Patient Travel Time Research Articles

Effectiveness of a Community-Based Ostomy Nursing Technique to Enhance the Delivery of Patient Care and Quality of Life

ABSTRACT This study aimed to develop and validate a community-based ostomy care training program for nursing staff, with the goal of enhancing their ostomy nursing competencies and improving patient satisfaction. Between March 2021 and October 2021, 20 registered nurses and 50 patients with enterostomy surgery who took part in the promotion of a new nursing technique in five community health service centers in the Wuxing District, Huzhou City, were enrolled in this study (forming the intervention group). In addition, 15 registered nurses and 40 patients with enterostomy surgery from four community health service centers with similar economic and health conditions in the same area were randomly selected as the control group. All community health service centers were independent institutions. The indexes before and after the promotion of the technique were compared, and the effectiveness of the training was evaluated by observing the improvement in nursing skills and changes in patient quality of life after the training. The “quality-of-life scale” was used to analyze the quality of life of patients who had undergone colostomy surgery. The new approach to ostomy care delivered in a community setting was found to improve staff knowledge and skill in ostomy care (p < 0.001), improve the quality-of-life scores of patients and reduce patient travel time and medical expenses. The promotion of ostomy nursing techniques in community health service centers has several benefits. It improves the ostomy nursing skill levels of community medical staff. This reduces the occurrence of ostomy complications. Additionally, it establishes an effective connection between tertiary hospitals and community health service centers. This connection is conducive to better nursing care for patients who have undergone ostomy surgery. The hospital – community – family nursing model can improve self-management abilities and reduce the incidence of complications of enterostomies.

Bridging distances and saving costs: insights from a pilot project of telerheumatology in a rural area of Pakistan.

Enhancing access to healthcare remains a formidable challenge in rural regions of low- and lower-middle-income countries. Amid evolving healthcare challenges, telerheumatology provides opportunities to bridge gaps and expand access to rheumatology care, particularly in remote areas. We describe a pilot telerheumatology program and its cost-, time-, and travel-saving potential in a remote rural setting in northern Pakistan. The telerheumatology program commenced at the Pakistan Institute of Medical Sciences Islamabad, providing services through video consultations to a basic health unit in the Gilgit-Baltistan region. Patients visiting from the Gilgit-Baltistan region willing to participate were recruited in the program. Demographics and logistical metrics were recorded in a dedicated registry. A total of 533 consultations were carried out from April 2022 to April 2023. The majority of the patients were female (318/533, 59.7%). The median age of patients was 50 ± 15.7 years. The average wait time for consultation was 20 ± 13 min. The average travel time to reach telecentre was 59 ± 53 min. The average travel cost to reach telecentre was 379 ± 780 PKR (1.85 ± 3.81 USD). The average duration of consultation was 15 ± 5 min. The most common diagnosis for consultation was knee osteoarthritis (237, 44.5%), chronic low back pain (118, 22.1%), and rheumatoid arthritis (42, 7.9%). On average, patients saved 787 ± 29 km of distance, 15 ± 1 h of traveling, and 6702 ± 535 PKR (33 ± 3 USD) that would have been required to travel to our tertiary care hospital. Telerheumatology substantially reduced travel time, distance, and cost for patients. It has the potential to deliver outpatient rheumatology consultation in an economically efficient manner, effectively breaking geographical barriers and expanding access to essential services for patients in remote areas.

Plastic Surgery Outreach Clinics Expand Access to Cleft and Craniofacial Care in Mississippi

Abstract Accessing treatment at ACPA (American Cleft Palate-Craniofacial Association)–approved centers is challenging for individuals in rural communities. This study aims to assess how pediatric plastic surgery outreach clinics impact access for patients with orofacial cleft and craniosynostosis in Mississippi. An isochrone map was used to determine mean travel times from Mississippi counties to the sole pediatric hospital and the only ACPA-approved team in the state. This analysis was done before and after the establishment of two outreach clinics to assess differences in travel times and cost of travel to specialized plastic surgery care. Two sample t-tests were used for analysis. The addition of outreach clinics in North and South Mississippi led to a significant reduction in mean travel times for patients with cleft and craniofacial diagnoses across the state's counties (1.81 hours vs 1.46 hours, P &lt; 0.001). Noteworthy travel cost savings were observed after the introduction of outreach clinics when considering both the pandemic gas prices ($15.27 vs $9.80, P &lt; 0.001) and post-pandemic prices ($36.52 vs $23.43, P &lt; 0.001). The addition of outreach clinics in Mississippi has expanded access to specialized healthcare for patients with cleft and craniofacial differences resulting in reduced travel time and cost savings for these patients. Establishing specialty outreach clinics in other rural states across the United States may contribute significantly to reducing burden of care for patients with clefts and craniofacial differences. Future studies can further investigate whether the inclusion of outreach clinics improves follow-up rates and surgical outcomes for these patients.

