Simulation to Educate Practicing Urologists in Rural Locations: Identifying Strategies to Increase Procedural Adoption

Introduction: The COVID-19 pandemic necessitated proliferation of telesimulation. This pedagogy may be useful in rural areas to increase procedural adoption and reduce healthcare disparities. Our aim was to determine the current status of surgical simulation education to retool rural practicing Urologists. Method(s): Literature search was performed with a trained librarian for PubMed, EMBASE and Web of Science. Title/ screening were performed to include all studies of surgical simulation involving rural surgical learners to identify simulation education opportunities for practicing rural Urologists. Data was then extracted: simulation event, skills focus, MERSQI score, type/number of learners, learner assessment and event evaluation. Result(s): Seven manuscripts met inclusion criteria. Most were published 2019-2020 and were cross sectional (5/7, 71%). Mean adjusted MERSQI score was 13 (range 6-15.5). A wide range of surgical skills were taught (incl. laparoscopy, cricothyroidotomy, chest tube insertion, damage control laparotomy), but no Urological surgical skills. Two articles described mobile simulation units for rural areas. A total of 232 learners were identified including 69 medical students. One fifth of rural learners were non-medical or non-physicians. Only one study involved faculty, who were general surgeons. Conclusion(s): Telesimulation education for practicing Urologists in rural areas is lacking. Current in-operating room telementoring for rural Urologists requires surgeons to travel and perform their first cases utilizing this new technique on patients. Telesimulation to teach Urological skills in rural areas of the US may increase dissemination of techniques with no patient risk and has significant potential to redress current healthcare disparities.

The Impact of COVID-19 on Systems of Care for Children and Youth With Special Health Care Needs

Introduction: This article describes the challenges and opportunities that the COVID-19 pandemic presented for providing and coordinating care for children and youth with special health care needs (CYSHCN) who rely on a diverse array of systems to promote their health, education, and well-being. Method(s): Peer-reviewed published literature and reports from the national government and nonprofit organizations that advocate for CYSHCN were examined, particularly concerning systems that impacted CYSHCN during COVID-19. Result(s): Pre-COVID-19, CYSHCN and their families faced challenges accessing and coordinating care across diverse systems. COVID-19 exacerbated these challenges because of disruptions in care and services that negatively impacted CYSHCN. COVID-19 also highlighted opportunities for positive change and care innovations. Discussion(s): Understanding the systems of care that CYSHCN rely on and the effects of COVID-19 on these systems can enhance access to and quality of care. Recommendations are made for practice, leadership, research, and policy.Copyright © 2022 National Association of Pediatric Nurse Practitioners

Vaccination coverage during pregnancy and factors associated with refusal

Objective. The vaccines currently recommended during pregnancy are the dTpa, the influenza vaccine, and, due to SARSCoV- 2 pandemic, the mRNA vaccine against COVID-19. The aim of this study was to evaluate vaccination coverage among pregnant women and factors associated with refusal. Materials and Methods. 307 patients who delivered at term between March and April 2022 at Careggi Hospital answered a questionnaire about vaccines during pregnancy. The primary aim was to assess vaccination coverage and factors associated with refusal. The secondary aim was to detect differences in vaccination between Italian and foreign women. Results. Overall, 74% of patients were vaccinated with dTpa, 82% against COVID-19 and only 33% against Influenza. Vaccination coverage for dTpa and COVID-19 was significantly higher among Italian than foreign patients (80% vs 51%, p < 0.001 and 86% vs 69%, p = 0.002, respectively). 89% of patients received recommendations for vaccines from the gynecologist, more frequently among Italians than foreigners (p = 0.01). The main reasons behind refusal of vaccinations were: reduced perception of the risk of disease in the case of influenza (41%), inadequate information received from the gynecologist regarding dTpa (35%), fear of side effects (63%) and of effects on the fetus (70%) from the COVID-19 vaccine. Conclusions. Adherence to the Influenza vaccine was low because of reduced perception of the disease risks. Fear of COVID-19 disease led most of the patients to receive the vaccination. The significant difference in vaccination coverage between Italians and foreigners is likely due to less information being received by foreign patients, an example of health care disparity.

