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White coats have been suggested to serve as fomites carrying and transmitting pathogenic organisms and potentially increasing the risk of healthcare-associated infections (HAIs). We aimed to examine the current evidence regarding white coat contamination and its role in horizontal transmission and HAIs risk. We also examined handling practices and policies associated with white coat contamination in the reviewed literature.We conducted a literature search through PubMed and Web of Science Core Collection/Cited Reference Search, and manually searched the bibliographies of the articles identified in electronic searches. Studies published up to March 3, 2021 that were accessible in English-language full-text format were included.Among 18 included studies, 15 (83%) had ≥100 participants, 16 (89%) were cross-sectional studies, and 13 (72%) originated outside of the United States. All of the studies showed evidence of microbial colonization. Colonization withThere is robust evidence that white coats serve as fomites, carrying dangerous pathogens, including multidrug-resistant organisms. A knowledge gap exists, however, regarding the role of contaminated white coats in HAI risk that warrants further research to generate the evidence necessary to guide the current attire policies for healthcare workers.

Therapeutic and recreational marijuana use are common among people living with HIV (PLWH). However, the distinction between perceived "therapeutic" and "recreational" use is blurred, with little information about the specific reasons for use and perceived marijuana effectiveness in adults with chronic conditions. We aimed to compare reasons for use and reason-specific perceived marijuana effectiveness between therapeutic and recreational users among PLWH. In 2018-2019, 213 PLWH currently using marijuana (mean age 48 years, 59% male, 69% African American) completed a questionnaire assessing their specific reasons for using marijuana, including the "main reason." Participants were categorized into one of three motivation groups: therapeutic, recreational, or both equally. For each specific reason, participants rated marijuana effectiveness as 0-10, with 10 being the most effective. The mean effectiveness scores were compared across the three motivation groups via ANOVA, with p

In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016–2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn’s disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson’s disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.

BackgroundDirect biomarkers such as phosphatidylethanol (PEth) have the capability to detect heavy alcohol use, but it is unclear how strongly self-reported reduction in alcohol use correlates with reduction in PEth. We sought to explore the strength of correlation between reductions in self-reported alcohol use and change in PEth among a sample of women living with HIV (WLWH) who participated in a clinical trial to reduce heavy alcohol use. We also sought to determine whether this correlation was stronger in women with lower body mass index (BMI) and women without an alcohol use disorder (AUD).Methods81 WLWH (mean age=48.7, 80% Black) engaging in a randomized trial of naltrexone versus placebo with a positive baseline PEth (≥8ng/ml), and alcohol use data at baseline, 2, and 7months were included in this analysis. Spearman correlation coefficients were compared to measure the correlation between baseline PEth and number of drinks per week by demographic, biological, and alcohol use factors. Mini-International Neuropsychiatric Interview was used to screen for AUD. Further analyses were stratified by BMI and AUD. Spearman correlation coefficients were calculated for the change in PEth and the change in number of drinks per week over 7months, including 3 time-points: baseline, 2, and 7months.ResultsAt baseline, the correlation between baseline PEth and the number of drinks per week was significantly stronger for those with a BMI ≤25 compared to those with a BMI>25 (r=0.66; r=0.26, respectively). Similarly, the correlation between baseline PEth and number of drinks was stronger for those who did not screen positive for AUD compared with those who did (r=0.66; r=0.25, respectively). When stratifying by BMI, a low-to-moderate correlation (r=0.32, p=0.02) was present for persons with a BMI>25; when stratifying by AUD, a moderate correlation (r=0.50, p&nbsp

