Citations

This study examines the patient- and hospital-level variation in time to initiation of inpatient management among patients admitted to general medical services.

AbstractPersons Living with Dementia (PLWD), diagnosed or undiagnosed, have high Emergency Department (ED) use. Identification of such patients poses significant challenges for emergency clinicians with considerable downstream implications on patients, care partners, and healthcare systems. With the advent of Geriatric Emergency Departments (GEDs) there is an opportunity to understand and improve care of PLWDs in EDs with effective allocation of resources and the development of novel techniques to better support detecting those at risk, communicating findings, and coordinating care for such patients. Advances have been made leveraging Electronic Health Record (EHR) data to risk stratify patients for dementia in the hope that those at high‐risk may benefit from further evaluation. The promise of multiple blood‐base biomarkers (BBM) as a future modality to improve detection of those at risk of dementias, will also have the potential to advance the delivery of care of PLWD and their care partners in EDs.Highlights EDs have an integral role in delivering care for Person Living with Dementia and their care partners. High acuity and fast paced ED environment and other barriers makes it difficult to identify Person Living with Dementia. EHR‐based risk stratification algorithms can identify patients at risk for Dementia in ED and outpatient settings. Use of Blood‐Based Biomarkers in the ED setting is novel and considerations of its use and implications need to be studied. EHR based risk stratification algorithm and Blood Based Biomarkers when used judiciously have the potential to overcome some of the known barriers to identify and improve care for Person Living with Dementia as they transition through EDs.

AbstractNational performance metrics ultimately enhance patient decision‐making and promote meaningful improvements in health care delivery, which makes having valid and reliable measures essential. This study examined US News and World Report metrics from 2019 to 2012 and used electronic health record data, combined with detailed chart review across 3 in‐system hospitals, to assess the provision of care compared to the attribution of patients assigned to the ear, nose, and throat (ENT) mortality group. Of the initial 47 ENT‐attributed deaths, 23 of those were verified, dimensioning the mortality rate from 1.7% to just 0.8%. These results underscore the necessity of rethinking measures and mortality attribution methodologies to be more accurate. Current methods use Medicare Severity Diagnosis Related Group billing coding to map the attribution. We suggest transitioning away from specialty ranking approaches and towards a procedure and condition “rating” approach to ensure that these ranking types capture data about the provision of care within a given encounter.

