Outpatient Health Care Settings Research Articles

1466. Antibiotic utilization reports may reduce prescribing practices for Upper Respiratory Infections

BackgroundMore than 90% of Upper respiratory tract infections (URI) have a viral etiology; nonetheless, these represent the most common reason for ambulatory antibiotic prescription. This translates in higher risk of antibiotic-related adverse events and promotion of antimicrobial resistance.MethodsA prospective single-center intervention surveying and providing individual, face-to-face comparative reports of antibiotic utilization, for any of the 4 diagnostic entities that constitute upper respiratory tract infection (common cold, pharyngitis, acute rhinosinusitis and acute bronchitis), was performed in our Emergency Department.Example of monthly provider reports used which included general and individualized goals. ResultsA total of 12 health care providers were followed for 12 months. Education, prescribing reports and individual goals were provided. The pre-intervention prescription rate from September to December 2018 averaged 74.75% (SD 20.59, 95% CI 61.6-87.8), with a post-intervention rate of 55.5% from September to December of 2019 (SD 19.20, 95% CI 43.3-67.7) that was statistically significant (p=0.0036). A higher use of antibiotic was observed in physicians when compared to non-physician providers in both pre and post intervention stages (reduction of 16.6% vs 23% after intervention respectively), with no statistical difference between the two groups (CI 95% of -38.82 to 2.395, p=0.0773). A proposed target of 50% or less was observed in 5 of 12 providers (41.6%), and 2 out of 12 (16.7%) had increase in their antibiotic utilization rate.Comparative use of antimicrobials in the pre (September-December 2018) and post (September-December 2019) - intervention periods. Average individual antimicrobial use rate before and after intervention. ConclusionRoutine face-to-face utilization reports may constitute an effective approach in reducing antibiotic prescription practices in the Emergency Department, and potentially, in other outpatient healthcare settings.Disclosures All Authors: No reported disclosures

221. Comparison of dental antibiotic prescribing between Australia, England, the United States and British Columbia in 2017

BackgroundAntibiotic resistance is recognised as a major public health burden. Dentists overprescribe antibiotics and prescribe for unnecessary indications. Tracking and investigating prescribing practices by healthcare professionals provides insights needed to inform targeted antibiotic stewardship interventions. It is unclear how dental antibiotic prescribing patterns differs between countries. The aim of this study was to compare antibiotic prescribing by dentists in Australia, England the United States (US) and British Columbia (BC).MethodsThis was a cross-sectional study of dispensed dental antibiotic prescriptions between January 1 and December 31, 2017, from Australia, England, US and BC. Dispensed dental antibiotic prescriptions included those from outpatient pharmacies and healthcare settings. Outcome measures included the proportion of dental antibiotic prescriptions by location and prescribing rates by population.ResultsEnglish dentists prescribed 1.6 times more antibiotics than those in Australia, and dentists in BC and US prescribed around twice more than Australian dentists. (Australia: 33.2 prescriptions/1000population; England: 53.5 prescriptions/1000population; US: 72.6 prescriptions/1000 population; BC: 65.0 prescriptions/1000 population). The types of antibiotics prescribed were similar across all countries, where penicillins were the predominant class prescribed (66.8–80.5% of antibiotic prescriptions). US dentists and dentists in BC prescribed more clindamycin compared to the dentists in other countries.ConclusionDentists in the US, England and BC prescribed at relatively higher rates than Australian dentists. The findings from this study should initiate an evaluation by dentists of their prescribing practices and responsibilities regarding their contribution towards antibiotic resistance. Further investigations can be aimed at determining country-specific factors that influence dental antibiotic prescription.DisclosuresLeanne Teoh, BDSc(Hons) BPharm(Hons), Australian Government Research Training Program Scholarship (Other Financial or Material Support, Scholarship awarded for the PhD candidature)

Use of a warm handoff interprofessional simulation to model asynchronous and patient-centered teamwork

