US Health Care Research Articles

Interconnected dynamics of duration, productivity and “bullshit” of labor (branch aspect on the example of the USA)

Within the framework of the generally accepted concept of the increasing role of materialized labor in productivity, a constant but slowing growth in the rate of labor productivity and a reduction in working hours, some paradoxes of labor productivity formed and developed in the past few decades. One of the paradoxical phenomena characteristic of industries with a traditionally high share of human labor is the increase in working hours due to additionally created jobs, assessed by D. Graeber as completely or partially meaningless (“bullshit”) labor. Such labor does not create value, but only participates in its redistribution in favor of the least valuable for society types of activity that, as a rule, serve the creation of a real product or socially significant service. This dynamic actualizes the problem of the relationship between productivity, duration and meaninglessness of labor, not only as socio-economic, but also cultural value. Based on data from the US Bureau of Labor Statistics and the results of factor analysis using a mathematical correlation-regression apparatus, the indicated relationships in the performance dynamics of two sectors of the US economy over a long period of time were modeled. It was empirically confirmed that in the context of a long-term increase in labor productivity, leading to a general reduction in working hours, a contradiction with the ethical principle of “purchasing” labor by the employer is gradually forming and developing, leading to stagnation and a subsequent increase in working hours due to the creation and diversification of different forms of meaningless labor. It is shown that the increase in the cost of living labor, expressed, in particular, in the need to allocate additional working time for socially meaningless work, objectively slows down productivity in construction and healthcare in the United States.

Medical Malpractice Payment Reports of Physician Assistants/Associates Related to State Practice Laws and Regulations

ABSTRACT Purpose: Authorizing physician assistants/associates (PAs) to provide care to patients and removing restrictive laws and regulations without sacrificing patient safety is essential to meet the needs of patients and the US healthcare system. The aim of this observational study was to determine if states with permissive compared to restrictive PA scope of practice laws and regulations had higher instances of medical malpractice payment reports (MMPR), a proxy of patient harm. Design: This observational study examined 10 years (2010-2019) of medical malpractice payment reports data from the National Practitioner Data Bank (NPDB) compared to the laws and regulations of states for the same period. Results: Negative binomial regressions indicated no statistically significant differences in MMPR rates between states with permissive versus restrictive PA practice laws and regulations. Five of six practice reforms decreased or had no significant effect on PA and physician MMPR occurrences. One reform was associated with a weak but statistically significant increased risk of MMPRs for PAs and a trend toward a decreased risk for physicians. Conclusion: This study suggests that removing restrictive laws and regulations to PA practice does not increase overall risks to patients or increase rates of malpractice within US healthcare.

Sustaining Care in Crisis: COVID-19’s Impact on US Physician Board Certification

ABSTRACT One of the COVID-19 pandemic’s many strains on the United States (US) healthcare system has been its impact on the physician board certification process. Understanding this effect is critical to maintaining access to qualified medical care and upholding the benchmark of board certification. The American Board of Medical Specialties (ABMS) has shown that US annual first-time physician certifications fell from a total of 31696 physicians in 2019 to 23558 in 2020. A survey sent to all 22 primary specialty boards under the ABMS received received responses from 7 boards. Results suggest that 5426 of 11722 (46.3%) applicants to responding specialty boards had testing canceled or rescheduled because of COVID-19. One board reported 4147 (80.5%) of its applicants were affected, requiring 2.9 times the original number of exam dates. Four specialty boards chose to newly incorporate a virtual format, with 2274 (19.4%) of all candidates taking part in the novel format. While COVID-19 altered board examinations for many physicians in 2020, successes and failures in implementing new certification modalities may hint at future opportunities to maintain and improve the certification process for US physicians.

Access to the American Health Care System: Biblical, Philosophical, and Theological Reflections on Justice

The issue of access to the American health care system seems destined to reappear in the 2024 presidential election. The political and economic debates regarding single-payer systems providing (near) universal health care are well documented. Supporters of the status quo, knowingly or unknowingly, rest their argument on the basic assumptions of utilitarianism. In response patrons investigating inequalities in access to the American health care system can turn to biblical, philosophical, and theological reflections on justice.

