Quality Of Patient Outcomes Research Articles

Expert perspectives on the active role of patients in their safety: Toward a framework using Delphi methodology.

To develop a framework for Patient Engagement in Patient Safety (PEPS) in hospital. The Delphi technique was embraced to involve a group of knowledgeable healthcare experts in the discussion and rating of the components of the PEPS framework. On a 5-point Likert scale, every item was separately rated based on the three aspects, which include applicability, clarity and validity. The PEPS framework included items with 75% or more of participants scoring 4-5 on all three aspects. Items not attaining 75% agreement on the aspects were either changed or discarded, after the group discussion and underwent another round of rerating. A total of 17 members participated in the consensus-building process. Following two rounds of rating, the consensus was reached on the final framework which consisted of 28 items in four dimensions, relating to healthcare professionals, patients, community, and helth system, and three components substituted with patient empowerment, effective communication and patient-centeredness. The development of PEPS framework is a stimulus to strengthen human resources for health capabilities, sustain a high level of quality patient outcomes, and improve the health system. Further studies to identify strategies are needed for the successful implementation of this framework.

Obesity in Patients Undergoing Lumbar Degenerative Surgery-A Retrospective Cohort Study of Postoperative Outcomes.

Retrospective cohort studying using a national, administrative database. The aim of this study was to determine the postoperative complications and quality outcomes of patients with and without obesity undergoing surgical management for lumbar degenerative disease (LDD). Obesity is a global epidemic that negatively impacts health outcomes. Characterizing the effect of obesity on LDD surgery is important given the growing elderly obese population. This study identified patients with who underwent surgery for LDD between 2007 and 2016. Patients were stratified based on whether the patient had a concurrent diagnosis of obesity at time of surgery. Propensity score matching (PSM) was then utilized to mitigate intergroup differences between patients with and without obesity. Patients who underwent three or more levels surgical correction, were under the age of 18 years, or those with any previous history of trauma or tumor were excluded from this study. Baseline comorbidities, postoperative complication rates, and reoperation rates were determined. A total of 67,215 patients underwent primary lumbar degenerative surgery, of which 22,405 (33%) were obese. After propensity score matching, baseline covariates of the two cohorts were similar. The complication rate was 8.3% in the nonobese cohort and 10.4% in the obese cohort (P < 0.0001). Patients with obesity also had longer lengths of stay (2.7 days vs. 2.4 days, P < 0.05), and higher rates of reoperation and readmission at all time-points through the study follow-up period to their nonobese counterparts (P < 0.05). Including payments after discharge, lumbar degenerative surgery in patients with obesity was associated with higher payments throughout the 2-year follow-up period ($68,061 vs. $59,068 P < 0.05). Patients with a diagnosis of obesity at time of LDD surgery are at a higher risk for postoperative complications, reoperation, and readmission.Level of Evidence: 4.

CROATIAN ADAPTATION AND VALIDATION OF THE PERCEIVED IMPLICIT RATIONING OF NURSING CARE (PIRNCA) QUESTIONNAIRE: A CROSS-SECTIONAL STUDY.

SUMMARYThe aim was to perform adaptation and validation of the Perceived Implicit Rationing of Nursing Care. Implicit delaying of nursing care is an intermediate step, linking nurses with the quality of outcomes for patients and nurses, and it is the result of prioritization of health care measures within the assigned group of patients cared for by nurses. The Perceived Implicit Rationing of Nursing Care instrument is a tool used to assess the rationing of care in nursing practice. Study participants were nurses working at hospital wards in 4 university hospitals in the Republic of Croatia. The questionnaire was filled-in by 438 nurses. Data were collected between April and November 2018. After principal axis factoring, a single factor solution based on the correlation matrix was adopted. The measured construct is one-dimensional, and the extracted factor explains 47.2% of its variance. Additionally, the reliability of the whole questionnaire was determined by using the internal consistency coefficient Cronbach alpha on the Perceived Implicit Rationing of Nursing Care with 31 of 0.96 particles, which is extremely high internal consistency reliability. In conclusion, the study found a high level of reliability and validity of the translated Perceived Implicit Rationing of Nursing Care questionnaire, fully comparable to that of the original. The questionnaire can be used to assess the phenomenon of implicit care rationing in Croatian hospitals.

