- Email: [email protected]
Readability of Patient Education Websites of Liver Transplant Centers - a Barrier to the Waitlist?
e78
Scientific Poster Presentations: 2017 Clinical Congress
CONCLUSIONS: When asked to recall decision-making at the time of breast cancer treatment, women reported not feeling fully informed of surgical options. These results suggest a patientperceived knowledge gap. Improved patient access to educational materials and decision aids may enhance the informed consent process. Better educated decision-making may eliminate the perceived urgency, allow for confident treatment decisions, and ultimately improve patient satisfaction. Racial Disparities in Primary Amputation vs Revascularization for Critical Limb Ischemia: A Meta-Analysis Samantha D Minc, MD, FACS, Louis F Fogg, PhD, Walter J McCarthy III, MD, FACS, Raj C Shah, MD Rush University Medical Center, Chicago, IL INTRODUCTION: In the US, non-whites undergo amputation for vascular disease at rates that are 2 to 4 times higher than whites. A growing body of literature has also demonstrated that non-whites presenting with critical limb ischemia (CLI) are also more likely to undergo primary amputation and less likely to be offered revascularization, even when accounting for comorbidities. This phenomenon remains an area of debate and a systematic review of the literature has never been performed. We present a meta-analysis of the existing data on race and primary amputation vs revascularization for CLI. METHODS: A database search was performed with PubMed using search query terms for PAD, diabetic foot, CLI, lower extremity amputation (LEA), and health disparities. Non-US and non-English articles were excluded. A meta-analysis was conducted to examine the rates of primary amputation for CLI for non-whites vs whites. RESULTS: A total of 695 articles were identified; records not related to PAD, LEA, CLI or race were excluded. Thirty-six fulltext articles were screened and 8 met criteria for inclusion. Based on the meta-analysis, the likelihood of primary amputation for CLI was 2.5 times higher in non-whites (odds ratio ¼ 2.52, CI 2.50-2.54, p<.001). One study found the difference to be statistically insignificant. CONCLUSIONS: Amputation is a devastating but preventable complication of vascular disease. In our meta-analysis, non-white race alone more than doubled the risk of primary amputation in patients presenting with CLI. Future work should be focused on obtaining prospective data, evaluating the etiologies of this disparity, and creating interventions to reduce it. Readability of Patient Education Websites of Liver Transplant Centers - a Barrier to the Waitlist? Yanik J Bababekov, MD, MPH, Bonnie Cao, Faith C Njoku, Ya-Ching Hung, MD, Joel T Adler, MD, MPH, James J Pomposelli, MD, PhD, David C Chang, PhD, Heidi Yeh, MD Massachusetts General Hospital/Harvard Medical School, Boston, MA
J Am Coll Surg
INTRODUCTION: After the Plain Writing Act of 2010, the Centers for Disease Control and Prevention developed the Clear Communication Index (CCI) to assess readability of patient communication materials. Patient education during the transplant process is known to increase compliance which predicts better patient outcomes; however, the readability of liver transplant educational materials is unknown at the national level. METHODS: The Scientific Registry of Transplant Recipients was searched for adult liver transplant centers (n¼115). Two independent reviewers assessed patient education information on liver transplant center websites for readability via the CCI. A score on the CCI 90% indicates the material is easy to understand. Additional analyses were performed to correlate education level of patients on the liver transplant waitlist with CCI score for United Network for Organ Sharing Regions (UNOS R). RESULTS: The median CCI score for websites was 72.6% (interquartile 67.5%, 75.0%). No patient information website had a CCI score 90%. State, organ procurement organization (OPO), number of centers per OPO, or UNOS R did not predict CCI scores for websites. Regression demonstrated that for every percent increase of patients with at least high school education in a UNOS R, CCI scores decreased by 0.2 for that UNOS R (p<0.001). CONCLUSIONS: Patient education materials for liver transplantation may be presented in a way that is not easy to understand. In some UNOS R, level of education confers an unfair advantage for access to the liver transplant waitlist. A quality improvement approach should decrease the health literacy burden of patient education materials.
