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Lack of access to cancer prevention education, early screening, and timely treatment, particularly in low socioeconomic, underserved communities, are cited as substantial barriers to improving survivorship. Outreach educational efforts with on-site screenings offered in partnership with community groups are known to be valuable in encouraging community members' uptake of healthy behaviors and adherence to screening recommendation. To create more engaging events, a community-academic partnership, We Engage 4 Health (WE4H), co-created 11 unique 4-panel comic-style stories designed to be read aloud together as attendees visit each event table. These colorful stories are shared on boards that stand on each table and are offered in both English and Spanish at this time. Many tables also have an accompanying hands-on activity. Together, they lead to meaningful "low stakes" discussions which support understanding of seemingly complex health information. Story topics include the cause of cancer (Cells Gone Wrong), cancer risk factors (Reducing Your Risk), the role of primary care in cancer screening (Primary Care for Prevention), the purpose of research (short Research Ready) and details about specific cancer types (Combatting Colon Cancer, Blocking Breast Cancer, Looking for Lung Cancer, Silencing Skin Cancer, Hindering HPV, and Professional Prostate Protection) and COVID-19 (Take Your Best Shot FAQs). A health passport is used to facilitate table visitation and survey collection at each table enables meaningful evaluation of the event as well as provides the community hosts and their partners baseline cancer data to inform future programing. In 2022, WE4H and the University of Cincinnati Cancer Center partnered with three different communities to co-host pilot events that served over 100 adult residents. Community, research interns and university students volunteered to work the tables at the event and received training prior. Post event surveys and discussions indicated that community partners appreciated the different take on a health fair event. Most volunteers indicated that they would enjoy volunteering again. Attendees indicated that they liked the graphic-style story format used and most preferred it to text and text with graphics approaches. Taken together, the data indicates that Reducing Your Risk events are useful in meaningfully engaging hard to reach, at risk attendees. Additional in-person and virtual events are being planned for 2023 as an approach to reach the medically underserved throughout our region.
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The aim of this research is to describe the use of telemedicine applied to patients characterised by a particular state of illness, which often drives them toward a frail and chronic status, in a systematic manner. This work employed the Tranfield approach to carry out a systematic literature review (SLR), in order to provide an efficient and high-quality method for identifying and evaluating extensive studies. The methodology was pursued step by step, analysing keywords, topics, journal quality to arrive at a set of relevant open access papers that was analysed in detail. The same papers were compared to each other and then, they were categorised according to significant metrics, also evaluating technologies and methods employed. Through our systematic review we found that most of the patients involved in telemedicine programs agreed with this service model and the clinical results appeared encouraging. Findings suggested that telemedicine services were appreciated by patients, they increased the access to care and could be a better way to face emergencies and pandemics, lowering overall costs and promoting social inclusion.Copyright © 2022 Inderscience Enterprises Ltd.
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PURPOSE: There is little information as to how America's broadband infrastructure might impact recent efforts to expand access to virtual care for underserved communities. OBJECTIVE: To examine potential and realized access to broadband internet services within Medically Underserved Areas (MUAs) that rely on community health care service providers for primary care. METHODS: This cross-sectional study included 214,946 US Census Block Group estimates from the 2017 and 2019 American Community Survey and the corresponding Federal Communications Commission database. Changes in household broadband subscription rates and Healthy People 2020 access thresholds within MUAs were assessed. FINDINGS: In 2019, 24,304 MUA households (31.9%) met Healthy People 2020 targets for broadband subscription rates, compared to 64.4% of non-MUA households (n = 89,285). On average, 74.7% of MUA households had a broadband internet subscription compared to 85.2% of non-MUA households, whereas 61.1% (n = 46,635) of MUA households had access to broadband speeds of at least 25.0 Mbps, compared to 75.6% (n = 104,696) of non-MUA households. Within urban households, there was a 0.8 to 1.3 to 1.6 annual percentage point convergence in MUA versus non-MUA broadband disparities between across quintiles (P < .05). Rural MUA households showed little improvement in broadband access between 2017 and 2019. CONCLUSIONS: There has been an overall convergence of broadband access disparities between MUA and non-MUA households over time, but less improvements in access among the most rural households. Reimbursement for audio-only telehealth visits by state Medicaid agencies would help drive down barriers to virtual health care options for populations residing in MUAs.
