diagnosis, which can and should be addressed with specific cancer diagnosis policies and general measures that strengthen public healthcare systems and networks. Key messages • Key health system factors influencing provider delays in cancer diagnosis are identified. • Evidence is provided for the design of policies to improve timely cancer diagnosis in studied countries.

Dementia in patients with early cardiovascular complications following ischaemic stroke: A neglected complication of the stroke-heart syndrome

Abstract Background Early cardiovascular complications may occur in 20-30% of patients following following ischaemic stroke (stroke-heart-syndrome, SHS). The risk of dementia in patients with SHS remains unexplored. We aimed to quantify the risk of incident dementia in patients with SHS. Methods We conducted a retrospective analysis using a global federated health care network (TriNetX). We included patients who were discharged alive post-ischaemic stroke from 2000 to 2022. These individuals were classified into two cohorts based on the incidence of cardiovascular complications within 30 days post-stroke (acute heart failure [HF], acute myocardial infarction [AMI], ventricular fibrillation or flutter [VFF], or Takotsubo disease [TTS]), ie. those with SHS (Group 1) and those with stroke-only (without SHS; Group 2). The primary outcome was the five-year risk of dementia (vascular dementia [F01], dementia in other disease [F02], unspecified dementia [F03], Alzheimer’s disease [G30]). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression analysis after 1:1 propensity score matching (PSM). Results We identified 70,113 patients with SHS (age 67.3±14.0; 42.2% females) and 1,092,540 patients with stroke-only (age 65.2±14.9, 48.1% females). Prior to PSM, patients with SHS were generally older and had a higher prevalence of cardiovascular treatments compared to those without SHS. Following PSM, 70,111 well-balanced patients were considered in each group, however, patients with SHS had a higher risk of dementia compared to patients with stroke-only (HR 1.25, 95%CI 1.20-1.30). Among the SHS complications, the highest dementia risks were associated with acute HF (HR 1.28, 95%CI 1.21-1.36) and AMI (HR 1.24, 95%CI 1.17-1.30), with no significant associations were found for TTS, and VFF. The increased risk of dementia in patients with SHS compared to patients with stroke-only was independent of oral anticoagulant (OAC) use, sex, and age (> or < 75 years) [Figure 1]. Conclusion Stroke-heart syndrome is associated with increased risk of dementia. Innovative strategies to identify and to prevent SHS complications would improve long-term prognosis in patients with recent stroke.

2.F. Scientific session: Challenges in healthcare architectures

Abstract The Workshop titled “Challenges in healthcare architectures” - proposed and developed by the three EUPHA Section: Urban Public Health (URB), Public Mental Health (MEN) and Environmental Health (ENV) - is aimed to foster the dialogue between designers (architects and urban planners), Public Health experts (operators, professionals and epidemiologists), general/sanitary Directors of healthcare facilities and medical staff, to establish a multidisciplinary approach for understanding together how to create and manage the healthcare facilities of the future. According to the main Conference topic “Sailing the waves of European public health: exploring a sea of innovation”, the workshop mainly addresses both the “Health care services and systems” and the “Health workforce, practice and training” EPH24 conference topics. The Workshops purpose is to explore the concept for the hospital of the future, that should be resilient to changes and capable of protecting different users’ health and tackle the transforming social, economic, environmental and epidemiological needs of the context in which they are located. As in many other spheres and economic activities, the pandemic accelerated the processes of innovation and digitization that had somehow already been activated. The healthcare issue, the use of smart devices for a dialogue between the healthcare professionals and the pervasive use of apps to monitor certain health parameters, are just some of the megatrends that were being observed and which have now necessarily entered into everyday life. In the same way, the hospital, which in the face of this gradual process of dematerialization and relocation of ‘softer’ clinical-diagnostic activities, reaffirms itself as a center of the highest specialty for the treatment and care of acute patients, for high-level clinical and experimental re-search, for diagnostics and more complex operations. At the same time, and finally, the hospital is inserted in a territorial healthcare facilities network, that should be planned, designed, and managed. The workshop program includes inputs which they argue current experiences, emerging practices and scientific outcomes related to the hospital design, planning and management sphere, coming from four different European countries. From designing to managing practices, in “Hospital Design and planning in the line of Foresight of Health Needs” and in “Sustainability in the Next Generation Hospital”. From digitalization in national resilience experiences, in “Digital Health Spaces in the City of Lisbon. The Role of Digitalization in linking Boundaryless Hospitals and Smart Health Cities” to novel approaches for specific disease, in “Building bridges: mobile mental health care units in four European countries”. Key messages • Explore the “hospital of the future” concept, resilient to changes, capable of protecting users’ health, and to tackle the transforming social, economic, environmental and epidemiological needs. • Establish a multidisciplinary and territorial approach, for understanding together how to create and manage the healthcare network of the future.

