Assessing risk among frail older adults in Ontario, Canada, during the COVID-19 pandemic: a mixed methods evaluation of a telephone outreach program

We developed a pandemic telephone outreach protocol to identify risk for social isolation, health destabilization, medication issues, inadequate services and supports, and caregiver stress among older adults at high risk of destabilization. Screening, conducted between April 1, 2020, and May 8, 2020, was targeted to those who had previously been screened as frail or who were identified as vulnerable by their family physician. This study describes the implementation and results of this risk screening protocol and describes patient, caregiver, and health professional perceptions of this outreach initiative. Mixed methods included satisfaction surveys and interviews completed by patients/caregivers (N = 300 and N = 26, respectively) and health professionals (N = 18 and N = 9, respectively). A medical record audit collected information on patient characteristics and screening outcomes. A total of 335 patients were screened in the early weeks of the pandemic, of whom 23% were identified with at least one risk factor, most commonly related to the potential for health destabilization and medication risk. Follow-up referrals were made most frequently to physicians, a pharmacist, and a social worker. The outreach calls were very well received by patients and caregivers who described feeling cared for and valued at a time when they were socially isolated and lonely. The outreach calls provided access to trusted COVID-19 information and reassurance that health care was still available. The majority of health professionals (>86%) were "very" or "extremely" satisfied with the ease of completing the screening via telephone and value for time spent;for 79% the protocol was "very" or "extremely" feasible to implement. Health professional interviews revealed that patients were unaware they could access care during the pandemic lockdown but were reassured that care was available, potential crises were averted, and they supported future implementation. Risk screening provides a significant opportunity to provide information, support, and mitigate potential risks and is an important and feasible component of pandemic planning in primary care.

India's policy and programmatic response to mental health of young people: A narrative review

India's response to meet the mental health needs of 252 million young people between 15 and 24 years is guided by the Mental Healthcare Act 2017 (MHCA), which advocates a rights-based approach to receiving mental healthcare, the National Mental Health Policy 2014, and the National Mental Health Program operational since 1982. We undertook a comprehensive narrative review of policies, programs, and legislations across five ministries of the Government of India-Health and Family Welfare, Education, Women and Child Development, Youth Affairs and Sports, and Social Justice and Empowerment-over the last ten years to map their approach and identify enablers and barriers for promoting youth mental health in India. Our work builds on the previous reviews on children and adolescents' mental health in India and captures the rapidly advancing policy landscape amidst the new challenges and opportunities presented by the COVID-19 pandemic, especially the increasing acceptability of digital health interventions including tele-consultations. We note that all the five ministries recognized mental health as an important aspect of overall development and well-being of young people. However, their approach is fragmented and a comprehensive approach to youth mental health is missing in the Indian context. Having said that, many enablers for integration of preventive, promotive, and curative mental health interventions exist especially as mental health is increasingly being recognized as an integral part of the comprehensive primary healthcare. However, much needs to be done in terms of strategic planning for screening, early detection and treatment, and developing strong referral systems between community, schools and mental healthcare services. Effective implementation of MHCA, sustainable intersectoral integration of mental health across youth-oriented services, empowerment of young people, and judicious use of digital technology hold the key to reimagining the approach to advance young people's mental health in India.Copyright © 2022 The Authors

Myocardial Injury Is Not Associated with Mortality in Severe Covid-19

Background Biochemical markers of cardiac injury and strain are proven indicators of severe COVID-19. Whether enzyme elevation is a product of cardiopulmonary strain versus myocardial viral injury is not well defined. CARDIO-COVID is a registry designed to study COVID-19 patients admitted to ICUs with evidence of cardiac injury. Methods Inclusion criteria for the CARDIO-COVID registry are PCR positive test for SARS-CoV2, ICU admission and either elevated troponin, elevated NT-proBNP/BNP, or new onset heart failure. Registry contains 1328 cases from 16 centers in the US, Canada, and Europe. 838 cases were included for analysis. Cases were collected between March 2020 - May 2021. Multivariate regression analyses were performed. Results Patients were 51.3% male, average age of 67.4 years and 32% Caucasian. 63% had pre-existing cardiovascular disease. Morbidity and mortality were common: 40% died, 50% underwent intubation, 20% required renal replacement therapy, and 5% had cardiac arrest requiring CPR. New onset arrhythmias were common (26%), but VT/VF was rare (4.8%). Cardiovascular complications were minor drivers of morbidity: 4.8% had ACS requiring catheterization, 8.0% had new onset heart failure (median EF 43% (IQR 31 - 47.75%), 4.4% had a CVA, and 6.7% had PE. Of patients who died, 65% died from hypoxemic respiratory failure, 10.5% from septic shock, 9.3% from PEA, and 3.1% from cardiogenic shock. Modeling showed insignificant increased odds of death in patients with MACE (p-value 0.22, OR 1.94 CI 0.67 - 5.82). Age (p-value 0.005) and intubation (p-value 0.001, OR 5.8 CI 2.1 - 18) were strongest predictors of death. Every increase in age by one year was associated with 5% increase in odds of death. Degree of cardiac enzyme elevation was not associated with MACE, death, or intubation. Conclusion While elevated cardiac enzymes are common in severe COVID-19, cardiac complications are not common drivers of mortality. Respiratory failure and septic shock are leading causes of death. These findings suggest that in severe COVID-19 cardiac enzyme elevation usually reflects cardiopulmonary strain from respiratory distress rather than myocardial injury portending cardiac failure or death.Copyright © 2023 American College of Cardiology Foundation