Understanding Washington State’s Low Uptake of Lung Cancer Screening in Two Steps: A Geospatial Analysis of Patient Travel Time and Health Care Availability of Imaging Sites

BackgroundEarly detection of lung cancer reduces cancer mortality; yet uptake for lung cancer screening (LCS) has been limited in Washington State. Geographic disparities contribute to low uptake, but do not wholly explain gaps in access for underserved populations. Other factors, such as an adequate workforce to meet population demand and the capacity of accredited screening facility sites must also be considered. Research QuestionWhat proportion of the eligible population for LCS have access to LCS facilities in Washington State? Study Design and MethodsWe used the enhanced two-step floating catchment (E2SFCA) model to evaluate how geographic accessibility in addition to availability of LCS imaging centers contribute to disparities. We used available data on radiologic technologist volume at each American College of Radiology (ACR) accredited screening facility site to estimate each site’s capacity to meet potential population demand. Spearman rank correlation coefficients of the spatial access ratios (SPARs) were compared with the 2010 Rural-Urban Commuting Area (RUCA) codes and Area Deprivation Index (ADI) quintiles to identify characteristics of populations at risk for lung cancer with greater and lesser levels of access. ResultsA total of 549 radiologic technologists were identified across the 95 ACR accredited screening facilities. We observed that 95% of the eligible population had proximate geographic access to any ACR facility. However, when we incorporated the E2SFCA method, we found significant variation of access for eligible populations. The inclusion of the availability measure attenuated access for most of the eligible population. Furthermore, we observed that rural areas were substantially correlated and areas with greater socioeconomic disadvantage were modestly correlated with lower access. InterpretationRural and socioeconomically disadvantaged areas face significant disparities. The E2SFCA models demonstrated that capacity is an important component and how geographic access and availability jointly contribute to disparities in access to LCS.

Healthcare Laboratories: a venture to ramp up health of rural India

Learning outcomes The learning objectives have been prepared following Bloom’s taxonomy (Bloom et al., 1956). After completing the case study, the students will be able to identify and recall the prerequisites necessary for establishing a pathology laboratory. (knowledge); analyze the micro- and macroenvironmental factors considered by Mr Sabihul Haque in the development of the strategic plan for Healthcare Laboratories (HCL) (knowledge and application); explain the key components of the Porter’s value chain and their significance in the operation of HCL (comprehension and evaluation); use the TOWS analysis to map the internal strengths, weaknesses, opportunities and threats of HCL (application and synthesis); and analyze the challenges faced by protagonist in managing HCL and generate suggestions for addressing the challenges (analysis and synthesis). Case overview/synopsis HCL, an enterprise established in 2018 in Sahdeo Khap, Gaya, Bihar, India, aims to provide high-quality pathological diagnostic services in semi-urban and rural areas. This health-care initiative is pioneering, offering pathology services to make high-quality, low-cost diagnostic services accessible in rural India. In rural settings, numerous health-care hurdles make it challenging for individuals to access the care they need. Since its inception, HCL has expanded its reach to connect more areas, facilitating diagnostic services for people in remote regions. The establishment of laboratories in semi-urban areas aims to reduce patient travel time, costs and health risks by bringing services directly to their doorstep. Haque, the chief executive officer of the lab, grappled with multiple challenges, including selecting an appropriate location for the lab, recruiting and retaining skilled workforce, managing logistics supply, collaborating with local health-care providers, dispelling the stigma among the population that superior services are only available in cities and enhancing health literacy in rural communities. Following numerous meetings with Ms Ummati Naiyyer, head of operations, they worked collaboratively to address these challenges, developing a blueprint and future plan to operate services in rural areas. This case study provides insights into the obstacles faced by HCL striving for success in rural areas. It elucidates the beneficial application of the Porter’s value chain, along with an analysis of macro- and microenvironmental factors. Unique challenges such as societal stigma and mistrust are specifically emphasized. Students engaging with this case study will enhance their problem-solving skills through brainstorming and providing recommendations, contributing to potential solutions for HCL’s difficulties. Complexity academic level The teaching notes for the HCL case is designed to enhance the learning experience of undergraduate and graduate students within the context of the course. This case study serves as a valuable teaching tool, allowing students to apply theoretical knowledge to real-world scenarios in the health-care industry. The notes provide a framework for instructors to facilitate discussions, encourage critical thinking and promote a deeper understanding of key concepts related to establishing diagnostic laboratories in rural areas. Supplementary materials Teaching notes are available for educators only. Subject code CSS3: Entrepreneurship.

Characterizing the Traveling Oncology Workforce and Its Influence on Patient Travel Burden: A Claims-Based Approach.

