Unscreened Patients Research Articles

Stress Screening and Social Intervention in Radiation Oncology Consultation: A Demonstration of Need

<h3>Purpose/Objective(s)</h3> Cancer-related stress is a common and under-treated condition. The NCCN recommends distress screening with the distress thermometer (DT) scale of 0-10 for all cancer patients at all stages of disease in all settings, emphasizing screening at initial visits and after changes in disease status. Distressed patients should be clinically evaluated and referred to social work (SW), mental health professionals, or chaplain care. This study assesses the rate of distress screening and receipt of appropriate SW care at a high-volume academic healthcare network. <h3>Materials/Methods</h3> All patients seen for Radiation Medicine consultation between 7/1/21-12/31/21 were reviewed. Rates of DT documentation, patient distress, and SW intervention (SW referral or consultation) within 14 days were assessed. Chi-square test was used to test if binary variables (curative vs noncurative consult and community vs central tertiary location) were associated with rates of DT screening and SW intervention. Binary logistic regression was used to test the relationship between age and distress. <h3>Results</h3> 2214 patients were seen for radiation oncology consult, and 784 (35%) had DT screening documented. 411 (52%) screened patients were distressed (DT ≥ 4), and 194 (25%) patients were severely distressed (DT ≥ 7). Median age was 67 years. Median distress level was 4 (SD = 3.2, R: 1-6). A total of 306 (14%) patients received SW intervention. Higher rates of SW intervention were present in screened patients vs unscreened patients (30% vs 5%, X²=265.9, p<0.001). Screened patients were more likely to get SW support if they were distressed vs not distressed (48% vs 10%, X²=140, p<0.001). 116 (60%) severely distressed patients received SW intervention. Each additional year of age was associated with a lower rate of reported distress (OR=0.983, p<0.001). Curative, noncurative, and benign consultations composed 58%, 39%, and 3% of the cohort respectively. Rates of distress (52% vs 56%, X²=0.791, p=0.34) and rates of distressed patients receiving SW intervention (51% vs 48%, X²= 0.179, p=0.672) were similar between curative vs noncurative consultations. More patients were seen at community campuses (58%) vs the central tertiary location (42%). Screenings were more frequently documented at community locations vs the central location (40% vs 29%, X²= 28.5, p<0.001). Distressed patients received higher rates of SW intervention at community locations vs the central location (55% vs 36%, X²=14, p<0.001). <h3>Conclusion</h3> Current rates of distress screening at radiation consultation are low. Since 52% of screened patients report distress and unscreened patients are less likely to receive SW support, these results underscore a large unmet need in the care of cancer-related stress. Differences in implementation at the central vs community location indicate unique program initiatives can improve screening and psychosocial support utilization.

LBODP048 Barriers To Diabetic Retinopathy Screening In Hospitalized Patients With Diabetes

Abstract Diabetic retinopathy (DR) is a leading cause of preventable vision loss in the in the U. S., and DR screening is essential to prevent blindness. Yet minority populations have consistently lower DR screening rates than Non-Hispanic Whites and knowledge about barriers versus facilitators for completion of DR screening in these groups remains scant. Improvement in DR Screening rates in safety net populations has been observed after placing digital retinal cameras in primary care sites to capture images where patients get their basic health care. In this study, we therefore assessed DR screening in patients at time of hospitalization as a possible additional site to capture unscreened patients with diabetes. We identified patient with diabetes admitted for any reason to a safety net hospital to evaluate perceived barriers to DR screening. We performed an anonymous survey in English or Spanish in 156 hospitalized adult patients with diabetes during hospital stays between 10/2019-12/2021, using a convenience sample. Barriers specified in the survey were derived from the literature. The study population had a mean [+SD] age of 50+10.5 years, were predominantly male [72.4%], of low-income [83.7% &amp;lt;$25,000/year] and minority groups [Latinos 79.5% and African American [10.3%]. Diabetes duration was &amp;gt;5years in 63.6% of patients. Reported DR screening rate in the 12 months prior to admission was only 31.4%, despite 97% of patients confirming they were aware that diabetes causes impaired vision and blindness. The main perceived barriers to DR screening identified in the survey were financial [50%], transportation [22%] and depression [17%]. There were no significant differences in the number or nature of perceived barriers in those who reported DR screening vs. those who did not. Surprisingly, the pandemic appeared to have little impact on DR screening rates. Comparison of patients surveyed before (n=96; 10/2019-03/20) and after COVID lockdown (n=60; 08/2020-12/2021), did not show any significant differences in patient demographics, number or nature of perceived barriers, or DR screening rates (32% vs 30%). However, DR screening among patients without a Primary Care Provider (PCP) was considerably lower compared to patients with a PCP, 10% vs 49% (p&amp;lt;0. 001). In summary, this study reveals low prior outpatient DR screening rates in hospitalized patients with diabetes in low-income minorities in a safety-net hospital, and identifies potential remediable barriers associated with this. The results suggest that cost and transport barriers could be addressed by implementation of DR screening during hospitalization in safety net hospitals. These results also emphasize the significance of a having a PCP. We conclude that inpatient DR screening and facilitating PCP-patient connections might lead to improvement in DR screening rates and thus prevent blindness in this segment of the diabetes population. Presentation: No date and time listed

