Specialty Health Care Research Articles

Assessment of knowledge, attitude, and practice regarding medical waste management among operation room personnel in a tertiary hospital.

Medical waste management (MWM) is of concern to the medical and surgical communities in the hospital. Adequate knowledge, attitude, and practice regarding the management of healthcare waste are important for the proper handling and disposal by physicians and healthcare workers. The aim of this study was an assessment of knowledge, attitude, and practices regarding medical waste management among operation room personnel in a tertiary hospital. This study was a descriptive cross-sectional survey conducted at a single-center government Comprehensive Specialized Hospital operation room from 1-30 September 2022. All specialty operation room healthcare personnel consenting to cooperate and participate were included in the study. The data were collected using a self-administered questionnaire. The collected data were analyzed using SPSS. The results were presented in texts, tables and graphs. From 130 operation room personnel, the results revealed that the majority of the total respondents were male (83.1%). Only 30 (23.1%) of the respondents were involved in training, whereas 100 (76.9%) of the study participants have not participated in training. It was found that 86 (66.2%) of the respondents had good knowledge, 113 (86.9%) of the respondents had a good attitude, and 27 (20.8%) of the respondents had good practice. The authors' study reveals that the majority of study participants have a moderate level of knowledge, a good level of attitude, and poor levels of practice, according to Bloom's cut-off point. The institution should more fully implement the training for operation room personnel to improve their level of knowledge and practice of medical waste management.

Suicide Screening, Risk Assessment, and Lethal Means Counseling During Zero Suicide Implementation.

The authors measured implementation of Zero Suicide (ZS) clinical practices that support identification of suicide risk and risk mitigation, including screening, risk assessment, and lethal means counseling, across mental health specialty and primary care settings. Six health care systems in California, Colorado, Michigan, Oregon, and Washington participated. The sample included members ages ≥13 years from 2010 to 2019 (N=7,820,524 patients). The proportions of patients with suicidal ideation screening, suicide risk assessment, and lethal means counseling were estimated. In 2019, patients were screened for suicidal ideation in 27.1% (range 5.0%-85.0%) of mental health visits and 2.5% (range 0.1%-35.0%) of primary care visits among a racially and ethnically diverse sample (44.9% White, 27.2% Hispanic, 13.4% Asian, and 7.7% Black). More patients screened positive for suicidal ideation in the mental health setting (10.2%) than in the primary care setting (3.8%). Of the patients screening positive for suicidal ideation in the mental health setting, 76.8% received a risk assessment, and 82.4% of those identified as being at high risk received lethal means counseling, compared with 43.2% and 82.4%, respectively, in primary care. Six health systems that implemented ZS showed a high level of variation in the proportions of patients receiving suicide screening and risk assessment and lethal means counseling. Two opportunities emerged for further study to increase frequency of these practices: expanding screening beyond patients with regular health care visits and implementing risk assessment with lethal means counseling in the primary care setting directly after a positive suicidal ideation screening.

Project Spotlight: Precast concrete panels bring aesthetic appeal to Chicago surgery center

The University of Illinois Health Specialty Care Building, a new out¬patient surgery center in the heart of Chicago’s Medical District, includes two levels of same-day surgery suites, three levels of specialty clinics, and a ground floor with check-in, pharmacy, and imaging services. Precast concrete panel manufacturer International Concrete Products (ICP) from Germantown, Wis., was brought in very early in the process to work with the design team to find solutions for the facility.

Telemedicine is here to Stay: Success and Utility of Video Consultations in Neonatology

Abstract Background and Objectives: “Synchronous videoconference telemedicine in neonatal office-practice” (SyNTOP) has been a routine practice in our center since the start of the COVID-19-related lockdown. We recently reported our experience with the “success” of this practice in terms of removing the need to visit the hospital over the next 48 h after the teleconsult. Methods: Secondary results of this retrospective descriptive study which analyzed 829 consults are presented in this manuscript. Data from electronic medical records of those who availed teleconsultation facility between March 2020 and April 2021 were retrieved. Relevant information about clinical presentation, findings from the video call, demographic information, decisions made by the clinician, and outcomes were collected. Best efforts were made to obtain follow-up information by the clinical team or guest–patient relations officers. Results: Fever (n = 118) and acute diarrheal disease (n = 58) were the common presenting complaints; most (80.5% and 95.5%, respectively) were resolved without physical examination; 265 developmental assessments were completed by video-facilitated checks. Fast-track vaccination visits where queries were resolved and bills paid online, were an innovation where well babies could avoid queues and possible exposure to crowds. One-fourths of SyNTOP were from outside the district, and 1.4% were from foreign countries. Conclusions: Teleconsults were successfully conducted in neonatal office practice for different health-care enquiries. Strategies such as fast-track vaccinations and online developmental follow-up assessments were performed by leveraging technology. We highlight the benefits of these innovations in our center with a view to enhance their uptake elsewhere. Such approaches have the potential to increase health equity and access to specialty health care.

