Visit Type Research Articles

Quality of Virtual vs. In-Person Outpatient Palliative Care: Disparities by Language and Race.

Virtual visits have increased in outpatient, clinic-based palliative care (OPC). The association between virtual visits and OPC outcomes is largely unknown. (1) Examine the association between visit type (virtual vs. in-person) and screening (yes/no) for psychosocial, spiritual, and goals of care needs. (2) Assess effect modification by language. We used data from the Palliative Care Quality Network (01/2017-03/2021). We conducted multivariable analyses adjusting for age, sex, diagnosis, self-reported race-ethnicity, and language, clustered by site, and included an interaction term to assess effect modification by language. Among 2684 patients, 29% had a virtual visit; 50% were ≥65 years old, 24% non-English preferred languages; 18% identified as Hispanic, 9% Black, 17% Asian, 6% Native Hawaiian/Pacific Islander. There were no differences by visit type in screening for psychosocial (aOR 0.87 vs. in-person visits, 95% CI 0.60-1.25), spiritual (aOR 0.81, 95% CI 0.57-1.15), or goals of care needs (aOR 1.05, 95% CI 0.85-1.31). Patients with non-English preferred languages (vs. English-speaking) had significantly lower odds of screening regardless of visit type. Patients identifying as Black (vs. White) also had significantly lower odds of screening. There were no differences by visit type in screening for psychosocial, spiritual, and goals of care needs. Patients with preferred languages other than English were significantly less likely to be screened than English speakers, though there was no further difference by visit type. Patients identifying as Black were also significantly less likely to be screened. Addressing these disparities in core OPC elements is essential in providing equitable, high-quality OPC.

Enrollment in Medicare is associated with fewer outpatient mental healthcare visits among those with mental health symptoms.

To test whether enrolling in traditional Medicare (TM) or Medicare Advantage (MA) at age 65 reduces mental healthcare utilization among individuals with mental health symptoms and low or moderate family incomes. We employ a fuzzy regression discontinuity design, comparing the likelihood of having an outpatient mental health visit or a psychotropic drug fill among individuals younger than or older than the age 65 Medicare eligibility threshold. We analyze 2014-2021 Medical Expenditure Panel Survey data. Our primary sample is restricted to individuals with probable mental health symptoms as indicated by their score on the Kessler K6 psychological distress scale (K6) and Patient Health Questionnaire-2 instrument (PHQ-2) and who have incomes less than 400% of the federal poverty level. Among individuals with probable mental health symptoms and low or moderate incomes, enrolling in Medicare (combining the effect of MA and TM) is associated with a 24.9 percentage point reduction (95% CI -49.1 to -0.8; p = 0.043) in the likelihood of having any type of outpatient mental health visit and a 31.3 percentage point reduction (95% CI -54.2 to -8.4; p = 0.008) in the likelihood of having a prescription drug fill for a psychotropic drug. Effects of MA and TM on mental healthcare utilization are not statistically different from each other. We observe no impact of enrolling in Medicare on the likelihood of having a visit to a primary care provider, having a visit to a non-mental healthcare specialist, or having a fill for a prescribed non-psychotropic drug. Enrolling in Medicare is associated with a reduction in the use of mental healthcare among individuals with probable mental health symptoms and low or moderate family incomes. Our findings suggest that the program poses access barriers specific to mental healthcare.

Telepsychiatry implementation in Qatar: A three-year analysis of no-show rates and its impact on mental health service delivery

Background: The COVID-19 pandemic triggered a rapid shift to telehealth and reshaped healthcare delivery worldwide. In Qatar, telehealth has emerged as a critical tool for ensuring uninterrupted care while minimizing the spread of viruses. However, its long-term efficacy, particularly in mental health services, is still poorly understood. The aim of this study was to address this gap by evaluating the post-pandemic impact of telehealth on the accessibility of mental health services in Qatar. Methods: We conducted a comparative analysis of no-show rates over a four-month period before the initiation of telepsychiatry and telepsychology (March to June 2019) and corresponding periods in 2020, 2021, and 2022. The analysis considered visit types (new visit and follow-up visit) in various psychiatric (child and adolescent, adult, geriatric, forensic, and intellectual disability) and psychological outpatient clinics before and after the implementation of telehealth services. Results: Among both new and follow-up cases, there was a significant reduction (p < 0.0001) in the collective proportion of no-show rates following the introduction of telehealth compared to the rates recorded before the implementation. Exceptions to this trend were appointments in child and adolescent mental health service psychology and forensic psychiatric services. Conclusion: Telehealth has proven instrumental in improving access to mental health services in Qatar post-pandemic. Its integration shows the potential for reducing no-show rates and enhancing continuity of care. These findings are important for healthcare policy-making and practice in Qatar and provide valuable insights into the global discourse on the evolving role of telehealth.

