Main Session
Sep
30
PQA 07 - Genitourinary Cancer, Patient Safety, Nursing/Supportive Care
3292 - Social Determinants of Health in Radiation Oncology Patient Safety Incidents
Presenter(s)
Javier Mora, MD - Harvard Radiation Oncology Program, Boston, MA
J. Mora1, K. Y. Shin2, T. K. Kosak3, J. Hudson4, and I. M. Pashtan3; 1Harvard Radiation Oncology Program, Boston, MA, 2Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, 3Department of Radiation Oncology, Dana-Farber Brigham Cancer Center, Boston, MA, 4Milford Radiation Oncology / Brigham and Women's Hospital, Boston, MA
Purpose/Objective(s):
An analysis of the impact of social determinants of health (SDOH) on patient vulnerability to radiation oncology (RO) safety incidents has not been performed. This study aims to explore whether there are significant social differences in patients experiencing RO safety incidents within a multi-institution cancer center.Materials/Methods:
Patient safety incident reports were collated from institutional repositories and matched to demographic data (sex, age, race/ethnicity, employment, ZIP-code level income/ residence, insurance type, marital status, education, preferred language, country of origin, substance use, body mass index (BMI)) via electronic medical record abstract. Incident severity, event type, and impacted workflow step were tabulated. Multivariable (MV) logistic regression was performed on factors in which at least half of subcategories had p = 0.05 univariably.Results:
From 1/1/2021-12/31/2022, 26,269 patients were seen in 454,412 encounters, of which 652 safety incidents were experienced by 605 (2.3%) patients. Patients with safety incidents had a higher median number of encounters than overall (29 vs. 10). Safety incidents were largely of no harm (93.6%) and occurred during treatment preparation (53.3%), although 28.9% of events occurred during treatment delivery or on-treatment quality assurance. Per Table, as compared to reference groups, patients of male sex or with current/unknown alcohol use had significantly lower odds of safety incidents; those with non-employed status, high school education, active smoking, and non-straight sexual orientation had significantly higher odds of safety incidents.Conclusion:
Non-employed status, high school education, active smoking, and non-heterosexuality were associated with significantly higher risk of experiencing a RO safety incident, whereas male sex and current/unknown alcohol use were associated with lower risk. Further study of SDOH will help identify vulnerable individuals and enhance equity, quality, and safety for RO patients. Abstract 3292 - Table 1| MV Category | OR (95% CI) | p |
| Male sex (ref: female) | 0.81 (0.69, 0.95) | 0.01 |
| Employment (ref: employed) | ||
| Not employed | 1.28 (1.06, 1.53) | 0.01 |
| Student | 1.21 (0.37, 2.93) | 0.71 |
| Unknown | 1.16 (0.82, 1.60) | 0.39 |
| Education (ref: college/graduate school) | ||
| 8th grade or less | 1.12 (0.70, 1.69) | 0.61 |
| High school/ GED | 1.40 (1.15, 1.69) | <0.01 |
| Some college/ associate/ vocational/ technical degree | 1.05 (0.79, 1.39) | 0.71 |
| Unknown | 1.17 (0.90, 1.51) | 0.22 |
| Alcohol use (ref: none) | ||
| Not currently | 0.85 (0.68, 1.06) | 0.15 |
| Yes | 0.73 (0.64, 0.98) | 0.03 |
| Unknown | 0.45 (0.28, 0.72) | <0.01 |
| Smoking (ref: never) | ||
| Active | 1.36 (1.01, 1.80) | 0.03 |
| Former | 1.16 (0.98, 1.37) | 0.09 |
| Unknown | 1.64 (0.81, 3.22) | 0.16 |
| Sexual Orientation (ref: straight) | ||
| Other | 1.51 (1.07, 2.06) | 0.01 |
| Unknown | 1.16 (0.98, 1.37) | 0.08 |
| Insurance (ref: commercial) | ||
| Medicare | 1.12 (0.94, 1.33) | 0.20 |
| Other/Unknown | 0.84 (0.54, 1.23) | 0.39 |