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Medically Underserved Area , Telemedicine , United States , Humans , Cross-Sectional Studies , Delivery of Health Care , Rural PopulationABSTRACT
While several studies have documented the rapid growth in telehealth visits during the pandemic, none have examined its relationship with greater overall access to care among vulnerable populations. We use Association of American Medical Colleges' Consumer Survey data to examine the relationship between access to care and telehealth use before and during the pandemic. The proportion of survey respondents who were always able to get medical care when needed was slightly lower in 2020 compared with prior years while telehealth use rose dramatically. Disparities in telehealth use for Medicaid beneficiaries and rural respondents disappeared during the pandemic, but remained for lower-income populations. Before the pandemic, telehealth use was associated with greater access, but not during the pandemic—when it appears to have become a substitute for in-person. After the pandemic, telehealth could once again be an opportunity to supplement access to care, if telehealth policies enacted during the pandemic are made permanent.
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Health professionals are increasingly using digital technology as a strategy to maximize community engagement and effectively implement health interventions, a phenomenon evidenced by the COVID-19 pandemic. While technology has improved health information dissemination, communication, and data management, it cannot replace the human-based interactions offered by traditional grassroots outreach that can influence long-term health behavior change, particularly for underserved communities. Digital community engagement can be part of the digital divide, often widening disparities by excluding those without access or limited access to technology. It may hinder the accurate collection of contextual and comprehensive data needed to analyze social determinants of health, thereby widening the equity gap. This commentary explores the challenges of using digital technology and justifies leveraging it to complement traditional community engagement rather than as a replacement.
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This paper examines the efficacy of telemedicine (TM) technology compared to traditional face-to-face (F2F) visits as an alternative healthcare delivery service for managing diabetes in populations residing in urban medically underserved areas (UMUPAs). Retrospective electronic patient health records (ePHR) with type 2 diabetes mellitus (T2DM) were examined from 1 January 2019 to 30 June 2021. Multiple linear regression models indicated that T2DM patients with uncontrolled diabetes utilizing TM were similar to traditional visits in lowering hemoglobin (HbA1c) levels. The healthcare service type significantly predicted HbA1c % values, as the regression coefficient for TM (vs. F2F) showed a significant negative association (B = −0.339, p < 0.001), suggesting that patients using TM were likely to have 0.34 lower HbA1c % values on average when compared with F2F visits. The regression coefficient for female (vs. male) gender showed a positive association (B = 0.190, p < 0.034), with HbA1c % levels showing that female patients had 0.19 higher HbA1c levels than males. Age (B = −0.026, p < 0.001) was a significant predictor of HbA1c % levels, with 0.026 lower HbA1c % levels for each year's increase in age. Black adults (B = 0.888, p < 0.001), on average, were more likely to have 0.888 higher HbA1c % levels when compared with White adults.
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Improving the protection of the right to health of ethnic Roma people is one of the most pressing public health challenges in contemporary Europe, as their life expectancy and health status remain significantly lower than their non-Roma counterparts. This paper analyzes Roma-led accountability initiatives that embrace social accountability and legal empowerment approaches to advocate for equitable fulfillment of the right to health. While these initiatives have led to the elimination of some harmful health practices (such as illegal cash bribes and violent and abusive treatment by medical professionals) and to improvements in health care, and some Roma communities have become driving forces for local and national health system reforms for advancing the fulfillment of health rights, the health inequalities affecting Roma communities remain significant. This issue also remains largely overlooked by European health research and policy experts, who are mostly reluctant to incorporate analyses of ethnicity and racialization into their research on health inequalities in Europe. The COVID-19 pandemic has further exacerbated these health inequalities.
