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e16798 Background: There are no accepted guidelines for testing individuals at elevated risk for developing pancreatic duct adenocarcinoma (PC). We initiated a prospective screening and surveillance program for individuals at elevated risk for PC. Methods: Eligibility for the Pancreatic Cancer Early Detection Protocol (PCEDP) was based on germ line status and/or family history of PC, provided that the imparted risk was either five times that of the general population or 7.5% lifetime risk for developing PC. Testing was continued alternating between Endoscopic Ultrasound (EUS) and Magnetic Resonance Imaging (MRI) of the abdomen. Objectives were was to analyze the number, type, and location of pancreatic conditions found and their associations with genetic or family history; and to evaluate the outcomes and/or complications that may have resulted from our testing. Results: From April 2014 through October 2019 we received 238 queries, out of which 75 individuals (31%) enrolled in the PCEDP. Eligibility was based upon individual’s germ line only (45%), family history only (32%), and both (23%). Germ line mutations were observed in 34 (BRCA2), 9 (BRCA1), 4 (ATM), 3 (PALB2), and 3 (CDKN2A) individuals. Median age at consent was 57, 60% were female,and88%, 4%, 3%, and 1% self-identified as Caucasian, African American, Hispanic, and Asian, respectively. 133 EUS procedures and 83 MRIs have been performed. No serious adverse events occurred. Standard Insurance approved and paid for the vast majority of tests. Four individuals withdrew (5%) and three (4%) were lost to follow up. Ten individuals (13%) were found to have abnormal findings in the pancreas and therefore met an endpoint of the study, including seven anechoic cysts and three suspected intraductal papillary mucinous neoplasms (IPMN). All individuals with endpoints were recommended to continue surveillance with EUS. Eight of the ten endpoints were found on baseline EUS, one one from baseline MRI, and one was found on the 3rd EUS. One of the individuals with a 2.5cm IPMN seen on baseline EUS underwent a subsequent distal pancreatectomy, with pathology revealing high grade dysplasia. Conclusions: Screening and surveillance for PC using EUS alternating with MRI was feasible and well tolerated in our population of individuals with an elevated risk. Baseline EUS was successful in detecting 10/75 = 13% of enrollees with some abnormal pancreatic finding, including one requiring intervention with a high grade pre-malignant IPMN.

148 Background: Care coordination (CC) has been identified by the IOM as critically important for the delivery of quality medical care. Coordination of care is especially important in oncology due to multiple encounters, many physicians, significant toxicities and several care transition points. Standard patient satisfaction surveys do not accurately measure CC and there are few instruments to measure a patient’s perspective of CC directly. In this project, multiple PDSA cycles were utilized with oncology patients to develop a Care Coordination Instrument (CCI) that was then used to compare the level of CC in two distinct practices. Methods: Survey questions were initially prepared by the research team after review of existing literature, submitted to oncology RNs, NPs and MDs and then modified based on their feedback. A new survey was then administered to 30 patients. This was again modified to eliminate or improve questions that were confusing to patients. A third survey instrument was developed and administered to an additional 30 patients. Statistical analysis identified that several questions were too structured leading to many “not applicable” responses. These were changed to a more conceptual framework. The survey was then administered to 30 patients in the myeloma practice and 30 in the GI oncology practice. Results: The CCI included questions from 4 areas of coordination (patient-physician; between health providers; during inpatient-to-ambulatory care transitions; during transitions across different phases of care) and 3 domains (Communication, Operational, Navigation). The GI oncology practice scored significantly better than the myeloma practice on the communication and navigation domains (p < 0.01). There was no significant difference in the operational domain. Conclusions: Testing to date suggests that the CCI is a useful instrument in measuring an oncology patient’s perception of CC. For two distinct practices, significant differences in the delivery of CC were identified. Further refinement is necessary to modify or eliminate questions with high levels of missing data due to non-responsiveness. Separate sub-scores across domains help identify specific targets for quality improvement interventions.

