Urban Health System Research Articles

2670. Sexual Health Evaluation Among People Tested for Mpox in an Urban Health System

Abstract Background The predominant mode of transmission in the 2022 mpox outbreak was sexually associated. Best practices for mpox evaluation include a sexual history, an anal and/or genital exam and STI testing. We hypothesized that the quality of clinical evaluation (QoC) for mpox varied by clinical setting. Methods A retrospective chart review was conducted on all patients in the Johns Hopkins Health System (JHHS) who tested for mpox from June 15 through December 15, 2022. Outcome measures included three QoC metrics (record of sexual history, anal and/or genital exam and concomitant STI testing). Fisher’s exact test was used to compare the frequency of QoC indicators by location of mpox testing (emergency department/urgent care [ED/UC], HIV/sexual health clinic [HIV/SH] or non-HIV/SH outpatient clinic [non-HIV/SH]). Results Of 269 patients tested for mpox, median age was 37 years, 48% were Black, 8% Latino, 71% assigned male sex at birth, 2% transgender women and 25% living with HIV (Table 1). Location of mpox testing was ED/UC (n=165), HIV/SH (n=50), or non-HIV/SH (n=54). Rates of mpox diagnosis and documentation of a sexual history, anal and/or genital exam and concomitant STI testing varied by site and were statistically significantly different (Table 2). HIV/SH had the highest rate of mpox test positivity (58%) and were most likely to meet these QoC indicators (96%, 78% and 82%, respectively) followed by ED/UC (74%, 50%, 57%, respectively) and HIV/SH clinics (68%, 32%, 30%). Conclusion In a high-volume tertiary care health system, only 50% of individuals tested for mpox had a documented anal and/or genital exam and 57% had concomitant STI testing. QoC indicators for mpox evaluation were highest in clinics where sexual health assessments are routine (HIV/sexual health), intermediate in ED/urgent care settings and lowest in non-HIV/sexual health settings. These findings support other studies that demonstrate a lack of consistent sexual health evaluation among individuals at risk for STIs. Strategies that decrease barriers to completed sexual history, exam and STI testing should be explored including audio-computer assisted patient report of sexual history, patient self-collection of STI testing and provider training. Disclosures Matthew M. Hamill, MBChB, PhD, Roche diagnostics: Honoraria Kelly Gebo, MD, MPH, Pfizer: Advisor/Consultant|Spark HealthCare: Advisor/Consultant

Embodying The Everyday: Health And Heritage Practice Relationships In Latin American And Caribbean Immigrant Communities In New York City

The sociocultural factors related to immigrant health perceptions and practices have been long flattened and essentialized in discussions of urban community health, leading to programs and policies that fall short in holistically addressing community needs. Responding to this shortfall, in this article, I take a phenomenological approach to understanding the relationships between ecological heritage practices and health in Latin American and Caribbean immigrant communities in New York City. Through ethnographic accounts of heritage practices, I identify broad themes related to everyday practice: health care pluralism, space and time constraints, social identity, and biological health. Foodways and the preparation of traditional dishes featured prominently in the 20 semi-structured interviews and participant observation across four diverse neighborhoods. I use the embodied ecological heritage (EEH) framework to theorize the connections between the practice of heritage traditions and the well body. I illustrate how everyday negotiations around how practices are defined and described as “normal” in the context of the new environments of the immigrant experience, so capturing the fluidity of the heritage practices and the traditional body as a site of wellness. Focus on this fluidity of heritage practice stands to improve the ways in which immigrant community health resources might be developed and deployed, providing a holistic lens often lacking in urban public health systems.

Primary Care Patient Interest in Multi-Cancer Early Detection for Cancer Screening.