Electrocardiographic deep learning for predicting post-procedural mortality: a model development and validation study

Preoperative risk assessments used in clinical practice are insufficient in their ability to identify risk for postoperative mortality. Deep-learning analysis of electrocardiography can identify hidden risk markers that can help to prognosticate postoperative mortality. We aimed to develop a prognostic model that accurately predicts postoperative mortality in patients undergoing medical procedures and who had received preoperative electrocardiographic diagnostic testing. In a derivation cohort of preoperative patients with available electrocardiograms (ECGs) from Cedars-Sinai Medical Center (Los Angeles, CA, USA) between Jan 1, 2015 and Dec 31, 2019, a deep-learning algorithm was developed to leverage waveform signals to discriminate postoperative mortality. We randomly split patients (8:1:1) into subsets for training, internal validation, and final algorithm test analyses. Model performance was assessed using area under the receiver operating characteristic curve (AUC) values in the hold-out test dataset and in two external hospital cohorts and compared with the established Revised Cardiac Risk Index (RCRI) score. The primary outcome was post-procedural mortality across three health-care systems. 45 969 patients had a complete ECG waveform image available for at least one 12-lead ECG performed within the 30 days before the procedure date (59 975 inpatient procedures and 112 794 ECGs): 36 839 patients in the training dataset, 4549 in the internal validation dataset, and 4581 in the internal test dataset. In the held-out internal test cohort, the algorithm discriminates mortality with an AUC value of 0·83 (95% CI 0·79-0·87), surpassing the discrimination of the RCRI score with an AUC of 0·67 (0·61-0·72). The algorithm similarly discriminated risk for mortality in two independent US health-care systems, with AUCs of 0·79 (0·75-0·83) and 0·75 (0·74-0·76), respectively. Patients determined to be high risk by the deep-learning model had an unadjusted odds ratio (OR) of 8·83 (5·57-13·20) for postoperative mortality compared with an unadjusted OR of 2·08 (0·77-3·50) for postoperative mortality for RCRI scores of more than 2. The deep-learning algorithm performed similarly for patients undergoing cardiac surgery (AUC 0·85 [0·77-0·92]), non-cardiac surgery (AUC 0·83 [0·79-0·88]), and catheterisation or endoscopy suite procedures (AUC 0·76 [0·72-0·81]). A deep-learning algorithm interpreting preoperative ECGs can improve discrimination of postoperative mortality. The deep-learning algorithm worked equally well for risk stratification of cardiac surgeries, non-cardiac surgeries, and catheterisation laboratory procedures, and was validated in three independent health-care systems. This algorithm can provide additional information to clinicians making the decision to perform medical procedures and stratify the risk of future complications. National Heart, Lung, and Blood Institute.

Betrayal-Based Moral Injury and Mental Health Problems Among Healthcare and Hospital Workers Serving COVID-19 Patients

ABSTRACT One factor potentially driving healthcare and hospital worker (HHW)’s declining mental health during the COVID-19 pandemic is feeling betrayed by institutional leaders, coworkers, and/or others’ pandemic-related responses and behaviors. We investigated whether HHWs’ betrayal-based moral injury was associated with greater mental distress and post-traumatic stress disorder (PTSD) symptoms related to COVID-19. We also examined if these associations varied between clinical and non-clinical staff. From July 2020 to January 2021, cross-sectional online survey data were collected from 1,066 HHWs serving COVID-19 patients in a large urban US healthcare system. We measured betrayal-based moral injury in three groups: institutional leaders, coworkers/colleagues, and people outside of healthcare. Multivariate logistic regression analyses were performed to investigate whether betrayal-based moral injury was associated with mental distress and PTSD symptoms. Approximately one-third of HHWs reported feeling betrayed by institutional leaders, and/or people outside healthcare. Clinical staff were more likely to report feelings of betrayal than non-clinical staff. For all respondents, 49.5% reported mental distress and 38.2% reported PTSD symptoms. Having any feelings of betrayal increased the odds of mental distress and PTSD symptoms by 2.9 and 3.3 times, respectively. These associations were not significantly different between clinical and non-clinical staff. As health systems seek to enhance support of HHWs, they need to carefully examine institutional structures, accountability, communication, and decision-making patterns that can result in staff feelings of betrayal. Building trust and repairing ruptures with HHWs could prevent potential mental health problems, increase retention, and reduce burnout, while likely improving patient care.

