Linguistic Biases in Letters of Recommendation Written for Rheumatology Fellowship Applicants

Our study aimed to investigate for implicit linguistic biases in letters of recommendation written for applicants applying to our rheumatology program, and to determine if differences in gender and race exist between the applicants. Additionally, we wanted to compare these results to the gender, race, academic rank, and position of the letter writers. We found that among the preliminary 50 letters, they showed that our letters seemed to show the opposite trends than other published studies. We anticipate the need for further study, and look forward to the results

Real time patient-reported outcome measures in patients with cancer: Early experience within an integrated health system

BACKGROUND: While patient-reported outcome measures (PROMs) have benefit in cancer clinical trials, real-world applications are lacking. This study describes the method of implementation of a cancer enterprise-wide PROMs platform. METHODS: After establishing a multispecialty stakeholder group within a large integrated health system, domain-specific instruments were selected from the National Institutes of Health\u27s Patient-Reported Outcomes Measurement Information System (PROMIS) instruments (pain interference, fatigue, physical function, and depression) and were administered at varying frequencies throughout each patient\u27s cancer journey. All cancer patients with an oncologic visit were eligible to complete the PROMs prior to the visit using a patient portal, or at the time of the visit using a tablet. PROMs were integrated into clinical workflow. Clinical partnerships were essential for successful implementation. Descriptive preliminary data were compared using multivariable logistic regression to determine the factors associated with method of PROMs completion. RESULTS: From September 16, 2020 to July 23, 2021, 23 of 38 clinical units (60.5%) implemented PROMs over 2392 encounters and 1666 patients. Approximately one third of patients (n = 629, 37.8%) used the patient portal. Black patients (aOR 0.70; 95% CI: 0.51-0.97) and patients residing in zip codes with higher percentage of unemployment (aOR: 0.07, 95% CI: 0.01-0.41) were among the least likely to complete PROMs using the patient portal. CONCLUSIONS: Successful system-wide implementation of PROMs among cancer patients requires engagement from multispecialty stakeholders and investment from clinical partners. Attention to the method of PROMs collection is required in order to reduce the potential for disparities, such as Black populations and those residing in areas with high levels of unemployment

Treatment fragmentation and timely treatment in racially and socioeconomically diverse patients with head and neck cancers

Background: Head and neck cancer treatment is complex, requiring timely, multidisciplinary coordination of care. Integrated care teams, multidisciplinary teams that work together, may improve quality and coordination of care, but can be at odds of patients\u27 ability to access care. Other variables, such as belonging to a racial minority or lower socioeconomic status have also been implicated in access to care. Treatment fragmentation, has been reported to increase cost of care and is associated with worse patient outcomes. However, its effect within a vertically integrated health system, with a salaried medical group, versus private practice, is unknown. This study aims to investigate the risk factors and effects of fragmentation among diverse patients with head and neck cancer treated within a vertically integrated health system. Methods: This retrospective cohort study investigates diverse patients with head and neck cancer treated from 2012-2019 undergoing ≥2 treatment modalities. Fragmentation was defined as receipt of treatment at \u3e1 treatment facility. Most practice providers practiced out of a single location, here named “Main Campus”. Demographic, disease, and insurance characteristics were collected. Census tract-level socioeconomic status variables include median household income, education composite score, and census block group-level of area deprivation index (ADI) within Michigan. Patients were compared by time to treatment initiation, defined as days from diagnosis to receipt of first treatment modality. In patients undergoing surgery as a first modality of treatment, days from first treatment to second treatment modality was also compared between patients undergoing fragmented and unfragmented care. Results: Fragmentation occurred in 10.2% of head and neck cancer patients. Unfragmented care was associated with being African American (adjusted odds ratio (aOR)=0.22, 95% confidence interval (CI)= 0.03 to 0.76) and residence in census block with higher ADI (aOR=0.84/decile, 95% CI=0.75 to 0.94). African American patients were more frequently treated at the main campus for their first and second modality of treatments (n=104, 92.9% and n=103, 92.8%) compared to all other races (p\u3c0.001 and p\u3c0.001, respectively). Time to treatment initiation was 34 days (IQR=20, 48) for patients receiving unfragmented care, which was equal to those receiving fragmented care (34 days, IQR=15 to 46; p=0.527). For 158 patients undergoing surgery, time to second treatment modality was also equal between unfragmented (36 days, IQR=29, 44) versus fragmented care (35 days, IQR=30, 41; p=0.624). Neither race nor ADI demonstrated differences in time to treatment initiation or time to second modality treatment. Conclusion: Within a vertically integrated health system, fragmentation occurred in a small minority of patients. While receipt of unfragmented care was associated with variables traditionally related to decreased access to health care, these populations did not experience delays in initiation of treatment or start of the second modality of treatment

Regional distribution of adult rheumatologists

To analyze the distribution of rheumatology practices in the US and factors associated with that distribution, in order to better understand the supply of the rheumatology workforce. Using the American College of Rheumatology membership database, all practicing adult rheumatologist office addresses were mapped with ArcView software. The number of rheumatologists per Core Based Statistical Area (CBSA) was calculated. To investigate whether sociodemographic factors correlated with clustering of rheumatologists, covariates from the 2010 US Census for each CBSA, including age, sex, race/ethnicity, and median household income, were modeled. Many CBSAs, predominantly smaller micropolitan areas, did not have a practicing rheumatologist. For some of these smaller micropolitan areas (with populations of at least 40,000), the closest practicing rheumatologist was more than 200 miles away. However, we also identified several more-populous areas (populations of 200,000 or more) without a practicing rheumatologist. Greater numbers of rheumatologists were more likely to practice in areas with higher population densities and higher median incomes. More rheumatologists were also found in CBSAs in which there were rheumatology training programs. These findings demonstrate that many smaller regions of the country have no or few practicing adult rheumatologists. Patients with chronic rheumatic conditions in these areas likely have limited access to rheumatology care. Policy changes could address potential regional rheumatology workforce shortages, but limitations of the current data would need to be addressed prior to implementation of such changes