US Health Care Research Articles

Economic Outcomes With Precision Diagnostic Testing Versus Usual Testing in Stable Chest Pain: Results From the PRECISE Randomized Trial.

The PRECISE (Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization) demonstrated that a precision diagnostic strategy reduced the primary composite of death, nonfatal myocardial infarction, or catheterization without obstructive coronary artery disease by 65% in patients with nonacute chest pain compared with usual testing. Medical cost was a prespecified secondary end point. PRECISE randomized 2103 patients between December 2018 and May 2021 to usual testing or a precision strategy that used deferred testing for the lowest risk patients (20%) and coronary computed tomographic angiography with selective computed tomography-derived fractional flow reserve for the remainder. Resource use consumption data were collected from all study participants and hospital cost data from US participants (n=1125) to estimate total medical costs. The primary and secondary economic outcomes were total costs at 12 months and at 45 days, respectively, from the US health care system perspective. The mean cost differences between the 2 strategies were reported by intention-to-treat. At 45 days, total costs were similar between the precision strategy and usual testing (mean difference, $182 [95% CI, -$555 to $661]). By 12 months, percutaneous coronary intervention and coronary artery bypass surgery had been performed in 7.2% and 2.0% of precision strategy patients and 3.5% and 1.7% of usual testing patients, respectively. At 1 year, precision strategy costs were $5299 versus $4821 for usual testing (mean difference, $478 [95% CI, -$889 to $1437]; P=0.43). Precision care decreased mean per-patient diagnostic cost by 27% and increased mean per-patient revascularization costs by 67%. In the PRECISE trial, the precision strategy, a risk-based approach endorsed by current clinical practice guidelines, improved the clinical efficiency of testing and had similar costs to usual testing at 45 days and a nonsignificant $478 cost difference at 1 year. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03702244.

Autism and Medical Complexity Among Children in the United States.

Ongoing systems-level changes aim to better identify and remedy the unmet health care needs of children with medical complexity (CMC). In tandem, home- and community-based services are expanding to support autistic children and their families. Despite the potential for overlap, CMC and autistic children are treated independently in services, research, and policy. We estimated the overlapping prevalence of CMC and autism among US children and health care expenditures for autistic CMC in comparison with other children. We analyzed 2 national cross-sectional surveys: the National Survey of Children's Health (NSCH; 2017-2018, 2019-2022, and 2021-2022) and the Medical Expenditures Panel Survey (MEPS; combined 2010-2021), selecting for children aged 0 to 17years. CMC were defined using 2 different algorithms varying in stringency. In the most recent 2021 to 2022 NSCH (n = 103 748), the prevalence of CMC among autistic children was 59.28% (95% CI, 55.61%-62.84%) using one algorithm and 17.56% (95% CI, 14.41%-21.24%) using the more stringent algorithm. Forty-one percent of CMC were autistic using either algorithm. In the MEPS data (n = 55 637), autistic CMC had significantly greater median health care expenditures compared with other CMC and other autistic children. There is extensive overlap of CMC and autism among children in the United States. When medical complexity and autism are both evident, expenditures are significantly higher than for either category alone. Despite this overlap and the associated high need, CMC and autism are generally treated as separate groups in services, research, and policy. These findings underscore the importance of cohesively understanding service needs across CMC, autistic children, and their caretakers.

Knowledge, Attitudes, and Decision-Making About Reproductive Health and Epilepsy: A Survey of Health Care Providers and Women With Epilepsy.

Cisgender women with epilepsy (WWE) have distinct reproductive health needs. It is unknown to what extent WWE and their health care providers (HCPs) are aware of recent research advances regarding the reproductive health of WWE. This study aimed to survey US health care providers and WWE about their knowledge, attitudes, and decision-making pertaining to reproductive health; their awareness of key findings from recent relevant research; and whether learning of these findings would change their decision-making. A market research firm conducted an online survey of US health care providers and WWE using a proprietary nationally representative panel. Eligible HCPs included physicians and advance practice providers in neurology, obstetrics-gynecology, and primary care, who treat WWE. Eligible WWE were 18-45 years old and reported an epilepsy diagnosis and taking antiseizure medication. Data were analyzed through descriptive statistics and logistic regression. Four hundred one HCPs and 199 WWE completed the full survey. Among HCPs, 38% reported being very or extremely comfortable treating pregnant WWE. Seventy-nine percent of HCPs reported that recent relevant research findings were new to them, with 65% reporting that the findings seemed plausible and 49% reporting that the findings would probably or definitely change their management of pregnancy for WWE.Thirty percent of WWE reported that pregnancy is very or extremely safe for WWE, while 50% reported that it is somewhat safe, and 21% not at all or not very safe. Ninety-one percent of WWE reported that research findings were new to them, 37% reported that the findings seemed plausible, and 64% reported that the findings would probably or definitely influence their reproductive decision-making. Survey findings suggest suboptimal awareness of recent research advances pertaining to the reproductive health of WWE among WWE and their HCPs. Findings also suggest that dissemination and implementation of such findings may be impactful on the medical decision-making of both HCPs and WWE. Findings may guide future initiatives to ensure prompt dissemination and implementation of research advances in epilepsy and reproductive health.

