Use In Patient Care Research Articles

Brief Communications Data Hygiene: Important Step in Decision Making with Implications for Health IT Professionals

Medical and health data that have been entered into an electronic data system in real-time cannot be assumed to be accurate and of high quality without verification. The adoption of the electronic health record (EHR) by many countries to the support care and treatment of patients illustrates the importance of high quality data that can be shared for efficient patient care and the operation of healthcare systems. This brief communication provides a high-level overview of an EHR system and practices related to high data quality and data hygiene that could contribute to the analysis and interpretation of EHR data for use in patient care and healthcare system administration.

Determinants of dental care use in patients with rare diseases: a qualitative exploration

BackgroundOral health is an inherent part of overall health as an important physiological crossroad of functions such as mastication, swallowing or phonation; and plays a central role in the life of relationships facilitating social and emotional expression.Our hypothesis was that in patients with rare diseases, access to dental care could be difficult because of the lack of professionals who know the diseases and accept to treat the patients, but also because some patients with cognitive and intellectual disabilities could not find adequate infrastructure to assist in managing their oral health.MethodsThis study employed a qualitative descriptive design including semi-structured interviews using guiding themes. The transcripts were reviewed to identify key themes and interviews were performed until the data were saturated and no further themes emerged.ResultsTwenty-nine patients from 7 to 24 years old were included in the study of which 15 patients had an intellectual delay. The results show that access to care is complicated more by aspects concerning intellectual disability than by the fact that the disease is rare. Oral disorders are also an obstacle to the maintenance of their oral health.ConclusionThe oral health of patients with rare diseases, can be greatly enhanced by a pooling of knowledge between health professionals in the various sectors around the patient’s care. It is essential that this becomes a focus of national public health action that promotes transdisciplinary care for the benefit of these patients.

Effects of bariatric surgery on cardiovascular-related acute care use in patients with hypertrophic cardiomyopathy.

Prior studies have suggested causal relationships between obesity and acute cardiovascular events. It has been also known that the risk of acute cardiovascular events is reduced by bariatric surgery. However, little is known about whether bariatric surgery lowers the risk of acute cardiovascular events in patients with obesity and hypertrophic cardiomyopathy (HCM). In this context, we aimed to investigate whether bariatric surgery is associated with a reduced risk of cardiovascular-related acute care use in patients with HCM. In this population-based study, the bariatric surgery group consisted of patients with HCM who underwent bariatric surgery from January 2004 to December 2014. The control group included those who have obesity and HCM and received non-bariatric elective intra-abdominal surgery during the same period. The outcome was cardiovascular-related acute care use (i.e. emergency department (ED) visits or unplanned hospitalizations for cardiovascular disease) during a 1-year post-surgery period. We used the SPARCS database, a population-based ED and inpatient database in New York State. We constructed logistic regression models with generalized estimating equations to compare the risk of the outcome events during sequential 6-month post-surgery periods. We adjusted for age, sex, number of ED visits and hospitalizations for cardiovascular disease within 2years before the index surgery, and the Elixhauser co-morbidity measures. We also performed propensity score (PS)-matching and inverse probability treatment weighting analyses using these variables. The analytic cohort consisted of 207 adults with obesity and HCM, including 147 patients who underwent bariatric surgery and 60 in the control group. The risk was not significantly different in the 1-6months post-surgery period. By contrast, in the 7-12months post-surgery period, the risk of cardiovascular-related acute care use was significantly lower in the bariatric surgery group (adjusted odds ratio 0.23; 95% CI 0.068-0.71; P=0.01) compared with the control group. In the PS-matched cohort, there were no significant differences in the baseline characteristics. The PS-matched analysis demonstrated lower risk of the outcome event in the bariatric surgery group in the 7-12months post-surgery period. The inverse probability treatment weighting analysis replicated the findings. Bariatric surgery was associated with a lower risk of cardiovascular-related acute care use in the 7-12months post-surgery period in this population-based study.

