Outpatient Volume Research Articles

Impact of the COVID-19 pandemic on hospital-based heart failure care in New South Wales, Australia: a linked data cohort study

BackgroundHealthcare policy implemented during the COVID-19 pandemic may have impacted the health of patients with heart failure. Australian data provide a unique opportunity to examine service disruption independent of significant COVID-19 burden. This study aimed to examine heart failure care during the pandemic in New South Wales (NSW).MethodsAnalysis of hospital utilisation among patients aged ≥ 18 years with a primary diagnosis of heart failure conducted using linked administrative health records from hospital admission, emergency department, non-admitted services, and mortality data collections. Health service utilisation and outcomes were compared “Pre-pandemic” (PP): 16th March 2018 – 28th August 2019 and “During pandemic” (DP): 16th March 2020 – 28th August 2021. Mortality data were available until December 2021.ResultsHeart failure-related ED presentations and hospital admissions were similar between the periods (PP = 15,324 vs DP = 15,023 ED presentations, PP = 24,072 vs DP = 23,145 hospital admissions), though rates of admission from ED were lower DP (PP = 12,783/15,324 (83.4% [95% CI 82.8-84.0]) vs DP = 12,230/15,023 (81.4% [95% CI 80.8-82.0%]). There was no difference according to age, sex, rurality, or socioeconomic status. Outpatient volume reduced DP (PP = 44,447 vs DP = 35,801 occasions of service), but telehealth visits increased nearly threefold (PP = 5,978/44,447 (13.4% [95% CI 13.1-13.8%]) vs DP = 15,901/35,801 (44.4% [95% CI 43.9-44.9%]) with highest uptake among the wealthy and those in major cities. Time to heart failure-related ED presentation, hospitalisation or all-cause mortality following index admission was longer DP (PP = 273 [IQR 259, 290] days, DP = 323 [IQR 300, 342] days, HR 0.91 [95% CI 0.88, 0.95]).ConclusionsPolicies implemented DP had minimal impact on volumes of inpatient heart failure care in NSW hospitals, but there were fewer admissions from ED and reduced volumes of publicly funded outpatient care. A rapid shift from patient-facing to remotely delivered care enabled compliance with restrictions and was associated with increased time to heart failure-related adverse events, but access was not afforded equally across the socio-demographic spectrum.

Is outpatient joint arthroplasty safe ina high volume academic centre? A retrospective monocentric study using an institutional pathway.

Hip and knee arthroplasties are daily procedures in orthopaedic departments. Recently, same-day discharge (SDD) became increasingly popular, but doubts remain about its safety and generalization. Our hypothesis is that outpatient arthroplasty, in a high volume centre and with an institutional protocol, is an effective and reliable practice. We realized a monocentric retrospective study of patients undergoing outpatient partial (UKA) or total (TKA) knee or hip arthroplasty (THA) in a high volume academic centre using a well-defined institutional pathway. Epidemiological data and complications occurring in the month following surgery were studied. 498 patients undergoing 501 arthroplasties (219 hips and 282 knees) were examined. The percentage of men and women was 60.28% and 39.72% respectively, mean age was 64.56 ± 9.59years, mean BMI was 26.87 ± 4.2 and the most represented ASA score was 2. The success rate for same-day discharge was 97.21%. The most frequent causes of failure were urinary retention (28.6%), orthostatic hypotension (28.6%) and insufficiently controlled pain (14.3%). The readmission rate in the month following the operation was 0.8% and the rate of emergency department visits was 1.6%. Finally, the rate of early consultation visits was 7.98%. The comparison between success and failure subgroups in the outpatient setting of our cohort did not highlight statistically significant differences for studied parameters. Outpatient arthroplasty, performed in a center used to managing such operations and with a well-established institutional pre- and post-operative protocol, is a safe practice.