Cost-effectiveness of full and partial opioid agonists for opioid use disorder in outpatient settings: United States healthcare sector perspective

IntroductionStudies show that medications for opioid use disorder (MOUD) reduce illicit opioid use, emergency healthcare services, opioid-related overdose, and death. However, few studies have investigated the long-term cost-effectiveness of MOUD in office-based opioid treatment (OBOT) and opioid treatment program (OTP) settings. We aimed to estimate the cost, utility, quality-adjusted life years gained (QALYs), and incremental cost-effectiveness ratios (ICERs) of three MOUD compared to each other and counseling without medication from a US healthcare sector perspective. MethodsOur study developed a Markov model to conduct a cost-effectiveness analysis of counseling and three MOUD in the OBOT and OTP settings: sublingual buprenorphine/naloxone (BUPNX), buprenorphine extended-release (XR-BUP) injection, and oral methadone. The model included five health states representing combinations of receiving or off treatment while either using or not actively using illicit opioids, and death. The cycle length was one month; the time-horizon was ten years. The study obtained model inputs from systematic reviews of published literature and public data. A 3 % annual discount rate was applied to cost and utility calculation. The primary outcomes included total costs, life-years (LYs), QALYs, and ICERs. We also conducted a scenario analysis using a hypothetical OBOT outpatient setting with methadone. ResultsIn the base-case OBOT setting, the total costs and QALYs, respectively, were counseling $22,848, 5.60; BUPNX $29,875, 5.82; and XR-BUP $63,936, 5.87. ICERs were $32,345/QALY (BUPNX vs. counseling) and $625,858/QALY (XR-BUP vs BUPNX). In the OTP setting, the total costs of counseling, methadone, BUPNX, and XR-BUP were $20,124, $27,000, $33,500, and $75,272, respectively. QALYs of methadone were 5.86. QALYs of counseling, BUPNX, and XR-BUP remained the same as in the OBOT setting. Incremental ICERs were $26,714/QALY (methadone vs counseling) and $3,337,623/QALY (XR-BUP vs methadone). BUPNX was dominated by methadone. In the scenario analysis, BUPNX was also dominated by methadone. ConclusionsOutpatient MOUD resulted in important gains in quality of life and life expectancy. In both OBOT and OTP settings, XR-BUP was not cost-effective. BUPNX was cost-effective in the OBOT setting, while it was dominated by methadone in the OTP setting. The cost-effectiveness of BUPNX and XR-BUP could be enhanced if the costs of these medications were reduced.

The clinical and economic impact of extended battery longevity of a substernal extravascular implantable cardioverter defibrillator.

The extravascular implantable cardioverter defibrillator (EV ICD) has extended projected battery longevity compared to the subcutaneous implantable cardioverter defibrillator (S-ICD). This study used modeling to characterize the need for generator changes, long-term complications, and overall costs for both the EV ICD and S-ICD in healthcare systems of various countries. Battery longevity data were modeled using a Markov model from averages reported in device labeling for the S-ICD and with engineering estimates based on real life usage from EV ICD Pivotal Study patient data to introduce variability. Clinical demographic data were derived from published literature. The primary outcomes were defined as the number of generator replacement surgeries, complications, and total healthcare system costs due to battery depletion over the expected lifetime of patients receiving EV ICD or S-ICD therapy. Average modeled battery longevity was determined to be 7.3 years for the S-ICD versus 11.8 years for the EV ICD. The probability of a complication after a replacement procedure was 1.4%, with an operative mortality rate of 0.02%. The use of EV ICD was associated with 1.4-1.6 fewer replacements on average over an expected patient lifetime as compared to S-ICD and a 24.3%-26.0% reduction in cost. A one-way sensitivity analysis of the model for the US healthcare system found that use of an EV ICD resulted in a reduction in replacement surgeries of greater than 1 (1.1-1.6) along with five-figure cost savings in all scenarios ($18 602-$40 948). The longer projected battery life of the EV ICD has the potential to meaningfully reduce long-term morbidity and healthcare resources related to generator changes from the perspective of multiple diverse healthcare systems.