Implementing Food as Medicine During COVID-19: Produce Prescriptions and Integrative Group Medical Visits in Federally Qualified Health Centers.

Food as Medicine is a rapidly developing area of health care in the United States, aimed at concurrently addressing nutrition-sensitive chronic conditions and food and nutrition insecurity. Recipe4Health (R4H) is a Food as Medicine program with an integrative health equity focus. It provides prescriptions for locally grown produce ('Food Farmacy') with or without integrative group medical visits, alongside training for clinic staff. To describe the initial implementation of R4H in four Federally Qualified Health Centers in Northern California, using a convergent mixed-methods approach. We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) implementation science framework to assess the first two years of R4H (2020-2022). We draw from 40 interviews (26 partner organization staff, 14 patients) and program data on reach and adoption. Qualitative data were analyzed using codebook thematic analysis. Reach: From January 2020 to August 2022, 3255 patients were referred to the program; 1997 of those referred (61%) enrolled in the Food Farmacy only (N = 1681) or Food Farmacy + integrative group medical visits (N = 316). Participating patients included a wide range of ages (mean age 41.4, [SD 20]; 18% < 18 years old) and racial and ethnic backgrounds (3% American Indian or Alaska Native, 6% Asian or Pacific Islander, 19% Black, 57% Hispanic/Latine, 7% white). 69% were female; 43% primarily spoke Spanish. Adoption: 84% of trained clinic staff referred two or more patients to R4H. Implementation: Elements of successful implementation included: (1) support from county government leadership, (2) centralized coordination of the multi-sector partnership, and (3) a flexible approach responsive to organizational and COVID-related shifts. R4H implementation informed statewide Medicaid policy changes. Maintenance: To date, all four clinics continue to participate in R4H. Centralized implementation, training, and administration of Food as Medicine programs can strengthen community health centers' capacities to concurrently address chronic conditions and food insecurity. Multi-sector partnerships can support Food as Medicine program sustainability.

Cash holdings in the US healthcare industry: Do different types of uncertainty matter?

This study examines the effects of economic policy uncertainty, categorical economic policy uncertainties, and pandemic uncertainty on the cash holdings of firms operating in the US healthcare industry. The SYS-GMM methodology is applied for 466 firms from 2001 to 2022. The results show that all uncertainties positively affect cash holdings contemporaneously, albeit at different magnitudes. Monetary policy, healthcare policy, and fiscal policy uncertainties are the most influential uncertainties, supporting the financial frictions and real options theories. Controlling for the severity of the pandemic over time, pandemic uncertainty has a positive contemporaneous effect and a negative lagged effect on cash holdings.

Abstract TP121: More Thrombectomy Transfers and Simpler Network Structures in Vertically Integrated ED-Hospital Pairs

Background: Stroke transfer networks have rapidly evolved with limited central organization in response to the emerging and evolving evidence base for endovascular thrombectomy (EVT). Simultaneously, the US healthcare system has undergone a period of rapid consolidation with large hospital systems purchasing smaller hospitals and physician practices, an evolution termed “vertical integration” (VI). The effect that vertical integration has on emergency stroke care is unclear. This analysis longitudinally characterizes VI and non-VI stroke transfer networks to assess their evolution. Methods: Using the 2016-2018 US Centers of Medicare Fee-For-Service files, we captured patients with ischemic stroke who had an ED-hospital transfer, defined as a beneficiary with: 1) any outpatient ED claim the day of or prior to the inpatient stroke claim, 2) an ED discharge status indicating transfer to an acute care hospital, and 3) originating and receiving facilities with different NPI numbers. We defined an ED-hospital dyad to be vertically integrated if the ED and hospital shared the same health system ID in the Agency for Healthcare Research and Quality's Compendium of US Health Systems. We characterized the vertical integration of the stroke transfer networks using descriptive statistics and the structure using multiple edge directed graphs. Results: We identified 13287, 14217, 15169 stroke transfers in 2016, 2017, and 2018, respectively. In 2016, 29% of VI stroke transfer network dyads had ≥1 transfer with EVT compared to only 17% of non-VI dyads. While the overall fraction of dyads with ≥1 transfer with EVT increased over time (2016: 20%, 2017: 25%, 2018: 28%), the relatively higher fraction in VI dyads with ≥1 transfer with EVT compared to non-VI dyads remained stable (2017: VI 32%, non-VI 22%; 2018: VI 35%, non-VI 26%). In VI stroke transfer networks in 2016, EDs sent stroke transfers to 1.2 hospitals on average, while hospitals received stroke transfers from 2.1 EDs. In non-VI stroke transfer networks, EDs sent stroke transfers to 1.9 hospitals on average, while hospitals received stroke transfers from 3.8 EDs. There was no substantial change in 2017 or 2018. Conclusion: From 2016 to 2018, a greater proportion of VI stroke transfer dyads had transfers for EVT than non-VI stroke transfer dyads. VI EDs on average transferred to fewer receiving hospitals than non-VI EDs, while VI hospitals on average received patients from fewer EDs than non-VI hospitals.

