Office Of Statewide Health Planning And Development Research Articles

Geriatric Distal Femur Fractures: Equivalent Long-Term Reoperation Rates Between Fixation and Primary Arthroplasty.

Our primary objectives were to 1) determine the rate of requiring conversion to arthroplasty after ORIF of geriatric distal femur fractures and 2) compare 10-year reoperation rates after open reduction internal fixation (ORIF) versus primary arthroplasty for geriatric distal femur fractures. Propensity-matched retrospective cohort study. All centers participating in the California Office of Statewide Health Planning and Development (OSHPD) database.Patients/Participants: All patients 65 or older who underwent operative management of a distal femur fracture between 2000 and 2017. ORIF, total knee arthroplasty (TKA), or distal femur replacement (DFR). Reoperation. A total of 16,784 geriatric distal femur fracture patients were identified, of which 16,343 (97.4%) underwent ORIF. The cumulative incidence of conversion to arthroplasty within 10 years of ORIF was found to be 3.5%, with young age and female sex identified as risk factors for conversion. There was no significant difference in 10-year reoperation free survival rate between propensity matched patients undergoing ORIF versus primary arthroplasty (94.5% vs. 96.2%, p=0.659). There were no differences in short-term complication or readmission rates between matched treatment cohorts, but arthroplasty was associated with a higher rate of wound infection within 90 days (2.0% vs. 0.2%, p=0.011). The 10-year cumulative incidence of conversion to arthroplasty after ORIF was found to be low. There was no significant difference in long term reoperation-free survival rates between patients undergoing ORIF versus primary arthroplasty. Primary arthroplasty was associated with significantly higher rates of acute wound or joint infection. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Adverse Maternal Outcomes Associated With Gestational Weight Gain in Women With Polycystic Ovarian Syndrome [ID: 1377702

INTRODUCTION: The objective of this study was to investigate maternal complications associated with gestational weight gain (GWG) in women with a history of polycystic ovarian syndrome (PCOS). METHODS: This was a retrospective cohort analysis using data abstracted from the California Office of Statewide Health Planning and Development (OSHPD) Linked Birth File with hospital discharge International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses between 2007 and 2012. Pregnancies in women with a history of PCOS were stratified based on the Institute of Medicine 2009 recommendations for GWG as follows: appropriate weight gain, excessive weight gain, inadequate weight gain, or weight loss. The maternal outcomes of interest included preeclampsia, cesarean delivery, blood transfusion, and intensive care admission. Logistic regression analysis was performed to estimate the odd ratio of the outcomes of interest for each GWG stratum in pregnancies with and without PCOS, with adjustments for confounding variables. RESULTS: There were 3,161,821 pregnancies, with 4,233 women with history of PCOS. The risk of cesarean delivery for women in the excessive weight gain cohort without PCOS was 1.35% versus 1.68% in the PCOS group (P<.001, 95% CI [1.38–2.04]). There were no significant differences in cesarean delivery rate for women with PCOS in the inadequate weight gain or weight loss groups. There were no statistically significant differences for preeclampsia, blood transfusion, and intensive care admission in pregnancies with and without PCOS based on GWG. CONCLUSION: In pregnancies affected by PCOS, excessive weight gain is associated with increased risk of cesarean delivery compared to women without PCOS.

The moderating role of housing quality on concentrated poverty and asthma-related emergency department visits among Hispanics/Latinos

Background Rates of asthma-related emergency department visits have been shown to vary significantly by place (i.e. neighborhood) and race/ethnicity. The moderating factors of asthmatic events among Hispanic/Latino-specific populations are known to a much lesser degree. Objective To assess the extent to which housing moderates the effect of poverty on Hispanic/Latino-specific asthma-related emergency department (ED) visits at an ecological level. Methods Using data from the Office of Statewide Health Planning and Development (OSHPD) and the 2016–2017 U.S. Census, a cross-sectional ecological analysis at the census tract-level was conducted. Crosswalk files from the U.S. Department of Housing and Urban Development were used to associate zip codes to census tracts. Negative binomial regression was used to estimate rate ratios. Results The effect of poverty on asthma-related ED visits was significantly moderated by the median year of housing structures built. The effect of mid-level poverty (RR = 1.57, 95% CI 1.27, 1.95) and high-level poverty (RR = 1.47, 95% CI 1.22, 1.78) in comparison to low-level poverty, was significantly greater among census tracts with housing built prior to 1965 in comparison to census tract with housing built between 1965 and 2020. Conclusion Communities with older housing structures tend to be associated with increased Hispanic/Latino ED visits apart from affluent communities.

Impact of race and payor status on patterns of utilization of partial and radical nephrectomy in patients with localized renal cell carcinoma (RCC).