Distal and Proximal Influences on Self-Reported Oral Pain and Self-Rated Oral Health Status in Saudi Arabia: Retrospective Study Using a 2017 Nationwide Database.

Oral health significantly influences overall well-being, health care costs, and quality of life. In Saudi Arabia, the burden of oral diseases, such as dental caries and periodontal disease, has increased over recent decades, driven by various lifestyle changes. To explore the associations between proximal (direct) and distal (indirect) influences that affect oral pain (OP) and self-rated oral health (SROH) status in the Kingdom of Saudi Arabia (KSA) using an adapted conceptual framework. This retrospective cross-sectional study used data from a national health survey conducted in KSA in 2017. The sample included adults (N=29,274), adolescents (N=9910), and children (N=11,653). Sociodemographic data, health characteristics, and access to oral health services were considered distal influences, while frequency and type of dental visits, tooth brushing frequency, smoking, and consumption of sweets and soft drinks were considered proximal influences. Path analysis modeling was used to estimate the direct, indirect, and total effects of proximal and distal influences on OP and SROH status. The mean age of adult respondents was 42.2 years; adolescents, 20.4 years; and children, 10.58 years. Despite OP reports from 39% of children, 48.5% of adolescents, and 47.1% of adults, over 87% across all groups rated their oral health as good, very good, or excellent. A higher frequency of tooth brushing showed a strong inverse relationship with OP and a positive correlation with SROH (P<.001). Frequent dental visits were positively associated with OP and negatively with SROH (P<.001). Sweet consumption increased OP in adolescents (β=0.033, P=.007) and negatively affected SROH in children (β=-0.086, P<.001), adolescents (β=-0.079, P<.001), and adults (β=-0.068, P<.001). Soft drink consumption, however, was associated with lower OP in adolescents (β=-0.034, P=.005) and improved SROH in adolescents (β=0.063, P<.001) and adults (β=0.068, P<.001). Smoking increased OP in adults (β=0.030, P<.001). Distal influences like higher education were directly linked to better SROH (β=0.046, P=.003) and less OP (indirectly through tooth brushing, β=-0.004, P<.001). For children, high household income correlated with less OP (β=-0.030, P=.02), but indirectly increased OP through other pathways (β=0.024, P=.003). Lack of access was associated with negative oral health measures (P<.001). Among the KSA population, OP and SROH were directly influenced by many proximal and distal influences that had direct, indirect, or combined influences on OP and SROH status.

Influence of Type of Dental Visit on the Incidence of COVID-19 and Related Hospitalisation Among Older People in Japan.

In 2020, the coronavirus disease 2019 (COVID-19) pandemic began worldwide. We examined the association between dental visit status and the incidence of COVID-19 and hospitalisation for it among older people based on medical claims data to help reduce COVID-19 severity. The study included 170,232 people who were 75-85 years old in fiscal 2019, with fiscal 2020 and 2021 serving as the follow-up period to ascertain the status of COVID-19. Using medical claims data, we investigated four types of dental visit (no visit, only periodontal treatment, periodontal and other treatment, and only other treatment) during fiscal 2019 and the incidence of COVID-19 and hospitalisation for COVID-19 during the follow-up period. Logistic regression analyses were performed with the incidence of COVID-19 and hospitalisation for COVID-19 as the dependent variables. Of the participants, 3206 (1.9%) developed COVID-19, of whom, 559 (17.4%) were hospitalised. There was not a significant association between the incidence of COVID-19 and type of dental visit. Participants with dental visits for periodontal treatment during the baseline year had a significantly lower odds ratio (OR) for hospitalisation due to COVID-19 compared to those without dental visits (OR: 0.71, 95% confidence interval: 0.58-0.78). The results suggest that dental visits for periodontal treatment including maintenance are important not only for maintaining oral health but also for preventing severe COVID-19.

Group text messaging as a residency teaching tool in outpatient neurology and headache: A mixed-methods observational study.

