Improving Equity and Access to COVID19 Monoclonal Antibody Infusions Ethan
1 Pan ,
1Donald
Zenobia
MAB treatment is thus an important prophylactic tool in battling severe COVID-19 illness. However, when comparing the demographic data of the patient population of Northwell, there were large racial disparities between patients who were eligible for MAB treatment, and those who received MAB treatment at Northwell. Northwell Health Solutions is the Care Management Organization for Northwell and is made up of teams who coordinate care for high risk populations.4 These activities include education, connection to provider visits, and connection to services like transportation. This care coordination could be invaluable in outreach to COVID-19 patients and providers in need of MAB therapy and connecting them to care.
and Choukri
Conclusions
Methods and Results Figure 1.
MAB Eligible Patients vs. MAB Recipients by Race 51.1%
White (non-Hispanic)
70.5% 14.8%
Hispanic African Amer/Black Asian Native Amer/Alaskan Other/Not Specified
7.6% 16.2% 5.2% 6.3% 4.5% 0.9% 0.6% 10.6% 11.6%
MAB Eligible Patients (n=9438) MAB Recipients (n=5916) MAB eligible patients from underrepresented groups were then called and triaged with the following workflow. Figure 2.
Challenges identified while contacting patients included: average length of time of each phone call (~10 minutes), matching patients to their native language speakers, calling outdated phone numbers, and refining the list of eligible patients (some patients had already been treated in the hospital for COVID-19 disease).
This project demonstrated that there were patients eligible but unaware of life-saving MAB treatment. It is important to increase the scale of this service to reach more patients and then connect them to referrals. Anecdotally, the majority of patients outreached who wanted treatment requested this directly from Northwell, without going through a PCP. This would be done through Northwell’s Care Coordination Program and the CARES, by outreaching eligible patients and then connecting them to services at scale. Further work should also be done to reach newly MAB eligible patients under the FDA’s EUA on 08/10/21 that allows post-exposure prophylaxis
Hypothesis A patient outreach program tested on a small scale and implemented through the Northwell Health Solutions Student project can provide proof of concept in order to be scaled through Care Coordination and improve the equity of MAB utilization in Long Island and NYC.
Using data from Health Information Exchange and Northwell affiliated lab data, patients eligible for MAB therapy between 01/01/21 and 07/27/21 were identified using criteria as defined by the FDA’s Emergency Use Authorization (EUA).3 This population was then compared to the population of patients who had received MAB infusions at Northwell sites during the same time period (Figure 1).
White patients were less likely to contract COVID-19 than patients who identified as any other race. Compared to other patients, white patients were also more likely to receive MAB treatment after testing positive for COVID-19. There are various socioeconomic factors that could play a part, including trust in the healthcare system, patient accessibility to Northwell facilities, and healthcare literacy. It is also possible that MAB eligible patients could have received MAB treatment from non-Northwell providers. If true, this would indicate a difference in access between Northwell patients of different demographics. However, Northwell is the largest provider of MAB treatment on Long Island where most patients from this study were residing.
Future Direction
This quality improvement project aims to both confirm that there is a disparity in MAB eligibility and treatment while also correcting this disparity.
Methods and Results
2 Messaoudi
and Barbara Zucker School of Medicine at Hofstra/Northwell 2Northwell Health Solutions
Background Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a virus that causes coronavirus disease 2019 (COVID-19). Since the end of 2019, there have been 228 million cases and 4.6 million deaths caused by COVID-19.1 Monoclonal antibody (MAB) infusion therapy has emerged as one of the most effective treatments in preventing COVID-19 cases from progressing to severe COVID 19 disease including hospitalization and death. REGEN-COV, one MAB treatment provided by Northwell Health, has been shown to reduce the risk of hospitalization for COVID-19 patients by 70% if given within 10 days of symptom onset.2
2 Brown ,
Resources Figure 7: Independent CRISPR knockout of CDK4 or CDK6 does not cause dropout in most breast cancer cell lines studied.
Some patients who had not been informed of MAB therapy were also provided a summary of the treatment and educational resources. We often recommended patients discuss this decision with a PCP. We were also aware to prioritize immunocompromised patients and unvaccinated patients, as they are more likely to have severe cases of COVID-19.
1. REGEN-COV Antibody Cocktail Clinical Outcomes Study in Covid-19 Outpatients https://www.medrxiv.org/content/10.1101/2021.05.19.21257469v1.full.pdf 2. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situationreports 3. US Food and Drug Administration. Fact sheet for health care providers: Emergency use authorization (EUA) of REGEN-COV (casirivimab with imdevimab). Available at: https://www.fda.gov/media/145611/download 4. https://www.northwell.edu/news/clinical-call-center-accredited-as-center-ofexcellence