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BACKGROUND: The supply of obstetrician-gynecologists and gynecologic oncologists across the United States has been described. However, these studies focused on reproductive-age patients and did not assess the growing demand for services to the advanced-age female population. OBJECTIVE: This study aimed to evaluate the supply of obstetrician-gynecologists and gynecologic oncologists who serve the US Medicare population per 100,000 female Medicare beneficiaries, over time and by state and region. STUDY DESIGN: The supply of obstetrician-gynecologists and gynecologic oncologists was extracted from the Physician and Other Supplier Public Use File database of Medicare Part B claims submitted to the US Centers for Medicare & Medicaid Services. Data were only available from 2012 to 2019. The supply of providers was divided by the number of original female Medicare beneficiaries obtained from the Kaiser Family Foundation; all values reported are providers per 100,000 female beneficiaries by state. Trends over time were assessed as the difference in provider-to-beneficiary ratio and the percentage change from 2012 to 2019. All data were collected in 2021. All analyses were performed with SAS, version 9.4. This study was exempt from institutional review board approval. RESULTS: In 2019, the average number of obstetrician-gynecologists per 100,000 female beneficiaries across all states was 121.32 (standard deviation±33.03). The 3 states with the highest obstetrician-gynecologist-to-beneficiary ratio were the District of Columbia (268.85), Connecticut (204.62), and Minnesota (171.60), and the 3 states with the lowest were Montana (78.37), West Virginia (82.28), and Iowa (83.92). The average number of gynecologic oncologists was 4.48 (standard deviation±2.08). The 3 states with the highest gynecologic oncologist-to-beneficiary ratio were the District of Columbia (11.30), Rhode Island (10.58), and Connecticut (9.24), and the 3 states with the lowest were Kansas (0.82), Vermont (1.41), and Mississippi (1.47). The number of obstetrician-gynecologists per 100,000 female beneficiaries decreased nationally by 8.4% from 2012 to 2019; the difference in provider-to-beneficiary ratio from 2012 to 2019 ranged from +29.97 (CT) to -82.62 (AK). Regionally, the Northeast had the smallest decrease in the number of obstetrician-gynecologists per 100,000 female beneficiaries (-3.8%) and the West had the largest (-18.2%). The number of gynecologic oncologists per 100,000 female beneficiaries increased by 7.0% nationally during the study period; this difference ranged from +8.96 (DC) to -3.39 (SD). Overall, the West had the smallest increase (4.7%) and the Midwest had the largest (15.4%). CONCLUSION: There is wide geographic variation in the supply and growth rate of obstetrician-gynecologists and gynecologic oncologists for the female Medicare population. This analysis provides insight into areas of the country where the supply of obstetrician-gynecologists and gynecologic oncologists may not meet current and future demand. The national decrease in the number of obstetrician-gynecologists is alarming, especially because population projections estimate that the proportion of elderly female patients will grow. Future work is needed to determine why fewer providers are available to see Medicare patients and what minimum provider-to-enrollee ratios are needed for gynecologic and cancer care. Once such ratios are established, our results can help determine whether specific states and regions are meeting demand. Additional research is needed to assess the effect of the COVID-19 pandemic on the supply of women's health providers.
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In March 2020, the United States responded to the COVID-19 pandemic. With this response of quarantining, social distancing, and other precautions, a need to ensure that access to healthcare occurred. Technology in the form of telemedicine and virtual visits addresses this need. Patients can use telemedicine and virtual healthcare services to improve convenience, improve access, and reduce other healthcare and pharmacy service barriers. The continuation and expansion of telemedicine and virtual visits in the practice of pharmacy provide more equitable access to healthcare and offer solutions to health disparities concerning language barriers and cultural differences, provided practitioners utilize effective communication. Copyright © 2022, Jobson Publishing Corporation. All rights reserved.
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Background: Parkinson's disease is the second most common neurodegenerative disorder and presents with a heterogeneous group of symptoms. Managing these symptoms requires coordinated care from a neurology specialist and a primary care provider. Access to neurology care is limited for those patients with Parkinson's disease who reside in rural areas given financial and mobility constraints along with the rarity of specialty providers. Methods: To close this gap, we developed and implemented a telehealth-based Project ECHO® (Extension for Community Healthcare Outcomes) program, "Parkinson ECHO," to provide education and support for rural clinicians and allied health members. The sessions focused on a topic within Parkinson's disease diagnosis or management followed by case discussions. We assessed the feasibility of this tele-mentoring educational offering, the favorability of this approach, and the effect it had on clinician confidence in diagnosing and treating Parkinson's disease using Likert-based surveys. Results: Thirty-three unique participants from 13 Oregon counties and one county in the state of Washington, of whom 70 % served rural and/or medically underserved communities, participated in Parkinson ECHO. There was a 52 % dropout rate based on survey response, though session attendance was higher. Participants were overall satisfied with the format and content of Parkinson ECHO. There were improvements in knowledge and confidence in diagnosing and treating Parkinson's disease which persisted 6 months following the conclusion of the program. Unexpectedly, two participants reported convening a multidisciplinary group to discuss improvements to PD care. Conclusion: The COVID-19 pandemic was an unexpected obstacle, but the teleconference nature permitted us to complete the program to positive effect. We found Parkinson ECHO did significantly increase participant confidence levels in diagnosing and managing Parkinson's disease.