An interprofessional education simulation in an outpatient clinic setting was utilized to allow pharmacy and social work students to practice the warm handoff communication technique. This event included 157 pharmacy and social work students. The primary objective of this encounter was for the learner to better understand the role of the partnering profession and demonstrate an appropriate warm handoff. The simulation included pre-event didactic education, performance of a warm handoff, and faculty-led debriefing. A novel warm handoff evaluation checklist was created to evaluate the performance of the students using the warm handoff communication technique. Students successfully initiated the warm handoff and demonstrated patient engagement by asking permission and using introductions. However, students did not perform as well with the more complex skills of communicating the patient's background, situation, and assessment to their colleagues. Students were asked to complete an anonymous, pre- and post-questionnaire to assess the impact and value of the interprofessional simulation and the likelihood that they would refer a patient to the partnering profession in the future. The post-questionnaire was evaluated both quantitatively and qualitatively using a content analysis of the open-ended questions. The quantitative analysis showed that students valued the simulation and the opportunity to practice and would use the skills gained in the future. The results also revealed an increased likelihood that students would refer patients to the partnering profession post-simulation. The content analysis of the open-ended question asking the learners what they thought was valuable about the simulation demonstrated that students value communicating with another healthcare team member with the patient in the room, learning about the role of other healthcare professionals, and practicing the warm handoff communication tool. Overall, this simulation was shown to be an effective activity to promote interprofessional care between pharmacy and social work students and to practice a warm handoff that promotes integrated patient care in outpatient healthcare settings.

Effect of “Speak Up” educational tools to engage patients in advance care planning in outpatient healthcare settings: A prospective before-after study

BackgroundTools for advance care planning (ACP) are advocated to help ensure patient values guide healthcare decisions. Evaluation of the effect of tools introduced to patients in clinical settings is needed. ObjectiveTo evaluate the effect of the Canadian Speak Up Campaign tools on engagement in advance care planning (ACP), with patients attending outpatient clinics.Patient involvement: Patients were not involved in the problem definition or solution selection in this study but members of the public were involved in development of tools. The measurement of impacts involved patients. MethodsThis was a prospective pre-post study in 15 primary care and two outpatient cancer clinics. The outcome was scores on an Advance Care Planning Engagement Survey measuring Behavior Change Process on 5-point scales and Actions (0−21-point scale) administered before and six weeks after using a tool, with reminders at two or four weeks. Results177 of 220 patients (81%) completed the study (mean 68 years of age, 16% had cancer). Mean Behavior Change Process scores were 2.9 at baseline and 3.5 at follow-up (mean change 0.6, 95% confidence interval 0.5 to 0.7; large effect size of 0.8). Mean Action Measure score was 3.7 at baseline and 4.8 at follow-up (mean change 1.1, 95% confidence interval 0.6–1.5; small effect size of 0.2). Practical valuePublicly available ACP tools may have utility in clinical settings to initiate ACP among patients. More time and motivation may be required to stimulate changes in patient behaviors related to ACP.

Abstract 366: Association Between Attitudes and Preferences in Cardiopulmonary Resuscitation with Personality Traits in High-risk, Out-patient Healthcare Settings

Background: Little is known about attitudes and preferences towards cardiopulmonary resuscitation (CPR) by outpatient healthcare employees. Investigations assessing the relationship between personality traits and willingness to perform CPR are few. Methods: From 10/2018-5/2019, the Columbia University Patient Safety Department partnered with the AHA to conduct training sessions on how to identify an individual in cardiac arrest and perform CPR at eight outpatient medical sites covering all major medical and surgical specialties (~1 million patient visits/year). Sites included did not have code teams and were in varying distances of the Emergency Department (ED). Participants, 80% of employees at each clinic, were surveyed on characteristics and motivation, as they apply to CPR, and completed the Ten-Item Personality Inventory (TIPI). Results: Of the 309 participants, 79% (244 of 309) were women and 32% (99 of 309) were Latinx. Before the investigation, 60% (185 of 309) of participants had learned CPR, but only 8.7% (27 of 309) of those individuals had refreshed their knowledge in the past year. About half, 46% (142 of 309), of participants, scored 6 or above (scale 0-7) on the openness personality trait and 77% (238 of 309) scored a 6 or above (scale 0-7) on the conscientiousness trait. More than half, 67% (207 of 309; CI 61-72) of participants claimed that harming others was a major concern in performing CPR at their practice. Participants with high openness scores were significantly less likely to cite their main concern during resuscitation as harm to the victim (p<0.005). When asked of their willingness to perform CPR, 27% (83 of 309; CI 22-33) of participants cited various patient characteristics as deciding factors. Participants with high conscientiousness scores were significantly less likely to view any patient characteristics as critical in the debate to perform CPR (p<0.0001). Conclusions: In out-patient healthcare offices, very few employees considered patient characteristics in their willingness to perform CPR; however, the majority are concerned that they will harm a patient by attempting to resuscitate. Future studies should look into the role of different personalities in willingness to perform CPR in a real-life setting.