Setting Up a Department of Neurosurgery in a Government Hospital in an LMIC: Jodhpur, India

The number of government institutes offering affordable super specialty and tertiary healthcare in India has traditionally not been able to keep pace with the growth in population, most of whom are too poor to be able to afford private healthcare services. To meet this mandate, 6 new institutes built on the template of the premier institute of the country-the All India Institute of Medical Sciences, New Delhi-were founded and began operations in 2012. Using the progress of our department as an example, the aim of this report is to outline the principles that were followed to set up the department of neurosurgery. The Department of Neurosurgery at All India Institute of Medical Sciences, Jodhpur, began providing services in August 2017. Data related to the inception and development of the department were collected. The department has grown during the past 5 years from 400 outpatients and 79 inpatients in 2017 to 11,144 outpatients and 1624 inpatients in 2022. Only 59 surgeries were performed in 2017 compared with 597 routine and 311 emergency procedures performed in 2022. Currently, the department has 7 faculty members performing all forms of complex skull base, craniovertebral junction, vascular, endovascular, epilepsy, and functional surgeries. A total of 134 studies have been reported in national and international journals, and 8 patents have been granted. We report the unique experiences of one department that could be useful as a template and as guidelines for the establishment process of a new department.

A Community Survey of Referral Sources to Identify Primary Care and Gender-Affirming Care Providers

IntroductionBarriers exist in access to primary care as well as specialty healthcare, such as gender-affirming care. Understanding the referral sources used to identify new providers for these types of care can help healthcare systems facilitate access. MethodsUsing data from a community-based survey, we assess demographics and information relevant to finding new healthcare providers. ResultsData from 165 participants suggests that seeking a new primary care provider was perceived as challenging. The most common referral sources for primary care providers were family/friends, a doctor, or a medical center website. The most common referral sources for gender-affirming care providers were a doctor, family/friends, or social media. There were significant differences in the types of referral sources most likely to be utilized for primary vs gender-affirming care. ConclusionPersonal connections, including trusted doctors, can be important sources of provider referrals. Additional resources may be needed to facilitate their ability to make quality connections. Community resources and social media can be important sources when existing social networks may not have knowledge about the needs of particular communities, especially those who may be at risk for discrimination. More inclusive and secure referral sources may be needed to ensure gender-affirming care referrals are made.

FRI520 Disparities In Available Surgeons And Specialty Physicians Providing Endocrine-related Health Care Coverage To Populations In South Texas And The Rio Grande Valley

Abstract Disclosure: V. Alia: None. E.W. Alvarado: None. E.M. Diaz: None. H. Reinhart: None. Introduction: The Rio Grande Valley and South Texas is home to some of the most medically underserved populations in the nation, with gaps in health care ranging from low rates of adequately insured individuals, to the amount of primary and specialty healthcare services available [1]. Populations living in these areas near the Texas-Mexico border have some of the highest incidence of metabolic and endocrine-related disease in the U.S., while paradoxically having a large deficit in endocrine-specialists available to meet the medical and surgical needs of the community [1,2,3]. Methodology: We analyzed data from the National Center for Health Workforce Analysis (NCHWA), as well as data from the Texas department of state health services (TDSHS) to determine current and projected endocrine-related healthcare coverage needs in South Texas and the Rio Grande Valley (RGV) between 2013 to 2025 and 2018 to 2032 respectively [2,3]. Results: Analysis of the data provided by the NCHWA revealed that by 2025 the southern region of the U.S. is projected to have the largest shortage of full-time equivalent (FTE) surgical specialty physicians in the entire country with a deficit of 10,210 [3]. ​Additionally, data displaying critical-shortages provided by the TDSHS stated that in 2018 the percent demand met (PDM) for FTE endocrinologists in South Texas was only 76.6% with a projected decline to 65.7% by 2032 [2]. Noteworthy data from the TDSHS also stated that in 2018 the RGV specifically had a significant deficit in endocrinologists with a PDM of only 53.6%, while simultaneously having a projected increase to 66.4% by 2032 [2]. The TDSHS classified specialties in South Texas to be critically short when they are projected to have a deficit of ≥100 FTEs and <80% of the physician demand being met [2]. Conclusion: The collection of data analyzed led us to effectively identify significant disparities in endocrine-related healthcare coverage in the South Texas region, specifically the RGV. Additionally, new multidisciplinary healthcare institutions built in the RGV are striving to improve patient access to primary and subspecialty care by recruiting and training physicians in the area, but further action is still needed to counteract the described critical-shortages in physicians responsible for the long-term management of endocrine-related diseases. Presentation: Friday, June 16, 2023

