Faculty Bibliography

BACKGROUND/UNASSIGNED:Precision oncology (PO) improves and extends the lives of patients living with cancer, but multiple studies have documented its underuse in practice. Specifically, studies note a significant lack of PO use within the Veterans Affairs (VA) medical system. A paucity of implementation of PO in oncologic practice poses a significant barrier to providing the most up-to-date guideline-based care. OBJECTIVE/UNASSIGNED:While several studies have explored determinants of PO use, we sought to contribute to the body of knowledge by additionally focusing on the unique perspectives of patients, as well as conducting a comprehensive study within the VA medical system, the United States' largest single-payer health care system. We conducted interviews with both patients and providers at multiple VA sites to identify and characterize barriers and facilitators of PO use in clinical care. METHODS/UNASSIGNED:Using a qualitative descriptive approach, we conducted semistructured interviews with 17 patients with cancer and 16 oncology providers recruited from multiple VA sites. Cancer types included prostate, gastrointestinal, and lung. Data were analyzed via a team-based coding approach using directed content analysis. Data were coded and then aggregated into themes and mapped to the Theoretical Domains Framework (TDF) and Behavior Change Wheel sources of behavior (Capability, Opportunity, and Motivation) based on the consensus of the study team. RESULTS/UNASSIGNED:The patient sample consisted of 17 all-male veterans seen at VA oncology clinics in 2022. Participants predominantly self-identified as White (n=9, 52.9%) or Black (n=6, 35.3%), and the majority (n=11, 64.7%) held a high school degree or a higher level of education. The provider sample consisted of 16 physicians, all of whom held MD degrees and practiced oncology. The provider sample represented 6 states, was 50% (8/16) female, and participants averaged 14 years in their current position. The overarching theme was the "Precision Oncology Feedback Loop," which captured the essence of the complex processes involved in facilitating PO care in the VA system. The TDF and Behavior Change Wheel helped categorize findings to identify where issues in the feedback loop could facilitate or generate barriers to care. CONCLUSIONS/UNASSIGNED:Our findings expand on the current literature by highlighting both patient and provider experiences across key TDF domains (Environmental Context and Resources, Knowledge, Memory, and Attention). The conceptual model produced by the analysis illustrates the complexities associated with the implementation. Our findings support the design of multilevel interventions that target increased knowledge or education, improved workflow, and ease of communication to enhance PO delivery.

OBJECTIVES/UNASSIGNED:This study evaluates and enhances language access services for Limited English Proficiency (LEP) patients in a large urban health system by integrating interpreter services into the Electronic Health Record (EHR), aiming to reduce care disparities and improve the digital experience for both patients and clinicians. MATERIALS AND METHODS/UNASSIGNED:Using a descriptive evaluation approach, the project assessed barriers to interpreter service usage and developed solutions informed by stakeholder engagement. Emphasis was placed on interfacing the EHR with the vendor platform, using existing devices, tracking utilization, ensuring cost-effectiveness, and implementing the solution across multiple hospitals and outpatient settings. RESULTS DISCUSSION AND CONCLUSION/UNASSIGNED:After implementation, audio and video interpreter service use rose significantly, with calls increasing from an average of 9700 calls per month in 2022 to over 68 176 calls per month by the end of 2024. Over 14 000 clinicians used the service for more than 121 077 unique patients. Average waiting times for the top ten languages fell below 30 seconds, and user satisfaction was high, with an average interpreter rating of 4.9. Conclusion: The EHR-integrated interpreter service has improved language service access, reduced waiting times and enhanced user satisfaction, marking noteworthy progress in overcoming language barriers and potentially decreasing healthcare disparities for LEP populations. We plan to assess the impact on patient outcomes.

AIM(S)/OBJECTIVE:To determine common and distinct factors experienced by nurses working in acute care settings during the second year of the COVID-19 pandemic. DESIGN/METHODS:An online qualitative descriptive study with eight open-ended questions and a comprehensive demographic profile administered via the Qualtrics XM survey software. METHODS:Thirteen countries formed teams and led online data collection in their respective countries through various approaches. The data collection period occurred between January 1, 2021, and February 28, 2022. Descriptive thematic analysis was conducted in English (with translation), Spanish, and Korean to analyse the qualitative data. Descriptive statistics summarised the responses to the demographic profile. RESULTS:Worldwide, a final sample size of n = 1814 produced 6483 qualitative data points for analysis. The results identified ongoing occupational risk factors for nurses during the pandemic's second year, including mental health issues, yet showed some improvements in access to personal protective equipment and resources. Four themes emerged from the qualitative analysis, highlighting role changes, living states, and insights into the implementation of pandemic response measures. CONCLUSION/CONCLUSIONS:Despite individual occupational risks nurses described, structural factors associated with healthcare delivery produced common nursing experiences during the pandemic. Additionally, at least two distinct stages of pandemic response implementation were demarcated by treatment availability (e.g., vaccine development). IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE/UNASSIGNED:There is potential for common pandemic response policies for nurses, centered on specific factors, such as the increased provision of mental health support services by healthcare organisations. IMPACT/CONCLUSIONS:This study helped determine the common and distinct work experiences during the second year of the COVID-19 pandemic. Nurses simultaneously experienced increased workload, role changes, perpetual fear and fatigue, daily hostility, and chaos in the implementation of pandemic responses. The results will impact nurses and those they serve along with future pandemic response policies. REPORTING METHOD/UNASSIGNED:We have adhered to the SRQR reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION/UNASSIGNED:This study did not include patient or public involvement in its design, conduct, or reporting.