Non-disclosure of drug use in outpatient health care settings: Findings from a prospective cohort study in Vancouver, Canada

BackgroundIllicit drug use is associated with severe health-related harms, yet people who use drugs (PWUD) face substantial barriers to healthcare. We sought to identify factors associated with disclosure of drug use to a healthcare provider and describe differences in self-reported quality of care received based on disclosure status. MethodsA client-reported experience questionnaire on healthcare access and quality, adapted from the World Health Organization Survey on Health and Health System Responsiveness, was administered within two ongoing prospective cohort studies of PWUD in Vancouver, Canada. Respondents not currently receiving addiction treatment were asked about experience of care and drug use disclosure to their most commonly accessed outpatient healthcare provider in the past 6 months. We used an adjusted logistic regression model to identify client characteristics associated with disclosure. ResultsFrom a total of 261 respondents (34.1% female), less than half (n = 125, 47.8%) reported disclosing drug use to their healthcare provider. Indigenous participants were less likely to disclose compared to non-Indigenous participants (adjusted OR: 0.55, 95% confidence interval: 0.30, 0.97). Disclosure was associated with lower self-reported quality of care (overall rating: disclosed 8.2 vs. did not disclose 8.8, p = 0.04). ConclusionsIn a sample of PWUD accessing outpatient healthcare services, we observed low rates of drug use disclosure, particularly for Indigenous respondents, and reduced quality of care for those who disclosed. These findings highlight the need for culturally safe and non-stigmatizing care to address pervasive stereotyping in the healthcare system and improved screening for substance use disorder in outpatient healthcare services.

Multidisciplinary Human Trafficking Education: Inpatient and Outpatient Healthcare Settings

ABSTRACT Background: While it is common for trafficked persons (TPs) to access healthcare, few health professionals have had training and lack confidence in their ability to respond effectively. Additionally, healthcare does not have evidenced-based education or policy for responding to TP. This study evaluated knowledge and confidence in responding to TPs among multidisciplinary participants from outpatient and inpatient settings. Methods: A revised version of the Provider, Responses, Treatment, and Care for Trafficked People (PROTECT) instrument was used. An additional question was added to record previous contact with trafficked persons. The first phase of data collection (n = 237) occurred pre and post education. The second phase of data collection (n = 106) was completed three months after implementation of a response policy and procedure. Results: Phase one results are statistically significant with a sharp increase in the number of participants who reported caring for a TP. Knowledge and confidence levels were also significantly impacted. The second phase did not show a significant change in confidence. However, six knowledge questions related to identifying potential cases of HT were significantly different, showing a decrease in knowledge over time. Discussion: This study documents the benefits of education based on Health, Education, Advocacy, Linkage (HEAL) Trafficking’s recommendations. Follow-up survey shows that without ongoing education or awareness activity, key knowledge areas decline. Therefore, while policy and awareness education are important, health professionals need ongoing education as well as incentive to utilize the response policy and procedure.

FASStR: a framework for ensuring high-quality operational metrics in health care.