Past Is Prologue: Dismantling Colonial Legacies to Advance Black Health Equity in the United States.

Colonialism underlies the commodification of health care in the United States and continues to harm well-being among Black Americans. We present four recommendations for addressing its health consequences: (1) Investments in epigenetic research to improve our understanding of how systemic oppression becomes biology. (2) Centering Black experiences and knowledge traditions in education, practice, and policy. (3) Support for Black scholars, trainees, and practitioners when they critic disciplinary tenets and practices. (4) Expansion of preventive care. Our health care system is a for-profit industry that exploits workers and harms the most marginalized, much like colonialism. Advancing health equity requires dismantling colonial legacies.

Abstract A062: Intersecting acculturation and decision making about cancer screening among sub-Saharan African immigrant men: A qualitative study

Abstract Background: Sub-Saharan African immigrant (SSAI) men constitute one of the fastest-growing immigrant populations in the United States and a large heterogeneous group in cancer survivorship. Yet research has ignored decision making about health and behavioral risk factors among SSAI communities. Intersecting acculturation and culture-specific perceptions about cancer screening within decision-making frameworks may be an essential step towards developing meaningful interventions for immigrant men’s healthcare. Objectives: This study aimed to gain insight into cancer-related beliefs and health decision-making practices among sub-Saharan African immigrant men. Methods: A qualitative design intersecting grounded theory analysis was employed using 16 semi-structured, in-depth individual interviews with SSAI men residing in Georgia and Florida. Participants were recruited from health fairs, community events, and by snowball effect. The average age of participants was 51 years with country of birth including Cameroon, Ethiopia, Ghana, Kenya, and Nigeria. An interview guide was prepared with emphasis on SSAI’s perspectives on lifestyle factors for cancer and decision making about cancer screening. Data were audio-recorded, transcribed, and analyzed using open, inductive, and axial coding via NVivo 12 qualitative data analysis software. Results: Findings identified key cultural factors impacting barriers to and facilitators of SSAI men’s decision-making processes and health-seeking behaviors. Most participants making positive decisions reflected on intercultural health practices made in collaboration with clinicians, significant others and community partnerships. Most participants with negative decisions tended to consider socio-cultural barriers and shortcomings in US health-care system. Participants’ preventative care decisions about cancer screening differed. Conclusions: This qualitative study illuminated key cultural factors among SSAI men that influenced their decision making about cancer screening and health-seeking behaviors. Future research should investigate longitudinal and quantitative studies to test decision-making outcomes. Funding Source: This study is funded by the National Institute on Minority Health and Health Disparities (1R15MD017012-01A1). Keywords: Cancer health disparities, Decision-making, Immigrant men, Intersectionality, Qualitative study Citation Format: Assata Kokayi, Gladys Asiedu, Kaitlin Van Voorhis, Rae Walker, M.E. Young, Folakemi Odedina, Motolani Ogunsanya, Ernie Kaninjing. Intersecting acculturation and decision making about cancer screening among sub-Saharan African immigrant men: A qualitative study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A062.

REMAP Periop: a randomised, embedded, multifactorial adaptive platform trial protocol for perioperative medicine to determine the optimal enhanced recovery pathway components in complex abdominal surgery patients within a US healthcare system

IntroductionImplementation of enhanced recovery pathways (ERPs) has resulted in improved patient-centred outcomes and decreased costs. However, there is a lack of high-level evidence for many ERP elements. We have designed...

We've Got You Covered: Rebooting American Health Care

Amitabh Chandra of Harvard University reviews “We’ve Got You Covered: Rebooting American Health Care” by Liran Einav and Amy Finkelstein. The Econlit abstract of this book begins: “Considers the objective and key elements of universal health insurance, presenting a blueprint for overhauling the US health-care system to guarantee essential medical coverage for everyone.”