Bioimpedance based determination of cardiac index does not show enough trueness for point of care use in patients with systolic heart failure.

Cardiac output (CO) is a key parameter in diagnostics and therapy of heart failure (HF). The thermodilution method (TD) as gold standard for CO determination is an invasive procedure with corresponding risks. As an alternative, thoracic bioimpedance (TBI) has gained popularity for CO estimation as it is non-invasive. However, systolic heart failure (HF) itself might worsen its validity. The present study validated TBI against TD.In patients with and without systolic HF (LVEF ≤ 50% or > 50% and NT-pro-BNP < 125 pg/ml, respectively) right heart catheterization including TD was performed. TBI (Task Force Monitor©, CNSystems, Graz, Austria) was conducted semi-simultaneously. 14 patients with and 17 patients without systolic HF were prospectively enrolled in this study.In all participants, TBI was obtainable. Bland-Altman analysis indicated a mean bias of 0.3L/min (limits of agreement ± 2.0L/min, percentage error or PE 43.3%) for CO and a bias of -7.3 ml (limits of agreement ± 34 ml) for cardiac stroke volume (SV). PE was markedly higher in patients with compared to patients without systolic HF (54% vs. 35% for CO).Underlying systolic HF substantially decreases the validity of TBI for estimation of CO and SV. In patients with systolic HF, TBI clearly lacks diagnostic accuracy and cannot be recommended for point-of-care decision making. Depending on the definition of an acceptable PE, TBI may be considered sufficient when systolic HF is absent.Trial registration number: DRKS00018964 (German Clinical Trial Register, retrospectively registered).

Attitudes and experiences of registered diabetes specialists in using health apps for managing type 2 diabetes: results from a mixed-methods study in Germany 2021/2022

BackgroundHardly any area of application for health apps is seen to be as promising as health and lifestyle support in type 2 diabetes mellitus. Research has emphasised the benefits of such mHealth apps for disease prevention, monitoring, and management, but there is still a lack of empirical data on the role that health apps play in actual type 2 diabetes care. The aim of the present study was to gain an overview of the attitudes and experiences of physicians specialising in diabetes with regard to the benefits of health apps for type 2 diabetes prevention and management.MethodsAn online survey was conducted amongst all 1746 physicians at practices specialised in diabetes in Germany between September 2021 and April 2022. A total of 538 (31%) of the physicians contacted participated in the survey. In addition, qualitative interviews were conducted with 16 randomly selected resident diabetes specialists. None of the interviewees took part in the quantitative survey.ResultsResident diabetes specialists saw a clear benefit in type 2 diabetes-related health apps, primarily citing improvements in empowerment (73%), motivation (75%), and compliance (71%). Respondents rated self-monitoring for risk factors (88%), lifestyle-supporting (86%), and everyday routine features (82%) as especially beneficial. Physicians mainly in urban practice environments were open to apps and their use in patient care despite their potential benefit. Respondents expressed reservations and doubts on app user-friendliness in some patient groups (66%), privacy in existing apps (57%), and the legal conditions of using apps in patient care (80%). Of those surveyed, 39% felt capable of advising patients on diabetes-related apps. Most of the physicians that had already used apps in patient care saw positive effects in increased compliance (74%), earlier detection of or reduction in complications (60%), weight reduction (48%), and decreased HbA1c levels (37%).ConclusionsResident diabetes specialists saw a real-life benefit with added value from health apps for managing type 2 diabetes. Despite the favourable role that health apps may play in disease prevention and management, many physicians expressed reservations regarding usability, transparency, security, and privacy in such apps. These concerns should be addressed more intensively towards bringing about ideal conditions for integrating health apps successfully in diabetes care. This includes uniform standards governing quality, privacy, and legal conditions as binding as possible with regard to apps and their use in a clinical setting.

Reinforcement Learning for Clinical Applications.

Reinforcement Learning for Clinical Applications.

Palliative Care Use in Advanced Cancer in the Garden State.

