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1.
SSM Qual Res Health ; : 100140, 2022 Jul 30.
Article in English | MEDLINE | ID: covidwho-1967154

ABSTRACT

Antigen-based rapid diagnostic tests (RDTs) for SARS-CoV-2 have good reliability and have been repeatedly implemented as part of pandemic response policies, especially for screening in high-risk settings (e.g., hospitals and care homes) where fast recognition of an infection is essential, but evidence from actual implementation efforts is lacking. We conducted a qualitative study at a large tertiary care hospital in Germany to identify step-by-step processes when implementing RDTs for the screening of incoming patients, as well as stakeholders' implementation experiences. We relied on 30 in-depth interviews with hospital staff (members of the regulatory body, department heads, staff working on the wards, staff training providers on how to perform RDTs, and providers performing RDTs as part of the screening) and patients being screened with RDTs. Despite some initial reservations, RDTs were rapidly accepted and adopted as the best available tool for accessible and reliable screening. Decentralized implementation efforts resulted in different procedures being operationalized across departments. Procedures were continuously refined based on initial experiences (e.g., infrastructural or scheduling constraints), pandemic dynamics (growing infection rates), and changing regulations (e.g., screening of all external personnel). To reduce interdepartmental tension, stakeholders recommended high-level, consistently communicated and enforced regulations. Despite challenges, RDT-based screening for all incoming patients was observed to be feasible and acceptable among implementers and patients, and merits continued consideration in the context of rising infections and stagnating vaccination rates.

3.
Inf Sci (N Y) ; 609: 1181-1203, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1966645

ABSTRACT

This study demonstrates the major role played by the healthcare and pharmaceutical industries during the COVID-19 pandemic. For this purpose, it provides evidence of a better risk-return relationship in these sectors through a multivariate study of monthly frequency. A global and dynamic ratio is developed to summarize different investor profiles according to their attitude toward risk and to consider the dynamic and changing nature of the economy and financial markets. This global ratio synthesizes the information from different orders of Kappa indices and Farinelli-Tibiletti ratios into a single measure. Additionally, we verify that Principal Component Analysis allows summarizing the information contained in the initial variables from the first new component. Our findings confirm that a filtering asset screening rule strategy is relevant and necessary. In this respect, passive management of midterm equal-weighted pharmaceutical portfolios outperforms both the pure financial and the healthcare investment strategies used during the pandemic.

4.
J Cancer Res Clin Oncol ; 2022 Jul 29.
Article in English | MEDLINE | ID: covidwho-1966142

ABSTRACT

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic is posing unprecedented challenges for patient care, especially for cancer patients. This study looks at asymptomatic (AS) COVID-19 positivity in cancer patients and its effects on their care. METHODS: We conducted a retrospective chart review of AS patients testing positive for COVID-19 upon screening at Fox Chase Cancer Center between January 2020 and September 2020. Relationships between positive tests and demographics, clinical characteristics, and treatment delays were investigated using conditional logistic regression or Mantel-Haenszel tests. RESULTS: Among 4143 AS patients who underwent COVID-19 testing, 25 (0.6%) were COVID-19 positive (cases) and these were matched to 50 controls. The median age was lower in the cases compared to that of the controls (64 vs 70 years old, p = 0.04). Of the cases, 10 patients (40%) never underwent their planned oncologic intervention [6/10 (60%) did not require the planned intervention once deemed okay to proceed]. Of the controls, only 1 patient (2%) did not undergo the planned intervention. Of these 15 COVID-19 positive patients who underwent the planned intervention, 11 (73.3%) had a delay related to COVID-19, with a mean delay duration of 18 days (range: 0-49, SD: 16.72). CONCLUSION: Cancer patients had lower incidence of AS COVID-19 than general population. Delays that occur due to AS COVID screening are not very long and serve as a tool to limit spread of virus. Further studies will be important in addressing delays in cancer care and concerns of patient safety as the pandemic continues.

5.
Journal of Hepatology ; 77:S240-S241, 2022.
Article in English | EMBASE | ID: covidwho-1967503

ABSTRACT

Background and aims: Canada is currently on target to reach the 2030 WHO goal of HCV elimination. Continued high rates of treatment initiation are required to meet this goal. Novel models have proven successful to engage populations who use drugs (PWUD) in HCV therapy with a simplified, task-shifted cascade of care: Tayside, Scotland pharmacy-based HCV screening and treatment has demonstrated excellent outcomes and progress towards local HCV elimination. The EPIC Study seeks to determine whether pharmacybased treatment successes can be replicated at community pharmacies in Victoria BC. Method: Four community pharmacies known to work with PWUD and provide opioid agonist therapy (OAT) were provided training sessions to equip staff with a standardized tool kit of resources. In fall 2020, pharmacy staff were trained to provide verbal informed consent and perform point of care HCV OraQuick antibody screening. Pharmacies were supported by a study nurse to link to HCV RNA testing when antibody positive patients were identified, with initiation of HCV treatment offered to those found to be RNA positive. (Figure Presented) Figure: (: THU296): Antibody responses after the COVID-19 vaccination in patients with AILD and healthy controls. (A-B) The seropositivity rate (A) and titers (B) of anti-RBD-IgG in patients with AILD and healthy controls. (D-E) The seropositivity rate (D) and titers (E) of NAbs in patients with AILD and healthy controls. The distribution of anti-RBD-IgG (C) and NAbs (F) antibody titers over time in patients with AILD and healthy controls. AILD, autoimmune liver disease;anti-RBD-IgG, spike receptor-binding domain IgG antibody;NAbs, neutralizing antibodies. The study nurse worked with pharmacy staff to strategize adherence and support as needed by study subjects. Qualitative interviews have been conducted with five pharmacy staff to explore their experiences with testing and monitoring HCV treatment and the feasibility of involving pharmacists in the HCV care cascade. Results: To date pharmacy staff completed 171 HCV OraQuick tests finding 53 tested positive for HCV antibodies: 23 people were HCV RNA negative, (20 previously treated and 2 self-cleared), 8 unk/LTF. Of the 22 RNA positive participants, 1 is pending treatment start, 21 people have started treatment, with 8 achieving SVR. While great success has been achieved in treating identified people, less than half of projected OraQuick tests have been completed. Although the onset of the Covid 19 pandemic was a fundamental barrier incorporating HCV testing at pharmacies, stigma related to HCV and illicit drug use continues to impact this process. Pharmacists described feeling hesitant about approaching participants, especially after receiving negative responses from clients about HCV testing. Some worried their relationship would change with clients as asking about HCV implied risky drug use. Conclusion: This innovative and novel approach to HCV therapy in PWUD attempted to use a pharmacy-based approach to find people with limited connection to primary health care to test and treat HCV. Increased training of pharmacy staff related to stigma around drug use and HCV is required both before and ongoing for successful integration of pharmacy-led HCV testing and treatment in Canada.