Introduction: Racial disparities in COVID-19 incidence, severity and mortality have been widely reported, with African Americans (AA) suffering disproportionately compared to White Americans (WA), but the epidemiological basis for these observations remains poorly understood. We hypothesize that AA have an excess of comorbid cardiovascular conditions compared to WA, accounting for the disparity in COVID-19 infection and death. Methods: We examined 63545 laboratory-confirmed COVID-19 cases from the One Florida Research Consortium’s sample of recipients of healthcare in Florida from January 2020 to April 2021. We assessed the prevalence of preexisting comorbid conditions, behavioral risk factors, and outcomes of AA, WA, and Hispanic patients testing positive for COVID-19. Outcomes were defined as admission to ICU or all-cause death in the index admission. Associations between risk factors and outcomes were evaluated using multivariate logistic regression analysis. Results: Compared to WA, Hispanic and AA COVID-19 patients were younger, more females, and more uninsured. AA patients with COVID-19 had the highest burden of comorbidities (especially cardiovascular), and worse combined comorbidity scores. They also had a higher rate of ICU admission and death. After adjustment for multiple variables, AA patients continued to have the highest adverse outcomes risk (OR=1.44; P < 0.001; Figure 1). Other significant predictors in the model included age, sex, poverty, cardiovascular comorbidities, cancer, and mental health disorders. Conclusions: Excess comorbidities from cardio-metabolic diseases exist in AA patients with COVID-19, who also suffer excess COVID-19 outcomes. However, these cardiovascular comorbidities did not account for all the risk of adverse COVID-19 outcomes. Reasons for the excess residual risk of in AA even after adjusting for comorbidities and other risk factors require further investigation, such as mediation analyses.

Measuring marijuana exposure represents one of the biggest challenges in marijuana-related outcomes research. The challenge mainly emerges from the significant variability in medical marijuana (MMJ) use characteristics on both the product level, including inter-product and intra-product composition variability and possibility of using multiple consumption modes, and the patient level, including variations in use patterns, frequency and intensity of use, and routes of administration. While MMJ-related observational research still mainly relies on self-reported MMJ exposure, there remains a lack of validated and reliable exposure measures and a lack of standardized dose units, necessitating the development of such measures. In the Medical Marijuana & Me (M3) study, a new combined cohort and cross-sectional study aiming to assess a multitude of MMJ-related outcomes among MMJ patients in Florida, we developed a set of new comprehensive measures to quantify MMJ use by assessing the specific modes of consumption, doses, frequency, and patterns of MMJ use. After reviewing the literature for existing MMJ measures, a multidisciplinary team of MMJ certifying physicians, pharmacists, researchers, MMJ patients, and dispensary personnel designed and developed a questionnaire covering a wide range of MMJ products, including flower, vape cartridges, concentrates for smoking, topical products, tinctures, oral concentrates, edible products, and others. MMJ dose and use are assessed via a nine-item MMJ use measure for each MMJ product participants use that gauges modes and routes of administration, frequency of use (per day, per week, per month), amount of consumed products, tetrahydrocannabinol and cannabidiol concentrations and ratios, and potency. For specific consumption modes (e.g., smoking and vaping), additional questions (e.g., number of inhalation seconds) were included to ensure a comprehensive approach of exposure measurement. Visual prompts such as product example photos were also included to enhance participant engagement and ease. We pilot-tested the questionnaires on twenty current MMJ patients in Florida, who provided feedback to improve the measures’ relatability and enhance accuracy in capturing their MMJ exposure. Some of the key challenges we encountered were measuring the “amount” of solid and liquid concentrates, and difficulty in determining dose of vape cartridges due to inconsistencies in THC concentration between nearly identical cartridges. The nine-item MMJ use questionnaire developed for M3 offers a framework for MMJ exposure quantification in current and future observational MMJ-outcomes research. Analyses resulting from M3 data will add to the sparse literature on MMJ dose measures and assist in validating measures similar to the measure developed for M3.