The impact of the COVID-19 pandemic on the incidence of herpes zoster : Nicolas Lecrenier

Background There have been several case reports of herpes zoster (HZ) following COVID-19 disease and vaccination. We conducted a non-systematic literature search to elucidate the global effects of the COVID-19 pandemic on the incidence of HZ. Methods The literature search was performed in October 2021 using PubMed and Embase. The search string was herpes zoster AND COVID-19. Publications were manually reviewed;case reports were removed. Results Three retrospective studies reported the risk of HZ following COVID-19 disease. One study (Bhavsar, 2021) used two US databases and found higher risk of HZ following COVID-19 disease (relative risk [RR]=1.15) and COVID-19 hospitalisation (RR = 1.21), respectively. A strong association between HZ and COVID-19 disease (RR = 5.27) was also reported in a study of the University of Florida patient registry (Katz, 2021). The third study (Barda, 2021) reported no association between COVID-19 disease and risk of HZ (RR = 0.82). In two of the three observational studies in Israel (Furer, 2021 and Barda, 2021), the incidence of HZ was increased following COVID-19 vaccination. The third study (Shasha, 2021) found no association (RR = 1.07). Other studies included a report in Brazil (Maia, 2021) that demonstrated a 35% increase in HZ diagnoses during the pandemic versus pre-pandemic and a published model (La, 2021) that estimated the declining uptake of recombinant zoster vaccine in the US may result in 63,117 avoidable HZ cases in those who remain unvaccinated in 2021. Conclusions Emerging data suggest that the COVID-19 pandemic may have increased the risk of HZ and negatively impacted HZ vaccine uptake. Therefore, there is an important need to increase awareness of HZ and HZ vaccination during the pandemic. Key messages • There is a need to increase awareness of HZ and HZ vaccination during the COVID-19 era. • Further studies are needed to fully understand the impact of COVID-19 on the risk of HZ.

BELZUTIFAN-INDUCED HYPERSENSITIVITY PNEUMONITIS

SESSION TITLE: Using Imaging for Diagnosis Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Immunotherapy is now a standard of care in solid-tumor oncology following the approvals of CTLA-4 and PD-1 inhibitors. Belzutifan, a small-molecule HIF-2a inhibitor, has recently gained FDA-approval for the treatment of advanced von Hippel-Lindau (VHL) associated renal cell carcinomas. CASE PRESENTATION: A 63-year-old female presented to our hospital with a one-day history of progressive dyspnea. Medical history is significant for metastatic renal cell carcinoma with pulmonary metastasis. Family and social history were noncontributory. Her cancer diagnosis was established in 2019 and had undergone cytoreductive nephrectomy and treatment with axitinib/pembrolizumab. As she had little improvement with immunotherapy, she was enrolled in a clinical trial at Memorial Sloan Kettering. Due to further disease progression, she was transitioned to lenvatinib/everolimus, though the treatment was discontinued due to anorexia and worsening pulmonary symptoms. Further work up revealed that she had ERG, MPL, VHL gene mutations. Thus, she was started on belzutifan two weeks prior to her presentation. Initial vitals were significant for hypoxia on room air that recovered with high flow nasal cannula (40L/80%). Physical examination was remarkable for severe respiratory distress with coarse breath sounds bilaterally. Laboratory studies revealed an acute leukocytosis with a neutrophilic prominence and a chronic metabolic alkalosis. COVID, flu PCR were negative. Chest x-ray demonstrated diffuse bilateral reticulonodular opacities. CTA revealed innumerable pulmonary nodules with areas of mass-like consolidation and a loculated left-sided pleural effusion. She was covered with azithromycin/ceftriaxone along with high-dose steroids and was admitted to the stepdown unit for further management. While in stepdown, she had a left PleurX catheter placed given her large effusion which was complicated by bloody output that required one unit of blood. Despite high-dose steroids, she had persistent hypoxia. As she remained unstable, goals of care discussions were held, which ultimately led to a change in code status to comfort measures. All aggressive measures were discontinued. She was started on comfort medications and ultimately passed away. DISCUSSION: Currently, neoplasms associated with VHL mutations are managed surgically to minimize the risk of metastatic disease. Nearly 70% of all patients with VHL mutations will develop renal cell carcinomas which means most patients undergo numerous surgical procedures. HIF-2a inhibition therefore offers an effective alternative that could reduce surgical burden and offer a new approach to management of VHL-associated disease. However due to its new approval, several adverse effects have yet to be documented. CONCLUSIONS: We report the only known case of Belzutifan-induced hypersensitivity pneumonitis and hope this case will become a useful contribution to the literature. Reference #1: Jonasch E, Donskov F, Iliopoulos O, Rathmell WK, Narayan VK, Maughan BL, Oudard S, Else T, Maranchie JK, Welsh SJ, Thamake S, Park EK, Perini RF, Linehan WM, Srinivasan R;MK-6482-004 Investigators. Belzutifan for Renal Cell Carcinoma in von Hippel-Lindau Disease. N Engl J Med. 2021 Nov 25;385(22):2036-2046. doi: 10.1056/NEJMoa2103425. PMID: 34818478. DISCLOSURES: No relevant relationships by Garrett Fiscus No relevant relationships by Niala Moallem No relevant relationships by Raj Parikh