6.
Gastroenterology ; 162(7):S-1044, 2022.
Article in English | EMBASE | ID: covidwho-1967403

ABSTRACT

Background: Colorectal cancer (CRC) screening is essential in preventive care (1, 2, 3). Societies, such as the American College of Gastroenterology (ACG) and the National Colorectal Cancer Roundtable (NCCRT), have a goal of reaching colorectal cancer screening rates of 80 % per community (4, 5). The screening rate in our clinic was 42.8 % in 2019;however, the majority of the residents were only offering invasive measures;such as colonoscopy. We aimed to improve the CRC screening rate by multiple modalities including;reeducating residents, implementing changes to the electronic medical record, and scheduling patients for wellness/preventative care visits to increase the colon cancer screening rate. Methods: Multiple methods were used as follows;An initial questionnaire to inquire about the CRC screening options given by the residents to the patient, then a didactic lecture to further explain different options, and a follow-up lecture in the clinic. Also, The Electronic medical record was adjusted to have a particular notification tab and preventive care options if the patient qualifies for CRC screening. The percent change, percent difference and the absolute difference were used to analyze the results. The Institutional Review Board approved this study. Results: CRC screening rates increased from 42.8% in 2019 to 67.4% in July 2020 with an absolute difference of 24.6, a percent difference of 44.65 %, and a percent change of 57.48 % (Figure 1). Discussion: Colonoscopy remains the gold standard for CRC screening;however other modalities are also approved including;stool testing and virtual colonoscopies (1, 2, 3, 6). Multiple societies in the United States have set a goal to reach 80% screening per community (4, 5). In 2019, the screening rate at our institution was 42.8 %. After noticing this, we decided to conduct this QI project to improve our screening rates. Our experience focused on a survey-based approach, mainly on assessing what residents offer for colon cancer screening, especially when the patients refuse colonoscopy as a form of screening (3). Residents were educated in their regular didactic sessions and with small seminars during their continuity clinic. Patient visits were also changed and focused on scheduling patients during regular wellness/preventative health care visits. Screening rates showed an absolute difference increase of 24.6 despite being affected by the COVID pandemic. We anticipate further increase in the following years and hopefully, we will reach the 80% screening goal of ACG and NCCRT (4, 5). Conclusions: Interventions that address root cause analysis and education continue to be the answer to most of our questions.(Figure Presented)

7.
Gastroenterology ; 162(7):S-1031, 2022.
Article in English | EMBASE | ID: covidwho-1967398

ABSTRACT

Background/Aim: It is easy to predict that the actual COVID-19 pandemic would have had a negative impact on cancer screening activities and the outcomes of screenings, but to date, real-time population-based evidence to substantiate this concern is very scarce. In this study, to understand the changes in the behavior and performance of CRC screening following the COVID-19 pandemic, the indicators of CRC screening processes and outcome measures were compared with both monthly data in 2019 and monthly changes focusing on the peaks that appeared in 2020. Method: This population-based nationwide study used fecal immunochemical test (FIT) and colonoscopy claims data from the Korean National Health Insurance System (NHIS) from 2019 to 2020. Data were analyzed from 15,867,759 subjects in 2019 and 16,155,930 subjects in 2020. We compared the data of CRC screening (FIT/ colonoscopy) of the COVID-19 pandemic period (2020) with those of the same period of 2019. Result: In the COVID-19 period, 3,445,660 (21.3%) subjects underwent FIT, whereas in 2019, 6,490,707 (40.9%) subjects performed FIT (almost 2-fold). Participation rate in colonoscopy after FIT positive fell in 2020 by 36.0% compared with the average rate recorded in 2019 (44.5%). In particular, it was confirmed that the participation rate of the CRC screening further decreased immediately after the COVID-19 peak periods (first and second wave: March 2020 and August 2020). Conclusion: The overall adherences to CRC screening tests decreased substantially during COVID-19 pandemic. Therefore, urgent modulation for not only easier access but also planning a restart for CRC screening is needed to address the growing burden of under-detected CRC in Korea.