EVALUATION OF LUNG CANCER SCREENING ELIGIBILITY IN A SMOKING CESSATION CLINIC LOCATED IN AN URBAN COMMUNITY: A QUALITY-IMPROVEMENT PROJECT

EVALUATION OF LUNG CANCER SCREENING ELIGIBILITY IN A SMOKING CESSATION CLINIC LOCATED IN AN URBAN COMMUNITY: A QUALITY-IMPROVEMENT PROJECT

Compliance with preoperative glucose testing and USPSTF diabetes screening guidelines in gynecologic oncology patients on an enhanced recovery pathway (408)

Compliance with preoperative glucose testing and USPSTF diabetes screening guidelines in gynecologic oncology patients on an enhanced recovery pathway (408)

Abstract 1434: Molecular characteristics of breast cancer patients subjected to screening for germline predisposition in a population-based observational study

Abstract An estimated 5-10% of breast cancer cases carry germline mutations in genes associated with a moderate to strong breast cancer risk, like BRCA1 and BRCA2. These mutations can influence disease onset, progression, biology of the tumor, potential for therapy, risk of recurrence and cancer risk of close relatives. This warrants clinical germline screening for such gene variants according to national guidelines on patient selection. In this study we aimed to molecularly and clinicopathologically contrast clinically screened patients and their tumors against unscreened patients. For this we used a population-based breast cancer cohort from southern Sweden with 6660 patients (14% of which had been screened) with accompanying RNA-sequencing and clinicopathological registry data. Screening subsets were analyzed within five clinically relevant breast cancer subgroups based on hormone receptor and lymph node status. Among other features, we investigated clinicopathological characteristics, risk of tumor recurrence, survival outcomes, tumor proliferation markers, immune cell content, genes differentially expressed and the pathways in which they were involved. Most differences were found in the triple negative breast cancer (TNBC) subgroup: when compared to patients that had not been screened, the screened subset contained younger individuals showing better overall survival, more proliferative tumors with upregulated genes that belong to DNA replication and double-strand break repair processes, lower proportion of M2 macrophages and higher proportion of T-helper 2 cells. As so, Swedish screening guidelines divide TNBC cases into two separate subsets possibly by selecting distinct underlying biological and mutational mechanisms associated with DNA repair deficiency (e.g., through BRCA1/2-deficiency), a disparity not seen in other breast cancer clinical subgroups. Understanding the molecular landscape of defined screening populations may improve future guideline updates, which in turn would also improve patient and resource handling. Citation Format: Deborah F. Nacer de Oliveira, Johan Vallon-Christersson, Hans Ehrencrona, Anders Kvist, Åke Borg, Johan Staaf. Molecular characteristics of breast cancer patients subjected to screening for germline predisposition in a population-based observational study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1434.

Machine learning application to find patients with lower-risk myelodysplastic syndrome from real-world data.