2020 CMS prior authorization for hospital outpatient departments: Associated surgical volume impact

BackgroundPrior authorization is common for privately administered Medicare Advantage plans but is rarely used for surgical care when considering publicly administered plans. A 2020 Centers for Medicare and Medicaid services (CMS) policy, CMS-1717-FC, requires prior authorization for Medicare Fee-for-Service beneficiaries undergoing select procedures (blepharoplasty, abdominoplasty, botulinum toxin injection, rhinoplasty, and vein ablation) in hospital outpatient departments. The impact of this policy on surgical volume at hospital outpatient departments and shifts in care to ambulatory surgery centers is unknown. MethodsThis study used a segmented interrupted time series and pre-post logistic regression model. This study was a retrospective cohort study using data from the Healthcare Cost and Utilization Project state ambulatory surgery database and state inpatient database. ResultsFrom 2016 through 2021, a total of 272,879 patients underwent the affected procedures. Pre–CMS-1717-FC, a trend of decreasing hospital outpatient department utilization was found for Medicare Fee-for-Service beneficiaries (–10.82, 95% confidence interval: –18.32 to –3.33, P = .01). In the post-implementation period, no change in the rate of decreasing hospital outpatient department utilization was found for Medicare Fee-for-Service beneficiaries (–3.45, 95% confidence interval: –36.15 to 29.25, P = .83). In the pre-policy period, Medicare Fee-for-Service beneficiaries were 46% less likely to use freestanding ambulatory surgery centers but 27% less likely to use hospital-owned ambulatory surgery centers. ConclusionCMS-1717-FC was not associated with significant changes in hospital outpatient department volume beyond baseline trends. Policy aiming to right-size prior authorization for these procedures and considering site-of-service will balance the need to ensure medical necessity while constraining costs.

Impact of the Early COVID-19 Pandemic on the Quality of Obstetric Care in a Tertiary Care Center in Karachi, Pakistan.

Objective This study aimed to assess the indirect impactof the COVID-19 pandemic on obstetric quality measures. Materials and methods This cross-sectional study was conducted at a private-sector tertiary care hospital in Karachi, Pakistan. Data were collected for specific antenatal, intrapartum, and postpartum care indicators during the initial six months of the COVID-19 phase (March to August 2020) and compared with baseline measures from the preceding six months before the COVID-19 phase (September 2019 to February 2020) using frequencies and percentages. Results During COVID-19, there was a 10% reduction (pre-COVID: 1041 and during COVID: 946)in outpatient obstetric volumes and a 65% increase(pre-COVID: 240 and during COVID: 396) in clinic cancellations, indicating a decreased influx of antenatal patients. Teleclinics served 8.3% (1429/18279) of the total obstetric patients during this period. Marginal decreases were observed in spontaneous vaginal deliveries 1358 (44%)vs 1049 (42.4%) and labor inductionrates 818 (26.6%)vs 606 (24.2%). Additionally, there was a slight increase in instrumental deliveries, 121 (3.9%) vs 114 (4.6%) during the COVID phase. However, these changes were not statistically significant. Similarly, no substantial impact was observed on elective and emergency C-sections. Notably, there were more cases of primary postpartum hemorrhage (PPH) during the COVID-19 phase 36 (1.17%) vs46 (1.86%), and these changes were statistically significant (p= 0.035). Similar trends were observed for eclampsia (p =0.05) and preeclampsia cases (p-value 0.074). However, other maternal morbidity indicators and intrauterine fetal deaths remained relatively unchanged. NICU admissions increased significantly (p=0.001), while early neonatal deaths remained unaffected. Patient satisfaction rates remained steady for inpatients and improved for outpatients during COVID-19. Conclusion The COVID-19 pandemic primarily affected antenatal volumes, neonatal admissions, and maternal morbidity indicators such as PPH, preeclampsia, and eclampsia. Despite the challenges, patient satisfaction and quality care standards were maintained during COVID-19 through new strategies and revised patient care processes.

Study on the Area of Waiting Space in the Old Area of a Tertiary Hospital Based on AnyLogic Simulation

The waiting space is the place where patients stay the longest during the entire medical treatment process, and the adequacy of its spatial area to the number of waiting patients has a significant impact on the treatment experience. Due to the continuous expansion of the medical scale and the increasing outpatient volume, congestion in the waiting areas of the old area of tertiary hospitals in Guangzhou is common, seriously reducing patients’ medical experience. Therefore, it is necessary to determine the optimal waiting area space in the old area based on the number of consultation rooms and evaluate the current situation of the waiting area to optimize the waiting area reasonably. Taking the Third Affiliated Hospital of Sun Yat-sen University as an example, this study determines the daily outpatient volume of departments under specific consultation room numbers, uses AnyLogic to simulate the medical treatment process of patients, outputs the change in the number of patients in the first waiting area. Based on the mean and peak number of waiting patients during peak hours, the study calculates the areas required for “generally adequate” and “specially adequate” waiting space respectively. These are then compared with the current area to evaluate the adequacy of the current waiting space.