Purpose: Advances in targeted therapeutics for histiocytic neoplasms have led to a growing survivor population, especially for Erdheim-Chester disease (ECD), Langerhans cell histiocytosis (LCH), and Rosai-Dorfman disease (RDD). This growing population is at risk of adverse health-related quality of life (HRQoL) as a result of the disease or treatments received. Patient-reported outcomes in this population remain understudied, and we aim to define their HRQoL using a validated tool. Methods: We enrolled patients from 2 histiocytosis centers and an international conference from Aug 2022-April 2023 to complete the PROMIS © (Patient-Reported Outcomes [PROs] Measurement Information System) 29+2 profile v2.1, which captures 8 domains of physical/mental health and functioning. Domains are reported as T-scores, with 50 being the general population mean. We calculated summary T-scores for Physical Health (PH) and Mental Health (MH), and differences of 3 from general population were considered clinically meaningful. We then used these T-scores to calculate each patient's PROMIS-Preference (PROPr) score, which is a health-utility score that measures overall HRQoL. A mean PROPr score difference of 0.4 from the US population mean of 0.52 was considered meaningful. We ran independent-samples t-tests to examine differences in PH/MH summary scores and PROPr between sub-cohorts. Finally, we performed a multinomial logistic regression analysis to identify factors associated with worse scores, and calculated odds ratios (OR) for each factor. Results: We included a total of 77 participants. Specific diagnoses included ECD (n=33, 42.9%), LCH (n=21, 27.3%), RDD (n=19, 24.7%), and other/unknown (n=4, 5.2%). Median age at diagnosis was 50y (9-79) and at survey was 54y (18-82), with a median 4 year difference between diagnosis and survey completion. Racial demographics included white (n=64, 83.1%), Black (n=12, 15.6%), and Asian (n=1, 1.3%). 4 patients (5.2%) identified as having a Hispanic ethnicity. Disease extent included unifocal (n=13, 16.9%), single system multifocal (ss-M, n=8, 10.4%), single system lung LCH (ss-L, n=3, 3.9%), or multisystem (n=53, 68.8%) disease. The most commonly involved organs included bone (n=44, 57.1%), kidney (n=24, 31.2%), skin (n=24, 31.2%), CNS (n=24, 31.2%), and pituitary (n=19, 24.7%). PH and MH summary scores were lower in various diagnostic categories as compared with the US population, and PROPr scores were reduced in all diagnostic categories. Bone involvement was associated with worse PH (-6.16, 95%CI -10.81, -1.52, [p=0.005]), MH (-7.96, 95%CI -12.48, -3.44, [p=<0.001]), and PROPr (-0.184, 95%CI -0.313, -0.056, [p=0.003]) scores. CNS involvement was associated with worse PH (-4.78, 95%CI -9.14, -0.42, [p=0.016]). We initially constructed a multinomial regression model using diagnosis, race, age at survey completion, and CNS and bone involvement. This model was not statistically significant, and in particular, diagnosis and age did not significantly contribute to the model. We then removed diagnosis and age and constructed a new model using the remaining variables, which was statistically significant for all 3 scores (p<0.05). We found that factors associated with worse PH score were disease involvement of bone (OR=6.19, 95%CI 1.88, 20.43 [p=0.003]) and CNS (OR=10.36, 95%CI 2.01, 53.39 [p=0.005] Figure 2). Factors associated with worse MH scores included female sex (OR=4.12, 95%CI 1.24, 13.66 [p=0.021]) and CNS involvement (OR=10.74, 95%CI 2.47, 46.79 [p=0.002]). Having race/ethnic group other than white/Non-Hispanic or Black was associated with improved MH. However, as this group had only 4 members, the significance of this is uncertain. Finally, CNS involvement was found to be associated with worse odds of having a low PROPr score (OR=10.46, 95%CI 2.17, 50.37 [p=0.003]). Conclusions: Several PROs were worse in patients with histiocytic neoplasms as compared with the general population. We further found that CNS involvement was independently associated with worse HRQoL, regardless of the diagnosis type. Additionally, female sex was associated with worse MH scores, and bone involvement with worse PH scores. PROPr score was particularly low among patients with ECD. Future research is warranted to assess the impact of treatments on HRQoL, as well as the economic loss resulting from loss of productivity as highlighted by low PROPr scores.

269 Background: There are strong data showing that patients (pts) with metastatic non-small cell lung cancer (NSCLC) receiving chemotherapy experience better quality of life (QOL) and longer overall survival (OS) when palliative care (PC) services are integrated early in their treatment course. Therefore, at our cancer center, pts with stage IV NSCLC have been referred to PC by oncology providers. In this study, we evaluated the uptake of PC services, specifically in pts with NSCLC who received immune checkpoint inhibitors (ICIs). ICIs have been considered to have less severe or less frequent adverse effects as compared to chemotherapy, possibly leading to fewer referrals to PC. Methods: We conducted a retrospective review of all pts at the Mayo Clinic Cancer Center in Florida who received single-agent ICI therapy for the treatment of stage IV NSCLC at any point between July 1, 2015, and July 1, 2022. The primary aim was to evaluate the uptake of PC services before or during treatment with ICIs. Descriptive statistics were used to characterize pt demographics and outcomes. Results: 129 pts were identified. 53.4% were male, and 46.6% were female. The majority of pts (84.4%) were white. 62 pts (48.0%) were seen by a PC provider before or during ICI treatment; 41 of these (31.7%) were seen by PC after starting ICI therapy. When grouped by year of ICI initiation, 30/73 pts (41.0%) treated between 2015 and June 2018 were seen by a PC provider, as compared to 15/31 pts (48.3%) treated between July 2018 and June 2020 and 17/25 pts (68.0%) treated between July 2020 and July 2022. Interestingly, the majority of pts who received PC services in the 2020-2022 group (12/17, or 70.5%) were seen by a PC provider for the first time prior to ICI initiation, whereas the majority of pts who received PC services prior to July 2020 (37/45, or 82.2%) were seen by a PC provider for the first time after ICI initiation. The mean number of PC visits increased from 1.59 in the 2015-2018 group to 1.84 in the 2018-2020 group and 4.96 in the 2020-2022 group. Conclusions: Uptake of PC services in pts with stage IV NSCLC receiving single-agent ICIs at our cancer center has increased over time, which is encouraging. Nevertheless, the numbers remain suboptimal, with less than 70% of pts receiving PC services. We plan to develop a multidisciplinary quality improvement project involving implementation of a mechanism to ensure that most patients with stage IV NSCLC, regardless of the type of systemic treatment they receive, are receiving PC services.

