Percentage Of Visits Research Articles

The Impact Of Telemedicine On Medicare Utilization, Spending, And Quality, 2019-22.

Telemedicine use remains substantially higher than it was before the COVID-19 pandemic, although it has fallen from pandemic highs. To inform the ongoing debate about whether to continue payment for telemedicine visits, we estimated the association of greater telemedicine use across health systems with utilization, spending, and quality. In 2020, Medicare patients receiving care at health systems in the highest quartile of telemedicine use had 2.5 telemedicine visits per person (26.8percent of visits) compared with 0.7 telemedicine visits per person (9.5percent of visits) in the lowest quartile of telemedicine use. In 2021-22, relative to those in the lowest quartile, Medicare patients of health systems in the highest quartile had an increase of 0.21 total outpatient visits (telemedicine and in-person) per patient per year (2.2percent relative increase), a decrease of 14.4 annual non-COVID-19 emergency department visits per 1,000 patients per year (2.7percent relative decrease), a $248 increase in per patient per year spending (1.6percent relative increase), and increased adherence for metformin and statins. There were no clear differential changes in hospitalizations or receipt of preventive care.

The role of organizations in shaping physician use of electronic health records.

The aim of the study was to (1) characterize organizational differences in primary care physicians' electronic health record (EHR) behavior; (2) assess within-organization consistency in EHR behaviors; and (3) identify whether organizational consistency is associated with physician-level efficiency. EHR metadata capturing averaged weekly measures of EHR time and documentation composition from 75,124 US primary care physicians across 299 organizations between September 2020 and May 2021 were taken. EHR time measures include active time in orders, chart review, notes, messaging, time spent outside of scheduled hours, and total EHR time. Documentation composition measures include note length and percentage use of templated text or copy/paste. Efficiency is measured as the percent of visits with same-day note completion. All analyses are cross-sectional. Across-organization differences in EHR use and documentation composition are presented via 90th-to-10th percentile ratios of means and SDs. Multilevel modeling with post-estimation variance partitioning assesses the extent of an organizational signature-the proportion of variation in our measures attributable to organizations (versus specialty and individual behaviors). We measured organizational internal consistency for each measure via organization-level SD, which we grouped into quartiles for regression. Association between internally consistent (i.e., low SD) organizational EHR use and physician-level efficiency was assessed with multi-variable OLS models. Extraction from Epic's Signal platform used for measuring provider EHR efficiency. EHR time per visit for physicians at a 90th percentile organization is 1.94 times the average EHR time at a 10th percentile organization. There is little evidence, on average, of an organizational signature. However, physicians in organizations with high internal consistency in EHR use demonstrate increased efficiency. Physicians in organizations with the highest internal consistency (top quartile) have a 3.77 percentage point higher same-day visit closure rates compared with peers in bottom quartile organizations (95% confidence interval: 0.0142-0.0612). Results suggest unrealized opportunities for organizations and policymakers to support consistency in how physicians engage in EHR-supported work.

Assessing the Effectiveness of Tobacco 21 Laws to Reduce Underage Access to Tobacco: Protocol for a Repeated Multi-Site Study.

Prior to the federal law passed in December 2019, many states passed an increased age of sale law prohibiting youth under age 21 (or Tobacco 21) from purchasing tobacco products, including e-cigarettes. Although previous research has documented tobacco retail sale violations, fewer studies have examined age verification and illegal tobacco sales in the context of Tobacco 21 or repeated purchase attempts in various settings. In this study conducted between 2019 and 2022, buyers aged 18 to 20 years made repeated unsupervised purchase attempts of cigarettes, cigars, e-cigarettes, tobacco-free nicotine pouches, and smokeless tobacco at over 180 tobacco or e-cigarette retailers in New Jersey, New York City, and Pitt County (North Carolina). Buyers documented whether they were asked for identification and whether they were able to successfully purchase a tobacco or nicotine product at each visit. The primary outcome will be the percent of retailers that checked the buyers' identification at store visits and the percent of visits that resulted in a successful underage tobacco product purchase. We will compare the results across time periods, study sites, products, and buyer characteristics (i.e., gender, minoritized racial/ethnic identity) while controlling for repeated visits. These results will inform improvements to current compliance check inspection programs as well as interventions that reduce youth access to tobacco.