Oncology outreach is a common strategy for extending cancer care to rural patients. However, a nationwide characterization of the traveling workforce that enables this outreach is lacking, and the extent to which outreach reduces travel burden for rural patients is unknown. This cross-sectional study analyzed a rural (nonurban) subset of a 100% fee-for-service sample of 355,139 Medicare beneficiaries with incident breast, colorectal, and lung cancers. Surgical, medical, and radiation oncologists were linked to patients using Part B claims, and traveling oncologists were identified by observing hospital service area (HSA) transition patterns. We defined oncology outreach as the provision of cancer care by a traveling oncologist outside of their primary HSA. We used hierarchical gamma regression models to examine the separate associations between patient receipt of oncology outreach and one-way patient travel times to chemotherapy, radiotherapy, and surgery. On average, 9,935 of 39,960 oncologists conducted annual outreach, where 57.8% traveled with low frequency (0-1 outreach visits/mo), 21.1% with medium frequency (1-3 outreach visits/mo), and 21.1% with high frequency (>3 outreach visits/mo). Oncologists provided surgery, radiotherapy, and chemotherapy to 51,715, 27,120, and 5,874 rural beneficiaries, respectively, of whom 2.5%, 6.9%, and 3.6% received oncology outreach. Rural patients who received oncology outreach traveled 16% (95% CI, 11 to 21) and 11% (95% CI, 9 to 13) less minutes to chemotherapy and radiotherapy than those who did not receive oncology outreach, corresponding to expected one-way savings of 15.9 (95% CI, 15.5 to 16.4) and 11.9 (95% CI, 11.7 to 12.2) minutes, respectively. Our study introduces a novel claims-based approach for tracking the nationwide traveling oncology workforce and supports oncology outreach as an effective means for improving rural access to cancer care.

Modelling the impact of sublingual immunotherapy versus subcutaneous immunotherapy on patient travel time and CO2 emissions in Sweden

In Sweden, allergy immunotherapy (AIT) is available as either subcutaneous immunotherapy (SCIT) injections or sublingual immunotherapy (SLIT) tablets and is used to treat moderate-severe allergic rhinitis (AR). This study sought to determine treatment-related CO2 emissions and travel times in Swedish patients receiving either SCIT or SLIT-tablets. A list of specialized Swedish AR clinics that administer AIT was determined, and respective co-ordinates retrieved. Swedish municipality population data were obtained from a national database. The mean distance from each Swedish municipality to the nearest AR clinic was calculated, adjusted using a detour index, and weighted by estimated patient population size. Transport modality data were obtained from a Swedish urban transport study and CO2 emissions were obtained from Government sources. The mean number of annual SLIT-tablets and SCIT doses required were calculated based on product labels and clinical expert input. The annual number of healthcare professional interactions were layered into the model to estimate changes in mean patient travel time, distance, and travel-related CO2 emissions associated with using SCIT versus SLIT-tablets. Mean annual travel-related CO2 emissions were 410 tonnes (to two significant figures [s.f.]; standard deviation [SD] 90) with SLIT-tablets, versus 1700 tonnes (SD 380) for SCIT, resulting in mean annual savings of approximately 1300 tonnes (SD 290) of CO2 if all AIT patients were to receive SLIT-tablets instead of SCIT, over 380 times greater than 2021 average Swedish CO2 emissions per capita. Approximate mean annual travel times for patients taking SLIT-tablets were 66,500 h (three s.f.; SD 14,400), and 278,000 h (SD 60,200) for SCIT, resulting in mean annual savings of 211,000 h (SD 45,800) if all AIT patients were to receive SLIT-tablets instead of SCIT. Compared with SCIT injections, SLIT-tablets led to substantial reductions in treatment-related CO2 emissions and travel times for Swedish patients.

The Impact of Travel Time on Trimodal Therapy Compared to Cystectomy for Bladder Cancer.