UTILIZING COMBINATION THERAPY WITH INHALED EPOPROSTENOL AND LOOP DIURETICS IN ACUTE HYPOXIC RESPIRATORY FAILURE FROM COVID-19

SESSION TITLE: What Lessons Will We Take From the Pandemic? SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Inhaled pulmonary vasodilators such as epoprostenol (IE) and nitric oxide have been used to treat refractory hypoxemia due to COVID-19 by improving ventilation-perfusion mismatch. One undesirable consequence of this therapy is increased left atrial pressures and risk of pulmonary edema due to systemic vasodilation. The concomitant use of diuretics could mitigate this side effect thereby optimizing IE’s therapeutic impact. The aim of this study was to assess improvement in oxygenation in spontaneously breathing and mechanically ventilated patients with COVID-19 who received IE alone and those who received both IE and loop diuretic (LD) within 24 hours of each other. METHODS: This is a retrospective case control study approved by the local IRB. Improvement in oxygenation was defined as an improvement in the PaO2/FiO2 (PF) ratio by at least 10% within the 24 hours following therapy. SpO2/FiO2 (SF) ratio was used as a surrogate in cases where arterial blood gas trend was not available. Data was analyzed using SPSS version 26 and chi-square analysis was used to compare the 2 groups. RESULTS: A total of 80 patients with COVID-19, confirmed through RT-PCR, received IE from October 2020 to February 2022. Patients were stratified into 2 groups: combination therapy with IE and LD (IE-LD;n = 34;42.5%) vs IE alone (n = 46;57.5%). Improvement in oxygenation was seen in 82.4% IE-LD patients, which was a statistically significant difference compared to19.6% IE patients (z = 5.568, p <.00001). Hospital length-of-stay was comparable (19.6 days in IE-LD, 25.0 days in IE;p = 0.13) but there was a trend towards decreased in-hospital mortality (64.7% in IE-LD, 82.6% in IE only). The eventual need for mechanical ventilation in spontaneously breathing patients (52.9% in IE-LD, 56.3% in IE;p = 0.85) and mean ventilator days in intubated patients (14.3 days in IE-LD, 16.6 days in IE;p = 0.61) were not statistically different between the 2 groups. CONCLUSIONS: IE is a valuable rescue therapy in cases of refractory hypoxemia due to Covid-19 as previous studies have shown that approximately half of all patients will show improvement in oxygenation. In our study, 43 out of 80 patients had an increase in PF or SF ratio of at least 10% and the majority of these received combination therapy rather than IE alone, suggesting that LD is an effective adjunct to IE. CLINICAL IMPLICATIONS: The role of inhaled pulmonary vasodilators in management of Covid-19 is well-documented as they have been shown to delay intubation in spontaneously breathing Covid-19 patients. Despite the small sample size and retrospective design, our study reports that using LD to minimize inadvertent effects of pulmonary edema when administering IE, can further improve oxygenation in this population. Thus, more studies investigating this combination therapy are warranted. DISCLOSURES: No relevant relationships by Kristine Bessette No relevant relationships by Raj Parikh No relevant relationships by Michael Perkins No relevant relationships by Mari-Elena Pino No relevant relationships by Saimir Sharofi