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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.
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STATEMENT OF PROBLEM/QUESTION: While telemedicine has been adopted in the ambulatory setting, various provider-level barriers remain DESCRIPTION OF PROGRAM/INTERVENTION: The COVID-19 pandemic prompted an exponential increase in the use of telemedicine, allowing safe and reliable access to ambulatory healthcare services for patients. RyanAdair is a federally qualified health center in New York City which also serves as the primary care practice site for our internal medicine residents. Telemedicine services were adopted and implemented at Ryan Adair in March 2020. Gradually, as in-person visits were re-introduced there was a 36% drop in televisits. We aim to identify some of the physician-perceived barriers to telemedicine use in an attempt to improve its utilization. MEASURES OF SUCCESS: This cross-sectional, single-site initiative is part of a larger effort to identify access to primary care among a medically underserved patient population. To understand the challenges and attitudes toward telemedicine, we surveyed residents in all 3 academic years (PGY1, PGY2, PGY3), preceptors, and ancillary staff at the site who provided these services. A link to an electronic survey was emailed to the physicians and a copy of the link via QR code was posted at the clinic documentation rooms with a goal to obtain a 40% response rate. The surveys are anonymous and voluntary, and all the data was devoid of any personal identifiers. FINDINGS TO DATE: 38.8% (n=61) of providers responded, with 78.7% (n= 48) of providers surveyed having conducted at least one televisit. 42.6% (n=26) of the providers surveyed were more comfortable with an in-person visit compared to a televisit. Among those who had conducted a televisit, the major barrier identified was limitations of physical exam 77% (n=47), followed by patient's inability to navigate the software for a video visit 70.5% (n=43), and provider's challenges with the software/accessories onsite 55.7% (n=34). 32.7% (n= 20) of providers mentioned that most of the time or occasionally they were not confident in their ability to conduct a video visit. 92% felt that they would like to continue telemedicine post-pandemic. KEY LESSONS FOR DISSEMINATION: Based on our survey, the main provider-perceived barriers to telemedicine use at an urban federally qualified health center were 1. limitations of the physical exam 2. inadequate patient access to needed technology, and 3. provider comfort with televisit navigation on-site. Whether these are true barriers or simply perceived barriers of the providers surveyed requires further investigation. Future directions include conducting qualitative focus groups with patients and incorporating formal telemedicine teaching and education as a part of resident training.
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STATEMENT OF PROBLEM/QUESTION: Even though they face a higher risk of COVID-19-related morbidity and mortality, racial and ethnic minorities in the Greater Boston area have had less access to COVID-19 testing and vaccinations. DESCRIPTION OF PROGRAM/INTERVENTION: We implemented a novel, community-based mobile health unit program by repurposing transportation vans with COVID-19 testing equipment, preventive hygiene kits, and mRNA vaccines. Our goal was to expand testing and vaccine availability in highly affected communities in the Greater Boston area. We used a “double equity” model by hiring workers from a local transportation company whose staff were at risk of unemployment. The vans were staffed with racially/ ethnically diverse and multilingual staff, including members of the target communities themselves. We incorporated a system of “trusted messengers” to answer questions about COVID-19 and in particular, vaccination from the community. We implemented this program with crucial input from community-based organizations and municipal public health departments. Van location sites were guided by community partners, in some cases incorporating SARS-CoV-2 wastewater surveillance data to meet rapidly changing community needs. MEASURES OF SUCCESS: Our goals were to (1) demonstrate the feasibility of a COVID-19 testing program guided by community partnerships and SARS-CoV-2 wastewater surveillance data;(2) improve access to COVID-19 testing in underserved communities;and (3) improve access to COVID-19 vaccination among racial/ethnic minorities. We collected ongoing feedback (e.g. through the local community advisory groups etc) on the mobile health program from community partners, patients, and staff. We compared sociodemographic characteristics of mobile health participants with the general population of the state of Massachusetts and the population of the target communities. FINDINGS TO DATE: From January 2021 - January 2022, our mobile health units have tested greater than 4500 persons in predominantly low socioeconomic communities that have been highly impacted by the pandemic. From May 2021 - January 2022, we vaccinated 5480 persons in these communities. An analysis of our program from January 2021 - January 2022 demonstrated that mobile health unit participants receiving COVID-19 vaccines were significantly more likely to be non-White and Hispanic compared with the general vaccinated population of the state of Massachusetts and of the target communities, and these findings were statistically significant. We also found that the mobile health units vaccinated more youth and adolescents in the target community compared with the general state vaccination data. KEY LESSONS FOR DISSEMINATION: Delivery of preventive COVID19 care via mobile health units is feasible and associated with high usage from affected communities when implemented with high stakeholder engagement and expertise from local public health departments. Employing diverse, multilingual, and well-trained healthcare staff as trusted messengers likely improved COVID-19 vaccine uptake in this population.