614 Background: Racial minorities experience intersecting forms of marginalization and suffer significant healthcare disparities. Prospective trials have shown similar outcomes with partial and radical nephrectomy among patients with localized RCC (Van Poppel et al Eur Urol 2011), and multiple studies suggest increasing use of the former technique (Breau et al Can J Urol 2020). We hypothesize that patients from minority groups, as well as those with non-private insurance, will have less access to this specialized procedure and therefore have a higher rate of radical nephrectomy. Methods: We utilized the California Office of Statewide Health Planning and Development (OSHPD) database that collects information from all inpatient admissions, emergency room visits and inpatient/outpatient procedures in the state. All patients undergoing nephrectomy (both partial and radical) were identified from Jan 1, 2012 to Dec 31, 2018 using CPT and ICD-9/10 codes to identify patients. Demographic data was collected with specific attention to race and payor status. Univariate and multivariate analyses were conducted to determine the association between demographic data and procedure type. Results: In total, 31,093 patients were identified; 57% were males, with a mean age of 58 years. Among these, 16,142 (51.9%), 8,645 (27.8%), 2,795 (9.0%), 2,032 (6.5%) and 1,479 (4.8%) were characterized as White, Hispanic, Asian, Black and other, respectively. Partial nephrectomy and radical nephrectomy were performed in 15,840 (50.9%) and 15,253 (49.1%) of patients. By race, partial nephrectomy was performed in 8,576 (53.1%), 4,107 (47.5%), 1,286 (46.0%), 1,124 (55.3%) and 747 (50.5%) of White, Hispanic, Asian, Black and other patients, respectively (p<0.001). Use of partial nephrectomy also differed among patients based on payor status, with rates of 6,800 (56.4%), 5,036 (43.9%), 1,817 (38.3%) and 2,187 (77.7%) among patients with private, Medicare, indigent coverage (e.g., MediCal or Medicaid) and other insurance, respectively (p<0.001). On multivariate analysis controlling for age, gender, comorbidities and frailty, race was independently associated with type of nephrectomy procedure. Conclusions: Our study confirms that race and payor status may have an influence on utilization of partial versus radical nephrectomy, with the highest rate of partial nephrectomies among Whites and patients with private insurance. Although there are multiple potential confounders (e.g., latency of diagnosis and resulting tumor size/complexity), it is possible that access to care may be an important driver of these disparities.

Impact of race and payer status on the choice of urinary diversion among patients with localized bladder carcinoma undergoing cystectomy.

455 Background: Prior studies have described significant disparities in the selection of urinary diversion (UD) in patients with localized bladder cancer undergoing cystectomy. Although the choice of UD has not been shown to impact oncologic outcomes, continent urinary diversions (CUD) are associated with lower rates of in-hospital complications and mortality, but higher costs (Farber NJ et al. Bladder Cancer 2018). Male gender, White race, and higher income have been associated with proportionally higher rates of CUD than patients from other races or those without private insurance (Barocas DA et al. Cancer 2014 and Rios EM et al. Urology 2020). Utilizing the California Office of Statewide Health Planning and Development (OSHPD) database, we investigated potential barriers to CUD in patients with bladder cancer undergoing radical cystectomy. Methods: The current procedural terminology (CPT) and the international classification of diseases (ICD)-9/10 codes were used to identify patients with bladder cancer undergoing radical cystectomy from Jan 1, 2012, through Dec 31, 2018. Type of UD and demographic data such as race and payer status were collected. Univariate and multivariable analyses were conducted to determine the association between demographic variables and CUD use. Results: In total, 9,342 patients who underwent radical cystectomy were identified, of which 3,061 had UD status noted. Of these, 13.2% (404/3061) were continent and 86.2% (2,657/3061) were incontinent diversions. CUD use was significantly higher in White patients (14.1%; 320/2276) compared to Asian (12.8%; 24/187), Hispanic (9.5%; 30/316) or Black (5%; 6/119) patients (P=0.01). Use of CUD was significantly higher in patients with private insurance (23.2%; 167/721) compared to those with Medicare (10.2%; 207/2023) or indigent (MediCal/Medicaid; 8.6%; 23/269; p<0.001) coverage. On multivariable analysis adjusting for comorbidities and care setting, Black (OR: 0.30, 0.13-0.69) and Hispanic (OR: 0.57, 0.38-0.86) race were associated with a lower probability of getting a CUD, while male patients (OR 1.88, 1.31-2.71) and those receiving care at academic centers (OR 3.10, 2.38-4.05) were more likely to receive a CUD. Payer status did not show a significant difference between the two procedures. Finally, the presence of chronic kidney disease represented a risk factor for not getting a CUD (OR: 0.61, 0.43-0.85), but not the presence of diabetes and frailty. Conclusions: Black or Hispanic race and female gender were associated with lower rates of CUD when controlling for other factors. We hypothesize that the higher costs for CUD, communication barriers, especially with non-English speakers, comorbidities, and a potential lack of cultural humility could lead to an unconscious bias from the healthcare team. Further research aimed at understanding and addressing these disparities is needed.

The inequity in emergency room utilization prior to colorectal cancer diagnosis and the opportunity to improve access to colorectal cancer screening.