Abstract A029: LGBTQ+ health navigation panel: Discussing barriers and facilitators in navigation to services for immigrant and non-immigrant LGBTQ+ community members in New York City area

Abstract Background: Patient navigation plays a crucial role both in patient care management and overcoming barriers to care. Navigating the complexities of US healthcare is difficult for everyone, including individuals who are native to the US as well as newly arrived immigrants and refugees from across the world. The LGBTQ+ community is greatly affected by a multitude of health disparities. Discrimination, stigma, bias, and prejudice towards the LGBTQ+ community contribute to those health disparities, which makes the role of LGBTQ+ health navigation even more essential. Patient advocacy and support in finding proficient clinical and social services is the core of LGBTQ+ patient navigation. The authors of this abstract will create a discussion-based panel to share experiences and tailored approaches that have successfully helped in navigating LGBTQ+ patients, addressing social determinants of health, creating inclusive environments, and contributing to LGBTQ+ proficient care. Methods: LGBTQ+ Health Navigation Panel will consist of several LGBTQ+ health advocates, navigators, and/or policymakers from healthcare and community-based institutions from across New York City area. They will participate in a discussion-based session model, which will be moderated by one of the authors of this abstract. Discussion: This LGBTQ+ patient navigation panel will focus on discussing healthcare services and navigation support for immigrant and non-immigrant LGBTQ+ community members in the New York City area. Services that we would focus on will be physical, mental, and social health, as well as patient advocacy and community education. In addition, a significant portion of our discussion will include topics of cancer prevention, screening, diagnosis, treatment, and survivorship in the LGBTQ+ community. Citation Format: Alexandr Trifonov, Kevin Moore, Megan C. Haseltine, Jason Domogauer. LGBTQ+ health navigation panel: Discussing barriers and facilitators in navigation to services for immigrant and non-immigrant LGBTQ+ community members in New York City area [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A029.

Public charge, legal estrangement, and renegotiating situational trust in the US healthcare safety net

AbstractUS immigration law increasingly excludes many immigrants materially and symbolically from vital safety-net resources. Existing scholarship has emphasized the public charge rule as a key mechanism for enacting these exclusionary trends, but less is known about how recent public charge uncertainty has shaped how noncitizens and healthcare workers negotiate safety-net resources. Drawing on ethnographic observations and interviews with 80 safety-net workers and patients in three US states from 2015 to 2020, I argue that intensifying anti-immigrant rhetoric surrounding public charge has extended a sense of surveillance into clinical spaces in previously unexamined ways. Drawing on theories of medical legal violence, system avoidance, and legal estrangement, I demonstrate how these dynamics undermined immigrants' health chances and compromised clinic workers' efforts to facilitate care. I also reveal how participants responded to this insinuation of legal violence in healthcare spaces by promoting situational trust in specific procedures and institutions.

Cost-Effectiveness Analysis of Trastuzumab Deruxtecan Versus Trastuzumab Emtansine for Patients With Human Epidermal Growth Factor Receptor 2 Positive Metastatic Breast Cancer in the United States

ObjectivesTo assess the cost-effectiveness of trastuzumab deruxtecan compared with trastuzumab emtansine as second-line therapy for patients with human epidermal growth factor receptor 2 positive metastatic breast cancer from a US healthcare sector perspective. MethodsA 3-state partitioned survival model was developed to estimate the cost-effectiveness of trastuzumab deruxtecan compared with trastuzumab emtansine. For both treatments, modeled patients were administered treatment intravenously every 3 weeks indefinitely or until disease progression. Transition parameters were principally derived from the updated DESTINY-Breast03 phase III randomized clinical trial. Costs include drug costs extracted from Centers for Medicare and Medicaid Services average sales price and administrative, adverse event, and third-line therapy costs derived from published literature, measured in 2022 US dollars. Health utilities for health states and disutilities for adverse events were sourced from published literature. Effects were measured in quality-adjusted life years (QALYs). We conducted both probabilistic sensitivity analysis and comprehensive scenario analysis to test model assumptions and robustness, while utilizing a lifetime horizon. ResultsIn our base-case analysis, total costs for trastuzumab deruxtecan were $1 266 945, compared with $820 082 for trastuzumab emtansine. Total QALYs for trastuzumab deruxtecan were 5.09, compared with 3.15 for trastuzumab emtansine. The base-case incremental cost-effectiveness ratio was $230 285/QALY. Probabilistic sensitivity analysis indicated that trastuzumab deruxtecan had an 11.1% probability of being cost-effective at a $100 000 per QALY willingness-to-pay threshold. ConclusionsDespite the higher efficacy of trastuzumab deruxtecan in patients with human epidermal growth factor receptor 2 positive metastatic breast cancer, our findings raise concern regarding its value at current prices.