Adult Primary Care Physician Visits Increasingly Address Mental Health Concerns

A high prevalence of mental health diagnoses in adults alongside ongoing shortages of mental health specialists and expansion of the patient-centered medical home have increased the involvement of primary care clinicians in treating mental health concerns. Using nationally representative serial cross-sectional data from the 2006-18 National Ambulatory Medical Care Surveys regarding visits to outpatient primary care physicians by patients ages eighteen and older, we sought to characterize temporal trends in primary care visits addressing a mental health concern. Based on a sample of 109,898 visits representing 3,891,233,060 weighted visits, we found that the proportion of visits that addressed mental health concerns increased from 10.7percent of visits in 2006-07 to 15.9percent by 2016 and 2018. Black patients were 40percent less likely than White patients to have a mental health concern addressed during a primary care visit, and Hispanic patients were 40percent less likely than non-Hispanic patients to have a mental health concern addressed during a primary care visit. These findings emphasize the need for payment and billing approaches (that is, value-based care models and billing codes for integrated behavioral health) as well as organizational designs and supports (that is, colocated therapy or psychiatry providers, availability of e-consultation, and longer visits) that enable primary care physicians to adequately address mental health needs.

Inappropriate and potentially avoidable emergency department visits of Swiss nursing home residents and their resource use: a retrospective chart-review

BackgroundEmergency department (ED) visits for nursing home residents lead to higher morbidity and mortality. Therefore, inappropriate visits (for conditions treatable elsewhere) or potentially avoidable visits (those avoidable through adequate chronic care management) must be minimized. This study aimed to investigate factors and resource consumption patterns associated with inappropriate and potentially avoidable visits in a Swiss tertiary hospital.MethodsThis is a single-center retrospective chart review in an urban Swiss university hospital ED. A consecutive sample of 1276 visits by nursing home residents (≥ 65 years old), recorded between January 1, 2015 and December 31, 2017 (three calendar years) were included. Case characteristics were extracted from ED electronic documentation. Appropriateness was assessed via a structured Appropriateness Evaluation Protocol; potentially avoidable visits—measured as ambulatory-care sensitive conditions (ACSCs)—were analyzed separately. Inter-group differences concerning ED resource use were tested respectively with chi-square or Wilcoxon rank sum tests. To identify predictors of inappropriate or potentially-avoidable visits, we used multivariable logistic regression analysis.ResultsSix percent of visits were rated as inappropriate: they had lower triage levels (OR 0.55 [95%-CI 0.33-0.92], p=0.024) and, compared to ambulance calls, they had higher odds of initiation via either patient-initiated walk-in (OR 3.42 [95%-CI 1.79-6.55], p≤0.001) or GP referrals (OR 2.13 [95%-CI 1.16-3.90], p=0.015). For inappropriate visits, overall ED resource use was significantly lower (median 568 vs. 1403 tax points, p≤0.001). Of all visits included, 29% were due to (often potentially-avoidable) ACSCs. In those cases, compared to ambulance initiation, odds of being potentially-avoidable were considerably lower for walk-in patients (OR 0.46 [95%-CI 0.27-0.77], p=0.004) but higher for GP referrals (OR 1.40 [95%-CI 1.00-1.94], p=0.048). Nurse work (93 tax points vs. 64, p≤0.001) and laboratory resource use (334 tax points vs. 214, p≤0.001) were higher for potentially-avoidable ED visits.ConclusionsWe revealed substantial differences between the investigated groups. While nearly one third of ED visits from nursing homes were potentially avoidable, inappropriate visits were lower in numbers and not resource-intensive. Further research is required to differentiate potentially avoidable visits from inappropriate ones and to determine these findings’ public health implications.

Design and methods for understanding the state of cystic fibrosis care amid the COVID-19 pandemic

BackgroundNovel therapies have dramatically changed cystic fibrosis (CF) and innovative care delivery systems are needed to meet future patient needs. Telehealth has been shown to be an efficient and desirable form of care delivery. The COVID-19 pandemic caused a rapid shift to telehealth, and this presented a unique opportunity to study facilitators, barriers, and satisfaction with this mode of care delivery. We aim to report survey methods, demographics and telehealth use among CF care programs, patients, and families during the pandemic. MethodsCF programs completed two surveys between July 29 and September 18, 2020, and between April 19 and May 19, 2021. Patients and families completed a similar survey between August 31 and October 30, 2020. The surveys addressed topics assessing the pandemic's financial impact, telehealth modes and experiences, licensure and reimbursement issues, health screening, and remote monitoring. Quantitative data were analyzed with descriptive statistics and were compared to the CF Foundation Patient Registry. ResultsMost programs (278 at timepoint one and 274 at timepoint two) provided telehealth during the pandemic. The percent of visits containing either telephone or video components changed from 45% to 25% over the time periods. Additionally, 424 patients and families from various ages and backgrounds responded to the survey and 81% reported having a telehealth visit. ConclusionsThe pandemic accelerated telehealth adoption and these datasets are a valuable source for exploring telehealth barriers and facilitators, the quality-of-care experience, financial and workforce implications, the impact on underrepresented populations, and implications for coverage and reimbursement.

