Outcomes Assessment Program Research Articles

A Clinically Immersive Medical Innovation Program for US MD Students: Curricular Description and Program Outcomes.

There is growing need for physician-innovators to address the mounting challenges within the US healthcare system. Despite this, there remains a significant gap in understanding of the efficacy of innovation programs for US MD candidates. We present initial program outcomes of a novel, clinically immersive medical innovation program offered to MD candidates at the David Geffen School of Medicine (DGSOM) at UCLA. A novel clinically immersive medical innovation curriculum was developed based on existing and reputable medical innovation frameworks and tailored for medical students. Curricular topics broadly included clinical ethnography, interviewing techniques, mind mapping, needs formulation and prioritization, quality improvement, intellectual property, reimbursement pathways, solution landscaping and prioritization, regulatory processes. The program was trialed during an unscheduled summer with voluntary enrollees from DGSOM Class of 2024. The traditional four-level Kirkpatrick model was employed to assess program outcomes. Program outcomes were positive on all four Kirkpatrick levels. Students rated enjoyment at 9.5/10 for lectures and 9.1/10 for clinical immersion. Student-perceived confidence in key skills increased by 43%, and 75% of faculty directly perceived improvement in ethnographic skills. Students were highly engaged in both didactics and clinical immersion, discovering on average 2.6 faculty-verified needs per week. Faculty largely felt their students discovered important unmet clinical needs and added value to their clinical practice. We developed and trialed a novel clinically immersive medical innovation curriculum tailored for medical students. This program achieved positive outcomes on all four levels of the Kirkpatrick model. Our findings have driven the local adoption of this program into our institution's medical school curriculum. We hope that the program efficacy demonstrated herein catalyzes more institutions to trial similar medical innovation programs.

An implementation evaluation of the Breaking Down human rights barriers to HIV services initiative in Ukraine.

Globally, stark inequities exist in access to HIV treatment and prevention. The eastern European and central Asian region is experiencing the sharpest rise in new HIV acquisition and deaths in the world, with low rates of treatment and prevention services, especially for key and vulnerable populations who face a range of human rights-related barriers to HIV prevention and treatment. An implementation learning evaluation approach was used to examine the implementation of the Breaking Down Barriers initiative targeting key and vulnerable populations in Ukraine. Between September 2022 and April 2023, researchers conducted 23 key informant interviews with individuals from the Ukrainian government, implementing organizations and human rights experts. Using a concurrent triangulation design, researchers and key informants, in a process of co-creation, sought to describe programme accomplishments, challenges and innovations in implementation, between 2021 and 2023, including periods before and after Russia's February 2022 full-scale invasion. Eight rights-based interventions related to HIV were identified in Global Fund programme documents and key informant interviews as making up the core of the Breaking Down Barriers initiative in Ukraine. These included programmes seeking to: eliminate stigma and discrimination; ensure the non-discriminatory provision of medical care; promote rights-based law enforcement practices; expand legal literacy ("know your rights"); increase access to justice; improve laws, regulations and policies; reduce gender discrimination, harmful gender norms and violence against women and girls; and mobilize communities for advocacy. These programmes received US$5.9 million in funding. Key informants reported that significant progress had been made addressing human rights barriers and scaling up interventions, both before and after Russia's invasion. Programme implementors adopted innovative approaches, including using paralegals, hotlines and other community-led interventions, to ensure that key and vulnerable populations, including displaced individuals, were able to access prevention and care. An implementation learning evaluation approach examining programmes addressing human rights barriers to HIV services, designed as a process of co-creation between researchers, programme implementors, government officials and human rights experts, can provide a robust assessment of programme outputs, outcomes and evidence of impact, despite a challenging operational environment.

Pediatric Acute Respiratory Distress Syndrome Severity and Health-Related Quality of Life Outcomes: Single-Center Retrospective Cohort, 2011-2017.