Abstract TP131: Factors Impacting Racial and Ethnic Disparities in the Use of Intravenous Thrombolytics in a Large Western US Healthcare System

Introduction: Studies of racial and ethnic disparities in using intravenous thrombolytics (IVT) for stroke in large healthcare systems and specific US states are lacking. This study examines potential contributors to disparities in IVT administration in a large Western healthcare system overall and by state (AK, CA, OR, TX and WA). Methods: This retrospective analysis of a systemwide stroke registry analyzed patients with ischemic stroke admitted January 2016 to September 2023. Patients aged &lt;18 years, those arriving &gt;4.5 hours from last known well (LKW), those with stroke occurring post hospital arrival and those receiving endovascular treatment were excluded. Generalized linear models were used to assess whether some racial and ethnic patient groups were less likely to receive IVT vs White patients, adjusting for age, National Institutes of Health Stroke Scale score at admission, LKW to arrival time, previous stroke, atrial fibrillation/flutter, obesity, mode of arrival, door-to–computed tomography scan time, insurance status and facility certification status. Results: Among 16,833 patients included, 45.0% received IVT. Overall, Black patients were less likely to receive IVT vs White patients ( Table 1 ), but this was not significant. By state, Black patients were less likely to receive IVT vs White patients in OR and WA ( Table 1 ). While Black and White patients had similar LKW to arrival times, Black patients were younger, had more severe strokes and used emergency medical service (EMS) at higher rates vs White patients ( Table 2 ). Compared with White patients, American Indian/Alaska Native patients were younger and used EMS at higher rates. Hispanic/Latino and Native Hawaiian/Pacific Islander patients were also younger and had more severe strokes than White patients. Conclusions: These data suggest that racial and ethnic disparities in stroke treatment vary by geography within a large healthcare system. Further analyses into the underlying factors are needed to guide tailored education at the local level.

The Impact of International Fellowship on Research Productivity: International Fellowship on Research Productivity.

International medical graduates (IMGs) represent a significant portion of the US physician workforce, comprising 25% across all specialties with a strong presence in internal medicine and primary care. However, their representation in plastic surgery remains limited at only 10%. Matching into a US plastic surgery residency is highly competitive for both US medical graduates and IMGs. This study aimed to quantify and identify trends in academic contributions from IMGs applicants in a plastic surgery residency program over the past 13 years, hypothesizing that IMG applicants have increasingly contributed to collaborative research projects.Data from National Resident Matching Program annual reports were analyzed, focusing on publications, research experience, and match status. An analysis of variance revealed significant differences between US MDs and IMGs in terms of publications and research experience. IMGs had a higher number of publications and work experience compared to matched US MDs, while US MDs had more research experiences than IMGs.The findings underscore the importance of research for IMGs, who often engage in additional research experiences to enhance their competitiveness for residency positions. The study showed that IMGs have a greater research output, contributing significantly to academic publications within the plastic surgery field. This productivity benefits the IMGs in securing residency positions and enriches the academic research environment of the residency programs.IMGs bring unique perspectives and innovative approaches to research, often collaborating internationally, which enhances the scope and quality of research projects. Their contributions are vital to the advancement of plastic surgery and the broader medical field. As the demand for physicians in the US grows, integrating IMGs into the healthcare system through strategic inclusion in research and clinical training is essential. This study highlights the critical role of IMGs in driving medical research and underscores the need for supportive policies to facilitate their integration into the US healthcare workforce.

An In-Depth Analysis of the State Laws That License International Medical Graduates Without American Residency Training.

