Utility of telephone visits at an urban safety-net hospital during 2020: A retrospective review.

Objective: During COVID-19, otolaryngology clinics rapidly implemented telehealth programs in accordance with social distancing guidelines and institutional policies. Our objectives are to evaluate the usefulness of telephone audio visits for underserved patients seeking otolaryngological care at an urban safety-net hospital and identify patient factors associated with telephone visit attendance. Methods: In a retrospective review of all adult telephone visits in 2020, we compared the demographics and visit characteristics of patients who attended telehealth versus in-person visits and patients who attended versus missed telehealth visits. Univariable and multivariable regressions were utilized to identify predictors of missing telehealth visits. Results: We identified 318 telehealth encounters completed by 254 patients (72.8% were of racial/ethnic minority; 76.3% had low-income, need-based insurances; 43.7% had limited English proficiency). The most common chief complaints were related to head and neck oncology (n = 85, 26.7%), otology/neurotology (n = 74, 23.3%), and general otolaryngology (n = 69, 21.7%). The following actions were executed during telephone visits: behavioral and/or medication patient education (n = 152, 47.8%); sharing testing/imaging/tumor board results (n = 125, 39.3%); referrals to another department (n = 103, 32.4%); rendering a new diagnosis (n = 98, 30.8%); changing medications (n = 60, 18.9%). Less than half of telephone visits (46.2%) resulted in in-person follow-up, most commonly for in-person exams. The distribution of race/ethnicity differed between attended in-person appointments versus telephone visits (p = .01), but race and ethnicity were not significant predictors of telephone visit attendance. Conclusion: Despite limited diagnostic capabilities, telephone audio visits can be an effective and accessible tool for providing continuity and advancing care in socially disadvantaged patients. Level of evidence: IV.

Gaps in Treatment and Surveillance: Head and Neck Cancer Care in a Safety-Net Hospital.

OBJECTIVE: Treatment delays and suboptimal adherence to posttreatment surveillance may adversely affect head and neck cancer (HNC) outcomes. Such challenges can be exacerbated in safety-net settings that struggle with limited resources and serve a disproportionate number of patients vulnerable to gaps in care. This study aims to characterize treatment delays and adherence with posttreatment surveillance in HNC care at an urban tertiary care public hospital in San Francisco. STUDY DESIGN: Retrospective chart review. SETTING: Urban tertiary care public hospital in San Francisco. SUBJECTS AND METHODS: We identified all cases of HNC diagnosed from 2008 to 2010 through the electronic medical record. We abstracted data, including patient characteristics, disease characteristics, pathology and radiology findings, treatment details, posttreatment follow-up, and clinical outcomes. RESULTS: We included 64 patients. Median time from diagnosis to treatment initiation (DTI) was 57 days for all patients, 54 days for patients undergoing surgery only, 49 days for patients undergoing surgery followed by adjuvant radiation ± chemotherapy, 65 days for patients undergoing definitive radiation ± chemotherapy, and 29 days for patients undergoing neoadjuvant chemotherapy followed by radiation or chemoradiation. Overall, 69% of patients completed recommended treatment. Forty-two of 61 (69%) patients demonstrated adherence to posttreatment visits in year 1; this fell to 14 out of 30 patients (47%) by year 5. CONCLUSION: DTI was persistently prolonged in this study compared with prior studies in other public hospital settings. Adherence to posttreatment surveillance was suboptimal and continued to decline as the surveillance period progressed.

Customized registry tool for tracking adherence to clinical guidelines for head and neck cancers: protocol for a pilot study.

BACKGROUND: Despite recommendations for monitoring patients with chronic and high-risk conditions, gaps still remain. These gaps are exacerbated in outpatient care, where patients and clinicians face challenges related to care coordination, multiple electronic health records, and extensive follow-up. In addition, low-income and racial/ethnic minority populations that are disproportionately cared for in safety net settings are particularly at risk to lapses in monitoring. METHODS: We aim to implement and evaluate a health information technology platform developed using systems engineering methodologies. The implementation is situated in a clinic that monitors patients with head and neck cancer within a large, urban, publicly funded hospital. Our study will evaluate the time it takes for patients to progress through key treatment milestones prior to and after implementation of the tool. We will use models controlling for secular trend to estimate the effect of the tool on improving timely and successful completion of guideline-based care processes. DISCUSSION: This protocol details the evaluation of the effectiveness of a human-centered health information technology intervention on improving timely delivery of care for high-risk populations. Other settings, including those that face challenges related to limited resources to devote to safety programs and fragmented health information technology, may benefit from this approach. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03546322. "Customized Registry Tool for Tracking Adherence to Clinical Guidelines for Head and Neck Cancers." Registered 1 June 2018.

The effects of superoxide dismutase in gerbils with bacterial meningitis.

BACKGROUND: Inflammatory products, such as oxygen radicals generated during the course of bacterial meningitis, can damage nerve endings, hair cells, and/or supporting cells in the cochlea. Superoxide dismutase (SOD), an O2-scavenger, has been shown to play an important role in the protection against radical toxicity in various animal experiments. OBJECTIVE: To study the antioxidant effects of SOD on the inflammatory response of gerbils with bacterial meningitis. STUDY DESIGN: Meningitis was induced in three groups of 10 gerbils by intrathecal (IT) injection of Streptococcus pneumoniae into the cisterna magna. Group 1 received IT SOD, group 2 received intramuscular (IM) SOD, and group 3, the control group, received IM normal saline. Histologic data and auditory brainstem responses (ABR) were obtained from each gerbil. RESULTS: Fibrosis and/or neo-ossification were near absent in the IT SOD group and significantly less fibrosis occurred in the IM group (IT vs. IM: P = 0.010; IT vs. control group: P = 0.001). The amount of surviving spiral ganglion cells correlated inversely with the extent of fibrosis (r = -0.753, P < 0.00001). CONCLUSIONS: IT injection of SOD significantly reduced cochlear fibrosis and neo-ossification, reduced the spiral ganglion cell loss, and decreased damage of the cochlear components following bacterial meningitis.