Abstract 10889: Impact of the COVID-19 Pandemic on Ambulatory Pediatric Cardiology Care by Race/Ethnicity

Introduction: Racial/ethnic disparities in congenital heart disease outcomes are well documented. The impact of COVID-19 on race/ethnicity in access to ambulatory pediatric cardiology care is unknown. Methods: To examine differences in ambulatory care visits by race/ethnicity and whether differences were exacerbated by the COVID pandemic (March 2020), we examined number of visits scheduled (0-18 years old) and visit completion (as scheduled, delayed completion within 6 months, incomplete) by race/ethnicity. We focused on early pandemic, April 2020 (vs April 2019) and later pandemic, July 2020 (vs April 2020), using chi-square and logistic regression. Results: Annual clinic volume fell by 4.5% during the pandemic (18,725 to 17,866). Race/ethnicity shifted slightly towards white compared to non-white minority (NWM) 30% vs 28%, p <0.001. Public insurance was constant at 33%, p =0.83. Telehealth visits accounted for 46% of visits during the pandemic (0.8% pre-pandemic), with different utility by white than NWM patients (49% vs 43%, p <0.001). Visits in April 2020 fell by 57% from April 2019 and percent of visits completed without delay declined from 69% to 39%, p <0.001. Visits in July were similar from 2019 to 2020 but visits completed without delay declined from 71% to 62%, p <0.001. Visit completion rates varied by race/ethnicity (Figure 1), with differences between white vs NWM early in the pandemic ( p =0.01). Differences in visit completion rates by race/ethnicity were not significantly different from the year prior ( p for interaction=0.74) or from April to July 2020 ( p for interaction=0.48). Conclusions: NWM have higher rates of incomplete/delayed visits compared to whites, though the difference was not statistically heightened by the pandemic. Telehealth visits have become a prominent part of ambulatory care, with higher completion rates by white patients. Efforts to reduce lapses in care are needed across demographics to ensure equitable care delivery.

144. Little evidence of same-day, oral antibiotic prescribing at ambulatory surgery centers

BackgroundThe objective of our study was to describe oral antibiotic prescriptions associated with procedures in ambulatory surgery centers (ASC) to evaluate if there are major national opportunities to improve antibiotic use in this setting.MethodsWe identified surgical procedures in ASCs and oral antibiotic prescriptions in the IBM® MarketScan® Commercial 2018 database, a large convenience sample of privately-insured individuals aged < 65 years. We excluded visits with same-day hospitalizations and those with infectious diagnoses that may warrant antibiotic treatment. We included only antibiotic prescriptions dispensed on the same day as an ASC visit. We calculated the number of visits and oral antibiotic prescriptions and the percent of visits with oral antibiotic prescriptions overall, and by patient age group (< 18 and 18–64 years), antibiotic class, and procedure type. We also calculated median antibiotic course length. Across-group comparisons were evaluated using chi-square tests.ResultsIn 2018, 918,127 ASC visits with surgical procedure codes were captured, of which 37,032 (4.0%) were associated with same-day oral antibiotic prescriptions. The percent of visits with antibiotic prescriptions was significantly higher among children compared to adults (9.4% vs 3.8%; p< 0.01); however, adults accounted for 89% of prescriptions. Respiratory/nasal and urinary tract system procedures were most frequently associated with antibiotic prescriptions (Figure). Median course length was 5 (interquartile range 3–7) days. The most common antibiotic class was cephalosporins (49.6% of prescriptions), followed by penicillins (12.6%) and fluoroquinolones (10.9%).Figure. Percent of ambulatory surgery center visits with same-day antibiotic prescriptions by procedure category, IBM® MarketScan® Commercial Database, 2018 ConclusionOnly 4% of ASC procedures were associated with same-day oral antibiotic prescriptions, suggesting antibiotics are not commonly prescribed in ASCs on the day of surgical procedures. Additionally, the observed 5-day median duration may suggest that some of these courses are intended for treatment rather than prophylaxis. Our estimates represent lower bounds for oral antibiotic prescriptions in this setting, as we only captured same-day prescriptions. However, our findings suggest that ASC facilities may not be high-impact targets for national, public health antibiotic stewardship efforts.Disclosures All Authors: No reported disclosures

Digit Preference in Office Blood Pressure Measurements, United States 2015-2019.