1555 Background: It is a challenge to identify patients with myelodysplastic syndrome (MDS) using structured data from electronic health records (EHRs). Current claims-based algorithms incorporating diagnosis codes, clinical labs, and procedures have not been validated against an expert reference standard. A machine learning-based approach was investigated to identify erythropoietin-stimulating agent (ESA)-treated, lower-risk (LR)-MDS patients from structured EHR data. Methods: A sample of 1,549 patients from the Syapse Learning Health Network (SLHN) was identified as potential ESA-treated LR-MDS patients by a team of clinicians and epidemiologists based on diagnosis and medication data from multiple health systems’ EHRs and cancer registries. Of these, 404 (25%) were confirmed as ESA-treated LR-MDS patients through a review of patient records by certified cancer registrars (CTRs). The sample was divided into training and validation sets at a ratio of 80/20, stratified by the outcome. Age, sex, diagnosis codes corresponding to MDS and chronic kidney disease, medication (ESA, luspatercept, lenalidomide), clinical lab tests (hemoglobin, absolute neutrophils, platelet, blast percentage), and evidence of bone marrow biopsy were included as the predictive variables for the models. Gradient boosting machines with a nested cross-validation scheme were adopted to build the optimal model on the training set. Model acceptance was evaluated based on precision and recall on the validation set. The optimal model was then applied to the remaining unscreened SLHN patient population. Results: The optimal model identified an additional cohort of 157 patients based on the predicted likelihood. Among these, 69 (44%) were CTR-confirmed ESA-treated LR-MDS patients, all of whom were previously missed by the initial expert-determined selection criteria, as shown in the table. Conclusions: The application of machine learning methods increased the rate of ESA-treated MDS patient identification even after the expertly-determined population was depleted. This suggests the application of machine learning models using EHR data may improve the efficiency of MDS patient identification and screening efforts for research, quality improvement, and clinical care. [Table: see text]

Prevalence and predictors for being unscreened for diabetic retinopathy: a population-based study over a decade

ObjectifDéterminer les facteurs de prédiction d'une absence de dépistage de la rétinopathie diabétique (RD) au sein d'une population de patients diabétiques dans un pays industrialisé. NatureÉtude populationnelle transversale, répétée et rétrospective. ParticipantsTous les patients présentant un diabète (de type 1 et de type 2) âgés de ≥ 20 ans et figurant dans le système de soins de santé universel de l'Ontario ont été recensés pendant 2 périodes (2011–2013 et 2017–2019). MéthodesLe test de Mantel–Haenszel a servi à calculer la comparaison du risque relatif (RR) dans les sous-catégories stratifiées en fonction des 2 périodes transversales. RésultatsAu total, 1 145 645 sujets diabétiques ont été recensés pendant la période 2011–2013 et 1 346 578, pendant la période 2017–2019. La proportion de patients qui n'ont subi aucun dépistage de la RD a diminué très légèrement pour passer de 35 % (n = 405 967) en 2011–2013 à 34 % (n = 455 027) en 2017–2019 de l'ensemble des sujets diabétiques (RR = 0,967; intervalle de confiance [IC] à 95 %: 0,964–0,9693; p < 0,0001). Les jeunes adultes (20–39 ans) constituaient la plus grande proportion de patients qui n'ont bénéficié d'aucun dépistage (62 % et 58 % en 2011–2013 et en 2017–2019, respectivement). Qui plus est, les sujets qui appartenaient à un quintile de revenus plus faibles (RR = 1,039; IC à 95% : 1,036–1,044; p < 0,0001), qui étaient des immigrants récents (RR = 1,286; IC à 95 % : 1,280–1,293; p < 0,0001), qui vivaient en milieu urbain (RR = 1,149; IC à 95 % : 1,145–1,154; p < 0,0001), qui avaient des antécédents de troubles de la santé mentale (RR = 1,117; IC à 95 % : 1,112–1,122; p < 0,0001) ou qui n'avaient pas accès à un médecin de soins primaires (RR = 1,656; IC à 95 % : 1,644–1,668; p < 0,0001) couraient un risque plus élevé d’échapper au dépistage. ConclusionsSelon notre étude populationnelle qui s'est étalée sur une décennie, 33 % des patients diabétiques ne font l'objet d'aucun dépistage de la RD. Les principaux facteurs de prédiction d'une absence de dépistage sont le jeune âge, le revenu faible, l'immigration, la résidence dans une grande ville, les troubles de la santé mentale et l'absence d'accès à un médecin de soins primaires.

150P Molecular characteristics of breast cancer patients subjected to screening for germline predisposition in a population-based observational study

5-10% of breast cancer cases carry germline mutations in genes associated with a moderate to strong breast cancer risk, like BRCA1 and BRCA2. These mutations can influence disease onset, progression, biology of the tumor, potential for therapy, risk of recurrence and cancer risk of close relatives warranting clinical germline screening. In this study we aimed to molecularly and clinicopathologically contrast clinically screened patients and their tumors against unscreened patients.