To determine factors associated with health-related quality of life (HRQL) decline among pediatric acute respiratory distress syndrome (PARDS) survivors. Retrospective cohort study. Academic children's hospital. Three hundred fifteen children 1 month to 18 years old with an unplanned PICU admission from December 2011 to February 2017 enrolled in the hospital's Outcomes Assessment Program. None. Pre-admission baseline and median 6-week post-discharge HRQL were assessed using the Pediatric Quality of Life Inventory or the Functional Status II-R. Patients meeting retrospectively applied Second Pediatric Acute Lung Injury Consensus Conference criteria for PARDS were identified, and PARDS severity was classified using binary (mild/moderate, severe) and trichotomous (mild, moderate, severe) categorization for noninvasive ventilation and invasive mechanical ventilation (IMV). PARDS occurred in 41 of 315 children (13.0%). Clinically important HRQL decline (≥ 4.5 points) occurred in 17 of 41 patients (41.5%) with PARDS and 64 of 274 without PARDS (23.4%). On multivariable generalized linear regression adjusted for age, baseline Pediatric Overall Performance Category, maximum nonrespiratory Pediatric Logistic Organ Dysfunction score, diagnosis, length of stay, and time to follow-up, PARDS was associated with HRQL decline (adjusted relative risk [aRR], 1.70; 95% CI, 1.03-2.77). Four-hour and maximum PARDS severity were the only factors associated with HRQL decline. HRQL decline occurred in five of 18 patients with mild PARDS at 4 hours, five of 13 with moderate PARDS (aRR 2.35 vs. no PARDS [95% CI, 1.01-5.50]), and seven of ten with severe PARDS (aRR 2.56 vs. no PARDS [95% CI, 1.45-4.53]). The area under the receiver operating characteristic curve for discrimination of HRQL decline for IMV patients was 0.79 (95% CI, 0.66-0.91) for binary and 0.80 (95% CI, 0.69-0.93) for trichotomous severity categorization. HRQL decline is common among children surviving PARDS, and risk of decline is associated with PARDS severity. HRQL decline from baseline may be an efficient and clinically meaningful endpoint to incorporate into PARDS clinical trials.

Merging machine learning and patient preference: a novel tool for risk prediction of percutaneous coronary interventions.

Predicting personalized risk for adverse events following percutaneous coronary intervention (PCI) remains critical in weighing treatment options, employing risk mitigation strategies, and enhancing shared decision-making. This study aimed to employ machine learning models using pre-procedural variables to accurately predict common post-PCI complications. A group of 66 adults underwent a semiquantitative survey assessing a preferred list of outcomes and model display. The machine learning cohort included 107 793 patients undergoing PCI procedures performed at 48 hospitals in Michigan between 1 April 2018 and 31 December 2021 in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) registry separated into training and validation cohorts. External validation was conducted in the Cardiac Care Outcomes Assessment Program database of 56 583 procedures in 33 hospitals in Washington. Overall rate of in-hospital mortality was 1.85% (n = 1999), acute kidney injury 2.51% (n = 2519), new-onset dialysis 0.44% (n = 462), stroke 0.41% (n = 447), major bleeding 0.89% (n = 942), and transfusion 2.41% (n = 2592). The model demonstrated robust discrimination and calibration for mortality {area under the receiver-operating characteristic curve [AUC]: 0.930 [95% confidence interval (CI) 0.920-0.940]}, acute kidney injury [AUC: 0.893 (95% CI 0.883-0.903)], dialysis [AUC: 0.951 (95% CI 0.939-0.964)], stroke [AUC: 0.751 (95%CI 0.714-0.787)], transfusion [AUC: 0.917 (95% CI 0.907-0.925)], and major bleeding [AUC: 0.887 (95% CI 0.870-0.905)]. Similar discrimination was noted in the external validation population. Survey subjects preferred a comprehensive list of individually reported post-procedure outcomes. Using common pre-procedural risk factors, the BMC2 machine learning models accurately predict post-PCI outcomes. Utilizing patient feedback, the BMC2 models employ a patient-centred tool to clearly display risks to patients and providers (https://shiny.bmc2.org/pci-prediction/). Enhanced risk prediction prior to PCI could help inform treatment selection and shared decision-making discussions.

Caregivers’ experiences of accessing HIV Early Infant Diagnosis (EID) services and its barriers and facilitators, India

BackgroundIndia has rolled out Early Infant Diagnosis (EID) program for HIV infection in all states. EID program consists of testing of Infants exposed to HIV periodically over 18 months of age which is a multi-step complex testing cascade. Caregivers represent the primary beneficiary of EID program i.e., infants exposed to HIV and face multiple challenges to access EID services. As part of national EID program outcome assessment study, this study narrates caregivers’ perspectives on barriers and facilitators to access and utilize EID services.MethodsThe study was conducted in 31 integrated counselling and testing centres (ICTCs) located in 11 high burden HIV states. A total of 66 in-depth interviews were conducted with caregivers’ of infants enrolled in EID program. Thematic analysis was carried out to help identify themes underlying barriers and facilitators to access EID services and utilization from caregivers’ perspectives.ResultsThe stigma and discrimination prevalent in society about HIV remains a key demand side (caregiver-level) barrier. Non-disclosure or selective disclosure of HIV status led to missed or delayed EID tests and delayed HIV diagnosis and initiation of Anti-Retroviral Therapy (ART) for infants exposed to HIV. On supply side (health system-level), accessibility of healthcare facility with EID services was reported as a key barrier. The distance, time and cost were key concerns. Many caregivers faced difficulties to remember the details of complex EID test schedule and relied on a phone call from ICTC counsellor for next due EID test. Delayed EID test results and lack of communication of test results to caregiver were reported as primary barriers for completing the EID test cascade.DiscussionThe study reports caregiver-level and health system-level barriers and facilitators for access to EID services from the caregivers’ perspectives. While, decentralisation and single window approaches can improve the access, timely communication of test results to the caregiver also need to be built in with appropriate use of technology. A holistic intervention including PLHIV support networks and the peer-led support mechanisms would be useful to address societal factors.ConclusionThe study findings have high significance for developing program implementation strategies to improve access and to build right-based and patient-centred EID services.

