Urban Safety Net Hospital Research Articles

Post-Mastectomy Patients in an Urban Safety-Net Hospital: How Do Safety-Net Hospital Breast Reconstruction Rates Compare to National Breast Reconstruction Rates?

Breast reconstruction (BR) has documented psychological benefits following mastectomy. Yet, racial/ethnic minority groups have lower reported rates of BR. We sought to evaluate the rate, type, and outcome of BR in a racially and ethnically diverse population within a safety-net hospital system. All patients who underwent mastectomy between October 2015 and July 2019 at Harbor-UCLA Medical Center were retrospectively examined. Rates and type of BR were analyzed according to patient characteristics (race/ethnicity, age, and body mass index), smoking status, cancer stage, and presence of diabetes mellitus. Breast reconstruction outcomes were also assessed. Of the 259 patients that underwent mastectomy, 87 (33.6%) received BR. Immediate BR was performed in 79 (30.5%) patients and delayed BR in 8 (3.1%). Of the 79 patients with immediate BR, 58 (73.4%) received implant-based BR and 21 (26.5%) autologous tissue. The BR failure rate was 10%, all implant-based. Increasing age and smoking negatively impacted BR rates. Black (P =.331) and Hispanic (P =.132) ethnicity were not independent predictors of decreased breast reconstruction. This study demonstrated that the rate, type, and quality of BR in this integrated safety-net hospital within a diverse population are comparable to national rates. When made available, historically underrepresented minority patients of Black and Hispanic ethnicity utilize BR.

Clinical Validation of a Dynamic Obstetric Hemorrhage Risk Assessment Tool at an Urban Safety-Net Hospital

Obstetric hemorrhage is the leading cause of maternal mortality worldwide. There are emerging risk assessment tools with labor factors to guide prenatal pre-transfusion testing. In this study, we describe a dynamic risk assessment tool that includes antepartum and intrapartum risk factors, and assess its efficacy in predicting obstetric hemorrhage and hemorrhage requiring transfusion in an urban safety-net hospital.

Coronavirus Disease 2019 and Hospital Readmissions: Patient Characteristics and Socioeconomic Factors Associated With Readmissions in an Urban Safety-Net Hospital System.

It is not yet known whether socioeconomic factors (ie, social determinants of health) are associated with readmission following hospitalization for coronavirus disease 2019 (COVID-19). We conducted a retrospective cohort study of 6191 adult patients hospitalized with COVID-19 in a large New York City safety-net hospital system between March 1 and June 1, 2020. Associations between 30-day readmission and selected demographic characteristics, socioeconomic factors, prior health care utilization, and relevant features of the index hospitalization were analyzed using a multivariable generalized estimating equation model. The readmission rate was 7.3%, with a median of 7 days between discharge and readmission. The following were risk factors for readmission: age 65 and older [adjusted odds ratio (aOR): 1.32; 95% confidence interval (CI): 1.13-1.55], history of homelessness, (aOR: 2.03 95% CI: 1.49-2.77), baseline coronary artery disease (aOR: 1.68; 95% CI: 1.34-2.10), congestive heart failure (aOR: 1.34; 95% CI: 1.20-1.49), cancer (aOR: 1.68; 95% CI: 1.26-2.24), chronic kidney disease (aOR: 1.74; 95% CI: 1.46-2.07). Patients' sex, race/ethnicity, insurance, and presence of obesity were not associated with increased odds of readmission. A longer length of stay (aOR: 0.98; 95% CI: 0.97-1.00) and use of noninvasive supplemental oxygen (aOR: 0.68; 95% CI: 0.56-0.83) was associated with lower odds of readmission. Upon readmission, 18.4% of patients required intensive care, and 13.7% expired. We have found some factors associated with increased odds of readmission among patients hospitalized with COVID-19. Awareness of these risk factors, including patients' social determinants of health, may ultimately help to reduce readmission rates.