Five-Year Outcomes of a Melanoma Screening Initiative in a Large Health Care System

Population-based skin cancer screening is currently not recommended owing to lack of data to quantify the balance of benefits and harms. To compare thickness-specific incidence of melanoma in screened vs unscreened patients following the initiation of a primary care-based skin cancer screening initiative. This observational study of a quality improvement initiative was conducted from January 1, 2014, through December 31, 2018, among patients 35 years and older presenting for a primary care visit at primary care practices within an academic and community-based health care system during the study period. Data analysis was performed January 2020 to January 2022. Primary care clinicians were offered training in melanoma identification through skin examination and encouraged to offer annual screening to patients 35 years and older. Thickness of melanomas diagnosed in screened and unscreened patients. Among 595 799 analyzed screen-eligible patients, 144 851 (24.3%) were screened at least once. Screened patients were older (median [IQR] age, 59 [49-67] vs 55 [45-66] years) and more likely to be female (82 244 [56.8%] vs 250 806 [55.6%]; P < .001) and non-Hispanic White (124 747 [86.1%] vs 375 890 [83.4%]; P < .001) than unscreened patients. After adjusting for age, sex, and race, screened patients were more likely than unscreened patients to be diagnosed with in situ (incidence, 30.4 vs 14.4; hazard ratio [HR], 2.6; 95% CI, 2.1-3.1; P < .001) or thin invasive (≤1 mm) melanoma (incidence, 24.5 vs 16.1; HR, 1.8; 95% CI, 1.5-2.2; P < .001). Screened patients were also more likely than unscreened patients to be diagnosed with in situ (incidence, 26.7 vs 12.9; HR, 2.1; 95% CI, 1.7-2.6; P < .001) or thin invasive (≤1 mm) interval melanomas (melanoma diagnosed at least 60 days after initial screening examination) (incidence, 18.5 vs 14.4; HR, 1.3; 95% CI, 1.0-1.7; P = .03). Incidence of melanoma thicker than 4 mm in unscreened and screened patients, respectively, was 3.3 and 2.7 (HR, 0.8; 95% CI, 0.4-1.4; P = .38) for all melanomas and 2.7 and 1.5 (HR, 0.6; 95% CI, 0.2-1.2; P = .15) for interval melanomas. In this quality improvement study, primary care-based melanoma screening was associated with increased detection of thin melanoma, raising concern about overdiagnosis. Further studies with longer follow-up are needed to determine the influence of screening on the incidence of thick melanoma and outcomes associated with high costs and poor outcomes, such as metastasis.

Use and Outcomes of Low-Dose CT Scan Lung Cancer Screening in the Medicare Population

Relatively little is known about various aspects of low-dose CT (LDCT) scan lung cancer screening in US clinical practice, including characteristics of cases diagnosed after screening. We assessed this using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. What were the characteristics of patients with lung cancer, including stage and survival, whose disease was diagnosed after LDCT scan screenings? We created an LDCT scan use cohort consisting of everyone in the 5%SEER-Medicare sample with≥ 12months of non-health maintenance organization (HMO) Part A and B coverage while 65 to 77 years of age from 2015 through 2019. LDCT scan use and lung cancer diagnosis rates were assessed in this cohort. Additionally, we created a lung cancer cohort consisting of patients who received a diagnosis between 2015 and 2017 at 65 to 78 years of age with complete (non-HMO Part A and B) coverage the year before diagnosis. The cases cohort comprised those screened or unscreened based on undergoing screening during that period; lung cancer characteristics and survival were compared between these groups. In the LDCT scan use cohort (n= 414,358), use rates increased from 0.10 (per 100 person-years) in 2015 to 1.3 in 2019. Among those with first screenings, 39.2%underwent a subsequent screen within 18months. The 1-year cumulative lung cancer diagnosis rate after initial screenings was 2.4%. Claims for prescreen counseling were infrequent (about 10%). Of 48,891 patients in the lung cancer cohort, 1,150 (2.4%) underwent screening. Among screened patients, 52.3%, 11.0%, 20.7%, and 16.0%received diagnoses of stages I, II, III, and IV disease, respectively. Lung cancer-specific survival through 3 years was significantly greater in screened versus unscreened patients overall and for all stages except stage II; 3-year lung cancer-specific survival was 89.0%in screened patients with stage I disease. LDCT scan use was low but increased over time. The lung cancer yield was substantial; cases among those who underwent screening primarily were in the early stage with high survival rates. Although screening rates were unacceptably low, screening outcomes in those Medicare recipients undergoing screening were favorable.