Forecasting hospital outpatient volume using an optimized medical two-stage hybrid grey model

PurposeForecasting outpatient volume during a significant security crisis can provide reasonable decision-making references for hospital managers to prevent sudden outbreaks and dispatch medical resources on time. Based on the background of standard hospital operation and Coronavirus disease (COVID-19) periods, this paper constructs a hybrid grey model to forecast the outpatient volume to provide foresight decision support for hospital decision-makers.Design/methodology/approachThis paper proposes an improved hybrid grey model for two stages. In the non-COVID-19 stage, the Aquila Optimizer (AO) is selected to optimize the modeling parameters. Fourier correction is applied to revise the stochastic disturbance. In the COVID-19 stage, this model adds the COVID-19 impact factor to improve the grey model forecasting results based on the dummy variables. The cycle of the dummy variables modifies the COVID-19 factor.FindingsThis paper tests the hybrid grey model on a large Chinese hospital in Jiangsu. The fitting MAPE is 2.48%, and the RMSE is 16463.69 in the training group. The test MAPE is 1.91%, and the RMSE is 9354.93 in the test group. The results of both groups are better than those of the comparative models.Originality/valueThe two-stage hybrid grey model can solve traditional hospitals' seasonal outpatient volume forecasting and provide future policy formulation references for sudden large-scale epidemics.

Disparities in Access to Outpatient Surgery Related to Removal of Procedures from Medicare's Inpatient Only List.

We assessed the shift from inpatient to outpatient surgical care related to changes to the Inpatient Only List in 2020 and 2021 compared to 2019. The extent to which procedures shift from the inpatient to outpatient setting following removal from Medicare's Inpatient Only List is unknown. Many health systems also encouraged a shift from inpatient to outpatient surgery during the COVID-19 pandemic. Assessing the relative change in outpatient surgical utilization for procedures removed from the Inpatient Only List during COVID-19 would provide empirical data on whether reimbursement policy changes or inpatient capacity needs during the pandemic were more likely to shift care from the inpatient to outpatient setting. We used administrative data from the PINC AI Healthcare Database across 723 hospitals to determine the within-facility relative change in outpatient vs inpatient procedural volume in 2020 and 2021 compared to 2019 using a multivariable conditional fixed-effects Poisson regression model. We also assessed whether outpatient surgical utilization varied by race and ethnicity. Using a multivariable linear probability model, we assessed the absolute change in risk-adjusted 30-day complication, readmission, and mortality rates for inpatient and outpatient surgical procedures. In 2020 and 2021 compared to 2019 respectively, there was a 5.3% (95% CI, 1.4% to 9.5%) and 41.3% (95% CI 33.1% to 50.0%) relative increase in outpatient elective procedural volume. Outpatient procedural volume increased most significantly for hip replacement which was removed from the Inpatient Only List in 2020 (increase in outpatient surgical utilization of 589.3% (95% CI, 524.9% to 660.3%)). The shift to outpatient hip replacement procedures was concentrated among White patients; in 2021, hip replacement procedural volume increased by 271.1% (95% CI, 241.2% and 303.7%) for White patients and 29.5% (95% CI, 24.4% and 34.9%) for Black patients compared to 2019 levels. There were no consistent or large changes in 30-day complication, readmission, or mortality risk in 2020 and 2021 compared to 2019. There was a modest increase in elective outpatient surgeries and a pronounced increase in outpatient orthopedic surgeries which were removed from the Inpatient Only List during the COVID-19 pandemic. Utilization of outpatient surgical procedures was concentrated among White patients.

Apheresis practice variation during the COVID-19 pandemic: Results of a survey.