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Individuals testing positive for BRCA1/2 genetic mutations, or hereditary breast and ovarian cancer mutations, are 33-55% more likely than women without these mutations to develop breast and/or ovarian cancers before the age of 70. While research involving these genetic mutations continues to emerge, there remains unanswered questions regarding prophylactic experiences and subsequent impacts on mental health within subgroups of BRCA1/2-positive women. The purpose of this analysis was to explore the impact of BRCA1/2 mutations, prophylactic surgeries, and surveillance regimens within the scope of everyday life within a sample of BRCA1/2 positive women from medically-underserved backgrounds living in the United States (US). A sample of 211 US adult women who have tested positive for BRCA1/2 mutations within the past 5 years and who identify with one or more medically-underserved populations (racial, ethnic, or sexual minority, person with a physical disability, chronically-ill, those in poverty, immigrant populations) elucidated compelling qualitative data. A total of 169 (80.1%) women completed open-ended questions at the end of the online survey. Thematic analysis was utilized to identify themes and subthemes concerning mental health, sources of stress, and methods of stress relief. The focus of the current analysis is on the sources of stress identified by the respondents. Fourteen subthemes were identified. The four most common stressors were concerns about post-treatment recovery (19% of respondents), recurrence of a new cancer (15%), medical unknown of having a genetic mutation that increases the risk of cancer (14%), and having to schedule and plan for continual surveillance (12%). The next five subthemes ranged from 7-9% and include waiting for medical results, personal finances and covering medical expenses, impact of the COVID-19 pandemic, pre-operative anxiety, and worrying about insurance coverage. Our findings support previous research on cancer stressors for women while adding important qualitative elements for a richer understanding. Furthermore, since much of the research on the lived experiences of BRCA1/2 has been on highly-educated, non-Hispanic white women, few studies have focused entirely on medically-underserved populations, which was the entirety of our sample. This work adds an important intersectional lens in which to better understand the experiences of living with a BRCA1/2 mutation.
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Background Influenza vaccine hesitancy rates are increasing in the United States, even as influenza infection accounts for significant pediatric morbidity and mortality. Disinformation and controversy surrounding COVID-related public health protections and SARS-CoV-2 vaccine roll-out may have unintended consequences that impact pediatric influenza vaccination. We sought to assess influenza vaccination rates before and during the COVID-19 pandemic in one pediatric primary care center (PPCC), which serves a predominantly Medicaid-insured, minoritized population. Method A cross-sectional study assessed influenza vaccination rates for children aged 6 months to 12 years (~17,000 patients) over influenza seasons (September-March): 1) 2018-19 and 2019-20 (pre-pandemic rates), and 2) 2020-21 and 2021-22 (intra-pandemic rates). Demographic characteristics and social risk questionnaires (e.g. food and housing insecurity, transportation and public benefit issues, etc.) were pulled from PPCC electronic medical record data. Total tetanus vaccinations during each influenza season were used as a comparison for general vaccination rates, as clinic visits varied due to COVID-related shutdowns. Generalized linear regression models with robust standard errors (SEs) evaluated differences in demographics, social factors, and influenza vaccination rates by influenza season by specifying an appropriate distribution and link function for each factor. In a subgroup of patients with clinic visits in 2018-19 and 2020-21, influenza vaccine rates were compared using the McNemar test. Multivariable logistic regression with robust SEs evaluated associations between influenza season, demographic characteristics, reported social risks, and influenza vaccination. Results The percentages of patients receiving influenza