558. Implementation and Outcomes of a COVID-19 Monoclonal Antibody Treatment Program in an Urban Safety-net Community Hospital

BackgroundNeutralizing monoclonal antibodies (mAbs) bind to the receptor binding domain of the spike protein of SARS-CoV-2. In November 2020, several mAbs were issued an EUA by the FDA as single-dose intravenous (IV) infusions for treatment of mild to moderate COVID-19. mABs were allocated to local health facilities capable of administering infusions and managing side effects. Creating an outpatient infusion program during the COVID-19 winter surge can be logistically difficult. Our goal was to implement a mAb outpatient infusion program at an urban safety-net community hospital designed to serve communities most heavily impacted by COVID-19. MethodsThe emergency department (ED) fast-track was repurposed for the mAb program with protocols from the infectious diseases physician and antimicrobial stewardship. Education materials with indications for mAbs were distributed in surrounding clinics serving our community. The program was available to all patients meeting criteria outlined in the protocol, 24/7, including but not limited to current ED patients and referrals from facilities in the vicinity.ResultsBetween December 1, 2020 and March 1, 2021, a total of 37 patients were treated: 51% male, 57% Hispanic or Latinx, 27% Black, and 95% (35) represented ZIP codes with high COVID-19 burden (Figure 1). Bamlanivimab was used for each instance and all infusions met criteria. Patient indications for mAb infusion are listed in Figure 2. Parenteral antibiotics were given to 10.8% and 35% received oral antibiotics upon discharge. At 30 days post-infusion, 8% (3) required hospitalization and there were no deaths. Zip codes with high COVID-19 disease burden served by our mAB infusion program Distribution of patients who received mAB infusions by indicationConclusionA mAb outpatient infusion program was successfully deployed in a safety-net community hospital. We believe strengths of the program included the flexible infusion hours and convenient referral site for patients and providers. Of importance, this program was able to provide services to minorities from ZIP codes most heavily impacted by COVID-19. Unfortunately, antibacterial use was common and may reflect broader unnecessary use in COVID-19 patients. Whilst mAb treatment was deemed appropriate in all instances via protocol inclusion criteria, antibacterial stewardship programs may need to expand to ED settings for COVID-19 management. Disclosures All Authors: No reported disclosures

333. Comparing COVID-19-related Morbidity and Mortality between Patients with and without Substance Use Disorder: A Retrospective Cohort Study

BackgroundEarly data suggest that people with substance use disorder (SUD) who develop coronavirus disease 2019 (COVID-19) have increased intubation and mortality rates when compared to those without SUD. Information on other COVID-19-related complications in this population is limited. We evaluated COVID-19 outcomes in patients with and without SUD.MethodsWe created a retrospective cohort of patients with COVID-19 admitted to an urban safety net hospital from 3/16/2020 to 4/8/2020. Inclusion criteria were admission with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 and age greater than 18 years. SUD included alcohol use disorder or heavy alcohol use as defined by the National Institute on Alcohol Abuse and Alcoholism, use of cocaine, non-prescribed opioids or amphetamines. Primary outcome was inpatient mortality. Secondary outcomes were clinical complications (intubation, secondary infections, renal failure, venous thromboembolism, stroke, hepatitis, myocardial infarct, multisystem organ failure) and resource utilization (length of stay, intensive care unit [ICU] admission, ICU days, readmission). We used multivariable regression to assess factors associated with mortality and length of stay, and univariate analyses for other outcomes.ResultsOf 409 included patients, 70 (17.1%) had SUD. Those with SUD were more likely to be male and have pulmonary disease or hepatitis C. There were no differences in other comorbidities, mean age or race/ethnicity. After multivariable analysis, SUD was not associated with mortality (aOR 1.60; 95% CI, 0.60-3.81). Similarly baseline oxygenation defined as the ratio of oxygen saturation to fraction of inspired oxygen (aOR 1.57; 0.11-13.0) and administration of immunomodulatory therapy (tocilizumab, sarilumab or anakinra) (aOR 1.41; 0.65-3.01) did not affect mortality. In contrast, age (aOR 1.06; 1.03-1.09), sex (aOR 2.30; 1.04-5.47) and obstructive sleep apnea (aOR 4.07; 1.64-9.66) were associated with mortality. We did not find any associations with secondary outcomes.ConclusionOur findings suggest that substance use alone may not increase COVID-19 adverse outcomes. Future studies should evaluate these results in the current period of improved COVID-19 therapy.Disclosures All Authors: No reported disclosures

Provider views on rapid diagnostic tests and antibiotic prescribing for respiratory tract infections: A mixed methods study.