The COVID-19 pandemic affected healthcare delivery across all specialties including apheresis. To describe the changes in apheresis service practices that occurred during the pandemic, the American Society for Apheresis (ASFA) Apheresis Medicine Attending Physician Subcommittee conducted a survey study. A 32-question survey was designed and distributed to 400 ASFA physician members on September 7, 2022. Attending physicians responded to questions about whether and how apheresis service practices changed during the COVID-19 pandemic compared with the time period prior to the pandemic in terms of: (1) procedure types and volumes, (2) patient consultation workflow, and (3) the use of telemedicine. Descriptive analyses were reported as number and frequency of responses. The survey response rate was 13.8% (55/400). Of these respondents, 96.4% (53/55) were attending physicians. The majority of respondents (42/53, 79.2%) indicated that the types of procedures performed during COVID-19 compared to pre-pandemic did not change. Most frequently for apheresis procedure volume, respondents reported: no change in their monthly inpatient volume (21/47, 44.7%) and a decrease in their monthly outpatient volume (28/46, 60.9%). Prior to COVID-19, 75.0% (30/40) of respondents performed consultations at bedside for inpatients and 67.4% (29/43) performed consultations at bedside for outpatients. Bedside consultations decreased in both settings during the pandemic but were still most frequently performed by attending physicians. At the same time, the use of telemedicine increased for 15.4% of survey respondents during COVID-19. Some, but not all, respondents observed or made changes to their apheresis service during the COVID-19 pandemic. A subset of changes, such as increased utilization of telemedicine, may persist.

Hospital Management Practice of Combined Prediction Method Based on Neural Network

In this article, the outpatient volume, hospitalization income and drug demand in hospital management are taken as the research objects, and a neural network combined prediction model is established to predict the outpatient volume with the fitting prediction results of cubic polynomial regression model and grey model as the input of the network and the actual statistical outpatient volume as the output. Lasso variable selection method is used to determine the main indexes affecting the income of inpatients in hospital, and a prediction model combining grey prediction and artificial neural network is established to predict the income of inpatients in hospital. By studying the key characteristics of hospital drug demand, BP neural network, RBF neural network and GRNN generalized regression neural network are selected to predict the drug demand. By solving the quadratic programming problem and according to the weight rules, a combination forecasting model based on neural network is established to predict the drug demand, and the accuracy and stability of the model are evaluated.

Adoption of a gastroenterology hospitalist model and the impact on inpatient endoscopic practice volume: a controlled interrupted time-series analysis

Background and AimsThe gastroenterology (GI) hospitalist staffing model has multiple potential benefits for the inpatient and outpatient care of GI patients. The GI hospitalist model may improve inpatient endoscopy efficiency via better provider familiarity with management of GI emergencies, hospital systems and workflow, and may also increase outpatient endoscopy capacity by decreasing the need for inpatient coverage by outpatient providers. However, the real-world impact of this model on inpatient and outpatient endoscopic volume remains uncertain. MethodsWe conducted a controlled interrupted time series analysis from September 2018 to March 2020 comparing inpatient endoscopy volume at two high-acuity hospitals within the same academic health system, one of which adopted a two-physician GI hospitalist model in July 2019. We also performed a single interrupted time series analysis of outpatient endoscopic volume of the practice employing GI hospitalists. ResultsAfter implementation of the GI hospitalist model, weekly volume of inpatient endoscopic procedures increased by 10.9 (95% CI: [0.6, 21.2]; p=0.024) compared to a hospital using traditional staffing. Outpatient endoscopic procedure volume also increased by 39.8 per week (95% CI: [-5.78, 85.44]; p=0.09), with no change in the number of physicians performing endoscopy. ConclusionsOur findings demonstrate that introduction of a GI hospitalist model increased inpatient and outpatient endoscopic volume in a large academic center.

Validation of phenomenon and cross-sectional investigation of predictors for a post-COVID-19 surge of osteoporosis outpatients in China

An unexpected surge of osteoporosis outpatients occurred after COVID-19 lockdown was lifted in China. To confirm the observation and identify possible reasons driving patients care seeking behaviors post-pandemic, we compared the outpatient volumes at the osteoporosis clinic in January through May, 2019–2022 and surveyed seven osteoporosis specialists across China to validate the phenomenon before devising an online questionnaire to collect patients’ characters and physical activity levels. Univariate and binary logistic regression analyses were calculated to identify predictors of post-lockdown care-seeking. We received 480 valid responses, including 397 (82.7%) patients having visited the clinic after lockdown and 83 (17.3%) having not. Four significant predictors were identified, including being female, experiencing pain, aggravating symptoms, and heightened anxiety during lockdown (P < 0.05). Both groups experienced lower physical activity levels during lockdown, which however was not a significant predictor (P = 0.317). The surge in osteoporosis outpatient visits after COVID-19 lockdown suggests vast latent demand for osteoporosis care accumulated during the pandemic. Four significant factors predict post-lockdown outpatient care-seeking, including being female, experiencing pain and aggravating symptoms, and heightened anxiety levels. Though physical activity levels decreased during lockdown, it failed to predict care-seeking. This demonstrates resilience of osteoporosis patients to resume regular care despite disruption and stress the substantial backlog of unmet healthcare needs.