PRESS survey: PREvention of surgical site infection-a global pan-specialty survey of practice protocol.

Surgical site infections (SSI) complicate up to 40% of surgical procedures, leading to increased patient morbidity and mortality. Previous research identified disparities in SSI prevention guidelines and clinical practices across different institutions. The study aims to identify variations in SSI prevention practices within and between specialties and financial systems and provide a representation of existing SSI preventative measures to help improve the standardization of SSI prevention practices. This collaborative cross-sectional survey will be aimed at pan-surgical specialties internationally. The study has been designed and will be reported in line with the CROSS and CHERRIES standards. An international study steering committee will design and internally validate the survey in multiple consensus-based rounds. This will be based on SSI prevention measures outlined in the CDC (2017), WHO (2018), NICE (2019), Wounds UK (2020) and the International Surgical Wound Complications Advisory Panel (ISWCAP) guidelines. The questionnaire will include demographics, SSI surveillance, preoperative, peri-operative and postoperative SSI prevention. Data will be collected on participants' surgical specialty, operative grade, of practice and financial healthcare system of practice. The online survey will be designed and disseminated using QualtricsXM Platform™ through national and international surgical colleges and societies, in addition to social media and snowballing. Data collection will be open for 3 months with reminders, and raking will be used to ascertain the sample. Responses will be analyzed, and the chi-square test used to evaluate the impact of SSI prevention variables on responses. Current SSI prevention practice in UK Vascular surgery varies considerably, with little consensus on many measures. Given the inconsistency in guidelines on how to prevent SSIs, there is a need for standardization. This survey will investigate the disparity in SSI preventative measures between different surgical fields and countries.

Abstract P226: Length Of Stay Discrepancies Between Rural And Urban Hospital Settings For Hypertension Admissions

Introduction: Rural populations experience greater barriers to healthcare access compared to urban populations. This can be attributed to fewer public health services, greater uninsured rate, and greater burden of healthcare shortages in urban healthcare settings. Our study aims to quantify the disproportionate allocation in healthcare resources through analysis of Length of Stay (LOS) in-respect to hypertensive urgency and hypertensive urgency. Methods: This cross-sectional study reviewed the LOS estimates for patients with ICD-10 diagnoses for Hypertension Emergency or Hypertension Urgency within the state of New York, categorized by the type of community hospital; rural or urban. This study utilizes the 2020 National Inpatient Sample (NIS), specifically for urban and rural hospitals in New York. ICD-10 codes included I16.1 & I16.9 for Hypertensive Emergency and I16.0 for Hypertensive Urgency. Community hospital setting was categorized as either rural or urban based on the overlying zip code of the admitting inpatient hospital. Results: LOS was unique to the community setting (p<0.01), but not to hypertensive disease (p=0.11). In summary, the LOS was longer in rural-level inpatient hospital systems when compared to their urban counterparts in both Hypertensive Urgency, 4.4 days vs 3.1 days (p=0.01), and Hypertensive Emergency, 5.5 days vs 3.4 days (p<0.01). Conclusion: The LOS of patients admitted for both hypertensive urgency and emergency were significantly higher in rural hospitals. Furthermore, increased disease severity emphasizes the divide in LOS between the community healthcare settings. Redistribution of resources to rural communities can enhance access to preventative healthcare services, specialty healthcare, and potentially decrease overall community disease burden.

Referral Patterns and Sociodemographic Predictors of Adult and Pediatric Behavioral Health Referrals in a Federally Qualified Health Center.