79 Background: The opportunity for early detection of colorectal cancer via screening is not fully realized. Previous efforts to maximize use of screening had targeted patients and primary care providers. Other wildly used healthcare settings may be suitable targets for intervention. We explored emergency room (ER) utilization in patients with colorectal cancer prior to their diagnosis using the linkage between California Cancer Registry (CCR) and OSHPD (Office of Statewide Health Planning and Development). Methods: Patients with diagnosis of colorectal cancer 2010-2015 were identified in the CCR and their records were linked with OSHPD (2009 – 2016) to assess ER utilization. This study aimed to evaluate the patterns of ER utilization (all and nay reason for ER visit) prior to the diagnosis of colorectal cancer. Results: A total of 66,451 colorectal cancer patients were identified, of which 57,876 (87%) were linked with OSHPD data. Among the linked population, 41% (23,890) had at least one ER visit prior to their diagnosis of colon cancer. Of the 23,890 with ER visit, 14% had 3 or more ER visits. The median number of days from first ER visit to diagnosis was 539 days (range: 2551 – 1). A total of 14,372 patients (25%) had an ER visit within one year of their colorectal cancer diagnosis. The median age of patients who had ER visits was younger than those who didn’t have an ER visit, 66 vs. 68 years. There was no difference in the number of ER visits between patients 50 and younger and those older than 50 years. There was no significant difference in the stage at presentation between those with prior ER visit and those without. Patients in high socioeconomic status were less likely to have an ER visit prior to colorectal cancer diagnosis (44%) compared to those with low SES status (36%). Patients with private insurance had a significantly lower likelihood of ER visits compared to those with federal and state funded insurance. Conclusions: A significant percentage of patients with colorectal cancer had ER visit prior to their diagnosis, many within one year of their diagnosis. Inequity in access to care, measured via poor SES and insurance type, was associated with higher chance of ER visit among colorectal cancer patients. Emergency room may be a targetable opportunity to remind and coordinate screening for colorectal cancer.

The affordable care act and do-not-resuscitate orders: Differences by race and ethnicity

BackgroundThe Affordable Care Act (ACA) created new payment rules that provided reimbursement for physicians to engage in advance care planning (ACP) conversations with patients. This reimbursement policy has the potential to increase ACP participation, including among racial and ethnic minority groups that have had lower ACP participation. ObjectivesTo examine whether the ACP payment rules were associated with an increase in use of do-not-resuscitate (DNR) orders, particularly among racial and ethnic minority groups, among patients diagnosed with heart failure (HF) in California. MethodsThe California Office of Statewide Health Planning and Development (OSHPD) Patient Discharge Data Set was used to identify a cohort of elderly patients with a principal diagnosis of HF. This study included 432,520 hospital admissions of patients over the age of 65 with a primary diagnosis of HF between 2012 and 2018. DNR status was identified using International Classification of Diseases, Clinical Modification Ninth and Tenth Revision, codes. ResultsThere was a small increase in the utilization of DNR orders overall after the ACA reimbursement policy, but the change was not significantly different for all racial and ethnic groups when compared to white non-Hispanic patients. ConclusionsACP payment rules provided in the ACA were associated with increased utilization of DNR, but the effect was not significantly different for racial and ethnic minorities hospitalized with HF in CA. Additional efforts are needed to increase ACP participation among racial and ethnic minorities.

Abstract B125: Use of ambulatory surgery centers for breast cancer surgery is associated with better survival: A population-based assessment in California

Abstract Background: Ambulatory surgery centers (ASCs) offer patients the convenience of having surgeries and procedures performed safely outside the hospital setting. Use of ASCs has gained growing popularity since its inception in 1970 due to high quality service, patient-centered care, reduced costs, and patient satisfaction. Breast cancer is the most common cancer among women and generally treated with surgery. Increasing volumes of breast cancer surgeries now happen in ASCs. Although there were reports of favorable outcomes following breast cancer surgery in ASCs, population-based assessment has been lacking. Our objective was to provide a population-based assessment of survival differences between breast cancer patients treated in ASCs and those treated in inpatient settings. Methods: We used the linked dataset between the cancer incidence and survival data collected by the California Cancer Registry (CCR) and the patient-level service utilization data from hospitals and healthcare facilities collected by the California Office of Statewide Health Planning and Development (OSHPD) records. We identified 191,400 adult women (>=18 years of age) diagnosed with first primary breast cancer during 2005-2019 with known disease stage in the CCR data, who also had first breast cancer related surgery records within 2 months before and 12 months after the cancer diagnosis during 2005-2020 in the OSHPD data. We compared the 5-year observed survival by cancer stage (localized, regional, or distant), surgery type (lumpectomy or mastectomy), and surgery setting (inpatient or ASC). Cox proportional hazards model was used to calculate the hazard ratios (HRs) of death probabilities by surgery setting, stratified by surgery type, while controlling for confounders of age, race/ethnicity, socioeconomic status, stage, and Charlson comorbidity score. Results: The proportion of surgery done in ASCs, as opposed to inpatients, was 96% among the localized-lumpectomy patients, 89% regional-lumpectomy, and 80% distant-lumpectomy. Use of ASCs is substantially lower among mastectomy patients across stage: 45% among the localized-mastectomy patients, 40% regional-mastectomy, and 36% distant-mastectomy. The 5-year survival is consistently higher for ASCs than inpatients regardless of stage and surgery type. According to the multivariable HRs, survival for ASC group was 25% higher than the inpatient group for lumpectomy and 12% higher for the mastectomy group (p<0.0001 for both). However, non-Hispanic black and low SES women respectively experienced excessive mortality in the multivariate analysis regardless of surgery type. Conclusion: The better survival outcomes associated with use of ASCs are reassuring. But more work needs to be done to address the racial and socioeconomic disparities in breast cancer treatment outcomes. Citation Format: Lihua Liu, Juanjuan Zhang, Kathy Wojcik, Irene Kang, Mary Falcone, Caryn Lerman. Use of ambulatory surgery centers for breast cancer surgery is associated with better survival: A population-based assessment in California [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B125.