BackgroundRespiratory tract infections (RTIs) are often inappropriately treated with antibiotics. Rapid diagnostic tests (RDTs) have been developed with the aim of improving antibiotic prescribing but uptake remains low. The aim of this study was to examine provider knowledge, attitudes and behaviors regarding RDT use and their relationship to antibiotic prescribing decisions across multiple clinical departments in an urban safety-net hospital.MethodsWe conducted a mixed methods sequential explanatory study. Providers with prescribing authority (attending physicians, nurse practitioners and physician assistants) who had at least 20 RTI encounters from January 1, 2016 to December 31, 2018. Eighty-five providers completed surveys and 16 participated in interviews. We conducted electronic surveys via RedCap from April to July 2019, followed by semi-structured individual interviews from October to December 2019, to ascertain knowledge, attitudes and behaviors related to RDT use and antibiotic prescribing.ResultsSurvey findings indicated that providers felt knowledgeable about antibiotic prescribing guidelines. They reported high familiarity with the rapid streptococcus and rapid influenza tests. Familiarity with comprehensive respiratory panel PCR (RPP-respiratory panel PCR) and procalcitonin differed by clinical department. Qualitative interviews identified four main themes: providers trust their clinical judgment more than rapid test results; patient-provider relationships play an important role in prescribing decisions; there is patient demand for antibiotics and providers employ different strategies to address the demand and providers do not believe RDTs are implemented with sufficient education or evidence for clinical practice.ConclusionPrescribers are knowledgeable about prescribing guidelines but often rely on clinical judgement to make final decisions. The utility of RDTs is specific to the type of RDT and the clinical department. Given the low familiarity and clinical utility of RPP and procalcitonin, providers may require additional education and these tests may need to be implemented differently based on clinical department.

Health Care Needs of Incarcerated Patients: A Case Study at a Large Urban Hospital.

This study examined a sample of incarcerated patients who received health care at an urban safety-net hospital in Massachusetts. Sociodemographic, clinical, and utilization data were obtained from patients' charts and administrative data. Our sample was 87% male and 36% Black and included a large proportion of patients with substance-related use. Incarcerated patients receiving outside care had a wide range of acute and chronic medical and surgical conditions, necessitating both emergent and scheduled care. The most frequent outpatient encounters included surgery (neurosurgery and oral/maxillofacial surgery), ophthalmology, medicine, and radiation oncology. Our findings provide a better understanding of the health care services that incarcerated patients may require outside their facilities and the kinds of interventions and policies that are needed to increase access to more timely care.

Use of Telehealth for Routine Postoperative Care in a Safety-Net Population

Introduction: Perceived barriers have historically limited telehealth to high-income settings. The COVID-19 pandemic necessitated changes in surgical care, including expanded telehealth access. This study aims to evaluate telehealth’s use for routine postoperative care at an urban safety-net hospital. We hypothesized that completion rates for telehealth would be higher than in-person follow-up, with no difference in the rate of complications. Methods: We performed a retrospective chart review of 410 patients undergoing inguinal hernia repair, appendectomy, cholecystectomy, and lipoma excision, from September 2019 to September 2020. We compared demographics, social determinants of health, co-existing conditions, and appointment completion between in-person and telehealth follow-ups, using univariate methods. Outcomes of interest were 90-day complications, 30-day surgery-related Emergency Department visits, and readmissions and reoperations. Results: Review identified 115 appendectomies, 168 cholecystectomies, 119 inguinal hernia repairs, and 10 lipoma excisions, with 54.4% urgent/emergent. Overall, 84.9% of surgical follow-ups were completed. Preliminary results from patients who underwent appendectomy showed that 15.6% of patients had telehealth and 55.1%in-person postoperative visits. Interpreters were required for 48.7% of patients, 31.3% had a primary care provider at the time of surgery, and 23.5% had unstable housing. The no-show rate for telehealth was 17.6%, compared to 11.7% for in-person visits (p=0.5). The NSQIP-predicted risk of complication was 4.0% in the telehealth and 4.1% in the in-person group;observed complication rates were11.8% for telehealth and 5.0% for in-person follow-up (n=8, p=0.3). Conclusion: In a safety-net population, preliminary results suggest similar rates of visit completion and complication for routine postoperative telehealth. [Formula presented]

