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Background Social determinants of health challenge in at-risk patients seen in safety net facilities. Study design We performed a retrospective review of surgical oncology specialty clinic referrals at a safety net institution evaluating referral compliance and times to first appointment and initiation of definitive treatment. Main outcomes measured included completion of initial visit, initiation of definitive treatment, time from referral to first appointment, and time from first appointment to initiation of definitive treatment. Results Of 189 new referrals, English was not spoken by 52.4% and 69.4% were Hispanic. Patients presented without insurance in 39.2% of cases. Electronic patient portal was accessed by 31.6% of patients. Of all new referrals, 55.0% arrived for initial consultation and 53.4% initiated definitive treatment. Malignant diagnosis ( P < .0001) and lack of insurance ( P = .01) were associated with completing initial consultation. Initiation of definitive treatment was associated with not speaking English ( P = .03), malignant diagnosis ( P < .0001), and lack of insurance ( P = .03). Times to first appointment and initiation of definitive treatment were not significantly affected by race/ethnicity, language, insurance, treatment recommended, or electronic patient portal access. Conclusion Access to surgical oncology care for at-risk patients at a safety net facility is not adversely affected by lack of insurance, primary spoken language, or race/ethnicity. However, a significant proportion of all patients fail to complete the initial consultation and definitive treatment. Lessons learned from safety net facilities may help to inform disparities in health care found elsewhere.

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PURPOSE: Pulmonary hypertension (PH) is a rare, life-threatening disease that is commonly associated with various comorbidities. Although multiple therapies are approved by FDA in recent years, less than significant improvement is seen in patient survival. A primary reason for suboptimal therapeutic benefits can be attributed to ability of current therapies to merely ameliorate PH symptoms without limiting the vasculopathy associated with disease progression. Due to existence of overlapping and interconnected pathological pathways, PH management has been a cumbersome task as the current therapeutic interventions only target one of the many pathological pathways involved. This study is aimed to evaluate the need for a multiple pathway modulating therapy for PH management. METHODS:To assess the need for multiple pathway modulating therapy, a survey was designed and distributed to PH clinicians and experts. The survey contained a total of 10 questions on a Likert scale of 1-5, and focused on issues surrounding current PH therapies: efficacy, safety, patient compliance and the need for a therapy modulating multiple pathways. Quantitative and qualitative responses were recorded, and the obtained data were analyzed. RESULTS:Preliminary results of the study showed that there was unanimous acceptance among PH healthcare professionals of the need for a therapy modulating multiple pathways (overall numeric response being 5 on a scale of 1-5). Furthermore, the current therapies were only moderately successful in terms of patient compliance (3 on a scale of 1-5). In addition to the issues with patient compliance and need for multiple pathway modulating therapy, it was also discovered that there are tremendous cost implications of PH treatment on payers. Based on preliminary calculations, a new therapy modulating multiple pathogenic pathways will minimize the number of prescription medications and mitigate re-hospitalization occurrences, thus saving each patient upwards of $150,000.CONCLUSIONS: Overall, we found that in consideration of disease outcome and cost burden of PH, there is great potential for a new multiple pathway modulating therapy to be successful in the PH market.CLINICAL IMPLICATIONS: Clinical implications of developing a novel therapy capable of modulating multiple pathogenic pathways responsible for PH pathogenesis will be beneficial in not only advancing the current PH therapeutic regimen but will also have significant benefits in elucidating and exploiting the pathological links between PH and several associated disorders.