International medical graduates (IMGs) have been integral to the United States (US) healthcare system and have helped tackle physician shortages for over a century. Current data suggest that by 2030, almost half the states will suffer from physician shortage and estimate a deficit of almost 139,000 physician jobs nationally. These numbers raise concern and call for innovative strategies to mitigate the potential problem. Against this background, the state of Tennessee has passed a law that allows IMGs licensed in a foreign country to obtain provisional licensure to practice in the United States, without the completion of a US-based residency. After the Senate bill SB 1451 was passed in Tennessee, several other states (including Arizona, Florida, Idaho, Illinois, Iowa, Virginia, and Wisconsin) have followed suit and started the legislative process to pass laws that provide a new entry point for IMGs seeking to practice medicine in the United States. Each of these laws comes with a unique set of stringent specifications and requirements for individuals who wish to use these novel pathways. Through this article, we highlight the pathways that have opened for IMGs to directly enter clinical practice in the United States (without residency or fellowship training) and explore their implications on patient care and diversity of physician workforce in America.

Spinal Muscular Atrophy Update in Best Practices: Recommendations for Treatment Considerations.

Spinal muscular atrophy (SMA) is an autosomal recessive disorder caused by biallelic variants of the Survival Motor Neuron 1 gene (SMN1) that affects approximately 1 in 15,000 live births. Availability of 3 SMN-enhancing treatments for SMA has led to urgency to review how clinicians and patients use these treatments for SMA, while additional research and real-world data and experience are being collected. This work describes important factors to assist with decision-making for SMN-enhancing treatments. A systematic literature review was conducted on SMN-enhancing treatments for SMA and related studies. A working group of American and European health care providers with expertise in SMA care identified barriers and developed recommendations through a modified Delphi technique with serial surveys and feedback through virtual meetings to fill gaps for information where evidence is limited. A community working group of an individual living with SMA and caregivers provided insight and perspective on SMA treatments and support through a virtual meeting to guide recommendations. The health care provider working group and the community working group agreed that when determining whether to start, change, add, or discontinue a treatment, essential considerations include patient and family/caregiver perspective, and treatment safety and side effects. When initiating treatment for patients newly diagnosed with SMA, important patient characteristics are age and Survival Motor Neuron 2 gene (SMN2) copy number. Furthermore, when initiating, changing, or adding treatment, current clinical status and comorbidities drive decision-making. When considering a medication or treatment plan change, unless there is an urgent indication, a treatment and associated patient outcomes should be monitored for a minimum of 6-12 months. When determining a treatment plan with an adolescent or adult with SMA, consider factors such as quality of life, burden vs benefit of treatment, and reproductive issues. Access to care coordination and interdisciplinary/multidisciplinary care are essential to treatment success. Sharing information about current knowledge of treatments and shared decision-making between health care providers and patients living with SMA and caregivers are essential to overcoming barriers to providing SMN-enhancing treatments.

Measuring, Comparing, and Predicting Knowledge Related to Reproductive Healthcare in the United States

ABSTRACT This study explores public knowledge of US reproductive healthcare policies through the measurement, comparison, and prediction of different knowledge items. The topic is important since previous research links knowledge to support for reproductive freedom (Buyuker et al. 2023; Jozkowski et al. 2023), and little research has been done on predicting reproductive healthcare policy knowledge. In April 2024, a representative sample of 775 Americans were surveyed. Employing descriptive statistics, statistical measurement techniques, and logistic regression, the study analyzed knowledge across four questions related to reproductive healthcare. Findings reveal significant gaps in knowledge about current events. Despite topical similarities, the questions lack statistical interrelation, challenging the prospects for latent measures of policy knowledge. Further, diverse predictors for each knowledge question suggest the need for nuanced educational campaigns tailored to specific knowledge items and demographic groups or attitudinal positions. This research initiates inquiry into the public’s understanding of governmental actors’ roles in reproductive healthcare policies.

Social mixing patterns of United States healthcare personnel at a quaternary health center: a prospective observational study.

Understanding healthcare personnel's (HCP) contact patterns are important to mitigate healthcare-associated infectious disease transmission. Little is known about how HCP contact patterns change over time or during outbreaks such as the COVID-19 pandemic. This study in a large United States healthcare system examined the social contact patterns of HCP via standardized social contact diaries. HCP were enrolled from October 2020 to June 2022. Participants completed monthly surveys of social contacts during a representative working day. In June 2022, participants completed a 2-day individual-level contact diary. Regression models estimated the association between contact rates and job type. We generated age-stratified contact matrices. Three-hundred and sixty HCP enrolled, 157 completed one or more monthly contact diaries and 88 completed the intensive 2-day diary. In the monthly contact diaries, the median daily contacts were 15 (interquartile range (IQR) 8-20), this increased slightly during the study (slope-estimate 0.004, p-value 0.016). For individual-level contact diaries, 88 HCP reported 2,550 contacts over 2 days. HCP were 2.8 times more likely to contact other HCP (n = 1,592 contacts) than patients (n = 570 contacts). Rehabilitation/transport staff, diagnostic imaging technologists, doctors, nurses, mid-level, and laboratory personnel had higher contacts compared with the lowest contact group (Nursing aids). Contact matrices concentrated in working-age populations. HCP contacts concentrate in their work environment, primarily with other HCP. Their contacts remained stable over time even during large changes to societal contact patterns during the COVID-19 pandemic. This stability is critical for designing outbreak and pandemic responses.