Multi-cancer early detection (MCED) tests are being developed, but little is known about patient receptivity to their use for cancer screening. The current study assessed patient interest in such testing. Our team conducted a prospective, observational study among primary care patients in a large, urban health system. They were asked to complete a telephone survey that briefly described a new blood test in development to identify multiple types of cancer, but was not currently recommended or covered by insurance. The survey included items to assess respondent background characteristics, perceptions about MCED testing, and interest in having such an MCED test. We also used multivariable analyses to identify factors associated with patient interest in test use. In 2023, we surveyed 159 (32%) of 500 identified patients. Among respondents, 125 (79%) reported a high level of interest in having an MCED test. Interest was not associated with personal background characteristics, but was positively associated with the following expectations: testing would be recommended for cancer screening, be convenient, and be effective in finding early-stage disease (OR = 11.70, 95% CI: 4.02, 34.04, p < 0.001). Research is needed to assess patient interest and actual uptake when detailed information on testing is presented in routine care.

Abstract 15182: Evaluation of an Electronic Clinical Decision Support Tool for Incident Elevated Blood Pressure in Adolescents

Introduction: The PedsBP Clinical Decision Support (CDS) is an electronic health record-linked tool developed in an urban health system that aims to improve the quality of blood pressure (BP) measurement and recognition of hypertension in children. Aims: To describe the feasibility of implementing the PedsBP tool for use in a rural health system, and to describe repeat BP measurement among patients 6-17 years with an incident hypertensive BP at high-intensity clinics using the PedsBP CDS. Methods: This is a 3-arm, parallel group, cluster randomized controlled pragmatic trial in 40 community-based primary care clinics in a rural Midwestern health system (Essentia Health). Clinics were randomized 1:1:1 to usual care, low-intensity implementation (PedsBP CDS only), or high-intensity implementation (Peds BP CDS plus in-person training, monitoring CDS use, and feedback). The PedsBP CDS includes an alert to re-measure a hypertensive BP at that visit, an alert that a hypertensive BP should be repeated in 1-3 weeks, and patient-specific order sets. Study outcomes include repeat BP measurement at an index visit and diagnosis of hypertension within 6 months of meeting clinical criteria. Safety outcomes include stroke, transient ischemic attack, acute renal failure, uncontrolled hypertension within 6 months of index visit. Results: Among 22,238 (50.9% female, mean age 11.7 years, SD=3.5 years) patients with visits between 8/1/22-1/31/23 at participating clinics, 4008 (18.0%) had an incident hypertensive BP and 239 (1.1%) met clinical criteria for hypertension. Among those who met clinical criteria for hypertension, there were no cases of uncontrolled hypertension or other safety outcomes. Of 7974 patients with encounters at 13 high-intensity clinics and with a BP measured, the initial BP was elevated for 1307 (16.4%) and remeasured in 628 (48.1%). Among 1265 patients at high-intensity clinics with a BP elevated and with body mass index (BMI) information, 482 (38.1%) were obese (BMI percentile ≥95%), 209 (16.5%) were overweight (BMI percentile 85% to &lt;95%), and 574 (45.4%) were not overweight or obese (BMI percentile &lt;85%). Conclusions: The PedsBP CDS is feasible to implement in a new health system and has the potential to improve the quality of pediatric BP care.

Emergency engagement for opioid use disorder: subjective measures of health and wellness following a warm hand-off in emergency departments

ABSTRACT Objectives This study describes an emergency department (ED)-based intervention for individuals with opioid use disorder (OUD) in an urban health system. The intervention utilized electronic health records to screen for OUD and implemented warm hand-offs using certified recovery specialists (CRS). The intervention also encouraged physicians to become certified to prescribe buprenorphine. Methods We surveyed individuals using the Center for Substance Use Treatment Government Performance and Results Act (GPRA) survey. 302 individuals were surveyed at baseline on self-reported drug use, quality of life, and health care utilization, and 53 completed a reassessment at three or six-month intervals. Differences in outcomes were assessed using pairwise t-tests at the 95% level of significance. Results Participation in the intervention was associated with a reduction in self-reported drug use and reductions in inpatient care. While we found an increase in quality of life, there were also increases in reports of “any depression.” Conclusion Better screening, warm hand-offs, and buprenorphine prescriptions in the ED can improve outcomes for individuals with OUD. Lessons learned include challenges reassessing individuals with OUD, the importance of supporting ED staff with buprenorphine training and CRS, and the possibility that depressive symptoms may emerge and worsen as individuals with OUD seek treatment.