To assess the feasibility and efficacy of group text messaging as a teaching tool to improve neurology resident knowledge and clinical pearl dissemination in an outpatient setting enriched with headache encounters, and to evaluate if learning points from this teaching method would influence resident care of subsequent patients. Inpatient neurology teaching during training is most often accomplished in team settings during rounds or conferences such as morning report, but outpatient teaching where headache is more likely encountered may be less consistently performed in such a setting where learning points may be shared. Few studies have evaluated whether group text messaging can be an innovative tool for teaching in residency training. Neurology residents in a continuity clinic pod at New York Presbyterian-Weill Cornell were included in this cohort from December 2020 through March 2024. Group text messages deidentified of any patient information were sent to the resident pod by their preceptor after each clinic session featuring one text message regarding a takeaway learning point pertaining to each patient encounter. Residents were surveyed on their satisfaction with this teaching method and whether these text messages improved their outpatient neurology knowledge. A total of 230 text messages were sent to a cohort of 21 residents across 4 academic years. Text message topics covered a variety of neurological subspecialties, most commonly headache and facial pain (44.8%), general neurology (15.7%), and neuromuscular (14.3%). In our survey, 93% of resident respondents reported that receiving clinical pearls improved their outpatient neurology knowledge and changed how they cared for subsequent patients. Reinforcement of traditionally one-on-one learning points in a teaching outpatient setting to engage a group of residents was feasible across visit types. There was an overall very positive response to this teaching method, and residents reported improved knowledge, which influenced their care of subsequent patients.

Impact of encounters on patient app use: results of a tethered mobile personal health record usage pattern analysis.

The adoption of tethered mobile personal health records provides not only medical information to patients but also various convenience functions related to hospital use, thereby increasing accessibility to healthcare services and promoting patient engagement. We analyse the tethered mobile personal health records app's usage logs to determine how it can contribute to improving medical service accessibility and patient engagement. Log data, that comprised menu type, log time, and date, were collected from the mobile personal health records app of a tertiary referral hospital. Clinical information, including patients' demographics and visit type, was collected from the clinical research warehouse system. The usage log was analysed in terms of the type of visit, service function, and time period. Outpatients accounted for 34% of the total app usage and was the most app-accessed visit type. The most utilized menu functions were lab test and visit schedule for visits or non-visits. For Inpatient and Health check-ups, menu usage patterns showed a focus on lab test results. While investigations and other menu usage showed double peaks in the morning and afternoon, peak usage of lab test results correlated with inpatient blood sampling times, which was around 9 am. App menus to access health information, particularly blood tests, emerged as the most accessed menu. Hence, when compared with blood sampling times and hospital information system usage patterns, encounters occurring in the hospital majorly impacted patient app use. For improved patient engagement, improving lab test function should be the priority.

Cognitive and Behavioral Outcomes of Snoring Among Adolescents

Snoring is central to sleep-disordered breathing (SDB), which arises from nocturnal upper airway resistance. Habitual snoring is associated with cognitive and behavioral problems in young children, but less is known about these associations in adolescents. To assess the longitudinal associations of snoring with cognition and problem behaviors among adolescents. This cohort study was a secondary analysis of the Adolescent Brain Cognitive Development (ABCD) Study dataset (release 5.0), which enrolled 11 875 children and a parent or caregiver from June 1, 2016, to October 15, 2018, at 21 participating US research institutions and followed-up for 5 years. The analysis was performed between December 2023 and April 2024. Parent-reported snoring categorized as none, nonhabitual (<3 nights/week), and habitual (≥3 times/week). Cognition was assessed using 5 measures from the National Institutes of Health Toolbox (NIH-TB), and caregiver-reported problem behaviors were assessed using the Child Behavior Checklist (CBCL), including Total Problems, Internalizing Problems, and Externalizing Problems. Longitudinal associations of snoring with these assessment measures were analyzed using linear mixed-effects models stratified by obesity. Model fits were assessed after including the fixed-effects of age, sex at birth, race, family income, follow-up time, visit type, and the random-effects of site and identification number. The study included data from 11 862 children at year 1 (mean age, 119.0 months [95% CI, 118.8 to 119.1 months]; 6164 male [52.2%]) and 11 198, 10 870, 10 064, and 4668 children at years 2 to 5, respectively. The proportion of habitual snorers decreased from 811 participants (6.8%) in year 1 to 150 participants (3.2%) in year 5. Snoring was not associated with any of the NIH-TB scores. A statistically significant association of snoring was identified with all CBCL scales. The largest-magnitude association was of snoring with the CBCL Total Problems scale among adolescents with obesity (β = 3.18; 95% CI, 2.59-3.77). In this cohort study analyzing associations of snoring with cognitive test scores and problem behaviors based on the ABCD dataset, the prevalence of snoring declined over time; snoring in adolescents was associated with problem behaviors but not cognitive deficits. These findings may aid shared decision-making regarding treatment options such as adenotonsillectomy for adolescents with SDB.

Patient Satisfaction with Telehealth Services in Primary Care.