Federally Qualified Health Centers (FQHCs) provide comprehensive care to medically underserved populations whose access to behavioral health services may be limited. The goal of the current study was to examine referral patterns to specialty mental health and subsequent treatment initiation in an FQHC. In a 13-month period from March 2017 to March 2018, 1201 patients received a specialty mental healthcare referral. Of these patients, 37% reported scheduling an appointment with this referral, 44% refused the referral, 4% reported improvement in symptoms and not needing a referral, and 5% were not able to be reached due to a contact number being out of service. Common referral reasons among adults were depression, anxiety, and stress, and the most prevalent pediatric referral reasons were behavioral problems, depression, attention deficit hyperactivity disorder (ADHD), and anxiety. These data suggest that of the patients who received a specialty mental health referral, only one-third scheduled an appointment. The study also suggested that anxiety problems may be underrecognized in both adult and pediatric patients. Although significant attention has been put on increasing access to behavioral health services, there is still an unmet need. Universal mental health screening and increased coordination with specialty mental health providers in the community may better address this need.

Causal modelling demonstrates metabolic power is largely affected by gait kinematics and motor control in children with cerebral palsy.

Metabolic power (net energy consumed while walking per unit time) is, on average, two-to-three times greater in children with cerebral palsy (CP) than their typically developing peers, contributing to greater physical fatigue, lower levels of physical activity and greater risk of cardiovascular disease. The goal of this study was to identify the causal effects of clinical factors that may contribute to high metabolic power demand in children with CP. We included children who 1) visited Gillette Children's Specialty Healthcare for a quantitative gait assessment after the year 2000, 2) were formally diagnosed with CP, 3) were classified as level I-III under the Gross Motor Function Classification System and 4) were 18 years old or younger. We created a structural causal model that specified the assumed relationships of a child's gait pattern (i.e., gait deviation index, GDI) and common impairments (i.e., dynamic and selective motor control, strength, and spasticity) with metabolic power. We estimated causal effects using Bayesian additive regression trees, adjusting for factors identified by the causal model. There were 2157 children who met our criteria. We found that a child's gait pattern, as summarized by the GDI, affected metabolic power approximately twice as much as the next largest contributor. Selective motor control, dynamic motor control, and spasticity had the next largest effects. Among the factors we considered, strength had the smallest effect on metabolic power. Our results suggest that children with CP may benefit more from treatments that improve their gait pattern and motor control than treatments that improve spasticity or strength.

The Role of Title 1 Secondary School Athletic Trainers in the Primary and Patient-Centered Care of Low Socioeconomic Adolescents.

Athletic trainers (ATs) provide regular encounters with a healthcare provider for many Title 1 student-athletes with healthcare access and quality barriers. Thus, they are uniquely positioned to serve as a student-athletes' first point of contact for general medical concerns. This study aimed to describe ATs' experiences providing primary care for Title 1 student-athletes. This qualitative design employing an interpretative phenomenological analysis (IPA) approach used in-depth, virtual focus groups to examine the experiences of ATs practicing at Title 1 secondary schools. The findings reveal that ATs were called upon to evaluate, treat, and, when necessary, refer student-athletes with general medical conditions. However, Title 1 ATs encountered numerous complex social determinants of health (SDoH) preventing efficient and effective referral to specialty healthcare providers. Thus, ATs ultimately felt their most important roles in the primary care of low socioeconomic adolescents were as caregivers who mitigated avoidable healthcare barriers in addition to coordinators of integrated care that assisted student-athletes and their families with navigating the healthcare system. Title I ATs need to be aware of the SDoH affecting their student-athletes and the ability of those SDoH to affect health outcomes as well as overall student-athlete health and well-being.

A Randomized Clinical Trial of Clinician-Supported PTSD Coach in VA Primary Care Patients.