Advances in diagnostic codes to document sexual assault in health care service.

To explore trends in documented sexual abuse/assault (SA) related episodes in California hospitals and emergency departments (ED), including the impact of a change in health care service reporting codification (from ICD-9-CM to ICD-10-CM) that more clearly defined SA in October 2015. Hospital and ED data were drawn from California's Office of Statewide Health Planning and Development (OSHPD). Descriptive and trend analyses of SA-related hospital and ED records (including patients' demographic information) were conducted to determine whether changes in ICD codification had an impact on documented SA-related episodes. All SA-related episodes (ICD-9-CM codes 995.83, 995.53; ICD-10-CM codes T74.21-T74.22, T76.21-T76.22) in California hospitals and EDs for the last decade of available data (2008-2017) were analyzed (n=20,215). An abrupt increase in documented SA episodes in hospitals and EDs began in October 2015, when specific ICD10 codes for suspected cases of SA were created. Documented SA-related episodes doubled in 1 month (164 vs. 385 episodes in September 2015 and October 2015, respectively). More than half (58.2%) of all SA-related episodes documented in Oct 2015 were coded as suspicious. The number of documented SA-related episodes continued increasing to the end of the time series (December 2017). Overall, the annual number of documented SA-related episodes increased by over 700% in only 4 years (900 vs. 6441 in 2013 and 2017, respectively), suggesting high rates of prior under-reporting and the need to introduce the new codes. African Americans were disproportionally impacted; however, the highest increases in age-adjusted rates between the ICD-9-CM and the ICD-10 codification period were found among the White population (2.46 vs. 16.53 per 100,000 inhabitants). SA episodes in the clinical population have been underestimated for many decades. Identifying SA victims and measuring SA-related health care utilization is a real challenge that needs further investigation.

Socioeconomic and geographic disparities in pediatric scoliosis surgery.

To compare the population of pediatric patients undergoing surgery for scoliosis in California by gender, race, and ethnicity and identify any underlying differences in social determinants of health as measured by the child opportunity index (COI), social deprivation index (SDI), and insurance category among them. This project extracted demographic reports including patient sex, race, zip code, insurance type, and associated diagnosis and procedure codes from the Office of Statewide Health Planning and Development (OSHPD). These data were combined with COI and SDI data, which further describe the socioeconomic environment of each patient. Census data were referenced to compare the population of patients receiving scoliosis procedures to the general population by race and ethnicity. Chi-square tests were performed for categorical data. Independent t-test and one-way analysis of variance (ANOVA) were performed for continuous data, with significance set at 0.05. Unfavorable SDI and COI scores were observed among males, Hispanics, and Black patients, and these patients were more likely to be covered by Medi-Cal. Length of stay was significantly higher among males and Medi-Cal recipients. The data demonstrate significant differences in social determinants of health as measured by race, ethnicity, gender, insurance type, COI, and SDI among patients ≤ 20years undergoing surgery for idiopathic scoliosis in California. The noted differences in socioeconomic status (SES) and insurance are known and/or expected to have an impact on access to quality health care, exposing a need for future studies to determine whether COI and SDI influence patient-reported outcomes after scoliosis surgery. IV.

Revisits After Emergency Department Discharge for Conditions with High Disposition-Decision Variability at Hospitals with High and Low Discharge Rates.