Strengthening the Attainment of Major Competencies of Program Outcomes through Open-ended Experiment using Statistical Designs

Abstract—Unit operations are very essential part of the chemical engineering and allied disciplines; and hence, basic knowledge about the principles and equipment used for various unit operations is mandatory for process engineer. Unit operations course introduces the foundation of process engineering concepts at the second year of undergraduate program of Bachelor of Engineering in Biotechnology. This course mainly focuses on the most essential unit operations utilized in Chemical and allied process industries such as mass transfer, heat transfer, momentum transfer and mechanical operations. The conventional teaching approach practiced so far in Unit Operations Laboratory course was not so effective in the attainment of certain specific core competencies of Program Outcomes (POs). To tackle this challenge, we introduced a system of classifying laboratory experiments into four distinct categories: Demonstration, Exercise, Structural Inquiry, and Open-ended experiments. These categorized experiments were thoughtfully crafted to target various significant technical and professional outcomes such as Investigations of Complex Engineering Problems, Communication, Life-long learning, Follow of Standard Operating Procedure (SOP) and Good Laboratory Practices (GLP). The evaluation criteria for each type of experiment were aligned with program outcomes, competencies, and performance indicators. This alignment proved highly beneficial in achieving a more precise assessment of program outcomes. This study focuses on implementing an interactive and collaborative learning approach in the Unit Operations laboratory course. of Experiments. More precisely, the study employs Central Composite Design (CCD) and Response Surface Methodology (RSM) concepts to examine how various factors influence the Leaching (Solid-Liquid Extraction) process. The leaching process is most important unit operations used in the extraction of substances from solids. The study helped in addressing several important competencies pertaining to the Program Outcomes- PO-4: Demonstrating the capacity to design, execute experiments, and analyze data; PO-10: Exhibiting effective communication skills; PO-12: Embracing lifelong learning; PSO-13: Adhering to Standard Operating Procedures (SOP) and Good Laboratory Practices (GLP). The assessment of student performance employed a rubric-based approach, and the attainment of program outcomes was documented. It was observed that, open-ended experimental approach, led to the improvements in the attainment of PO’s in terms of competencies and performance indicators. To enhance the teaching-learning process, formal and anonymous feedback was gathered from students to identify areas of improvement and deficiencies. Keywords—Central Composite Design; Collaborative learning; Design of experiments; Open-ended experiment; Program outcome; Response Surface Methodology;

Excellence in Academic Physical Therapy: Promoting a Culture of Data Sharing.

Data analytics are increasingly important in health professions education to identify trends and inform organizational change in rapidly evolving environments. Unfortunately, limitations exist in data currently available to determine physical therapy (PT) academic excellence. It is imperative that the American Council of Academic Physical Therapy (ACAPT) be able to demonstrate data-informed progress in addressing the common challenges faced by Doctor of Physical Therapy programs. The Task Force to Explore Data and Technology to Evaluate Program Outcomes was convened by ACAPT to explore current and desired data and the needs, technology, and costs that would be required for ACAPT to assess program outcomes relative to excellence criteria. The Task Force performed a gap analysis of measures of excellence, provided evidence-based recommendations for advancing the use of data and technology systems in academic PT, and generated a comprehensive Assessment Excellence Map that subsequently led to a new streamlined Excellence Framework in the launch of the ACAPT Center for Excellence. The vision of universal excellence in PT education necessitates clear alignment and centralization of common data to support efficient processes to assess excellence. The transformative nature of data is untapped in PT academic endeavors, and nascent work to establish and sustain a culture of centralized data sharing and assessment will help to drive program-level and profession-level excellence in PT education.

Family Presence at the PICU Bedside: A Single-Center Retrospective Cohort Study.