Six Stages of Engagement in ADHD Treatment Described by Diverse, Urban Parents.

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition in children. Although ADHD is treatable, barriers remain to engagement in treatment, especially among socioeconomically disadvantaged and racial and ethnic minority families. Our goal was to examine the process by which families engage in ADHD treatment and to identify targets for an intervention to improve engagement in care. We conducted in-depth semistructured qualitative interviews with 41 parents of diverse youth aged 3 to 17 years old in treatment of ADHD at an urban safety net hospital. Parents were asked about their journey through diagnosis and treatment, community attitudes about ADHD, and other factors influencing treatment access and decision-making. Transcripts were analyzed by using thematic analysis. Of children with ADHD, 69.2% were male, 57.7% were Black or African American, and 38.5% were of Hispanic, Latino, or Spanish origin. Parents were 92.7% female, were 75.6% English speaking, and had a median income of $20 000. Parents described 6 stages to the process of engaging in care for their child's ADHD, which unfolded like a developmental process: (1) normalization and hesitation, (2) fear and stigmatization, (3) action and advocacy, (4) communication and navigation, (5) care and validation, and (6) preparation and transition. Barriers often occurred at points of stage mismatch between parents and providers and/or systems. Difficulty resolving an earlier stage interfered with the progression through subsequent stages. The 6 stages framework could be used to develop new strategies to measure engagement and to design family-centered interventions to facilitate engagement in ADHD treatment.

S3383 Gap in Care: Follow-Up of Incidental Hepatic Steatosis on Imaging in an Urban Safety-Net Hospital

Introduction: Nonalcoholic fatty liver disease (NAFLD), an emerging public health crisis, results from fat accumulation in the liver without heavy alcohol use or other causes. Patients often receive the diagnosis after steatosis is identified on imaging ordered by primary care physicians (PCP) and emergency department (ED) providers. Clear guidelines for managing this incidental finding are lacking. We aimed to determine the level of follow-up in patients with incidental steatosis on imaging study. We hypothesized that incidental steatosis on imaging would be uncommonly addressed in most patients. Methods: We identified the most recent 170 patients with hepatic steatosis on imaging (MRI, CT, US) between 2019 and 2020 at a major urban safety-net hospital by searching for the keywords “steatosis” or “fatty liver”. We excluded patients with drug and alcohol abuse and known diagnosis of liver disease. Through chart review, we determined if any follow-up actions, including hepatology referral, liver elastography, or liver function tests (LFTs), were ordered within 12 months of this finding. Patients’ characteristics, co-morbidities, and follow-up were compared between ordering providers from either the emergency department (ED) or outpatient (OP) setting. Data were analyzed with Microsoft Excel and GraphPad software. Results: Of the 170 patients, 94 (55%) met the inclusion criteria for incidental steatosis. There was no significant difference in gender, BMI, diabetes, and cardiovascular disease between ED and OP groups. The proportion of patients with hypertension and hyperlipidemia was significantly higher in the OP group as compared to the ED group (p < 0.05). While not statistically significant, liver elastography, LFTs, and referral to hepatology were more frequently performed in the OP group (Table). Importantly, of those with incidental steatosis, 88% did not receive any follow-up action. Conclusion: In our patient group with incidental steatosis on imaging, the vast majority did not receive any type of follow-up action. Our finding may suggest that the incidental steatosis was missed or underappreciated by clinicians and thus depriving patients from timely intervention.Table 1:: Comparison of Patient Characteristics and Follow-up orders between ED vs OP visits. *Statistical significance p < 0.05. Data are numbers (%) of patients unless otherwise indicated. NOTE: BMI: Body Mass Index