Neoadjuvant chemotherapy followed by radical cystectomy (RC) and Transurethral Resection of Bladder Tumor (TURBT) followed by concurrent chemoradiation therapy (trimodal therapy, TMT) are both evidence-based approaches to the management of muscle-invasive bladder cancer, and no randomized evidence conclusively supports the use of one treatment over another. Literature suggests that increasing distance to radiation therapy (RT) facilities reduces the likelihood that patients will receive RT, though this has not been evaluated in bladder cancer. We hypothesize that greater travel time between a patient's home and their closest RT facility is associated with a lower likelihood of undergoing TMT. Clinical data and the locations of patient residences and surgical facilities performing RC were obtained from the California Cancer Registry. RT facility locations were compiled from state regulatory databases and dosimetric accrediting bodies. Travel time was identified using the Google Distance Matrix API. California patients diagnosed with T2-4N0 bladder cancer in 2018-2019 who underwent TMT (> = 55Gy) or RC were included in this analysis. Chi-square tests, Kruskal-Wallis tests, and univariate and multivariate logistic regressions were performed to assess factors associated with an increased likelihood of receipt of TMT, and to compare travel times for patients receiving TMT vs RC. A total of 536 patients met inclusion criteria, and 27.1% underwent TMT. Patients receiving TMT were more likely to be older, White, male, and live further from their nearest RT facility. After adjusting for age, sex, and race/ethnicity, patients undergoing TMT were more likely than RC patients to live more than 30 minutes away from the nearest RT facility (OR 1.53, p = 0.21, ref<15 minutes). On multivariate analysis, patients receiving TMT were less likely than surgical patients to live 30-60 minutes or >60 minutes from their treatment facility ((OR 0.5, p-value<0.01, and OR 0.23, p-value <.001), ref: <30 minutes). Only 26.2% of patients who received TMT were treated at their nearest RT facility, while 13.3% of patients undergoing RC were treated at their nearest surgical facility. In a modern cohort of bladder cancer patients in California, about a quarter of T2-4N0 patients are undergoing bladder preservation. Patients undergoing TMT lived further from their nearest RT facility than patients undergoing surgery. Surgical patients were more likely to live >30 minutes from their treating facility than TMT patients. A minority of patients underwent treatment at the facility nearest to them, regardless of treatment modality chosen. Taken together, this suggests that proximity to the nearest RT facility may not be associated with a higher likelihood of undergoing TMT. Examination of actual treatment facilities (as opposed to the closest facility) shows that patients are traveling further for surgical care than TMT.

Intravenous or subcutaneous natalizumab in patients with relapsing–remitting multiple sclerosis: investigation on efficiency and savings—the EASIER study

IntroductionEASIER is a multicenter, observational, cross-sectional study investigating the consumption of healthcare resources, including healthcare professional (HCP) active working time, the costs associated with the current natalizumab intravenous (IV) administration, and the potential impact of the adoption of subcutaneous (SC) route.MethodsThe EASIER study has three parts: (1) time and motion study to measure healthcare resources and working time needed for natalizumab IV administration using a digital data collection tool operated directly by HCPs; (2) HCP structured questionnaire-based estimation of the potential impact of natalizumab SC vs. IV administration; and (3) patient survey on the burden of natalizumab administration.ResultsNine Italian multiple sclerosis (MS) centers measured 404 IV natalizumab administration procedures and administered 26 HCP questionnaires and 297 patient questionnaires. Patients had a mean of 52 (range 1–176) previous IV administrations and spent a mean (median, IQR) of 152 (130, 94–184) minutes in the center per each IV procedure, with IV infusion covering 50% of the total. Including patient travel time, an average of 5 h was dedicated to each IV administration. Active working time by HCP amounted to 29 min per IV administration procedure, 70% of which by nursing staff.With adoption of the SC route, HCPs estimated a 50% reduction in patient procedure time and 55% lower HCP active working time. This translated into a 63% cost reduction for the MS center per natalizumab administration procedure.ConclusionsSC natalizumab administration will consistently reduce consumption of patient and HCP times per procedure and associated costs.

Patient Travel Distance to Neurologist Visits.

The density of neurologists within a given geographic region varies greatly across the United States. We aimed to measure patient travel distance and travel time to neurologist visits, across neurologic conditions and subspecialties. Our secondary goal was to identify factors associated with long-distance travel for neurologic care. We performed a cross-sectional analysis using a 2018 Medicare sample of patients with at least 1 outpatient neurologist visit. Long-distance travel was defined as driving distance ≥50 miles 1-way to the visit. Travel time was measured as driving time in minutes. Multilevel generalized linear mixed models with logistic link function, which accounted for clustering of patients within hospital referral region and allowed modeling of region-specific random effects, were used to determine the association of patient and regional characteristics with long-distance travel. We identified 563,216 Medicare beneficiaries with a neurologist visit in 2018. Of them, 96,213 (17%) traveled long distance for care. The median driving distance and time were 81.3 (interquartile range [IQR]: 59.9-144.2) miles and 90 (IQR: 69-149) minutes for patients with long-distance travel compared with 13.2 (IQR: 6.5-23) miles and 22 (IQR: 14-33) minutes for patients without long-distance travel. Comparing across neurologic conditions, long-distance travel was most common for nervous system cancer care (39.6%), amyotrophic lateral sclerosis [ALS] (32.1%), and MS (22.8%). Many factors were associated with long-distance travel, most notably low neurologist density (first quintile: OR 3.04 [95% CI 2.41-3.83] vs fifth quintile), rural setting (4.89 [4.79-4.99]), long-distance travel to primary care physician visit (3.6 [3.51-3.69]), and visits for ALS and nervous system cancer care (3.41 [3.14-3.69] and 5.27 [4.72-5.89], respectively). Nearly one-third of patients bypassed the nearest neurologist by 20+ miles, and 7.3% of patients crossed state lines for neurologist care. We found that nearly 1 in 5 Medicare beneficiaries who saw a neurologist traveled ≥50 miles 1-way for care, and travel burden was most common for lower-prevalence neurologic conditions that required coordinated multidisciplinary care. Important potentially addressable predictors of long-distance travel were low neurologist density and rural location, suggesting interventions to improve access to care such as telemedicine or neurologic subspecialist support to local neurologists. Future work should evaluate differences in clinical outcomes between patients with long-distance travel and those without.