To determine factors associated with bedside family presence in the PICU and to understand how individual factors interact as barriers to family presence. Mixed methods study. Tertiary children's hospital PICU. Five hundred twenty-three children of less than 18 years enrolled in the Seattle Children's Hospital Outcomes Assessment Program from 2011 to 2017. None. Quantitative: Family was documented every 2 hours. Exposures included patient and illness characteristics and family demographic and socioeconomic characteristics. We used multivariable logistic regression to identify factors associated with presence of less than 80% and stratified results by self-reported race. Longer PICU length of stay (LOS), public insurance, and complex chronic conditions (C-CD) were associated with family presence of less than 80%. Self-reported race modified these associations; no factors were associated with lower bedside presence for White families, in contrast with multiple associations for non-White families including public insurance, C-CD, and longer LOS. Qualitative: Thematic analysis of social work notes for the 48 patients with family presence of less than 80% matched on age, LOS, and diagnosis to 48 patients with greater than or equal to 95% family presence. Three themes emerged: the primary caregiver's prior experiences with the hospital, relationships outside of the hospital, and additional stressors during the hospitalization affected bedside presence. We identified sociodemographic and illness factors associated with family bedside presence in the PICU. Self-reported race modified these associations, representing racism within healthcare. Family presence at the bedside may help identify families facing greater disparities in healthcare access.

Expanding midwifery care in the United States: Implications for clinical outcomes and cost.

This study compared clinical and financial outcomes for low-risk birthing people between those attended by midwives and those attended by obstetricians during hospital births. We conducted a retrospective cohort analysis of births from January 1, 2016 to December 31, 2020 at hospitals participating in a perinatal quality improvement collaborative, Obstetrical Care Outcomes Assessment Program (OB COAP), in the Northwest region of the United States and estimated risk ratios using a multivariate regression approach with a modified Poisson binomial for mode of delivery, labor interventions, and newborn outcomes comparing midwife-led to obstetrician-led care. Using publicly available data on average costs of vaginal and cesarean births, we then extrapolated the cost differences in care between midwives and obstetricians. Births in the midwife group were less likely to be associated with induction (17.6% vs. 20.3% RR 0.74; 95% CI 0.70-0.78), epidural use (58.9% vs. 76.3% RR 0.78; 95% CI 0.77-0.80), and episiotomy (2.2% vs. 3.4% RR 0.68; 95% CI 0.58-0.81). Cesarean birth was also lower in the midwifery group (7.8% vs. 12.3% RR 0.68, 95% CI 0.62-0.73), without a corresponding increase in risk in adverse neonatal outcomes. We estimated that expanding midwifery care to 100% of low-risk births across the United States could save as much as $340 million per year. Midwifery care is associated with a lower risk of cesarean birth and other interventions versus care provided by obstetricians and is therefore likely lower-cost.

Assessment of Program Outcomes in Outcome Based Education through Students' Co-Curricular Activities

ABSTRACT (OBE) has become the focal point in the Indian Higher education system. The National accrediting agency, such as NBA and NAAC expresses the significance of assessing the program outcomes. This paper discusses assessing program outcomes through students' cocurricular activities such as paper and project presentations and internships/industrial projects. The proposed method gives an in-view of the rubricsbased measurement of program outcomes PO1-PO12, PSO1&2 mapped with students' co-curricular activities. The outcome-based assessment of program outcomes will be beneficial in advancing higher education in India. Keywords: co-curricular activities; internship; outcome based education; paper and project presentation; program outcomes; rubrics

Assessment and Evaluation of Engineering, ICT and Architecture Program Outcomes Using ABET Criteria for LPU - Cavite

Assessment and Evaluation of Engineering, ICT and Architecture Program Outcomes Using ABET Criteria for LPU - Cavite

Real-World Evidence of Collecting Quality of Life (QoL) and Symptoms Perception Using the HM-PRO© Tool As a Patient-Reported Outcome Measure (PROM) in Patients with Lymphoma While Receiving Intravenous Chemotherapy