IMPACT study: measuring the impact of caregiving on families and healthcare professionals of children and adults living with mucopolysaccharidoses in Ireland.

Disease trajectories are often uncertain among individuals living with mucopolysaccharidoses (MPS) due to the progressive nature of the illness and the goal of care. This study investigated the impact on caregivers and care providers of children and adults living with MPS. The study used a cross-sectional design and a convenience sampling strategy which involved two sequential study components. The stage 1 quantitative component included three validated scales: the abbreviated World Health Organization Quality of Life (WHOQOL-BREF), the Paediatric Inventory for Parents (PIP) and the 14-item Resilience Scale (RS-14). The stage 2 qualitative component consisted of two focus groups with healthcare professionals (HCPs) (n = 9) working with children and adults living with MPS across three clinical sites in Ireland. Data were collected between November 2017 and July 2019. A total of 31 parents identified as caregivers participated in this study. The mean quality of life (QoL) score was 93.81, indicating a significantly high QoL. The PIP frequency total mean was 102.74 and difficulty mean 104.94. The mean score for the RS-14 was notably high, 81.42 out of a maximum of 98. The majority of the results showed high levels of concern for the future, with just under 50% finding themselves very often feeling scared that their child's condition will deteriorate or that their child will die and finding these thoughts very difficult. The healthcare professionals' (HCPs) perceptions were focused on the complexity of MPS, coping strategies, managing expectations and support services. The overall findings of the study reinforced the need for sustained and enhanced psychological support to ensure both families of children and adults living with MPS and the HCPs are supported in the continued delivery of quality patient care and outcomes. Subjective and objective measures from family caregivers and HCPs yield results that can decrease stress and improve psychological support. Impact of caregiving on families and healthcare professionals of children and adults living with mucopolysaccharidoses in Ireland Mucopolysaccharidoses (MPS) is a group of one of the many rare inherited metabolic disorders that come under category three of life-limiting conditions. Children born with this genetic condition show no change at birth, but effects start to show in subsequent years as it is a progressive disease. The severity of the condition varies according to the specific type, ranging from very mild symptoms to, in most cases, multisystemic, restricted growth or mental and physical disabilities. Recent developments in treatments for some forms of MPS have dramatically changed the quality of life (QoL) for patients. Other forms of treatment are currently under investigation and development. This study aimed to provide a detailed and reliable evidence base on the impact of caregiving for patients living with MPS on family caregivers and healthcare providers. Paper questionnaires were completed by the family caregivers of children and adults living with MPS. These three questionnaires focused on measuring QoL, parental stress and anxiety, and resilience among these families. Two focus group interviews were carried out with healthcare professionals working with children and adults living with MPS across three clinical sites in Ireland.A total of 31 parents completed the questionnaires in this study, indicating a significantly high QoL and notably high resilience. The majority of the parental stress results were related to concern for the future, with just half of the families finding themselves very often scared that their child's condition will deteriorate or that their child will die and find these thoughts very difficult. The healthcare providers also spoke about the complexity of MPS, coping strategies, managing expectations and support services for the families of children and adults living with MPS. This study provided evidence for clinicians and policymakers to improve the availability of appropriate healthcare provisions for people living with MPS and their families.

263. An Evaluation of Quality Indicators for the Management of Staphylococcus aureus Bacteremia: A Nested Case-Control Study

