Specialty Care Services Research Articles

Trauma exposure and disclosure in Hispanic youth at clinical high risk for psychosis: A retrospective review study.

This exploratory study aimed to examine differences in rates of self and clinician-reports of trauma in youth at clinical high risk for psychosis (CHR) and whether rates of reporting differed by ethnicity. Self-reported history of trauma was collected at intake amongst youth at CHR enrolled in Coordinated Specialty Care (CSC) services (N = 52). A structured chart review was conducted for the same sample to identify clinician-reported history of trauma throughout treatment in CSC. For all patients, frequency of self-reported trauma at intake to CSC (56%) was lower compared to clinician-reports of trauma throughout treatment (85%). Hispanic patients self-reported trauma at intake (35%) less frequently than non-Hispanics (69%) (p = .02). No differences were found in clinician reported exposure to trauma by ethnicity throughout treatment. Whilst further research is needed, these findings suggest the need for formalised, repeated, and culturally appropriate assessments of trauma within CSC.

Cognitive enhancement interventions are effective for schizophrenia: why not provide them early?

Cognitive enhancement interventions are effective for schizophrenia: why not provide them early?

Abstract P5-07-06: Prospective cohort of breast cancer patients exposed to a navigation program for timely access to referral services in Mexico

Abstract Background: Patient navigation (PN) is an essential component of cancer care that reduces barriers and enhances the provision of comprehensive, patient-centered care. PN programs and evidence regarding their effectiveness in low- and middle-income countries are limited. This study aimed to assess whether a PN program for the systematic identification of breast cancer (BC) patients’ medical and support needs facilitated referral and timely access to the specialty and supportive care services they required. Methods: This prospective cohort included women ≥18 years with a recent BC diagnosis (≤3 months [m]), treated at Hospital Zambrano Hellion TecSalud in Mexico, and who provided signed informed consent to participate in the PN program from Apr-21 to Jul-22. Participants completed a series of target questions and validated questionnaires to systematically identify their health needs at baseline, 3 m and 6 m since diagnosis. Subsequently, the navigator had a face-to-face or remote meeting with each patient to inform them about the needs detected at each timepoint. According to these needs, the navigator provided referral to the required services. However, it was each patient’s decision whether she attended to the recommended services. Patients’ attendance to referrals provided at baseline and 3 m were assessed at 3 m and 6 m, respectively. Descriptive statistics were employed. Results: During the analyzed period, 263 patients were invited to participate in the study. Of these, 161 (61%) agreed to participate, 57 (22%) agreed but did not complete any survey, and 45 (17%) denied participation. At the time of the analysis, 148, 119 and 86 patients had completed baseline, 3 m and 6 m navigation, respectively. Median time from BC diagnosis to the baseline navigation meeting post survey-completion was 46 days (12-90). Patients’ median age at baseline was 48 years (24-88). Most had ≥high school education (93%), were unemployed (51%) and were married/in domestic partnership (73%). As for medical insurance, most had public (32%) or both public and private coverage (32%), while the rest had private (26%) or no insurance (9%). Patients’ referrals according to their needs and the rate of attendance to those services are detailed in the Table. The main barriers that were qualitatively identified for non-attendance to referral services were time restrictions, patient-provider miscommunication, medical coverage limitations, and financial constraints. Feedback regarding the PN program was provided in 72 cases. All respondents were very satisfied (97%) or satisfied (3%) with the program; affirmed the navigator had facilitated their referral to all (97%) or some (3%) of the services they believed they needed; and stated that the program aided to better cope with their illness (100%). Conclusion: Patients experienced diverse health needs during their trajectory through BC, mainly in terms of psychological support, genetic counseling, maintenance of an adequate weight and access to support groups. However, a suboptimal proportion of patients received attention by the required services. This PN program effectively detected patients’ needs and provided referrals to specific services. Moreover, patients were highly satisfied with the program and believed it aided their coping process. Yet, several barriers that hinder attendance to the referral services might exist and should be identified to enhance the provision of timely, comprehensive care. Table. Patients’ referral and attendance to specialty and supportive care services. Citation Format: Fernanda Mesa-Chavez, Emmeline Rochelle-Palacios, Mauricio Canavati-Marcos, Cynthia Villarreal-Garza. Prospective cohort of breast cancer patients exposed to a navigation program for timely access to referral services in Mexico [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-07-06.