5.17 Psychometric Properties of the ADHD Stigma Questionnaire-Revised Among Parents of Children in Primary Care

Children with ADHD and their families may face stigma as a result of ADHD symptoms, label, or treatment. The ADHD Stigma Questionnaire (ASQ) is an existing measurement tool that has been validated with adolescents. However, it does not include items capturing medication or courtesy stigma (ie, stigma toward parents due to a child’s ADHD). In this study, we worked with an expert panel to add 8 new medication and courtesy stigma items to the ASQ and conducted a psychometric evaluation of the revised version (ASQ-R) completed by parents. A total of 159 English-speaking parents of children between ages 0 and 17 years were recruited from pediatric clinics at an urban safety-net hospital between September 2018 and May 2021 to complete the ASQ-R and a demographic questionnaire. We conducted an exploratory factor analysis on the ASQ-R and calculated average scores to assess the level of ADHD stigma perceived by parents. The ASQ-R supports a new 4-factor model including the following 4 factors: 1) concern for public attitudes; 2) disclosure concerns; 3) medication stigma; and 4) parenting inadequacy. Factors reflecting concern for public attitudes and disclosure concerns are similar to the original factors. The newly added items delineated 2 newly defined factors, and 8 items (7 old, 1 new) were dropped from the final questionnaire due to failure to load or redundancy. The ASQ-R can help to evaluate ADHD stigma perceived by parents of children with ADHD with its 4 factors. More data should evaluate its performance with other populations.

Interprofessional Oral Health Collaboration: A Survey of Knowledge and Practice Behaviors of Hospital-Based Primary Care Medical Providers in New York City.

BackgroundThe siloed delivery of oral and medical health care in the United States has contributed to a lack of awareness of the consequences of poor oral health and has hampered effective interprofessional education and collaboration. The aim of this study was to assess the knowledge and practice behaviors of primary care medical providers in an urban safety-net hospital regarding collaboration with dentists and integration of oral health into overall health-care delivery.MethodsA 36-item survey was designed in a web-based platform (Survey Monkey®) and electronically distributed in September 2020 to 181 primary care medical providers (physicians, nurses, physician assistants) within a municipal hospital in the Bronx, New York. The questionnaire included sections on demographics, current practices, oral health knowledge, and opinions regarding interprofessional collaboration. Descriptive statistics and bivariate analyses using the chi-square and Fisher’s exact test were performed with a significance level of 0.05.ResultsThe response rate was 66% (119 respondents). The vast majority (80%) reported little or no training in oral health and 85% reported no team experience with oral health professionals. Medical providers’ confidence in examining the oral cavity was positively associated with previous additional training (p = 0.001) and with team experience (p = 0.005). The two most commonly reported barriers to willingness to collaborate were lack of formal relationships with dental providers (74%) and competing priorities (69%).ConclusionOverall, there is very limited awareness and integration of oral health into the clinical practice of medical providers at this safety-net hospital. However, those providers with previous training and team experience had greater oral health confidence. Given the critical importance of oral health to overall health, increased efforts should be directed to further educate and train medical providers and address barriers to interprofessional care.

Potential barriers to lung cancer screening in a minority population: Assessing attitudes, beliefs, and values towards screening with low-dose computed tomography amongst a high-risk minority population.