Poorly defined measurement impairs interinstitutional comparison, interpretation of results, and process improvement in health care operations. We sought to develop a unifying framework that could be used by administrators, practitioners, and investigators to help define and document operational performance measures that are comparable and reproducible. Retrospective analysis. Health care operations and clinical investigators used an iterative process consisting of (1) literature review, (2) expert assessment and collaborative design, and (3) end-user feedback. We sampled the literature from the medical, health systems research, and health care operations (business and engineering) disciplines to assemble a representative sample of studies in which outpatient health care performance metrics were used to describe the primary or secondary outcome of the research. We identified 2 primary deficiencies in outpatient performance metric definitions: incompletion and inconsistency. From our review of performance metrics, we propose the FASStR framework for the Focus, Activity, Statistic, Scale type, and Reference dimensions of a performance metric. The FASStR framework is a method by which performance metrics can be developed and examined from a multidimensional perspective to evaluate their comprehensiveness and clarity. The framework was tested and revised in an iterative process with both practitioners and investigators. The FASStR framework can guide the design, development, and implementation of operational metrics in outpatient health care settings. Further, this framework can assist investigators in the evaluation of the metrics that they are using. Overall, the FASStR framework can result in clearer, more consistent use and evaluation of outpatient performance metrics.

Prospective Multicenter Evaluation of an Advanced Extracellular Matrix for Wound Management.

To evaluate an advanced extracellular matrix made of ovine forestomach matrix (OFM) for healing a variety of wound types. Participants were enrolled from inpatient, outpatient, and home healthcare settings. The OFM was used to treat all wounds and applied to the wound bed every 3 to 7 days until closure. Researchers enrolled 29 participants with 33 wounds. Average time to wound closure was 8.2 weeks, the percentage of wounds that reduced in size by 50% or more at 4 weeks was 64%, the average wound area reduction at 4 weeks was 66%, and 73% of wounds had closed at 12 weeks. No adverse effects were observed. This represents the first Canadian evaluation of OFM for the treatment of wounds, and the positive healing outcomes observed could support more widespread adoption of this matrix.

298 - Validity of the Somatic Symptom Disorder scale (SSD-12) for the assessment of DSM-5 B Criteria in a specialized outpatient mental health care setting

298 - Validity of the Somatic Symptom Disorder scale (SSD-12) for the assessment of DSM-5 B Criteria in a specialized outpatient mental health care setting

Follow-Up Care After Behavioral Health-Related Hospitalization for Children and Adolescents.

Although the coordination of follow-up behavioral health-related care between hospitals and outpatient behavioral health care settings is important, studies on this topic are few. Claims were selected from Truven Health Analytics' Marketscan databases during 2014 for youth aged 2-18years who had an inpatient stay with a behavioral health diagnosis. Analyses identified whether youth received a behavioral health follow-up visit within 30days following a hospitalization. The percentage of children who received post-hospitalization follow-up care was 59.1% (Medicaid) and 59.4% (private insurance). While children less than 15years old (Medicaid) had increased odds of follow-up care compared with youth aged 15-18years, children 2-9years old with commercial insurance had decreased odds of follow-up care. Variations in follow-up care by patient characteristics provide an opportunity to target efforts to increase coordinated care to those who are least likely to receive it.

Impact of Corona Virus Disease-2019 on occupational therapy practice in India: An online national survey

Background: India imposed several consecutive lockdowns to control the spread of coronavirus disease-2019 (COVID-19) beginning March 2020. As a result, many establishments, including outpatient health-care settings and educational institutions, were closed. Consequentially, many health-care professionals experienced disruption in their work lives and faced financial crisis. Objectives: The objective was to assess the impact of COVID-19 on the occupational therapy (OT) community in India. Study Design: This is a cross-sectional study. A ten-item electronic survey was developed based on the research question to gather data. Methods: An online survey form was e-mailed to 760 OTs in India identified through convenience sampling. The survey link, generated through SurveyMonkey, was also shared on four WhatsApp Messenger groups (TNAIOTA Official Group, OTist Group, Clinic OT, and IPOTPDG1) with many Indian OTs (snowball sampling). In addition, the survey link was shared through Facebook Messenger to around 200 OTs in India. Data were collected from May 24, 2020 to June 21, 2020. Results: The number of responses received was 99. Eighty-seven respondents reported experiencing disruption in work, of which 37 reported 81%–100% income loss. The income loss was high among private practitioners and low among academicians. Respondents utilized telehealth to overcome the disruption. Conclusions: COVID-19 has severely impacted the work lives of OTs in India and caused financial strain. This study provides preliminary data and some suggestions for the professional organizations and leaders to consider when advocating for the profession. Further in-depth exploration is recommended.

