Racial, Ethnic, and Socioeconomic Differences in Primary Care No-Show Risk with Telemedicine During the COVID-19 Pandemic.

BACKGROUND: The coronavirus 2019 (COVID-19) pandemic resulted in rapid implementation of telemedicine. Little is known about the impact of telemedicine on both no-show rates and healthcare disparities on the general primary care population during the pandemic. OBJECTIVE: To compare no-show rates between telemedicine and office visits in the primary care setting, while controlling for the burden of COVID-19 cases, with focus on underserved populations. DESIGN: Retrospective cohort study. SETTING: Multi-center urban network of primary care clinics between April 2021 and December 2021. PARTICIPANTS: A total of 311,517 completed primary care physician visits across 164,647 patients. MAIN MEASURES: The primary outcome was risk ratio of no-show incidences (i.e., no-show rates) between telemedicine and office visits across demographic sub-groups including age, ethnicity, race, and payor type. RESULTS: Compared to in-office visits, the overall risk of no-showing favored telemedicine, adjusted risk ratio of 0.68 (95% CI 0.65 to 0.71), absolute risk reduction (ARR) 4.0%. This favorability was most profound in several cohorts with racial/ethnic and socioeconomic differences with risk ratios in Black/African American 0.47 (95% CI 0.41 to 0.53), ARR 9.0%; Hispanic/Latino 0.63 (95% CI 0.58 to 0.68), ARR 4.6%; Medicaid 0.58 (95% CI 0.54 to 0.62) ARR 7.3%; Self-Pay 0.64 (95% CI 0.58 to 0.70) ARR 11.3%. LIMITATION: The analysis was limited to physician-only visits in a single setting and did not examine the reasons for visits. CONCLUSION: As compared to office visits, patients using telemedicine have a lower risk of no-showing to primary care appointments. This is one step towards improved access to care.

Applying the Value Transformation Framework in Federally Qualified Health Centers to Increase Clinical Measures Performance.

INTRODUCTION: The transition in health care from a volume-based to value-based model of care, combined with pressures brought about by the COVID-19 pandemic, makes the need for efficiency and coordination of the health center system imperative. The Value Transformation Framework (VTF), developed with health centers in mind, provides an organizing framework to support transformation of infrastructure, care delivery, and people systems. METHODS: NACHC applied the VTF within a cohort of health centers across the country to drive systems change and improve performance on measures of clinical care. RESULTS: A comparison of health centers "participating" in application of the VTF relative to "nonparticipating" health centers nationally showed improvement during 3 years of program implementation. Significant differences ( p < .05) favoring health centers who participated were noted for screening of colorectal cancer ( p < .001), depression ( p < .001), hypertension ( p < .001), obesity ( p = .001), and cervical cancer ( p = .011). Performance for diabetes control also favored participating programs, although the difference did not quite reach significance ( p = .45). CONCLUSIONS: Applying a systems approach, organized by the VTF, with evidence-based interventions and deployed in a learning community, can result in improved performance across multiple measures of clinical care.

C-reactive protein levels associated with COVID-19 outcomes in the United States.

CONTEXT: COVID-19 caused a worldwide pandemic, and there are still many uncertainties about the disease. C-reactive protein (CRP) levels could be utilized as a prognosticator for disease severity in COVID-19 patients. OBJECTIVES: This study aims to determine whether CRP levels are correlated with COVID-19 patient outcomes and length of stay (LoS). METHODS: A retrospective cohort study was conducted utilizing data obtained between March and May 2020. Data were collected by abstracting past medical records through electronic medical records at 10 hospitals within CommonSpirit Health. Patients were included if they had a positive COVID-19 test from a nasopharyngeal swab sample, and if they were admitted and then discharged alive or had in-hospital mortality and were ≥18 years. A total of 541 patients had CRP levels measured and were included in this report. Patient outcome and LoS were the endpoints measured. RESULTS: The 541 patients had their CRP levels measured, as well as the demographic and clinical data required for analysis. While controlling for body mass index (BMI), number of comorbidities, and age, the first CRP was significantly predictive of mortality (p<0.001). The odds ratio for first CRP indicates that for each one-unit increase in CRP, the odds of death increased by 0.007. For LoS, the first CRP was a significant predictor (p<0.001), along with age (p=0.002). The number of comorbidities also predicted LoS (p=0.007), but BMI did not. The coefficient for the first CRP indicates that, for each one-unit increase in CRP, LoS increased 0.003 days. CONCLUSIONS: The results indicate that there is a positive correlation between the CRP levels of COVID-19 patients and their respective outcomes with regard to death and LoS.

93 Virtual Burn Camp 2020 vs. In-Person Burn Camp - Did It Hit the Mark

Introduction Burn camps have served burn-injured youth in the U.S. for over 35 years. Camp is a rehabilitation program that has been recognized as an important part of young survivors' recovery. The 2020 global pandemic made an in-person camp impossible, so volunteers rallied to provide a virtual experience. Registered campers received a "Camp in a Box" filled with activities, art supplies, a camp tee-shirt, and snacks to enjoy at Virtual Burn Camp (VBC). Participants connected with campers and counselors online. This study sought to determine how youth viewed VBC compared to in-person camp, how the pandemic was affecting their emotional status and whether VBC helped them. Methods The study asked participants to rate survey items regarding levels of comfort, connection, and support at VBC vs. in-person camp on a 4-point scale from 1. NO! 2. no 3. yes 4. YES! Multiple choice questions such as My favorite thing about virtual camp, and " Things I missed most about regular burn camp" - choose 2. General stress & anxiety levels related to Covid-19 were assessed, as well as if VBC helped to reduce their anxiety/stress levels. Results Pediatric burn survivors (n=77) participating in 2 virtual camps, demographic's included mean age 13.8 years, male (n=39%), female (n=61%), visible scars (74%) vs. (10%) hidden scars with the majority representing racial/ethnic minorities (65%) vs. white (35%). Campers reported feeling more connected at in-person camp (84%) vs. VBC (38%). Feeling supported was higher at regular burn camp (84%), but the majority (76%) also claimed feeling supported at VBC. Camper's favorite things about VBC were Camp in a Box (66%), Being Part of the Burn Community (51%), and Seeing Counselors (47%). Things missed most about regular burn camp were seeing Friends (83%) and Counselors (61%). Respondents reported high Covid-19 related stress/anxiety levels (66%) and (88%) said that VBC reduced their anxiety/stress. Top benefits included feeling Happy (48%) and Thankful (32%). Conclusions Pediatric burn survivors place a high value on their burn community involvement. Though not the preferred camp method, the VBC earned high marks for camper's improved emotional status and for reducing their Covid-19 stress and anxiety levels. The program succeeded in helping Virtual Campers feel supported and provided an important venue for connecting them with their burn-injured peers and camp counselors.