INTRODUCTION: Electronic collection of patient-reported outcomes (PROM) is becoming widespread in healthcare to objectively measure and collect the patient's subjective experience during their illness. The implementation in routine cancer care during treatment remains to be seen. More specifically, little is known about the use and success of electronic reporting during active cancer treatment in frail and older patients. HM-PRO© is a validated PROM tool developed by the European Hematology Association Specialized Working Group of QoL in patients with hematologic malignancies. OBJECTIVES: The primary end point was to analyze the adverse effects reported by patients when receiving intravenous chemotherapy treatment and its impact on the quality of life of patients over time through the HM-PRO© questionnaire. METHODS: Of the 200 patients included in the health outcomes assessment program, 90 patients with a diagnosis of lymphoma and with at least two completed questionnaires were collected during the period 2020-2022. The scores and answers to the HM-PRO© questionnaires were also gathered. HM-PRO© questionnaires were submitted electronically through the hospital patient portal prior to the start of treatment and subsequently at 3, 6, 12 months and 1 year after starting chemotherapy. The questionnaires included questions about eating habits, social life, mental health and personal emotional situation, physical condition and symptoms derived from the lymphoma itself and/or chemotherapy. The statistical analysis was performed using a generalized model with patient analysis of the time variable including the necessary confounding variables for each quality variable. Temporal autocorrelation with the AR1 function has been considered. RESULTS: Demographic data are shown in Table 1. Age at diagnosis did not influence any parameter except for physical status where we found significant differences (p=0.002, rho=0.1095), probably in relation to greater frailty in older patients. However, the side effects of treatment, and the symptoms associated with the disease were tolerated similarly regardless of age. In terms of gender differences, men were less affected in their eating & drinking habits. Men show a tendency to remain with less symptomatic burden during treatment. The involvements of the social and emotional spheres were similar in both sexes Symptoms related to the disease or treatment improved after 6 months (p<0.02) from the onset of chemotherapy. Physical condition improved significantly after one year (p=0.03) regardless of the lymphoma' stage and the comorbidities. The nutritional status of patients also improved after 12 months and was influenced by the stage of lymphoma, with better scores among patients with localized disease (p=0.02). At the social level, patients experienced a significant improvement after 6 months, especially those with localized stages and a lower score on the CIRS (Cumulative Illness Rating Scale) scale. This does not occur in the emotional sphere where it takes more than 12 months to observe a significant improvement (p=0.03). This was probably because mental health and psychological sequelae were more complex to deal with in the short term (Figure 1). CONCLUSIONS: Intravenous chemotherapy is not free of adverse events and may affect patients in very different ways; it is important to compile these side effects in order to help healthcare workers to provide a more individualized care. Older patients suffer a greater deterioration of their physical condition but their other spheres are no more affected than in the rest of the population. Geriatric assessment is fundamental and age alone should not be the only limiting factor in treating our patients. If we take into account the stage of the lymphoma, it significantly affects the social aspect and the eating habits of the patients. On the other hand, a higher score on the CIRS scale only correlates with a worse score on the social well-being. This indicates that a comprehensive approach to all spheres of the patient's life must turn now into a reality. The self-perception of symptoms due to lymphoma as well as the chemotherapy-related toxicity impact negatively in the quality of life of patients in a relevant way during the first year after diagnosis, improving significantly afterwards to their baseline situation. Intensive treatment does not indefinitely affect the quality of life of hematologic patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Cesarean delivery rates and indications in pregnancies complicated by diabetes

Objective Rates of pregestational (PGDM) and gestational diabetes (GDM), and their associated pregnancy complications, are rising. Pregnancies complicated by diabetes have increased cesarean delivery (CD) rates; however, there are limited data regarding the current rates of, and contributing factors to, these deliveries. The Robson Ten Group Classification System (TGCS) is a clinically relevant, standardized framework that can be used to evaluate and analyze cesarean rates. The objective of this study was to evaluate rates of, and indications for, intrapartum, unplanned CD among pregnancies complicated by diabetes, compared to normoglycemic (NG) pregnancies, in a large United States birth cohort. Methods This retrospective cohort study used chart-abstracted data on births between 24 and 42 weeks’ gestation at 17 hospitals that contributed to the Obstetrical Care Outcome Assessment Program database between 01/2016 and 03/2019. The CD rate for NG pregnancies, and pregnancies complicated by gestational and PGDM was calculated and compared using the Robson TGCS. The indications for intrapartum CD in patients with term, singleton, vertex gestations without a prior cesarean were then analyzed. Univariate and multivariate logistic regression models were used to compare the cesarean rate and indications for CD, between the diabetic groups and the NG group. Results were adjusted for maternal age, BMI, neonatal birth weight, and insurance status, as well as clustering by hospital. Results A total of 86,381 pregnant people were included in the study cohort. Of these 76,272 (88.3%) were NG, 8591 (9.9%) had GDM, and 1518 (1.8%) had PGDM. Compared to NG patients, overall cesarean rates were higher in patients with GDM (40.3% vs. 29.7%; aOR 1.25, 95%CI 1.18–1.31) and PGDM (60.0% vs. 29.7%; aOR 2.53, 95%CI 2.04–3.13). This finding remained true when the cohort was restricted to term, singleton, vertex laboring patients without a prior cesarean; compared to NG patients, the cesarean rate was higher in patients with GDM (17.4% vs. 12.2%, aOR 1.37, 95%CI 1.29–1.45) and PGDM (26.0% vs. 12.2%, aOR 2.55, 95%CI 2.00–3.25). The cesarean rate for fetal indications was similar in the GDM (5.7%) and NG (4.4%) groups, while those patients with PGDM had a significantly higher rate (10.4%; aOR 2.01, 95%CI 1.43–2.83). Similarly, the rate of cesarean for labor dystocia in patients with PGDM was significantly higher than in NG patients (16.9% vs. 7.0%, and aOR 2.28, 95%CI 1.66–3.13) while patients with GDM had an intermediate rate (10.6% vs. 7.0%, aOR 1.49, 95%CI 1.40–1.57). Conclusions The CD rate is significantly higher in pregnancies complicated by diabetes, particularly pregestational, compared to NG pregnancies. Despite controlling for maternal factors and birth weight, pregnancies complicated by diabetes are more likely to undergo an unplanned intrapartum cesarean secondary to labor dystocia than their NG counterparts, but only pregnancies complicated by PGDM have an increased risk of cesarean for fetal indications. More research is needed to understand whether this higher cesarean rate is due to factors intrinsic to diabetes in laboring patients or is due to a difference in the way clinicians manage diabetics in labor.