Posttraumatic stress disorder (PTSD) is common in primary care patients; however, evidence-based treatments are typically only available in specialty mental healthcare settings and often not accessed. To test the effectiveness of a brief primary care-based treatment, Clinician-Supported PTSD Coach (CS PTSD Coach) was compared with Primary Care Mental Health Integration-Treatment as Usual (PCMHI-TAU) in (1) reducing PTSD severity, (2) engaging veterans in specialty mental health care, and (3) patient satisfaction with care. Multi-site randomized pragmatic clinical trial. A total of 234 veterans with PTSD symptoms who were not currently accessing PTSD treatment. CS PTSD Coach was designed to be implemented in Veterans Affairs PCMHI and combines mental health clinician support with the "PTSD Coach" mobile app. Four 30-min sessions encourage daily use of symptom management strategies. PTSD severity was measured by clinician-rated interviews pre- and post-treatment (8weeks). Self-report measures assessed PTSD, depression, and quality of life at pretreatment, posttreatment, and 16- and 24-week follow-ups, and patient satisfaction at post-treatment. Mental healthcare utilization was extracted from medical records. Clinician-rated PTSD severity did not differ by condition at post-treatment. CS PTSD Coach participants improved more on patient-reported PTSD severity at post-treatment than TAU participants (D = .28, p = .021). Coach participants who continued to have problematic PTSD symptoms at post-treatment were not more likely to engage in 2 sessions of specialty mental health treatment than TAU participants. Coach participants engaged in 74% more sessions in the intervention and reported higher treatment satisfaction than TAU participants (p < .001). A structured 4-session intervention designed to align with patient preferences for care resulted in more patient-reported PTSD symptom relief, greater utilization of mental health treatment, and overall treatment satisfaction than TAU, but not more clinician-rated PTSD symptom relief or engagement in specialty mental health.

Effect of Disease Severity on Comorbid Conditions in Atopic Dermatitis: Nationwide Registry-Based Investigation in Finnish Adults

The majority of registry studies on atopic dermatitis include only patients and diagnoses from specialized healthcare. The aim of this retrospective, real-world cohort study was to evaluate the effect of atopic dermatitis severity on comorbidities and total morbidity, with comprehensive data from both primary and specialty healthcare registries covering the entire Finnish adult population. In total, 124,038 patients were identified (median age 46 years; 68% female) and stratified by disease severity. All regression analyses (median follow-up 7.0 years) were adjusted at a minimum for age, sex, obesity, and educational level. Compared with mild atopic dermatitis, severe atopic dermatitis was significantly associated with multiple morbidities, including neurotic, stress-related and somatoform disorders, abscesses, erysipelas/cellulitis, impetigo, herpes zoster, extragenital herpes, bacterial conjunctivitis, septicaemia, lymphomas, alopecia areata, urticaria, other dermatitis, contact allergy, osteoporosis, and intervertebral disc disorders (p < 0.001). In addition, there were significant associations with alcohol dependence, depression, condylomas, rosacea, migraine, sleep apnoea, hypertension, enthesopathies, atherosclerosis, and drug-induced cataract (p < 0.05). Odds ratios were modest and mostly were between 1.10 and 2.75. Furthermore, patients with severe atopic dermatitis had lower incidences of prostate cancer, cystitis, and anogenital herpes than patients with mild atopic dermatitis (p < 0.05). These results suggest that severe atopic dermatitis results in significant overall morbidity.

NLRB Reignites “Divide and Conquer” Organizing

In 2011, the NLRB in Specialty Healthcare &amp; Rehabilitation Center of Mobile, 357 NLRB 934 (2011) issued its now‐famous “micro‐union” decision. The Specialty Healthcare decision established a new standard by which to analyze “community of interest” tissues. As many readers may know, “community of interest” is a metric by which the appropriateness of voting units is determined. A union is not permitted to simply pick the individuals it wants to represent. The job categories for those individuals must share some degree of commonality with respect to issues such as wages, hours, supervision, job duties, and work rules. Employees who are found to share a sufficient number of those factors are deemed to share a “community of interest.”

Impact of an Urban Project ECHO: Safety-Net Clinician Self-Efficacy Across Conditions

To mitigate the lack of specialty healthcare, Project ECHO (Extension for Community Health Outcomes) trains community-based primary care clinicians to better prevent the progression of, manage, and treat common health conditions. ECHO-Chicago launched in 2010 as the first urban-centered ECHO program, focusing on safety-net clinicians, and has trained over 5,175 community clinicians across 34 topic areas. This paper examines self-efficacy among ECHO-Chicago participants across 11 clinical series, including a novel use of qualitative themes from self-efficacy questions. Five years of baseline and postseries survey data were collected from 2014 to 2019, resulting in 951 participants. Paired t-tests assessed change from baseline survey to postsurvey, and Cohen's d determined effect size. Change was assessed by individual series, adult or pediatric focus, participants' prescription privilege status, and across series by qualitative question theme. Metrics included total change, any improvement, a 10% target, and a clinical competency threshold. Analysis occurred from July 2020 to January 2022. All clinical series achieved statistically significant improvement in self-efficacy, and most had a large effect size. A total of 80% had any improvement, 65% met the 10% target of 0.7 points, and 52% met the competency threshold of 5.0 in the postsurvey. Prescribers had a significantly greater increase in their self-efficacy scores than nonprescribers. With a comparison across series, each theme achieved statistical significance, with most reaching large effect sizes. ECHO-Chicago successfully increased participants' self-efficacy. This inquiry adds an urban focus, years of data, multiple series, and a novel qualitative theme component to enable comparisons across rather than solely within the ECHO series.