ROLE OF PROCALCITONIN IN PATIENTS WITH COVID-19 AND HOSPITAL-ACQUIRED PNEUMONIA

SESSION TITLE: Imaging Across the Care Spectrum SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus 2 (SARS-CoV-2) has led to approximately 474 million cases and a devastating 6 million deaths worldwide, to date. Despite a relatively low incidence of secondary bacterial infections in COVID-19 patients, the frequency of empiric treatment with antibiotics is as high as 60 to 100%, highlighting a lack of stringent antibiotic stewardship. This promotes the development of multidrug resistant microorganisms. The purpose of this study was to evaluate the utility of the procalcitonin (PCT) biomarker in identifying the development of hospital acquired pneumonia (HAP) in COVID-19 patients. METHODS: We conducted a single center retrospective study of COVID-19 patients admitted between March 2020 to March 2021. COVID-19 patients who developed HAP during their index hospitalization were compared to those who did not develop HAP. Included in the study were COVID-19 positive patients who received empiric antibiotics for < 48 hours and had at least one PCT value ≥ 48 hours since admission. Exclusion criteria included patients with conditions that could affect PCT values including chronic kidney disease stage 5 and above, malignancy and elevated bilirubin levels. Patients with positive microbiology data < 48 hours of admission and those receiving antibiotic therapy prior to admission were excluded as well. All data was analyzed via SPSS. RESULTS: The median age of the cohort was 65 years. There was no difference in demographics in those who had HAP compared to those who did not. Median Charlson comorbidity index (CCI) (3,2;p=0.6) PCT (0.16, 0.13;p=0.91), ferritin (707, 659.5;p=0.48), and C-reactive protein (CRP) (10.56, 6.78;p=0.19) within 48 hours of admission did not differ significantly between the groups either. Notably, PCT (0.09,0.47;p=0.01) and CRP (3.37, 6.59, p=0.01) 48 hours after admission were significantly higher in COVID-19 patients who developed HAP. However, when PCT and CRP were included in multivariate logistic regression, neither remained a significant predictor of HAP. The odds ratios of PCT and CRP 48 hours after admission were 1.25 (95% CI:0.85-1.8;p=0.27) and 1.08 (95% CI:0.95-1.23;p=0.22), respectively. CONCLUSIONS: Our study did not show a significant difference in the median CCI, PCT, CRP and ferritin obtained within 48 hours of admission in patients who developed HAP versus those who did not. However, PCT and CRP obtained 48 hours after admission, were higher in patients who developed HAP. CLINICAL IMPLICATIONS: The data support the use of PCT and CRP as potential tools to predict the development of concomitant HAP in COVID-19 patients and as guides for antibiotic stewardship in this patient population. DISCLOSURES: No relevant relationships by Mythri Anil Kumar No relevant relationships by Tara McLaughlin No relevant relationships by Raj Parikh No relevant relationships by Meher Singha

CARES Act Aid to Ophthalmologists and Optometrists During the COVID-19 Pandemic

Purpose : Congress passed the CARES Act (Coronavirus Aid, Relief, and Economic Security) Provider Relief Fund to help healthcare providers recoup lost revenue during the pandemic. We aimed to determine how much of this federal aid was provided to ophthalmology and optometry practices, and whether the amount of aid received varied based on practice size. Methods : We used the Centers for Medicare and Medicaid Services (CMS) Physician Compare National Database to identify medical practices that provide eye care. We used practice names to link this database to the Health and Human Services (HHS) Provider Relief Fund (PRF) database to determine how much aid each practice received through the CARES Act. Results : We identified 2,625 optometry or ophthalmology practices that received funding through the CARES Act Provider Relief Fund that were not hospital-owned or affiliated with multi-specialty practices. Large practices with more than 10 clinicians accounted for only 268 of the 2,625 practices in our sample, but received nearly half of all funding ($182 million). Per-practitioner funding varied based on practice size (p=0.047), but differences in per-practitioner funds were not significant after adjusting for practice specialty (ophthalmology, optometry, or both). We also found that retina specific practices tended to receive more than their counterparts. Conclusions : This study demonstrates a relatively uniform distribution of per capita funds when adjusted for ophthalmologists, optometrists, and mixed-practices regardless of practice size. This policy demonstrates how federal aid is distributed to independent ophthalmology practices, and that smaller practices which are at higher risk may need larger per capita payments to remain viable during times of economic stress.