Geospatial analysis of psychiatry workforce distribution and patient travel time reveals disparities in access to mental healthcare

Geospatial analysis of psychiatry workforce distribution and patient travel time reveals disparities in access to mental healthcare

Telemedical consultations on oncology in the Republic of Bashkortostan

BACKGROUND: The COVID-19 worldwide pandemic enabled the expanded use of telemedical technologies in many areas of medicine. Remote consultations helped conserve medical resources and reduce the risk of spreading COVID-19 while preserving patients access to medical care. In addition, telemedicine played a role in caring for patients who live in remote regions. Other benefits include savings in transportation costs and travel time both for patients and caregivers. Telemedicine, together with remote health monitoring technologies, has high potential in developing a preventive healthcare system and increasing the accessibility of medical care and meets current challenges by improving healthcare quality and providing an individual approach to patients. In 2020, the Center of Telemedicine was created in the Republican Clinical Oncological Dispensary (RCOD) to organize and improve telemedical assistance to the population of the Republic of Bashkortostan in the oncology profile.&#x0D; AIM: To analyze telemedical consultations (TMCs) on oncology in the Republic of Bashkortostan for the period of 20202022.&#x0D; METHODS: Quantitative count and comparison of the TMCs conducted by the RCOD of the Ministry of Health of the Republic of Bashkortostan in 20202022 and sent to the National Medical Research Center (NMRC) were performed. The work on referrals to the NMRC for revision of examination results (computer tomography, magnetic resonance imaging, positron emission tomography/computed tomography, and histological examinations), obtaining a second opinion, and determining treatment tactics was organized.&#x0D; RESULTS: In 2020, 32,076 TMCs were conducted, while 225 TMCs were performed with the NMRC. In 2021, the RCOD conducted 52,139 TMCs (a 62% increase compared to 2020), whereas 473 TMCs took place in the NMRC (a 110% increase compared to 2020). During the 12 months of 2022, 57,456 TMCs were performed by RCOD staff (a 10% increase over the previous year), and 672 TMCs were conducted with the NMRC (a 42% increase compared to 2021). For feedback from referring medical organizations and monitoring and evaluating the quality of regional TMCs, conference calls were held with the Ministry of Health of the Republic of Bashkortostan, chief physicians, and oncologists of the Republic of Bashkortostan.&#x0D; CONCLUSIONS: TMCs allow for the rapid exchange of medical information, thereby reducing the time of diagnosis and timely prescription of treatment, the implementation of timely routing of patients and improving the quality and availability of medical care in the oncology profile in the Republic of Bashkortostan. The annual increase in the number of TMCs is due to the growing need for this type of specialized medical care in this profile.

Specialised treatment of colorectal cancer in certified cancer centres: Do patients really have to travel further?

In Germany, many cancer patients are treated outside of cancer centres certified by the German Cancer Society (DKG) resulting in underuse of these facilities and inferior oncological treatment. One way to address this issue would be to restructure the healthcare landscape by following the Danish approach that limits cancer treatment to specialized hospitals. Such an approach would have an impact on the travelling times to treatment centers. The present study determines the impact on patient travel times using the example of colorectal cancer. For the present analysis, data from structured quality reports (sQB) and from patients insured with the AOK who underwent resection of the colon or rectum during 2018 were used. In addition, data from the DKG regarding an existing certification of a colorectal cance centre were used. Travel time was defined as the time patients spent in an average car with average traffic from the midpoint of the ZIP code of their residence to the coordinates of the hospital. The coordinates of the hospitals and the midpoints of the ZIP codes were obtained by querying the Google API. Travel times were calculated with a local Open Routing Machine server. The statistical programs R and Stata were used for analyses and cartographic representations. In 2018, nearly half of all patients with colon cancer were treated at the hospital nearest to their place of residence, of whom approximately 40% were treated at a certified colorectal cancer centre. Overall, only about 47% of all treatments took place at a certified colorectal cancer centre. Travel time to the chosen treatment site averaged 20 minutes. It was minimally shorter (18 minutes) if no certified centre was chosen and minimally longer (21 minutes) for those whose treatment took place in a certified colorectal cancer centre. Modeling of redistributions of all patients to certified centres resulted on an average travel time of 29 minutes. Even if treatment were limited to specialized hospitals, treatment close to home would still be guaranteed. Regardless of certification, parallel structures can be identified, especially in metropolitan areas, which indicate a potential for restructuring.