Blood pressure (BP) measurement error may lead to under- or overtreatment of hypertension. One common source of error is terminal digit preference, most often a terminal digit of "0." The objective was to evaluate national trends in terminal digit preference in office BP measurements among adults with treated hypertension. Data were from IQVIA's National Disease and Therapeutic Index, a nationally representative, serial cross-sectional survey of office-based physicians. The analysis included office visits from 2015 to 2019 among adults aged ≥18 years receiving antihypertensive treatment. Annual trends were examined in the percent of systolic and diastolic BP measurements ending in zero by patient sex, age, and race/ethnicity, physician specialty, and first or subsequent hypertension treatment visit. From 2015 to 2019, there were ~60 million hypertension treatment visits annually (unweighted N: 5,585-9,085). There was a decrease in the percent of visits with systolic (41.7%-37.7%) or diastolic (42.7%-37.8%) BP recordings ending in zero. Trends were similar by patient characteristics. However, a greater proportion of measurements ended in zero among patients aged ≥80 (vs. 15-59 or 60-79) years, first (vs. subsequent) treatment visits, visits to cardiologists (vs. primary care physicians), and visits with systolic BP ≥140 or diastolic BP ≥90 (vs. <140/90) mm Hg. Despite modest improvement, terminal digit preference remains a common problem in office BP measurement in the United States. Without bias, 10%-20% of measurements are expected to end in zero. Reducing digit preference is a priority for improving BP measurement accuracy and hypertension management.

ED utilization trends for medical oncology patients at Thomas Jefferson University during COVID-19.

238 Background: For patients receiving cancer care, utilization of acute care resources can be frequent and, in many instances, is avoidable. At Thomas Jefferson University (TJU), up to 50% of emergency department (ED) visits for medical oncology patients on active treatment (receiving intravenous or oral chemotherapy within 30 days) may be preventable based on OP-35 criteria. The COVID-19 pandemic drastically altered healthcare delivery, prompting providers and patients to re-evaluate the safety and necessity of acute care. We aimed to evaluate the effect of the COVID-19 pandemic on ED utilization for medical oncology patients at TJU. Methods: We reviewed the total number of visits to the TJU ED for all patients and for medical oncology patients from January 1, to May 31, 2020. We defined the months of January and February as “Pre-COVID” and the months of April and May as “COVID”. We excluded data from March in our analysis. For medical oncology patients, we tallied both the number of patients with an ED visit and total ED visits for each month. We stratified patients by whether or not they were on active treatment. We reviewed the outcome of each ED visit and categorized results as admission (inpatient admission or observation) or discharge. We classified each ED visit as avoidable or unavoidable using OP-35 criteria. Results: In the Pre-COVID months there were 489 total visits by 432 oncology patients; 41% (179) of these patients were on active treatment. During COVID months there were 313 visits by 284 oncology patients; 48% (137) were on active treatment at the time of visit. During COVID, total ED visits decreased by 37%. Visits by medical oncology patients decreased by 35%. For medical oncology patients on active treatment, we observed a 21% reduction in ED visits. In the Pre-COVID months, 38% of oncology patient visits were considerable potentially avoidable and 41% of visits ended with a discharge to home. In comparison, during COVID, 31% of visits were considered potentially avoidable and 35% of visits ended with a discharge to home. Conclusions: We observed a decrease in ED utilization by oncology patients that mirrored decrease in total ED utilization following the COVID-19 outbreak. The decrease was less prominent for patients on active treatment. The percent of visits that were potentially avoidable and the percentage of patients discharged to home from the ED decreased slightly during the COVID period. Further analysis is ongoing to understand factors driving reduction in ED utilization observed immediately following the COVID-19 outbreak.

The Relationship Between Follow-up Appointments and Access to Primary Care.

