Screening and Telephone-Based Intervention for Unhealthy Alcohol Use in a Diverse Federally Qualified Health Center System in Texas.

Background: Screening and brief intervention (BI) can reduce risky alcohol use but has not been widely implemented in primary care settings. We sought to implement a screening and telephone-based program within a Federally Qualified Health Center (FQHC).

Design: Prior to this program, adult patients were routinely screened using AUDIT-C with no further systematic follow-up.

Preventive Care Needs of the North Carolina Medicaid Expansion Population.

Introduction: Effective December 2023, North Carolina expanded Medicaid eligibility to cover individuals up to 138% of the Federal Poverty Level. The authors sought to understand the preventive care needs of the newly Medicaid-eligible population.

Methods: The authors conducted a repeat cross-sectional analysis using the 2016, 2018, 2020, and 2022 North Carolina Behavioral Risk Factor Surveillance Survey.

Perspectives of international experts and the Danish citizens on the 'relevant knowledge' that citizens need for making informed choices about participation in cancer screening: Qualitative study.

Objectives: This study aimed to investigate the perspectives of international experts and Danish citizens on relevant knowledge about population-based breast, colorectal and cervical cancer screening.

Methods: This was a qualitative interview study with focus group interviews with experts and Danish citizens eligible for breast, colorectal and/or cervical cancer screening. Data were collected using semi-structured interview guides, audio-recorded and transcribed verbatim.

A Resident-Led Quality Improvement Initiative to Increase End-of-Life Planning in Primary Care.

Despite many benefits of end-of-life (EOL) planning, only 1 in 3 adults has EOL documentation, with low rates in resident primary care clinics as well. To increase clinic completion of life-sustaining treatment (LST) notes and advance directives (AD) for veterans at highest risk for death. The setting was a Veterans Affairs (VA) internal medicine primary care clinic.

Achieving Equitable Lung Cancer Screening Implementation in a Texas Safety Net Health System.

Introduction: A lung cancer screening program using low dose CT (LDCT) in a Federally Qualified Health Center (FQHC) in Central Texas was developed and assessed for equitable implementation.

Methods: From 11/2020-8/2023, patients aged 55-77 years who currently smoked or quit within 15 years with ≥20 pack-years of exposure were identified through EHR query and mailed outreach, or through direct provider referrals. A bilingual social worker confirmed eligibility, provided telecare shared decision-making (SDM), coordinated screening, and offered smoking cessation.

Supporting Care Transformation Through a Comprehensive Graduate Medical Education Curricular Program in a Department of Internal Medicine.

Background: The imperative to train physicians in skills required to lead care transformation is increasingly recognized, yet few Graduate Medical Education (GME) programs exist to meet this need.

Aim: Describe the development, outcomes, and lessons learned from a novel GME care transformation curricular program.

Setting: Department of Internal Medicine (IM) at Dell Medical School at The University of Texas, Austin.

Resident-led improvement project to screen for primary hyperaldosteronism in patients with resistant hypertension in an outpatient clinic.

Clinical practice guidelines recommend screening for primary hyperaldosteronism (PH) in patients with resistant hypertension. However, screening rates are low in the outpatient setting. We sought to increase screening rates for PH in patients with resistant hypertension in our Veterans Affairs (VA) outpatient resident physician clinic, with the goal of improving blood pressure control.

Costs and Projected Effect of a Federally Qualified Health Center-Based Mailed Colorectal Cancer Screening Program in Texas.

Introduction: Mailed stool testing for colorectal cancer (CRC) may improve screening uptake and reduce the incidence and mortality of CRC, especially among patients at federally qualified health centers (FQHCs). To expand screening programs it is important to identify cost-effective approaches.

Methods: We developed a decision-analytic model to estimate the cost, effects on screening and patient outcomes (CRCs detected, CRCs prevented, CRC deaths prevented), and cost-effectiveness of implementing a state-wide mailed stool testing program over 5 years among unscreened, age-eligible (aged 50-75 y) patients at FQHCs in Texas.

Lived Experiences and Fear of Cancer Recurrence Among Survivors of Localized Cutaneous Melanoma.

Importance: Most of the rapid increase in cutaneous melanoma incidence in the US has been localized disease that is treated surgically and is associated with high survival rates. However, little is known about the psychological well-being of survivors in the US.

Objective: To explore the lived experiences and fear of cancer recurrence among survivors of localized cutaneous melanoma.

Association of Receipt of Systemic Treatment for Melanoma With Insurance Type in North Carolina.

Background: Previous studies of hospital-based patients with metastatic melanoma suggest sociodemographic factors, including insurance type, may be associated with the receipt of systemic treatments.

Objectives: To examine whether insurance type is associated with the receipt of systemic treatment among patients with melanoma in a broad cohort of patients in North Carolina.