Facing Healthcare Access Challenges With Specialty Care Clinics in Central Appalachia

Access to specialty care and diagnostic services in rural healthcare settings are required to achieve quality healthcare outcomes. St. Mary’s Health Wagon network of free clinics, established in 1980, serves a region with an array of health disparities and poor social determinants of health. In 2018, the administration envisioned implementation of an interprofessional team to deliver diagnostic services targeting healthcare access challenges in southwest Virginia, which is historically unprecedented. The cost of diagnostic services in the area was not equitable for the poor, uninsured, and underinsured. Many patients had to use the emergency department for radiologic exams, incurring more debt that cannot be afforded or paid or simply forgoing needed diagnostic services. The leadership team applied for and secured a United Health Foundation Grant that fulfilled their vision, employing ultrasound, diagnostic x-ray, mammogram, telecystoscopy, telecolposcopy, and dental visits into the network of clinics. To date, St. Mary’s Health Wagon has performed 3,587 exams (342 ultrasounds, 282 x-rays, 273 mammograms, 21 telecystoscopies, 16 telecolposcopies, and 2,669 dental visits) free of cost for the patients. While there were some challenges with the implementation of these services, the benefits yielded quick diagnosis and treatment, leading to optimal patient outcomes.

Does use of primary care-based behavioral health programs differ by race and ethnicity? Evidence from a multi-site collaborative care model

BackgroundCollaborative care models (CoCM) that integrate mental health and primary care improve outcomes and could help address racial and ethnic mental health disparities. We examined whether use of these programs differs by race/ethnicity. MethodsThis retrospective study examined two CoCM interventions implemented across primary care clinics in a large health system in Massachusetts: 1) a primary care-based behavioral health program for depression or anxiety (IMPACT model) and 2) referral to community-based specialty care services (Resource-finding). Outcomes included enrollment, non-completion, and symptom screening rates, and discharge status for Black, Hispanic and White patients referred for CoCM, 2017–2019. ResultsBlack and Hispanic vs. White patients referred to CoCM (n = 17,280) were more likely to live in high poverty ZIP codes (34% and 40% vs. 9%). Rates of program enrollment, non-completion, and symptom screening were similar across groups (e.g., 76%, 77%, and 75% of Black, Hispanic, and White patients enrolled). Hispanic vs. White patients were more likely to be enrolled in IMPACT (56%) vs. Resource-finding (43%). Among those completing IMPACT, Hispanic vs. White patients were more likely to be stepped to psychiatry vs. discharged to their primary care provider (51% vs. 20%, aOR = 1.55, 95% CI: 1.02–2.35). ConclusionsBlack and Hispanic patients referred to CoCM were similarly likely to use the program as White patients. Hispanic patients completing IMPACT were more frequently referred to psychiatry. ImplicationsThese results highlight the promise of CoCMs for engaging minority populations in mental healthcare. Hispanic patients may benefit from additional intervention or earlier linkage to specialty care.

Systematic CKD Care Approaches: A Potential Solution for the Costly ESRD Program

Care of patients with advanced kidney disease includes dialysis, kidney transplant, vascular access, primary care, and other specialist care, which are often siloed among multiple physicians, dialysis clinics, vascular access centers, and health system or hospital-based transplant programs. Other than the patient themselves, no one provider has holistic patient visibility or responsibility. Given that hospitals often lose money on Medicare patients who require dialysis services, momentum from innovation in advanced kidney care management, new technology with the potential for reduced costs, expansion of Medicare Advantage, and Medicare incentives for home dialysis could be leveraged by health systems to ultimately reduce the nearly $50 billion annual Federal spending on patients with kidney failure in the United States. Health systems, which offer many primary and specialty care services, may be uniquely positioned to leverage the more favorable economics associated with these changes to move kidney care from siloed, provider-centric care to integrated, patient-centric care. With 60% of patients initiating dialysis through an unplanned hospitalization, a holistic health system approach that includes offerings of kidney care management and kidney replacement therapy could move financial incentives away from the interests of any single provider and toward better addressing the total needs and the goals of the patient.