17 Background: While the National Lung Screening Trial (NLST) has shown a relative reduction in mortality from lung cancer with the application of the United States Preventative Services Task Force (USPSTF) guidelines for the use of Low-Dose Computed Tomography (LDCT) in a select high risk population, many studies have shown that the rate of screening has been below the national average in minority population. Furthermore, lung cancer mortality still appears to be disproportionately higher amongst minority populations. With this study, we aim to evaluate the attitudes, beliefs and values towards lung cancer screening with LDCT in a predominantly Black and Hispanic population in our outpatient clinic. Methods: A survey was conducted over a 3-month period in our outpatient department at an urban inner-city safety net hospital. We included high risk smokers, aged 50 to 80 years who reported no evidence of symptoms. The survey consisted of 20 questions; these included utilizing the Health Belief Model to assess beliefs on perceived susceptibility, severity, benefits and barriers to screening, questions exploring fears of cancer screening and questions assessing overall willingness to undergo lung cancer screening with LDCT. We also included a question on the willingness of participants to engage in educational sessions with regards to lung cancer screening and risk reduction. Results were collected and analyzed via univariate logistic regression model to compare patient populations. Results: 67 patients participated in our survey. 62% were Black, 34% were Hispanic and 4% were Asian/Pacific Islanders. The mean age of our population was 64.5 years and they had an average of 27.2 pack-years of smoking. Issues related to insurance coverage and co-pay were identified as the most significant concern with regards to the unwillingness to undergo screening (p &lt; 0.05). Other concerns identified were the fear of a positive screening result, fear of radiation exposure and lack of understanding of the association with smoking history and lung cancer (p = 0.12). All participants responded yes to being open to be educated on reducing their risk of lung cancer (p &lt; 0.05). Conclusions: While many factors still exist with regards to lung cancer screening in minority populations, the cost of medical care, fear of radiation exposure and anxiety were identified as potential barriers to willingness to screen. Structured educational programs were identified as a possible measure that can be implemented to address these factors, with the potential to increase the willingness to undergo screening in a high risk minority population.

S1075 Hepatocellular Carcinoma Screening in Patients with Substance Abuse Disorder in a Large Urban Safety Net Hospital

S1075 Hepatocellular Carcinoma Screening in Patients with Substance Abuse Disorder in a Large Urban Safety Net Hospital

Implementation of an enhanced recovery protocol at a safety net hospital : a silver lining to COVID-19?

AimsThis study aimed to evaluate whether an enhanced recovery protocol (ERP) for arthroplasty established during the COVID-19 pandemic at a safety net hospital can be associated with a decrease in hospital length of stay (LOS) and an increase in same-day discharges (SDDs) without increasing acute adverse events.MethodsA retrospective review of 124 consecutive primary arthroplasty procedures performed after resuming elective procedures on 11 May 2020 were compared to the previous 124 consecutive patients treated prior to 17 March 2020, at a single urban safety net hospital. Revision arthroplasty and patients with < 90-day follow-up were excluded. The primary outcome measures were hospital LOS and the number of SDDs. Secondary outcome measures included 90-day complications, 90-day readmissions, and 30day emergency department (ED) visits.ResultsThe mean LOS was significantly reduced from 2.02 days (SD 0.80) in the pre-COVID cohort to 1.03 days (SD 0.65) in the post-COVID cohort (p < 0.001). No patients in the pre-COVID group were discharged on the day of surgery compared to 60 patients (48.4%) in the post-COVID group (p < 0.001). There were no significant differences in 90-day complications (13.7% (n = 17) vs 9.7% (n = 12); p = 0.429), 30-day ED visits (1.6% (n = 2) vs 3.2% (n = 4); p = 0.683), or 90-day readmissions (2.4% (n = 3) vs 1.6% (n = 2); p = 1.000) between the pre-COVID and post-COVID groups, respectively.ConclusionThrough use of an ERP, arthroplasty procedures were successfully resumed at a safety net hospital with a shorter LOS and increased SDDs without a difference in acute adverse events. The resulting increase in healthcare value therefore may be considered a ‘silver lining’ to the moratorium on elective arthroplasty during the COVID-19 pandemic. These improved efficiencies are expected to continue in post-pandemic era.Cite this article: Bone Jt Open 2021;2(10):871–878.

