Frequent users of EMS suffer from disproportionate comorbidities, particularly substance abuse and psychiatric disorders. This population responds well to the intervention of a specially trained paramedic as measured by EMS usage. Tangherlini N , Villar J , Brown J , Rodriguez RM , Yeh C , Friedman BT , Wada P . The HOME Team: evaluating the effect of an EMS-based outreach team to decrease the frequency of 911 use among high utilizers of EMS. Prehosp Disaster Med. 2016;31(6):603-607.

This cohort study examines the risk of mortality and years of potential life lost among patients with active tuberculosis disease compared with individuals without active tuberculosis.

Active tuberculosis (TB) is preventable. To quantify the potential value of prevention, we assessed active TB burden in a large health system from 1997 to 2016. Compared with a matched non-TB cohort, patients with active TB had higher mortality (8.4% vs 1.3%), mean number of hospitalizations (0.55 vs 0.10), emergency department visits (0.78 vs 0.28), and outpatient visits (14.6 vs 5.9) in the first year. TB-associated hospital use (mean number of hospitalizations and total length of stay) increased from 1997–2000 compared with 2013–2016 despite decreasing active TB incidence. Active TB is associated with high mortality and health care utilization and has remained stable or increased over time.

<p class="Pa5"><strong>Objectives: </strong>To determine whether patients who are English proficient become aware of e-cigarettes through different marketing tac­tics and have dissimilar patterns of use than patients who are non-English speaking.</p><p class="Pa5"><strong>Design: </strong>This was a cross-sectional study surveying adult English- and Spanish-speak­ing patients. ANOVA and chi-squared tests were used to examine differences between groups.</p><p class="Pa5"><strong>Setting: </strong>A large public, safety-net hospital in Los Angeles County, California.</p><p class="Pa5"><strong>Results: </strong>Respondents (N=1899) were predominately Hispanic (78%), foreign-born (68%), and reported Spanish as a primary language (64%). Native English speakers re­ported the highest use of e-cigarettes (26%), followed by non-native (13%) and non- English speakers (2%) (P&lt;.001). In terms of marketing, native and non-native English speakers were more likely to have friends and family as sources of e-cigarette informa­tion (P&lt;.001). Native speakers were more likely to see advertisements for e-cigarettes on storefronts (P=.004) and on billboards (P&lt;.001). Non-English speakers were most likely to learn about e-cigarettes on the news (P&lt;.001) and in advertisements on the television and radio (P=.002). Differ­ences in reasons for use were not significant between the three groups.</p><p><strong>Conclusions: </strong>Native and non-native English speakers become aware of e-cigarettes through different mechanisms and use e-cigarettes at a significantly higher rate than non-English speakers. These results highlight an opportunity for public health programs to concentrate on specific channels of com­munication that introduce patient popula­tions to e-cigarettes to slow the spread of e-cigarette usage.</p><p><em>Ethn Dis. </em>2017;27(3):217- 222; doi:10.18865/ed.27.3.217</p>

BackgroundActive tuberculosis (TB) often results from reactivation of latent tuberculosis infection (LTBI). This can be prevented through LTBI screening and treatment, yet only 12% of Californians have undergone LTBI therapy. Updated estimates on the complete burden of active TB are needed to rationally allocate resources for LTBI program implementation.MethodsWe identified all patients with microbiologically confirmed active TB in a large, integrated health system (Kaiser Permanente Northern California, or KPNC) from 1997 to 2016. We calculated active TB incidence in KPNC and measured this against California’s reported cases. Within KPNC, we compared mortality, hospital, emergency department, and ambulatory care use among persons with active TB to age-, sex-, and year-of-diagnosis-matched cohort of persons without active TB.ResultsActive TB incidence was lower in KPNC (3.4/100,000 person-years) than in California (7.2/100,000 person-years). Among 2,522 active TB cases, early and delayed mortality was high with 7.0% dying within 1 year of diagnosis and 6.2% dying 1–5 years post-diagnosis. Of the 1,957 active TB patients who continued to receive care through KPNC for at least one year post-diagnosis, 603 (30.8%) had at least one hospitalization. In KPNC, active TB patients had higher healthcare utilization than the matched cohort in the one year following diagnosis: 0.6 vs. 0.1 hospitalizations, 9.5 vs. 4.6 days mean length-of-stay, 0.8 vs. 0.3 emergency department visits, and 14.6 vs. 5.9 ambulatory visits.ConclusionPatients with active TB disease have substantial mortality and high inpatient and outpatient healthcare utilization. By improving LTBI screening and treatment, large healthcare systems may be able to reduce the burden and costs associated with active TB.Disclosures All authors: No reported disclosures.

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BackgroundDespite increased efforts to promote HIV screening, a large proportion of the US population have never been tested for HIV.ObjectiveTo determine whether provider education and personalised HIV screening report cards can increase HIV screening rates within a large integrated healthcare system.DesignThis quality improvement study provided a cohort of primary care physicians (PCPs) a brief educational intervention and personalised HIV screening report cards with quarterly performance data.ParticipantsParticipants included a volunteer cohort of 20 PCPs in the department of adult and family medicine.Main measuresPer cent of empaneled patients screened for HIV by cohort PCPs compared with PCPs at the Kaiser Permanente Oakland Medical Center (KPOAK) and the non-Oakland Medical Centers in Northern California region (Kaiser Permanente Northern California (KPNC)).Key resultsOf the 20 participating PCPs, 13 were female and 7 were male. Thirteen were internal medicine and seven family medicine physicians. The average age was 40 years and average practice experience was 9 years after residency. During the 12-month intervention, the estimated increase in HIV screening in the cohort PCP group was 2.6% as compared with 1.9% for KPOAK and 1.8% for KPNC.ConclusionsThese findings suggest that performance-related report cards are associated with modestly increased rates of HIV screening by PCPs.