Trends in low-value oncology care during the COVID-19 pandemic

Background: Low-value services, which provide minimal patient benefit while entailing costs and risks, are prevalent in cancer care. Shifts in cancer care delivery during the COVID-19 pandemic to minimize exposure provided opportunities for health systems and clinicians to prioritize higher-value over lowvalue oncology services. Methods: In this retrospective cohort study, we investigated the association between the COVID-19 pandemic period and low-value cancer care practices using administrative claims from the HealthCore Integrated Research Environment, consisting of ∼65 million members managed by 14 health plans across the US. We identified commercial or Medicare Advantage members diagnosed with breast, colorectal, or lung cancer between January 2015 and March 2021. Low-value cancer care practices were identified from peer-reviewed medical literature, including ASCO and ASTRO Choosing Wisely campaigns and evidence-based pathways. Five low-value practices were studied: (1) conventional fractionation instead of hypofractionation for early-stage breast cancer;(2) off-pathway systemic therapy;(3) non-guideline-based antiemetic use for minimal-, low-, or moderate-to-high-risk chemotherapies;(4) Positron Emission Tomography/Computed Tomography (PET/CT) instead of conventional CT for staging;and (5) aggressive end-of-life care (chemotherapy ≤14 days, multiple emergency department visits ≤30 days, ICU utilization ≤30 days, hospice initiation ≤3 days, and/or no hospice before death). We used linear probability models to evaluate the association between the COVID- 19 period (March to December 2020) and the 5 outcomes, adjusting for patient, facility, geographic and temporal characteristics. Results: Among 204,581 members (mean age 63.1, 139,488 [68.1%] female), 83,593 (40.8%) had breast cancer, 56,373 (27.5%) had colon cancer, and 64,615 (31.5%) had lung cancer. Rates of low-value care were similar in pre-COVID vs. COVID periods: conventional radiotherapy: 22.1% vs. 9.4%;off-pathway systemic therapy: 36.7% vs. 43.2%;non-guideline-based antiemetics: 61.2% vs. 58.1%;PET/CT imaging: 39.9% vs. 41.3%;aggressive end-of-life care: 75.8% vs. 73.3%. In adjusted analyses, the COVID-19 period was associated with no changes in off-pathway therapy (adjusted percentage point difference [aPPD] 0.82, SD 0.08, p = 0.33), PET/CT imaging (aPPD 0.10, SD 0.005, p = 0.83), and aggressive end-of-life care (aPPD 2.71, SD 0.02, p = 0.16). Small changes in conventional radiotherapy (aPPD 3.93, SD 0.01, p < 0.01) and non-guideline-based antiemetics (aPPD -3.62, SD 0.006, p < 0.01), were noted. Conclusions: The shock of the COVID-19 pandemic did not meaningfully change several metrics of low-value cancer care. Broader changes to payment and incentive design should be considered to turn the tide toward higher-value cancer care.

Bringing experimental therapeutics clinical trials network (ETCTN) to underrepresented population

Background: Access to health care including clinical trials (CT) leading to paradigm-changing cancer treatments are critical for high quality cancer care and equity in society. In this report, we highlight methods in accruing to ETCTN wherein underrepresented rural, low-income, and racial minorities comprise >50% of enrollment. Methods: University of Kansas Cancer Center (KUCC) is one of eight National Cancer Institute (NCI) designated cancer centers awarded CATCH-UP.2020 (CATCH-UP), a congressionally mandated P30 supplement to enhance access for minority/underserved populations to ETCTN precision medicine CT. KUCC catchment area is 23% rural by Rural Urban Continuum Codes (RUCC);almost 90 % of counties are designated primary care HPSA's (Health Professional Shortage Areas). KUCC Early Phase and Masonic Cancer Alliance (rural outreach network) partnered to operationalize CATCH-UP. We engaged disease-focused champion investigators in disease working groups and MCA physicians who selected scientifically sound CT that fit catchment area needs. Patient and Investigator Voices Organizing Together, a patient research advocacy group provided practical feedback. MCA navigator coordinated recruitment. Telehealth was used for rural patients that would have a significant distance to travel just to be screened. Results: CATCH-UP was initiated in September 2020. Twenty-eight CT were activated, many in community sites. Average activation time was 81 days. Delays were mainly from CT amendments. KUCC enrolled the first patient in the CATCH-UP program. In 6 months, we met accrual requirements (24/year, 50% minorities). During first year, we enrolled 47 (>50% minorities), an increase of 680% from our average accrual of 6/year (>50% minorities) in ETCTN through Early Drug Development Opportunity Program (2016-2020). To date, we have enrolled 61, 54% from rural, HPSA, race and other minorities. Although the proportion of minorities did not change but remained high, this funding allowed us to substantially increase the number of patients from a catchment area with high proportion of geographically and socioeconomically underserved minorities given access to early phase CT through ETCTN. Conclusions: Amid COVID-19 pandemic, the NCI CATCH-UP program and methods we used allowed access to novel therapies for rural, medically underserved, and other minority groups.

Ozone Trends and the Ability of Models to Reproduce the 2020 Ozone Concentrations in the South Coast Air Basin in Southern California under the COVID-19 Restrictions

