Judged 3-Minute Oral Presentation Session IV

Background/Significance:

Community health needs assessments (CHNA) are conducted by nonprofit hospitals and health systems every three years. There is not a standardized methodology or reporting structure on how to conduct a CHNA yet each cycle organizations survey the communities they serve trying to identify where areas of concern are regarding health factors, issues, and outcomes. The work in conducting the surveys and evaluating this information is a result of collaboration between nonprofit health systems, local health departments (LHDs), and community organizations.

Purpose:

While this assessment is required as part of provisions described in the Affordable Care Act (ACA), the data collected can provide important directions for community-based efforts to improve health and as a method of tracking the health needs of a community over time.

Methods:

Information gleaned from the community came in two different formats: qualitative and quantitative. The qualitative data were collected from interviews and focus groups for a variety of community groups while the quantitative data were collected via a survey that could be taken online or with paper copy. The survey data was a convenience sample for respondents within the county.

Results:

The analysis identified five major themes for concern that were supported by both qualitative and quantitative responses. Chronic disease, maternal and infant health, mental health, substance use, and violence.

Conclusion:

Nonprofit health systems, LHDs, community organizations, and research focusing on the geographic region where CHNAs are conducted can benefit from using this data to inform interventions and initiatives to improve the health of their respective communities.

Background/Significance:

Many oncology medications are restricted to outpatient (outpatient restricted medications [ORMs]) due to delayed pharmacologic effect and significant cost. To enforce restrictions and promote cost avoidance, we developed an appeals process for requests to administer ORMs in the hospital.

Purpose:

To standardize an appeals process in Wisconsin Advocate Health sites when oncologists request ORMs.

Methods:

A literature search demonstrated a lack of quality reviews and similar multidisciplinary appeals processes. The Pharmacy and Therapeutics committee determined the list of ORMs while involvement in the appeals process was decided to be best addressed by the oncology team. The original workflow was implemented in January of 2021. ORMs were identified by the pharmacist during order processing. Once identified, the pharmacists collaborated with the Oncology Medical Director and the site Chief Medical Officer to approve or deny administration. During utilization of this process, several discharge barriers were identified. This prompted involvement of other healthcare team members, including the Care Management Team and Physician Advisor, which began in July 2023. These teammates addressed the discharge barriers, and the financial implications associated with the consideration of the ORMs. Data collection was obtained prospectively through the electronic medical record, a patient roster Excel document, and a BI Power report to identify ORMs administered.

Results:

Data was compared yearly from 2021 to 2024. The percentages of ORMs not administered in the hospital compared to the total amount was 66.7%, 68%, 60.7%, and 69.2% for 2021, 2022, 2023, 2024, respectively. Most frequently considered ORMs over the 4 years were pembrolizumab, bevacizumab-awwb, and atezolizumab. As oncologists became familiar with the process, the percentage of pharmacist interventions decreased: 75%, 55%, 42.9%, and 17.3%, respectively. Cost avoidances resulting from denial of ORMs were over $204,000, $278,000, $281,000, and $335,000, respectively.

Conclusion:

A multidisciplinary process was successfully implemented to adhere to appropriate medication administration restrictions.

Background/Significance:

Tardive dyskinesia (TD) is a movement disorder characterized by involuntary, repetitive movements, frequently involving the face and limbs. A variety of medications are associated with the development of TD, including those used for the treatment of gastroparesis. Metoclopramide has a black box warning from the FDA for TD. In this study, medications used to treat gastroparesis were evaluated for their likelihood of causing the adverse drug reaction (ADR) of TD based on reports to the FAERS database.

Purpose:

Tardive dyskinesia can be an irreversible condition that is debilitating to patients. It is important to understand that some medications that are commonly used to treat gastroparesis can have this side effect and possibly shift focus to other medications that are less likely to cause this.

Methods:

FAERS is a collection of voluntarily reported adverse reactions used for post-marketing surveillance of medications. A total of 29,661,136 FAERS reports from Jan 1968 to Dec 2024 were reviewed. Reports for 15 medications used to treat gastroparesis were included for analysis. Filtering of duplicate reports and data analysis were performed using the Open Vigil program. The reporter odds ratio (ROR) was measured to determine the likelihood that the medication was associated with TD and determine the likelihood of a signal for an adverse drug reaction (ADR). The formula for ROR is as follows: ROR = (a/c)/(b/d), a: drug with the specific ADR, b: all drugs with the specific ADR, c: all ADRs of the specific drug, d: all other drugs with other ADRs).

Results:

Three medications, domperidone, granisetron, and cyclizine had too few reports to analyze using this method. Of the others, an extremely elevated risk of TD was seen with metoclopramide (ROR=499, CI 486-512). Other medications demonstrating signals for TD included promethazine (ROR=3.14, CI 2.75-3.59), mirtazapine (ROR=2.98, CI 2.68-3.32), lorazepam (ROR=2.12, CI 1.94-2.32), erythromycin (ROR=1.89 CI1.43-2.51), nortriptyline (ROR=1.86, CI 1.08-3.20), and alprazolam (ROR=1.20 CI 1.08-1.33).