Treating individuals with suicidal ideation in primary care: Patient-level characteristics associated with follow-up in the Collaborative Care Model.

The Collaborative Care Model (CoCM) is an evidence-based approach which embeds behavioral health providers (BHPs) into primary care. Whether patients with suicidal ideation (SI) are willing to engage in CoCM is unclear. Using Patient Health Questionnaire-9 (PHQ-9) administrative data from primary care practices within an urban academic health system, we identified patients with and without SI who were referred to a CoCM BHP. We compared engagement, defined as attendance at ≥1 CoCM visit, across groups. Between 2018 and 2022, 7391 primary care patients were referred to a CoCM BHP. Eight hundred and ninety-two of these patients reported SI on the PHQ-9 (754 on "several days" during the previous 2 weeks and 138 on "more than half or most days"). Across groups, most patients engaged in CoCM. Patients reporting SI on several days engaged at a lower rate (61.4%) than those reporting SI on more than half or most days (65.9%). Both SI groups engaged at a lower rate than the 6499 patients who did not report SI (67.5%). Most patients referred to a CoCM BHP engaged in ≥1 visit. Rates were lower for patients with SI, with the lowest rate among those reporting SI on several days.

Unique Breast Cancer Screening Disparities in a Safety-Net Health System

Breast cancer screening (BCS) disparities leave historically underserved groups more vulnerable to adverse outcomes. This study explores granular associations between BCS and patient sociodemographic factors in a large urban safety-net health system. A retrospective review among female patients ages 50-74 within an urban safety-net health system was conducted in 2019. All patients had a primary care visit in the past 2 years. Multiple patient health and sociodemographic characteristics were reviewed, as well as provider gender and specialty. Bivariate analyses and multivariable logistic regression were performed in 2022. The BCS rate among 11,962 women was 69.7%. Over half of patients were non-White (63.6%) and had public insurance (72.3%). Patients with limited English proficiency made up 44.3% of the cohort. Compared to their sociodemographic counterparts, patients with White race, English proficiency, and Medicare insurance had the lowest rates of BCS. Serious mental illness and substance use disorder were associated with lower odds of BCS. In multivariable analysis, when using White race and English speakers as a reference, most other races (Black, Hispanic, and Other) and languages (Spanish, Portuguese, and Other) had significantly higher odds of screening ranging from 8% to 63% higher, except Asian race and Haitian Creole language. Female (versus male) and internal medicine-trained providers were associated with higher screening odds. Multiple unique variables contribute to BCS disparities, influenced by patient and health system factors. Defining and understanding the interplay of these variables can guide policymaking and identify avenues to improve BCS for vulnerable or traditionally under-resourced populations.

B - 91 Cognition as a Premonitory Symptom of Migraine.

Migraine is often accompanied by premonitory symptoms (neurologic symptoms preceding migraine pain) which serve as "warning signs." Cognition changes are commonly described during the premonitory period (period preceding pain onset). Ecological momentary assessment can be utilized to understand if perceived cognitive changes are a symptom patients use as an indicator of the premonitory period. Participants with episodic migraine were recruited through a large urban health system and online advertising (n = 43). Individuals participated in a three-month, three-times-a-day electronic diary answering questions regarding migraine attack symptoms, including perception of being in a premonitory period, and the presence of premonitory symptoms, including "difficulty thinking or concentrating." The frequency of perceived cognitive difficulties was analyzed during the perceived premonitory period (endorsing "I think I might get a headache") vs. the perceived interictal period (endorsing "I do not anticipate a headache"). Cross tabs evaluated the frequencies of perceived cognitive difficulties during different migraine phases. Participants were predominantly White (n = 33, 76.7%), non-Hispanic (n = 33, 76.7%) women (n = 36, 83.7%). Thirty-three participants endorsed subjective cognitive difficulties at least once during the premonitory phase (n = 33; 76.75%). Difficulty thinking and concentrating was endorsed 35.16% of the time when participates also reported anticipating a headache in the morning and only 8.36% of the time when participants reported not anticipating a headache. Participants perceived cognitive decline as a premonitory symptom. Difficulty concentrating and thinking was endorsed more when participants anticipated getting a headache vs. when not. Assessing subjective cognitive decline as a premonitory symptom can guide individualized interventions for migraine and elucidate the relationship between cognition and migraine.