8.
Gastroenterology ; 162(7):S-495, 2022.
Article in English | EMBASE | ID: covidwho-1967328

ABSTRACT

Background: Colorectal cancer (CRC) screening volume declined by as much as 90% during the coronavirus 2019 (COVID-19) pandemic. The incidence of new patient encounters for CRC also dropped during 2020. CRC screening delays due to COVID-19 have raised concerns about CRC disease upstaging through 2030. In addition to expanding fecal immunochemical testing (FIT) programs, efforts to systematically schedule patients at higher risk for CRC should be an essential mitigation strategy after COVID-19 delays. The effect of COVID-19 delays on CRC incidence remains unknown. Methods: We conducted a single-center, retrospective cohort study assessing incident CRC following COVID-related delays in colonoscopic procedures. COVID-19 pandemic was used as an independent exposure event, defined as “pre-COVID” (June 1, 2019 to August 31, 2019) and “COVID-delayed” (June 1, 2020 to August 31, 2020). The odds of a pathology-confirmed CRC diagnosis with staging were assessed. ANOVA, Chi-square test, and Fisher Exact Test, where necessary, were used to determine the unadjusted odds ratio (OR) with a 95% confidence interval (CI). Results: A total of 852 pre-COVID patients and 245 patients following COVID-scheduling delays underwent colonoscopy. The average age between cohorts was similar (pre-COVID 63.2+/- 10.5 vs. COVID-delayed 62.2 +/-12.6). About 90% of the patients were male, with about 63% self-identifying as White in both cohorts. An increased odds of CRC was detected in the COVID-delay period (9/245 CRC cases;3.7%), compared with the pre-COVID period (8/852 cases;0.9%;OR = 4.02;95% CI: 1.54-10.54). There was also a trend toward upstaging of disease with 55.5% of CRC diagnosed patients having Stage III/IV in the COVID-delayed period compared to only 25% having Stage III/IV disease in the pre-COVID period (p= 0.34). Conclusion: Colonoscopy delays imposed during the COVID-19 pandemic were associated with the postponement of critical CRC diagnoses. Increased use of FIT testing, along with ongoing optimization of colonoscopy triage strategies, are necessary to mitigate the effects of ongoing COVID pandemic-related CRC screening/surveillance scheduling delays

9.
Gastroenterology ; 162(7):S-490, 2022.
Article in English | EMBASE | ID: covidwho-1967325

ABSTRACT

Background: During the early stages of the SARS-CoV-2 pandemic, many endoscopic colorectal cancer (CRC) screening programs were temporarily halted, including at the Veteran's Administration (VA). The VA instituted triage and prioritization of endoscopic procedures, and fecal immunohistochemical testing (FIT) was recommended as the preferred CRC screening option over colonoscopy. We sought to determine impact of gastroenterologist (GI) recommendation to primary care providers (PCPs) to offer FIT testing to veterans who were referred for screening colonoscopy. Methods: Veterans referred for average risk screening colonoscopy, verified by GI chart review, between 3/11/2020 and 12/29/2020 at the VA Pittsburgh Health Care System (VAPHS) were included. Referring PCPs were sent standardized communication regarding assignment of a low priority to the screening colonoscopy request, and recommendation of FIT testing as the preferred CRC screening strategy. Recommendation was active, by requiring PCP acknowledgement of the FIT recommendation, or passive, by adding a comment to the procedure referral. We reviewed the charts of veterans to collect demographic information, then determine if FIT ordered, subsequently completed, or if colonoscopy was completed. Results: Eighty one screening colonoscopy requests were identified. Minimum follow-up from initial procedure consult order to chart review was 10 months with a median of 16 months. A total of 40 FIT were ordered (49.4%). Among those with FITs ordered, 24 (60.0%) were completed, 5 underwent screening colonoscopy (12.5%), and screening outcome was not available for 11 (27.5%). For veterans whom FIT was not ordered (n = 41), 15 (36.6%) underwent screening colonoscopy, and screening outcome was not available for 26 (63.4%). PCP ordering of FIT was not related to mean patient age (58.7 vs 57.2, p = 0.91), clinic location (academic urban vs urban vs satellite, c2 = 0.47), intervention type (active vs passive, c2 = 0.47), or phase of the pandemic (early vs late, c2 = 0.90). Overall veteran CRC screening completion was significantly greater for those whom FIT was ordered by their PCP vs those who did not have FIT ordered (72.5% vs 36.6%, c2 = 0.01). Conclusions: During the 2020 SARS-CoV-2 pandemic, when there were limitations on access to colonoscopy, gastroenterologist recommendation to PCPs to order FIT as an alternative to screening colonoscopy was successful half the time. FIT ordering was independent of veteran age, clinic location, intervention type, or pandemic phase. When ordered, veteran completion of FIT was 60%. There was wide variation in veteran CRC completion rate by PCP FIT ordering, suggesting either that FIT enhanced access to CRC screening, or, veteran factors influenced FIT ordering. This will inform future interventions aimed at increasing FIT utilization as an alternative to colonoscopy.(Figure Presented)