Cancer is the second leading cause of death in the United States. Patients with metastatic cancer have a high symptom burden. Major global and domestic cancer care recommendations advise integration of palliative care services for these patients. Palliative care is specialized care that can decrease cost, improve symptom burden, and improve quality of life. Patient factors driving the use of palliative care remain poorly understood but may include both physiological and psychological needs, namely, pain and depression, respectively. The objective of this study was to identify patient-level predictors associated with inpatient palliative care use in patients with metastatic cancer. This was a secondary analysis of the 2018 New Jersey State Inpatient Database. The sample was limited to hospitalized adults with metastatic cancer in New Jersey. Descriptive statistics characterized the sample. Generalized linear modeling estimated the effects of pain and depression on the use of inpatient palliative care. The sample included 28 697 hospitalizations for patients with metastatic cancer. Within the sample, 4429 (15.4%) included a palliative care consultation. There was a 9.3% documented occurrence of pain and a 10.9% rate of depression. Pain contributed to palliative care use, but depression was not predictive of an inpatient care consultation. Age, income category, and insurance status were significant factors influencing use. Understanding demographic and clinical variables relative to palliative care use may help facilitate access to palliative care for adults experiencing metastatic cancer. Increased screening for pain and depression may expand palliative care use for adults with metastatic cancer receiving inpatient care.

Development and Effectiveness of a Rater Training Curriculum for Evaluating Student Medical Spanish Oral Proficiency Using the Physician Oral Language Observation Matrix

To improve language-concordant, equitable healthcare for Spanish speakers, many United States medical schools offer medical Spanish education. However, there is no clinically contextualized, standardized approach to medical student language assessment. This article reports on the development and effectiveness of a training curriculum to prepare raters to use a new rubric, the Physician Oral Language Observation Matrix (POLOM), to reliably rate medical student Spanish oral proficiency after observing videorecorded encounters between students and standardized patients. Curriculum effectiveness was primarily evaluated by examining each rater trainee’s level of agreement with expert consensus POLOM ratings (i.e., inter-rater reliability as measured by the generalizability theory dependability coefficient). Out of the study’s nine rater trainees, who were from either medical or linguistic professional backgrounds, five proceeded to the calibration phase, and four attained the reliability threshold required for calibration. The paper concludes that this rater training curriculum can successfully train raters to use the POLOM reliably when evaluating medical student Spanish oral proficiency during videorecorded healthcare encounters. To allow for improved assessment of student language skills prior to use in patient care, future efforts should focus on POLOM validity assessment and larger scale rater recruitment, training, calibration, and maintenance.

Impact of a link worker social prescribing intervention on non-elective admitted patient care costs: A quasi-experimental study

Healthcare systems in many countries are enthusiastically adopting link worker social prescribing interventions that aim to tackle the social determinants of health by linking patients to voluntary and community sector activities and sources of support to address their social needs and improve condition management. Social prescribing interventions aim to improve health and reduce healthcare spending. However, despite the diversion of healthcare budgets to fund social prescribing, we still lack robust evidence for its effectiveness. In this study we evaluate whether participation in a social prescribing intervention reduced non-elective admitted patient care use and costs for 8283 patients aged between 40 and 74 years, with a diagnosis of type 2 diabetes and living in an area of high socioeconomic deprivation in north-east England. Patients were followed for a total of 6 years: 2 years pre-intervention and 4 years post intervention. Exploiting a natural experiment, we used a two-part difference-in-differences regression model to estimate costs conditional on healthcare use. We also estimated intervention effects across several intervention and control groups and sample subgroups. Participation in the intervention resulted in reductions of up to -£77.57 [95% CI: -152.30, -2.84] (for high engagement patients) per patient, per year, in non-elective care costs. Reductions were greater for patients with higher levels of engagement with the intervention. Sub-group analyses showed greater cost reductions for non-White patients, older patients, and patients without additional co-morbidities. Our findings suggest that engagement with a link worker social prescribing intervention may reduce non-elective healthcare spending, perhaps through enabling better condition management that results in fewer avoidable health crises.