IntroductionThe first proposed emergency care alternative payment model seeks to reduce avoidable admissions from the emergency department (ED), but this initiative may increase risk of adverse events after discharge. Our study objective was to describe variation in ED discharge rates and determine whether higher discharge rates were associated with more ED revisits.MethodsUsing all-payer inpatient and ED administrative data from the California Office of Statewide Health Planning and Development (OSHPD) 2017 database, we performed a retrospective cohort study of hospital-level ED discharge rates and ED revisits using conditions that have been previously described as having variability in discharge rates: abdominal pain; altered mental status; chest pain; chronic obstructive pulmonary disease exacerbation; skin and soft tissue infection; syncope; and urinary tract infection. We categorized hospitals into quartiles for each condition based on a covariate-adjusted discharge rate and compared the rate of ED revisits between hospitals in the highest and lowest quartiles.ResultsWe found a greater than 10% difference in the between-quartile median adjusted discharge rate for each condition except for abdominal pain. There was no significant association between adjusted discharge rates and ED revisits. Altered mental status had the highest revisit rate, at 34% for hospitals in the quartile with the lowest and 30% in hospitals with the highest adjusted discharge rate, although this was not statistically significant. Syncope had the lowest rate of revisits at 16% for hospitals in both the lowest and highest adjusted discharge rate quartiles.ConclusionOur findings suggest that there may be opportunity to increase ED discharges for certain conditions without resulting in higher rates of ED revisits, which may be a surrogate for adverse events after discharge.

Do liquidity constraints affect the investment decisions of California hospitals?

We explore how hospitals' liquidity constraints affect investment decisions for two types of hospital investments: general and health information technology capital investment. In the literature, only one dimension of the investment strategy, namely cash flow, has been examined empirically. Using the neoclassical model of investment and annual hospital financial data from California's Office of Statewide Health Planning and Development (OSHPD) from 1997 to 2007, we investigate the impacts of liquidity constraints such as cash flow and marginal profitability of capital on investment decisions across hospital ownership types. The system GMM estimation results reveal that hospitals face liquidity constraints for general capital investment, and these constraints are more pronounced in nonprofit hospitals than in for-profit or government-owned hospitals. However, they are not liquidity constrained for health IT capital investments. This represents that liquidity constraints are not the cause of the low health IT investment of California hospitals.

MP16-07 FRAILTY AS A PREDICTOR OF SACRAL NEUROMODULATION OUTCOMES

You have accessJournal of UrologyCME1 May 2022MP16-07 FRAILTY AS A PREDICTOR OF SACRAL NEUROMODULATION OUTCOMES Colby Souders, Mary Enoh Adakama, Allison Sih, Seth Cohen, Maude Carmel, Jennifer Anger, Karyn Eilber, and Kai Dallas Colby SoudersColby Souders More articles by this author , Mary Enoh AdakamaMary Enoh Adakama More articles by this author , Allison SihAllison Sih More articles by this author , Seth CohenSeth Cohen More articles by this author , Maude CarmelMaude Carmel More articles by this author , Jennifer AngerJennifer Anger More articles by this author , Karyn EilberKaryn Eilber More articles by this author , and Kai DallasKai Dallas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002549.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Geriatric patients with overactive bladder or urge incontinence (UUI) are often medically under-treated. Concerns regarding anticholinergic side effects, polypharmacy, and cost of beta-3 agonists result in limited treatment options. Sacral neuromodulation (SNM) is a minimally invasive and non-pharmacological option. Geriatric patients considered frail may not be offered SMN due to concerns of surgery complications, treatment efficacy, and complexity of device operations. Thus, the purpose of this study is to investigate SNM outcomes in geriatric patients who meet frailty criteria. METHODS: We reviewed California Office of Statewide Health Planning and Development (OSHPD) from 1/1/2012-12/31/2018. Using Current Procedural Terminology (CPT) codes, we identified patients who underwent Stage 1 (CPT:64581) and Stage 2 (CPT:64590) SNM surgery. Treatment was considered successful if a patient proceeded to Stage 2 from Stage 1. Patient age, gender, ethnicity, academic status surgery facility, and payor status were obtained. The SNM patient population was then analyzed using a validated claims-based frailty index (Kim, 2018). Univariate (chi-square/ T-test) and multivariate analysis were performed to assess for associations between variables of interest and completion of Stage 2. RESULTS: We identified 2,400 patients who underwent Stage 1, and 1,132 patients successfully proceeded to Stage 2. Rates of Stage 2 were higher in females compared to males (36.6% vs. 50.5%, p<0.001), those who had surgery at academic medical centers (58.6% vs. 20.8%, p<0.001), and those with a diagnosis of urgency (52.1% vs. 45.3%, p=0.003). These findings remained significant with multivariate analysis. Of the 2,400 patients identified 363 (15.1%) met frailty criteria and 165 (45.5%) underwent Stage 2. For non-frail patients, SNM success rate was 47.5% (p=0.514) (Table 1). There were no significant associations between patient age, ethnicity, payor status, and completion of Stage 2. CONCLUSIONS: Our work demonstrates that frailty had no significant adverse impact on success of SNM treatment. However, female gender, surgery at an academic center, and a diagnosis of UUI were more likely to have treatment success than patients with other indications. This data supports recommendation of SNM to older, frail patients, especially those with UUI. Source of Funding: The Medical Student Training in Aging Research Program and the National Institute on Aging (T35AG026736) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e277 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Colby Souders More articles by this author Mary Enoh Adakama More articles by this author Allison Sih More articles by this author Seth Cohen More articles by this author Maude Carmel More articles by this author Jennifer Anger More articles by this author Karyn Eilber More articles by this author Kai Dallas More articles by this author Expand All Advertisement PDF DownloadLoading ...