Objective: Patient satisfaction is an imperative factor in integrating telehealth services as a treatment modality in health care systems. Here, we compared patient satisfaction from telehealth versus in-person health care visits in a large heterogeneous population. Methods: We conducted a retrospective cohort study of patients making telehealth or in-person primary care visits between January 2021 and August 2022. Patient satisfaction with both service types was evaluated using a validated survey. Logistic regression models were employed to assess the association between type of visit (in-person/telehealth) and patient satisfaction (satisfied/unsatisfied) while accounting for sociodemographic and clinical characteristics. Results: Of the 247,087 surveys included in the study, 86,580 (35%) were answered following telehealth visits. Telehealth visitors were more satisfied than in-person visitors in aspects related to doctor-patient interactions, such as "courtesy and respect," "attentive listening," and "coherent explanations" (aOR = 1.17, 95% CI: 1.14-1.21; aOR = 1.16, 95% CI: 1.12-1.19; aOR = 1.15, 95% CI: 1.12-1.18, respectively), and less satisfied in aspects related to indirect services, such as adherence to appointment scheduling, effort required on the part of the patient, and staff cooperation (aOR = 0.95, 95% CI: 0.93-0.97; aOR = 0.89, 95% CI: 0.87-0.91; aOR = 0.85, 95% CI: 0.83-0.87, respectively). Importantly, considerably more telehealth visits were delayed (44%) than in-person visits (27%). Adjustment for this factor further strengthened the observed association between telehealth services and patient satisfaction. Conclusions: While telehealth was associated with high levels of satisfaction in doctor-patient interaction, improvements are still needed in indirect services. Addressing issues related to staff cooperation and streamlining processes to reduce delays could improve overall patient satisfaction with telehealth.

Public perceptions of dietetics services in Australia and New Zealand.

The aim of this study was to examine expectations, perceptions and attitudes about dietetics services among the Australian and New Zealand public, to provide insights for building a future dietetics workforce that will meet consumer needs. A cross-sectional, anonymous, online survey was employed to gain perspectives of a representative sample of Australian and New Zealand adults. Questions were purposely designed to collect views regarding sources of dietary information, expectations of dietetics service providers and factors influencing choice of dietetics service provider. Data were analysed descriptively and using Pearson's chi-square test to assess relationships between categorical variables. Free-text responses were analysed using content analysis. Of 2601 respondents, approximately one third (32%) had seen a dietitian. Doctors were the most trusted sources of dietary information (87%), particularly with participants over 60 years (χ(1) = 44.168, V = 0.130, p < 0.001). Cost was the most frequently reported factor influencing choice of dietetics services (56%), with 88% of respondents interested in accessing a dietitian, preferably in-person (64%), if they could do so for no cost. Participants anticipated that dietitians would offer services like meal plans (59%) and nutritional analysis (48%) as well as weight and other body measurements (56%). Some expectations such as blood tests (54%) were outside the usual scope of dietetic practice. The results of this study have implications for practising dietitians, dietetics educators, and funders of dietetics services. Cost as a barrier suggests that advocacy to government for funding type, duration and number of visits to dietitians is still required.

Telephone Survey-Reported Perceptions of Telehealth Visits Among Black and Non-Black Patients Diagnosed With Cancer.

Empirical evidence underscores both benefits of telehealth visits and persistent disparities in use for Black adults. Guided by the Technology Acceptance Model, we evaluated perceptions regarding telehealth visits among Black and Non-Black adults receiving cancer care from two academic health systems. Between April 2022 and October 2023, a survey was conducted among adult patients treated for cancer in the past 3 years. Survey recruitment was stratified by visit type (telehealth or in-person) and race. Before a scheduled oncology visit, respondents completed a telephone survey to assess their perceptions of usefulness, ease of use, and attitudes toward telehealth visits. Frequency differences were estimated using chi-square tests, and prevalence differences using logistic regression. The survey was completed by 773 respondents (42% Black) with a 15% response rate. Black respondents were younger and less likely to report male sex, being married, having a college education, comfortable income, or confidence in medical and e-literacy. Compared with Non-Black respondents, Black respondents perceived telehealth visits as less useful for determining health needs (37% v 48%) and asking questions (9% v 15%). They thought that telehealth visits were less easy with regard to understanding their health care provider (14% v 21%) and the ability to connect (23% v 30%). Black respondents expressed more concern about internet access (26% v 15%), access to electronic devices (17% v 9%), and finding assistance for connecting (24% v 12%). They also found telehealth visits to be less private (19% v 34%). Racial differences in telehealth ease of use and usefulness perceptions highlight the need for oncology practices to couple connectivity support with effective communication strategies to avoid disparities in oncology telehealth services.