Health care operations managers need to balance scheduling frequent follow-ups for patients with chronic conditions and fitting in patients requiring care for new complaints. We quantify how frequency of follow-up visits corresponds with access to care for patients receiving care from the Department of Veterans Affairs (VA). We use patient data collected between October 2013 and June 2016 by the Survey of Healthcare Experiences of Patients (SHEP). Our sample is comprised of 94,496 patients. We estimate logistic models with 1-month lagged facility-level predictors. We calculate monthly measures characterizing facility-level service provision, including the average time between successive primary care visits, the average primary care visit length, the percentage of primary care appointments that are overbooked, the percent of visits that are unscheduled (i.e., walk-ins), and the ratio of patients to providers. We control for economic factors that are associated with health care supply and demand, including median household income, veteran priority status, the Zillow Housing Price Index, and veteran unemployment rates. We also control for patient demographics. We restrict the data to patients with at least one in-person primary care visit who have provided information on their ability to access urgent and routine care. We find that shorter average follow-up times are associated with better access for patients needing urgent or routine care. A 1-month increase in the average time between successive primary care visits is associated with 10% (p < 0.001) lower odds of reporting being able to access urgent care within 1day and 13% (p < 0.001) lower odds of reporting usually or always being able to access routine care when needed. Facilities with higher average follow-up times are more likely to have patients report that they are unable to quickly access urgent or routine primary care.

Abstract P333: National Trends in the Quality of Office Blood Pressure Measurements, 2014-2019

Introduction: Clinical practice guidelines emphasize the importance of accurate blood pressure measurement and recording to diagnose and treat hypertension. Trends in terminal digit preference (typically manifest by a terminal digit of ‘0’) have not been examined nationally. The growing use of automated blood pressure devices may have reduced terminal digit preference and improved accuracy over time. Objective: To evaluate trends in terminal digit preference in office blood pressure measurements among adults with hypertension by patient and provider characteristics. Methods: We used IQVIA National Disease and Therapeutic Index (NDTI) data from January 2014 through June 2019. The NDTI is designed to be nationally-representative of all patient visits to office-based physicians and uses a two-stage stratified sampling design to sample ~4,000 physicians per quarter who report information on all patient visits on 2 random workdays. We included all hypertension treatment visits (~60M/year) among adults aged ≥18. We examined trends in the proportion of hypertension treatment visits with recorded systolic (SBP) and diastolic (DBP) blood pressure measurements with a terminal digit ‘0’. The expected percent of blood pressures with ‘0’ is 10% for automated and 20% for manual readings. Results: There was a decrease in the percent of visits with SBP (43.0% to 37.4%) or DBP (44.3% to 38.1%) recordings ending in zero ( Table ). The decrease in percent of SBPs with a terminal zero was similar by patient and provider characteristics, though the percentage of SBPs with a terminal ‘0’ was consistently higher among patients aged ≥60, when SBP ≥140 mmHg, and among cardiologists. Conclusions: Terminal digit preference is common indicating systematic error in blood pressure measurement and recording, despite some improvement over time. This may lead to under- and overtreatment of patients with hypertension. Improving the quality of blood pressure measurement is central to improving hypertension diagnosis and control in clinical practice.

A Center-Wide Study of D-Dimer Testing for Pulmonary Embolism in the ED Setting

Abstract Pulmonary embolism (PE) is a life-threatening condition associated with a very high mortality. While its diagnosis remains challenging, the use of diagnostic tests has increased tremendously. There are many different guidelines used to work up suspected PE. The Wells and/or Geneva scores are used to estimate the pretest probability (PTP) of PE before any complementary testing is done. While a CT pulmonary angiography (CTPA) should not be performed in individuals with a low/intermediate PTP and a negative D-dimer (DD), some data suggest that up to 55% of patients with low PTP undergo a CTPA, even though they might not have had a DD or had a negative DD. As such, in this study, we wanted to evaluate the use of DD in our emergency department (ED). A pilot study was conducted using an interactive software developed in-house for the evaluation of health care quality, efficiency, and effectiveness. The EMR database (EPIC) we use consists of laboratory, clinical, pathological, and radiological reports, allowing us to use different search criteria and to outline cutoff values for continuous and categorical variables while permitting us to define a timeframe for the different observations. We looked at all ED visits in the period from 2014 to 2018 in which CTPAs were done for suspected PE. A total of 8,873 ED visits from 2014 to 2018 had a CTPA done for suspected PE. Of these, 6,117 cases had no DD done and 1,812 had a DD done along with CTPA. The high percent of visits with imaging done without a DD (69%) is justified if these are all cases with a high PTP (DD not indicated). If this assumption was true, then we expected a high percent of positive confirmation of PE by imaging. However, only 11% of these cases showed positive findings of PE. This rate is similar to published studies in many US hospitals that demonstrate overuse of CT owing to a lack of using the PTP-based approach. On the other hand, a vast majority of cases in our study with normal DD (&lt;0.5 μg/L) had negative CT results (98%). Interestingly, all four cases that had positive PE findings by CT despite a negative DD (2%) were women (three below the age of 62 with chronic and/or subsegmental PE and one 47-year-old with a DD = 0.49 μg/L). This finding calls for consideration of age and possibly gender-based DD reference ranges. Lastly, while CTPA is considered the gold standard for PE diagnosis, it has limitations: cost, increased length of stay, unnecessary exposure of radiation, contrast, and unnecessary treatment of subsegmental PE. Therefore, an approach using PTP and using DD appropriately is warranted in order to prevent patients from being exposed to unnecessary risks and also to reduce costs.