Analysis of Falls within Paediatric Hospital and Community Healthcare Settings

PurposeTo identify characteristics of paediatric falls within a healthcare setting. Design and methodsA retrospective analysis of falls occurring within inpatient, outpatient, emergency and community healthcare settings of children aged 0–<18 years was conducted using data from the Children's Health Queensland Hospital and Health Service (CHQ-HHS) Clinical Incident Database and Electronic Medical Record between January 1st 2015 and December 31st 2017. One-sample and two-sample Chi-squared tests with post-hoc tests were performed to assess relationships between categorical variables. ResultsThe final dataset contained 385 fall events. Children 0–2 years fell most frequently (46.75%) and falls were higher in males (55.58%). Falls from bed were the most common mechanism (30.65%). The incidence rate of inpatient falls was 0.53 falls per 1000 bed days in the tertiary hospital setting and 1.2% of presentations to inpatient community health facilities. Falls from bed were most common in the tertiary hospital inpatient setting (39.84%, p < .001) and the emergency department (72.13%, p < .001). Falls from furniture/equipment constituted 26.04% of outpatient falls. Most falls occurred in the presence of parents/caregivers (79.48%) and 4.66% of fallers sustained multiple falls. ConclusionsThis study provides a comprehensive review of the characteristics of fall events in CHQ-HHS over a three-year period and summarises the existing literature in paediatric fall prevention. Practice implicationsRisk assessment and management plans should focus on education, particularly surrounding bed safety. Our findings have informed the development of an integrated evidence-based paediatric-specific fall risk assessment tool and management plan to prevent falls in hospital and community healthcare settings.

Investigating the feasibility and reliability of the Pictorial Fit-Frail Scale.

the Pictorial Fit-Frail Scale (PFFS) was designed as a simple and practical approach to the identification of frailty. To investigate the feasibility and reliability of this visual image-based tool, when used by patients, caregivers and healthcare professionals (HCPs) in clinical settings. observational study. three outpatient geriatric healthcare settings. patients (n = 132), caregivers (n = 84), clinic nurses (n = 7) and physicians (n = 10). the PFFS was administered to all patients. Where available, HCPs and caregivers completed the scale based on the patients' health. In the geriatric day hospital, the PFFS was completed on admission and administered again within 7-14days. Time and level of assistance needed to complete the scale were recorded. Intraclass correlation coefficients (ICCs) and 95% confidence intervals (CIs) were used to assess test-retest and inter-rater reliability. mean time to complete the scale (minutes:seconds ± SD) was 4:30 ± 1:54 for patients, 3:13 ± 1:34 for caregivers, 1:28 ± 0:57 for nurses and 1:32 ± 1:40 for physicians. Most patients were able to complete the scale unassisted (64%). Mean patient PFFS score was 11.1 ± 5.3, mean caregiver score was 13.2 ± 6.3, mean nurse score was 10.7 ± 4.5 and mean physician score was 11.1 ± 5.6; caregiver scores were significantly higher than patient (P < 0.01), nurse (P < 0.001) and physician (P < 0.01) scores. Test-retest reliability was good for patients (ICC = 0.78, [95%CI = 0.67-0.86]) and nurses (ICC = 0.88 [0.80-0.93]). Inter-rater reliability between HCPs was also good (ICC = 0.75 [0.63-0.83]). the PFFS is a feasible and reliable tool for use with patients, caregivers and HCPs in clinical settings. Further research on the validity and responsiveness of the tool is necessary.

Decision support intervention (Plan Well Guide) for patients and their substitute decision-makers to improve engagement in advance care planning: protocol for a randomised trial

ObjectiveThe purpose of this randomised trial is to evaluate the efficacy of a decision support intervention for serious illness decisions (the Plan Well Guide decision aid; www.PlanWellguide.com) in increasing the...