Eight Principles for a Quality Healthcare Practice

The intricacies of the healthcare system often can feel overwhelming for patients. However, several strategies stand out among the best-run healthcare and medical practices in the United States. These can serve as guideposts for medical practice professionals fostering trust with patients and encouraging patients to have an active involvement in their care.

Two Approaches to Advance Care Planning for People with Dementia: Acceptability among US and Dutch Healthcare Providers

AbstractBackgroundAdvance care planning (ACP) may include concrete treatment orders or important goals or both. Providers may differ on these approaches to ACP, which may also differ across countries. We investigated the acceptability and preferences for these two ACP approaches for people with dementia among healthcare providers from the Netherlands (NL) and the US.MethodFifty providers from each country, whose specialty includes providing end‐of‐life care for people with dementia, viewed short animation videos about the two approaches of ACP and completed a semi‐structured interview. Qualitative content analysis summarized the comments of the providers on each ACP approach (reasons and conditions for acceptability, (dis)advantages, barriers and facilitators), and the reasons for their preferences.ResultExcept for three nurse practitioners from the US, all participants were physicians (e.g., NL: elderly care physicians, family physicians; US: geriatricians, internists, family medicine physicians). The acceptability and preferences were similar in the two countries. Both approaches were considered acceptable for people with dementia by the vast majority of providers (concrete orders approach: 86% (both countries); important goals approach: 96% (NL) and 98% (US)). Slightly more providers preferred the important goals approach compared to the concrete one (NL: 42% vs. 34%; US: 46% vs. 36%), others had no preference. While the concrete approach may facilitate immediate decisions in emergent situations and may be easier for providers to conduct with available forms, the important goals approach takes the life view of the person with dementia into consideration, can be implemented in more situations and may be easier for the person with dementia. Differences between the two countries included the role of the family caregivers and the power of providers to make decisions.ConclusionProviders found both approaches acceptable, but there was diversity in the preferred approach in both countries. Future research should investigate how the preference of individual providers interacts with the preferences of people with dementia and family caregivers, and whether this influences the experience of ACP and subsequent care provision. Examining administrative, legal, and educational issues that may shape preferences may inform more patient‐centered ACP.

Bridging the Gap: The Global CEOi Collaborative Workgroup for Adoption of Alzheimer’s disease Blood‐Based Biomarkers in Clinical Practice

AbstractBackgroundThe United States healthcare system is not prepared for disease modifying therapies (DMTs) of Alzheimer’s disease (AD). Eligibility for DMTs will be contingent on confirmation of AD pathology using biomarkers. Major difficulties are expected in providing PET and CSF testing in the population. Blood‐based biomarkers (BBMs) could greatly reduce the burden of biomarker testing by triaging patients for subsequent confirmation of AD brain pathology in specialty and primary care. The Global CEO Initiative on Alzheimer’s Disease (CEOi) has convened a Workgroup (WG) to develop guidelines and recommendations for the widespread adoption of BBMs in clinical practice to support feasible, timely, and accurate AD dementia diagnosis among symptomatic patients.MethodOver 80 stakeholders spanning academia, healthcare, advocacy, industry, non‐profit, and venture capital have joined the Workgroup, ensuring a wide range of expertise. The Workgroup consists of three active workstreams. Workstream A has defined use cases for symptomatic patients and minimum viable test specifications; Workstream B will provide recommendations on implementing BBMs in clinical practice; and Workstream C serves to educate practicing clinicians on outputs garnered from Workstreams A and B. Jointly led by 2 CEOi‐nominated experts, each Workstream has a core team, consisting of 6‐8 experts, and meet on a weekly basis to drive the WG objectives. General Workstream meetings are held periodically for the core team to present plans and outputs for full group input and feedback.ResultWorkgroup members have conceptualized the clinical care pathway for operationalizing BBM across specialty and primary care settings; and will present a feasible framework for real‐world implementation of BBMs. We have defined appropriate‐use criteria for BBMs in clinical settings, including test specifications, and will provide actionable recommendations to accelerate adoption in clinical care, while critically considering implementation challenges such as test result interpretation, and value to existing diagnostic pathway. Strategies to facilitate optimal implementation including novel educational tools will be disseminated.ConclusionThe Workgroup seeks rapid, efficient and effective utility of BBMs in clinical practice that is scientifically valid, and patient focused. Successful adoption will facilitate effectual triaging of patients for comprehensive diagnostic evaluations, streamlining patient access to appropriate and integrated care.