HbA1c and Infection in Diabetic Elective Hand Surgery: A Veterans Affair Medical Center Experience 2012-2018.

Hemoglobin A1c (HbA1c) is an indicator of glucose control over a 3-month period. The plastic surgery service began screening HbA1c levels prior to surgery when a trend in infectious complications was noted in diabetics. We made a cutoff value of < 8% for elective hand surgery. The institutional review board approved a 7-year retrospective chart review (#201900402) 2012 through 2018 of our elective diabetic hand surgery cases. Data collected included: surgery, HbA1c levels within 3 months before surgery, glucose finger sticks day of surgery, and infectious complications up to 30 days after surgery. A Fisher exact test using a P value of < .05 and a logistic regression analysis using a P value of < .05 were used to determine statistical significance between infectious complications and screening. In all, 848 cases were recorded in the data base. Infection complication rates before and after screening were not statistically significant (P = .44). All major complications (3) requiring a return to the operating room involved surgery within the flexor sheath before screening was enforced. This was not statistically significant (P = .25). The relative risk of an infectious complication involving the flexor sheath in unscreened patients was 3.66. A logistic regression analysis found no correlation with infectious complications based on the 3 variables of screening time (P = .99), preoperative finger stick values (P = .12), or HbA1c levels (P = .29). The data did not support our guidelines for enforcing HbA1c cutoff levels prior to elective hand surgery. Consider enforcing levels < 8% when the flexor sheath may be violated.

Abstract MP72: Renal Artery Stenosis Screening Among Women With Hypertensive Disorders Of Pregnancy And Associations With Pregnancy Outcomes

Introduction: Patients with hypertensive disorders of pregnancy (HDoP) have increased prevalence of renal artery stenosis due to fibromuscular dysplasia (FMD) that is usually diagnosed years post-partum. Because renal artery FMD is a treatable cause of hypertension, earlier diagnosis has potential to decrease maternal risk and improve pregnancy outcomes. We sought to characterize utilization of renal artery duplex screening among women with HDoP and associations with pregnancy outcomes. Hypothesis: We hypothesize that renal artery duplex screening for renal artery stenosis among women with HDoP will be low. Methods: Women diagnosed with HDoP treated at a single academic medical center from 2016-2021 were identified using ICD-9&amp;10 codes for hypertension of pregnancy, pre-eclampsia, eclampsia, and HELLP syndrome. Screening for renal artery FMD was categorized based on performance of at least one renal duplex ultrasounds during the study period. Associations with maternal demographic factors and pregnancy outcomes based on screening status were explored using descriptive statistics and categorical tests. Results: 11,564 women diagnosed with HDoP were identified. Mean age was 37.1±8.5 years. Race was categorized as 17% African American, 5% Asian, and 73% white; 4% of women had Hispanic or Latino ethnicity. 33% of patients were current or former smokers. Renal artery stenosis screening was performed on 72 women (0.6%). No significant differences in age, race, or ethnicity were identified between screened versus unscreened patients. Renal artery duplex results were abnormal in 14/72 (19%) of women screened, and an additional 3 women were diagnosed with FMD at a non-renal anatomic location based on imaging studies other than renal artery duplex. Women screened for renal artery stenosis for 44/8386 pregnancies (0.5%) associated with HDoP during the study period and had higher rates of preterm delivery (53% versus 20%; P&lt;0.001). Conclusions: Renal artery stenosis screening is uncommon among women with HDoP, but identified abnormal findings in a significant proportion of studies. Associations between screening and preterm delivery may reflect selection bias based on severity of HDoP symptoms and related risks. Renal artery stenosis screening may be under-utilized among women with HDoP, and expanded screening has potential to reduce both short- and long-term maternal risk and improve pregnancy outcomes.

Epidemiological impact of lung cancer screening by low dose CT scan in the French Department of the SOMME