S387 A Majority of Patients with Positive Multitarget-Stool DNA (mt-sDNA) Test Results Do Not Complete Follow-Up Colonoscopy: Results From a Large Urban Health System

S387 A Majority of Patients with Positive Multitarget-Stool DNA (mt-sDNA) Test Results Do Not Complete Follow-Up Colonoscopy: Results From a Large Urban Health System

Trainee experiences with resident-as-teacher training: results from four teaching hospitals of an urban academic health system

Trainee experiences with resident-as-teacher training: results from four teaching hospitals of an urban academic health system

Screening fathers for postpartum depression in a maternal-child health clinic: a program evaluation in a midwest urban academic medical center

BackgroundPostpartum depression (PPD) impacts fathers as well as mothers, and is estimated to affect between 8 and 13% of fathers. Paternal PPD is a risk factor for worsened quality of life, poor physical and mental health, and developmental and relational harms in the father-mother-child triad. There are no current recommendations for PPD screening among fathers. Paternal PPD screening was piloted in an intergenerational postpartum primary care clinic.MethodsThe pilot was carried out in an intergenerational postpartum primary care clinic located at a Midwest urban academic safety net health system from October 2021 to July 2022. Fathers actively involved in relationships with mothers or infants receiving primary care in the clinic were approached with mothers’ permission. A novel survey instrument was used to collect demographic/social data, as well as mental health history and current stress levels; an Edinburgh Postnatal Depression Scale (EPDS) was also administered. Screenings were completed by social workers; data were collected in REDCap and descriptive statistics were calculated in SAS.Results29 fathers were contacted and 24 completed screening (83%). Mean age was 31 years (range 19–48). Most (87%) identified as belonging to a racial or ethnic minority group. Fathers self-reported low rates of stress and preexisting mental health conditions, but 30% screened positive for PPD on EPDS (score of ≥ 8, or suicidal ideation). Gaps in health care were found, as one-quarter (26%) of fathers were uninsured and half (54%) did not have a primary care provider. After screening, two requested mental health services, and three established new primary care with a physician.ConclusionsParticipation was high in a PPD screening pilot for fathers in a primary care setting. This small sample of fathers demonstrated significant peripartum mental health challenges unlikely to have been identified otherwise. For some participants, engaging in PPD screening was an effective tool to prompt their subsequent engagement with general health care. This pilot is a step toward incorporating the health of fathers into models for supporting the health of families. Expanding screening for paternal PPD into routine primary care is necessary to reach more affected fathers.

Characterizing atrial fibrillation symptom improvement following de novo catheter ablation.

Atrial fibrillation (AF) symptom relief is a primary indication for catheter ablation, but AF symptom resolution is not well characterized. The study objective was to describe AF symptom documentation in electronic health records (EHRs) pre- and post-ablation and identify correlates of post-ablation symptoms. We conducted a retrospective cohort study using EHRs of patients with AF (n = 1293), undergoing ablation in a large, urban health system from 2010 to 2020. We extracted symptom data from clinical notes using a natural language processing algorithm (F score: 0.81). We used Cochran's Q tests with post-hoc McNemar's tests to determine differences in symptom prevalence pre- and post-ablation. We used logistic regression models to estimate the adjusted odds of symptom resolution by personal or clinical characteristics at 6 and 12 months post-ablation. In fully adjusted models, at 12 months post-ablation patients, patients with heart failure had significantly lower odds of dyspnoea resolution [odds ratio (OR) 0.38, 95% confidence interval (CI) 0.25-0.57], oedema resolution (OR 0.37, 95% CI 0.25-0.56), and fatigue resolution (OR 0.54, 95% CI 0.34-0.85), but higher odds of palpitations resolution (OR 1.90, 95% CI 1.25-2.89) compared with those without heart failure. Age 65 and older, female sex, Black or African American race, smoking history, and antiarrhythmic use were also associated with lower odds of resolution of specific symptoms at 6 and 12 months. The post-ablation symptom patterns are heterogeneous. Findings warrant confirmation with larger, more representative data sets, which may be informative for patients whose primary goal for undergoing an ablation is symptom relief.