Transparency in United States healthcare sustainability: a scoping review

Transparency in United States healthcare sustainability: a scoping review

P-271. Contact Patterns of United States Health Care Workers at Quaternary Health Center: Stability of contacts during the post-pandemic era

Abstract Background We lack understanding of how health care workers’ (HCWs) contacts change over time or in response to pandemics. This study describes the social contact patterns of HCWs in a large United States health care system via standardized social contact diaries. Mean number of total contacts over time (Jan 2021-May 2022): The mean contacts noted with dark-blue line with 95% confidence intervals (95%CI) in dark gray. The dashed black line shows the linear regression of contacts over time. The-axis is interrupted as the study was closed in June and July 2021. Methods Inpatient and outpatient HCWs enrolled from October 2020 to June 2022. Participants completed a monthly survey of all contacts during a single representative working day selected by the participant. Direct contact was defined as being within 2 meters of another person. Indirect contact was defined as being in the same room but more than 2 meters. In June 2022, participants completed a 2-day individual-level contact diary. We generated age-stratified contact matrices. Contacts were described by contact type, duration and contact relationship. Number and duration of contacts by job were compared by chi-squared test and number of contacts over time by linear regression. Average contacts of health care worker with all individuals The individual tiles color and numeric fill denote the average number of contacts per HCW of that age range with a contact of that age range. A horizontal marginal histogram shows the age break down of HCW participants and a vertical marginal histogram shows the resulting distribution of contact’s ages. Results 360 HCWs enrolled, 95 completed 1 or more monthly contact diary and 88 completed the intensive 2-day diary. The total number of contacts was stable over time (β0.14, p 0.20, Fig.1). HCWs reported direct contacts with less than 5 patients, 5-9 patients, 10-19 patients or 20 more patients, 50%, 29%,15% or 6% of the time respectively. HCWs reported direct contact with less than 5 other HCWs, 6-10 HCWs, 11-20 or 21 or more 19%, 39%, 27 % or 15% of the time respectively. In the June 2022, a total of 2,550 contacts were reported, 1,592 (62%) were with HCWs, and 570 (22%) with patients. Social workers, rehab/transport and doctors were more likely to have contact with 20 or more patients vs. other professions. Nurses, imaging technologists and rehab/transport were more likely to spend 20 minutes or more with patients vs. other professions. Contact matrices were not age assortative with HCWs having similar contacts across all working ages (Fig. 2). HCWs’ physical contacts focused on extremes of age (Fig. 3). Contact type varied by job with nearly all groups having more contacts with colleagues than patients (Fig, 4). Average physical contacts of HCWs per day: The The individual tiles color and numeric fill denote the average number of physical contacts per HCW of that age range with a contact of that age range. A horizontal marginal histogram shows the age break down of HCW participants and a vertical marginal histogram plot the resulting distribution of contact’s ages. Conclusion HCW contacts concentrated in their work environment and most contacts were focused in the working-age population. These contacts were stable over time even in the COVID-19 pandemic response. HCWs were 2.8 time more likely to contact HCWs than patients. Number of contacts of 2 days by participant job and contact individual Grouped box plots show the number of contacts over the 2-day intensive diary by HCW job (x-axis) and the HCWs relationship with the contact (e.g. colleague, patient or other). Disclosures Lauren Pischel, MD, Auxa Health: Advisor/Consultant Amyn Malik, MBBS, MPH, PhD, Analysis Group, Inc: Former Employee. We consulted with Pharma and Biotech on different research studies Ben Lopman, PhD, Epidemiological Research and Methods, LLC: Advisor/Consultant|Hillevax, Inc: Advisor/Consultant Albert I. Ko, MD, Merck: Grant/Research Support|Regeneron: Grant/Research Support Saad Omer, MBBS MPH PhD, Meta: Advisor/Consultant|Meta: Grant/Research Support

P-1358. Understanding Fungal Infections and Trends in Fungal Resistance: A Single Center Evaluation