BackgroundCommunity-acquired Staphylococcus aureus bacteremia (CA SAB) is a common infection with high mortality. Ten Oever et al. recently used expert consensus methods to develop a set of 25 quality indicators for SAB care in five domains (i.e., follow up blood cultures, echocardiography, non-antibiotic interventions including source control, antibiotic treatment, and other management aspects). Associations between these quality indicators and patient outcomes have not been evaluated. We assessed associations between proposed quality indicators and all-cause 30-day mortality among patients with CA SAB.MethodsWe conducted a nested case-control study within a described national multicenter cohort of patients with SAB in the Veterans Health Administration (VHA). The cohort included 2,093 patients who were: 1) admitted to acute care hospitals between 1/2012 and 12/2014 for CA SAB (the first positive blood culture before or within 48 hours of admission with no recent healthcare exposure); 2) survived at least 96 hours after the SAB onset. We identified paired cases (who died within 30 days) and controls (who survived an equal time), matched 1:1 for age (+/- 5 years), gender, admission year and month, and methicillin susceptibility of isolates. We reviewed charts to extract information for quality indicators. We estimated associations between quality indicators and mortality using logistic regression, adjusting for patient demographics and comorbidity.Results164 patients (82 cases and 82 controls) were included. The median patient age was 68.5 (IQR: 62–80) years, and 74 (45.1%) had methicillin-resistant isolates. All patients received at least one domain of quality indicator (median: 3 [IQR: 2–4]). When analyzed individually, only two domains (follow-up blood cultures: OR 0.27 [95% CI: 0.11–0.68]; source control: OR: 0.13 [0.05–0.31]) were associated with mortality. There was a dose-response relationship in which more domains received was associated with decreased mortality (Figure).Association Between the Number of Satisfied Quality Indicator Domains and All-Cause 30-day Mortality ConclusionAmong patients with CA-SAB, the number of satisfied quality indicator domains was associated with 30-day mortality with a dose-response relationship. This finding supports the relevance of these quality indicators for SAB management.Disclosures All Authors: No reported disclosures

Clinic- and Hospital-Based Home Care, Outpatient Parenteral Antimicrobial Therapy (OPAT) and the Evolving Clinical Responsibilities of the Pharmacist.

Clinic- and hospital-based home care describes models of care where services commonly associated with hospital inpatient care are provided at the patient’s home or in an outpatient or community-based clinic. Hospital in the Home (HITH), also termed Hospital at Home (HaH) in parts of Europe and America, is a common and important example of this type of care. Other examples include infusion centers, skilled nursing facilities (particularly in the USA), self-administration models (including home infusion services) and administration through outpatient or community clinics. Different models of HITH care are used internationally and these encompass a wide range of services. Medication administration, particularly outpatient parenteral antimicrobial therapy (OPAT), is an important element in many of these models of care. There is a key role for pharmacists since the provision of medication is integral in this model of patient care outside the hospital setting. Data on the growing importance of HITH and OPAT as well as the administration of medications suited to clinic- and hospital-based home care, including subcutaneous and intramuscular injectables, immunoglobulins and other blood fractions, cancer chemotherapy, total parenteral nutrition, biologicals/biosimilars, vasopressors and enzymes, using differing service models, are described. The pharmacist’s role is evolving from that involved primarily with dose preparation and supply of medications. Their clinical expertise in medication management ensures that they are an integral member and leader in these models of care. Their role ensures the safe and quality use of medicines, particularly across transitions of care, with the pharmacist taking on the roles of educator and consultant to patients and health professional colleagues. Activities such as antimicrobial stewardship and ongoing monitoring of patients and outcomes is fundamental to ensure quality patient outcomes in these settings.

Abstract PO-028: Role of community outreach activities in cancer prevention in Kenya

Abstract Background: International Cancer Institute (ICI) is a leading organization with a pro- actively evolving approach in care, research, training and advocacy with a focus on cancer control in sub-Saharan Africa. ICI was started in May 2019 and is working in more than 15 counties in Kenya. The goal of ICI is to produce quality patient outcomes working with a team of highly qualified healthcare professionals. Treatment and care for Non-Communicable Diseases (NCDs) in sub-Saharan Africa and specifically for cancer is expensive and not accessible to the entire population. There is evidence that most cases are diagnosed at stage 3 and 4 making intervention options minimal at that level. However, early screening for cancers ensures early diagnosis as well as awareness creation on the need for continuous screening. Aim: To conduct community outreach activities with an aim of promoting prevention, early diagnosis and linkage to care for cancer. Strategy: ICI, using advocacy, as one of its core pillars, raises awareness at local and national levels through mass public health education on NCDs and screening. This is conducted by the ICI outreach team which is multidisciplinary and includes Clinicians, an Oncology Pharmacist, an Oncology Nurse, a Palliative care Nurse, a Patient Care coordinator, a Monitoring and evaluation expert, Program management technical experts, Data management expert as well as a Histotechnician. The ICI team works with counties to develop and plan for community mass screening events. Program Process: Counties partner with ICI for support in the establishment of county NCD treatment and care programs. A technical working group (TWG) with representatives from both the County health management team and ICI is then formed to guide the integrated NCD program implementation process. Outcomes: Establishment of comprehensive cancer centers where routine screening for cervical, breast and prostate cancers as well as diabetes and hypertension can be done in addition to diagnosis and treatment at county level. Coordination of community mass screening events in selected sub-county hospitals is then done from the established cancer centers. The integrated NCD program partnership offers capacity building for County healthcare providers (HCPs) through mentorship and skills training in cancer screening, diagnosis, treatment, palliative care and survivorship. Conclusion: Comprehensive community outreach activities are avenues for awareness creation and early detection of cancers. Integrated NCD programs incorporating diabetes and hypertension in cancer programs creates wider community impact and plays a great role in reducing the number of cases being diagnosed at late stages. Citation Format: Gloria Kitur, Emmah Achieng, Fredrick Chite Asirwa, Edwin Odoyo, Andrew Koech. Role of community outreach activities in cancer prevention in Kenya [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-028.