Abstract Purpose: Taste and smell abnormalities (TSA) are common in patients receiving chemotherapy and may lead to altered nutritional intake, treatment withdrawal, and impaired quality of life. Lipid peroxidation in the oral cavity is one cause of TSA. Lactoferrin (LFN), an iron-binding salivary protein, reduces production of lipid oxidation byproducts and has been shown to reduce perception of unpleasant flavors. To assess the feasibility of LFN as a treatment for TSA, we conducted pilot investigations among patients with cancer who self-reported TSA following onset of chemotherapy. The primary objective was to assess change in subjective taste and smell perception from baseline to completion of 30-days of LFN supplementation.Methods: Patients were treated with 750mg LFN daily for 30 days and followed for an additional 30 days without LFN. TSA was measured via the taste and smell questionnaire (TSQ) including taste (score 0-10), smell (score 0-6), and composite scores (0-16, 0=no TSA) at baseline, day 30, and day 60.Results: 26 patients enrolled; 19 remained on study at day 30 and 17 at day 60. Baseline mean TSQ scores were 6.5 (taste), 3.1 (smell) and 9.6 (composite). By day 30, mean composite TSQ score improved by 1.7 (p=0.018); taste and smell improved by 0.6 (p=.062) and 1.1 (p=.042) respectively. From baseline to day 60, mean composite TSQ score improved by 3.8 (p<.0001); taste and smell improved by 1.9 (p=.001) and 1.8 (p=.003). Conclusions: Further evaluation of LFN is warranted to determine its value for improving self-reported TSA among patients receiving chemotherapy.

e24082 Background: Allogeneic hematopoietic cell transplantation (allo-HCT) is associated with significant short- and long-term sequelae that affect patients’ overall quality of life (QoL) and their physical and psychological well-being. Studies have shown improvement in patient QoL and physician satisfaction with palliative care involvement in the allo-HCT process. However, patient and physician perceptions regarding palliative care often impact timely referral. We conducted a prospective study to examine patient perceptions of palliative care both before and after palliative care consultation during evaluation for allo-HCT. Methods: This is a prospective, single-center study, of patients > 18 years of age, who were referred for a palliative care consultation as part of standard evaluation for allo-HCT. Patients were administered a pre- and post-visit internally derived questionnaire to assess their understanding and comfort level with palliative care. The primary objective of this study was to examine patient perceptions of palliative care consultation during evaluation for allo-HCT. Primary end point was the change in patient pre- and post- questionnaire responses. Secondary endpoint was the completion of advance care planning documentation pre- and post- consultation. Results: We enrolled 32 patients (male = 14) undergoing evaluation for allo-HCT with a primary diagnosis of AML (n = 8), NHL (n = 8), MDS (n = 7), ALL (n = 2), and other (n = 7). Following consultation with palliative care there was a statistically significant increase in patient understanding of the reason for the appointment, p = 0.0006. There was also a significant increase in patient’s knowledge of palliative care, with only 28% describing their knowledge as “good” or “excellent” prior to consultation and 79.3% after consultation, p < 0.0001. There was an observed positive, non-statistically significant, trend in patient comfort level with palliative medicine with only 20.7% (n = 6) describing their comfort as “high” or “very high” prior to consultation and 51.7% (n = 15) after consultation, p = 0.60. There was a higher rate of completion of advance care planning documentation following consultation with palliative medicine 56.3% vs 71.4%, p = 0.042. Conclusions: Palliative care consultation prior to allo-HCT increases a patient’s understanding of the role of palliative medicine as part of their allo-HCT and improves advance care planning. These findings need to be validated in a larger, multicenter, patient cohort.