S3448 Amyloidosis Diagnosed by the GI Doctor

Introduction: Amyloid light-chain (AL) amyloidosis is the most common form of amyloidosis and is the main type to involve the gastrointestinal tract. Monoclonal Gammopathy of Undetermined Significance (MGUS) is a Plasma Cell Dyscrasia (PCD) with potential to precipitate amyloidosis. Our patient presented with a constellation of signs and symptoms that lead to his diagnosis. Case Description/Methods: A 59-year-old man with a history of Hemoglobin S-C presented with recurrent admissions to our hospital for new-onset orthostasis, weight loss, and dyspnea progressing over a 9 month period. Physical exam was unimpressive at the first presentation. Labs were significant for a NT-Pro BNP of 17,100 pg/ml. Echocardiography and cardiac MRI showed a restrictive filling pattern with preserved ejection fraction, however a specific etiology was not identified. Serum immunofixation revealed monoclonal IgA light chain proliferation. Bone marrow biopsy confirmed MGUS. The patient later developed epigastric pain with associated chronic watery diarrhea, peripheral edema, and hypoalbuminemia. A CT demonstrated colonic wall thickening with trace abdominal ascites. Enteroscopy revealed severe inflammation of the duodenum and jejunum characterized by edema, friability, scalloping, and diffuse petechiae. Colonoscopy showed similar but patchy involvement throughout. Histology was initially inconclusive. However, our suspicion remained high so slides were sent to a GI specialty lab. Pathology ultimately demonstrated immunoglobulin light chain lambda amyloidosis. He developed nephrosis as well. A work-up for autoimmune, infectious, and malignant causes was negative. The patient was ultimately transferred to a nearby hospital with specialty care services. (Figure) Discussion: AL amyloidosis develops as a result of monoclonal light chain deposition in various tissues. The cardiac and renal systems are most commonly involved. The main causes include PCDs and autoimmune illnesses. The diagnosis is often delayed. It should be suspected in a patient who presents with restrictive cardiomyopathy or otherwise unexplained heart failure. Our patient’s illness manifested as restrictive cardiomyopathy and likely protein losing enteropathy. MGUS can precede amyloidosis by about 12 years so this was an important finding. Initial GI biopsies were inconclusive but ultimately cinched the diagnosis, highlighting the importance of remaining skeptical. Treatment is aimed at the underlying cause.Figure 1.: Endoscopy Images.

Regional well-being inequalities arising from healthcare expenditure public policies in Spain.

Well-being inequalities arising from different healthcare expenditure public policies is currently a hot topic at a national scale, but especially so at a sub-national level because the inequalities in question are among citizens of the same country. Spain is an optimal study area to carry out research on this topic because it is considered to have one of the best health systems in the world, it is one of the top-ranking countries in terms of life expectancy rates (the indicators we use for well-being), and it has a decentralized public health system with significantly different regional healthcare expenditure public policies. Given that the factors involved in the complex direct, indirect, and second-order relationships between well-being and health spending are latent in nature, and that there are more hypotheses than certainties regarding these relationships, we propose a partial least squares structural equation modeling specification to test the research hypotheses and to estimate the corresponding impacts. These constructs are proxied by a set of 26 indicators, for which annual values at a regional scale were used for the period 2005–2018. From the estimation of this model, it can be concluded that mortality, expenditure and resources are the factors that have the greatest impact on well-being. In addition, a cluster analysis of the indicators for the constructs included in this research reveals the existence of three clearly differentiated groups of autonomous communities: the northern part of the country plus Extremadura (characterized by the lowest well-being and the highest mortality rates), Madrid (with the best results in well-being and mortality, the lowest public health expenditure per inhabitant and percentage of pharmaceutical spending, and the highest percentage in specialty care services and medical staff spending), and the rest of the country (south-eastern regions, with similar well-being values to those of the first group but with less health expenditure). Finally, a principal component analysis reveals that “healthiness” and “basic spending” are the optimal factors for mapping well-being and health spending in Spain.