Clinical coordination in cancer diagnosis: healthcare stakeholders’ viewpoints in Latin America

Abstract Background Delays in diagnosis contribute to increasing cancer mortality rates in Latin American countries due to, among others, highly fragmented healthcare systems. The objective of this study, part of a larger research project (EquityCancer-LA), was to analyze cross-level coordination during cancer diagnosis and factors influencing it from healthcare stakeholders’ perspectives in Chile, Colombia, and Ecuador. Methods This descriptive-interpretative qualitative study was based on 114 semi-structured individual interviews in 2022-23 using a criterion sample of health professionals from primary care (PC) (n = 40) and secondary care (SC) (n = 44) as well as managers and policy makers (n = 30) from two public healthcare networks in each country. Sample reached saturation. A thematic analysis was conducted first by country and then comparatively, guided by the theoretical framework of clinical coordination. Results In all countries, informants highlighted limited cross-level exchange of information and limited coordination of clinical management, delays in referral, and long waiting times after referral, leading to diagnostic delays. Factors hindering coordination differed across countries: structural (insufficient personnel, access to diagnostic tests in PC); organizational (limited/inadequate coordination mechanisms, e.g. shared clinical records; poor working conditions); and health professional characteristics (limited knowledge and skills among PC doctors). Direct feedback was emphasized to facilitate coordination of cancer diagnosis: virtual joint clinical conferences in Chile, co-location of PC and SC in Colombia, and informal networks (based on personal contacts) in Ecuador. Conclusions The findings underscore the critical coordination problems contributing to delays in cancer diagnosis. Addressing these challenges requires strategic interventions aimed at strengthening primary care and fostering cross-level coordination. Key messages • Cancer diagnosis in Latin America suffers from coordination deficits due to structural, organizational, and professional factors. • Strengthening primary care and cross-level coordination is needed.

Implementing a Hospital-Wide Programme Using iPARiHS to Prevent and Manage Incontinence-Associated Dermatitis and Improve Hospital-Acquired Pressure Injuries.

To outline the implementation of a hospital-wide programme using the Integrated Promoting Action on Research Implementation in Health Services framework to prevent and manage incontinence-associated dermatitis and improve hospital-acquired pressure injuries. This is an empirical research study using mixed methods. The study, conducted across surgical, medical and critical care wards between June and October 2023, aimed to address knowledge gaps, enhance clinical practice and evaluate the effectiveness of interventions. The implementation strategy included education modules, engagement of staff through focus groups and targeted interventions such as individualised toileting plans and structured skin care regimens. Data collection involved audits, incident reporting and clinician knowledge surveys. Findings indicate a reduction in hospital-acquired incontinence-associated dermatitis and pressure injuries postimplementation, with observed improvements in clinician knowledge. However, challenges including workload, skill mix and resource limitations were identified as barriers to implementation. The sustainability and scalability of the programme were emphasised, with ongoing monitoring and evaluation essential for long-term success. This study underscores the importance of evidence-based interventions, interdisciplinary collaboration and leadership support in improving patient outcomes and reducing healthcare costs associated with preventable skin injuries. Further research is needed to assess implementation in community settings and scale up interventions across healthcare networks. Analysing a hospital-wide programme using the Integrated Promoting Action on Research Implementation in Health Service framework to prevent and manage incontinence-associated dermatitis and improve hospital-acquired pressure injuries, could help identify the challenges for delivering patient-centred care. No patient or public involvement. To describe the implementation study, we referred to the StaRI Guideline. This intervention study was applied to the whole population and was therefore not a trial and did not require trial registration. The study was considered low risk and the Human Research Ethics Application (HREA) was approved.