Using Syndromic Surveillance and Climatic Data to Detect High Intensity HFMD Seasons

Using Syndromic Surveillance and Climatic Data to Detect High Intensity HFMD Seasons

Trends in and predictors of hydromorphone administration in US emergency departments (2007-2014).

To examine recent trends in and predictors of hydromorphone administration in US emergency departments (EDs) compared with other opioids. Retrospective review of data from the National Hospital Ambulatory Medical Care Survey from 2007 to 2014. All adult ED visits where an opioid analgesic was administered were included. Trends in and predictors of hydromorphone administration were assessed using survey-weighted logistic regression, comparing hydromorphone visits with ED visits where other opioids were administered. From 2007 to 2014, in an estimated 128.9 million US ED visits where opioids were administered, hydromorphone use increased significantly from 30.2 percent in 2007 to 36.8 percent of visits in 2014 (p = 0.027). Hydromorphone accounted for a greater proportion of opioids administered by the end of the study period, compared to other opioids. Patient characteristics associated with hydromorphone were age <65 years, white race, private insurance or Medicare, and severe pain. Patients who received hydromorphone also had indicators of higher severity illness, including more laboratory testing, procedures, and higher admission rates. Common conditions where hydromorphone was administered were headache, back pain, musculoskeletal pain, and abdominal pain. From 2007 to 2014, hydromorphone was administered to more than one in three US ED patients who were administered opioids, and several factors predicted its use. High use was found in some conditions where opioid use is inappropriate, suggesting a need for additional initiatives to promote rational prescribing of high-potency opioids.

Data Quality Improvements in National Syndromic Surveillance Program (NSSP) Data

ObjectiveReview the impact of applying regular data quality checks to assess completeness of core data elements that support syndromic surveillance.IntroductionThe National Syndromic Surveillance Program (NSSP) is a community focused collaboration among federal, state, and local public health agencies and partners for timely exchange of syndromic data. These data, captured in nearly real time, are intended to improve the nation's situational awareness and responsiveness to hazardous events and disease outbreaks. During CDC’s previous implementation of a syndromic surveillance system (BioSense 2), there was a reported lack of transparency and sharing of information on the data processing applied to data feeds, encumbering the identification and resolution of data quality issues. The BioSense Governance Group Data Quality Workgroup paved the way to rethink surveillance data flow and quality. Their work and collaboration with state and local partners led to NSSP redesigning the program’s data flow. The new data flow provided a ripe opportunity for NSSP analysts to study the data landscape (e.g., capturing of HL7 messages and core data elements), assess end-to-end data flow, and make adjustments to ensure all data being reported were processed, stored, and made accessible to the user community. In addition, NSSP extensively documented the new data flow, providing the transparency the community needed to better understand the disposition of facility data. Even with a new and improved data flow, data quality issues that were issues in the past, but went unreported, remained issues in the new data. However, these issues were now identified. The newly designed data flow provided opportunities to report and act on issues found in the data unlike previous versions. Therefore, an important component of the NSSP data flow was the implementation of regularly scheduled standard data quality checks, and release of standard data quality reports summarizing data quality findings.MethodsNSSP data was assessed for the national-level completeness of chief complaint and discharge diagnosis data. Completeness is the rate of non- null values (Batini et al., 2009). It was defined as the percent of visits (e.g., emergency department, urgent care center) with a non-null value found among the one or more records associated with the visit. National completeness rates for visits in 2016 were compared with completeness rates of visits in 2017 (a partial year including visits through August 2017). In addition, facility-level progress was quantified after scoring each facility based on the percent completeness change between 2016 and 2017. Legacy data processed prior to introducing the new NSSP data flow were not included in this assessment.ResultsNationally, the percent completeness of chief complaint for visits in 2016 was 82.06% (N=58,192,721), and the percent completeness of chief complaint for visits in 2017 was 87.15% (N=80,603,991). Of the 2,646 facilities that sent visits data in 2016 and 2017, 114 (4.31%) facilities showed an increase of at least 10% in chief complaint completeness in 2017 compared with 2016. As for discharge diagnosis, national results showed the percent completeness of discharge diagnosis for 2016 visits was 50.83% (N=36,048,334), and the percent completeness of discharge diagnosis for 2017 was 59.23% (N=54,776,310). Of the 2,646 facilities that sent data for visits in 2016 and 2017, 306 (11.56%) facilities showed more than a 10% increase in percent completeness of discharge diagnosis in 2017 compared with 2016.ConclusionsNationally, the percent completeness of chief complaint for visits in 2016 was 82.06% (N=58,192,721), and the percent completeness of chief complaint for visits in 2017 was 87.15% (N=80,603,991). Of the 2,646 facilities that sent visits data in 2016 and 2017, 114 (4.31%) facilities showed an increase of at least 10% in chief complaint completeness in 2017 compared with 2016. As for discharge diagnosis, national results showed the percent completeness of discharge diagnosis for 2016 visits was 50.83% (N=36,048,334), and the percent completeness of discharge diagnosis for 2017 was 59.23% (N=54,776,310). Of the 2,646 facilities that sent data for visits in 2016 and 2017, 306 (11.56%) facilities showed more than a 10% increase in percent completeness of discharge diagnosis in 2017 compared with 2016.ReferencesBatini, C., Cappiello. C., Francalanci, C. and Maurino, A. (2009) Methodologies for data quality assessment and improvement. ACM Comput. Surv., 41(3). 1-52.