Impact of COVID-19 Pandemic on Utilization of Healthcare Services and Spending Patterns in Dubai, United Arab Emirates: A Cross-Sectional Study.

The COVID-19 pandemic affected the utilization of healthcare services in many parts of the world. The response to the healthcare burden imposed by the COVID-19 pandemic was associated with ensuring the provision of optimum healthcare services. This study aimed to estimate the effect of the COVID-19 pandemic on health services utilization and spending patterns in Dubai, the UAE. This cross-sectional study used secondary data on healthcare utilization and spending to compare between 2019 and 2020. The data was extracted from the health insurance claims on the eClaimLink platform. Descriptive and inferential statistics were used to calculate the percent change of service utilization and spending and percentages of total claims by each encounter type across major diagnostic categories (MDCs). In 2020, there was an overall reduction in outpatient visits and inpatient admissions of 27% and 21%, respectively, compared to 2019. Outpatient visits and prescriptions decreased across all the MDCs except mental and behavioral disorders, which showed an increase of 8% in outpatient visits and 29% in prescriptions. The admissions to the healthcare facilities were also reduced significantly across various MDCs, ranging from 10% to 44%. Similarly, a downward trend was seen in diagnostics for different MDCs. An increase in expenditure on diagnostics and drugs for neoplasm was reported, despite a corresponding decrease in outpatient and inpatient admissions for the same. A significant decrease in overall healthcare utilization and corresponding healthcare spending, resulting from a decline in outpatient and inpatient volume in healthcare facilities at all the levels (hospitals, clinics, speciality centres), was reported during the pandemic. The impact of the pandemic on mental health was reported by this study, as it showed an upward trend in utilization and spending. For the neoplasms, although the utilization declined, the expenditure on diagnostics and drugs during each encounter increased significantly.

Outpatient Total Hip Arthroplasty Volume up Nearly 8-Fold After Regulatory Changes With Expanding Demographics and Unchanging Outcomes: A 10-Year Analysis

BackgroundWith the removal of total hip arthroplasty (THA) from the inpatient-only (IPO) lists, the orthopedic landscape across the United States has changed rapidly. Thus, this study aimed to: 1) characterize the change in THA volume for outpatient and inpatient surgeries; 2) elucidate demographical differences before and after removal from the IPO list; and 3) analyze 30-day complications, readmissions, and reoperations. MethodsThe National Surgical Quality Improvement Program database was queried for primary THAs between January 2010 and December 2021. The primary outcome was the annual volume of outpatient and inpatient THAs. Secondary outcomes involved 30-day complications, readmissions, and reoperations. The variables between cohorts were analyzed using goodness-of-fit Chi-square tests with summary statistics. ResultsOf the 332,423 THAs between 2010 and 2021, 88% were inpatient THAs (n = 292,974) and 12% were outpatient THAs (n = 39,449). From 2019 to 2021, the volume of inpatient THA decreased by 55% (42,779 to 19,075), while outpatient THA increased by 751% (2,518 to 21,424). Patients who had a THA after 2019 were older (P < .001), more commonly women (P < .001), white (P < .001), and more likely American Society of Anesthesiologists Class III (P < .001). The outpatient cohort had fewer 30-day complications, readmissions, and reoperations. The length of stay for both cohorts decreased until 2019, before increasing in 2020 and 2021 for inpatient THAs, while home discharge and operative time increased for both. ConclusionsThe volume of outpatient THA increased almost eightfold after its removal from the IPO lists in 2020. Despite expanding eligibility with older patients and more comorbidities, 30-day complications, readmissions, and reoperations remain low. These findings support the safe transition to outpatient THA with appropriate patient selection and optimization.