Cultural and Social Factors in Care Delivery Among African American Caregivers of Persons With Dementia: A Scoping Review.

Cultural and social factors significantly influence the care provided to persons with dementia. This scoping review aimed to map emerging evidence on the influence of cultural and social factors on care delivery among Africa American caregivers of persons with dementia, especially during the COVID-19 pandemic. Using a systematic scoping review approach, we identified 21 studies on cultural and social factors influencing care delivery. The search included EMBASE, CINAHL, the Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, and Epistemonicos. A narrative synthesis of the data revealed that cultural and social factors greatly influence African American caregivers of persons with dementia and COVID-19 in care delivery, who perceive caregiving as a responsibility and not just a job. These caregivers are additionally guided by their racial identity and faith beliefs, integrating family values and culture into caregiving. African American caregivers showed compassion and resilient care selfperceptions. Supporting compassionate care delivery by African American caregivers requires an understanding of the social and cultural factors which drive their commitment to quality care for older adults with dementia in a pandemic environment.

Telemedicine in SLE patients

Remote care and telemedicine (TM) can improve healthcare access and outcomes, particularly in chronic diseases. During the pandemic, the clinical management of patients with SLE, who are at risk of severe COVID-19 infection, was undermined. TM care was widely advocated by national and international rheumatology societies. Ad hoc use of TM has been frequent during the pandemic. In this session, the evidence surrounding TM use in the management of patients with SLE before and after the onset of COVID-19 outbreak will be discussed. Local experience with some practical points to consider in using TM delivered care for follow-up of SLE patients will also be shared. The ultimate goal of TM will be to achieve safety and effectiveness that is comparable to traditional care, and improve efficiency without increasing costs and healthcare disparity.

Patient perceptions and satisfaction of telemedicine use in rheumatology during the covid-19 pandemic: A single-center, descriptive study in the Philippines

Background: Telemedicine became the emergent means of providing and continuing medical care due to the COVID 19 pandemic. This study aims to evaluate the knowledge, perception, and satisfaction with the use of telemedicine among patients with rheumatic diseases. An understanding of our patients' experiences can be utilized to provide access to care, improve gaps in delivery of care, and improve healthcare disparities. Method(s): Filipino patients with rheumatic disease who had telehealth visits between June 2020 and August 2021 in St Luke's Medical Center Outpatient Department participated in an online survey. Information on demographics, diagnosis, knowledge and experience on telemedicine, and perspectives on benefits and limitations of telemedicine were collected. Result(s): There were 70 respondents: 52.9% with SLE, 25.7% with RA, 10% with osteoarthritis, 5.7% with psoriatic arthritis, 2.9% with scleroderma. Results showed that 64.3% are familiar with the use of video conference platforms. Facebook messenger was the most used (85.7%). Half of respondents have used telemedicine on their own, while 33% required assistance. The remaining respondents have not used telemedicine due to lack of experience or awareness on how to proceed with consults. The reasons for using telemedicine were restrictions of the pandemic (82.9%), limited access to clinics (31.4%), and disability (1.4%). Most remain satisfied with telemedicine (75.7%), 50% of patients stated that telemedicine was comparable to an in-clinic visit, and 85.7% (N = 60) would recommend its use. Conclusion(s): Filipinos with rheumatic disease are knowledgeable on online platforms and telemedicine, however, it is important to note the digital divide. Patients need assistance and improved awareness on accessing remote care. Providing continuity of healthcare can lead to less complications and better outcomes despite pandemic restrictions. There is an overall favorable satisfaction for care. Half the respondents remain satisfied with telemedicine. Rheumatologists need further studies on benefits and outcomes on providing remote healthcare.

COVID-19: Salt in the Wound of Health Care Inequality and the Cause of a New Health Care Disparity.

