Medical Technology and Practice Patterns

What it reported doing in 2024

Nimhd r01 md017063-01 racial and ethnic disparities in hcc surveillancein 2024, we focused on two research aims: aim 1 was to evaluate gaps and disparities in hcc surveillance among adults with cirrhosis across four safety-net health systems in the u.s. We identified adults with cirrhosis from march 1, 2017 to february 28, 2022 across four safety-net health systems in California, Florida, Ohio, and Texas. Cirrhosis was identified using established definitions based on icd-9/10 codes. Patients with baseline hcc diagnosis were excluded. The primary outcome was receipt of hcc surveillance imaging (ultrasound, ct, or mri scans of the abdomen) within first 6 months (hcc6mo) of cirrhosis diagnosis during the study period. Among a multi-center safety-net cohort of cirrhosis patients, over 70% received some form of abdominal imaging within 6 months, but less than 30% received imaging specifically for an indication of hcc surveillance. We concluded that significant disparities in hcc surveillance were observed across sociodemographic factors. These findings were presented at the 2024 american association for the study of liver diseases (aasld) conference: gaps and disparities in hepatocellular carcinoma surveillance among a multi-center safety-net cohort of adults with cirrhosis. Robert j. Wong, patricia jones, bolin niu, paulo pinheiro, mae thamer5, onkar kshirsagar, yi zhang, et al. Poster presentation at aasld november 2024 san diego convention center san diego ca.aim 2 was to evaluate clinician-level factors contributing to underuse of hcc surveillance in patients with cirrhosis. Surveillance for hepatocellular carcinoma (hcc) in patients with cirrhosis is underused. We sought to identify potentially modifiable factors to address barriers in hcc surveillance is critical to improve patient outcomes. We conducted a survey study that included primary care clinicians (pccs) and gastroenterology and hepatology clinicians at 5 safety-net health systems in the us. Clinicians were surveyed from march 15 to september 15, 2023, to assess knowledge, attitudes, beliefs, perceived barriers, and covid-19-related disruptions in hcc surveillance in patients with cirrhosis. The main outcome measures were hcc surveillance knowledge that was assessed with 6 questions querying the respondent's ability to correctly identify appropriate use of hcc surveillance. Attitudes, perceived barriers, and beliefs regarding hcc surveillance and perceived impact of the covid-19 pandemic-related disruptions with hcc surveillance were assessed with a series of statements using a 4-point likert scale and compared pccs and gastroenterology and hepatology clinicians.overall, 347 of 1362 clinicians responded to the survey (25.5% response rate), among whom 142 of 237 (59.9%) were pccs, 48 of 237 (20.3%) gastroenterology and hepatology, 190 of 236 (80.5%) were doctors of medicine and doctors of osteopathic medicine, and 46 of 236 (19.5%) were advanced practice clinicians. On hcc knowledge assessment, 144 of 270 (53.3%) scored 5 or more of 6 questions correctly, 37 of 48 (77.1%) among gastroenterology and hepatology vs 65 of 142 (45.8%) among pccs (p < .001). Those with higher hcc knowledge scores were less likely to report barriers to hcc surveillance. Pccs were more likely to report inadequate time to discuss hcc surveillance (37 of 139 [26.6%] vs 2 of 48 [4.2%]; p = .001), difficulty identifying patients with cirrhosis (82 of 141 [58.2%] vs 5 of 48 [10.4%]; p < .001), and were not up-to-date with hcc surveillance guidelines (87 of 139 [62.6%] vs 5 of 48 [10.4%]; p < .001) compared with gastroenterology and hepatology clinicians. While most acknowledged delays during the covid-19 pandemic, 62 of 136 pccs (45.6%) and 27 of 45 gastroenterology and hepatology clinicians (60.0%) reported that patients with cirrhosis could currently complete hcc surveillance without delays. We concluded that in this survey study, important gaps in knowledge and perceived barriers to hcc survei

Financial Efficiency

• Mission deployment rate: 86.5%; rating input score 87
• Program expense ratio: 65.7%; rating input score 66
• Fundraising efficiency: Limited

Transparency & Controls

• Consistency checks: 92.9%; rating input score 93; 19th percentile among comparable filings
• Pay-setting controls: 2 of 6 controls in place; rating input score 33
  • Compensation committee: Missing
  • Independent consultant: Missing
  • Other Form 990s reviewed: Missing
  • Written employment contract: Missing
  • Compensation survey or study: Pass
  • Board or committee approval: Pass
• Foreign activity oversight: Limited
• Grant itemization coverage: Limited
• Major donor itemization: Yes; rating input score 100
• Related-party transparency: Limited

Accountability

• Independent voting board: 75%; rating input score 75; 16th percentile among comparable filings
• Governance controls: 6 of 8 controls in place; rating input score 75
  • Conflict-of-interest policy: Pass
  • Whistleblower policy: Pass
  • Document-retention policy: Pass
  • CEO compensation review process: Pass
  • Other executive compensation review process: NotApplicable
  • Form 990 shared with the board: Pass
  • Board meeting minutes documented: Pass
  • Audit committee oversight: Missing
  • Independent financial-statement audit: Fail

Sustainability

• Operating margin: -23.5%; rating input score 8; 8th percentile among comparable filings
• Total-asset coverage ratio: 3.82; rating input score 80; 80th percentile among comparable filings
• Liabilities to assets ratio: 0.18; rating input score 33; 33rd percentile among comparable filings
• Officer compensation ratio: 68%; rating input score 1; 1st percentile among comparable filings

Growth

• Program expense growth: -5.4% per year; rating input score 0; 7th percentile among comparable filings
• Revenue growth: -1.4% per year; rating input score 0; 10th percentile among comparable filings
• Asset growth: -3.6% per year; rating input score 0; 8th percentile among comparable filings