Expanding veteran treatment access points through Close To Me (CTM) infusion service.

1519 Background: Diagnosing and treating more than 43,000 Veterans annually, the Veterans Affairs (VA) National Oncology Program (NOP) oversees the largest integrated providers of hematology/oncology services in the US. Within the VA, parenteral therapies are primarily offered at VA Medical Centers (VAMC) in urban areas, often inaccessible to rural patients. Travel distance, parking, time, and caregiver support can prevent patients from adhering to treatment regimens. To resolve these challenges, NOP launched the Close to Me (CTM) infusion service. The service seeks to reduce travel time for patients, improve VA care continuity, and increase access points to patient-centric care by administering treatments utilizing the network of VA Community Based Outpatient Clinics (CBOC). Methods: In the CTM CBOC infusion service select medications are compounded at the main VAMC, then transported via a registered nurse to the surrounding CBOCs for administration. Eligible patients must be established with a VA hematologist/oncologist and tolerated 1 cycle of treatment at the VAMC. Patients are assessed via telehealth prior to each treatment at the CBOC. Patient drive miles saved was calculated by subtracting the mileage between the patient’s home address and the CBOC from the patient’s home address and the VAMC, then multiplied by number of treatment visits at the CBOC. Medication cost avoidance was calculated by subtracting the VA purchase price from the 2023 published Centers for Medicare and Medicaid Services reimbursement rates, then multiplied by number of treatments received at the CBOC. The first CTM CBOC clinics were opened within the Minneapolis VA Health Care System in October 2021, followed by the VA Pittsburgh Healthcare System in June 2022. Results: From October 2021 through December 2022, 373 unique patients were treated within CTM CBOC clinics for a total of 532 patient visits. The CTM infusion service resulted in 43,249 patient drive miles saved and 813,352 in medication cost avoidance. No medical emergencies were reported during CTM CBOC treatments. One medication was discarded without use due to damage during shipping. One compounded product was not used due to change in patient status. One patient was non-adherent with treatment appointments on two occasions resulting in an overall 99.6 % treatment adherence. Conclusions: The CTM infusion service optimizes current VA infrastructure to increase access points to hematology/oncology treatment, reduce travel burden for patients, increase treatment appointment adherence and reduce medication cost expenditures. To facilitate expansion of this successful service, NOP has provided funding and support to 11 additional VAMCs to implement one of the CTM solutions including CBOC, mobile infusion unit or home infusion. A comprehensive implementation toolkit was developed to encourage the independent adoption of this service at appropriate locations across VA.

Impact of patient travel time on disparities in precision oncology clinical trials.

3113 Background: Precision oncology revolutionizes cancer care, allowing personalized treatments to improve outcomes. Precision oncology often entails participation in genotype-matched clinical trials, resulting in referrals from institutions providing comprehensive genomic profiling (CGP) testing to those conducting these trials. It is still being determined whether there are regional disparities in precision oncology. Methods: We conducted a retrospective review of 1127 patients (pts) referred to National Cancer Center Hospital (NCCH) for participation in genotype-matched clinical trials following CGP testing performed between June 2020 and June 2022. Travel distance and time were calculated utilizing Google Maps from the patient's residence to the NCCH. A total of 23 covariates were preselected and dichotomized per previous research or expert consensus as follows: age, sex, performance status, body mass index, tumor type, number of lines of prior therapies, number of metastatic sites, liver metastases, brain metastases, pleural or peritoneal effusions, biopsiability, neutrophil, hemoglobin, platelet, albumin, creatinine, total bilirubin, LDH, AST, CRP, place of residence (urban vs. rural), referring hospitals, and household income. All independent variables associated with participation in genotype-matched trials (P &lt; 0.20) were included in a multivariable model, and variable importance was calculated using a machine learning (ML) model (gradient-boosted decision tree). Results: A total of 127 (11%) of 1127 pts were enrolled in the genotype-matched trials. Of 127 pts, 82 (65%) and 45 (35%) participated in phase 1 trials and phase 2/3 trials, respectively. The overall median travel distance and time were 38 km (interquartile range [IQR] 21–107) and 55 minutes (IQR 35–110), respectively. In multivariable regression, travel distance (≥100km vs. &lt;100km) was not associated with the proportion of genotype-matched trial participation (9% vs. 12%; odds ratio [OR], 0.68; 95% confidence interval [CI], 0.42–1.07; P = 0.11); however, in pts with travel time ≥120 minutes, the proportion of genotype-matched trial participation was significantly lower than those with travel time &lt; 120 minutes (7% vs. 13%; OR, 0.54; 95% CI, 0.32–0.89; P = 0.019). The proportion of genotype-matched trial participation decreased as travel time increased from &lt;40 minutes to 40–120 minutes to ≥120 minutes (13% vs. 12% vs. 7%, respectively; OR, 0.67; 95% CI, 0.50–0.88; P = 0.006). Travel time was also identified as an important factor in the ML model, whereas low-income and residence in rural areas were of minor importance. Conclusions: Patients with travel time ≥120 minutes were less likely to participate in genotype-matched clinical trials than those with travel time &lt;120 minutes. Regional disparities may be creating inequities in precision oncology, which warrant immediate action, including decentralization of clinical trials.