Abstract 093: Can Hypertension Control be Improved Within a Short Time Frame? - Results From Implementing the Measure Accurately, Act Rapidly and Partner With Patients (MAP) Program

Objective: Evaluate a multifaceted quality improvement program with evidenced-based interventions for Measuring blood pressure (BP, mm Hg) accurately, Acting rapidly to manage uncontrolled BP, and Partnering with patients to promote BP self-management (MAP) in primary care. Methods: Study design : Quasi-experimental, pre-post intervention, design. BP control and BPs of uncontrolled patients were compared at baseline, February 2015[A1] to May 2016, at the last visit of the next 6 months.. Measure accurately included training staff in BP measurement. If attended BP was ≥140/90, unattended, automated office (AO) BP was obtained. Act rapidly included intensification of BP meds when unattended AOBP was ≥140/90 assessed by percent of visits with uncontrolled BP and no treatment change (therapeutic inertia). Partner with patients including BP self-monitoring and using low-priced generic BP meds assessed indirectly by the fall in systolic BP (SBP) per therapeutic intensification. Population Studied: Hypertensive patients (21,035) from 16 practices who had a visit during the baseline period and either no visit (4,691) or at least one visit (16,344) during the program. Results: BP control rose from 65.6% (13,790 of 21,035) to 74.8% (12,234 of 16,344) (p&lt;.001); 12 of 16 practices had significant increases in BP control. In uncontrolled patients at baseline, mean SBP/DBP fell from 149/85 to 139/80 (p&lt;.001/p&lt;.001). Measure accurately lowered SBP 12.8 mm Hg (p&lt;.001) in uncontrolled patients with better technique in attended BP reducing SBP ≥6.5 mm Hg per practice; while unattended AOBP lowered SBP 8.6 mm Hg (p&lt;.001). Therapeutic inertia was unchanged (50.2% vs. 48.4%; p=.10); the mean fall in SBP per therapeutic change increased from 5.4 to 14.0 mm Hg (p&lt;.001). Conclusions: MAP was associated with significant improvement in hypertension control in primary care during a six-month period. The decrease in SBP and improved control were largely explained by Measure accurately and Partner with patients as therapeutic inertia (Act rapidly) did not change. Evidence-based strategies in MAP provide opportunities for primary care practices to quickly improve hypertension control toward the national goals of 80%, and importantly to reduce cardiovascular risk.