Total Hip and Total Knee Arthroplasty Outpatient Case Volume During the 2020 COVID-19 Pandemic in New York and California

BackgroundInpatient total hip and total knee arthroplasty were substantially impacted by the SARS-CoV-2 (COVID-19) pandemic. We sought to characterize the transition of total joint arthroplasty (TJA) to the outpatient setting in 2 large state health systems during this pandemic. MethodsAdult patients who underwent primary elective TJA between January 1, 2016 and December 31, 2020 were retrospectively reviewed using the New York Statewide Planning and Research Cooperative System and California Department of Health Care Access and Information datasets. Yearly inpatient and outpatient case volumes and patient demographics, including age, sex, race, and payer coverage, were recorded. Continuous and categorical variables were compared using descriptive statistics. Significance was set at P < .05. ResultsIn New York during 2020, TJA volume decreased 16% because 22,742 fewer inpatient TJAs were performed. Much of this lost volume (46.6%) was offset by a 166% increase in outpatient TJA. In California during 2020, TJA volume decreased 20% because 34,114 fewer inpatient TJAs were performed. Much of this lost volume (37%) was offset by a 47% increase in outpatient TJA. ConclusionsThis present study demonstrates a marked increase in the proportion of TJA being performed on an outpatient basis in both California and New York. In both states, despite a decrease in overall TJA volume in 2020, outpatient TJA volume increased markedly. Level of EvidenceTherapeutic Level IV, Retrospective Cohort Study.

The Effects of the Multi-Hospital Global Budget Payment on Medical Expenditure and Service Volume: The Evidence from Dangyang County, China.

Global budget payment is currently the prevailing payment strategy internationally. In China, the concept of multi-hospital global budget payment has been proposed with the aims of achieving cost control effects while also encouraging hospital collaboration and optimising allocation of healthcare resources. This study seeks to analyse the impact of multi-hospital global budget payment in China on healthcare expenditure and service volume. A retrospective comparative study was carried out in Dangyang County, China. The exposure cases were migrants who were not locally registered in the residence registration system. The study period encompassed January 1, 2017, to December 31, 2019. Including 3,246,164 outpatient medical records and 242,685 inpatient medical records. The key variables are medical expenditure and service volume indicators. Continuous variables were reported as mean and tested by t-test. We used interrupted time series analysis models to estimate the changes in the level and trend of each outcome measure after the policy. After the outpatient global budget payment reform, the monthly medical expenditure of the hospital alliance has transitioned from a discernible upward trajectory to a deceleration in the rate of growth. The outpatient volume in public and private high-level hospitals decreased at a rate of -419.26 person/month and -137.04 person/month, respectively. In terms of inpatient service volume, only private high-level hospitals reported a decrease, with a reduction rate of -15.38 individuals per month. This study presents new evidence demonstrating that the multi-hospital global budget payment can effectively control costs and promote resource reallocation when implemented jointly with hospital alliance policies. However, overly lenient budget caps risk counterproductive effects.

Estimate of Increase in Colorectal Cancer Diagnoses with Expansion of Fecal Immunochemical Testing in an Urban Safety-Net Population.

Fecal immunochemical test (FIT) is less effective in detecting advanced adenomas (AA) than colonoscopy. Increase in FIT for colorectal cancer (CRC) screening may lead to an increased number of undetected AAs which may develop into future CRCs. We determined the potential impact of FIT expansion on missed AAs and future CRC diagnoses in an urban, tertiary-care, safety-net hospital. CRC and AA diagnoses were identified in patients undergoing colonoscopy for average-risk CRC screening or positive FIT between 2017 and 2019 at Boston Medical Center. Poisson regression modeling was used to estimate the frequency of AAs per year by age group using data from 2017 to 2019, assuming average outpatient volume and proportion of screening colonoscopies. Total number of patients who received FIT was extrapolated from those who underwent colonoscopy for positive FIT. We estimated AAs per year if 'one-time' FIT was used for screening in 75% and 100% of the population and subtracted this from the estimated AAs per year under the Poisson model to determine missed AAs. We used previously described, age and gender specific estimates of the annual progression of AA to CRC. The estimated number of CRCs detected per year is 4.6/1785 males and 4.6/2086 females screened. With 75% FIT expansion, we estimate an additional 3.5 (95% CI 1.3, 9.5) and 2.2 (95% CI 0.64, 7.6) CRCs; with 100% FIT expansion, we estimate an additional 7.4 (95% CI 3.7, 14.9) and 4.2 (95% CI 1.7, 10.5) CRCs, in 5years, in males and females, respectively. Expansion of FIT may substantially increase CRC incidence.