Abstract 11349: Substance Use and Associated Risk of Incident Atrial Fibrillation

Introduction: Atrial fibrillation (AF) is a common arrythmia associated with high morbidity and mortality. Understanding modifiable risk factors that contribute to AF could have a broad impact on patient outcomes. While work has been done to understand the association between alcohol use and AF, there is limited understanding in the relationship between non-alcohol substance use and new-onset AF. Our study sought to investigate the associations of methamphetamine, cocaine, opiate, and cannabis use with incident AF. Methods: This is a retrospective observational study of 23,561,844 adult inpatient hospitalizations and ED visits from January 1, 2005 to September 30, 2015 in California’s Office of Statewide Health Planning and Development (OSHPD) database. International Classification of Disease (ICD) codes were used to document AF and methamphetamine, cocaine, opiate, or cannabis use disorders. All patients with prevalent AF were excluded from analysis. Results: Methamphetamine use (n=98,271), cocaine use (n=48,700), opiate use (n=10,032), and cannabis use (n=132,834) disorders were coded as part of routine clinical care. In multivariate analysis adjusting for age, race, sex, income, and cardiovascular risk factors, methamphetamine, cocaine, opiate, and cannabis use were associated with higher incidence of AF ( Table ). The cumulative probability of incident AF increased over time with all four substances ( Figure ). Conclusion: Patients with documented methamphetamine, cocaine, opiate, or cannabis use disorders had an increased risk of incident AF that was independent of the risk already portended by established cardiovascular risk factors.

Racial Disparities in Outcomes of Women Undergoing Myomectomy.

To assess the association of racial and socioeconomic factors with outcomes of abdominal myomectomies. All women undergoing abdominal myomectomy in California from 2005 to 2012 were identified from the OSHPD (Office of Statewide Health Planning and Development) using appropriate International Classification of Diseases and Current Procedural Terminology codes. Demographics, comorbidities, surgical approaches, and complications occurring within 30 days of the procedure were identified. Multivariate associations were assessed with mixed effects logistic regression models. The cohort of 35,151 women was racially and ethnically diverse (White, 38.8%; Black, 19.9%; Hispanic, 20.3%; and Asian, 15.3%). Among all procedures, 33,906 were performed through an open abdominal approach, and 1,245 were performed using a minimally invasive approach. Proportionally, Black patients were more likely than White patients to have open procedures, and open approaches were associated with higher complication rates. Overall, 2,622 (7.5%) women suffered at least one complication. Although severe complications did not vary by race or ethnicity, Black (9.0%), Hispanic (7.9%), and Asian (7.5%) patients were more likely to suffer complications of any severity compared with White patients (6.7%, P<.001). As compared with patients with private insurance (6.4%), those with indigent payer status (Medicaid [12.1%] and self-pay [11.1%]) had higher complication rates (P<.001). Controlling for all factors, Black and Asian patients were more likely to suffer complications compared with White patients. The overall complication rate after abdominal myomectomy was 7.5%. Comorbidities, an open approach, and indigent payer status were associated with increased complication risk. Controlling for all factors, Black and Asian patients still had increased risks of complications.

Community Benefit Report Spending and Content Analysis

There is substantial debate regarding the community benefits provided by nonprofit hospitals in exchange for tax-exempt status at the federal and state levels. Despite the controversy surrounding this topic, research into community benefit spending is a relatively new area of academic research. This study examines community benefit reports from nonprofit hospitals in the California Office of Statewide Health Planning and Development (OSHPD) database. We employ text-based content analysis to determine how the language used in current-year reports impacts community benefit spending in the following year. Our study contributes to the literature because it is the first paper that conducts text-based content analysis of community benefit reports using the following five textual characteristics: length, boilerplate, fog, specificity, and tone. We find that the length, specificity, and tone of the reports significantly impact community benefit spending.

Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Cervical Cancer.

To evaluate outcomes of the first pregnancy after fertility-sparing surgery in patients with early-stage cervical cancer. We performed a population-based study of women aged 18-45 years with a history of stage I cervical cancer reported to the 2000-2012 California Cancer Registry. Data were linked to the OSHPD (California Office of Statewide Health Planning and Development) birth and discharge data sets. We included patients with cervical cancer who conceived at least 3 months after a fertility-sparing surgery, which included cervical conization or loop electrosurgical excision procedure. Those undergoing trachelectomy were excluded. The primary outcome was preterm birth. Secondary outcomes included growth restriction, neonatal morbidity, stillbirth, cesarean delivery, and severe maternal morbidity. We used propensity scores to match similar women from two groups in a 1:2 ratio of case group participants to control group participants: population individuals without cancer and individuals with cervical cancer (women who delivered before their cervical cancer diagnosis). Wald statistics and logistic regressions were used to evaluate outcomes. Of 4,087 patients with cervical cancer, 118 (2.9%) conceived after fertility-sparing surgery, and 107 met inclusion criteria and were matched to control group participants. Squamous cell carcinoma was the most common histology (63.2%), followed by adenocarcinoma (30.8%). Patients in the case group had higher odds of preterm birth before 37 weeks of gestation compared with both control groups (21.5% vs 9.3%, odds ratio [OR] 2.7, 95% CI 1.4-5.1; 21.5% vs 12.7%, OR 1.9, 95% CI 1.0-3.6), but not preterm birth before 32 weeks. Neonatal morbidity was more common among the patients in the case group relative to those in the cervical cancer control group (15.9% vs 6.9%, OR 2.5, 95% CI 1.2-5.5). There were no differences in rates of growth restriction, stillbirth, cesarean delivery, and maternal morbidity. In a population-based cohort, patients who conceived after surgery for cervical cancer had higher odds of preterm delivery compared with control groups.