Abstract Background Invasive fungal infections cost the US health care system billions and are challenging to treat. In 2021 alone, the CDC estimates that fungal infections contributed to over $7 billion in direct medical costs and over 7,000 deaths in the US. The most common agents used to treat clinical fungal infections are azoles. However, antifungal resistance is on the rise. Exposure to agricultural fungicides has been identified as likely contributing to increased resistance to medical azoles, as there has been incidence of infection with azole-resistant fungi in patients who were azole-naïve. Furthermore, in vitro studies have demonstrated that fungi exposed to agricultural azoles develop cross-resistance to medical azoles. This study aims to describe retrospective antifungal susceptibility trends for medical azoles in patients at UCSD Health and agricultural azole use in San Diego and Imperial Counties. Methods Chart review was used to obtain sensitivity data (minimum inhibitory concentrations or MICs) for non-Candida fungal isolates sent for susceptibility testing from UCSD Health patients from January 2016 through February 2024. Data on fungal isolates including species, date of isolate collection, susceptibility data, and patient zip code were collected. Agricultural azole use data is publicly available from the California Department of Pesticide Regulation and was analyzed for azoles applied in San Diego and Imperial Counties from 2016 to 2021. Results 189 fungal isolates from 170 patients were included in the analysis. Fusarium demonstrated high resistance to common medical azoles which did not change over time. A. fumigatus also exhibited minimal change in MICs for itraconazole and posaconazole but showed possible increase in MICs over time for voriconazole and isavuconazole. Imperial County had an 8 to 10-fold higher use of agricultural azoles compared to San Diego County. Conclusion Fusarium demonstrated resistance to all common medical azoles. There may be a possible increase in resistance of A. fumigatus to voriconazole and isavuconazole over time, however this is limited by small sample size. This study highlights the need for increased antifungal susceptibility testing at UCSD Health. Disclosures Nina Haste, PharmD, PhD, Novartis: Spouse is an employee

P-232. Reduction in Catheter-associated Urinary Tract Infections (CAUTIs) Post-Implementation of External Urethral Catheters (EUC) in the Intensive Care Units at a Quaternary Medical Center

Abstract Background Catheter associated urinary tract infections (CAUTIs) have significant clinical and financial impact on the US healthcare system. In a systematic review published in 2018, the attributable cost of a CAUTI was estimated to exceed $1000 (1). Indwelling urinary catheters increase risk for CAUTIs proportionate to the length of catheter use (figure 1). External Urethral Catheters (EUC) have the potential to reduce risk of CAUTIs. We conducted this quality improvement project to study the impact of EUC use on CAUTIs in the ICUs at our institution. Figure 1. Length of Foley Catheter placement to CAUTI by organisms. Methods EUC use was introduced in female (F) and male (M) patients since July 2018 and November 2021, respectively at our hospital. In this retrospective review, cases of CAUTIs were reviewed pre and post implementation of EUCs; in F from Jan 2015 to Jan 2021 and in M from Nov 2019 to Nov 2023 in patients admitted to the ICUs. National Healthcare Safety Network (NHSN) definition for CAUTIs was utilized for this project. Additionally, information on pathogens implicated in these infections was obtained. Figure 1: Distribution of organisms in Female population Results There were a total of 157 CAUTIs noted in the study period; of the 132 F cases, 95 cases occurred pre and 37 cases post EUC implementation (RR 2.5 &amp; RRR 61%). Of the 25 M cases, 15 cases were in pre and 10 cases post (RR 1.5 &amp; RRR 33%) EUC use. Overall, there was an absolute risk reduction of 0.402. E.coli was the most common pathogen in both males (24%) and females (47%). There was an overall higher incidence of Enterococcus spp in the male population (20%) when compared to the female population (11.4%) (Figure 2&amp;3). Figure 3: Distribution of organisms in male population Conclusion Nosocomial infections are well described as a burden for ICU patients, but the results of this study demonstrate that there are possible interventions to mitigate CAUTIs. Clinicians and nursing staff should evaluate the need for indwelling urinary catheters on a daily basis. Favoring placement of EUC over indwelling urinary catheter has the potential to significantly reduce the burden of this disease. Figure 4: Total case pre and post implementation of EUC. Disclosures All Authors: No reported disclosures

P-604. Preliminary real-world Abrysvo vaccine effectiveness (VE) against Respiratory Syncytial Virus (RSV)-related lower respiratory tract disease (LRTD) hospitalizations and emergency department (ED) visits—Kaiser Permanente of Southern California (KPSC), November 2023-April 2024