Reducing Overuse of 3-Day Repeat Type and Screen Testing across an 11-Hospital Safety Net System.

According to the American Association of Blood Banks, a Type and Screen (T&S) is valid for up to three calendar days. Beyond a limited number of clinical indications such as a transfusion reaction, repeat T&S testing within 3days is not warranted. Inappropriate repeat T&S testing is a costly medical waste and can lead to patient harm. To reduce inappropriate duplicate T&S testing across a large, multihospital setting. The largest urban safety net health system in the USA, with 11 acute care hospitals. Our first intervention involved adding the time elapsed since the last T&S order into the order and the process instructions that described when a T&S was indicated. The second intervention was a best practice advisory that triggered when T&S was ordered before the expiration of an active T&S. The primary outcome measure was the number of duplicate inpatient T&S per 1000 patient days. Across all hospitals, the weekly average rate of duplicate T&S ordering decreased from 8.42 to 7.37 per 1000 patient days (12.5% reduction, p < 0.001) after the first intervention and to 4.32 per 1000 patient days (48.7% reduction, p < 0.001) after the second intervention. Using linear regression to compare pre-intervention to post-intervention 1, the level difference was - 2.46 (9.17 to 6.70, p < 0.001) and slope difference was 0.0001 (0.0282 to 0.0283, p = 1). For post-intervention 1 to post-intervention 2, the level difference was - 3.49 (8.06 to 4.58, p < 0.001) and slope difference was - 0.0428 (0.0283 to - 0.0145, p < 0.05). Our intervention successfully reduced duplicate T&S testing using a two-pronged electronic health record intervention. The success of this low effort intervention across a diverse health system provides a framework for similar interventions in various clinical settings.

Depressive symptoms and anxiety among women with a history of abortion living in urban slums of Bangladesh

BackgroundGlobally, major emphasis has been placed on understanding the physiological consequences of losing a pregnancy. However, its mental health impact on socially disadvantaged women remains unexplored. To further inform the field the present study investigated the prevalence and factors associated with the development of depressive symptoms and anxiety among women with a history of spontaneous abortion living in the urban slums of Dhaka, Bangladesh.MethodsInformation was obtained from 240 women who experienced a spontaneous abortion from July 2020 to December 2021. It was obtained through the urban health and demographic surveillance system (UHDSS) survey. Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) were used to measure mental health symptoms. Bivariate and multivariate linear regression analyses were performed to assess the associated factors with the mental health outcomes.ResultsOf the 240 women, majority (77.50%) of the women experienced mild to severe depressive symptoms and more than half (58.75%) of the respondants experienced mild to severe anxiety, within one and half years of experiencing spontaneous abortion. A higher level of education and being employed were protective factors for anxiety and depressive symptoms, respectively. However, women with higher sexual and reproductive health rights (SRHR) knowledge had significantly increased anxiety and depressive symptoms. In contrast, receiving post-abortion care (PAC) was associated with decreased anxiety and depressive symptoms.ConclusionThe findings indicate that ensuring access to affordable PAC services and integrating mental health services into the standard PAC service package is crucial. This study also emphasizes the importance of providing education for women living in urban slums and encouraging them to participate in economic activities.