OVERCOMING OLDER ADULT RESISTANCE TO TECHNOLOGY TO SUPPORT DIGITAL HEALTH LITERACY: A CBPR APPROACH

Abstract Overall low digital use by older adults creates a barrier to tools that enable them access to basic and specialty healthcare through telehealth and address their isolation and loneliness. In particular, older adults with low-income, like low-income isolated Home Delivered Meal (HDM) program recipients, can be most vulnerable to this barrier. A university team and a local Commission on Aging jointly secured funding to pilot the Virtual Table (VT) model which builds on relationships between HDM drivers and meal recipients to overcome lack of interest and skepticism of technology like the internet and video chatting. For the pilot, 25 recipients were recruited to learn basic technology skills (e.g., email, video chat) from trusted peer tutors through weekly one-to-one sessions, in-person or by video, leading to knowledge and skills to support telehealth utilization. Twenty recipients (80%) are completing the pilot. Results to date show increased technology use and comfort, together with confidence to use telehealth. Participants valued the interactions with tutors as well as what they learned. Feedback from tutors, agency staff, and participants has been used to refine the pilot during implementation. Building on the lessons learned and feedback, the goal for the next stage of collaboration is developing a set of effective tools to implement VT in several diverse communities. Four VT ‘graduates’ will be actively involved as co-producers of these revised tools. In addition, older adult home-delivered-meal (HDM) recipients, agency staff, tutors, and other older adult volunteers will directly participate in ongoing evaluation of the new resources.

The continuing evolution of a cancer prevention, screening, and survivorship ECHO: A second year of implementation.

An estimated 39,010 Indiana residents were diagnosed with cancer in 2021. To address the cancer burden, Project ECHO (Extension Community Healthcare Outcomes) was launched in 2019 in Indiana to build specialty healthcare capacity among non-specialists. Due to positive outcomes from the pilot year, the Cancer Prevention, Screening, and Survivorship ECHO was implemented for a second year. The purpose of this study was to measure the participation and regional impact of this ECHO. ECHO sessions occurred twice monthly from October 2020 to October 2021. Changes were implemented in response to feedback from the pilot year, including making the curriculum more practical for learners and adding accreditation opportunities. Participant information and feedback was extracted from electronic surveys for review. There were 24 ECHO sessions with 213 unique participants, increased from 140 unique participants in the pilot year. An average of 23.5 individuals attended each session, increased from 15.5 individuals per session. Enrolled participants served in a diverse set of roles and represented 247 zip codes, 30 Indiana counties, and 32 states across the United States, each of which increased from the pilot year. In this second year, this ECHO expanded to reach more participants with increased attendance and a more diverse distribution of roles within healthcare, which may be attributed to feedback-driven curriculum design. Cancer care is multi-disciplinary, with health educators, nurses, and administrators, each acting within the cancer care continuum. As a result, this ECHO has been adapted to serve an increasingly broad distribution of professionals. The second year of the Cancer Prevention, Screening, and Survivorship ECHO displayed increased overall enrollment and participation, greater diversity among participant roles, and a wider reach across Indiana and the United States.

Content Validity Testing of a Novel Cognitive Screen Used to Inform Occupational Therapy Treatment Planning