The year 2020 will forever be associated with a new chapter in the history of global health, COVID-19. However, this new chapter would have a similar message because many other chapters were written before it. The COVID-19 pandemic would disproportionately affect minorities, those of low socioeconomic class, and those with limited access to health care. However, COVID-19 would also bring about a new health care disparity, limiting access to medical care for those with non COVID-19 related medical needs.

Telemedicine during a pandemic with osteopathic considerations

Health care continues to make strides in the industry by incorporating technological innovation to capture consumer demand and financial growth. Over the past 10 years, significant technology advances in health care include developing electronic health records, patient portals, self-service kiosks, remote monitoring devices, genome sequencing and telemedicine. The topics covered include visit how-to's, presenting yourself professionally, displaying empathy and treating the whole person in the virtual platform. Practice management topics include benefits of telemedicine, billing and coding, reimbursement, and legal consideration. Multiple tables display various topics, including different types of telemedicine, different virtual platforms, CPT codes to code the visit and billing modifiers associated with telemedicine. Copyright © 2020 by the American College of Osteopathic Family Physicians. All rights reserved.

BCTRIMS: Impact of the Covid 19 pandemic on healthcare access for people with MS

The Covid-19 pandemic has resulted in disruptions in healthcare access for people with multiple sclerosis (pwMS) all over the world. Different strategies were applied during the diverse phases of the ongoing pandemic, including the broad use of telehealth which is partially able to mitigate the impact on MS care. Nonetheless, MS is a complex condition and standard care involves multidisciplinary team assessments and frequently onsite medical interventions, which needed to be reinvented in a short time. Besides the physical distance, healthcare providers (HCPs) had to deal with the shortening of human and financial resources, with direct consequences on treatment decisions, especially in resource-limited settings. Additionally, Covid-19 affects the countries in different ways, and political, cultural, and socioeconomic factors determined distinct local responses to the pandemic leading to huge heterogeneity in healthcare access to all chronic neurological conditions. A more systematic approach is still necessary to bridge the gap between the accumulated knowledge on risk assessment of Covid-19 infection and vaccination in pwMS and effective disease-modifying therapies (DMT) choices. Finally, a joint effort from the scientific community and healthcare stakeholders should be encouraged to continue to use telehealth in a standardized way in order to expand access and reduce healthcare disparities.

Impact of a History Tonsillectomy and Adenoidectomy on COVID-19 Hospitalization and ICU Admission

Introduction: It is hypothesized that tonsils and adenoids could be target organs for the SARS-CoV-2 virus. This study sought to exam the impact of a history of tonsillectomy and adenoidectomy (T&A) on COVID-19 hospitalization and intensive care unit admission (ICUA) and develop a predictive model. Method(s): One thousand COVID-19 positive (COVID+) and 1000 COVID-19 negative (COVID-) tested patients, randomly selected from a single institution from March to May 2020, were included. Patient demographics and clinical data were extracted. Chi-square, Fisher exact, and Wilcoxon rank sum tests were used for group comparisons. Multivariate (MV) logistic regression models built stepwise using Akaike information criterion were used to assess factors associated with hospitalization and ICUA in COVID+ patients. Result(s): COVID+ patients had statistically significant lower rates of T&A (19.9% vs 15.8%, P=.016), had a higher mean age (51.8 vs 54.5 years, P=.002), rate of African American race (19.3% vs 27.4%, P<.001), and male gender (38.2% vs 46.4%, P=.0008) compared with COVID- patients. Variables predictive of hospital admission for COVID+ patients included age (hazard ratio 1.5, P<.0001), African American race (2.1, P=.0008), immunosuppressive disease (2.3, P=.0025), male gender (2, P=.0008), and diabetes (1.9, P=.0050), along with asthma and heart disease in the MV model. Variables predictive of ICUA for COVID+ patients included age (1.3, P=.013), heart failure (2.8, P=.0059), and diabetes (3.5, P<.0001) in addition to tonsillectomy, immunosuppression, and COPD/ asthma in the MV model. Tonsillectomy appeared to have a covariate-adjusted association with reduced odds of ICUA but was not significant (0.5, P=.057). Conclusion(s): COVID+ patients had statistically significant lower rates of T&A in this study when compared with COVID- patients. Male gender and African American race were associated with increased odds of hospitalization, which warrants further investigation into a cause and the potential influence of health care disparities. Tonsillectomy appeared to have a covariate-adjusted association with reduced likelihood of ICUA but did not reach significance.