Influence of socioeconomic aspects on morbidity and mortality rates from COVID-19 in the state of Tocantins, Brazil

This study aimed to analyze the spatial correlation of COVID-19 with social vulnerability indices in the state of Tocantins. Methodology: An ecological and cross-sectional study was conducted, analyzing the temporal evolution of the pandemic using the local bivariate Moran's index and the Kernel intensity estimator for COVID-19 cases in Tocantins from 2020 to 2022. Results: The northern region of the state showed the highest concentration of cases and deaths, a concerning fact given the high social vulnerability of most municipalities in this region. Conclusion: The study identified a positive spatial correlation between the incidence and mortality rates of COVID-19 and the social vulnerability index of the municipalities. These findings highlight the need to strengthen preventive measures and expand the physical, technological, and human resources of the healthcare network, especially in areas serving populations with higher vulnerability and traditional communities. This is particularly relevant as the disease also affects more isolated areas, impacting indigenous, riverside, and quilombola populations.

GLP-1 Receptor Agonists Confer No Increased Rates of IBD Exacerbation Among Patients With IBD.

In patients with inflammatory bowel disease (IBD), multimorbidity with obesity and type 2 diabetes is common and increasing. Glucagon-like peptide 1 (GLP-1) receptor agonists are increasingly being prescribed for patients with IBD, yet their impact on patients with IBD is largely unknown. We aimed to assess the impact of GLP-1 receptor agonists on the course of IBD. We identified all IBD patients prescribed GLP-1 receptor agonists at a large academic healthcare network between 2009 and 2023. We analyzed demographics and IBD characteristics in the year pre- and post-GLP-1 receptor agonist prescription and matched them to non-IBD controls. Our primary outcome was IBD exacerbation in the year following GLP-1 receptor agonist initiation, measured as a composite of IBD-related hospitalization, corticosteroid prescription, medication escalation or changes, or IBD-related surgery. Secondary outcomes included change in metabolic risk factors. Overall, 224 patients met inclusion criteria. At GLP-1 receptor agonist initiation, the median age was 54 years, 63% were female, 77% were White, and median BMI was 33.2kg/m2. Compared to the 12-month period prior to GLP-1 receptor agonist initiation, in the 12 months post-GLP-1 receptor agonist initiation, there was no change in rates of IBD exacerbation, IBD-related hospitalization, steroids prescription, medication escalation or changes, or IBD-related surgery. There was a significant decrease in BMI in the year following GLP-1 receptor agonist initiation (median BMI 33.5 vs 31.6kg/m2, P < .01), with rates of decrease comparable to non-IBD matched controls. In patients with IBD, GLP-1 receptor agonists are effective for weight loss and associated with few episodes of disease exacerbation.

Hospital Network Centralization of Primary Total Joint Arthroplasty Is Associated With Reduced Early Complication Rates But Not Reduced Readmission or Reoperation Rates: A Retrospective Database Study