Discussion:

A number of medications used to treat gastroparesis demonstrate signals for TD. The risk for TD with the use of metoclopramide is once again demonstrated to be extremely high, emphasizing its avoidance as extended use and prescription in high-risk groups (elderly persons, women, and diabetic patients). Clinicians should warn patients of the risk of TD when prescribing these medications associated with TD.

Background/Significance:

Patients with placenta accreta spectrum (PAS) are at risk for complications during cesarean hysterectomy. Obesity increases the risk of complications at time of delivery. There is limited data on how obesity specifically affects outcomes for PAS patients undergoing hysterectomy, and understanding this relationship could lead to improved preoperative planning and improved maternal outcomes.

Purpose:

We sought to evaluate the rates of adverse maternal outcomes among those with placenta accreta spectrum undergoing hysterectomy in patients with and without obesity.

Methods:

A retrospective cohort study utilizing the National Inpatient Sample (HCUP/AHRQ) from 2017 to 2021. Those with an ICD-10 code diagnosis PAS who underwent hysterectomy (ICD-10 procedure code for hysterectomy) were included. Those with an ICD-10 code for obesity were compared to those without. The primary outcome was a composite of severe maternal morbidity (SMM) as defined by the CDC. Secondary outcomes included gestational age at delivery, preterm delivery, maternal length of stay, hemorrhage rates, blood transfusion, disseminated intravascular coagulation, infection, wound complications, or surgical complications. The groups were compared via Student’s t-tests, chi-squared, and logistic and linear regression analyses.

Results:

A total of 1,987 subjects met inclusion criteria, of which 447 (23.0%) were identified as having obesity. Subjects with obesity were more likely to be younger, non-Hispanic black, use tobacco, be publicly insured, in the lowest quartile of income, and have hypertension, pre-gestational diabetes, and history of cesarean. On univariate analysis, those with obesity had higher rates of preterm delivery, more frequent use of cystoscopy or ureteral stent placement, and lower rates of disseminated intravascular coagulation. There was no difference in the rate of the primary composite outcome of SMM, wound complication, or any surgical complication. After controlling for confounders, there was no association between subjects with obesity and adverse outcomes in those undergoing hysterectomy for placenta accreta spectrum including risk of infection or surgical complications

Conclusions:

Obesity in PAS patients undergoing hysterectomy is not associated with adverse outcomes when controlling for confounders.

Background/Significance:

In 2024, the United States experienced the simultaneous emergence of two periodic cicada broods, Broods XIII and XIX, in addition to the emergence of annual cicadas, resulting in an unprecedented burden of cicadas on daily life. Previous research has shown that cicadas can pose a health risk, including allergic reactions and unintentional trauma. The extent of the impact of the 2024 cicada emergence on public health is unknown.

Purpose:

The aim of this study was to inform public health preparedness for similar future events by examining the frequencies and characteristics of urgent care (UC) and emergency department (ED) visits related to the 2024 cicada emergence.

Methods:

This was a retrospective review of all UC and ED visits in the Advocate Health Care and Aurora Health Care (Advocate Health – Midwest) system from April 1 through July 31, 2024, the four months of highest cicada emergence concentration. Advocate Health – Midwest is the largest health care system in Illinois and Wisconsin, states impacted by the two cicada broods. Using the electronic health record, patient charts were searched for the word "cicada" along with expected spelling variations from typing or dictation errors. Qualifying charts were reviewed and qualitatively coded by two emergency physicians. Patient data extracted included diagnosis, demographics, arrival mode, length of stay, disposition, diagnostics and therapeutics. Visits determined to be unrelated to cicadas were excluded. Conflicting results were resolved via consensus.

Results:

There were 331,170 visits to 28 different EDs and UCs in the system during the study period. Of those, 48 mentioned the word “cicada” or a spelling variant. Thirty-two visits were identified as related to cicadas. Patient ages ranged from 7 weeks to 84 years. Trauma was the most common category of visit (27), and was due to falls (17), blunt trauma (4), vehicle or bicycle accident (3), muscle strain (2), or penetrating injury (1). Other categories included allergic reactions (2), environmental exposure (2), and neurologic complication (1). Most patients self-presented; fewer than half utilized EMS transport. Imaging was frequently utilized as 21 (65.6%) of patients received an x-ray and 14 (43.7%) a CT. Seven patients suffered fractures and five patients were admitted.

Conclusion:

The public health impact of the 2024 cicada emergence on a large, geographically relevant health care system was modest but individuals did experience morbidity, largely related to traumatic events.