10.
Gastroenterology ; 162(7):S-462-S-463, 2022.
Article in English | EMBASE | ID: covidwho-1967307

ABSTRACT

Background: In COVID-19, hospitalized patients are at high risk for malnutrition upon admission due to intense catabolic processes coupled with comorbidities. Malnutrition has been strongly linked to adverse health economic outcomes in the hospital setting and society guidelines recommend early intervention to preserve lean body mass and mitigate adverse health economic outcomes. We have previously reported that malnourished African Americans (P=0.014) and females (P<0.001) were less likely to receive oral nutrition supplement (ONS) orders in a cohort of 8,713 adult malnourished patients hospitalized in a tertiary care center over a one-year period. We determined if there were disparities in the ordering of ONS in hospitalized COVID-19 patients during the height of the pandemic in 2020. Methods: This is a retrospective cohort study consisting of 3,431 COVID-19 adult (18 years and older) inpatient encounters at five Johns Hopkins affiliated hospitals between March 1, 2020, and December 3, 2020. Patients diagnosed with COVID-19 were identified as those who were assigned an ICD-10 billing code of U07.1 for COVID-19. Malnourishment among patients was identified as those who risk screen positive upon admission by use of the malnutrition universal screening tool (MUST) and confirmed by registered dietitians. Patient feeding status was identified as those who had a record of diet orders placed. Patient data was derived from JH-CROWN: The COVID-19 Precision Medicine Analytics Platform (PMAP) Registry and extracted using Python 3, version 3.7.5, kernel in JupyerLab, version 1.1.4. Statistics were conducted with SAS (version 9.4) software to examine the effect of malnutrition on mortality and hospital length of stay among COVID-19 inpatient encounters while accounting for possible covariates. Results: Older patients were more likely to have received ONS (P<0.001) (Table 1). Patients with diabetes (P=0.0410), hypertension (P=0.0296), COPD (P=0.0013), and malnutrition (P=0.0106) were also more likely to have received ONS (Table 1). Males were more likely to receive ONS than females (0.0089) (Table 1). Whites were more likely to receive ONS than Blacks, Asian, or Other races (P=0.0037) (Table 1). In the logistic regression model, females (P=0.0079), blacks (P=0.0026), and Other races (P=0.0143) were less likely to receive ONS (Table 2). Patients with diabetes were more likely to receive ONS (P=0.0255) (Table 2). Older (P=0.059) patients and those with COPD (P=0.0709) are suggestive of an increased likelihood of receiving ONS (Table 2). Conclusions: Gender and race disparities exist in the ordering of ONS was in a robust cohort of COVID-19 adult inpatients from five US hospitals. Further studies should be conducted to determine if there is a widespread racial and gender bias in the ordering of ONS.(Table Presented)(Table Presented)

11.
Gastroenterology ; 162(7):S-309, 2022.
Article in English | EMBASE | ID: covidwho-1967296

ABSTRACT

Introduction Faecal immunochemical test (FIT) has been introduced as an effective screening test for colorectal cancer in the general population and colonoscopy is the gold standard test for confirmation of colon cancer. Due to the emergence of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic, endoscopy services were severely reduced to emergency only in order to minimise COVID-19 infection spread throughout the world. Subsequently, FIT has been used as a triage tool to refer urgently (2 week wait cancer pathway) along with other alarm symptoms, e.g. anaemia, weight loss and change in bowel habit;to endoscopy services in the UK. The aim of this study was to determine the diagnostic efficacy of FIT in colorectal disease within a London based district general hospital. Secondary aims including assessing whether FIT has any diagnostic efficacy in inflammatory bowel disease (IBD). Methods From March to December 2020 all cases referred to the 2 week wait cancer pathway were analysed. The FIT score as well as well as presenting alarm symptoms were recorded prior to further investigation. The post colonoscopy outcome was also recorded to assess which patients were diagnosed with Colo-rectal cancer. Results There were 386 cases referred under 2 weeks wait cancer pathway. Of them 137 had positive FIT (>10 microgram/gram). Only 12 of those had colorectal cancer diagnosed on colonoscopy (8.8%). Median age of 68.5 (the range 44- 90 years), 58 % female and 42% were male respectively. The sensitivity of FIT in colorectal cancer diagnosis was 90% with a specificity of 48%, positive predictive value (PPV) was 6% and negative predictive value (NPV) 99%, However, out of 137 FIT positivity, there were 14 cases diagnosed inflammatory bowel disease (IBD, 13 Ulcerative colitis and 1 Crohn's disease). The sensitivity of FIT in diagnosing IBD was 93%, and specificity was 49% The PPV is 8% and NPV 99%. The Median age 56 (range 25-82 years), 57% were male and 43% were female. Those with a positive FIT and new IBD diagnosis appeared to be a younger, male dominant group. Conclusion FIT is a useful Colo-rectal cancer screening tool within the general population though its diagnostic yield is low. Its use has dramatically increased throughout the pandemic allowing a release of pressure off 2 week wait services with fewer referrals in FIT negative patients. Using FIT as a rule out method should be approached with caution as it is clear some Colo-rectal malignancies can present as FIT negative. FIT may also have a potential in assisting the diagnosis of IBD, in particular ulcerative colitis, within a younger group of the population though remains inferior to faecal calprotectin. Judicious use of the FIT in specific age groups is recommended in order to minimise both patient and practitioner anxiety and unnecessary referral.