Comparison of Opioid Prescribing by Dentists in the United States and England

The United States consumes most of the opioids worldwide despite representing a small portion of the world's population. Dentists are one of the most frequent US prescribers of opioids despite data suggesting that nonopioid analgesics are similarly effective for oral pain. While oral health and dentist use are generally similar between the United States and England, it is unclear how opioid prescribing by dentists varies between the 2 countries. To compare opioid prescribing by dentists in the United States and England. Cross-sectional study of prescriptions for opioids dispensed from outpatient pharmacies and health care settings between January 1 and December 31, 2016, by dentists in the United States and England. Data were analyzed from October 2018 to January 2019. Opioids prescribed by dentists. Proportion and prescribing rates of opioid prescriptions. In 2016, the proportion of prescriptions written by US dentists that were for opioids was 37 times greater than the proportion written by English dentists. In all, 22.3% of US dental prescriptions were opioids (11.4 million prescriptions) compared with 0.6% of English dental prescriptions (28 082 prescriptions) (difference, 21.7%; 95% CI, 13.8%-32.1%; P < .001). Dentists in the United States also had a higher number of opioid prescriptions per 1000 population (35.4 per 1000 US population [95% CI, 25.2-48.7 per 1000 population] vs 0.5 per 1000 England population [95% CI, 0.03-3.7 per 1000 population]) and number of opioid prescriptions per dentist (58.2 prescriptions per dentist [95% CI, 44.9-75.0 prescriptions per dentist] vs 1.2 prescriptions per dentist [95% CI, 0.2-5.6 prescriptions per dentist]). While the codeine derivative dihydrocodeine was the sole opioid prescribed by English dentists, US dentists prescribed a range of opioids containing hydrocodone (62.3%), codeine (23.2%), oxycodone (9.1%), and tramadol (4.8%). Dentists in the United States also prescribed long-acting opioids (0.06% of opioids prescribed by US dentists [6425 prescriptions]). Long-acting opioids were not prescribed by English dentists. This study found that in 2016, dentists in the United States prescribed opioids with significantly greater frequency than their English counterparts. Opioids with a high potential for abuse, such as oxycodone, were frequently prescribed by US dentists but not prescribed in England. These results illustrate how 1 source of opioids differs substantially in the United States vs England. To reduce dental opioid prescribing in the United States, dentists could adopt measures similar to those used in England, including national guidelines for treating dental pain that emphasize prescribing opioids conservatively.

Knowledge and Practice Survey on Zika Virus Infection Among General Adults in Brunei Darussalam.

A cross-sectional survey was conducted to assess the knowledge and practices on Zika virus infection among general adults in Brunei Darussalam. From February to June 2017, 439 adults were interviewed from outpatient health care settings. Most participants were Malays (87.0%) and females (61.5%), with a mean age of 40.7 years. Only 25.1% had a total knowledge score of 15 to 28 points (of a possible score of 0-28). Females and those living in households of <8 people were more likely to have higher total knowledge scores (15-28 points). Media was the preferred source to get updates. Also, 67.4% had a total prevention practice score of 19 to 36 points (of a possible score of 0-36). Those who attained secondary level education or below, had no pregnant women present in their household, and scored 15 to 28 points for knowledge were more likely to have higher prevention practice scores (19-36 points). Knowledge on Zika was significantly associated with prevention practices against mosquito bites and breeding.

Outpatient Pediatric Antibiotic Use: a Systematic Review.

The majority of pediatric antibiotic use occurs in outpatients. However, the optimal strategies for antimicrobial stewardship in this setting are unknown. We sought to identify studies relevant to pediatric outpatient stewardship that have been published in the past decade. The details of this systemic review are presented along with targets for future stewardship efforts and discussion regarding effective outpatient stewardship strategies. In 2016, the CDC released the "Core Elements of Outpatient Antibiotic Stewardship" that serve as practical guidelines to develop impactful and sustainable ASP interventions: commitment, action for policy and practice, tracking and reporting, and education and expertise. However, there has not been a recent review of the primary medical literature on pediatric outpatient stewardship. A systematic review of pediatric antibiotic control strategies published in 2007 identified 28 studies overall, 8 of which focused on outpatients. Two subsequent systematic reviews published in 2015 and 2018 intentionally excluded outpatients. Outpatient settings are a crucial component of pediatric antimicrobial stewardship in the USA. Establishing effective stewardship interventions can protect children and optimize clinical outcomes in outpatient healthcare settings. Based on our review of the literature, it is clear that the optimal outpatient stewardship strategies remain to be elucidated. However, there is robust literature describing variability in outpatient antibiotic prescribing that can be used to target interventions.