Methods: We conducted a retrospective cohort study between 2011 and 2017 of patients with stages III-IV melanoma using data from the North Carolina Central Cancer Registry linked to Medicare, Medicaid, and private health insurance claims across the state.

Risk of Mortality After a Diagnosis of Melanoma In Situ.

Importance: The incidence of melanoma in situ (MIS) is increasing more rapidly than any invasive or in situ cancer in the US. Although more than half of melanomas diagnosed are MIS, information about long-term prognosis following a diagnosis of MIS remains unknown.

Objective: To evaluate mortality and factors associated with mortality after a diagnosis of MIS.

Delayed Diagnostic Paracentesis Is Associated with Increased Preventable Healthcare Utilization in Disadvantaged Patient Populations with Advanced Liver Disease and Elevated INR.

Background: Patients hospitalized with cirrhosis, ascites, and elevated INR often experience delays in timely diagnostic paracentesis.

Aims: Identify whether delays in diagnostic paracentesis were associated with adverse outcomes in a hospital system serving a large disadvantaged population.

Methods: Retrospective cohort analysis of patients admitted from January 2017 to October 2019 with cirrhosis, ascites, and INR ≥ 1.

Understanding the role of access in Hispanic cancer screening disparities.

Background: Hispanic populations in the United States experience numerous barriers to care access. It is unclear how cancer screening disparities between Hispanic and non-Hispanic White individuals are explained by access to care, including having a usual source of care and health insurance coverage.

Methods: A secondary analysis of the 2019 National Health Interview Survey was conducted and included respondents who were sex- and age-eligible for cervical (n = 8316), breast (n = 6025), or colorectal cancer screening (n = 11,313).

Equitable Implementation of Mailed Stool Test-Based Colorectal Cancer Screening and Patient Navigation in a Safety Net Health System.

Background: Mailed stool testing programs increase colorectal cancer (CRC) screening in diverse settings, but whether uptake differs by key demographic characteristics is not well-studied and has health equity implications.

Objective: To examine the uptake and equity of the first cycle of a mailed stool test program implemented over a 3-year period in a Central Texas Federally Qualified Health Center (FQHC) system.

Design: Retrospective cohort study within a single-arm intervention.

Patient-Reported Outcomes of Breast Reconstruction: Does the Quality of Decisions Matter?

Background: Little is known about how the quality of decisions influences patient-reported outcomes (PROs). We hypothesized that higher decision quality for breast reconstruction would be independently associated with better PROs.

Methods: We conducted a prospective cohort study of patients undergoing mastectomy with or without reconstruction.

Trends in Oral Anticoagulant Use Among 436 864 Patients With Atrial Fibrillation in Community Practice, 2011 to 2020.

Background Among patients with nonvalvular atrial fibrillation (AF) and an elevated stroke risk, guidelines recommend direct oral anticoagulants (DOACs) over warfarin for stroke prevention. Changes in DOAC use over the past decade have not been well described. Methods and Results We evaluated trends in use of DOACs and warfarin from 2011 to 2020 among adults with AF and a CHADS-VASc score ≥2 based on electronic health record data from 88 health systems in the United States contributing to Cerner Real World Data.

Projecting the Combined Health Care Burden of Seasonal Influenza and COVID-19 in the 2020-2021 Season.

Unlabelled: In mid-2020, there was significant concern that the overlapping 2020-2021 influenza season and COVID-19 pandemic would overwhelm already stressed health care systems in the Northern Hemisphere, particularly if influenza immunization rates were low. Using a mathematical susceptible-exposed-infected-recovered (SEIR) compartmental model incorporating the age-specific viral transmission rates and disease severity of Austin, Texas, a large metropolitan region, we projected the incidence and health care burden for both COVID-19 and influenza across observed levels of SARS-CoV-2 transmission and influenza immunization rates for the 2020-2021 season. We then retrospectively compared scenario projections made in August 2020 with observed trends through June 2021.

#ColonCancer: Social Media Discussions About Colorectal Cancer During the COVID-19 Pandemic.

Purpose: Colorectal cancer (CRC) is the second leading cause of cancer-related mortality worldwide. Social media platforms such as Twitter are extensively used to communicate about cancer care, yet little is known about the role of these online platforms in promoting early detection or sharing the lived experiences of patients with CRC. This study tracked Twitter discussions about CRC and characterized participating users to better understand public communication and perceptions of CRC during the COVID-19 pandemic.

Would You Recommend Aspirin to This Patient for Primary Prevention of Atherosclerotic Cardiovascular Disease? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death in the United States. Reducing ASCVD risk through primary prevention strategies has been shown to be effective; however, the role of aspirin in primary prevention remains unclear. The decision to recommend aspirin has been limited by the difficulty clinicians and patients face when trying to balance benefits and harms.