Telemedicine Compared to Office-Based Care of Patients With Cardiac Symptoms: Treatment and Outcomes

BackgroundAn increasing proportion of visits are now delivered via a virtual platform. Virtual visits are limited by the lack of important components of cardiovascular assessment such as physician examination and electrocardiogram. ObjectivesThe purpose of this study was to evaluate the quality of care delivered by virtual visits compared to office-based visits among adults who sought care for 3 common cardiac-related symptoms: dyspnea, dizziness, or palpitations. MethodsRetrospective cohort study of 992,526 outpatient visits between January 1, 2017, and December 31, 2021, within an integrated health system, including 356,159 visits for dyspnea, 412,913 for dizziness, and 223,454 for palpitations. We compared the differences in patient characteristics associated with telemedicine visits versus in-office visits, evaluated the referral rates for noninvasive cardiac testing, and examined the association between virtual visits and 30-day clinical outcomes. ResultsAmong 992,526 visits, 71.5% were office visits, 25.8% telephone visits, and 2.7% video visits. Median age was 59 (IQR: 43-72) years, and 63.1% were women. Patient characteristics associated with increased likelihood of virtual visits included younger age, female sex, being non-Hispanic Black, and being from lower-income households. No association was observed between visit types and 30-day cardiovascular hospitalization for patients with dizziness or palpitations. However, for patients with dyspnea, evaluation via virtual visits was associated with a higher risk of 30-day hospitalization for heart failure (aOR: 1.25; 95% CI: 1.16-1.36 for telephone visits; aOR: 1.45; 95% CI: 1.17-1.80 for video visits). Compared to office-based visits, patients with dyspnea were less likely to be referred for echocardiogram with telephone (aOR: 0.73; 95% CI: 0.72-0.75) or video visits (aOR: 0.92; 95% CI: 0.87-0.98). ConclusionsVirtual visits may be appropriate for some clinical concerns but not all. Optimal alignment of clinical conditions with appropriate care modalities is an important component of a successful telemedicine strategy.

A pilot study of thecardiopulmonary effects in healthy volunteers after exposure to high levels of PM2.5 in a New York City subway station.

Subway systems are becoming increasingly common worldwide transporting large populations in major cities. PM2.5 concentrations have been demonstrated to be exceptionally high when underground, however. Studies on the impact of subway PM exposure on cardiopulmonary health in the United States are limited. Healthy volunteers in New York City were exposed to a 2-h visit on the 9th Street Station platform on the Port Authority Trans-Hudson train system. Blood pressure, heart rate variability (HRV), spirometry, and forced impulse oscillometry were measured, and urine, blood spot, and nasal swab biosamples were collected for cytokine analysis at the end of the 2-h exposure period. These endpoints were compared against individual control measurements collected after 2-h in a "clean" control space. In addition to paired comparisons, mixed effects models with subject as a random effect were employed to investigate the effect of the PM2.5 concentrations and visit type (i.e., subway vs. control). Mean PM2.5 concentrations on the platform and during the control visit were 293.6 ± 65.7 (SD) and 4.6 ± 1.9µg/m3, respectively. There was no change in any of the health metrics, but there was a non-significant trend for SDNN to be lower after subway exposure compared to control exposure. Total symptomatic scores did increase post-subway exposure compared to reported values prior to exposure or after the control visit. No significant changes in cytokine concentrations in any specimen type were observed. Mixed-effects models mostly corroborated these paired comparisons. Acute exposures to PM on a subway platform do not cause measurable cardiopulmonary effects apart from reductions in HRV and increases in symptoms in healthy volunteers. These findings match other studies that found little to no changes in lung function and blood pressure after exposure in underground subway stations. Future work should still target potentially more vulnerable populations, such as individuals with asthma or those who spend increased time underground on the subway such as transit workers.