How can stroke care be improved for younger service users? A qualitative study on the unmet needs of younger adults in inpatient and outpatient stroke care in Australia

Background: The incidence of young stroke is increasing worldwide. However, young adults are inadequately supported in their recovery by a system of stroke care in which the older patient is the majority consumer.Purpose: To examine the unmet needs of younger stroke survivors in inpatient and outpatient healthcare settings and identify opportunities for improved service delivery.Materials and Methods: In-depth semi-structured interviews were undertaken with 19 participants aged 18–55 at the time of their first-ever stroke and inductively analysed using a rigorous qualitative descriptive approach.Results: Many unmet care needs were identified within three emergent themes: inadequately addressed psycho-emotional and cognitive needs after young stroke; isolation from lack of information and structured support; and failure to deliver age-relevant patient-centred care. These themes were further divided into sub-themes and the sub-themes were named in a manner to signpost the way forward for young stroke care.Conclusions: This study provides new insights into the experience of inpatient and outpatient stroke care by younger stroke survivors and outlines possible improvements for clinical practice. Future research should evaluate the effect of targeted strategies to support younger adults after stroke.Implications for rehabilitationPost-stroke rehabilitation might be improved by providing more support for the non-physical effects of stroke (e.g., psycho-emotional support, cognitive rehabilitation).Younger stroke survivors may also benefit from a long-term community care plan and longer-term rehabilitation.Patient-centered rehabilitation and education about self-management interventions appear to be important areas for further development.Future research is required to evaluate the effect of targeted strategies to support younger stroke survivors, as well as identify the needs of younger adults with post-stroke communication impairment.

Transition of dose-adjusted EPOCH therapy into the outpatient healthcare setting: Quality and cost considerations for outpatient treatment.

110 Background: Dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (EPOCH)-containing regimens are frequently utilized in lymphoma, however, outpatient EPOCH or modified inpatient/outpatient EPOCH has not been described extensively. We transitioned inpatient EPOCH to the outpatient setting and modified EPCOH to be given in the inpatient setting with rituximab outpatient to improve quality of care and access to patient assistance programs. We describe our institutional experiences with inpatient and modified EPOCH to the outpatient setting. Methods: A single-center, institutional review board-approved retrospective study was conducted for adults receiving EPOCH-based regimens. Clinical and financial data were collected by chart review for each patient. Descriptive statistics were utilized for analysis. Results: A total of 31 patients received 116 cycles of an EPOCH-containing regimen (11 [9.5%] inpatient), 54 [46.5%] outpatient, and 51 [44.0%] hybrid inpatient and outpatient). Nine outpatient cycles, 9 (17.6%) hybrid cycles and no inpatient cycles resulted in admissions for FN. Two inpatient cycles were delayed (18.2%) due to disease-related procedures and one (9.1%) was delayed due to low blood counts. Five (9.2%) outpatient cycles were delayed due to logistics (i.e. insurance delays, scheduling errors) and two (3.7%) outpatient cycles were delayed due to disease-related adverse events (bowel obstruction, chest pain). Transitioning EPOCH to the outpatient setting decreased overall costs for hospital stays on average by $19,792 per cycle with an overall approximate cost savings to the health-system of 1,114,992 dollars with 432 bed days saved. Costs savings to patients with medications assistance programs is pending final analysis. Conclusions: EPOCH-containing regimens can be safely transitioned into the outpatient setting, side effects can be monitored and outcomes optimized, to better adapt treatment strategies for individualized patient therapies. As new healthcare payment models are developed, outpatient treatments allow for adaptive financial options both for the health-system and the patient.