Experiences of individuals receiving a sex chromosome multisomy diagnosis.

Sex chromosome multisomies (SCMs) are genomic conditions with variable phenotypes that range from undetectable to requiring extensive clinical intervention. Currently, many individuals with SCMs are diagnosed in adolescence or adulthood based on physical symptoms related to pubertal development and infertility. Given the expansion of genetic testing in routine clinical practice, the diagnosing clinician is increasingly a primary care or family medicine provider. This study aims to help providers better understand the patient experience of receiving a diagnosis. We conducted a survey of individuals (n = 55) with SCMs using closed and open-ended questions. Open-response questions were qualitatively analyzed and are reported here with the descriptive results of the closed-ended questions. Most participants were diagnosed with 47,XXY (n = 51; 85.0%), identified as White race/ethnicity (n = 46; 88.5%), and were college graduates or higher (n = 29; 54.7%). Many participants reported dissatisfaction with the delivery of the diagnosis, expressing that it was rushed and their provider lacked detailed information about the condition. Participants were frustrated by the general lack of availability of high-quality informational resources from both medical and other sources at the time of diagnosis. Some participants also described the social and psychological impact of the diagnosis and how it was delivered. To the best of our knowledge, this is the largest survey of individuals diagnosed with SCMs, which is notable considering their prevalence and low diagnostic rate. Our findings provide patient-informed insight on how to improve the delivery of SCM diagnoses, especially delivery in a primary care setting, including the provision of up-to-date information and proactive referral to specialty care and counseling services.

Estimation of Respiratory Rate from Breathing Audio.

The COVID-19 pandemic has fueled exponential growth in the adoption of remote delivery of primary, specialty, and urgent health care services. One major challenge is the lack of access to physical exam including accurate and inexpensive measurement of remote vital signs. Here we present a novel method for machine learning-based estimation of patient respiratory rate from audio. There exist non-learning methods but their accuracy is limited and work using machine learning known to us is either not directly useful or uses non-public datasets. We are aware of only one publicly available dataset which is small and which we use to evaluate our algorithm. However, to avoid the overfitting problem, we expand its effective size by proposing a new data augmentation method. Our algorithm uses the spectrogram representation and requires labels for breathing cycles, which are used to train a recurrent neural network for recognizing the cycles. Our augmentation method exploits the independence property of the most periodic frequency components of the spectrogram and permutes their order to create multiple signal representations. Our experiments show that our method almost halves the errors obtained by the existing (non-learning) methods. Clinical Relevance- We achieve a Mean Absolute Error (MAE) of 1.0 for the respiratory rate while relying only on an audio signal of a patient breathing. This signal can be collected from a smartphone such that physicians can automatically and reliably determine respiratory rate in a remote setting.

Reducing Delay From Referral to Admission at a U.S. First-Episode Psychosis Service: A Quality Improvement Initiative.

Duration of untreated psychosis (DUP), the period between psychosis onset and entry into care, is a time of great vulnerability. Longer DUP predicts poorer outcomes, and delayed treatment access can limit the effectiveness of coordinated specialty care (CSC) services. This column details one component of a broader early detection campaign, a quality improvement intervention focusing on reducing the delay between confirmation of eligibility and admission to care within a benchmark period of 7 days. Median delay significantly fell (from 13.5 to 3 days), and the proportion of admissions that met the benchmark increased (from 33% to 71%) over 4 years. This intervention provides a sustainable model to reduce wait times at CSC services.

Supporting Success: ASTHO's Strategies for Reducing Maternal Mortality and Morbidity.

Supporting Success: ASTHO's Strategies for Reducing Maternal Mortality and Morbidity.

Transgender Care Experiences, Barriers, and Recommendations for Improvement in a Large Integrated Health Care System in the United States.