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Research Objectives: The Centers for Medicare and Medicaid Services (CMS) uses hospital readmissions as an indicator of quality of care during the index hospitalization. Patients with hematologic malignancies are at high risk of abnormal blood glucose levels, in particular hyperglycemia. Hyperglycemia during hematopoietic stem cell transplantation (HCT) is associated with adverse outcomes such as infection, delayed engraftment, and prolonged length of stay. Little is known about the association between pre-stem cell infusion glucose patterns as a prognostic indicator of patient outcomes. Methods: This single institution retrospective study using electronic health records (EHR) investigated the association of mean glucose levels prior to stem cell infusion with length of stay (LOS), 30 and 90 day readmissions, and time to engraftment in 739 patients undergoing bone marrow transplant between January 1, 2009 and December 31, 2013. Data was sorted and reported with the assistance of our BMT data management team and our institution's Data Warehouse who procured information from EPIC, EPIC's predecessor, and hospital-linked databases. Data were analyzed using descriptive statistics, Kruskal-Wallis, and Chi-square analyses. Results: Mean age was 57+ 14. The majority of population was male (55%) and was racially and ethnically mixed (White 38%, African American 23%, Hispanic 6%, Asian 7%, Other 21%). Twenty two percent of patients had a diagnosis of diabetes (ICD9 250.X). A review of mean glucose levels prior to stem cell infusion in 619 evaluable patients identified five unique patterns (see Figure), characterized by glucose levels 7 days prior to infusion (normal/moderate/high) and trend over time (stable/increasing): normal/stable (n=445), high/stable (n=16), moderate/increasing (n=75), high/ increasing (n=28), and moderate/stable (n=55). Kruskal-Wallis and Chi-square analyses showed that a normal/ stable pattern of daily mean blood glucose prior to stem cell infusion was associated with significantly lower LOS (p<0.0001) and lower 90 day readmission (p=0.0212). Conclusions: Our study indicates that the pattern of pre-transplant blood glucoses may be a prognostic indicator of adverse outcomes in patients undergoing HCT, in particular LOS and 90 day readmission rate. This has important implications for health care utilization. The mechanism to this association of blood glucose patterns and increased use of health services is currently being investigated further by our team. While study limitations include its retrospective nature and that this is a single institution study, its strengths include a robust sample size and use of EHR. EHR could be used further as a modality to help identify those patients who might merit endocrine consults and stricter glucose control to limit LOS and readmission rate. EHR may also help to pinpoint the etiology to the hyperglycemia, such as exposure to steroids or other agents as well as more physiologic causes. In addition, future studies may incorporate biomarkers to help predict patient outcome in relation to glucose levels. Above are the trajectories of 619 evaluable patients categorized into five unique groups of patients each with a different trend in blood glucose values 7 days prior to transplant. Group 4 starts at around 100 and worsens up to transplant. Group 5 starts out high at 500 and stays high until transplant. Group 2 starts out at 100 and remains there until transplant. Group 3 starts at 120 and stays there. Group 1 starts at 120 and increases to 160. As you can see from the table under the graph most patients are in group 2 (72%). Table 1. Pre-Transplant BG Trajectory Group P-value 1 2 3 4 5 LOSMedian [Q1-Q3] 23.69 [18.27-38.28] 20.12 [16.18-26.19] 24.04 [20-29.89] 23.67 [20.77-26.93] 22.56 [19.72-28.05] <0.0001 Time to engraftment among engrafted*Median [Q1-Q3] 11 [10.5-12] 11 [10-12] 11 [10-12] 11 [11-12] 11 [9-12] 0.2530 30 Day Readmission No Yes 52 (69%) 23 (31%) 355 (80%) 90 (20%) 38 (69%) 17 (31%) 20 (71%) 8 (29%) 12 (75%) 4 (25%) 0.1410 90 Day Readmission No Yes 39 (52%) 36 (48%) 300 (67%) 145 (33%) 30 (55%) 25 (45%) 14 (50%) 14 (50%) 11 (69%) 5 (31%) 0.0212 Disclosures No relevant conflicts of interest to declare.