Poster 374: Patient knowledge of and willingness to pay for platelet-rich plasma injections: A prospective survey study on orthopedic sports medicine patients

Objectives: The efficacy of platelet-rich plasma (PRP) injections for sports-related injuries is a hotly- debated topic. PRP is a cash-pay procedure that is not covered by insurance, and it is actively advertised for a number of different indications, some without supporting evidence. Yet, an increasing number of patients are asking their physicians for PRP injections. The aim of this study is to better understand patients’ knowledge of PRP and willingness to pay out of pocket. Methods: This ongoing Institutional Review Board-approved prospective study included patients presenting with a new chief complaint at a sports medicine orthopedic office in a large urban academic health system. Patients completed an anonymous survey prior to evaluation by an orthopedic surgeon. The survey collected demographic information, clinical information, knowledge of PRP, willingness to pay for PRP based on expected percentage pain reduction, and motivators behind willingness to pay. Two cohorts included: 1) patients who had heard of PRP and 2) patients who had not. The latter group was given a short educational excerpt on PRP. Two-tailed Mann-Whitney U and Kruskal-Wallis tests evaluated pain scores and willingness to pay for PRP between the cohorts. Spearman rank correlation tests evaluated correlations between household income and willingness to pay. Results: To date, we have enrolled 32 patients of which 37.5% had previous orthopedic surgery, 43.75% had seen another medical provider for their current symptoms and 37.5% had previously heard of PRP. Patients who had heard of PRP (versus those that had not) reported lower median pain scores (median 4.75 versus 5.0 out of 10), the same hindrance of daily activities (median 3.0 out of 5), and longer duration of symptoms (median 5.0 months versus 1.0 month), although not statistically significant. Patients were willing to pay more for a greater anticipated reduction in pain: median of $50, $250, and $500 for 25%, 50% and 100% reduction in pain, respectively (Table 1) (p&lt;0.05). Patients who had heard of PRP were willing to pay more for PRP (median $500 versus $200; Table 1); this was not statistically significant. There was no correlation between patients’ income and willingness to pay. Finally, regarding willingness to pay for a given percent reduction in pain, patients reported their top three motivators to be symptoms affecting their day-to-day life, desire to try non-surgical interventions, and desire to return to normal activity (Table 1). For patients who had not heard of PRP, after being informed of PRP these patients reported physician trust as the greatest motivator behind their willingness to pay (Table 1). Conclusions: This ongoing study demonstrates the correlation between willingness to pay and perceived effectiveness of PRP while also noting motivators to pay. Moreover, we were also able to demonstrate some differences between patients who had heard of PRP versus those that had not. These data may be further refined with ongoing enrollment and will provide important insights into patients’ knowledge and how this impacts decision-making in the context of PRP injections. [Table: see text]

Care-seeking practices for non-communicable chronic conditions in a low-income neighborhood in Southern India.

Given that access to healthcare is less challenging in urban India, evidence shows that affordable government healthcare services are underutilized by the vulnerable and disadvantaged groups. There are emerging studies on healthcare seeking behavior in the context of short-term morbidities and communicable diseases that attempted to understand this gap of underutilization of government healthcare services, but similar studies are rare in the context of non-communicable diseases (NCDs) and associated chronic conditions. Given the urban health system is ill- prepared and ill-equipped to deliver NCD services, it is important to understand how the vulnerable and disadvantaged groups seek healthcare for chronic conditions. This article investigates the care-seeking practices of these individuals living in a low-income neighborhood and care-seeking pathways for chronic conditions. The study is conducted at Kadugondanahalli-a low-income neighborhood with the presence of a recognized slum, in Bengaluru city. A total of twenty in-depth interviews are conducted with individuals diagnosed with non-communicable chronic conditions. Participants were selected through purposive and snowball sampling method. The data is collected between January 2020 to June 2021. The study participants practice a wide range of care-seeking practices based on the management of comorbidity and multimorbidity, recognizing the symptoms and severity, experiences of family members, belief, and purchase and consumption of medicines. These practices clearly highlighted not only the nuances of non-adherence to the long-term treatment and medications, but it also strongly influences the care-seeking behavior, which in turn make the care-seeking continuum very complex. The care-seeking continuum attempted each of the components (i.e. the screening, diagnosis, treatment, and control) of NCD care cascade but participants often failed to do screening on time, delayed diagnosis, and did not meet the treatment goals, leading to their conditions becoming further uncontrolled due to the care-seeking practices they practice. These practices delayed not only the diagnosis but also the completion of each component of the care cascade. This study emphasizes strengthening of the health system in addressing the individual and community level practices, that significantly affect the entire care-seeking continuum, in the sustained monitoring and adherence to the treatment of chronic conditions.