Transgender individuals who pursue gender affirmation medical procedures often need to navigate a complex health system and interact with multiple health care providers in primary and specialty care. We sought to better understand patient, provider, and system level barriers to transgender care in a large integrated health care system in California. Three 90-min focus groups were conducted with 13 transgender individuals who received specialty care between April and August 2018 in Kaiser Permanente Southern California. Participants cited common adversities such as misgendering and system-wide insensitivity during health care encounters and low levels of understanding of their transgender experience among primary care providers. Provider-patient relationship improvements were recommended for pre- and postsurgical care and service-provider sensitivity training. Suggestions include better care coordination, reducing redundancy in clearance for specialty care services, and enhancing patient support for navigation of gender affirmation services. Participants requested careful consideration when implementing systemwide routine processes such as using pronouns and names when calling patients in for visits or describing procedures on service invoices. Education and training programs for improving transgender care competency and enhancing care coordination between primary care and specialty care for transgender patients are warranted. Including transgender voices with lived-experience as active stakeholders in ongoing efforts such as community advisory boards to identify care gaps may facilitate patient-centered and culturally sensitive transgender care and increased patient satisfaction. There is a need for systematic training for transgender care competent providers and enhancement of care coordination between primary care and specialty care.

Meeting the Primary Care Needs of Autistic Individuals.

In 1996, the Institute of Medicine adopted the following definition of primary care: the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.1 On the basis of our previous work in the Health Care Transitions Research Network, we know that young autistic adults and their families struggle to find adult primary care providers who understand their needs.2,3 The overall goals of health and health care are to increase lifespan and maximize quality of life. Primary care for autistic adults needs to improve for them to attain these goals.Autistic adults have a significantly higher prevalence of common chronic medical conditions, including dyslipidemia, hypertension, diabetes, obesity, and thyroid disease.4 However, despite an increased need for health services in this population, autistic individuals are faced with health care barriers from childhood to adulthood, which limit their access to high-quality primary and preventive care* services throughout the life course.Both autistic children and older youth have higher levels of health service use, including a higher percent of pediatrician visits, specialty care services, and inpatient hospitalizations, compared to non-autistic individuals. Interestingly, despite this increased contact with the health care system, autistic children are less likely to have received important preventive health services including immunizations for influenza and other vaccinations.5 In addition to receiving fewer vaccines in childhood, autistic individuals continue to face barriers in access to care as adults. Autistic adults report significantly higher odds of unmet health care needs related to physical health and mental health, compared to non-autistic adults.6 Furthermore, although autistic adults are as likely as non-autistic adults to have a primary care provider, they are less likely to have received a tetanus vaccine, and, if female, less likely to have received cervical cancer screening in the past 3 years. Beyond vaccination and cervical cancer screening, little is known about the use and access of autistic individuals to other routine guideline-driven preventive services such as colon cancer and breast cancer screening.The deficit in primary and preventive care services faced by autistic individuals, as well as the increased prevalence of various chronic medical conditions is related to a combination of both provider discomfort with treating autistic individuals as well as autism-specific barriers such as communication deficits, which pose a challenge for delivery of care through conventional models of medical practice. In a study on the patient experience, autistic patients experienced heightened anxiety when communicating with the physician, during the physical exam, and while in the waiting room. These difficulties could be alleviated by preplanning individualized accommodations to overcome environmental and process barriers such as rooming the patient immediately and not performing vital signs at the time of intake.7 Such interventions may help improve clinic visits as well as the patient-doctor interaction.Further interventions are needed to bridge the existing gaps in primary and preventive care and to address the increased prevalence of chronic health conditions in autistic individuals. Future directions should include research on differences in access to routine guideline-driven preventive health services such as colon and breast cancer screening, as well as further evaluation of the origin of the disparities in access to care faced by autistic individuals. Care for autistic individuals should incorporate guideline-driven practices provided to the general population in addition to personalized accommodations to improve delivery of care.

Bleeding Disorders in Women and Girls: State of the Science and CDC Collaborative Programs.