12.
Gastroenterology ; 162(7):S-306, 2022.
Article in English | EMBASE | ID: covidwho-1967294

ABSTRACT

Background: Ontario Health (Cancer Care Ontario) oversees ColonCancerCheck (CCC), Ontario's population-based organized colorectal cancer (CRC) screening program. CCC recommends average risk screening with the fecal immunochemical test (FIT), but colonoscopy is available opportunistically. A central lab mails FIT kits directly to people upon request from care providers. CCC's recommendations are promoted centrally with Regional Cancer Programs and regional clinical leaders. At the start of the COVID-19 pandemic, FIT kit mailing and mailed letters to invite/remind people to screen were paused. Colonoscopy capacity varied with the waves of the pandemic depending on local factors. Subsequently, CCC gradually implemented recovery activities, such as resuming FIT kit and letter mailing, and provided guidance on screening prioritization, which included conversion of low yield colonoscopy to FIT. Aim: To understand the impact of COVID-19 on CRC screening in Ontario across four periods: pre-, early-, mid- and late-COVID-19. Methods: We compared key performance indicators over time: percent overdue for CRC screening, FIT requisition volumes, FIT requisition rejection rates, FIT kit return rates, colonoscopy volumes and colonoscopy wait times. Results: Comparing pre- to late-COVID-19 periods, the percent of people overdue for CRC screening increased (39.5% vs. 43.1%). An increase in FIT participation was observed, with greater volumes of FIT kits being requested (101,925 vs. 119,113 per month) and improved FIT kit return rates (54.7% vs. 60.8%). However, FIT requisition rejection rates also increased (5.7% vs. 15.0%). Overall colonoscopy volumes declined (24,432 vs. 21,317 per month), with decreases in average risk screening colonoscopy (15.5% vs. 9.9%). The proportion of people getting a colonoscopy within 8 weeks of an abnormal FIT result improved (81.2% vs. 83.5%). Interpretation: While screening performance declined at the start of the pandemic, as screening activities resumed, it has improved in key areas, even exceeding pre-COVID metrics: greater FIT participation, a reduction in average risk screening colonoscopies, and improved colonoscopy wait times for abnormal FIT. Fewer patient-provider interactions and participant reluctance to seek healthcare may have led to an increase in the number of people overdue for CRC screening. CCC's centralized approach to FIT distribution and its pandemic response, including consistent messaging and a regional infrastructure, facilitated the uptake of pandemic guidance and may have led to improved performance. Conclusions: These results suggest that there are opportunities for organized screening programs to improve performance during times of crisis. Sustaining these program performance improvements post-pandemic is essential if CRC screening participation is to return to pre-pandemic levels. (Table Presented)

13.
Gastroenterology ; 162(7):S-304, 2022.
Article in English | EMBASE | ID: covidwho-1967293

ABSTRACT

Background The COVID-19 pandemic led to significant alterations in the delivery of cancer screening. The resulting decrease in outpatient visits and cancellations of non-urgent procedures have negatively affected colorectal cancer (CRC) screening, though the impact on different types of healthcare systems remains unclear. We aimed to quantify and compare the effect of the first wave of the pandemic on CRC screening uptake at a safety-net hospital and a private health system based in New York City (NYC). Methods In this retrospective study, we identified individuals aged 50 to 75 years presenting for outpatient care at a safety-net public hospital (Bellevue Hospital) and private health system (NYU Langone Health) in March through September of 2019 and 2020 (first wave of the pandemic in NYC). We excluded those who were up-to-date with CRC screening before each study period or had a prior diagnosis of CRC, hereditary cancer syndrome, inflammatory bowel disease, or colectomy. The primary outcome was the proportion of screening-eligible patients seen in the outpatient setting who underwent CRC screening. Results The safety-net hospital had a total of 9,569 outpatient visits in 2019 and 7,280 in 2020. Overall, 552 (5.8%) and 289 (4.0%) screening tests were completed in 2019 and 2020, respectively (p < 0.01). Of these, there were 382 (69.2%) fecal immunochemical tests (FIT) in 2019 and 256 (88.6%) in 2020 (p < 0.01). For individuals who had positive FIT results, 17.2% in 2019 and 25.0% in 2020 had colonoscopy follow-up within 6 months (p = 0.62). A total of 5 and 3 cases of CRC were diagnosed in 2019 and 2020, respectively. In the private health system, there were 99,889 visits in 2019 and 33,849 in 2020. Overall, 658 (0.66%) and 250 (0.74%) completed screening tests in 2019 and 2020, respectively (p = 0.13). Of the screening tests, 518 (78.7%) were FIT in 2019 and 206 (82.4%) were in 2020 (p = 0.22). Of the positive FIT results, 29.4% in 2019 and 27.0% in 2020 had colonoscopy follow-up within 6 months (p = 0.80). A total of 97 and 43 CRC cases were diagnosed in 2019 and 2020, respectively. Conclusion In our study of a safety-net hospital and a private health system in NYC, outpatient volume and absolute numbers of screening tests and CRC diagnoses decreased for both institutions during the COVID-19 pandemic. We observed a decrease in screening rate and increase in proportional FIT use in the public hospital but not the private health system. Although colonoscopy follow-up rate after positive FIT results were low for both institutions, which may reflect incomplete capture of colonoscopy examinations, there were no differences before and during the pandemic. (Table Presented) (Table Presented)