12572 Incidental Adrenal Enlargement On Ct Scan In South Brooklyn Health, How Often Is It Functional?

Abstract Disclosure: R. Ruggiero: None. N. Simon: None. Background: Incidental findings of adrenal hyperplasia are increased due to the widespread rise in cross sectional imaging, as well as improvement of imaging modalities. There is a lack of literature reporting on the prevalence of incidental adrenal hyperplasia. One study reported a prevalence of 11.3%. Adrenocortical hyperplasia can result from endocrine disorders such as ACTH dependent and independent Cushing syndrome, primary aldosteronism, Multiple Endocrine Neoplasia type 1, and congenital adrenal hyperplasia. Other reported causes are radiographic adrenal enlargement of unknown cause and without clinical or biochemical manifestations, inflammation, neoplasms, and depression. Most cases are a radiographic finding with no clinical significance. One study reported that 69.23% of cases were nonfunctional. There are currently no guidelines in place for biochemical evaluation of incidental adrenocortical hyperplasia. Patients are typically referred to endocrinology services. Objective: The purposes of this study was to: 1. Evaluate the number of patients referred to endocrinology clinic for incidental abnormal adrenal imaging. 2. Examine the percentage of abnormal adrenal imaging findings on CT scan, in particular adrenal hyperplasia, that are hormonally active. Methods: This was a retrospective study of patients who were referred to endocrinology clinic or electronic endocrine consult for incidental abnormal adrenal imaging, excluding those with clear diagnosis of masses, nodules, adenomas, or cysts. Data collected included demographics, type of study imaging and radiologist reader, hormonal studies, comorbid conditions such as diabetes mellitus, hypertension, obesity, osteoporosis, as well as visit type to endocrinology service (e-consult vs in person). Results: The total number of consults referred to endocrinology during this period was 138. Due to repeat referral or having an adrenal pathology other than hyperplasia, 83 patients were excluded from analysis. There were 55 patients with isolated adrenal hyperplasia, 86% of whom were Caucasian, 11% Hispanic, and 78% of patients were female. Median age 63 years old. Hypertension was noted in 69% of patients, 36% had diabetes mellitus or dysglycemia, 36% were obese, and 1.8% had osteoporosis. Imaging reading was performed by 3 radiologists, 75% of cases reported by one reader. Only 5% of referrals were answered as an e-consult. About 27% of patients did not show up to establish care. Hormonal workup was completed by 60% of the patients, with 16 % having abnormal findings. One patient required confirmatory workup. No patients required treatment. Conclusion: Adrenal Hyperplasia is often an incidental radiologic finding, that can be reader dependent. Most cases are nonfunctioning without abnormal findings on hormonal workup. E-Consultation can be an efficient tool to help PCP and reduce endocrine clinic visits. Presentation: 6/1/2024

Identifying barriers to being offered and accepting a telehealth visit for cancer care: Unpacking the multi-levels of documented racial disparities in telehealth use.

382 Background: The use of telehealth visits in cancer care can improve accessibility, timeliness, and convenience for patients. However, disparities in its use persist with few studies having evaluated both patient- and community-level factors in relation to telehealth visit use in cancer care. Methods: We assembled a cohort of adults with an upcoming healthcare visit related to their cancer treatment at two academic medical centers (one in central NC and one in southeast MI) and their community affiliates. Black adults and those with a scheduled telehealth visit were oversampled during recruitment. Pre-visit surveys administered by telephone (N=773, RR=15%) collected information on sociodemographic characteristics, use of telehealth visits, healthcare access concerns, and patient symptoms/visit goals. We linked participant residential address to community-level measures, including broadband access. The two patient-reported outcomes of interest were 1) whether a choice in visit type (virtual or in-person) was offered and 2) scheduled visit type among those offered a choice. Associations of each outcome with sociodemographic characteristics and barriers (individual- and census tract-level) were assessed through estimation of unadjusted and adjusted prevalence differences (PDs). Results: 773 adults (RR=15%) were included in the cohort, mostly from the central NC site (N=621, RR=23%). After excluding non-recall for being offered a choice, the analytic sample (N=725) was 46% aged &lt;65 years, 42% Black, and 67% women. Black participants were less likely than non-Black participants to be offered a choice (15% vs 23%, PD= -8.7 (-14.4, -3.0), and if offered a choice, less likely to accept a telehealth visit: 20% vs 67%, PD= -47.0 (-62.0, -32.0). Similarly, women were less likely to be offered a choice (16% vs 27%, PD= -10.9 (-17.4, -4.4)) and accept a telehealth visit 42% vs 63%, PD= -20.8 (-36.8, -4.7). Those who expressed technology-related worries were less likely to schedule a telehealth visit, such as those who were worried about internet access: 33% vs 57%, PD adj = -11.9 (-32.9, 9.2). Participants who indicated their insurance did not cover telehealth visits were less likely to be offered a choice (10% vs 24%, PD ad = -9.4 (-23.1, 4.4). Lower community technology access (e.g. broadband ownership) and higher area-level poverty were associated with both outcomes, although these estimates were attenuated after adjustment. Conclusions: Not being offered a choice in visit type and/or not accepting a telehealth visit were associated with individual- and community-level barriers as well as demographic characteristics which may reflect additional unmeasured structural inequities (namely racism and sexism). Interventions to improve access to telehealth visits in cancer care should consider patient- and community-level barriers to care.

Telemedicine in geriatric oncology is here to stay.