ContextLung cancer is the leading cause of cancer death worldwide. In recent years, screening using low-dose CT scan has shown a reduction in lung cancer-related mortality and in all-cause mortality. The DEP KP80 study was implemented in the French department of the Somme with the aim of investigating lung cancer screening in practice. The results of the first round showed a prevalence of 2.7% for lung cancer, with the majority at localized stages (77%).The primary objective of our study was to compare the stage at diagnosis of patients with lung cancer screened as part of DEP KP80 and those who were not screened. The secondary objectives were to describe the epidemiological characteristics of lung cancer in the French department of the Somme for the period in question and to compare survival rates in screened and unscreened patients. MethodsThis retrospective cohort study compared from May 2016 to December 2017 the characteristics of patients with lung cancer screened as part of DEP KP80 and those who were not screened, using data from the Somme Cancer Registry. ResultsIn total, 644 patients with lung cancer were included (18 in the screened group and 626 in the unscreened group). There was a significant inversion in the stage distribution at diagnosis, with a predominance of metastatic or locally advanced stages (69%) and a minority of early stages (31%) in unscreened patients, and a majority of early stages (77.8%) and a lower proportion of locally advanced or disseminated stages (22.2%) in screened patients (p < 0.01). In the screened group, there was a significant improvement in survival, a higher rate of surgical resection, and a longer time interval between first contact and treatment initiation. ConclusionLung cancer screening by low-dose CT scan in the French department of the Somme showed an impact on stage at diagnosis, with a majority of early stages in screened patients, allowing for curative treatment with a significant improvement in survival.

A 1-Year Review of a Nationally Led Intervention to Improve Suicide Prevention Screening at a Large Homeless Veterans Clinic.

Suicide is a national public health concern and veterans are a particularly vulnerable population. The Veterans Health Administration (VHA) Office of Mental Health and Suicide Prevention implemented a national, standardized process for suicide risk screening in October 2018, which was instituted at the West Los Angeles Veterans Affairs Medical Center Homeless Patient Aligned Care Team (HPACT) clinic. This article examines the results of the screening initiative after implementation, describes difficulties faced in implementation, and suggests strategies that might be used to overcome those challenges. Over 1 fiscal year (October 1, 2018 to September 30, 2019) the HPACT clinic had 2932 unique veterans assigned to its care; 1876 (64%) received a primary screen of suicide risk, 523 (18%) were not screened, and 533 (18%) were exempt from screening by protocol. Of the 523 (18%) unscreened patients, 331 (11%) patients had no HPACT visit and 132 (5%) did not visit any VHA site during the period. There were 192 (7%) patients who visited but were not screened of which 19 (1%) declined screening. Most missed screening opportunities were due to patients being lost to follow-up. There were 5 challenges identified for screening implementation, including health record factors, communication, clinician buy-in, system factors, and patient factors. Thus, promoting interprofessional collaboration, visualizing effective process flows, establishing clear lines of communication and roles for involved staff, and opening avenues for continuous feedback and troubleshooting were all effective in increasing comfort with suicide assessment and screening rates.

Implementing Health Related Social Needs Screening in an Outpatient Clinic.

Introduction/Objectives:Health-related social needs (HRSN) screening efforts have reported high rates of identified social needs. Little is known if efforts to conduct HRSN screening in resource-constrained federally-qualified health centers (FQHC) successfully captures a representative patient population.Methods:This cross-sectional study extracted EMR data from 2016 to 2020 for 4731 screened patients from 7 affiliated clinics of a FQHC. Unscreened patients were pulled as a random sample from the study period. A multivariable logistic regression was used to identify sociodemographic traits, chronic disease diagnoses and burden, and clinic visit type and frequency associated with being screened for HRSN.Results:BHC screened 4731 unique patients or <1% of the total clinic population. Screened patients had a median of 3.3 (±2.5) unmet HRSN. Medicaid patients had higher odds of being screened (aOR = 1.38, CI 1.19-1.61) relative to Medicare patients. The odds of being screened for social needs increased with more provider visits per year: compared to fewer than 1 visit per year, patients with 1 to 3 provider visits (aOR = 2.06, CI 1.73-2.32), 4 to 6 provider visits (aOR = 3.34, CI 2.89-3.87), and more than 6 provider visits (aOR = 5.16, CI 4.35-6.12) all had higher odds of social needs screening. Patients with a higher comorbid disease burden (>2 conditions, aOR = 2.80, CI 2.07-3.79) had higher odds of screening.Conclusions:Our findings demonstrate an increased likelihood to screen patients who visit outpatient services more often and have a higher comorbid disease burden. To meet state-level Medicaid requirements, resource-constrained FQHCs that implement clinic wide HRSN screening may be well served to identify a priori strategies to ensure representative and equitable screening across the patient population.