Background: Hospital networks centralize primary total joint arthroplasty (TJA) within their existing systems to develop specialized service lines with higher surgical volumes to reduce adverse events. It is not known what role hospital network centralization has had on primary TJA outcomes. Purpose: We sought to determine whether the degree of hospital network centralization for primary TJA is associated with (1) 90-day postoperative complication rates, (2) 90-day hospital readmission rates, or (3) 1-year revision rates. Methods: We conducted a retrospective database study of Medicare Part A beneficiaries who underwent inpatient primary TJA for osteoarthritis in 2016 and 2017 ( n = 523,142 patients); individual hospital-level characteristics and hospital networks were also identified ( n = 360 unique networks, n = 3339 hospitals). Patients having surgery at a hospital that was not a member of a health care network were excluded ( n = 163,998 patients) because we wanted to examine only the role of network structures on outcomes; this resulted in a cohort of 359,144 patients. Hospital network centralization, which was defined as the percentage of total network cases performed at the highest volume hospital and categorized into quartiles (eg, lowest 25% of networks by concentration, 26%–50% of networks by concentration, etc). Primary outcomes included postoperative 90-day complications, 90-day readmissions, and 1-year revisions. Multivariable logistic and linear regressions evaluated associations of hospital network centralization with outcomes and controlled for relevant patient-level and hospital-level covariates, including hospital network volumes. Results: Odds of 90-day complications were lower in the most centralized hospital networks than in least centralized networks (odds ratio [OR] = 0.85; 95% confidence interval [CI]: 0.75, 0.95). Degree of centralization was not associated with readmissions or 1-year revision rates. Non-modifiable patient and individual hospital characteristics appeared to have a greater association with complications, readmissions, and early revision rates than hospital network centralization or volume. Conclusion: This retrospective database study found that increased centralization of primary TJA within a hospital network was associated with lower 90-day complication rates but not with 90-day readmission or 1-year revision rates. This suggests that structural changes within hospital networks may be beneficial to reduce early complications in this patient population. In addition, our findings suggest that risk adjustment in assessing non-modifiable patient and hospital risk factors may be important when assessing TJA outcomes.

Smart Green Cotton Textiles with Hierarchically Responsive Conductive Network for Personal Healthcare and Thermal Management.

Whereas cotton as an abundant natural cellulose has been widely used for sustainable and skin-friendly textiles and clothes, developing cotton fabrics with smart functions that could respond to various stimuli is still eagerly desired while remaining a great challenge. Herein, smart multiresponsive cotton fabric with hierarchically copper nanowire interwoven MXene conductive networks that are seamlessly assembled along a 3D woven fabric template for efficient personal healthcare and thermal comfort regulation is successfully developed. The robust hierarchically interwoven conductive network was "glued" and protected by organic conductive polymer poly(3,4-ethylenedioxythiophene) along a 3D interconnected fabric template to enhance interfacial adherent and environmental stability. Benefiting from the robust multiresponsive hierarchically interwoven conductive network, smart cotton fabric exhibits real-time response to various external stimuli (light/electrical/heat/temperature/stress), and the details of human activities can be accurately recognized and monitored. Furthermore, the porous structure of 3D smart fabric induced strong capillary force and confinement to phase change materials PEG, which exhibits a wide range of phase transition temperatures for efficient thermal comfort regulation. After further encapsulation with transparent fluorosilicone resin, the smart cotton fabric exhibits excellent self-cleaning performance with water/oil repellent. The smart multiresponsive cotton fabrics hold great promise in next-generation wearable systems for efficient personal healthcare and thermal management.

OA17.04 Implementation of a Natural Language Processing (NLP) Model to Detect Incidental Lung Nodules in a Nationwide Health Care Network

OA17.04 Implementation of a Natural Language Processing (NLP) Model to Detect Incidental Lung Nodules in a Nationwide Health Care Network

The clinical and genetic spectrum of paediatric speech and language disorders.

Speech and language disorders are known to have a substantial genetic contribution. Although frequently examined as components of other conditions, research on the genetic basis of linguistic differences as separate phenotypic subgroups has been limited so far. Here, we performed an in-depth characterization of speech and language disorders in 52 143 individuals, reconstructing clinical histories using a large-scale data-mining approach of the electronic medical records from an entire large paediatric healthcare network. The reported frequency of these disorders was the highest between 2 and 5 years old and spanned a spectrum of 26 broad speech and language diagnoses. We used natural language processing to assess the degree to which clinical diagnoses in full-text notes were reflected in ICD-10 diagnosis codes. We found that aphasia and speech apraxia could be retrieved easily through ICD-10 diagnosis codes, whereas stuttering as a speech phenotype was coded in only 12% of individuals through appropriate ICD-10 codes. We found significant comorbidity of speech and language disorders in neurodevelopmental conditions (30.31%) and, to a lesser degree, with epilepsies (6.07%) and movement disorders (2.05%). The most common genetic disorders retrievable in our analysis of electronic medical records were STXBP1 (n = 21), PTEN (n = 20) and CACNA1A (n = 18). When assessing associations of genetic diagnoses with specific linguistic phenotypes, we observed associations of STXBP1 and aphasia (P = 8.57 × 10-7, 95% confidence interval = 18.62-130.39) and MYO7A with speech and language development delay attributable to hearing loss (P = 1.24 × 10-5, 95% confidence interval = 17.46-infinity). Finally, in a sub-cohort of 726 individuals with whole-exome sequencing data, we identified an enrichment of rare variants in neuronal receptor pathways, in addition to associations of UQCRC1 and KIF17 with expressive aphasia, MROH8 and BCHE with poor speech, and USP37, SLC22A9 and UMODL1 with aphasia. In summary, our study outlines the landscape of paediatric speech and language disorders, confirming the phenotypic complexity of linguistic traits and novel genotype-phenotype associations. Subgroups of paediatric speech and language disorders differ significantly with respect to the composition of monogenic aetiologies.