DETRIMENTS TO PULMONARY REHABILITATION REFERRAL IN A RURAL COMMUNITY HOSPITAL: THE QI PROJECT

SESSION TITLE: Respiratory Care: Oxygen, Rehabilitation, and Inhalers SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: 1.To educate patients about the severity of their disease process while inpatient. 2.To educate about and offer Pulmonary rehabilitation before they are discharged from the hospital. METHODS: 1.Education of care team regarding importance of pulmonary rehabilitation. 2.Forming a report in EPIC (EMR) enlisting current COPD exacerbation inpatients. 3.Approaching patients in a multidisciplinary fashion regarding pulmonary rehabilitation. RESULTS: There was an average of 3-5 inpatient COPD exacerbation patients per week who were approached from the begining of our QI. We saw less than 5% of patients actually enrolling and coming through pulmonary rehabilitation. CONCLUSIONS: In a rural setting there are a lot of factors that play a role in healthcare disparities. Taking an example of COPD patients in our community, despite having a functional pulmonary rehabilitation program and innovative approach to education and enrollment regarding pulmonary rehabilitation, we still faced a lot of obstacles in having the COPD patients to be able to follow and get help through outpatient pulmonary rehabilitation. The main reasons stated are as follows - lack of transportation, high fall risk, no insurance/inability to afford pulmonary rehabilitation, baseline poor functional status. CLINICAL IMPLICATIONS: Despite numerous benefits, traditional Pulmonary Rehabilitation (PR) as a resource remains underutilized in chronic lung disease.Less than 3% of eligible candidates for PR attend one or more sessions after hospitalization due to many barriers, including the ongoing COVID-19 pandemic. Our QI project is an effort to educate COPD patients on the importance of pulmonary rehabilitation while they are admitted inpatient for an exacerbation. Going through the project, we identified several valid reasons on why Pulmonary rehabilitation still remains an underutilized tool in this disease. We hope to establish reasons and work on approaching different hurdles that are faced. Accessibility in terms of higher number of rehabilitation programs and functional transport to and from, better insurance coverage on the part of insurance companies, better understanding of the disease process and patient education are all the different factors that can be worked on. DISCLOSURES: No relevant relationships by Parul Dutta No relevant relationships by Gaurav Dutta

HOME-BASED PULMONARY REHABILITATION: NOVEL APPROACH OF AN ESTABLISHED MODEL IN A SINGLE VETERANS AFFAIRS MEDICAL CENTER EXPERIENCE