The benefits of Heart Rate Variability (HRV) in the assessment of health and exercise performance

The purpose of this brief report is to stimulate further interest and to raise awareness in relation to the usefulness of assessing cardiac autonomic nerve function using heart rate variability (HRV). The paper outlines the mechanisms associated with HRV and the relationships between HRV, health, and athletic performance. The paper then summarizes the potential benefits of HRV in the assessment of health and exercise adaptations. The paper also provides suggestions about the practical implications of HRV measurement during data collection. We hope that the content provides useful information for the application of HRV for health evaluation and training adaptations. In addition, we hope the paper will provide a better understanding of how HRV measurements can be interpreted and used. Finally, the paper provides practical applications that are effective in the assessment of health and athletic training program outcomes.

Government Regulation and Percutaneous Coronary Intervention Volume, Access and Outcomes: Insights From the Washington State Cardiac Care Outcomes Assessment Program

BackgroundIt is unclear how to geographically distribute percutaneous coronary intervention (PCI) programs to optimize patient outcomes. The Washington State Certificate of Need program seeks to balance hospital volume and patient access through regulation of elective PCI.Methods and ResultsWe performed a retrospective cohort study of all non‐Veterans Affairs hospitals with PCI programs in Washington State from 2009 to 2018. Hospitals were classified as having (1) full PCI services and surgical backup (legacy hospitals, n=17); (2) full services without surgical backup (new certificate of need [CON] hospitals, n=9); or (3) only nonelective PCI without surgical backup (myocardial infarction [MI] access hospitals, n=9). Annual median hospital‐level volumes were highest at legacy hospitals (605, interquartile range, 466–780), followed by new CON, (243, interquartile range, 146–287) and MI access, (61, interquartile range, 23–145). Compared with MI access hospitals, risk‐adjusted mortality for nonelective patients was lower for legacy (odds ratio [OR], 0.59 [95% CI, 0.48–0.72]) and new‐CON hospitals (OR, 0.55 [95% CI, 0.45–0.65]). Legacy hospitals provided access within 60 minutes for 90% of the population; addition of new CON and MI access hospitals resulted in only an additional 1.5% of the population having access within 60 minutes.ConclusionsMany PCI programs in Washington State do not meet minimum volume standards despite regulation designed to consolidate elective PCI procedures. This CON strategy has resulted in a tiered system that includes low‐volume centers treating high‐risk patients with poor outcomes, without significant increase in geographic access. CON policies should re‐evaluate the number and distribution of PCI programs.