Women and girls with bleeding disorders experience abnormal and excessive bleeding that can negatively impact their overall health and quality of life. In this report, we provide an overview of the biology, types, clinical care, and state of the science related to bleeding disorders in girls and women and describe Centers for Disease Control and Prevention (CDC) activities related to (1) surveillance of bleeding disorders in women; (2) scientific review, research, and collaboration to inform health care gaps in identifying and caring for women with bleeding disorders; and (3) development of health promotion and education programs to bring awareness about bleeding disorders to both women and girls in the population at large and various health care providers who care for women. Findings generated from surveillance and research activities inform the development of new public health programs aimed at improving diagnostic and health care services and empowering women with bleeding disorders with the knowledge they need to navigate a complex health care system with the need for specialty care services. Additional work is needed to improve provider awareness and understanding of the unique needs of women and girls with bleeding disorders to achieve appropriate care and treatment and ensure optimal outcomes and quality of life.

The Integral Role of CBOCs in Rural Healthcare: Promises and Challenges

Community-based outpatient clinics are critical to extending the geographic reach of VA’s healthcare delivery system. Nationwide, 733 CBOCs provide outpatient care to nearly half of the VA’s patient population. The 13 rural CBOCs in the study sample provide outpatient primary care, mental health care, and a limited number of specialty care services. Located 1–3.5 hours away from their closest VA Medical Center, these CBOCs have a wide—sometimes interstate—service catchment area. To effectively serve increasingly older and medically complex patient populations, they rely heavily on partnerships with larger VA Medical Centers and local community providers for inpatient, residential, and additional outpatient services. CBOCs experience myriad staffing challenges, including staff turnover, “access providers” working at multiple CBOCs, and highly variable training in rural health and geriatrics. While some CBOCs have robust telehealth offerings, others cannot currently grow their telehealth capacity owing to constraints in clinic space and provider schedules.

Predicting longitudinal service use for individuals with substance use disorders: A latent profile analysis

IntroductionSubstance use disorders (SUD) are chronic conditions that often warrant coordinated medical care throughout a relapsing and remitting course. However, SUD treatment is frequently measured as a binary outcome, where individuals either receive or do not receive care following the immediate treatment seeking event. This study aimed to describe longitudinal treatment seeking behaviors by assessing service use patterns among individuals with diagnosed SUDs in a safety net hospital that offers a “no wrong door” care model. This study also examined whether certain patient subgroups were more likely to transition to service use patterns that support recovery or treatment disengagement over time. MethodsThe team conducted a retrospective cohort study using electronic health record data from adult patients diagnosed with SUDs (n = 1157) who regularly accessed services at a safety net hospital over a five-year period. The study used latent class analysis (LCA) and latent profile analysis to empirically identify distinct treatment utilization profiles of individuals with SUDs. We used multinomial logistic regression to evaluate predictors of class membership and transitions over a five-year period. ResultsThe research team identified five distinct service use classes, including patients who disengaged from services (42.4%), or those who predominantly used outpatient substance use services (7.0%), mental health services (13.0%), primary care services (24.7%), or other specialty care services (13.1%). Being female and an older adult were statistically significant predictors for membership in any service use–driven status. Black patients had increased odds for “substance use service” and “primary care” service statuses over time. ConclusionLCA and latent transition analysis (LTA) methods are novel approaches for identifying profiles of patients with higher risk for health services disengagement. SUD treatment engagement strategies are needed to reach males, young adults, and individuals with non-opioid SUDs.

Coronavirus Disease 2019 Emergency and Remote Eye Movement Desensitization and Reprocessing Group Therapy With Adolescents and Young Adults: Overcoming Lockdown With the Butterfly Hug.