SESSION TITLE: Impact of Health Disparities and Differences SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: To address rural healthcare disparities by providing access to home based pulmonary rehabilitation (HBPR) program for eligible veterans at the Salem Veterans Affairs Medical Center (VAMC) who reside in remote areas or those with barriers of long travel time and transportation hardship. METHODS: The Pulmonary Section at the Salem VAMC received a grant from the Office of Rural Health to establish HBPR program for eligible veterans. Its goal was to improve quality of life and potentially reduce COPD hospitalizations and exacerbations (AECOPD). Under the direction of pulmonologists, the program was run by an exercise physiologist (EP). Referrals were received from inpatient and outpatient providers. After an initial in-person evaluation, weekly telehealth meetings (telephone, video) occurred over 12 weeks. Veterans were provided with the equipment, and an individualized targeted exercise program along with education and counseling on tobacco cessation, nutrition, oxygen compliance, stress management, medication adherence. Follow up appointments were scheduled at 3, 6 and 12 months post completion. RESULTS: Between September 2020 and January 2022, 312 consults were received, 206 consults were scheduled and 175 veterans enrolled. To date, 100 have completed the program with 24 ongoing. 30% declined service, citing: comorbidities, physical debility, difficulty remembering scheduled appointments, lack of motivation, social reasons, worsening health status. Mean age was 71, male predominance (95%). Referral diagnoses included: COPD (86%), chronic hypoxic respiratory failure (55%), COVID-19 (11%), Interstital Lung Diseases (10%). Mean FEV1 was 57% predicted, mean MMRC Dyspnea Scale 2.5, mean BODE score 5. 20% of enrolled veterans were active smokers, 72% were former smokers. 6 minute walk test increased from 156 meters on enrollment to 216 meters on completion. 45 veterans required hospitalization for pulmonary issues during their participation in the program. EP identified on weekly appointments 20 AECOPD that were treated as outpatient, 1 spontaneous pneumothorax that led to hospitalization, and facilitated the refill of inhalers or adjustment of medical regimen. Patient satisfaction score, including perception of benefit post completion was 29.4/30. CONCLUSIONS: HBPR at the Salem VAMC provided access to eligible veterans, overcoming barriers of rurality, transportation hardship and lack of nearby conventional programs. It also offered off business hours PR to veterans who continue to work. It allowed decrease in community care referrals thus establishing useful and cost effective service. CLINICAL IMPLICATIONS: Pulmonary Rehabilitation has been shown to reduce morbidity, improve functional status and have mortality benefit. Healthcare discrepancies and disparities have been a major obstacle for enrollment. HBPR would address these issues and contribute to decreased health service utilization and costs. DISCLOSURES: No relevant relationships by Nathalie Abi Hatem No relevant relationships by Brittany Frost No relevant relationships by Mitchell Horowitz No relevant relationships by Deepa Lala

IMPROVING ACCESS TO ADVANCED CARDIORESPIRATORY THERAPIES FOR UNDERSERVED PATIENTS AND MINORITIES WITH A MULTIDISCIPLINARY EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) PROGRAM IN A LARGE PUBLIC HOSPITAL NETWORK

SESSION TITLE: Impact of Health Disparities and Differences SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Vulnerable patients, including minorities and underserved populations whose care relies on public hospitals, have limited access to advanced cardiac or respiratory care in shock centers or extracorporeal membrane oxygenation (ECMO)-capable hospitals, especially when socioeconomic or insurance barriers play a role in patient selection. Our aim is to describe the implementation of an ECMO program for cardiac and respiratory failure during the COVID-19 pandemic in the largest public health system in the country, as a strategy to mitigate healthcare disparities and improve access to care for minorities. METHODS: We collected clinical, demographic and socioeconomic data of all patients undergoing ECMO at Bellevue Hospital Center, the shock and ECMO center for New York City’s Health and Hospitals’ network. This public health system includes 11 Hospitals and provides care to 1 million New Yorkers. The decision to proceed with ECMO took place with a multidisciplinary team discussion, which was also in charge of providing longitudinal care during their hospitalization. RESULTS: A total of 49 patients were included [30 veno-venous (VV) ECMO, 19 venoarterial (VA) ECMO, including 9 extracorporeal cardiopulmonary resuscitation (ECPR)] from April 1st, 2020 to March 30th, 2022. The median age was 42.6 years, 57% were male, 38% were Hispanic, 35% African American, 14% white, 6% Asian and 8.2% had other ethnicities;33% were uninsured, 49% lived below the poverty level reported for New York City and 20% were undocumented. Level of education was 8th grade or less in 2.1%, high school in 24.5%, ≤ 2 years of college in 10.2%, >4 years of college in 12.2% and unknown in 51%. ECMO survival was 56% for VV ECMO, 44% for VA ECMO and 33% for ECPR. Survival to discharge was 56% for VV, 33% for VA and 33% for ECPR. One VV ECMO patient was bridged to lung transplant, there were no patients bridged to LVAD or heart transplant. Bleeding complications occurred in 3 patients (6%) and there were no procedural related complications. CONCLUSIONS: Our multidisciplinary ECMO program demonstrates feasibility to provide care to underserved and vulnerable populations with outcomes comparable to the national average, despite the challenges related to the potential limitations in bridging strategies for such patients. While socioeconomic and insurance status have a key role in bridging options for ECMO, they should not be a major determinant in denying patients advanced cardiopulmonary support if clinically indicated. CLINICAL IMPLICATIONS: Access to advance cardiorespiratory therapies including ECMO for vulnerable populations is a present need and is feasible with a multidisciplinary team DISCLOSURES: Speaker/Speaker's Bureau relationship with Zoll Please note: 3 years Added 04/04/2022 by Carlos Alviar, value=Honoraria No relevant relationships by Fariha Asef No relevant relationships by Sripal Bangalore No relevant relationships by Samuel Bernard No relevant relationships by Lauren Bianco No relevant relationships by Nishay Chitkara No relevant relationships by Jennifer Cruz No relevant relationships by Michael DiVita Research support relationship with Eurofins Viracor Please note: 12/1/2021 ongoing Added 12/23/2021 by Randal Goldberg, value=Grant/Research Support No relevant relationships by Kerry Hena No relevant relationships by William Howe No relevant relationships by Norma Keller no disclosure on file for Ma-Rosario Mertola;no disclosure on file for Thor Milland;No relevant relationships by vikramjit mukherjee No relevant relationships by Kayla Nunemacher No relevant relationships by Mansi Patel No relevant relationships by Radu Postelnicu No relevant relationships by Deepak Pradhan No relevant relationships by Vito Stasolla no disclosure on file for Amit Uppal;No relevant relationships by Susan Vlahakis No relevant relationships by Kah Loon Wan no disclosure on file for Victoria Yunaev;

