ImportanceCancer screening deficits during the first year of the COVID-19 pandemic were found to persist into 2021. Cancer-related deaths over the next decade are projected to increase if these deficits are not addressed.ObjectiveTo assess whether participation in a nationwide quality improvement (QI) collaborative, Return-to-Screening, was associated with restoration of cancer screening.Design, Setting, and ParticipantsAccredited cancer programs electively enrolled in this QI study. Project-specific targets were established on the basis of differences in mean monthly screening test volumes (MTVs) between representative prepandemic (September 2019 and January 2020) and pandemic (September 2020 and January 2021) periods to restore prepandemic volumes and achieve a minimum of 10% increase in MTV. Local QI teams implemented evidence-based screening interventions from June to November 2021 (intervention period), iteratively adjusting interventions according to their MTVs and target. Interrupted time series analyses was used to identify the intervention effect. Data analysis was performed from January to April 2022.ExposuresCollaborative QI support included provision of a Return-to-Screening plan-do-study-act protocol, evidence-based screening interventions, QI education, programmatic coordination, and calculation of screening deficits and targets.Main Outcomes and MeasuresThe primary outcome was the proportion of QI projects reaching target MTV and counterfactual differences in the aggregate number of screening tests across time periods.ResultsOf 859 cancer screening QI projects (452 for breast cancer, 134 for colorectal cancer, 244 for lung cancer, and 29 for cervical cancer) conducted by 786 accredited cancer programs, 676 projects (79%) reached their target MTV. There were no hospital characteristics associated with increased likelihood of reaching target MTV except for disease site (lung vs breast, odds ratio, 2.8; 95% CI, 1.7 to 4.7). During the preintervention period (April to May 2021), there was a decrease in the mean MTV (slope, −13.1 tests per month; 95% CI, −23.1 to −3.2 tests per month). Interventions were associated with a significant immediate (slope, 101.0 tests per month; 95% CI, 49.1 to 153.0 tests per month) and sustained (slope, 36.3 tests per month; 95% CI, 5.3 to 67.3 tests per month) increase in MTVs relative to the preintervention trends. Additional screening tests were performed during the intervention period compared with the prepandemic period (170 748 tests), the pandemic period (210 450 tests), and the preintervention period (722 427 tests).Conclusions and RelevanceIn this QI study, participation in a national Return-to-Screening collaborative with a multifaceted QI intervention was associated with improvements in cancer screening. Future collaborative QI endeavors leveraging accreditation infrastructure may help address other gaps in cancer care.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide with over 3 × 10 6 deaths in 2019. Such an alarming figure becomes frightening when combined with the number of lost lives resulting from COVID-caused respiratory failure. Because COPD exacerbations identified early can commonly be treated at home, early symptom detections may enable a major reduction of COPD patient readmission and associated healthcare costs; this is particularly important during pandemics such as COVID-19 in which healthcare facilities are overwhelmed. The standard adjuncts used to assess lung function (e.g., spirometry, plethysmography, and CT scan) are expensive, time consuming, and cannot be used in remote patient monitoring of an acute exacerbation. In this paper, a wearable multi-modal system for breathing analysis is presented, which can be used in quantifying various airflow obstructions. The wearable multi-modal electroacoustic system employs a body area sensor network with each sensor-node having a multi-modal sensing capability, such as a digital stethoscope, electrocardiogram monitor, thermometer, and goniometer. The signal-to-noise ratio (SNR) of the resulting acoustic spectrum is used as a measure of breathing intensity. The results are shown from data collected from over 35 healthy subjects and 3 COPD subjects, demonstrating a positive correlation of SNR values to the health-scale score.

Health care professionals working collaboratively on interprofessional teams are essential to optimize patient-centered care. Collaboration and teamwork can be best achieved if interprofessional education (IPE) starts early for health professions students. This commentary describes the formation, implementation, impact, and lessons learned from students' curricular and co-curricular activities and faculty collaboration over a five-year trajectory of the Eastern Shore Collaborative for Interprofessional Education (ESCIPE). This collaborative is an inter-institutional, interprofessional team and includes 18 faculty members from nine health disciplines with administrative support to prepare practice-ready graduates through effective IPE curricular and co-curricular activities. This collaborative also serves as a resource for interprofessional education, research and scholarship initiatives for faculty members. Activities include educational programs such as an emergency preparedness point-of-dispensing (POD) drill, patient management laboratory simulation, geriatric assessment interdisciplinary team workshop, medical mission as public/global health rotation and service-learning program, rural health fair, and annual university health festival for community outreach. The ESCIPE has also facilitated interprofessional faculty assessment and development, research and scholarship opportunities.

BACKGROUND: Access and quality of health care for cardiopulmonary disease in the United States ranks poorly compared with economically similar nations. No recent comprehensive assessment of the cardiopulmonary workforce is available. This systematic review was conducted to evaluate current published evidence about the workforce caring for persons with cardiopulmonary disease.METHODS: This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Structured searches of medical databases were conducted to find studies published from 2006 through 2016. Because of the paucity of quantitative data retrieved, a qualitative synthesis was conducted. Thematic analyses were performed on 15 identified articles through a process of open and axial coding.RESULTS: There is published evidence of current and projected workforce shortages in all clinical settings where care of persons with cardiopulmonary disease occurs. Advanced practice providers complete much of their cardiopulmonary training on the job. The aging population and the advent of new medical interventions are projected to increase growth in health-care demand. Some physicians limit hiring of advanced practice providers because of a deficiency in formal cardiopulmonary training.CONCLUSIONS: There is a gap in care between the needs of persons with cardiopulmonary disease and cardiopulmonary providers. Strategies resolving this problem may include one or more approaches that reduce the administrative burden associated with current care and assure the availability of suitably trained providers. CHEST 2020; 157(5):1221-1229

Background Survivorship care plans seek to improve the transition to survivorship, but the required resources present implementation barriers. This randomized controlled trial aimed to identify the simplest, most effective approach for survivorship care planning. Methods Stage 1-3 breast, colorectal, and prostate cancer patients aged 21+ completing treatment were recruited from an urban-academic and rural-community cancer center. Participants were randomized, stratified by recruitment site and cancer type, 1:1:1 to (a)mailed plan, (b)plan delivered during one-time transition visit, or (c)plan delivered during transition visit plus 6-month follow-up visit. Health service use data were collected from participants and medical records for 18 months. The primary outcome, receipt of all plan-recommended care, was compared across intervention arms using logistic regression adjusting for cancer type and recruitment site with p < 0.05 considered statistically significant. Results Of 378 participants randomized, 159 (42.1%) were breast, 142 (37.6%) prostate, 77 (20.4%) colorectal cancer survivors; 207 (54.8%) from the academic site, 171 (45.2%) from the community site; 316 analyzable for the primary outcome. There was no difference across arms in the proportion of participants receiving all plan-recommended care: 45.2% mail, 50.5% one-visit, 42.7% two-visit (2-sided P = 0.60). Adherence by cancer type for mail, one-visit, and two-visit, respectively, was 52.2%, 53.3%, 40.0% for breast cancer; 48.6%, 64.1%, 57.1% for prostate cancer; and 23.8%, 19.0%, 26.1% for colorectal cancer. There were no statistically significant interactions by recruitment site or cancer type. Conclusions This study did not find differences in receipt of recommended follow-up care by plan delivery approach. Feasibility and other factors may determine the best approach for survivorship care planning.