Social media use for patient care: an evaluation of health practitioners in Cross River state, Nigeria

&lt;p&gt;This study aimed to evaluate the extent to which health practitioners in Cross River state, Nigeria, use social media for patient care and to assess the barriers militating against its liberal use for patient care. The study adopted the cross-sectional survey design and used 550 respondents selected through the cluster, simple random and purposive sampling techniques, from selected secondary and tertiary health facilities. Furthermore, quantitative and qualitative methods involving the questionnaire and key informant interview respectively were used to elicit information from respondents. Quantitative data were analyzed using descriptive statistics while content analysis was used to handle qualitative data. The result of data analysis revealed that health practitioners in Cross River state, Nigeria do social media use for patient care very minimally and this is attributed to a wide range of factors, including the absence of a clear-cut regulatory framework governing social media use in health care delivery, and lack of institutionally provided resources for social media use. The study thus recommends that healthcare administrators must, as a matter of necessity, mainstream social media use into health care practice by flexible guidelines, regulations, and materials that would make social media use for patient care desirable by health practitioners in Nigeria.&lt;/p&gt;

Palliative Care Use in Patients With Acute Myocardial Infarction and Do-Not-Resuscitate Status From a Nationwide Inpatient Cohort

ObjectiveTo examine the predictors, treatments, and outcomes of the use of palliative care in patients hospitalized with acute myocardial infarction (AMI) who had a do-not-resuscitate (DNR) order. Patients and MethodsUsing the National (Nationwide) Inpatient Sampling database for 2015-2018, we examined the predictors, in-hospital procedures, and outcomes of palliative care recipients among patients with AMI who had a DNR order. ResultsWe identified 339,270 admissions with AMI that had a DNR order, including patients who received palliative care (n=113,215 [33.4%]). Compared with patients who did not receive palliative care, these patients were more frequently younger (median age, 81 vs 83 years; P<.001), were less likely to be female (50.9% [57,626 of 113,215] vs 54.7% [123,652 of 226,055]; P<.001), and were more likely to present with cardiac arrest (11.6% [13,133 of 113,215] vs 6.9% [15,598 of 226,055]; P<.001). Patients were more likely to receive palliative care at a large (odds ratio [OR], 1.47; 95% CI, 1.44 to 1.50) or teaching (OR, 2.10; 95% CI, 2.04 to 2.16) hospitals compared with small or rural ones. Patients receiving palliative care were less likely to be treated invasively, with reduced rates of invasive coronary angiography (OR, 0.46; 95% CI, 0.45 to 0.47) and percutaneous coronary intervention (OR, 0.47; 95% CI, 0.45 to 0.48), and were more likely to die in the hospital (52.4% [59,325 of 113,215] vs 22.9% [51,766 of 226,055]). ConclusionIn patients who had a DNR status and were hospitalized and received a diagnosis of AMI, only one-third received palliative care.

Race and Socioeconomic Status Are Associated With Inferior Patient-Reported Outcome Measures Following Rotator Cuff Repair

To investigate the impact social determinants of health (SDOH) have on National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive test scores and postoperative health care use in patients who undergo rotator cuff repair (RCR). All patients who underwent RCR surgery by 3 shoulder and/or sports medicine fellowship-trained orthopaedic surgeons between July 2017 and January 2020 were included. The electronic medical record (EMR) was used to identify SDOH for each patient. PROMIS computer adaptive test measures of Upper Extremity function, Pain Interference, and Depression were completed preoperatively and postoperatively (6 months and 1 year). Postoperative health care use (clinical visits, virtual encounters, imaging encounters, and physical therapy visits) were recorded as well. Univariate associations, multiple linear regressions, and Wilcoxon rank-sum tests were used to analyze mean differences between patient groups based on SDOH. Three hundred thirty-eight patients who underwent RCR were included. Patients who were Black, in lower median household income quartiles, had public insurance, and female reported lower PROMIS scores compared with their counterparts. Smokers and White patients attended fewer postoperative office visits whereas Black patients had more physical therapy and nonvisit encounters compared with their respective counterparts. Black race and lower socioeconomic status are associated with worse function and pain outcomes post-RCR compared with White race. Similarly, Black race and positive smoking status are associated with differential use of health care following RCR. Further attention may be required for these patients to address health care disparities. III, retrospective cohort study.