The current U.S. emission control requirements for on-road motor vehicles are driven by the ozone problem in the South Coast Air Basin (SoCAB) in southern California. Based on ozone modeling performed for Air Quality Management Plans (AQMPs), the SoCAB ozone attainment plan requires large (>80%) amounts of emission reductions in oxides of nitrogen (NOx) from current levels with more modest (similar to 40%) controls on Volatile Organic Compounds (VOC). The shelter in place orders in response to the 2020 COVID-19 pandemic resulted in an immediate reduction in emissions, but instead of ozone being reduced, in 2020 the SoCAB saw some of the highest observed ozone levels in decades. We used the abrupt emissions reductions from 2019 to 2020 caused by COVID-19 to conduct a dynamic model evaluation of the Community Multiscale Air Quality (CMAQ) model to evaluate whether the models used to develop ozone control plans can correctly simulate the ozone response to the emissions reductions. Ozone modeling was conducted for three scenarios: 2019 Base, 2020 business-as-usual (i.e., without COVID reductions), and 2020 COVID. We found that modeled ozone changes between 2019 and 2020 were generally consistent with the observed ozone changes. We determined that meteorology played the major role in the increases in ozone between 2019 and 2020;however, the reduction in NOX emissions also caused ozone increases in Los Angeles County and into western San Bernardino County, with more widespread ozone decreases further to the east.

Impact of the COVID-19 Pandemic on in-Person Visit Rates Among Patients with Hematologic Malignancies in the United States

Background/objectives: The COVID-19 pandemic led to a dramatic reduction of in-person medical care in the general population;however, impacts have not been well-characterized for patients with hematologic malignancies. This study assessed the impact of COVID-19 on healthcare delivery for patients with hematologic malignancies with documented active treatment. Methods: Patients from the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database with confirmed diagnosis of AML, DLBCL, FL, MCL, CLL or MM, and age ≥ 18 years at initial diagnosis were included. To be included in the study, documented receipt of at least one systemic, non-maintenance line of therapy between March 1, 2016 - February 28, 2021 was required. Patients were categorized into treatment types within lines of therapy: Oral therapy (OralTx);outpatient infusions (OutPtTx);and inpatient infusions, including hematopoietic transplants and CAR-T cell therapy (InPtTx). Monthly visit rates were calculated as the number of visits (telemedicine or in-person [in-clinic treatment administration, vitals, and/or labs]) per active patient per 30-day standardized month. Only visits occurring within a line of therapy were included (i.e. during active therapy, excluding surveillance). Telemedicine was only available for ion during the pandemic period. We used time-series forecasting methods on pre-pandemic monthly visit rate data (March 2016 - February 2020) to estimate projected counterfactual visit rates between March 2020 - February 2021 (expected in-person visit rates if the pandemic had not occurred) for all diseases combined, each disease, and each treatment type. Differences between projected and actual monthly visit rates during the pandemic period were considered statistically significant and related to the pandemic if the actual visit rate was outside of the 95% prediction interval (PI) surrounding the projected estimate. Results: A total of 22,559 patients were included in this analysis (6,241 OralTx, 14,501 OutPtTx, 7,675 InPtTx): 4,069 AML, 3,641 DLBCL, 2,004 FL, 1,899 MCL, 4,574 CLL and 6,701 MM. There was a gradual downward trend in in-person visit rates across all diseases over the study period (March 2016 - February 2021, Figure) and general visit frequencies were lower for OralTx and higher for OutPtTx and InPtTx overall. For all diseases combined, early pandemic months (March - May 2020) saw an 18% (95% PI 8.9% - 25%) reduction in in-person visit rates averaged across OralTx and OutPtTx, with the projected rate being 1.5 (95% PI 1.3 - 1.6) visits per patient per month, compared to an actual rate of 1.2. Reductions in the in-person visit rates were significant for all 3 treatment types for MM, for OralTx for CLL, and for OutPtTx for MCL and CLL. Telemedicine visit rates were greatest for patients who received OralTx, followed by OutPtTx, then InPtTx, with greater use in the early pandemic months and subsequent decrease in later months. All in-person visit rates increased close to predicted rates in the later half of the pandemic period. Conclusions: In treatment of hematologic malignancies, overall documented in-person visit rates for patients on OralTx and OutPtTx significantly decreased during early pandemic months, but returned close to the projected rates later in the pandemic. There were no significant reductions in the overall in-person visit rate for patients on InPtTx. Variability in these trends by disease type was observed, with significant reductions in in-person visits impacting MM, CLL, and MCL. Figure. Visit rates over time according to treatment category [Formula presented] Disclosures: Lau: Roche: Current equity holder in publicly-traded company;Flatiron Health Inc: Current Employment. Wang: Roche: Current equity holder in publicly-traded company;Flatiron Health: Current Employment. Davidoff: AbbVie: Other: Family member consultancy;Amgen: Consultancy. Huntington: Bayer: Honoraria;Thyme Inc: Consultancy;Novartis: Consultancy;Flatiron Health Inc.: Consultancy;Genentech: Consultancy;eaGen: Consultancy;Servier: Consultancy;AstraZeneca: Consultancy, Honoraria;TG Therapeutics: Research Funding;DTRM Biopharm: Research Funding;AbbVie: Consultancy;Pharmacyclics: Consultancy, Honoraria;Celgene: Consultancy, Research Funding. Calip: Pfizer: Research Funding;Roche: Current equity holder in publicly-traded company;Flatiron Health Inc: Current Employment. Shah: AstraZeneca: Research Funding;Seattle Genetics: Research Funding;Epizyme: Research Funding. Stephens: CSL Behring: Consultancy;TG Therapeutics: Membership on an entity's Board of Directors or advisory committees;AstraZeneca: Consultancy;Celgene: Consultancy;JUNO: Research Funding;Mingsight: Research Funding;Abbvie: Consultancy;Arqule: Research Funding;Adaptive: Membership on an entity's Board of Directors or advisory committees;Novartis: Research Funding;Epizyme: Membership on an entity's Board of Directors or advisory committees;Beigene: Membership on an entity's Board of Directors or advisory committees;Innate Pharma: Membership on an entity's Board of Directors or advisory committees;Karyopharm: Membership on an entity's Board of Directors or advisory committees, Research Funding. Miksad: Flatiron Health Inc: Current Employment, Current holder of individual stocks in a privately-held company;Roche: Current equity holder in publicly-traded company. Parikh: GNS Healthcare: Current holder of individual stocks in a privately-held company;Onc.AI: Current holder of individual stocks in a privately-held company;Humana: Honoraria, Research Funding;Nanology: Honoraria;Thyme Care: Honoraria;Flatiron Health Inc: Honoraria. Takvorian: Pfizer: Research Funding;Genentech: Consultancy. Neparidze: GlaxoSmithKline: Research Funding;Janssen: Research Funding;Eidos Therapeutics: Membership on an entity's Board of Directors or advisory committees. Seymour: Flatiron Health Inc: Current Employment;Janssen: Membership on an entity's Board of Directors or advisory committees;Roche: Current equity holder in publicly-traded company;Karyopharm: Honoraria, Membership on an entity's Board of Directors or advisory committees;Pharmacyclics: Membership on an entity's Board of Directors or advisory committees.