MP51-18 COMPARING ENCOUNTERS FOR UROLOGIC VS. NON-UROLOGIC PROBLEMS AMONG PATIENTS WITH GENITOURINARY CONGENITALISM

You have accessJournal of UrologyPediatric Urology IV (MP51)1 Sep 2021MP51-18 COMPARING ENCOUNTERS FOR UROLOGIC VS. NON-UROLOGIC PROBLEMS AMONG PATIENTS WITH GENITOURINARY CONGENITALISM Michael Sadighian, Debbie Goldberg, William Shibley, Johsias Maru, Hillary Copp, and Lindsay Hampson Michael SadighianMichael Sadighian More articles by this author , Debbie GoldbergDebbie Goldberg More articles by this author , William ShibleyWilliam Shibley More articles by this author , Johsias MaruJohsias Maru More articles by this author , Hillary CoppHillary Copp More articles by this author , and Lindsay HampsonLindsay Hampson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002077.18AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract INTRODUCTION AND OBJECTIVE: Little is known about patients with genitourinary congenitalism (GUC) and their utilization of the healthcare system. The primary aim of this study is to describe healthcare utilization among the GUC population in four key parameters: frequency of encounters, care setting, length of stay, and cost of care. The secondary aim is to compare these parameters for urologic encounters vs. non-urologic encounters within the GUC population. METHODS: We queried the California Office of Statewide Health Planning and Development (OSHPD) database from 1995 to 2017, which captures all patient encounters at California-licensed hospitals, emergency rooms, and ambulatory surgery centers. We identified the GUC cohort by ICD and CPT codes corresponding with spina bifida, hypospadias, disorders of sexual development, prune belly syndrome, bladder exstrophy, posterior urethral valves, and epispadias. Based on discharge diagnosis we determined whether a patient’s encounter was for reasons related to their urologic condition versus encounters for any other medical problem. Comorbidities were determined by the Charlson Comorbidity Index. We used SAS for statistical analysis with a cutoff of p<0.01 for statistical significance. RESULTS: Our analysis included 591,508 encounters by GUC patients for urologic problems (n=127372) and non-urologic problems (n=464136; Table 1). Mean age was lower for urologic encounters compared to non-urologic encounters (p<0.001). Over one-third of encounters occurred in patients with comorbidities. When GUC patients sought care for urologic problems, the majority of encounters were inpatient admissions (56%) followed by emergency room visits (27%), whereas 56% of non-urologic encounters took place in the emergency room (p<0.001). When GUC patients are admitted to the hospital, mean length of stay (p<0.001) and cost of care (p<0.001) were both greater for urologic diagnoses compared to non-urologic diagnoses. CONCLUSIONS: GUC patients are more likely to be admitted to the hospital with greater length of stay and cost of care for problems related to their urologic condition. Future studies should investigate predictors of inpatient admission and length of stay in this vulnerable population. Source of Funding: UCSF Urology © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e903-e903 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Sadighian More articles by this author Debbie Goldberg More articles by this author William Shibley More articles by this author Johsias Maru More articles by this author Hillary Copp More articles by this author Lindsay Hampson More articles by this author Expand All Advertisement Advertisement Loading ...

MP19-10 TRENDS IN TRANSGENDER DIAGNOSIS CODE USAGE FOR CALIFORNIA ED VISITS FROM 2012 TO 2019: DO CURRENT ICD CODES FOR TRANSGENDER PEOPLE HELP OR HINDER HEALTH SERVICES RESEARCH?