14.
Gastroenterology ; 162(7):S-282, 2022.
Article in English | EMBASE | ID: covidwho-1967272

ABSTRACT

Background: The COVID-19 pandemic increased barriers to accessing preventative healthcare, jeopardizing previous progress to reduce colorectal cancer (CRC) morbidity and mortality. This study identifies populations with hindered access to CRC screening and surveillance colonoscopies during the pandemic and whether these disparities are being rectified as healthcare adapts. Methods: Colonoscopies during six-month intervals, July 1- Dec 31, 2019 and 2020 (pre-pandemic and pandemic) and Jan 1-June 30, 2021 (pandemic), were reviewed. Patients were categorized based on procedure indication, demographics, Social Vulnerability Index (SVI), and Charlson Comorbidity Index (CCI). SVI estimates communities' ability to prevent human and financial loss in a disaster on a scale from 0- 1. Higher SVI indicates increased vulnerability. Results: 2387 (2019) colonoscopies prepandemic and 2585 (2020) and 2563 (2021) during the pandemic were identified, of which, 1066, 1167, and 820 (Chi-square, p<.0001) were completed for CRC screening and surveillance respectively. The total average (avg) CRC risk patients presenting for first colonoscopy declined during the pandemic, from 232 pre-pandemic to 190 in 2020 and 145 in 2021 (p<.0001). Fewer of these patients presented from highly vulnerable communities, SVI >0.8, during the pandemic, 39 in 2019 vs 16 in 2020 and 22 in 2021 (p=0.03). Of all screening and surveillance, fewer patients presented from communities with SVI >0.8 during the pandemic, 109 in 2019 versus 69 in 2020 and 78 in 2021 (p=0.0005). Avg CCI of screening and surveillance patients increased each year (ANOVA, 3.67±0.08 vs. 3.92±0.08 vs. 3.98±0.09, p=0.01). Discussion: It is important to address the decline in CRC preventative care during COVID-19, especially among avg CRC risk first-time screeners, patients from vulnerable communities, and healthier individuals. If the pandemic persists and this trend continues, there will be an increasing backlog of patients from these vulnerable groups to catch up on. There was moderate improvement in the percent of patients presenting from vulnerable groups in 2021 but the absolute totals remained low. Patients from higher SVI communities may have disproportionately increased hardships during the pandemic preventing them from obtaining preventive healthcare. Emphasis on addressing the social determinants of health will be imperative to promote health in these populations. It is probable that healthier patients with few medical complaints were less likely to see a physician and offered CRC prevention. Those who have not been screened before would not have been contacted by gastroenterology clinics if they were not established patients. To counter these trends, the gastroenterology community should develop a systematic plan to expand use of open access colonoscopies, alternative screening methods and targeted outreach.

15.
Gastroenterology ; 162(7):S-281, 2022.
Article in English | EMBASE | ID: covidwho-1967271

ABSTRACT

Introduction The COVID-19 pandemic led to a sharp decrease in colorectal cancer screening rates as all non-urgent procedures, including average-risk screening colonoscopies, were suspended for infection control and resource conservation. In response to pandemic restrictions, many organizations have turned to alternative strategies such as fecal immunochemical test (FIT) outreach programs. Though prior randomized controlled trials have demonstrated success of mailed programmatic stool test initiatives, there are few studies examining specific strategies for delivering such programs. Methods Baseline pre-intervention FIT completion data was obtained between March 2020 and July 2020 at the Providence VA Medical Center. We then implemented a programmatic mailed FIT initiative at a single community-based outpatient clinic between February 2021 and August 2021 by 1) identifying all patients due for average risk colorectal cancer screening through a VA database, 2) sending primer letters and a brief survey to confirm average risk, 3) mailing FIT kits and 4) sending reminder letters 4 weeks after mailed FIT kits. The primary endpoint was overall FIT completion rate. Secondary endpoints included survey response rate, completed FIT after initial mailing and reminder letter, positive FIT rate, and rate of colonoscopy completion for positive FIT. Results Baseline FIT completion rate prior to the intervention was 29.8% (148/497). A total of 378 patients were identified through the database as being due for average risk colorectal cancer screening and were sent primer letters with surveys. 36.5% (138/378) of patients responded to the survey and 23.3% of those who responded (32/138) were found to be at increased risk and were removed from the FIT mailing list. 36.9% (126/347) of patients completed their FIT within 4 weeks of initial kit mailing. An additional 6.7% (15/221) returned their FIT after a reminder letter. The overall FIT completion rate after our interventions was 40.6% (141/347) which was a statistically significant improvement compared with the pre-intervention group (p=0.0012 using Fisher's exact test). 8.5% (12/141) of patients who completed their FIT had a positive result. Of these patients, 58.3% (7/12) had documented colonoscopy completion within 6 months of positive FIT and 41.6% (5/12) either declined the procedure or were unresponsive to scheduling attempts. Conclusion Programmatic mailed FIT outreach is an effective strategy to enhance colorectal cancer screening. Primer and reminder letters are a simple yet effective steps for improving mailed FIT completion rates. Further studies are needed to validate these methods to optimize averagerisk colorectal cancer screening, particularly in the era of COVID-19 where colonoscopy capability is limited at many centers. (Figure Presented)

16.
Gastroenterology ; 162(7):S-171, 2022.
Article in English | EMBASE | ID: covidwho-1967254

ABSTRACT

Background. Malnutrition has been linked to longer hospital stays and adverse health economic outcomes. In COVID-19, there is a paucity of data on whether malnutrition is associated with adverse outcomes in the hospital setting. Methods. This is a retrospective cohort study consisting of 4,311 COVID-19 adult (18 years and older) inpatients at five Johns Hopkins affiliated hospitals between March 1, 2020, and December 3, 2020. Patient data were derived from their COVID-19 database JH-CROWN: The COVID-19 Precision Medicine Analytics Platform (PMAP) Registry and extracted using Python 3, version 3.7.5, kernel in JupyterLab, version 1.1.4. Malnourishment among patients was identified as those who were malnutrition nutrition risk screen positive upon admission by use of the malnutrition universal screening tool (MUST) and confirmed by registered dietitians, Statistics were conducted with SAS v9.4 (Cary, NC) software to examine the effect of malnutrition on mortality and hospital length of stay among COVID-19 inpatient encounters while accounting for possible covariates in linear regression analysis predicting log-transformed length of stay. Results. COVID-19 patients who are older, male, or have lower BMIs have a higher likelihood of mortality (Table 1). In the linear regression model, for every 1% increase in BMI, the length of stay decreased by 0.38% (p<0.001) (Table 2). Differences in race (p=0.001) (Table 1), were associated with differences in the likelihood of mortality and length of stay;being Asian (p=0.0029), Black (p<0.001), or Other (p<0.001) were associated with decreased length of stay compared to Whites (Table 2). Patients with diabetes, hypertension, diarrhea, COPD, and malnutrition were more likely to have higher mortality (p<0.001) (Table 1) and more likely to have a longer hospital length of stay (p<0.001) (Table 2). Overall, 12.9% (555/4,311) of adult COVID-19 patients were diagnosed with malnutrition and were associated with an 87.9% (p<0.001) (Table 2) increase in hospital length of stay. Differences in the source of admission to the hospital affected the likelihood of mortality (p<0.001) (Table 1) and length of stay (Table 2). Conclusions. In a cohort of COVID-19 adult inpatients, malnutrition was associated with a higher likelihood of mortality and increased hospital length of stay. In the linear regression model, malnutrition was associated with an increase in the length of stay by 87.9%. Interestingly, decreases in BMI were associated with increased hospital length of stay. Race and admission source also plays a key role in affecting a patient's hospital length of stay and mortality. These results support the idea that malnutrition appears to be a predictor for COVID-19 inpatient outcomes similar to that of other known highrisk comorbidities like diabetes, hypertension, and COPD.(Table Presented)(Table Presented)