Early Lessons From Working With Local Partners to Expand Private-Sector Health Care Networks in Burundi and Mali.

The private health care sector is an important source of service delivery in low- and middle-income countries (LMICs). Yet, the private sector remains fragmented, making it difficult for health system actors to support and ensure the availability of quality health care services. In global health programs, social franchising is one model used to engage and organize the private health care sector. Two social franchise networks, ProFam in West Africa and Tunza in East and Central Africa, provide health care through branded networks of facilities. However, these social franchise networks include a limited number of private health care facilities, and in fragile contexts, like Burundi and Mali, they have faced challenges in integrating with national health systems. The MOMENTUM Private Healthcare Delivery (MPHD) project in Burundi and Mali sought to expand the number of health facilities it engaged beyond the existing ProFam and Tunza networks. The expansion aimed to help improve service quality in more private facilities while advancing localization and reducing fragmentation for improved stewardship by health system actors. MPHD achieved this expansion by removing barriers for private health facilities to join inclusive, nonbranded networks and engaging local partners to build and maintain these networks. We share lessons learned regarding the growing role of local organizations as actors within mixed health systems and provide insights on strengthening stewardship of the increasingly heterogeneous private health care delivery sector in LMICs, particularly in fragile settings.

Trends over time in oral anticoagulation and stroke rates in atrial fibrillation: A community-based study

ObjectivesOver the last decade, direct oral anticoagulants (DOAC) have become preferred over warfarin for stroke prevention in atrial fibrillation (AF). The objectives of this study were to quantify the shift over time from warfarin to DOACs and parallel changes in ischemic and hemorrhagic stroke rates in AF. Materials and methodsThis community-based retrospective study was undertaken within a single integrated health care network from 2011 to 2021. Changes over time in warfarin and DOAC use were quantified by year, both overall and stratified by CHA2DS2-VASc score. Ischemic and hemorrhagic stroke rate changes over time were evaluated by Poisson regression. Stroke rates were evaluated in different time eras: 2011–2015 and 2016–2021. ResultsAmong 31,978 AF patients followed an average of 5.5 years, any OAC use increased from 50.2 % (2011) to 59.4 % (2020) (p < 0.001). Warfarin use decreased from 49.3 % to 30.8 %, while DOAC use increased from 2.0 % to 30.8 % (both p < 0.001). In 2020, patients with CHA2DS2-VASc 0–1 and 2–5 were more likely to use DOACs than warfarin (18.6 % vs. 6.7 %; 33.0 % vs. 28.2 %), whereas in CHA2DS2-VASc 6–9 DOACs were used less frequently (30.0 % vs. 40.8 %). Ischemic stroke rates significantly increased by 19 % (95 % CI: 7 %, 32 %) from 2011 to 2015, but significantly decreased by 18 % (10 %, 26 %) from 2016 to 2021. Hemorrhagic stroke rates stabilized in 2016–2021 (+3 %; −18 %, 30 %) after increasing in 2011–2015 (+36 %; 4 %, 78 %). ConclusionImprovements in ischemic and hemorrhagic stroke rates coincided temporally with increased uptake of OACs and a shift toward increased uptake of DOACs relative to warfarin.