Cervical cancer screening among English- and Spanish-speaking Hispanic women in an urban safety net health system, 2015–2020

BackgroundThe Hispanic population is heterogeneous with differences in health behaviors across subgroups by nativity and preferred language. We evaluated cervical cancer screening adherence among English- and Spanish-speaking Hispanic patients receiving care at a safety net health system.MethodsElectronic health records were used to identify 46,094 women aged 30–65. Up to date (UTD) screening was defined based on date of last Pap test, human papillomavirus (HPV) test, or Pap/HPV co-test.ResultsOverall, 81.5% of 31,297 Hispanic women were UTD. English-speaking Hispanic women had a lower prevalence of being UTD when compared to Spanish-speaking Hispanic women (aPR: 0.94, 95% CI: 0.93 – 0.96). Further, those with indigent healthcare plans had a higher prevalence of being UTD when compared to those with private insurance (aPR: 1.10, 95% CI: 1.09 – 1.12), while all other health insurance plans were associated with lower UTD screening when compared to private insurance.ConclusionsThese findings suggest screening differences within the Hispanic population, highlighting the need for disaggregated research assessing heterogeneity within racial/ethnic groups, specifically among Hispanic populations.

Cohort Profile: Urban Health and Demographic Surveillance System in slums of Dhaka (North and South) and Gazipur City Corporations, Bangladesh.

Cohort Profile: Urban Health and Demographic Surveillance System in slums of Dhaka (North and South) and Gazipur City Corporations, Bangladesh.

LBP-23 - Improving hepatitis B screening and linkage to care rates via the electronic medical record, provider engagement, and patient navigation in a large, urban health system

LBP-23 - Improving hepatitis B screening and linkage to care rates via the electronic medical record, provider engagement, and patient navigation in a large, urban health system

Using machine learning-based boosting algorithm to predict hepatotoxicity after local therapy and association with survival in patients undergoing liver directed therapy.

e16229 Background: Hepatocellular carcinoma typically arises in the setting of chronic liver disease. In carefully selected patients, liver directed therapy has been demonstrated to improve survival; however, this benefit from cancer specific survival may be offset by increased mortality from diminished hepatic functional reserve. Treatment-related hepatotoxicity also may vary between liver directed treatment modalities for a given tumor. Our aim was to determine if a machine learning approach could estimate hepatotoxicity prior to treatment. Methods: We identified all patients with hepatocellular carcinoma who underwent liver directed therapy at a large urban academic health system who also had post-treatment laboratory follow-up at 6 months. Patients were categorized as having worse liver function if they experienced a decline in albumin-bilirubin (ALBI) grade or more than 0.5 absolute decline in ALBI score at post treatment follow-up. A machine learning, extreme-gradient boosting (XGBoost) approach was employed to identify predictive features for hepatotoxicity using fine-tuned hyperparameters. Results: The study cohort consisted of 269 patients. 48 (18%) were categorized as having worsened hepatic function after liver directed therapy, with an average decline of -0.72 in ALBI score. Median survival after liver directed therapy was 5.8 years, with worsening hepatic function associated with a 5 month decline in overall survival. 158 (59%) patients received transarterial chemoembolization, 99 (37%) patients received stereotactic body radiotherapy and 12 (7%) patients received Y-90. A machine learning model was developed resulting in an Area Under the ROC Curve (AUC) of 0.894 in a 10-point decision tree model. On SHAP analysis, the features with the largest impact on hepatotoxicity prior to treatment was pretreatment T-stage followed by Child-Pugh Score. Conclusions: A machine learning model was developed to accurately classify patients who sustained treatment related hepatotoxicity. Significant decline in ALBI score or grade was associated with a worsening of overall survival. Future studies in larger prospective clinical trials utilizing this machine learning-based methodology of assessing liver dysfunction after focal therapy are required to validate these findings.