Recycling Opportunities in a High Volume Academic Clinical Chemistry Laboratory

Abstract Many sectors of industry, including the biomedical sector, have quantified waste, and created sustainability strategies to mitigate its environmental impact. One of these strategies utilizes the waste hierarchy, a model which ranks the concepts reduce, re-use and recycle in order of the most to least sustainable practice. However, to date, the clinical laboratory has seldom been evaluated for total waste production and mitigation strategies and additional public reporting of the physical amount of waste produced in these areas are lacking in the literature. In this study, we aimed to identify specific wastes produced from performing the CMP over the course of a year in our automated clinical chemistry laboratory and what proportion would be recyclable. The total in- and outpatient testing volumes as well as volumes of quality control and calibrations needed to perform the CMP at our institution were collected retrospectively from 07/14/2021 - 07/14/2022. We further identified disposables waste items such as calibrator kits, quality control kits, patient blood specimen tubes, shipping packaging and reagent wedge kits that are necessary to perform the CMP. In addition, to obtain a conservative and consistent evaluation to the total amount of waste produced from the CMP, the average weights for components of the reagent test wedge kits which includes plastic wedges, cardboard shipping boxes, and paper package inserts were calculated. These weights in conjunction with total testing volumes was used to determine the total, recyclable, and non-recyclable waste produced from these disposable items. A total of 1089.2 kg of reagent kit wastes were estimated to be produced by performing the CMP over the course of a year. Of this waste, cardboard shipping boxes and paper package inserts were determined to be recyclable (233.6 kg) and the plastic reagent wedges were determined to be non-recyclable (855.5 kg) as they were not labelled with the universally recognized recycling code, were composed of proprietary plastic material, and contained biohazardous contaminants. Overall, 21.4 % of the total specific waste weight was found to be recyclable. The CMP is a small subset of the clinical chemistry test menu that produces a considerable amount of recyclable and non-recyclable waste.

Panel Interview of Oncology Practices with Emergent Experience of Teclistamab in the Real World: The Tec-Pioneer Study

Background Teclistamab was recently approved as the first-in-class B-cell maturation antigen (BCMA) x CD3 bispecific therapy with personalized weight-based dosing for relapsed or refractory multiple myeloma (MM). Given its novelty, there are immediate needs for data based on real-world (RW) practices to optimize operational processes and improve experiences while ensuring patient safety in the RW. The aims of this study were to describe how US clinicians with early RW experience with teclistamab (1) manage the step-up dosing (SUD) and transition of care (ToC) to and from referring sites; (2) monitor, manage, and prevent adverse events (AEs), i.e., cytokine release syndrome (CRS), infections, and immune effector cell-associated neurotoxicity syndrome (ICANS); and (3) perceive desired future care models for optimal patient care. Methods Between April and July 2023, 60-minute, 1-on-1 in-depth structured interviews were conducted virtually with hematologists and oncologists who had treated patients with teclistamab in a RW setting. Interviews elicited clinicians' current SUD and ToC processes in their practices, AE management, and perspectives on SUD model evolution. A subsequent 90-minute roundtable discussion was held in June 2023 to discuss interview findings. Results A total of 20 clinicians representing 19 practices across 14 states completed interviews: 84% (16/19 practices) treated &amp;gt;50 patients with MM monthly, 69% had treated &amp;gt;10 patients with teclistamab, and 90% were academic medical centers. Of these interviewees, 10 participated in the roundtable discussion, joined by 3 community clinicians without teclistamab experience. Among the 19 interviewed practices, 14 (74%) were administering SUD exclusively in inpatient settings. This was being done predominantly (86%; 12/14) in 1 continuous admission with a planned length of stay of 7 days, and with 71% (10/14) following a day 1-3-5 dosing schedule. Five practices reported using outpatient models (Figure 1). The sophistication of outpatient models varied and depended on multiple factors at the practice level, including prior outpatient cellular therapy experience, staffing/facility structure, patient volume, and outpatient monitoring capability. Most (95%) of the interviewed practices initiated teclistamab for patients referred from community practices; 53% transferred at least 1 patient back to a referring practice to continue teclistamab. The time to transfer ranged from 2 weeks to 2 months to (1) ensure that patients were responding to and tolerating treatment prior to transfer and (2) recover any financial loss from inpatient SUD. Community clinicians preferred to resume care of their patients once patients were deemed clinically stable. More than half (68%) of practices reported leveraging existing CAR-T protocols for AE monitoring and management. Patients were typically monitored for CRS every 4 hours for vital signs and daily for complete blood count, comprehensive metabolic panel, C-reactive protein, and ferritin. CRS prophylaxis with tocilizumab was reported by 11% of practices. 74% (14/19) of practices used tocilizumab for treatment of grade 2 or higher CRS. 94% (17/18) of reporting practices utilized intravenous immunoglobulin for primary infection prophylaxis, typically at a dose of 0.4 g/kg every 4-8 weeks to maintain an IgG level above 400 mg/dL. ICANS risk was considered low, and corticosteroids were the preferred treatment for ICANS. Payer reimbursement, treatment availability and lack of approved indications were noted as barriers for certain prophylactic treatments. Clinicians indicated a desire to administer SUD in an outpatient setting for patient convenience and to reduce healthcare resource use. Comorbidities, tumor burden, and caregiver support were key patient-level factors to be considered for outpatient SUD. Remote patient monitoring was a potential solution to enhance the outpatient SUD administration. Conclusions The results indicated diverse RW administration and patient management strategies in practices with early familiarity with teclistamab, and consolidated practice-based experiences to help inform clinicians employing this innovative therapy. As patient care models evolve, outpatient or community-based SUD may become more common in the future. Ongoing evidence generation on RW treatment outcomes of various SUD models and AE management strategies is warranted.