Trends in Utilization and Perioperative Outcomes in Robotic-assisted Bariatric surgery using the MBSAQIP database: A 4-Year Analysis.

Robotic-assisted surgery has become increasingly popular across surgical subspecialties. We aimed to analyze trends in the national utilization and outcomes in bariatric surgery. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®) data for 2015-2018 was queried. We included robotic-assisted sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), adjustable gastric band (AGB), biliopancreatic diversion with duodenal switch (BPD-DS), and revisional cases. The Kruskal-Wallis test or Wilcoxon rank-sum were used for comparing continuous variables and Cochran-Armitage trend analysis for categorical variables when comparing years, or with Fisher's Exact Test when directly comparing categories. Of 760,076 bariatric cases performed between 2015 and 2018, 7.4% with robotic and 90.4% with laparoscopic approach. SG constituted 61.3% of robotic volume. Utilization of robotic surgery increased 1.96-fold; SG represented the most substantial increase of 2.16-fold, followed by a 1.53-fold in RYGB. The 30-day readmission and re-intervention rates decreased from 5.63% to 4.78% (p<0.01), and 2.31% to 1.46% (p<0.01), respectively. The overall leak rate improved from 0.64% to 0.39% (p=0.01). Mortality and re-operations remained statistically unchanged. When compared to laparoscopic approach, the operative time were significantly longer in the robotic group. Regarding postoperative outcomes, when adjusted for patient characteristics, there were no differences between two approaches except a higher leak rate in robotic group in 2015. A steady increase in robotic bariatric surgery is apparent. While the operative time remains significantly longer in the robotic group, trends indicate improvement in key quality metrics and patient outcomes as utilization increases.

Telemedicine in the intensive care unit: A vehicle to improve quality of care?

The high demand for intensive care, which is predicted to further increase in the future, is contrasted by a shortage of trained intensivists and specialized nurses. Telemedicine has been heralded as a promising solution. Yet, there is considerable heterogeneity in tele-critical care when it comes to measurable effects. However, the focus has been on telemedical solutions substituting on-site intensivist functions, and outcome measures have primarily been mortality and length of stay. In a new model of telemedicine for the ICU, telemedicine could be used to increase adherence to best practice guidelines and indicators of process quality. Further, indicators of process quality, functional outcomes and quality of life measures should be incorporated in the evaluation of outcomes, as patients frequently value those higher than mere survival.

The intersection of pharmacy leadership and management with clinical skills: Education plays a key role

IntroductionClinical pharmacy service expansion is a challenge of scalability, and education can play a big part in the profession's transition to patient care. Underdeveloped staff management and leadership skills may prohibit scalability of innovative patient care service models observed in research and academic pharmacy environments. CommentaryIn today's rapidly evolving healthcare industry, formal education in leadership and management may provide the prerequisite skills for frontline pharmacists to innovate and scale clinical care services thereby improving quality patient outcomes. One important component of this is the use of pharmacist-extenders and team-based task delegation to eliminate technical tasks from the pharmacist's workload and maximize time spent in functions requiring professional judgment. ImplicationsThe Academy should develop leadership and management skills in tandem with patient care-related skills to optimize care delivery. Specifically, pharmacy educators should lean into concepts of organizational behavior and evidence-based management. The future of pharmacy is highly dependent on future pharmacist leaders; development of successful leaders is imperative to the profession of pharmacy.