Advancing age is the most important risk factor for cancer. Collaborations with medical and surgical-oncology divisions, and supportive services are required to assist older adults with cancer through their assessment and treatment trajectories. This often requires numerous clinical encounters which can increase treatment burden on the patient and caregivers. One solution that may lighten this load is the use of telemedicine. At Memorial Sloan Kettering, the Cancer and Aging Interdisciplinary Team (CAIT) clinic risk stratifies and optimizes older adults planned for medical cancer treatment. We analyzed patients seen in the CAIT clinic between May 2021 and December 2023, focusing on their utilization of telemedicine, and on the differences in characteristics of the visits and the results of the Geriatric Assessment based on visit type. Of the 288 patients (age range 67-100) evaluated, the majority (77%) chose telemedicine visits. Older age, lower educational status, living in New York City, abnormal cognitive screen, impaired performance measures, IADL dependency and having poor social support were all associated with choosing an in-person visit as opposed to telemedicine. Older patients with cancer frequently choose and can complete telemedicine visits. Efforts should be directed to develop an infrastructure for remote engagement, improving reach into rural and underserved areas, decreasing the burden generated by multiple appointments.

The association of oncology telehealth visits with acute care events and follow-up appointments.

384 Background: Use of telehealth visits in cancer care expanded with the pandemic, yet few studies have assessed its impact on subsequent care outcomes. We evaluated differences in acute care events (ACEs) and follow-up visits among patients with telehealth compared to in-person oncology visits. Methods: We identified a cohort of adults with an upcoming oncology visit related to their cancer treatment at two academic medical centers (in central NC and southeast MI) and their community affiliates. Black adults and those with a scheduled telehealth visit were oversampled. Pre-visit surveys administered by telephone collected information on sociodemographic characteristics, prior telehealth use, health status/symptoms and travel distance. We joined survey and electronic health record (EHR) data and used geocoding to assign census-tract-level community characteristics to participants. ACE and follow-up visit use were ascertained via the EHR. Unadjusted and adjusted prevalence differences in ACEs within 30 and 180 days as well as follow-up visits within 7 and 30 days were assessed by visit type. Results: 502 patients were study eligible, 90 telehealth and 412 in-person visits. In unadjusted and adjusted models, the proportion of patients incurring an ACE within 7 and 30 days was not significantly different (6 vs. 3% and 17 vs. 10%, telehealth vs. in-person, respectively). Nor did the proportion of patients having a follow-up visit within 7 or 30 days differ significantly (26 vs. 20% and 65 vs. 54%, telehealth vs. in-person, respectively). Some patient characteristics were similar regardless of visit format. For example, most patients were older (63 mean age SD 13), not currently employed (66%), and reported getting by/living comfortably with current income (88%), having some college education (80%), no transportation troubles (85%), and activated patient portal accounts (89%). Symptom presentation per the PRO-CTCAE was similar between groups as was broadband connectivity. Telehealth patients were significantly less likely to be Black (14 vs. 44%), female (48 vs. 72%), have breast cancer (22 vs. 48%), received chemotherapy (72 vs. 83%), or to live within 60 minutes of care (49 vs. 68%), and more likely to have advanced disease (24 vs. 14%), report LGBTQ sexual orientation (10 vs. 4%), and be married (70 vs. 57%). Conclusions: Similar ACE and follow-up visit use among those with telehealth and in-person visits supports the idea that telehealth could be a viable substitute for some in-person care within oncology. Differences between those using telehealth and in-person visits highlight equity concerns and missed opportunities to enhance patient convenience and other aspects of care access. To better understand telehealth’s impact, not only on care use, but other indicators of quality (including patient outcomes), matching via propensity score analyses are needed and underway.

Leveraging electronic medical record (EMR) changes and virtual care towards improving tobacco screening and referral rates.