95. Racial, ethnic and financial disparities in spine surgery in the state of Washington

<h3>BACKGROUND CONTEXT</h3> Racial and financial disparities in health care remain an obstacle to providing quality patient care. Although previous studies have identified these disparities as being risk factors for postoperative complications, none have examined the preoperative variables that may contribute to these disparities. <h3>PURPOSE</h3> This study aims to evaluate the determinants of health that contribute to racial and ethnic disparities in spine surgeries, and to investigate whether patient race and ethnicity is an independent predictor of preoperative and postoperative outcomes in Washington State. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of the Washington State Surgical Clinical Outcomes Assessment Program (Spine COAP) database. <h3>PATIENT SAMPLE</h3> A total of 43,288 adult patients (>18 years old) undergoing four or fewer spinal levels surgery. <h3>OUTCOME MEASURES</h3> The Spine COAP database was queried for all elective spine surgery cases performed from January 1st 2015 to December 31st 2020. Patient's race and ethnicity were recorded by patient's self-report in the survey of Spine COAP into six racial categories: American Indian/Alaskan Native, Asian, Black/African American, Native Hawaiian/Pacific Islander, White/Caucasian or Other/Multiple, and one ethnicity: Latino or Hispanic. Due to the reduced number in some of the racial groups, we grouped the patients into White Non-Hispanic (WNH), White Hispanic (WH), Black/African American (AA), Asian (AS) and Other (Native Hawaiian/Pacific islander, Native American/ Alaskan Native, and Multiracial). Demographic variables comprised patient's age, sex, body mass index, insurance type and work status. Patient comorbidities included were hypertension, diabetes mellitus and smoking status. Preoperative interventions included were pain management (record of preoperative analgesia use and type), conservative management, and glucose management (evaluation in pre- and postoperative time period of blood glucose levels and insulin use). Surgical procedure type, lumbar (fusion/nonfusion) or cervical (fusion/nonfusion), were obtained. Postoperative outcomes included were length of hospital stay, discharge location (home vs others) and 30-day complications (reoperations and infections). <h3>METHODS</h3> Descriptive analysis showing the distribution of the demographics, financial, preoperative, operative and postoperative factors across the racial/ethnic groups were performed. Multivariate analysis for the association between racial groups and preoperative & postoperative outcomes were performed using logistic regression models to calculate odds ratios [OR (95%CI)] for binary outcomes. All variables were adjusted for a priori selected sex, patient age, BMI and insurance status at admission. All analyses were conducted in Stata 14.0 (College Station, TX) (StataCorp, 2015), with a significance level considered at 0.05 alpha level for the outcome analysis. <h3>RESULTS</h3> A total of 43,288 patients were identified of whom 87.7% were White-Non-Hispanic (WNH), 3.4% were White-Hispanic (WH), 3% were African-American (AA), 2.7% were Asian (AS) and 2.1% were Other (including American Indian/Alaska Native and Hawaiian/Pacific Islander and multiracial). WNH patients were older than all the minority groups. The AS group had a higher proportion of females compared with all the other racial groups. All minority groups reported higher prevalence of DM compared to WNH patients. BMI was higher for WNH, WH, AA and Others compared to AS patients. AA patients had higher prevalence of hypertension and current smoking status compared to the other racial groups. Minority groups demonstrated highest rate of not having medical insurance. Minority groups were less likely to have conservative management (physical therapy, acupuncture, etc) prior to surgery. Minority groups were more likely to have pain management (analgesics, steroid injections) and more likely to have preoperative glucose management compared to the WNH patients prior to surgery. Minority groups were more likely to have hospital stay greater than 4 days (the AA group being twice likely compared to WNH) and they were less likely to be discharged home (the AA group being the most affected group). We found that the Minority groups were more likely to have postop complications (including SSI and reoperations) compared to the WNH group. In the context that the 30-day postoperative complications rate was very low, this is in addition to only 12% of the people having surgery are part of the minority group. <h3>CONCLUSIONS</h3> Our results indicate differences on the preoperative management and postoperative outcomes among the racial/ethnic groups. This suggests that disparities among minority groups still exist in spinal surgery in Washington State. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Exclusive Breastfeeding in the Northwest: Disparities Related to Race/Ethnicity and Substance Use.

Mothers who are Black, Indigenous, and people of color (BIPOC) are disproportionately impacted by substance use in pregnancy and less likely to breastfeed. Our objectives were to assess relationships between substance use in pregnancy and exclusive breastfeeding at discharge (EBF) and race/ethnicity and EBF, and determine the extent to which substance use influences the relationship between race/ethnicity and EBF. This is a retrospective cohort study of term mother-infant dyads using 2016 to 2019 data from a Northwest quality improvement collaborative, Obstetrical Care Outcomes Assessment Program. Stepwise and stratified multivariable logistic regression analyses were conducted to determine associations between independent variables consisting of characteristics, including maternal race/ethnicity and substance use, and the dependent variable, EBF. Our sample consisted of 84,742 dyads, 69.5% of whom had EBF. The adjusted odds of EBF for non-Hispanic Black and Hispanic mothers were half, and for American Indian/Alaska Native mothers two-thirds, that of White mothers (aOR [95% CI]: 0.52 [0.48, 0.57], 0.51 [0.48, 0.54], 0.64 [0.55, 0.76], respectively). Substance use did not mediate the association between race/ethnicity and EBF, but it modified the association. Among those reporting nicotine or marijuana use, Hispanic mothers were half as likely as White mothers were to exclusively breastfeed. Other factors associated with a lower likelihood of EBF included public or no insurance, rural setting, C-section, NICU admission, and LBW. Disparities in EBF related to race/ethnicity and substance use were pronounced in this study, particularly among Hispanic mothers with nicotine or marijuana use.

The Rise of Population Genomic Screening: Characteristics of Current Programs and the Need for Evidence Regarding Optimal Implementation.