Applying the Clinician-reported Genetic testing Utility InDEx (C-GUIDE) to genome sequencing: further evidence of validity

Genome sequencing (GS) outperforms other rare disease diagnostics, but standardized approaches to assessing its clinical utility are limited. This study assessed the validity of the Clinician-reported Genetic testing Utility InDEx (C-GUIDE), a novel tool for assessing the utility of genetic testing from a clinician’s perspective, for GS. C-GUIDE ratings were completed for patients who received GS results. For each patient, total C-GUIDE and single item global scores were calculated. Construct validity was assessed using linear regression to determine the association between C-GUIDE total and global item scores and measure the effects of potential explanatory variables. Ratings were completed for 67 pediatric and 36 adult patients. GS indications were neurological for 70.9% and results were diagnostic for 28.2%. When the C-GUIDE assessed primary (PV), secondary (SV), and pharmacogenomic (PGx) variants, on average, a one unit increase in the global item score was associated with an increase of 7.3 in the C-GUIDE score (p < 0.05). Diagnostic results were associated with an increase in C-GUIDE score of 5.0 compared to non-diagnostic results (p < 0.05) and an increase of one SV was associated with an increase of 2.5 (p < 0.05). For children, decreased age of one year was associated with an increase in C-GUIDE score of 0.3 (p < 0.05). Findings provide evidence that C-GUIDE measures the construct of clinical utility in pediatric and adult rare disease populations and is sensitive to changes in utility related to variant type. Quantifying the clinical utility of GS using C-GUIDE can inform efforts to optimize its use in patient care.

Use of non-curative oncological care in osteosarcoma.

78 Background: Osteosarcoma is the most common form of bone cancer, but the utilization of palliative care (PC) in patients with this cancer has not previously been investigated in the NCDB. Methods: This study retrospectively evaluated the use of palliative care in osteosarcoma patients diagnosed and recorded in the National Cancer Database (NCDB) between 2004 and 2017. Patients were identified by the International Classification of Diseases for Oncology, Third Edition (ICD-O-3) coding, and patients with other malignancies or missing follow-up data were excluded. Cross tabulations with Chi-square analysis were performed to evaluate frequencies of different patient and tumor characteristics. Multivariable logistic binary regression was performed to evaluate relationships between patient and tumor characteristics and the use of palliative care. Results: A total of 7498 patients were analyzed with 2.8% of all patients diagnosed having any form of palliative care utilization. Of this group, 53.37% received PC within the first 12 months after diagnosis. Those receiving PC were most likely to be treated with non-curative surgery, radiation, chemotherapy, or any combination of these modalities (56.7%). No significant increase in PC utilization was noted over the 13-year duration of this study. Palliative care usage was increased in patients with greater tumor diameter, tumors in the bones of the trunk &amp; skull, or stage IV tumors. Palliative care usage was decreased in patients living 25-49 miles of their treatment facility, those living in pacific states, those with chondroblastic osteosarcoma, or those with private insurance. Conclusions: Palliative care use in patients with osteosarcoma increases with tumor stage, tumor size, or more proximal tumors, but overall utilization remains markedly low. Future studies should further define these patterns of care and help expand the utilization of PC.