The global impact of the COVID-19 pandemic on pediatric spinal care: A multi-centric study.

The COVID-19 pandemic has affected healthcare worldwide since December 2019. We aimed to identify the effect of the COVID-19 pandemic on outpatient clinic and surgical volumes and peri-operative complications for pediatric spinal deformities patients. In this multi-center retrospective study, outpatient visits (in-person and virtual care) and pediatric spine surgeries volumes in four high-volume pediatric spine centers were compared between March and December 2019 and the same period in 2020. Peri-operative complications were collected and compared in the same periods. Descriptive statistics were calculated, and comparative analyses were performed. During the 2020 study period, the outpatient visit (in-person and virtual care) volume decreased during local lockdown periods by 71% for new patients (p < 0.001) and 53% for returning patients (p = 0.03). Overall, for 2020, there was a 20% reduction in new patients (p = 0.001) and 21% decrease in returning patients (p < 0.001). During the pandemic, there was also 20% less overall surgical volume of adolescent idiopathic scoliosis (AIS) patients undergoing primary posterior spinal fusion, with a 70% reduction during lockdown times (p < 0.001). Complication rate and profile were similar between periods. There was a significant decrease in outpatient pediatric spine outpatient visits, particularly new patients, which may increase the proportion of pediatric patients with spinal deformities that present late, meeting surgical indication. This, in combination with the reduction in surgical volume of AIS over the first year of the pandemic, could result in an extended waitlist for surgeries during years to come. Complication rate was similar for both periods, suggesting it is safe to continue elective pediatric spine surgery even in a time of a pandemic. level IV.

Total Knee Arthroplasty During the COVID-19 Pandemic: Rapid Return to Baseline Volume and Continuation of Trend Toward Outpatient Surgery

Background: COVID-19 was a major disruptor in the United States throughput of total knee arthroplasty (TKA). After elective surgery resumed following initial suspensions, restrictions waxed and waned as COVID-19 waves peaked and ebbed. The specific impact of the pandemic on overall and outpatient TKA volume has not been fully studied. Purpose: Thus, this study aimed to observe how TKA volume and that proportion performed on an outpatient basis evolved through the pandemic. Methods: The PearlDiver database was utilized to identify patients undergoing elective TKA, from January 2018 to April 2021. Descriptive analysis was utilized to report the monthly changes in elective TKA volume and the proportion performed in the outpatient setting. A linear forecast analysis using historical data was utilized to determine the expected volume and proportion performed outpatient during the pandemic. This was compared to the observed case volume and setting. Results: Within 3 months following suspension of elective TKA, the total volume had returned to what was expected (Actual: 15,692; Expected: 15,586 (95% CI: 13,345-17,738). During the third peak of the pandemic, volume decreased but returned to projections within 2 months (Actual: 16,227; Expected: 17,181 (95% CI: 14,540-19,823). The pandemic did not cause the proportion of outpatient cases to differ from pre-pandemic predictions. Conclusion: In this nationwide analysis, the pandemic was not shown to have a lasting effect on TKA volume. The shift toward outpatient TKA during the pandemic seems likely to have represented a transition which had already begun prior to March 2020.