17.
Gastroenterology ; 162(7):S-159, 2022.
Article in English | EMBASE | ID: covidwho-1967249

ABSTRACT

Objectives Colorectal cancer (CRC)-related services decreased substantially as a result of the COVID-19 pandemic. Large numbers of procedures were suspended and many have not yet been completed. Resulting delays in cancer screening and diagnosis may negatively impact CRC outcomes. In this study, we predict this impact, and compare different recovery scenarios in the United States. Methods The MISCAN-Colon model was used to simulate the US population in 2020, and evaluate different impact and recovery scenarios. Scenarios were defined in terms of the duration and severity of the disruption (% of eligible adults affected), the length of delays, and the duration of the recovery. In the base-case analysis, we considered a 12-month disruption period, starting in March 2020. During this period, part of preventive and diagnostic procedures were cancelled and delayed. The severity of disruption by month was based on published literature (Embase and Ovid Medline, through December 21, 2020). The assumed delays in services followed a discrete-time distribution, which was a function of the severity of disruption. During recovery, colonoscopy capacity was increased to catch up missed procedures, over a period of 6, 12, or 24 months. In sensitivity analyses, we varied the disruption period (6-18 months) and severity of disruption (lower/higher). Primary outcomes were excess CRC cases and deaths, required excess colonoscopy capacity during recovery, and additional number-needed-to-scope during recovery to prevent one death. Results The COVID-19 pandemic reduced preventive colonoscopies by an estimated 30% in 2020, and overall colonoscopies by 25%. For a 24-month recovery period, the model predicted 8,010 (0.21%) excess CRC cases during 2020-2040, 7,370 (0.69%) excess CRC deaths (Figure 1), and required 103,900 (8.3%) excess colonoscopies per recovery month (Table 1). Shorter recovery periods decreased long-term excess CRC cases to 5,540 and 2,740, for 12 and 6 months, respectively and excess deaths to 5,150 and 4,820. However, this reduction in excess cases came at a cost of 254,600 and 579,600 excess colonoscopies per month. The prevention of the excess CRC deaths through the shorter recovery periods of 6 or 12 months required an additional 1,150 and 840 colonoscopies per excess death prevented compared to the 24-month recovery. In sensitivity analysis, the predicted overall impact varied between 1,930-12,630 deaths, and 83,600-887,700 colonoscopies (Table 1). Conclusions Delayed cancer-related services due the pandemic will likely cause thousands of CRC cases and deaths in the next 20 years. The impact could be limited if the backlog were cleared within 6 or 12 months vs. 24 months. However, additional endoscopy capacity needs should be balanced against competing medical interests. Keywords: COVID-19, Colorectal cancer, screening, diagnosis (Figure Presented) (Table Presented)

18.
Gastroenterology ; 162(7):S-110, 2022.
Article in English | EMBASE | ID: covidwho-1967242

ABSTRACT

Background Colorectal cancer (CRC) screening rates are typically lower in public safety-net hospital systems, and optimal screening modalities have yet to be determined in this population. There is evidence that fecal immunochemical test (FIT) is a cost-effective approach in this setting, especially as the COVID-19 pandemic decreased the accessibility of colonoscopy. Mailed FIT outreach programs have been shown to markedly increased CRC screening for vulnerable patients. However, there is limited evidence regarding individual facets of these programs, such as returning FIT by mail. In the process of establishing a complete mailed FIT program during the pandemic, we evaluate the effect of allowing patients to mail back a completed FIT they received in person. Methods Patients at a safety-net hospital in New York City aged 50-75 who were not up to date with CRC screening were evaluated. We included patients 30 days before and after the implementation of mail-able FIT kits in July 2021. All patients due for CRC screening were only offered FIT as a screening modality, and prior to the intervention were required to visit the clinic to both obtain and return the FIT. We implemented a partial mailed FIT program, in which FITs picked up in clinic can be mailed directly to the lab after completion. We also randomly surveyed patients who received a FIT and did not complete it in the period prior to our intervention to assess reasons for incompletion. Results A total of 5,153 and 5,180 patients aged 50-75 were seen in clinic 30 days prior and 30 days after the implementation of the mail-able FIT kit respectively. A total of 571 patients were provided a FIT kit that required a return trip to the clinic for completion. Of these patients, 289 (50.6%) completed a FIT. In comparison, there were a total of 781 patients who were provided a FIT kit allowed to be mailed back for completion. Of these patients, 464 (59.4%) completed a FIT (p < 0.01). A total of 45 patients with an incomplete FIT prior to the intervention were called, and 12 patients were reached. Of these patients, 10 endorsed forgetting about the test, and 2 endorsed difficulty scheduling time to drop off the test. Conclusion Organized mailed FIT outreach was previously shown to improve CRC screening in a safety-net setting. We have further shown that implementing a program with FIT kits that can be mailed back significantly improves screening. While our mail-able kits would improve screening in patients with difficulty returning to clinic, many in our population would potentially benefit from reminders to complete. Future work could assess long-term completion rates of our program, and compare it with a full mailed FIT outreach program to quantify the potential increased benefit of also mailing kits to patients.