Motivating change in resident language use through narrative medicine workshops

BackgroundThere are many ways that students and trainees learn to talk about patients. The way trainees and physicians use language during clinical care is important, as labeling patients can have adverse effects on patient safety. Communication is considered a core competency by The Accreditation Council on Graduate Medical Education (ACGME). Past research has shown that participants in narrative medicine curricula report developing stronger communication skills however it is not clear how these workshops motivated trainees to use language differently during patient care. To explore this, we interviewed second-year residents in academic year 19–20 about their experiences both in participating in narrative medicine workshops and giving patient care.MethodsThe framing context for this constructivist thematic analysis is a series of narrative medicine workshops facilitated for interns in an internal medicine residency program at a large academic medical center during the 18–19 academic year. We developed a semi-structured interview study that allowed residents to reflect on their experiences in these workshops. Eighteen out of 60 residents (30%) were interviewed.ResultsWe found that sessions regarding language use in patient care shaped how interns thought about and used language during clinical work, a finding that arose spontaneously during interviews.ConclusionsOur research suggests that workshops aimed specifically at addressing the use of language in healthcare can have meaningful impact on trainees. Our study makes a unique contribution to the scholarship by suggesting that training in narrative medicine can lead to a change in the way that trainees use language during their clinical work.

Utilization of Palliative Care in Osteosarcoma: A National Cancer Database Review.

Background: Osteosarcoma is the most common form of bone cancer, but the utilization of palliative care (PC) in patients with this cancer has not previously been investigated in the National Cancer Database (NCDB). Methods: Patients diagnosed with osteosarcoma (2004-2017) were identified within the NCDB. Cross tabulations with Chi-square analysis were performed to evaluate frequencies of palliative care use by patient, facility, and tumor characteristics. Multivariate logistic binary regression was performed to evaluate relationships between patient, treatment facility, and tumor characteristics and the use of palliative care. Results: A total of 7498 patients were analyzed with 2.8% of patients diagnosed having any form of palliative care utilization. Of this group, 53.37% received PC within the first 12 months after diagnosis. Of the 2.8% of patients receiving PC the most common forms of PC utilized were non-curative symptom-directed surgery, radiation, or chemotherapy, or a combination of these modalities (56.7%). Palliative care usage was increased in patients with greater tumor diameter, tumors in the bones of the midline, or stage IV tumors. Palliative care usage was decreased in patients living within 25-49 miles of their treatment facility, those living in pacific states, those with chondroblastic osteosarcoma, or those with private insurance. Conclusion: Palliative care use in patients with osteosarcoma increases with tumor stage, tumor size, or more proximal tumors, but overall utilization remains markedly low. Future studies should further define these patterns of care and help expand the utilization of PC.

Integrating Quality Improvement and Community Engagement Education: Curricular Evaluation of Resident Population Health Training

The Accreditation Council for Graduate Medical Education requires all residents be trained in population health, but the most effective training strategies to impact care of patients and populations are not well established. The purpose of this study is to assess resident self-efficacy and expected application of population management skills through iterative experiential, longitudinal, team-based training in the office and community settings. Using a prospective longitudinal curricular evaluation, we surveyed residents at a single institution from 2014-2020, evaluating self-efficacy in population health skills as well as perceived impact on patient care and future practice. We collected surveys before and after participating in a 3-year, longitudinal, team-based, experiential population health curriculum that integrates clinic-based quality improvement and community engagement projects. Fifty-nine of 68 residents (87%) responded to the presurvey, and 42/56 (75%) responded to the postsurvey. We observed significant increases in resident self-efficacy in all population health skills. All respondents reported finding common population health skills that were applicable in both office and community settings; 81% reported care of their continuity clinic patients changed because of taking part in the curriculum. Finally, 94% of respondents reported the intention to use population health skills and incorporate quality improvement (75%) and community engagement (100%) in future practice. Teaching population health management skills in both office and community settings allows residents to integrate and apply these skills across settings and may enhance their use in patient care and future practice.