Prior literature has shown inequities in patient-clinician interactions experienced by individuals with chronic low back pain (CLBP) with underlying pain-related stigmatization and invalidation. Yet, there is a notable gap in understanding how these inequities intersect with multiple systems of oppression, including racism and sexism. This qualitative study examined intersectional perspectives and experiences of patient-clinician interactions among individuals with CLBP. Semi-structured interviews were conducted after the participants engaged in simulated enhanced or limited patient-clinician interactions as part of an experimental study. Participants were asked to compare the simulated patient-clinician interaction to their real-life patient-clinician interactions for their CLBP. The study included 50 participants with CLBP for at least three months and half the days in the past six months. Participants were Black and multi-racial women (n=14), Black and multi-racial men (n=12), non-Hispanic White women (n=12), and non-Hispanic White men (n=12). A basic qualitative approach with principles from constructivist grounded theory and intercategorical intersectional research were used to propose three core categories when describing inequities in patient-clinician interactions: higher-level systems (subcategories: institutional, community, macro-level), the patient-clinician interaction (subcategories: being taken seriously, person-centered care), and effects of the patient-clinician interaction (subcategories: indirect, direct effects). Inequities were identified across all categories, disproportionately affecting Black and multi-racial women. Black and multi-racial women also distinctly shared a wider range of both positive and negative patient-clinician interactions and effects from these interactions, and potential pathways to more equitable care. These findings highlight the need for multi-level interventions to promote more equitable care for individuals with CLBP. PERSPECTIVE: This qualitative study examined intersectional perspectives and experiences of patient-clinician interactions among individuals with CLBP. Multiple intersecting systems shaped inequities in patient-clinician interactions. Black and multi-racial women shared the broadest range of patient-clinician interactions, distinctly discussed intersecting systems of oppression, and highlighted pathways to more equitable care.

BACKGROUND:Patients with heart failure (HF) often have difficulty obtaining life-saving medications due to coverage barriers, such as prior authorizations and high out-of-pocket costs. To promote better coverage for high value therapies and inform policymakers about cost effectiveness, the American Heart Association/American College of Cardiology/Heart Failure Society of America added Value Statements to HF guidelines. We assessed whether these guidelines influenced Medicare drug coverage policies for 2 life-saving, costly HF medications: angiotensin receptor neprilysin inhibitors (ARNI-guideline "high value") and sodium glucose cotransporter-2 inhibitors (SGLT2i-guideline "intermediate value"). METHODS:We performed an observational study using Medicare prescription drug plan formulary files from April 2020 to April 2023 to separately assess for changes in coverage barriers to ARNI and SGLT2i after Value Statement publication (April 2022), and subsequent Medicare plan online update (October 2022). The primary outcome was the percentage of plans each month with any barrier to drug coverage (prior authorizations, tier ≥3 out-of-pocket cost-sharing, step therapy, or no coverage). Analyses used interrupted time series and difference-in-differences approaches. Difference-in-differences analyses used direct oral anticoagulants as a control due to their comparable cost and use as ARNI and SGLT2i, but without a Value Statement. RESULTS:Among 7396 Medicare drug plans, monthly rates of any coverage barrier ranged from 94.3% to 97.4% for ARNI and 93.2% to 96.6% for SGLT2i. Most barriers were due to tier ≥3 out-of-pocket cost-sharing requirements (ARNI: 94.3%-95.8%; SGLT2i: 93.2%-95.6%). Coverage barriers remained stable in April 2022 and declined slightly in October 2022. In difference-in-differences analyses, the presence of a Value Statement was associated with a ~1 percentage point decline in coverage barriers for both ARNI (difference-in-differences estimate, -1.07% [95% CI, -1.44% to -0.70%]) and SGLT2i (-1.32% [95% CI, -1.63% to -1.00%]). CONCLUSIONS:Coverage barriers to ARNI and SGLT2i were common and changed only slightly after publication of Value Statements in HF guidelines. There is a critical need for robust strategies to improve access to life-saving HF medications.

This paper is an examination of the relationship between continuity of care with home health physical therapists following hospitalization and the likelihood of readmission. We conducted a retrospective cohort study. Using rehospitalization as the dependent variable, a continuity of care indicator variable was analyzed with a multivariable logistic regression. The indicator variable was created using the Bice-Boxerman Index to measure physical therapist continuity of care. The mean of the index (0.81) was used to separate between high continuity (0.81 or greater) of care and low continuity of care (lower than 0.81). The sample included 90,220 patients, with data coming from the linking of the Outcome Assessment and Information Set (OASIS) and an administrative dataset. All subjects lived in the NYC metro area. Inclusion criteria was a patient's admission to their first home health care site following discharge occurring between 2010 and 2015, and individuals who identified as Male or Female. In comparison to low continuity of physical therapy, high continuity of physical therapy significantly decreased hospital readmissions (OR = 0.74, 95% CI 0.71-0.76, p ≤ .001, AME = -4.28%). Interpersonal continuity of physical therapy care has been identified as a key factor in decreasing readmissions from the home care setting. The research suggests an increased emphasis in preserving physical therapist continuity following hospitalization should be explored, with the potential to reduce hospital readmissions.

INTRODUCTION/UNASSIGNED:for head and neck cancer (HNC), a patient-reported symptom measure available only in English. METHODS/UNASSIGNED: = 4) diagnosed with HNC. RESULTS/UNASSIGNED:The translation was acceptable in cultural relevance (average CVI score = 0.95) and equivalence (average CVI score = 0.84). Cognitive interviews revealed 9 problematic items that differed in words and meaning, primarily addressing pain and swallowing symptoms. These items were refined and included in the final translation of the Spanish ePVA. CONCLUSION/UNASSIGNED:These study findings underscore the need for survey instrument translations that account for variations in shared languages spoken across countries.