19.
Gastroenterology ; 162(7):S-109-S-110, 2022.
Article in English | EMBASE | ID: covidwho-1967241

ABSTRACT

Introduction Screening for colorectal cancer (CRC) varies significantly by sociodemographic factors. The Health Resources and Services Administration (HRSA) provides primary care services, including CRC screening, to over 30 million medically underserved individuals at Federally Qualified Health Centers (FQHCs) in the United States (US). Given known disparities in CRC screening utilization and the national decline in screening due to the COVID- 19 pandemic, we aimed to determine the change in screening rates in FQHCs between 2019 and 2020 and factors associated with changes in rates. Methods This repeated cross-sectional analysis was conducted using 2019 and 2020 data from the Uniform Data System (UDS), which includes FQHC quality data for all US FQHCs. We ed CRC screening rates for each FQHC and for each state (FQHCs only) for patients age 50-75 for the years 2019 and 2020. We then calculated the change in screening (2020 rate minus 2019 rate) for each FQHC and for each state. To compare FQHC characteristics, we separated FQHCs into quartiles based on the 2020 screening rate and used ANOVA to compare FQHC characteristics between quartiles. Lastly, we performed a multivariable logistic regression to determine FQHC-level characteristics (2020 data) associated with an increase vs. decrease in screening rate from 2019 to 2020. Results In the 50 states, there were 1308 FQHCs and 7,132,411 FQHC patients eligible for CRC screening in 2020. Change in screening rates by state ranged from -11.1% (North Carolina) to +6.71% (Alaska) (mean= -3.55%) (Figure). The mean change in screening rates in FQHCs was -3.6% (range -62% to +58%) (Table). FQHCs with the lowest screening rates in 2020 (quartile 1, Table) had higher percentages of Black (p<0.001), male (p=0.018), homeless (p<0.001), uninsured (p<0.001), and low-income (p<0.001) patients, and were more likely to be in urban settings (p<0.001). FQHCs with the highest screening rates (quartile 4, Table) had a higher percentage of White (p<0.001) patients. When controlling for FQHC characteristics (including number of patients and 2019 CRC screening rate), each one point increase in the percentage of White patients served in a FQHC was associated with lower odds (aOR 0.71;95%CI=0.56-0.91) of experiencing a decrease in CRC screening rates in 2020 compared to 2019 (data not shown). Discussion FQHCs in the US have below-average CRC screening rates and saw notable declines in CRC screening utilization during the COVID-19 pandemic. Extent of decline varied broadly by state and FQHC, and declines were greater in FQHCs that served a higher proportion of (Figure Presented) Figure. Percent change in colorectal cancer (CRC) screening rate among adults age 50 to 74 at Health Resources and Services Administration-funded FQHCs between 2019 and 2020, by US state. (Table Presented) Table. FQHC characteristics (2020 data) and CRC screening rates (2019 and 2020) for HRSA-funded FQHCs in the US overall and by 2020 CRC screening rate quartiles.

20.
Gastroenterology ; 162(7):S-43, 2022.
Article in English | EMBASE | ID: covidwho-1967237

ABSTRACT

Background and Aims: Reliance on in-visit, opt-in screening for colorectal cancer (CRC) may be an obstacle to screening, especially during the COVID-19 pandemic and among low income and vulnerable populations. We aim to describe and evaluate the effectiveness of a CRC screening outreach campaign in a safety-net health system testing opt-out and opt-in text message outreach followed by mailed fecal immunochemical test (FIT) kits. Methods: From November 2020 to April 2021, the outreach campaign targeted patients ages 50-75 from 11 primary care clinics within the San Francisco Health Network who had previously completed a FIT test and were overdue for CRC screening. Patients were assigned to receive a language-concordant, pre-alert text message notifying that they would be mailed a FIT kit 1) unless they opted out of receiving a kit or 2) if they opted in to receiving a kit. The primary outcome was screening participation at 3 months after outreach. Results: A total of 371 patients were assigned to receive opt-out text messages and 522 received opt-in text messages. FIT kits were mailed to 96.5% (n = 358) of the opt-out group and 19.3% (n = 101) of the opt-in group. Screening uptake at 3 months was significantly higher in the optout group than in the opt-in group (58.8% vs. 18.0%, P < 0.001;difference = 40.8%, 95% confidence interval 34.8%-46.8%). Black/African American patients had lower screening rates (33.3% in opt-out group and 9.4% in opt-in group) compared to Hispanic/Latino (53.3% in opt-out group and 26.7% in opt-in group) and Asian (66.7% in opt-out group and 26.7% in opt-in group) patients. Conclusions: During the COVID-19 pandemic, optout text messaging followed by mailed FIT kits improved population-level CRC screening rates in a safety-net health system. Tailored initiatives are needed to address low screening rates for Black/African American patients.

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