PP.15.03] MEASURE ACCURATELY, ACT RAPIDLY AND PARTNER WITH PATIENTS (MAP) IMPROVES HYPERTENSION CONTROL

Objective: A quality improvement program to improve hypertension control with evidenced-based interventions for Measuring blood pressure (BP, mmHg) accurately, Acting rapidly to manage uncontrolled BP, and Partnering with patients to promote self-management of BP (MAP) was implemented in 2016 in a Family Medicine residency in South Carolina, United States. Design and method: Hypertensive patients were included in the study if they had a visit in the year before intervention (baseline period) and at least one visit during the six-month intervention period. Omron HEM-907 devices were used to measure BP with a checklist for positioning; if initial BP was > = 140/90, the automated office BP (AOBP) device was used to measure three additional BPs one minute apart with the patient alone in the examination room (measure accurately) and display the AOBP mean. When AOBP mean was > = 140/90, intensification of antihypertensive medications (act rapidly) took place and was assessed by the percent of visits with uncontrolled BP and no treatment change (therapeutic inertia). Facilitating BP self-monitoring and using affordable generic medications (partner with patients) was assessed indirectly by a reduction in systolic BP (SBP) per therapeutic change. Results: 714 hypertensive adults met inclusion criteria (mean age 54.4 years, 53.8% black, 66.0% female, 50.3% Medicaid). From baseline to the last intervention visit, BP control increased from 61.2% to 88.0% (p < 0.01). Among 277 uncontrolled hypertensive patients at baseline, mean systolic/diastolic BP fell from147/88 to 131/79 (p < 0.01/p < 0.01) and 80.5% (223/277) were controlled to < 140/90. For measuring accurately, SBP was 12.7 mmHg (p < 0.001) lower among the uncontrolled group with improved technique; while AOBP measurement showed a 2.5 mmHg (p < 0.05) lower SBP. Therapeutic inertia was unchanged (44.4% vs. 38.3%; p = 0.57); the reduction in SBP per therapeutic change increased from 8.3 mmHG to 21.6 mmHG (p < 0.01). Conclusions: MAP was associated with better hypertension control in a medically underserved population. Data indicate that measuring accurately and better patient engagement, i.e., greater decrease in SBP with each therapeutic change, accounted for improved hypertension control. Plans are in place to spread the program to 40 additional practices.

Using information technology (IT) to improve communication between the emergency room and cancer clinic.

158 Background: A communication gap was identified at the Cancer Centre of Southeastern Ontario which resulted in oncologists at the cancer centre (CC) not consistently being informed when oncology patients (pt) were seen in the emergency room (ER). An automated IT notification system was developed to inform oncologists when their pt were seen in the ER. Methods: Pt who had been seen within 60 days in the CC were considered active. An IT notification system linked active CC visits and ER visits. A list was generated daily of pt that were both CC and in the ER and this was emailed through a secure system to treating oncologists. Following six months of usage an evaluation was performed which identified which pt were being seen in ER (by disease site, treatment regimen and other factors). A survey evaluated oncologist feedback regarding usefulness of this system. Results: From December 2014 to May 2015 notifications were analyzed. A total of 773 pt (12% of total active cancer patients) had an ER visit resulting in 1267 visits; 56% of pt had more than one visit. Thirty-three percent of visits result in admission to the hospital. The highest usage of the ER was palliative care (26% of pt) and hematology (29% of visits). The risk of dying in the three months following an ER visit was 20% as compared to &lt; 2% for all pt seen in the ER during that time period. Sixty-three percent of the 41 oncologists responded to a survey. The majority used this notification system (85%) and found that the report improved patient care (87%). Oncologists typically used this information to check up on pt information on the electronic medical record and if appropriate visited pt that had been admitted to hospital. Conclusions: Cancer pt who have an ER visit are now automatically being reported to the treating oncologists. This process has been able to identify at risk pt for ER visits and this information will be used to develop targeted measures for these high risk populations. The report is very popular with oncologists and is now considered standard practice at our CC.

“All faiths and none”?

Nearly 10,000 records of visits by members of the Department of Spiritual Health Care to patients in St Thomas’ and the Evelina London Children’s Hospitals were analysed. Less than one percent of patients proactively sought support from the Department. Department initiated visits raised this to over three percent, with each patient being visited nearly three times on average. Increasing the availability and awareness of Muslim and Buddhist care providers resulted in a higher proportion of visits to patients with these religious beliefs. Despite nearly a quarter to half of all patients not being religious, only four percent of visits were to these patients. This indicates that the pastoral and spiritual needs of many patients who were not religious were not being met. This should be a serious cause for concern.