Abstract A093: Implementation of a financial hardship screening among Native American patients with cancer

Abstract Introduction: Financial hardship and financial hardship screening are emerging concerns in oncology. Native American patients may be at increased risk of financial hardship due to factors including poverty, medical comorbidities, and lack of private health insurance coverage. Financial hardship for Native American patients with cancer has only rarely been studied, and implementation of screening for financial hardship for these patients has never been reported. Methods: Guided by input from a stakeholder advisory board consisting of patient, provider, and staff members at a single cancer center in Oklahoma, we implemented a financial hardship screening tool, the COmprehensive Score for financial Toxicity (COST) – Functional Assessment of Chronic Illness Therapy (FACIT) among 42 Native American patients with cancer. We conducted key informant interviews with ten of these patients and four clinical staff involved in the implementation process. Patient interviews included questions about current financial hardship, experiences in discussing financial hardship with the cancer care and primary care team, and acceptability of the COST-FACIT tool. Clinician interviews focused on their experience with the project, including implementation of the COST-FACIT tool, barriers to implementation, and sustainability. Recorded interviews were transcribed and thematically analyzed using MAXQDA® software. COST-FACIT tool data were analyzed using SAS v. 9.4 Results: Three-quarters (76%, n=32) of participants who completed the COST-FACIT tool reported moderate or severe financial hardship (Score <25 out of max 44, with lower scores indicating more hardship). A higher percentage of patients experiencing financial hardship were younger, covered by Medicaid, unemployed, not married/cohabiting, had lower income, and lower education compared to those with no/mild hardship (Scores ≥25). Among patients and clinicians, we identified themes of 1) financial hardship screening perception and intervention experiences, 2) screening efficacy and opportunities for improvement, and 3) systematic and patient related themes of Native American health systems and culture. Conclusions: Financial hardship was reported by the majority of Native American patients with cancer included in our study. Patients expressed a positive experience with the screening tool, including identification of financial challenges though timing of the tool in regards to their cancer diagnosis varied across patients. Clinicians experienced challenges in implementation of the COST-FACIT tool related to logistics, the COVID-19 pandemic, and concerns for sustainability. However, clinicians reported a positive experience with the tool and interactions with patients and referrals that resulted from the screening. Citation Format: Amanda E. Janitz, Amber S. Anderson-Buettner, Stefani D. Madison, Mark P. Doescher, Dorothy A. Rhoades. Implementation of a financial hardship screening among Native American patients with cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A093.

Effectiveness of Virtual Reality-Based Rehabilitation Interventions in Improving Postoperative Outcomes for Orthopedic Surgery Patients.

The surge in orthopedic surgeries strains the US healthcare system, necessitating innovative rehabilitation solutions. This review examines the potential of virtual reality (VR)-based interventions for orthopedic rehabilitation. The effectiveness of VR-based interventions in orthopedic surgery patients is scrutinized. While some studies suggest better patient-reported outcomes and satisfaction, mixed results emerge from others, demonstrating comparable or varied results compared to traditional rehabilitation. The underlying mechanisms of VR-based rehabilitation are elucidated, showing its positive impact on proprioception, pain management, agency, and balance. Challenges of unfamiliarity, patient engagement, and drop-out rates are identified, emphasizing the need for tailored approaches. VR technology's immersive environments and multisensory experiences offer a novel approach to addressing functional deficits and pain post-surgery. The conclusion drawn is that VR-based rehabilitation complements rather than replaces conventional methods, potentially aiding in pain reduction and functional improvement. VR-based rehabilitation holds promise for enhancing orthopedic surgery outcomes, presenting a dynamic approach to recovery. Its potential to reshape healthcare delivery and reimbursement structures underscores its significance in modern healthcare. Overall, VR-based rehabilitation offers a promising avenue for optimizing postoperative recovery in orthopedic surgery patients.