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making II (MP19)1 Sep 2021MP19-10 TRENDS IN TRANSGENDER DIAGNOSIS CODE USAGE FOR CALIFORNIA ED VISITS FROM 2012 TO 2019: DO CURRENT ICD CODES FOR TRANSGENDER PEOPLE HELP OR HINDER HEALTH SERVICES RESEARCH? Joshua Sterling, Arnav Srivastava, Kevin Chua, Sho Yoshitake, Farnoosh Nik-Ahd, and Maurice Garcia Joshua SterlingJoshua Sterling More articles by this author , Arnav SrivastavaArnav Srivastava More articles by this author , Kevin ChuaKevin Chua More articles by this author , Sho YoshitakeSho Yoshitake More articles by this author , Farnoosh Nik-AhdFarnoosh Nik-Ahd More articles by this author , and Maurice GarciaMaurice Garcia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002004.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The prevalence of people who identify as transgender (TG) in the U.S. is estimated to be between 0.6-0.7%. Knowledge of the health care needs, and how this underserved community utilizes health care services (such as emergency departments (ED)) lags in comparison to data for cis-gender individuals. A significant roadblock to epidemiologic and health services research is that many electronic medical record (EMR) systems still do not reliably capture which patients are transgender. The objectives of this study are: 1. To better understand which ICD diagnosis codes are most/least used by ED clinicians, in anticipation of future research; and 2. To measure how many TG patients utilized ED services in California from 2012-2019. METHODS: ED data from 2012-2019 from California's Office of Statewide Health Planning and Development (OSHPD) database was abstracted and analyzed for encounters that had a primary or secondary diagnosis code associated with being TG, (Figure 1A). ICD- 9 codes were used from 2012 through Q3 2015 and ICD-10 codes were used for the remaining time interval. Excel and XLSTAT were for all data analysis. RESULTS: In 2012, 389 (0.004%) ED visits carried a TG code, compared to 1679 (0.013%) visits in 2019. This represents an increase of over 330% between 2012-2019, which was statistically significant, total number of ED visits (all patients) during this time increased 22%. Trends for ICD code usage, total encounters with a transgender associated code, and use of TG ICD codes as the primary diagnosis are shown in Figure 1B. CONCLUSIONS: While results show a significant increase in the use of TG-associated diagnosis codes over the observation period, the number of encounters identified is still far below what would be expected based on the estimated number of TG people in CA (0.76% of the CA population = 298K TG people). Accurate identification is important to assist care providers to: 1. Provide appropriate care, 2. Protect TG patients as they pass through the healthcare system, and 3. Facilitate epidemiologic research to ensure TG people have the health resources they need. Current ICD codes are insufficient to achieve these goals (they are redundant, confusing, and inexact). New ICD codes are warranted. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e331-e331 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Sterling More articles by this author Arnav Srivastava More articles by this author Kevin Chua More articles by this author Sho Yoshitake More articles by this author Farnoosh Nik-Ahd More articles by this author Maurice Garcia More articles by this author Expand All Advertisement Loading ...

Pregnancy after breast cancer: A population-based study of survival and obstetric outcomes.

e18783 Background: Studies have suggested that pregnancy after breast cancer is safe, but the women who are able to conceive after cancer may also have a better prognosis. We sought to evaluate survival and obstetric outcomes among breast cancer patients in a population-based cohort. Methods: We studied women aged 18-45 years with a history of stage I-III breast cancer reported to the California Cancer Registry (CCR, 2000-2012). CCR data were linked to the 2000-2012 California Office of Statewide Health Planning and Development (OSHPD) birth cohort to ascertain both oncologic characteristics and obstetric outcomes. We compared overall survival (OS) for breast cancer patients who did or did not conceive at least 1 year after diagnosis. Breast cancer patients who conceived were matched in a 1:5 ratio to breast cancer patients who did not conceive via optimal bipartite matching accounting for follow-up time such that controls were diagnosed within a 3-month window of the cases and were alive at the time the case delivered; the distributions of cases and controls were directly balanced on socioeconomic and clinical covariates including stage, hormone receptors, and receipt of chemotherapy and radiation. For the obstetric outcomes, propensity score matching in a 1:5 ratio was used to match the same breast cancer patients who conceived to population based controls without cancer who delivered during the study years. Wald statistics, conditional Cox proportional hazards model, and conditional logistic regressions were used to evaluate outcomes. Results: We matched 417 patients aged 18-45 years at time of breast cancer diagnosis who conceived at least one year following diagnosis with 2,085 breast cancer patients who did not conceive. All covariates were balanced within 0.1 mean standardized difference. The majority of the cohort was non-Hispanic White (51%), with stage II disease (53%). The 5-year overall survival for cases relative to controls was 97.6% and 95.7% respectively. There was no difference in overall survival between patients who conceived and those who did not conceive following treatment for breast cancer (HR 0.58, 95% CI 0.3-1.1). Breast cancer patients did not have higher risks of preterm birth before 37 weeks (odds ratio [OR] 0.91, 95% CI 0.39-2.14), small-for-gestational age birthweight ( &lt; 10th percentile: OR 0.93, 95% CI 0.67-1.29; &lt; 5th percentile: OR 0.67, 95% CI 0.39-1.14), cesarean delivery (OR 1.12, 95% CI 0.92-1.35), severe maternal morbidity (OR 1.14, 95% CI 0.61-2.12), or neonatal morbidity (OR 1.08, 95% CI 0.77-1.53) relative to controls. Conclusions: In a population-based cohort, breast cancer patients who conceived at least 1 year after diagnosis did not have worse OS than matched breast cancer patients who did not conceive. Breast cancer patients who conceived during the study period did not have an increased risk of adverse obstetric outcomes compared to population-based controls without cancer.