426 Background: Continued smoking after a cancer diagnosis is associated with poorer outcomes. Ontario Regional Cancer Centres are required to screen all new cancer patients for tobacco use and offer referrals for cessation support to patients using tobacco. At Princess Margaret Cancer Centre (Toronto, Canada), we leveraged an EMR change to Epic along with uptake in virtual care strategies from COVID-19, to improve both tobacco screening and referral rates for new patients. Methods: Following the EMR transition to Epic in June 2022, we piloted EMR and virtual care strategies from Jan 2023 to Mar 2024 to improve both tobacco screening and referral rates. Due to precautions during COVID-19, screening and referrals were completed using a hybrid pre-visit electronic tobacco use assessment questionnaire and in clinic paper-based referral system. Our interventions were co-developed by a team of hospital leadership, IT team members and clinicians. These included: 1) Collation of tobacco assessment data sources on Epic (Jan 2023); 2) Creation of an Epic referral inbox to track referrals (Aug 2023); 3) Assignment of electronic pre-visit tobacco assessments questionnaires to correct visit types (Sep 2023); 4) Creation of a half-day virtual nursing clinic to offer referrals for cessation support to patients initially declining support or those who were not offered using monthly reports from Epic (Nov 2023). Screening and referral rates were tracked monthly and quarterly during this period. Results: From Jan 2023 to March 2024, 15,063 new patients presented to our cancer centre. Baseline screening and referral rates before COVID-19 were 47% and 16%, respectively. Prior to this QI initiative, screening and referral rates were 18% and 1%, respectively. Post implementation, screening and referral rates improved to 42% and 25% (Table); rates of current tobacco use remained consistent from 12-16%. Collation of tobacco use assessments data on Epic had the greatest impact on improving screening rates from 18% to 39% (p&lt;0.001), while the virtual nursing clinic helped to improve referral rates from 3% to 25% (p&lt;0.001), with the greatest referral rate in Jan 2024 at 36%. Our virtual nursing clinic was feasible, where among patients contacted who initially declined or were not offered cessation support, 90% were contacted within 1-3 phone calls. Among patients contacted, 20% accepted a referral, while 41% of patients had already quit smoking by the time of contact. Conclusions: Both EMR and virtual care strategies helped to successfully improve both tobacco screening and referral rates for smoking cessation support; with the greatest impact from the collation of EMR data sources on tobacco use and development of a virtual nurse led clinic. Quarterly tobacco screening and referral rates. Jan-Mar 2023 Apr-Jun 2023 Jul-Sep 2023 Oct-Dec 2023 Jan-Mar 2024 Screening 33% 38% 39% 41% 42% Referrals 0% 1% 3% 20% 25%

Downstream Emergency Department and Hospital Utilization Comparably Low Following In-Person Versus Telemedicine Primary Care for High-Risk Conditions.

Telemedicine use expanded greatly during the COVID-19 pandemic. More data is needed to understand how this shift may impact other venues of acute care delivery. We evaluate the association of visit modality (telephone, video, or office) and downstream emergency department (ED) and hospital visits among primary care visits for acute, time-sensitive conditions. Observational study of patient-scheduled primary care telemedicine and office visits for acute conditions (cardiac, gastrointestinal, neurologic, musculoskeletal, and head and neck) in a large, integrated healthcare delivery system. Adults with a new self-booked primary care appointment for an eligible acute condition from January 1, 2022, to December 31, 2022 (with no primary care, ED, or hospital visits in prior 30 days). Visit modality, including office, video, or telephone. Seven-day ED and hospital utilization, adjusted for patient and visit characteristics. Among 258,958 primary care visits by 239,240 adult patients, 57.7% were telemedicine visits; of these, 72.4% were telephone and 27.6% were video. Telephone visits were the timeliest, with over 70% of visits scheduled within 1 day of booking. Rates of 7-day ED utilization were low, and varied by condition group, with cardiac visits having the highest rates (4.8%) and musculoskeletal visits having the lowest (0.8%). There was less than a 1% absolute difference in ED use by visit modality for all condition types; however, telephone visits were associated with slightly higher rates than video visits. The 7-day hospitalization rate was less than 1% and observed between visit type differences varied by clinical condition. Among office, telephone, and video visits in primary care for potentially high-risk, time-sensitive conditions, downstream ED and hospital use were uncommon. ED utilization was lower for video visits than telephone visits, although telephone visits were timelier and may offer a safe and accessible option for acute care.

The Relationship Between Provider and Patient Racial Concordance and Receipt of Postpartum Care.

Access to postpartum care (PPC) varies in the US and little data exists about whether patient factors may influence receipt of care. Our study aimed to assess the effect of provider-patient racial concordance on Black patients' receipt of PPC. We conducted a cross-sectional study analyzing over 24,000 electronic health records of childbirth hospitalizations at a large academic medical center in Alabama from January 2014 to March 2020. The primary outcome variable was whether a Black patient with a childbirth hospitalization had any type of PPC visit within 12weeks after childbirth. We used a generalized estimating equation (GEE) logistic regression model to assess the relationship between provider-patient racial concordance and receipt of PPC. Black patients with Black main providers of prenatal or childbirth care had significantly higher adjusted odds of receiving PPC (adj. OR 2.26, 95% CI 1.65-3.09, p < .001) compared to Black patients with non-Black providers. White patients who had White providers did not have statistically significantly different odds of receiving PPC compared to those with non-White providers after adjustment (adj. OR 0.88, 95% CI 0.68-1.14). Although these results should be interpreted with caution given the low number of Black providers in this sample, our findings suggest that in one hospital system in Alabama, Black birthing people with a racially concordant main prenatal and delivery care provider may have an increased likelihood of getting critical PPC follow-up.