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Statement for Telehealth

In 2020, telehealth (TH) in pediatric gastroenterology (GI) practice experienced unprecedented, meteoric growth, despite undefined best practices for the subspecialty. Use of synchronous video for TH first occurred in 1964, it was increasingly described in the literature from the 1970s to 1990s, and then catapulted to the forefront during the COVID-19 Public Health Emergency (PHE) beginning March 2020. Due to the sudden need for increased TH utilization by nearly all health care providers TH became essential to clinical practice. TH broadly encompasses most remote activities of clinical care, provider and patient education, and general health services. Prior to the COVID-19 PHE, surveys indicate that only 50% of North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) membership had any experience with telehealth. Although experience has grown dramatically, best practices for TH in pediatric GI, hepatology, and nutrition remain undefined and non-standardized. Key areas for review include: historical perspective, general and subspeciality usage, health care disparities, quality of the provider-patient interaction, modes of health care delivery, logistics and operations, licensure and liability, reimbursement and insurance coverage, research and quality improvement priorities, and future use of telehealth in pediatric GI with a call for advocacy. This present position paper from the Telehealth Special Interest Group of NASPGHAN provides recommendations for pediatric GI-focused telehealth best practices, reviews areas for research and quality improvement growth, and presents advocacy opportunities. Summary of Recommendations * The decision of when and how to use telehealth should be shared between patients-families and providers with the goals to achieve quality medical care and excellent patient experience * Telehealth is convenient for patients-families, affords a high degree of satisfaction and may improve access to high-value subspecialty care * Digital disparities exist for telehealth and providers need to be mindful of inequity in telehealth access and healthcare delivery * Individual providers carry the responsibility of licensed, secure, and HIPAA-compliant telehealth delivery in accordance with governmental regulations * Advocacy for permanent insurance coverage, reimbursement parity and universal licensure is urgently needed.