S718 Prolonged Impact of Pandemic Restrictions on Healthcare Utilization in Patients With IBD

Introduction: The COVID-19 pandemic disrupted healthcare delivery due to local restrictions and public health precautions. Who was most impacted, and the duration of these impacts in patients with IBD has not been quantified to date. Methods: This is an analysis of retrospectively collected data in a large urban safety-net hospital. We identified a cohort of patients with IBD, and quantified their healthcare utilization (HU) during three distinct 90-day periods related to the COVID-19 pandemic;pre-restrictions, restriction period, and recovery period. Demographic data were collected for all patients. Health care utilization was determined by the number of IBD clinic visits (in-person and virtual), abdominal imaging scans, emergency department (ED) visits, hospital admissions, and IBD-related endoscopic procedures. Results: We identified and collected data on 311 patients were collected, during the three time periods. The demographics of this cohort were representative of our IBD population;mean age 46, 53% female, 35% Black, 44% federal or state insurance. Clinic visits declined by 60%, imaging by 50%, and endoscopy declined by 91% during the restriction period (Figure 1). Older age and Black race were significantly associated (p<0.05) with clinic absence during the restriction period. During the recovery period, healthcare utilization remained significantly reduced;clinic visits only improved by 14%, despite universal use of telemedicine (Figure 1). Neither ED visits nor hospitalizations increased in the recovery period. No demographic factor was associated with the resumption of clinic visits, ED, or endoscopy. Conclusion: Pandemic public health restrictions significantly reduced HU for patients with IBD, and these had not recovered within 90 days after the opening of restrictions. Age and race were associated with loss of follow-up during the restriction periods. No increase in ED or hospitalization was noted during the recovery period.

31.2 MENTAL HEALTH OF SCHOOL-AGE CHILDREN DURING COVID-19

There is urgent concern about the effect of the COVID-19 pandemic on child mental health due to isolation, school closures, loss of loved ones, and financial difficulties. Our goal was to assess the longitudinal effect of the COVID-19 pandemic on the mental health of racial- and ethnic-minority school-aged children seen at a primary care practice at an urban safety-net hospital setting.

Characterizing Substance Use Disorders Among Transgender Adults Receiving Care at a Large Urban Safety Net Hospital.

In the midst of the opioid crisis, increasing attention has been given to assessing and addressing substance use disorders (SUDs) among transgender and gender diverse (TGD) populations. As electronic health records begin to more uniformly collect gender identity data, clinicians and public health professionals are better able to examine the prevalence of SUDs and the receipt of SUD treatment services in these populations. We utilized cross-sectional electronic health records data from January 2005 to December 2019 from a large safety-net hospital in Massachusetts. A cohort of TGD patients was identified using self-reported gender identity data as well as diagnostic and procedures codes associated with receipt of gender-affirming care (n = 2000). We calculated odds of SUD diagnosis and receipt of medications for SUD among TGD patients. Among a cohort of 2000 TGD patients, 8.8% had a SUD diagnosis. SUD diagnoses were more common among older, Black, and transmasculine patients, as well as those holding public health insurance. SUD diagnoses were less likely among those reporting college-level education. Of those with an opioid use disorder (OUD), 46% were prescribed an FDA-approved medication for OUD. SUD diagnoses among TGD patients were associated with demographic, socioeconomic, and gender-related factors. We found a modestly lower prevalence of non-tobacco SUD among our cohort of TGD patients than the national average of 7.4%. Despite a relatively better receipt of prescription treatment services than the national average, the low rate of treatment overall represents a missed opportunity to address SUDs in these vulnerable populations.