S319 Are We Screening for Colorectal Cancer During Inpatient Hospital Admissions? 15-year Trends of Inpatient Screening Colonoscopies

Introduction: Colorectal cancer screening is mostly performed as an ambulatory same-day procedure and reimbursed as a preventive measure for patients >50 years of age in an average risk population. We attempted to detect and analyze trends of screening colonoscopies performed during inpatient admissions. Methods: Hospitalization data were extracted from Nationwide Inpatient Sample (NIS) of patients above age 50 years from 2004 to 2018 with associated primary ICD-9 and ICD-10 diagnosis and procedure codes for screening colonoscopy (V76.51; Z12.11; 45.23; 0DJD8ZZ). We stratified age groups into 50-59, 60-69 and above age 70. Sociodemographic data, patients’ primary insurance and median household income by zip code was used as a surrogate endpoint to assess socioeconomic burden and associated trend patterns. Additionally, all associated diagnoses with colonoscopy procedures were analyzed. Results: A total of nationally estimated 3 315 885 inpatient colonoscopies were identified. Only a minor proportion (27,294) was associated with primary diagnosis of screening for malignant neoplasm of the colon, and the trend has not significantly increased throughout the years (Figure 1). Diverticulosis of colon with hemorrhage (12%), gastrointestinal hemorrhage (9%), melena (3.4%), internal hemorrhoids (3%) and iron deficiency anemia (3%) were 5 top most common associated diagnosis with rest of the procedures. There has been no change in the proportion of colonoscopies performed depending on insurance type, and no increase noted in patients residing in the lowest income areas. Colonoscopy performance increased in males (42% to 47%) and 60-69 age group (21% to 27%), some increase was noted in Black and Hispanic population (Table). Procedures have shifted to teaching hospitals from 36% in 2000 to 71.8% in 2018. Mortality remained stable ranging from 1.4% to 1.9% throughout the years. Conclusion: Analysis of inpatient screening colonoscopy hospitalizations >50 years of age throughout 15 years has demonstrated that only ∼0.8% of the total colonoscopies were associated with diagnosis of screening for malignancy and no significant increasing trend has been demonstrated throughout 15 years. An increase has been noted in screening minorities and men in 60-69 age group. No increase has been noted for CRC screening of the lowest income population. Analysis is necessary to further determine barriers for performing inpatient screening colonoscopies and capturing more unscreened patients in the >50 years age group.Figure 1.: Proportion of Inpatient Screening Colonoscopy, NIS 2004-2018Table 1.: Racial distribution of inpatient colonoscopies performed for all associated diagnosis codes, NIS 2004-2018

The Utility of Lower Extremity Screening Duplex for the Detection of Deep Vein Thrombosis in Trauma

Trauma patients are high-risk for venous thromboembolism (VTE). Lower extremity screening duplex ultrasonography (LESDUS) is controversial and not standardized for early VTE diagnosis. By implementing risk stratification and selective screening, we aim to optimize resource utilization. A retrospective review were conducted at a Level-1 Trauma Center, January 2015-October 2019. LESDUS was performed within 72-h of presentation, then weekly. Demographics, VTE data, and outcomes were collected from the trauma registry. Risk assessment profile (RAP) score was calculated based on collected data. Of 5,645 patients included, 2,813 (49.8%) were screened for lower extremity deep vein thrombosis (LEDVT). Of 187 patients with LEDVT, 154 were diagnosed on LESDUS, 18 after negative LESDUS, and 15 in unscreened patients. Patients with VTE were older (61y versus 55, P < 0.01), more often male (70.9% versus 29.1%, P=0.03), had higher ISS (16 versus 10, P < 0.01), longer hospital length of stay (LOS) (11.5 d versus 3, P < 0.01), longer ICU LOS (4.5 d versus 1, P < 0.01), and increased mortality (9.1% versus 4.3%, P=0.01). RAP was higher in VTE patients versus those without (nine versus three, P < 0.01). RAP ≥8 was 62.5% sensitive and 70.4% specific for VTE. Chemoprophylaxis delay also correlated with increased VTE (OR=1.48, 95% CI=1.03-2.12). VTE remains a significant complication in trauma patients. Despite a universal LESDUS protocol, only 50% of patients underwent screening and 20% of all LE DVTs were not identified on LESDUS. To optimize resource utilization and protocol adherence, LESDUS should only be performed if RAP ≥8 or if unable to administer timely chemoprophylaxis.