<h3>Research Objectives</h3> To quantify the content validity of a novel cognitive screen being developed to better inform inpatient occupational therapy treatment planning. <h3>Design</h3> Two iterative rounds of Delphi-style expert review panels were conducted. <h3>Setting</h3> Gaylord Specialty Healthcare, a long-term acute care hospital in Wallingford, Connecticut, USA. <h3>Participants</h3> The first Delphi panel consisted of 9 content and field experts, including: 4 Occupational Therapists; 2 Speech Language Pathologists; 2 Neuropsychologists; and 1 Physician Assistant specialized in physical medicine and rehabilitation. The second panel consisted of 6 content experts, including: 4 Occupational Therapists; 1 Speech Language Pathologist; and 1 Physician Assistant specialized in physical medicine and rehabilitation. <h3>Interventions</h3> During both Delphi-style expert review panels, the relevance, essentiality, and clarity of each item was discussed. At the end of each discussion, panelists were asked to complete a content validity survey, summarizing their evaluation of each item. <h3>Main Outcome Measures</h3> Based on panelists' responses to the content validity survey, item and scale level relevance, essentiality, and clarity were quantified by calculating the respective content validity index, content validity ratio, and content clarity index. To ensure agreement, scale and item level relevance was also assessed by calculating the universal agreement and kappa statistics. <h3>Results</h3> After being drafted by the authors, an initial 24 item instrument covering 9 cognitive domains was presented to the first expert panel. In addition to evaluating the content validity/item relevance, item essentiality, and item clarity of the measure, two additional items were removed. In its current iteration, the final measure consists of 22 items/questions. From the first to second panel: the mean content validity score increased from 0.87 to 1.0, universal agreement increased from 0.52 to 1.0, the mean essentiality score increased from 0.52 to 0.94, and the mean clarity score increased from 2.5 to 2.9. <h3>Conclusions</h3> Following two rounds of Delphi-style expert panel review, we have determined this new cognitive assessment displays overall excellent content validity and is ready to proceed with criterion and construct validity testing. <h3>Author(s) Disclosures</h3> Authors have no relevant conflicts to disclose at this time.

Chatbot-Delivered Cognitive Behavioral Therapy in Adolescents With Depression and Anxiety During the COVID-19 Pandemic: Feasibility and Acceptability Study.

Symptoms of depression and anxiety, suicidal ideation, and self-harm have escalated among adolescents to crisis levels during the COVID-19 pandemic. As a result, primary care providers (PCPs) are often called on to provide first-line care for these youth. Digital health interventions can extend mental health specialty care, but few are evidence based. We evaluated the feasibility of delivering an evidence-based mobile health (mHealth) app with an embedded conversational agent to deliver cognitive behavioral therapy (CBT) to symptomatic adolescents presenting in primary care settings during the pandemic. In this 12-week pilot study, we evaluated the feasibility of delivering the app-based intervention to adolescents aged 13 to 17 years with moderate depressive symptoms who were treated in a practice-based research network (PBRN) of academically affiliated primary care clinics. We also obtained preliminary estimates of app acceptability, effectiveness, and usability. This small, pilot randomized controlled trial (RCT) evaluated depressive symptom severity in adolescents randomized to the app or to a wait list control condition. The primary end point was depression severity at 4-weeks, measured by the 9-item Patient Health Questionnaire (PHQ-9). Data on acceptability, feasibility, and usability were collected from adolescents and their parent or legal guardian. Qualitative interviews were conducted with 13 PCPs from 11 PBRN clinics to identify facilitators and barriers to incorporating mental health apps in treatment planning for adolescents with depression and anxiety. The pilot randomized 18 participants to the app (n=10, 56%) or to a wait list control condition (n=8, 44%); 17 participants were included in the analysis, and 1 became ineligible upon chart review due to lack of eligibility based on documented diagnosis. The overall sample was predominantly female (15/17, 88%), White (15/17, 88%), and privately insured (15/17, 88%). Mean PHQ-9 scores at 4 weeks decreased by 3.3 points in the active treatment group (representing a shift in mean depression score from moderate to mild symptom severity categories) and 2 points in the wait list control group (no shift in symptom severity category). Teen- and parent-reported usability, feasibility, and acceptability of the app was high. PCPs reported preference for introducing mHealth interventions like the one in this study early in the course of care for individuals presenting with mild or moderate symptoms. In this small study, we demonstrated the feasibility, acceptability, usability, and safety of using a CBT-based chatbot for adolescents presenting with moderate depressive symptoms in a network of PBRN-based primary care clinics. This pilot study could not establish effectiveness, but our results suggest that further study in a larger pediatric population is warranted. Future study inclusive of rural, socioeconomically disadvantaged, and underrepresented communities is needed to establish generalizability of effectiveness and identify implementation-related adaptations needed to promote broader uptake in pediatric primary care. ClinicalTrials.gov NCT04603053; https://clinicaltrials.gov/ct2/show/NCT04603053.