Legacy of COVID‐19 – the opportunity to enhance surgical services for patients with colorectal disease

The COVID-19 crisis has undoubtedly taken a toll on the care of patients with colorectal disease. Elective services, be that face to face contact, endoscopy or operating all but ceased during the pandemic.

General Surgery Residency and Emergency General Surgery Service Reduces Readmission Rates and Length of Stay in Nonoperative Small Bowel Obstruction.

Nonoperative management of adhesive small bowel obstruction (ASBO) results in resolution for the majority of patients. Previous studies have demonstrated that outcomes for patients with ASBO are improved when patients are admitted to a surgical service, but the effect of general surgery resident coverage is unclear. This study measures quality outcomes for patients with ASBO after the establishment of a new general surgery residency program. An institutional review board-approved retrospective chart review of admissions for ASBO was conducted following the implementation of a protocol for ASBO nested within a newly developed resident-run emergency general surgery (EGS) service. Patients successfully treated without operative intervention were analyzed. During the study period, 612 patients were admitted for ASBO. After initiation of the residency, 74% of ASBO were admitted to a surgical service compared with 35% prior to residency (P < .01). Length of stay was reduced by 0.77 days (P = .016), average direct total cost per patient was reduced by 24% (P = .002), and 30-day readmissions were reduced by 35.7% (P = .046). There was no significant difference in mortality (1.4% vs 1.0%). Admission to a resident-run surgical service was associated with statistically significant improvement in outcomes for patients with ASBO. These data corroborate prior studies demonstrating the positive impact of residency programs on patient outcomes and provide additional evidence that general surgery residency programs improve outcomes for patients with surgical disease.

Factors Related to the Clinical Competence of Registered Nurses: Systematic Review and Meta-Analysis.

To determine the factors associated with the clinical competence of registered nurses. Systematic review and meta-analysis was used. The search strategy was limited to 10 years, ranging from January 2009 to December 2019, in Science Direct, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, ProQuest, and Google Scholar. A meta-analysis was performed using R Studio with the metafor package (Boston, MA, USA; https://rstudio.com/products/rstudio/older-versions/). A total of 22 studies were included, representing 33,961 nurses. There were 28 factors associated with clinical competence. Of those, 13 factors were significantly supported and included for meta-analysis, grouped into (a) individual-related factors, (b) job satisfaction, (c) bullying, (d) burnout, and (d) specific knowledge. The effect size of those factors ranged from -0.14 to 0.50. Among individual-related factors, salary has the largest effect size on competence and is considered important. Clinical competence is positively affected by job satisfaction, but negatively influenced by bullying and burnout. Although specific knowledge has a large effect size, it does not significantly affect the clinical competence of registered nurses. It is critical to understand factors related to the clinical competence of registered nurses to maintain quality care and patient outcomes in clinical settings. The findings serve as data to help nurse managers find effective ways to improve the knowledge, skill, attitudes, and performance of registered nurses.

An educational collaboration for student nurse engagement on the essential skill of delegation

A common goal for healthcare providers and nursing faculty is the provision of effective delivery of care and safe practice settings. Decisions around the delegation of care are critical for quality patient outcomes. The purpose of this collaborative project between schools of nursing and a local community healthcare facility was to provide educational training to prelicensure nursing students on the delegation expectations for nursing professionals.

Complications, Costs, and Quality Outcomes of Patients Undergoing Cervical Deformity Surgery With Intraoperative BMP Use.