The coronavirus disease 2019 (COVID-19) pandemic has represented an individual and collective trauma with an impact on mental health. Restrictive measures such as lockdowns have increased risk factors for the development or triggering of various psychopathologies. Timely psychological intervention has constituted a protective factor that has been indicated as a form of prevention. The main objective of this study was to measure changes in the levels of traumatic stress and anxiety in a clinical population of adolescents and young adults aged 13 to 24 years – already assisted by the local primary and specialty care services before the pandemic – following a trauma-focused psychotherapeutic group intervention according to the eye movement desensitization and reprocessing protocol, conducted remotely before the end of the first lockdown. The Impact of Event Scale-Revised (IES-R), State-Trait Anxiety Inventory (STAI) scales, and the Emotion Thermometer were administered pre- and post-treatment. At the end of the treatment, the Post-Traumatic Growth Inventory (PTGI) questionnaire was administered. The results show that there was a significant improvement pre- and post-intervention in the scores of the scales STAI, IES-R, and Emotion Thermometer with a reduction in post-traumatic symptoms related in particular to the domains of intrusiveness and hyperarousal. The domain of avoidance was less significantly modified by therapy. This overall clinical improvement did not correlate with any of the demographic variables of the sample. In addition, the results show a significant positive global perceived change (PTGI) that did not correlate with the reduction of anxiety or post-traumatic symptoms measured by the other self-report scales. The explored use of telemedicine has revealed a valuable clinical opportunity.

Predictors of Persistent Symptoms in People in Coordinated Specialty Care Services for Early Psychosis in New York State.

This study aimed to determine the prevalence and predictors of persistent transdiagnostic symptoms in the first year of enrollment in OnTrackNY, a coordinated specialty care (CSC) program for individuals with recent-onset nonaffective psychosis. Three groups were defined by using the Mental Illness Research, Education, and Clinical Centers Global Assessment of Functioning symptom subscale: persistently symptomatic, intermittent, and improving to moderate. The authors compared groups on baseline demographic characteristics, family and living situation, clinical measures, and pathways to care. Of 1,129 eligible participants, 12% were persistently symptomatic through follow-up. Being medication nonadherent, being homeless, having a diagnosis of schizophrenia, and having a longer duration between symptom onset and program enrollment were predictive of persistent symptoms during the first year of CSC. Findings suggest that despite intensive treatment, severe symptoms in young people with psychosis may persist because of economic barriers, treatment delays, and lack of stability.

Bridging the gap by providing access to oncology care to rural communities: A hybrid delivery model combining in-person visits with Telehealth.

e18528 Background: Americans who live in rural areas experience unique barriers to access healthcare such as limited transportation, shortages in oncology providers, limited access to advanced services which contribute to poor health outcomes. The current COVID-19 pandemic has provided a catalyst for rapid adoption of telehealth. A regional cancer center has established a novel rural health partnership program that utilizes a hybrid model of on-site visits and telehealth to increase access to advanced oncology care for patients in rural communities. Here we describe the collaboration and benefits of this model. Methods: The rural health hybrid delivery model utilizes a combination of in-person and telehealth visits to provide immediate access to the regional center’s oncology care team and specialized services such as advanced surgeries, radiation, precision medicine, and clinical trials. Speed to care was built into the model as a key feature, offering initial appointments within 3 business days from the time of the referral, wherein treatment plans are developed facilitating immediate start. The model is a collaborative partnership, ensuring a coordinated care process driven by the regional oncologists working in coordination with the local provider to meet the needs of the patient. The patient is able to decrease transportation time, cost, and obtain care closer to their support system by keeping the patient in their community for basic needs. For more complex requirements, on-site visits are coordinated. This allows access to the regional center’s specialty oncology care services not available locally, while keeping the patient engaged with their local provider, which increases service utilization and expands the patient base. Leveraging telehealth visits at the local hospital ensures access to adequate broadband and technology capabilities to facilitate continuity of patient care. Results: This model provides the patient with timely access to specialty cancer care in their local community. Partnerships with two rural health systems were implemented in July and November 2020. 14 patients are enrolled in the program to date with a 100% retention rate. The turnaround time from treatment plan to treatment is 6 business days. There was a total of 62 oncology telehealth appointments, reducing patient travel by 12,705 driving miles, 310 travel hours, saving $7,380 in travel costs and accommodation. Conclusions: Telehealth provides a bridge to the rural health access gap, and advances health equity by offering specialized care to patients in their local communities. Improving access to best practice treatment strategies for all cancer patients moves us closer to resolving disparities in outcomes. Applications of this hybrid model of care to other rural sites is a promising strategy to reduce rural-urban disparities in cancer care.