vaccinations by influenza season are depicted in Table 1. Pre-pandemic, 42% of patients with a clinic visit were vaccinated (2019-20), and this rate decreased to 30% by 2021-22 during the pandemic. Both influenza and tetanus vaccinations significantly differed across influenza seasons, with lower uptake during the COVID-19 pandemic (p < 0.01, Table 1). Both mean age (5.5, 5.7, 6.0, and 6.2 years for the 2018-19, 2019-20, 2020-21, and 2021-22 influenza seasons, respectively) and positive social risk screens (13%, 22%, 25%, 27% for the 2018-19, 2019-20, 2020-21, and 2021-22 influenza seasons, respectively) significantly increased across influenza seasons (p < 0.01). Of a subset of 1629 patients with clinic visits in both 2018-19 and 2021-22 seasons, 42% received the influenza vaccine in 2018-19, but only 30% have received the vaccine in 2021-22 (McNemar's test, p < 0.01). In a multivariable regression model, the 2020-21 (OR 0.88 [0.82-0.94]) and 2021-22 (OR 0.68 [0.62-0.74]) influenza seasons, age (OR 0.98 [0.97-0.99]), black race (OR 0.58 [0.54-0.62]), and self-pay (OR 0.84 [0.72-0.99]) were associated with influenza vaccine refusal (p < 0.05). Conclusion Influenza vaccination rates within one PPCC decreased over the years of the COVID-19 pandemic and have not rebounded. New interventions to promote influenza and possibly other vaccines are needed to improve evidence-based child health measures.
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Objective: Pancreatectomies are technically challenging procedures frequently associated with morbidity and mortality. Nonetheless, pancreatectomies are the only potentially curative treatment for pancreatic cancer. The aim of this study is to compare the clinical and cost outcomes of patients undergoing pancreatectomy for treatment of pancreatic cancer at our institution against national benchmarks of large, specialized complex care medical centers (LSCMCs) and safety-net hospitals (America's Essential Hospitals, AEHs). Methods: The Vizient Clinical Data Base was queried for all participating institutions performing any type of pancreatectomy for pancreatic cancer for adults over the age of 18 from 2018-2020. Institution-level clinical and cost outcomes were compared across our institution, LSCMCs, and AEHs. Clinical outcomes included hospital length of stay (LOS) index, 30-day mortality index, case mix index (CMI), and percentage of 30-day readmissions. Cost outcomes comprised the direct cost index. LOS, mortality, and direct cost indices were defined as the ratio of observed values to expected values, derived from the Vizient comparison hospitals. Indices with a value greater than one indicated the observed value was greater than the expected comparison value for that measure. Continuous variables were summarized as weighted means and standard deviation. Continuous measures were analyzed by the twosample t-test or Mann-Whitney U test, as appropriate. P-values with α<0.05 defined statistical significance. Results: A total of 78 LSCMCs and 52 AEHs performed 6,795 pancreatectomies from 2018-2020. Our institution performed a total of 90 pancreatectomies during this period. LOS index was below national benchmarks at our institution (1.08-0.82), LSCMCs (0.91-0.85), and AEHs (0.94-0.93), with an increasing CMI at our institution (3.33-4.20) from 2018-2020. The mortality index declined at our institution (5.07-0.00) below national benchmarks compared to LSCMCs (1.23-1.29) and AEHs (1.19-1.45). 30-day readmissions were lower at our institution (6.25-10.26%) compared to LSCMCs (17.62-16.83%) and AEHs (18.93-15.51%). Direct cost index at our institution declined (1.00 to 0.67) below the benchmark compared to LSCMCs (0.90-0.93) and AEHs (1.02-1.04). Conclusion: From 2018-2020, clinical and cost outcomes after pancreatectomies for pancreatic cancer at our safety-net hospital are comparable to peer LSCMCs and AEHs. These outcomes have improved, exceeding national benchmarks despite an increasing CMI over this 3-year period. These findings are of particular importance given the growing reimbursement constraints coupled with the strain of the COVID-19 pandemic on the health care system. This study highlights the role of LSCMCs and safety-net hospitals in providing high-quality care to a medically underserved population requiring complex surgery. (Figure Presented)