Quantum image encryption protocol for secure communication in healthcare networks

Quantum image encryption protocol for secure communication in healthcare networks

Long-lifespan, biodegradable, self-disinfecting, and gas-sensing electronic mask with a Janus-structured all-natural fiber network for personal healthcare

Conventional disposable surgical masks have become an integral part of our daily lives, however, present a limited filtration efficiency, brief operative lifespan, and inability to degrade naturally, bringing a heavy burden to the environment. Moreover, these masks cannot efficaciously eliminate bacteria, potentially causing secondary and cross infections among users, thereby failing to curb the spread of infectious diseases. Herein, a fire-new, long-lifespan, biodegradable, self-disinfecting, and gas-sensing electronic-mask is nano-engineered with a Janus-structured all-natural fiber network (SA-CPN) constructed from animal-collagen and plant-fibers. SA-CPN demonstrates exceptional filtration performance (99.9%) for PM2.5 and maintains outstanding filtration efficiency after 10 test-cycles or 32 h in high-humidity conditions. SA-CPN exhibits robust antibacterial origins for extended periods, with antibacterial rates of 98.30%, 99.36%, and 98.11% against P aeruginosa, S aureus, and E coli, respectively, and can effectively filter airborne bacterial aerosols. Moreover, SA-CPN achieves real-time detection of ammonia concentrations, effectively identifying ammonia levels in exhaled human breath and external environments, and monitoring the human respiratory rate, potentially identifying underlying health conditions. The directional water vapor transmission capability of SA-CPN improves comfort when wearing. Notably, SA-CPN can fully biodegrade within 5 h under enzyme action. The proposed multifunctional electronic mask, featuring biocompatibility, biodegradability, self-disinfection, and ammonia sensing capabilities, holds significant promise in personal medical protective equipment for health monitoring and disease prevention.

Physical Restraint Use in Hospitalized Patients: A Study of Routinely Collected Health Records Data.

The use of restraints in hospitalized patients is associated with physical and psychological adversity for patients and staff. The minimization of restraint use is a key goal in the hospital setting. Reaching this goal requires an accurate assessment of existing patterns of use across clinical settings. This study reports the rate of physical restraints among patients hospitalized within a multi-entity healthcare network along with stratification by care context, diagnostic, and demographic factors, and examines the sensitivity and specificity of ICD-10 code Z78.1 "physical restraint status" for defining physical restraints relative to electronic health record (EHR) documentation. The EHR was used for a retrospective analysis of all adults hospitalized between 2017 and 2022. Hospitalized adults. Patient demographics, structured diagnostic information, care area, length of stay, and in-hospital mortality, Z78.1 coding for physical restraints, restraint documentation in orders and flowsheets. Among 742,607 hospitalizations, 6.3% (n=47,041) involved the use of physical restraint based on coding or EHR documentation. Treatment in the intensive care unit (ICU) included restraint in 39% of encounters whereas treatment outside the ICU included restraint use in 1.3% of encounters. Besides critical illness, demographic factors including increasing age (adjusted odds ratio (aOR)=1.21 [1.19-1.23]), male gender (aOR=1.56, [1.52-1.60]), unknown race (aOR=1.27 [1.19-1.35]), and preferred language other than English (aOR=1.24, [1.18-1.29]) were associated with higher odds of restraint utilization. As compared to EHR orders or documentation of restraint, the ICD-10 code for physical restraint had a sensitivity of 1.5% and a specificity of 99.99%. Among adults admitted to acute care hospitals, clinical, demographic, and operational factors were associated with increased odds of restraint, with care in the ICU associated with greatly increased odds of restraint. Research into restraint utilization using coded administrative claims data is likely limited by the sensitivity of physical restraint coding.

Survey of the endoscopy workforce’s perception of sustainability

ObjectiveThe National Health Service is a significant contributor to greenhouse gas emissions, with endoscopy ranking as the third highest contributor of waste in healthcare. We aimed to ascertain the endoscopy...