Abstract Background While the pivotal randomized clinical trial documented the efficacy of the RSVpreF vaccine (Abrysvo) against RSV-related LRTD, the limited number of hospitalizations and ED visits hampered VE assessment for these clinical outcomes. We evaluated Abrysvo’s effectiveness against 1st occurrence of RSV-related inpatient or ED LRTD in KPSC, a large US healthcare system.Table 1.Characteristics of study population, KPSC Methods In this test-negative case control study, we assessed VE among adults ≥60 years of age by analyzing KPSC members’ electronic health records and enhancing specimen testing from 11/24/2023-4/9/2024. Events from inpatient or ED settings meeting an ICD-10 code-based LRTD case definition with a respiratory specimen tested on GenMark RP2 expanded multiplex PCR assay were included. Cases were defined as RSV+ episodes. Analyses were conducted using two sets of pre-specified controls: 1) ‘Strict’: RSV- and positive for a non-vaccine preventable disease (VPD) etiology, and 2) ‘Broad’: all RSV-. The strict approach accounted for lower sensitivity of RSV testing among adults and potential bias associated with VPD controls. Exposure was defined as Abrysvo receipt ≥21 days before encounter. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated from a multivariable logistic regression model with adjustment for patient demographic and clinical characteristics. VE was calculated as 1−OR multiplied by 100%.Table 1.Characteristics of study population, KPSC, cont. Results The overall study population included 4,469 KPSC members: &amp;gt;50% were ≥75 years, 93% had ≥1 comorbidities, and 15% immunocompromised. In the strict analysis, there were 425 cases and 522 controls who received Abrysvo a median of 59 days before illness onset; VE compared to no vaccine receipt was 84% (95% CI: 29–97). In the broad analysis, there were 425 cases and 4,044 controls who received Abrysvo a median of 53 days before illness onset; adjusted VE was 82% (95% CI: 28–96).Table 2.Abrysvo Vaccine Effectiveness against RSV LRTD hospitalizations and ED visits, KPSC Conclusion This study demonstrated real world VE of Abrysvo during its first 5 months of use against severe LRTD in the hospital and ED settings among US adults ≥60 years of age. These results expand on efficacy results from clinical trial populations by including a substantial number of persons age 75+ years and with comorbidities and immunocompromising conditions. Disclosures Sara Y. Tartof, PhD MPH, GSK: Grant/Research Support|Pfizer Inc: Grant/Research Support Negar Aliabadi, MD, MS, Pfizer Inc: employment|Pfizer Inc: Stocks/Bonds (Public Company) Jeff Slezak, MS, Dynavax Technologies: Grant/Research Support|Pfizer: Grant/Research Support Vennis Hong, MPH, Pfizer: Grant/Research Support Bradley Ackerson, MD, Dynavax: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Qing Liu, M.S., Pfizer Inc.: Stocks/Bonds (Public Company) Sally Shaw, DrPH, MPH, Pfizer: Grant/Research Support Sabrina Welsh, MPH, Pfizer Inc: Stocks/Bonds (Public Company) Julie Stern, MPH, GlaxoSmithKline: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi: Grant/Research Support Michael Dutro, PharmD, Pfizer: Stocks/Bonds (Public Company) Erica Chilson, PharmD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds (Public Company) Elisa Gonzalez, MS, Pfizer: Stocks/Bonds (Private Company) Robin Hubler, MS, Pfizer, Inc.: Employee of Pfizer Inc.|Pfizer, Inc.: Stocks/Bonds (Private Company) Luis Jodar, PhD, Pfizer Inc: Employment|Pfizer Inc: Stocks/Bonds (Public Company) Bradford D. Gessner, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Elizabeth Begier, MD, M.P.H., Pfizer Vaccines: Employee|Pfizer Vaccines: Stocks/Bonds (Private Company)

P-257. Effectiveness of Pulsed-Xenon Ultraviolet Disinfection during Terminal Cleaning of Patient Rooms in the Intensive Care Unit on the Sustained Containment of Drug-resistant Acinetobacter baumannii

Abstract Background Environmental disinfection by ultraviolet (UV) has been shown to be effective in controlling transmission of multidrug-resistant organisms, and introduced into daily practices in addition to manual terminal cleaning in some hospitals in the US. However, its effectiveness outside the US healthcare setting is not well investigated. Moreover, its effectiveness to control gram-negative bacteria has not been well described. Methods This study was conducted in the intensive care unit (ICU) of Yamagata University Hospital, a 637-bed tertiary referral hospital. Sporadic transmission of two drug-resistant Acinetobacter baumannii (2DRA) began in late 2013. Despite intensified hand hygiene promotion and manual terminal cleaning, transmission of 2DRA continued. In January 2018, we added pulsed-xenon ultraviolet (PX-UV) disinfection for the terminal cleaning after every patient discharge. The study periods were defined as follows: the baseline period (August 2016 to January 2018, manual cleaning only) and the intervention period (February 2018 to December 2023, addition of PX-UV). All patients admitted in the ICU were regularly screened for 2DRA for the detection of possible acquisition of 2DRA throughout the study periods. Results The incidence of acquisition of 2DRA in the ICU significantly declined (4.45 per 1,000 patient days in the baseline period to 1.09 in the intervention period, relative risk (RR): 0.26, 95% confidence interval: 0.12-0.51). Cases in the intervention period were sporadic, and no cluster was found. In contrast, in non-ICU wards, where PX-UV disinfection was performed only after the discharge of patients known to be colonized or infected with 2DRA or other multidrug-resistant pathogens, possible transmission of 2DRA was observed several times. Conclusion Adding PX-UV after manual terminal cleaning was effective in controlling acquisition of 2DRA in the ICU patients. The effectiveness of PX-UV in controlling gram-negative MDROs in the non-US healthcare settings is suggested. In contrast, there was room for improvement in controlling of 2DRA in non-intervention wards. Disclosures All Authors: No reported disclosures