0436 Obstructive Sleep Apnea (OSA) Patient Journey: Retrospective Analysis of Real-world Data

Abstract Introduction OSA affects about 30% of US adults and up to 90% remain undiagnosed and untreated. This study aimed to characterize the OSA patient journey by identifying the most common OSA care pathways in the U.S. We also sought to compare time from diagnosis to treatment initiation between groups. Methods Data was extracted from a national administrative claims database (01/01/2016–02/28/2020). Inclusion criteria included age ≥18 years and 12 months continuous enrollment before/after the first OSA diagnosis (index date). OSA was defined as ICD-10 diagnosis preceded by HSAT, in-lab PSG, and/or split-night PSG within the prior 12 months. Exclusion criteria included prior OSA diagnosis/treatment or central sleep apnea. Patient pathway, demographics (at time of OSA diagnosis), timeframes, and comorbidities were assessed. Associations between sex, region, payer, and median patient journey times were investigated using generalized linear models adjusted for baseline characteristics. Results A total of 86,827 OSA patients (45.1% female; median age, 50±11.8) were identified, of which 60.8% initiated PAP therapy, 1.5% received an oral appliance, and 37.6% initiated neither treatment within the year following diagnosis. For patients initiating PAP, the most common care pathways identified for patients, and their median time to treatment initiation were HSAT-only (23.4%, 35 days), PSG+titration (22.9%, 58 days), split-night titration (16.8%, 28 days), PSG-only (11.2%, 37 days), HSAT+HSAT (6.9%, 37 days), titration+titration (3.9%, 31 days) and HSAT+titration (3.5%, 75 days). Relative to patients in PSG-only, individuals in HSAT-only were more likely to initiate PAP (56.1% versus 33.6% initiation). Longer timeframes from sleep test to PAP initiation were observed for patients with commercial insurance versus Supplemental Medicare (OR: 95% CI, 1.10: 1.07–1.14) and females (1.05: 1.04–1.06). There were significant differences in patient timeframes according to region (p&amp;lt; 0.00001). Notable patterns of differences in journey time and PAP initiation were observed based on patient Metropolitan Statistical Area (MSA) diversity and MSA median household income levels, when combined. Conclusion This is the first national analysis to characterize common OSA treatment pathways. Time to treatment initiation varied widely between OSA care pathways. Patient sex, region, payer, and household income were associated with time to treatment initiation. Support (if any) Primasun

Health professionals’ preferences with the use of pegfilgrastim on-body injector at oncology centers in 8 cities in Colombia

BackgroundFebrile neutropenia associated with some chemotherapy regimens can lead to potentially fatal complications and high health care costs. Administration of pegfilgrastim using an On-Body Injector (OBI) may be more convenient for cancer patients and physicians in countries with limited access to high-complexity healthcare. This study aims to describe physician and nurse preferences regarding different options for administration of pegfilgrastim at cancer centers, the chemotherapy schemes for which pegfilgrastim is most frequently prescribed and how healthcare providers prioritize certain administration schemes according to patients’ access to healthcare services.MethodsObservational, descriptive, cross-sectional study and survey, conducted between 2019 and 2020, to describe physician and nurse preferences regarding options for administration of pegfilgrastim at cancer centers, the demographics of the study population and characteristics of participating cancer centers. It included 60 healthcare professionals practicing at oncology centers from 8 cities in Colombia who were contacted and surveyed via telephone. Quantitative continuous variables were summarized using central tendency and dispersion measures.ResultsIt was found that 35% of participants are haemato-oncologists, oncologists or hematologists, 30% are general practitioners, and 35% are other healthcare professionals (i.e., nurse, oncology nurse and head nurse). Our study shows that 48% of physicians prefer the use of OBI, particularly in the scheme of 24 h after myelosuppressive chemotherapy administrations. Regardless of patient frailty and travel time to the clinic, over 90% of healthcare providers (HCPs) prefer to prioritize preventing the patient from having to return to the clinic for pegfilgrastim administration as well as to increase healthcare staff availability through the use of OBI.ConclusionsThe present study is the first one in Colombia that sought the reasons behind HCPs’ choice to use OBI pegfilgrastim. Our results indicate that most professionals prefer to avoid the patient having to re-enter the care center for pegfilgrastim administration to facilitate access to healthcare for patients; patient characteristics and ease of transport are determining factors for respondents when choosing an option for drug administration. We found OBI is the preferred alternative by most HCPs and a good resource optimization strategy in the context of cancer patients’ health care in Colombia.