915-P: Annual Wellness Visits and Preventive Care Utilization among Medicare Beneficiaries in the Diabetes Belt and Surrounding Areas

Objective: Medicare beneficiaries are eligible to receive free Annual Wellness Visits (AWVs) for assessing preventive care needs, identifying care resources, and scheduling visits. We previously reported that AWVs are associated with increased use of preventive care for patients with diabetes. In this study, our objective is to conduct a case-control study to examine whether AWVs are associated more strongly with preventive care use in the Diabetes Belt than in surrounding areas. Methods: We used a sample of ∼900,000 Medicare Fee-for-Service beneficiaries who lived in the Diabetes Belt and surrounding areas in 2014 - 2015. We identified patients who have used an annual foot exam, eye exam, A1c test, and microalbuminuria (MA) test and those who did not in 2015. We used the dates of service receipt and the last day of the year (12/31) as the event date for users and non-users, respectively. We looked one full year before the event date to identify any AWVs. We used propensity-score stratification to estimate log odds of 4 preventive care use of annual foot exam, eye exam, A1c test, and MA test. Results: For all four services, AWV users had significantly higher preventive care use compared to non-users. In 3 preventive services, AWVs were more strongly associated with preventive care use in the Belt than in the surrounding areas (foot exam, ORs = 2.38 vs 2.16, p &amp;lt; 0.001; A1c test, ORs = 1.44 vs. 1.36, p = 0.002; MA test, ORs = 1.70 vs. 1.44, p &amp;lt; 0.001; eye exam, ORs 1.22 vs. 1.19, p=0.063) . Discussion: AWVs appear to have stronger effects on preventive care use for patients with diabetes in the more healthcare resource-poor Diabetes Belt than in the surrounding areas. AWVs may help to reduce disparities in the use of recommended preventive care for patients with diabetes. Disclosure M.Sohn: None. T.L.Mcmurry: None. H.Kang: None. S.Kim: None. J.M.Lobo: n/a. Funding NIDDK R01DK113295

Survey of palliative care use in primary malignant bone tumors: An NCDB review.

e23514 Background: Palliative care has been associated with reduced patient symptom burden, improved physician satisfaction, and reduced cost of care. However, its use in primary bone tumors has not been well classified. Methods: This study retrospectively evaluated the use of palliative care in patients with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma &amp; chordoma) diagnosed and recorded in the National Cancer Database (NCDB) between 2004 and 2018. Patients were identified by ICD-O-3 coding and patients with other malignancies were excluded. Cross Tabulations with Chi-square analysis was performed to evaluate frequencies of different patient and tumor characteristics. Multivariable logistic binary logistic regression was performed to evaluate relationships between patient and tumor characteristics and the use of palliative care. Results: 24,401 patients with primary malignant bone tumors were identified. Overall, only 2.52% had any form of palliative care utilization. Of those receiving palliative care, 55.5-65.1% were treated with only non-curative surgery, radiation, chemotherapy, or any combination of these modalities. Odds of palliative care were decreased for patients with chordomas, patients living more than 24 miles from the treatment facility, patients living in west-south-central or pacific states, or patients with private insurance, medicare, or unknown insurance status. Odds of palliative care were increased in patients with greater tumor diameter or unknown tumor size, tumors in the midline, increased tumor grade, stage 4 tumors, or patients living in urban areas. Conclusions: Palliative care use in patients with primary bone tumors increases with tumor stage, tumor grade, tumor size, midline tumors, or in patients living in urban areas, but overall utilization remains markedly low. Future studies should be done to investigate these patterns of care and help expand the utilization of palliative care.

Increased health care use in patients with moderate-to-severe asthma due to frequent preferred medication changes

Asthma is the most common chronic pediatric respiratory disease, affecting 6.1 million US children under the age of 18 years,1 with 60% of these children diagnosed with having persistent asthma. Per guidelines of the National Heart, Lung, and Blood Institute, children with moderate and severe asthma (steps 3-6) should be prescribed daily inhaled corticosteroids (ICSs).2 Studies looking at asthma hospitalizations reveal that a history of hospitalization within the past 12 months is a predictor for readmission.