P-211. Implications of Skilled Nursing Facility Origin on Clostridioides difficile Infection Hospitalizations in the United States

Abstract Background Clostridioides difficile infection (CDI) occurs in nearly half a million Americans annually. Skilled nursing facility (SNF) residents are at increased CDI risk due to older age, underlying comorbidities, and frequent healthcare exposure. The study sought to describe the implications of CDI originating in SNFs, including CDI acuity, health outcomes, transitions of care, and economics. Methods This was a retrospective cohort study using the Premier Healthcare Database, which represents approximately one-quarter of United States healthcare systems. Older adult (65+ years) patients were included if they had an index, non-recurrent CDI hospitalization (ICD-10 code A04.72) between July 1, 2019 and December 31, 2022. Patient and CDI characteristics, health outcomes (inpatient mortality, hospital length of stay [LOS], readmission for recurrent CDI [rCDI]), and hospital costs were compared between patients admitted from a SNF compared to a non-SNF point of origin. Results A total of 94,330 index CDI hospitalizations were included. Patients were predominantly female (58.4%), White race (81.6%), and treated in urban settings (86.5%). Only 5.3% (n=5,003) of CDI patients were admitted from a SNF; however, 28.4% (n=26,891) were discharged to a SNF. One-third (31.0%) of patients admitted from a non-healthcare location were discharged to a SNF. Patients admitted from a SNF were older (median age 79 vs. 76 years) and more likely to have a secondary CDI diagnosis (85.0% vs. 74.4%) and emergent admission (90.2% vs. 82.1%) compared to non-SNF patients. Patients admitted from SNFs were also more likely to experience poor CDI health outcomes, including higher inpatient mortality (12.8% vs. 8.2%), readmissions for rCDI (14.8% vs. 13.8%), median hospital costs ($17,728 vs. $14,832), and longer median hospital LOS (8 vs. 7 days) (p&amp;lt; 0.05 for all). Median costs were significantly higher for patients discharged to a SNF compared to a non-SNF location ($19,560 vs. $11,481). Conclusion Older, hospitalized CDI patients originating from SNFs disproportionately experience poor outcomes in health and financial burden. Over one-quarter of CDI patients were discharged to a SNF suggesting a major impact on physical function, quality of life, and associated risk. Disclosures Kelly Reveles, PharmD, PhD, AstraZeneca: Grant/Research Support|Ferring Pharmaceuticals: Advisor/Consultant

Race and Ethnicity as Factors in Healthcare Discrimination in the United States: A Cross-Sectional Study.

Discrimination is the unfair or prejudicial treatment of people and groups based on certain characteristics. Discrimination in health care can impede access to quality care for patients and lead to poor health outcomes. This study aimed to investigate factors, including race and ethnicity, associated with discrimination in health care in the United States. A cross-sectional study utilizing the 2021 Medical Expenditure Panel Survey (MEPS) was conducted. Adults (≥ 18years old) who responded to questions about discrimination in health care were identified. Population characteristics were summarized using weighted mean, standard deviation, and percentages. A weighted t-test for continuous variables and a chi-square test for categorical variables were used to compare subject characteristics. Weighted logistic regression was used to explore factors associated with discrimination in health care, while controlling for important covariates. A total of 238,097,086 participants (unweighted n = 17,239) were included in the study. Average (SD) age of the population was 48 (18) years old in 2021 and 52% were female. Compared to non-Hispanic White population, non-Hispanic Black and non-Hispanic other races were more likely to experience discriminated when receiving health care by 285% (OR = 3.85, p < 0.001) and 207% (OR = 3.07, p < 0.001), respectively. Females were also more likely to experience discrimination than males (OR = 1.97, p < 0.001). Other factors associated with discrimination in health care were asthma diagnosis, being a smoker and poverty. Discrimination in health care is associated with being part of a minority racial and ethnic groups, being female, being an older individual, being a smoker and living in poverty. These associations may contribute to inequitable health outcomes in the United States.