Purpose: Advances in clinical genomic sequencing capabilities, including reduced costs and knowledge gains, have bolstered the consideration of genomic screening in healthy adult populations. Yet, little is known about the existing landscape of genomic screening programs in the United States. It can be difficult to find information on current implementation efforts and best practices, particularly in light of critical questions about equity, cost, and benefit. Methods: In 2020, we searched publicly available information on the Internet and the scientific literature to identify programs and collect information, including: setting, program funding, targeted population, test offered, and patient cost. Program representatives were contacted throughout 2020 and 2021 to clarify, update, and supplement the publicly available information. Results: Twelve programs were identified. Information was available on key program features, such as setting, genes tested, and target populations. Data on costs, outcomes, or long-term sustainability plans were not always available. Most programs offered testing at no or significantly reduced cost due to generous pilot funding, although the sustainability of these programs remains unknown. Gene testing lists were diverse, ranging from 11 genes (CDC tier 1 genes) to 59 genes (ACMG secondary findings list v.2) to broad exome and genome sequencing. This diversity presents challenges for harmonized data collection and assessment of program outcomes. Conclusions: Early programs are exploring the logistics and utility of population genomic screening in various settings. Coordinated efforts are needed to take advantage of data collected about uptake, infrastructure, and intervention outcomes to inform future research, evaluation, and program development.

The association of severe pain experienced in the pediatric intensive care unit and postdischarge health-related quality of life: A retrospective cohort study.

Pain may be a modifiable risk factor for lower health-related quality of life after pediatric critical illness. To evaluate the association between severe pain experienced in the (pediatrc intensive care unit) and postdischarge health-related quality of life. This was a retrospective cohort study. Children aged 1 month to 18 years admitted to the pediatric intensive care unit and enrolled in the Seattle Children's Hospital Outcomes Assessment Program were included. Pain was assessed every 2 h by bedside nursing staff using a behavioral pain scale or numeric pain scale. A day of severe pain was defined as a pediatric intensive care unit day with ≥25% of pain scores ≥7/10. Baseline (preadmission) and postdischarge (median 6 weeks) health-related quality of life was assessed by the Pediatric Quality of Life Inventory (PedsQL™) or the Stein Jessop Functional Status II-R (FS II-R, for children with developmental disability). The cohort was stratified by diagnosis category (surgical vs. medical), and associations were measured using linear regression models. Among 546 patients, 11.9% experienced ≥1 day of severe pain. In multivariable linear regression, each day of severe pain was independently associated with a lower postdischarge health-related quality of life score by 3.6 points (95% CI -6.3 to -0.9) adjusted for baseline health-related quality of life score, age, baseline cognitive function, days with multi-organ dysfunction, pediatric intensive care unit length of stay, and decline in overall function. This association was stronger among surgical patients than medical patients with each day of severe pain resulting in a lower postdischarge health-related quality of life score by 5.3 points (95% CI -9.6 to -0.9) versus 2.6 points (95% CI -5.8 to 0.6). Surgical patients had lower postdischarge emotional functioning than physical functioning subdomain scores. Children who experience severe pain in the pediatric intensive care unit have lower postdischarge health-related quality of life adjusting for baseline health-related quality of life, particularly among children who have undergone surgery. Attention to pain management may be important to improve postdischarge health-related quality of life.

Minimally-invasive approach to emergent colorectal surgery in aging adults: A report from the Surgical Care Outcomes Assessment Program

BackgroundDespite known benefits of minimally invasive surgery(MIS) in elective settings, MIS use in emergency colorectal surgery(CRS) is limited. Older adults are more likely to require emergent CRS, and MIS is used less frequently with increasing age. MethodsA retrospective cohort was constructed of emergent CRS cases performed between 2011 and 2019. Discharge(DC) disposition, adverse events, and length of stay(LOS) between MIS and open surgery were compared and stratified by age. Adjustment was made for selected confounders using inverse probability weighting. ResultsOf 6913 emergent CRS cases across 50 hospitals, 1616(23%) were approached MIS. MIS cases were more likely [OR(95%CI)] to DC home [<65yo:1.7(1.3,2.2); 65–74:1.5(1.1,1.9); 75+:1.2(0.9,1.5)] and have fewer adverse events [<65yo:0.6(0.5,0.8); 65–74:0.7(0.5,0.9); 75+:0.7(0.5,0.9)]. LOS was shorter [Mean difference in days(95%CI)] [<65yo: 2.2(-2.9,-1.4); 65–74: 0.9(-2.7,1.0); 75+: 0.7(-1.7,0.2)]. ConclusionsMIS in emergent CRS is associated with increased DC to home, fewer adverse events, and shorter LOS. Benefits persisted with age after adjustment, suggesting an opportunity for improved MIS delivery in older adults.