An epidemiological study using national administrative data from the MarketScan database. The aim of this study was to identify the impact of bone morphogenetic protein (BMP) on postoperative outcomes in patients undergoing adult cervical deformity (ACD) surgery. BMP has been shown to stimulate bone growth and improve fusion rates in spine surgery. However, the impact of BMP on reoperation rates and postoperative complication rate is controversial. We queried the MarketScan database to identify patients who underwent ACD surgery from 2007 to 2015. Patients were stratified by BMP use in the index operation. Patients <18 years and those with any history of tumor or trauma were excluded. Baseline demographics and comorbidities, postoperative complication rates, and reoperation rates were analyzed. A total of 13,549 patients underwent primary ACD surgery, of which 1155 (8.5%) had intraoperative BMP use. The overall 90-day complication rate was 27.6% in the non-BMP cohort and 31.1% in the BMP cohort (P < 0.05). Patients in the BMP cohort had longer average length of stay (4.0 days vs. 3.7 days, P < 0.05) but lower revision surgery rates at 90 days (14.5% vs. 28.3%, P < 0.05), 6 months (14.9% vs. 28.6%, P < 0.05), 1 year (15.7% vs. 29.2%, P < 0.05), and 2 years (16.5% vs. 29.9%, P < 0.05) postoperatively. BMP use was associated with higher payments throughout the 2-year follow-up period ($107,975 vs. $97,620, P < 0.05). When controlling for baseline group differences, BMP use independently increased the odds of postoperative complication (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.1-1.4) and reduced the odds of reoperation throughout 2 years of follow-up (OR 0.49, 95% CI 0.4-0.6). Intraoperative BMP use has benefits for fusion integrity in ACD surgery but is associated with increased postoperative complication rate. Spine surgeons should weigh these benefits and drawbacks to identify optimal candidates for BMP use in ACD surgery. 3.

Home sweet home? How home health aide compensation, benefits and employment security influence the quality of care delivered by home health organizations.

The number of home health care organizations has grown, and the number of home health aide jobs is among the fastest growing, drawing attention to the home health care industry. Despite increased transparency into the quality of care delivered by home health care organizations, less is known about how organizational work practices directed at home health aides, who work remotely on the frontlines of providing caring home health services, impact quality. We examine how an organization's benefits and compensation practices for home health aides, as well as changes to home health aide employment security within the organization, impact the quality of care delivered by home health care organizations. We conduct a large-scale longitudinal archival study of Medicare-certified home health organizations using a fixed-effects specification to test the effects of home health aide benefits equality and compensation on the quality of patient outcomes within home health organizations. In addition, we use the proportion of contract home health aides to test moderating effects of employment insecurity. Benefits equality positively impacts quality, whereas compensation has a negative relationship with quality. However, when an organization increasingly utilizes contract aides, the positive effect of benefits equality on quality is weaker, whereas under these same conditions, compensation has a positive relationship with quality. Compensation and benefits practices impact quality, and the effect these practices have on quality varies under conditions of employment insecurity created by the organization's use of contract home health aides. Home health organizations should employ a nuanced approach to improving quality, increasing compensation to permanent home health aides when the organization increases their use of contract home health aides and equally distributing benefits to home health aides when the organization does not rely as heavily on contract home health aides.

Exploring the use of curbside consultations for interprofessional collaboration and clinical decision-making

ABSTRACT Nurse practitioners utilize curbside consultation, an interprofessional collaboration communication process in which one clinician seeks advice from another, in clinical decision-making practices. Nevertheless, this process is not well-understood. A qualitative design with individual open-ended interviews was used to explore the phenomenon of curbside consultation among nurse practitioners for clinical decision-making. Twenty primary care and specialty nurse practitioners participated. Participants were recruited via purposive sampling from in-patient and out-patient settings in order to reach saturation of themes. Using inductive content analyses, the findings revealed that nurse practitioners made multiple decisions in the course of information-seeking and its application during the curbside consultation process. Motivated by the patient’s best interest, nurse practitioners provided advice in the curbside consultation exchange and sought answers to questions encountered in clinical decision-making. Multiple resources were often utilized with curbside consultation frequently evolving into formal consultation. Dynamics of curbside consultation included (a)synchronous approaches including text, e-mail, telephone, or face-to-face processes. Once information was received, nurse practitioners decided whether they (dis)agreed with advice and if validation was necessary. Nurse practitioners utilized curbside consultation for clinical decision-making and means for interprofessional collaboration, thereby increasing clinical competency and promoting quality patient outcomes. Implications of curbside consultation for education and practice require further exploration to enhance outcomes of curbside consultation processes.