Underutilization of Guideline-based Abdominal Aortic Aneurysm Screening in an Academic Health System

Early detection of Abdominal Aortic Aneurysms (AAA) allows for life-saving surgical intervention. The US Preventive Services Task Force (USPSTF) recommends a one-time screening for AAA with ultrasonography in men aged 65-75 who have ever smoked. Although published as a grade B recommendation, the uptake of these guidelines remains unclear. The objectives of our study were to identify the screening rate per year of eligibility for AAA between 2016 and 2019 according to USPSTF guidelines and to assess for patient- and system-level factors associated with receipt of screening. Data were extracted from electronic health record (EHR) from three academic affiliated hospitals. Index screening eligibility date was defined as the 65th birthdate for male patients with a prior history of smoking. Patients with an index screening eligibility date between January 1, 2016, and December 31, 2019, were included in the study population. Screened patients were identified by an encounter record for ultrasound, computed tomography, or magnetic resonance imaging. We calculated screening rate per year of eligibility by dividing the number of screened patients by the sum of person-years of all eligible patients then multiplied by 100. Characteristics of screened and unscreened patients were analyzed using unadjusted descriptive statistics. There were 10,166 eligible patients who turned 65 years old between January 1, 2016, and December 31, 2019, representing 20,273 person-years. Mean age at the end of study period was 66.5 (±1.13 years). The population consisted of 68.5% white, 25.4% African Americans (AA), 0.96% Asian, and 0.97% American Indian or Alaskan Native (AI/AN). Overall, a total of 2222 patients (21%) were screened between 2016 and 2019. Screening rate per year of eligibility was 10.7%. Of the 2584 eligible AA patients, 626 received screening (24.2%) compared with 1466 of the 6968 (21.0%) eligible white patients, 29.6% and 21.2% for Asian and AI/AN patients, respectively (P = .014). Median household income quartile ranking was not significantly different between unscreened and screened patients (P = .12). Compared with unscreened patients, screened patients were more likely to receive screening for colon cancer (31.6% vs 39.9%, P < .0001), prostate cancer (36.3% vs 42.7%, P < .0001), and hyperlipidemia (10.9% vs 13.4%, P = .001). Unscreened patients were less likely to have visited a primary care provider (37.7% vs 45.1%, P < .0001) or cardiologist (27.4% vs 38.0%, P < .0001) during the study period. Screening for AAA per USPSTF guidelines is underutilized, regardless of racial group. Racial variation needs further investigation. Provider- and system-level policy interventions may be necessary to bolster institutional screening efforts.

Detecting diabetic retinopathy through machine learning on electronic health record data from an urban, safety net healthcare system.

ObjectiveClinical guidelines recommend annual eye examinations to detect diabetic retinopathy (DR) in patients with diabetes. However, timely DR detection remains a problem in medically underserved and under-resourced settings in the United States. Machine learning that identifies patients with latent/undiagnosed DR could help to address this problem.Materials and MethodsUsing electronic health record data from 40 631 unique diabetic patients seen at Los Angeles County Department of Health Services healthcare facilities between January 1, 2015 and December 31, 2017, we compared ten machine learning environments, including five classifier models, for assessing the presence or absence of DR. We also used data from a distinct set of 9300 diabetic patients seen between January 1, 2018 and December 31, 2018 as an external validation set.ResultsFollowing feature subset selection, the classifier with the best AUC on the external validation set was a deep neural network using majority class undersampling, with an AUC of 0.8, the sensitivity of 72.17%, and specificity of 74.2%.DiscussionA deep neural network produced the best AUCs and sensitivity results on the test set and external validation set. Models are intended to be used to screen guideline noncompliant diabetic patients in an urban safety-net setting.ConclusionMachine learning on diabetic patients’ routinely collected clinical data could help clinicians in safety-net settings to identify and target unscreened diabetic patients who potentially have undiagnosed DR.

Primary care and mental health: Where do we go from here?

Primary care has been dubbed the “de facto” mental health system of the United States since the 1970s. Since then, various forms of mental health delivery models for primary care have proven effective in improving patient outcomes and satisfaction and reducing costs. Despite increases in collaborative care implementation and reimbursement, prevalence rates of major depression in the United States remain unchanged while anxiety and suicide rates continue to climb. Meanwhile, primary care task forces in countries like the United Kingdom and Canada are recommending against depression screening in primary care altogether, citing lack of trials demonstrating improved outcomes in screened vs unscreened patients when the same treatment is available, high false-positive results, and small treatment effects. In this perspective, a primary care physician and two psychiatrists address the question of why we are not making headway in treating common mental health conditions in primary care. In addition, we propose systemic changes to improve the dissemination of mental health treatment in primary care.