MP34-19 HEMATURIA REFERRALS AT A SAFETY NET HOSPITAL: A FOCUS ON PATIENT DEMOGRAPHICS AND COMPLIANCE

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety II (MP34)1 Sep 2021MP34-19 HEMATURIA REFERRALS AT A SAFETY NET HOSPITAL: A FOCUS ON PATIENT DEMOGRAPHICS AND COMPLIANCE Liz Wang, Remington Lim, Christopher Noyes, Batsheva Rubin, Shaun Wason, and David Wang Liz WangLiz Wang More articles by this author , Remington LimRemington Lim More articles by this author , Christopher NoyesChristopher Noyes More articles by this author , Batsheva RubinBatsheva Rubin More articles by this author , Shaun WasonShaun Wason More articles by this author , and David WangDavid Wang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002043.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hematuria accounts for over 20% of referrals to urology with completion rates of only 5-18%. Our study characterizes the referral trends for hematuria and analyzes the socioeconomic factors affecting follow-up appointment rates at a safety net hospital. METHODS: We performed a retrospective review of patients referred to urology at an urban safety net hospital for microscopic and gross hematuria from 2018-2019. Demographics of patients were analyzed with an emphasis on gender, race, language, and insurance status. Appropriateness of the referral and completion of the workup, including imaging and cystoscopy, were studied. Univariate analysis was performed using chi-square test, Fisher’s exact test or t-test, and odds ratios were calculated. RESULTS: 333 patients were referred for microscopic or gross hematuria. We excluded 45 patients who did not show for consultation and 53 patients with a known history of genitourinary malignancy or urolithiasis. 59.2% patients had a pre-referral urinalysis with microscopy and 28.9% had a urine culture. 5.5% patients had only a dipstick urinalysis and 16.2% had no urine studies. The majority of patients were non-White (68.5%), publicly insured (75.3%). 40.8% were non-English speaking. Only 150 (63.8%) completed the hematuria workup with both upper tract imaging and cystoscopy. Of the remaining 85, 28 missed cystoscopy, 26 missed imaging, and 31 missed both. Odds of completing a hematuria evaluation was not significantly associated with any factors, including age, gender, BMI, smoking status, race, language, insurance status, or referral center. CONCLUSIONS: Within an urban safety net hospital system, 40% of hematuria referrals were missing the recommended urinalysis with microscopy. Although workup completion rates were higher compared to prior studies, they remain relatively low regardless of socioeconomic factors. Stratified 2020 AUA hematuria guidelines, which obviate the need for cross sectional imaging, may improve hematuria completion rates. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e623-e624 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Liz Wang More articles by this author Remington Lim More articles by this author Christopher Noyes More articles by this author Batsheva Rubin More articles by this author Shaun Wason More articles by this author David Wang More articles by this author Expand All Advertisement Loading ...

A Cross-Sectional Analysis of Barriers Associated With Non-Attendance at a Urology Telehealth Clinic in a Safety-Net Hospital

To analyze the factors associated with non-attendance at a urology telehealth clinic in a large urban safety-net hospital after institutional-mandated transition to telehealth due to COVID-19. We identified all encounters scheduled for telehealth after March 17, 2020 and in the subsequent 8 weeks. Logistic regression was used to identify factors associated with attendance. In total there were 322 telehealth encounters, 228 (70.8%) of which were attended and 94 (29.2%) that were not attended. Racial/ethnic minorities accounted for 175 (77.0%) of attended and 73 (76.7%) of non-attended encounters. On multivariable regression, single/divorced/widowed (odds ratio [OR] 2.36, 95% confidence interval [CI] 1.26-4.43), current substance use disorder (OR 5.33, 95% CI 2.04-13.98), and being scheduled for a new patient appointment (OR 1.81, 95% CI 1.04-3.13) were associated with higher odds of not attending a telehealth encounter. Race/ethnicity, primary language, and country of birth were not associated with odds of attendance. Our findings identify several social factors (social support, substance use) associated with non-attendance at outpatient telehealth urology encounters at an urban safety-net hospital during the early stages of the COVID-19 pandemic. These barriers may have a greater impact specifically within a safety-net healthcare system and will inform equitable provision of urology telehealth programs in the future FUNDING: Goldberg-Benioff Endowed Professorship in Cancer Biology. The sponsors had no involvement with this study.