Housing instability increases for stimulant-involved overdose deaths after linking surveillance data to electronic health records in Kentucky

BackgroundAccording to the U.S. Centers for Disease Control and Prevention, approximately 10.2 % of fatal overdoses in 2022 were among people experiencing homelessness or housing instability. In the United States, the majority of all drug overdoses now involve stimulants. MethodsWe linked stimulant-involved fatal overdose records occurring between 2017 and 2021 from Kentucky’s Drug Overdose Fatality Surveillance System to the electronic health records (EHR) of the state’s largest safety-net hospital network. We used State Unintentional Drug Overdose Reporting System (SUDORS) definitions of homelessness or housing instability to establish baseline estimates before linking decedents to medical records. After linkage, we augmented SUDORS data with structured administrative billing codes, semi-structured address data, and unstructured clinical notes identifying homelessness from the EHR. ResultsThere were 313 individuals with stimulant-involved fatal overdoses linked to at least one medical encounter in the EHR (2017–2021). Thirty-three individuals (10.5 %) were identified as having unstable housing according to SUDORS. After linkage, 130 individuals (41.5 %) had evidence of housing instability. For this period, these 313 individuals represent 8.0 % of stimulant-involved overdoses in KY or 38.5 % of stimulant-involved overdoses from residents of the primary and secondary catchment area of our healthcare network. ConclusionsThe single-site increase in observed housing instability in stimulant-involved fatal overdoses suggests that increased data linkage between state medicolegal death investigation system and EHRs would significantly improve the public health surveillance of overdoses.

A bilevel hierarchical covering model to protect a healthcare network against failures

A bilevel hierarchical covering model to protect a healthcare network against failures

A-207 Enhancing Healthcare Delivery Network Laboratories: The Role of Third-Party Consultants in Benchmarking and Reviewing RFP Results

Abstract Background Healthcare delivery networks, particularly laboratory services, play a critical role in patient care and diagnosis. However, ensuring the quality and efficiency of these services can be challenging due to the complex and dynamic nature of healthcare systems. Third-party consultants offer valuable expertise in benchmarking and reviewing Request for Proposal (RFP) results, which can improve the quality and cost-effectiveness of laboratory services within healthcare networks. Methods To evaluate the role of third-party consultants in enhancing healthcare delivery network laboratories, the author conducted surveys to 50 laboratory leaders with a 50% response rate and analyzed the following aspects: Benchmarking: Comparing laboratory performance metrics with industry best practices and peer institutions to identify areas for improvement. RFP Review: Utilizing subject matter experts to assess the technical and financial proposals submitted by vendors to ensure compliance with RFP requirements and to identify the most suitable vendor for the network. Emotional Procurement: Minimizing the influence of emotional factors, such as personal relationships or brand loyalty, during the RFP process. Results Improved Quality: 65% said they can save &amp;gt;50 hours of labor utilizing a 3rd party for RFP, thus able to focus on patient results and quality. Cost Savings: 76% of respondents said consultants can help networks reduce expenses and improve their financial performance by 10-20% above and beyond incumbent negotiations. Emotional Procurement Mitigation: While the specific statistics supporting the influence of consultants on mitigating emotional factors in procurement decisions are not readily available, the broader impact of emotions on decision-making is well-documented. Therefore, while direct statistics may be limited, the influence of emotions on procurement decisions is a recognized factor in the field of decision science and consumer behavior. Turn around time: 70% of respondents said utilizing a 3rd party can reduce the turnaround time of a sourcing event from &amp;gt;3 months to &amp;lt; 1months. Conclusions Third-party consultants can provide valuable insights and expertise in benchmarking and reviewing RFP results, leading to several benefits. They can play a crucial role in enhancing healthcare delivery network laboratories by providing valuable expertise in benchmarking, reviewing RFP results, communication and reducing turnaround time. By improving quality, reducing costs, mitigating emotional procurement based on brand loyalty, and enhancing collaboration, consultants can help networks deliver high-quality services to patients and improve their overall performance. Consultants can facilitate more focused communication and partnership development between laboratories, vendors, and other stakeholders, ensuring a seamless transition and optimal performance without scope creep. As healthcare networks continue to evolve and face new challenges, the role of third-party consultants will become increasingly important in ensuring the quality and efficiency of laboratory services, potentially resulting in $100’s of millions in cost takeout across the country.