Centers for Medicare and Medicaid Services (CMS) Quality Payment Program: A New Financial Conflict of Interest for Physicians Mateusz Graca, Jason D Keune, MD, MBA, FACS St Louis University, St Louis, MO INTRODUCTION: As part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Centers for Medicare and Medicaid Services (CMS) released legislative transformations to Medicare, replacing the Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula with the Quality Payment Program (QPP), a value-based reimbursement model. This requires physicians to report self-elected performance metrics that will be combined into a composite score used for determining payment adjustments from CMS. METHODS: In this analysis of presumed practical consequences of MACRA and subsequent ethical considerations for physicians, we will begin by discussing the deficiencies of national health care in regards to quality and patient safety. We will then explain the key features of MACRA, including the unintentional creation of a financial conflict of interest for physicians between striving to increase their quality of care versus adapting to MACRA by selfreporting more easily achieved measures, unrelated, or only
Scientific Poster Presentations: 2017 Clinical Congress
CONCLUSIONS: When asked to recall decision-making at the time of breast cancer treatment, women reported not feeling fully informed of surgical options. These results suggest a patientperceived knowledge gap. Improved patient access to educational materials and decision aids may enhance the informed consent process. Better educated decision-making may eliminate the perceived urgency, allow for confident treatment decisions, and ultimately improve patient satisfaction. Racial Disparities in Primary Amputation vs Revascularization for Critical Limb Ischemia: A Meta-Analysis Samantha D Minc, MD, FACS, Louis F Fogg, PhD, Walter J McCarthy III, MD, FACS, Raj C Shah, MD Rush University Medical Center, Chicago, IL INTRODUCTION: In the US, non-whites undergo amputation for vascular disease at rates that are 2 to 4 times higher than whites. A growing body of literature has also demonstrated that non-whites presenting with critical limb ischemia (CLI) are also more likely to undergo primary amputation and less likely to be offered revascularization, even when accounting for comorbidities. This phenomenon remains an area of debate and a systematic review of the literature has never been performed. We present a meta-analysis of the existing data on race and primary amputation vs revascularization for CLI. METHODS: A database search was performed with PubMed using search query terms for PAD, diabetic foot, CLI, lower extremity amputation (LEA), and health disparities. Non-US and non-English articles were excluded. A meta-analysis was conducted to examine the rates of primary amputation for CLI for non-whites vs whites. RESULTS: A total of 695 articles were identified; records not related to PAD, LEA, CLI or race were excluded. Thirty-six fulltext articles were screened and 8 met criteria for inclusion. Based on the meta-analysis, the likelihood of primary amputation for CLI was 2.5 times higher in non-whites (odds ratio ¼ 2.52, CI 2.50-2.54, p<.001). One study found the difference to be statistically insignificant. CONCLUSIONS: Amputation is a devastating but preventable complication of vascular disease. In our meta-analysis, non-white race alone more than doubled the risk of primary amputation in patients presenting with CLI. Future work should be focused on obtaining prospective data, evaluating the etiologies of this disparity, and creating interventions to reduce it. Readability of Patient Education Websites of Liver Transplant Centers - a Barrier to the Waitlist? Yanik J Bababekov, MD, MPH, Bonnie Cao, Faith C Njoku, Ya-Ching Hung, MD, Joel T Adler, MD, MPH, James J Pomposelli, MD, PhD, David C Chang, PhD, Heidi Yeh, MD Massachusetts General Hospital/Harvard Medical School, Boston, MA
J Am Coll Surg
INTRODUCTION: After the Plain Writing Act of 2010, the Centers for Disease Control and Prevention developed the Clear Communication Index (CCI) to assess readability of patient communication materials. Patient education during the transplant process is known to increase compliance which predicts better patient outcomes; however, the readability of liver transplant educational materials is unknown at the national level. METHODS: The Scientific Registry of Transplant Recipients was searched for adult liver transplant centers (n¼115). Two independent reviewers assessed patient education information on liver transplant center websites for readability via the CCI. A score on the CCI 90% indicates the material is easy to understand. Additional analyses were performed to correlate education level of patients on the liver transplant waitlist with CCI score for United Network for Organ Sharing Regions (UNOS R). RESULTS: The median CCI score for websites was 72.6% (interquartile 67.5%, 75.0%). No patient information website had a CCI score 90%. State, organ procurement organization (OPO), number of centers per OPO, or UNOS R did not predict CCI scores for websites. Regression demonstrated that for every percent increase of patients with at least high school education in a UNOS R, CCI scores decreased by 0.2 for that UNOS R (p<0.001). CONCLUSIONS: Patient education materials for liver transplantation may be presented in a way that is not easy to understand. In some UNOS R, level of education confers an unfair advantage for access to the liver transplant waitlist. A quality improvement approach should decrease the health literacy burden of patient education materials.
Centers for Medicare and Medicaid Services (CMS) Quality Payment Program: A New Financial Conflict of Interest for Physicians Mateusz Graca, Jason D Keune, MD, MBA, FACS St Louis University, St Louis, MO INTRODUCTION: As part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Centers for Medicare and Medicaid Services (CMS) released legislative transformations to Medicare, replacing the Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula with the Quality Payment Program (QPP), a value-based reimbursement model. This requires physicians to report self-elected performance metrics that will be combined into a composite score used for determining payment adjustments from CMS. METHODS: In this analysis of presumed practical consequences of MACRA and subsequent ethical considerations for physicians, we will begin by discussing the deficiencies of national health care in regards to quality and patient safety. We will then explain the key features of MACRA, including the unintentional creation of a financial conflict of interest for physicians between striving to increase their quality of care versus adapting to MACRA by selfreporting more easily achieved measures, unrelated, or only