Racial Disparities in Telemedicine Uptake during the COVID-19 Pandemic Among Patients with Hematologic Malignancies in the United States

Background/objectives: The COVID-19 pandemic impacted healthcare visit trends, propelling healthcare systems to reduce in-person visits and hospital admissions and increasingly rely on telemedicine;whether there are differences in these trends across racial groups is unknown. This study investigated potential racial disparities in visits during the pandemic for patients with documented active treatment for hematologic malignancies. Methods: We used the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database to select patients with confirmed diagnosis of AML, DLBCL, FL, MCL, CLL or MM, at least 18 years old at initial diagnosis, and documented race in the EHR as Black/African American or White were included. Patients were categorized into treatment types within lines of therapy: Orals (orals + outpatient infusions with orals) vs. Inpatient treatments (chemotherapy, hematopoietic transplants & CAR-T cell therapy). Monthly visit rates were calculated as the number of visits (telemedicine or in-person [in-clinic treatment administration, vitals, and/or labs]) per active patient per 30-day standardized month, except for months in which the patient was considered not active (e.g. no documented therapy, surveillance). We used time-series forecasting methods on pre-pandemic monthly visit rate data (March 2016 - February 2020) to estimate projected counterfactual monthly visit rates (expected rates if the pandemic did not occur) between March 2020 - February 2021 for all diseases combined, for each disease, each treatment type, and each race. Differences between projected and actual monthly visit rates during the pandemic period were considered significant and related due to the pandemic if the actual visit rate was outside of the 95% prediction interval (PI) surrounding the projected estimate. We used cross-correlation analysis to test for significant differences in visit rates between Black and White patients. Results: The analysis included 17,621 patients (2,225 Black, 15,396 White): 3,041 AML, 2,715 DLBCL, 1,558 FL, 1,511 MCL, 3,813 CLL and 5,244 MM (1,166 Black, 4078 White). Across all diseases and treatment categories, Black patients had no significant reductions in in-person visit rates throughout the pandemic period compared to the projected rates. There was, however, an 18% statistically significant reduction (95% PI 9.9% - 25%) in in-person visit rates for White patients on orals during early pandemic months (March - May 2020) from a projected visit rate of 2.0 (95% PI 1.8 - 2.2) visits per patient per month to an actual visit rate of 1.61. There was no significant reduction in in-person visit rates for White patients on inpatient treatments. Telemedicine uptake was significantly higher for White patients compared with Black patients for all diseases combined across all treatment categories (Figure A & B) (t = 9.5, p < 0.01), AML inpatient treatments (t = 2.4, p = 0.04), MM orals (Figure C) (t = 6.0, p < 0.01) and MM inpatient treatments (Figure D) (t = 2.3, p = 0.04). Conclusions: A tradeoff in reductions in in-person visits and uptake of telemedicine use was observed overall. White patients had significantly higher telemedicine uptake compared with Black patients for both oral and inpatient treatments. In-person visit rates for Black patients were unchanged regardless of treatment category. These in-person visit rates reflect documented telemedicine use disparities, which requires further study into possible compound causes, including economic and societal factors. Figure. Trends over time in telemedicine visit rates for White patients (blue line) and Black patients (black line) [Formula presented] Disclosures: Neparidze: Eidos Therapeutics: Membership on an entity's Board of Directors or advisory committees;GlaxoSmithKline: Research Funding;Janssen: Research Funding. Lau: Flatiron Health Inc: Current Employment;Roche: Current equity holder in publicly-traded company. Wang: Flatiron Health: Current Employment;Roche: Current equity holder in publicly-traded company. Davidoff: Amgen: Consultancy;AbbVie: Other: Family member consultancy. Huntington: Bayer: Honoraria;Servier: Consultancy;Pharmacyclics: Consultancy, Honoraria;Thyme Inc: Consultancy;Genentech: Consultancy;AbbVie: Consultancy;SeaGen: Consultancy;Celgene: Consultancy, Research Funding;Flatiron Health Inc.: Consultancy;DTRM Biopharm: Research Funding;TG Therapeutics: Research Funding;AstraZeneca: Consultancy, Honoraria;Novartis: Consultancy. Calip: Flatiron Health Inc: Current Employment;Roche: Current equity holder in publicly-traded company;Pfizer: Research Funding. Shah: AstraZeneca: Research Funding;Seattle Genetics: Research Funding;Epizyme: Research Funding. Stephens: Adaptive: Membership on an entity's Board of Directors or advisory committees;Celgene: Consultancy;Abbvie: Consultancy;CSL Behring: Consultancy;Novartis: Research Funding;Karyopharm: Membership on an entity's Board of Directors or advisory committees, Research Funding;JUNO: Research Funding;Mingsight: Research Funding;AstraZeneca: Consultancy;Innate Pharma: Membership on an entity's Board of Directors or advisory committees;Beigene: Membership on an entity's Board of Directors or advisory committees;TG Therapeutics: Membership on an entity's Board of Directors or advisory committees;Epizyme: Membership on an entity's Board of Directors or advisory committees;Arqule: Research Funding. Miksad: Flatiron Health Inc: Current Employment, Current holder of individual stocks in a privately-held company;Roche: Current equity holder in publicly-traded company. Parikh: Onc.AI: Current holder of individual stocks in a privately-held company;Humana: Honoraria, Research Funding;Flatiron Health Inc: Honoraria;Thyme Care: Honoraria;Nanology: Honoraria;GNS Healthcare: Current holder of individual stocks in a privately-held company. Takvorian: Genentech: Consultancy;Pfizer: Research Funding. Seymour: Janssen: Membership on an entity's Board of Directors or advisory committees;Roche: Current equity holder in publicly-traded company;Pharmacyclics: Membership on an entity's Board of Directors or advisory committees;Flatiron Health Inc: Current Employment;Karyopharm: Honoraria, Membership on an entity's Board of Directors or advisory committees.

Development and implementation of the Mobility Clinic COVID-19 pandemic patient outreach program

Background: At the beginning of the COVID-19 pandemic, there was uncertainty if individuals with spinal cord injury (SCI) were at greater risk for adverse health events. Certainly, there was great concern over direct effects (e.g. physical illness, hospitalization) but also fear of indirect effects (e.g. mental health, isolation, caregiver disruption) due to COVID-19 and the public health measures to contain it. Since individuals with SCI often have limited or tenuous access to healthcare and resources, they are at greater risk than the general population of destabilization. Objective: To proactively identify risks that may be exacerbated by the pandemic and mitigate them where possible, a primary care outreach program was developed. Methods: A screening algorithm was developed by our interdisciplinary Mobility Clinic team, and focuses on 5 domains: health destabilization, mental health, access to services and supports, social isolation, and caregiver stress. The algorithm was administered by phone to a total of 107 individuals, who were identified as past and current Mobility Clinic patients. Any risks identified received further investigation by the team. We used the opportunity to educate patients about the risks of COVID-19 and protective measures. Follow-up with patients continued every 6-8 weeks throughout the duration of the pandemic. An evaluation of this outreach program involved a description of the patient population contacted, the identification of common risks for patients, and patient satisfaction with the program. Results: The contacted patient population consisted of 76 males and 31 females. 74 patients were identified as having a spinal cord injury. Some of the most common questionnaire responses by patients with SCI included feelings of stress and/or anxiety and a reduction in Personal Support Worker services leading to increased caregiver stress. A patient satisfaction survey demonstrated that 83% of patients (n=12) were very satisfied with the phone call and the care received. Conclusion: The outreach program helps us to proactively identify risks for individuals with SCI and address any healthcare needs they have. Risk assessment and care at the primary care level can mitigate adverse events and hospitalizations, which is especially important during a pandemic situation when healthcare and hospital resources are limited.