Differential patient travel distance and time to psoriasis clinical trial sites.

Considering the known disparities in racial representation in psoriasis clinical trials, this study sought to characterize travel distance and time to reach a psoriasis clinical trial site as a potential barrier to trial participation for multiple demographic and geographic variables. We determined travel distance and time from every census tract population center in the United States to the nearest psoriasis clinical trial site using ArcGIS and linked travel estimates to demographic characteristics in each census tract based on 2020 American Community Survey. The average distance and time traveled to reach a psoriasis clinical trial site nationally were 45.6 miles and 51.8min, respectively. Urban residence and Northeast location had significantly lower travel distance and time relative to their geographic counterparts. Travel burden was significantly greater among Native American and Black races, individuals without college education and Veterans Affairs beneficiaries relative to their counterparts. These findings reveal disparate access regarding rurality, race, education and insurance type, which may encourage investigators to increase travel funding for underrepresented groups and diversity recruitment efforts to promote access to psoriasis clinical trials.

Abstract Number ‐ 207: Modeling Optimal Patient Transport in a Stroke Network Capable of Remote Telerobotic Endovascular Therapy

Introduction Endovascular therapy (EVT) is the standard‐of‐care for large vessel occlusion stroke; however, timely access to treatment is still limited for a large proportion of the population. Telerobotic EVT has the potential to decrease time to treatment and expand existing networks of care to more rural populations. It is currently unclear how its implementation would impact existing stroke networks. Methods Conditional probability models were generated to predict the probability of excellent outcome (modified Rankin Scale 0–1 at 90 days post stroke) for patients with suspected large vessel occlusion (LVO). A baseline stroke network was created for California using existing intravenous thrombolysis (IVT) centers and comprehensive stroke centers (CSCs) capable of IVT and EVT. Optimal transport decisions and catchment areas were generated for the baseline model and three hypothetical scenarios through conversion of IVT centers at various distances from a CSC into centers capable of Telerobotic EVT [i.e. hospitals ≥ 15 and &lt; 50 miles from a CSC were converted (Scenario 1), ≥ 50 and &lt; 100 miles (Scenario 2), and ≥ 100 miles (Scenario 3)]. Catchment areas were calculated for each scenario using varied robotic procedural delay times and success rates. Results In the baseline model, 51 hospitals were designated as CSCs and 142 hospitals were designated IVT centers. Conversion of IVT centers into Telerobotic EVT centers decreased median travel time for LVO patients in all three scenarios. The estimated number of robotically treated LVOs per year in Scenarios 1, 2, and 3 were 2172, 740, and 212, respectively. Scenario 1 (15‐50 miles) was the most sensitive to robotic time delay and success rate, but all three scenarios were more sensitive to decreases in procedural success rate compared to time delay. Conclusions Telerobotic EVT has the potential to improve care for stroke patients outside of major urban centers. Compared to procedural time delays in robotic EVT, a decrease in procedural success rate would not be well tolerated. This modeling analysis can inform system planning for the potential advent of remote EVT care.

Rapid triage and transition to telehealth for heart transplant patients in the COVID-19 pandemic setting

Background In the setting of the COVID-19 pandemic, a rapid uptake of telehealth services was instituted with the aim of reducing the spread of disease to vulnerable patient populations including heart transplant recipients. Methods Single-center, cohort study of all heart transplant patients seen by our institution's transplant program during the first 6 weeks of transition from in-person consultation to telehealth (23 March – 5 June 2020). Results Face-to-face consultation allocation strongly favored patients in the early post-operative period (34 vs. 242 weeks post-transplant; p < 0.001). Telehealth consultation dramatically reduced patient travel and wait times (80 min per visit saved in telehealth patients). No apparent excess re-hospitalization or mortality was seen in telehealth patients. Conclusions With appropriate triage, telehealth was feasible in heart transplant recipients, with videoconferencing being the preferred modality. Patients seen face-to-face were those triaged to be higher acuity based on time since transplant and overall clinical status. These patients have the expected higher rates of hospital re-admission, and therefore should continue to be seen in person.