Tackling healthcare inequities through a social media-based platform to connect solid tumor patients with COVID-19 to clinical trials

Background: COVID-19 has contributed to healthcare inequity amongst minorities and lower socioeconomic populations, while complicating present anti-cancer treatment regimens. Due to their immunocompromised status, cancer patients are at an increased risk of severe SARS-CoV-2 infection. While sentiment analysis via SM has seen vast growth among healthcare professional, deeper connection and management has been lacking. Given the higher usage of SM impressions and the increase in healthcare disparities especially at the intersection of oncology and COVID-19, the aim of this study was to develop a platform that can: (1) show that the relationships highlighted within these tweets can be realized in biomolecular interactions-specifically within the interaction between solid tumors and COVID-19;(2) use SM data to connect patients with clinical trials. Methods: To determine this relationship, ontologies, which are groupings of terms and related identifiers, such as genes, were created for general search terms, utilizing the Human Phenotype Ontology. They were then combined with “COVID-19” and used as search terms in Twitter's Standard Search tool. The keywords with the most matches were then queried through clinicaltrials.gov and European Bioinformatics Institute's (EBI) Protein Search Tool to find relevant clinical trials and proteins. Finally, the proteins found by the EBI protein search were run through the SwissModel Tool to find relevant protein structures before being used in binding using Polar+'s Binding Platform from Iff Technologies, which provides K values related to 50% inhibition for each medication or immunotherapy. This produced a set of disease-specific keywords that are related to top tweets, clinical trials, protein structures, and binding concentration values in relevant biomolecular pathways for the keyword set “Tumor COVID-19”. Results: The example shown in Table is produced via our platform, with keywords with tweet numbers greater than 95% of all tweets with connected keywords used. Conclusions: By utilizing SM with highly relevant keywords, this platform can combat healthcare inequity by connecting patients and their tweets to clinical trials and enhance literacy about their medical conditions, while providing a greater understanding of the biomolecular pathways involved.

Implementing proven methods in a community-based health system to improve breast cancer screening rates during the COVID-19 pandemic

Background: There are reduced screening rates across the United States secondary to the COVID-19 pandemic;the additional anticipated deaths from breast and colorectal cancer, secondary to reduced screening, is approximated at 10,000 people. A study of thirty-two health systems in Georgia noted an 8% decrease in screening mammography compared to pre-pandemic rates. To help reverse the decline, Northeast Georgia Medical Center (NGMC) participated in the “Return to Screening” initiative, in conjunction with the American Cancer Society (ACS). A quality improvement project was performed at the community-based hospital system to increase breast cancer screening rates, using a multidisciplinary approach with a focus on health care disparities. Methods: The initial goal was to increase screening mammograms by 10% (n = 14,364) from June 1st to December 1st 2021. Interventions were selected by a multidisciplinary team of NGMC researchers, clinical providers, and oncology administrators. Interventions varied in category, encompassing unique patient and provider-specific approaches. The evidence-based interventions were tailored to address health care disparities in the local population. This included identification and quantification of cultural groups in the community to ensure quality patient access. Integrative collaboration consisted of intermittent meetings to certify consistent communication, project reflection and identification of barriers. The selected interventions were executed monthly, with simultaneous data tracking of mammography rates. Results: From June 1st to December 1st 2021, a total of forty evidence-based interventions were successfully implemented. Analysis of screening rates demonstrated a 15% increase across the allotted time period, corresponding to an average of 1,302 mammograms monthly (n = 15,284). This exceeded the initial anticipated goal of increasing screening by 10% (n = 14,364). Analysis of mammography results identified 331 new cases of breast cancer diagnosed within the allotted period, a 7% mean diagnosis rate increase. Certain planned interventions were unable to be conducted and required modification due to limitation of the ongoing pandemic;however, this solidified the use of social media and virtual participation as effective methods of community outreach. Conclusions: We identified key methods to engage the local community and successfully increased rates of screening mammography. Interventions were tailored to the local population, ensuring patient-centered tools and a personalized approach to medicine. The multidisciplinary, consistent collaboration with stakeholders ensured quality of care for the local patient population. This project demonstrates the importance of local community engagement to impact national cancer screening rates, and thus, ensure earlier detection of breast cancer. .