Impact of Providing Data on Family Medicine Practice Management Education.

Residents need to learn about practice management, including how to improve the quality of their patient care utilizing practice data. However, little is known about the effectiveness of providing practice data to residents. This study examined the effectiveness of utilizing resident practice management reports. We provided residents quarterly practice management reports with individual resident data on coding compliance (determined by manual chart review by a certified coder), clinical productivity (number of clinic sessions, visits per session, relative value units [RVUs] per visit, and RVUs per session), and patient quality outcomes (rates of diabetes mellitus control, diabetic nephropathy screening/management, hypertension control, influenza immunization, pneumococcal immunization, and colorectal cancer screening). We compared all data to national metrics. Quality outcome data was also provided by clinical team and with comparison to nonresidency departmental clinics. We surveyed residents before and after receiving these practice management reports to determine how they felt it prepared them for future practice (on a 9-point Likert scale). There was significant improvement in the ability to implement clinic-based processes to improve patient care (6.5 vs 5.6; P=.04) and learning about clinical productivity/financial aspects of practicing family medicine (6.3 vs 5.4; P=.03). Other areas had trends of improvement, although not statistically significant. Providing residents with their clinic practice data, with reference to team practice data and national benchmarks further helps them learn and apply practice management, when superimposed on an existing infrastructure to teach practice management.

Adapting STEMI care for the COVID-19 pandemic: The case for low-risk STEMI triage and early discharge.

The coronavirus pandemic has resulted in the need for rapid assessment of resource utilization within our hospital systems. Specifically, the overwhelming need for intensive care unit (ICU) beds within epicenters of the pandemic has created a need for consideration as to how acute coronary syndrome cases, and specifically ST‐elevation myocardial infarction (STEMI) patients, are managed postprocedure. While most patients in the United States continue to be managed in coronary care units after primary percutaneous coronary intervention, there is a robust literature regarding the ability to triage STEMI patients safely and efficiently with low‐risk features to non‐ICU beds. We review the various risk scores for STEMI triage and the data supporting their usage. In summary, these findings support an approach to low‐risk STEMI triage that does not come at the expense of quality patient care or outcomes, where up to two‐thirds of patients with STEMI may be able to be safely managed without ICU‐level care.

662-P: Oral Health: Neglected Diabetes Intervention

Oral health and diabetes can be mutually detrimental, Diabetes Education guidelines encourage good oral health practices: brushing, flossing and visiting dentist. We assessed the quality of patient outcomes and behaviors and provider support for oral health in a public hospital specialty diabetes (DM) clinic. Patients (n=99) completed waiting room surveys on oral health history, practices, barriers and knowledge. For quality assessment, providers completed self-administered surveys on their visit discussions for oral health. Population was 54% male, had mean age 59 yr and mean DM duration 13 yr, 24% had completed &amp;lt; 12th grade, 23% were current smokers, and 36% had some dental coverage. While most patients knew good oral health practices, only a minority followed them. This was reflected in tooth loss and oral problems. Most patients knew DM causes dental problems (75%) and dental problems could worsen DM (60%). Most (93%) reported they should brush 2 or more times per day, only 51% did that; (74%) believed in at least once daily flossing but only 31% did so; 82% said they should visit a dentist 2 or more times a year, only 17% did so. Access to dental care was a major issue: 66% reported cost and 11% time as barriers to dental visits. Brushing barriers included: time – 23%, forget – 11%, “don’t know”/”lazy” – 11% and tired – 7%. Good oral health practices decreased with age and tooth loss but increased with higher education. Only 17% utilized charity or sliding scale clinics. They had lost median of 7 teeth and 13% were completely edentulous. In past year 40%, had tooth ache, 30% bleeding gums, 20% loose teeth, and 28% decayed teeth. Provider support was low. Per the provider survey a minority (&amp;lt;30%) discussed the 3 oral health practices with half or more of patients. Patient oral health outcomes and practices are poor. Knowledge is not a major barrier. Oral health is associated with better DM control and quality of life, but intervention and support may be neglected by providers. DM Clinics must assess and improve oral health practices and education. Disclosure D.C. Ziemer: None. C.S. Barnes: None. R.S.M. Rupasinghe: None. S. Khare: None.