Background/Objective: Tetrahydrocannabinol (THC) is the primary psychoactive cannabinoid in cannabis. THC has potential therapeutic efficacy for some conditions but can lead to adverse drug events when used in higher concentrations. Higher concentrations are typical for smokable medical marijuana (MMJ) products which often contain 20 % THC or more. On March 18, 2019, Florida Senate Bill 182 (SB182) authorized cannabis flower for smoking. The objective of this study was to assess the effect of SB182 on the weekly dispensed amount of THC per certified MMJ patient in Florida. Methods: Data were obtained from the Florida Department of Health Office of Medical Marijuana Use (OMMU) weekly reports, which detailed aggregate MMJ utilization from 04/06/2018 (onset of reporting) until 03/13/2020 (onset of COVID-19 emergency orders). We calculated the weekly amount of dispensed THC per certified patient by summing the total weekly amount of THC in dispensed MMJ across all non-smokable and smokable routes of administration in the pre- and post-periods. These totals were divided by total certified MMJ patients in that week. Given the lack of information of THC content in smokable MMJ products in Florida, we calculated THC amounts using averages of THC concentrations in smokable products (10% and 20%) based on published estimates from other states with MMJ programs. Interrupted time series analysis without control was conducted by fitting a generalized least squares linear model to estimate changes in the overall trend and changes in the level after SB182. We used a phase-in period to allow for time between the first dispensed MMJ products in a form of smoking (3/22/2019), and measurable effects of SB182 (07/19/2019). Autocorrelation and moving averages were ruled out by using autocorrelation and partial autocorrelation plots. Results: In the scenario with 10% average THC in smokable products, SB182 led to a significant level increase of 35.1 mg (95% CI: 4.85-56.34 mg) in the weekly dispensed amount of THC per MMJ patient. This was an increase of roughly 10.7% compared to the estimated amount in the week before the phase-in period (328.20 mg). In the same scenario, a continuously increased trend of 2.23 mg per week (95% CI: 1.16-3.31 mg) was observed in the 35 weeks following SB182. In the second scenario (assumed 20% average THC in smokable products), SB182 was associated with a level increase of 138.4 mg (95% CI: 102.14-174.75 mg) in the weekly dispensed amount of THC per MMJ patient, which corresponds to an increase of 42.2%, compared to 328.20 mg, and a trend increase of 5.62 mg (95% CI: 4.33-5.61 mg) per week in the following 35 weeks from law implementation. Conclusion: The inclusion of smokable MMJ in the Florida MMJ program was associated with a significant increase of the weekly dispensed amount of THC per certified MMJ patient, by increasing the level, as well as the overall trend following law implementation. Further studies should investigate the potential health and safety impacts of increases in dispensed THC in MMJ programs.

Background: Little is known about the clinical training or practice experiences among physicians who certify patients for medical marijuana. The objective of this study was to determine information sources, factors influencing recommendations, clinical practices in patient assessment, communications, and recommendations, and priority areas for additional training among physicians who certify patients for medical marijuana. Methods: A cross-sectional state-wide anonymous survey of registered medical marijuana physicians in Florida between June and October 2020 was administered. Numerical responses were quantified using counts and percentages. The frequencies for “often” and “always” responses were aggregated when appropriate. Results: Among 116 respondents, the mean (standard deviation) age was 57 (12) years old, and 70% were male. The most frequently used information sources were research articles (n = 102, 95%), followed by online sources (n = 99, 93%), and discussions with other providers and dispensary staff (n = 84, 90%). Safety concerns were most influential in patient recommendations (n = 39, 39%), followed by specific conditions (n = 30, 30%) and patient preferences (n = 26, 30%). Ninety-three physicians (92%) reported they “often” or “always” perform a patient physical exam. Eighty-four (77%) physicians provided specific administration route recommendations. Half (n = 56) “often” or “always” provided specific recommendations for Δ-9-tetrahydrocannabinol: cannabidiol ratios, while 69 (62%) “often” or “always” provided specific dose recommendations. Online learning/training modules were the most preferred future training mode, with 88 (84%) physicians “likely” or “very likely” to participate. The top 3 desired topics for future training were marijuana-drug interactions (n = 84, 72%), management of specific medical conditions or symptoms (n = 83, 72%), and strategies to reduce opioids or other drugs use (n = 78, 67%). Conclusions: This survey of over 100 medical marijuana physicians indicates that their clinical practices rely on a blend of research and anecdotal information sources. While physicians report clinical factors as influential during patient recommendation, patient assessment practices and treatment regimen recommendations vary substantially and rely on experimental approaches. More research is needed to inform evidence-based practice and training, especially considering details on drug interactions, risk-benefit of treatment for specific clinical conditions, and strategies to reduce opioid use.

Introduction: Cardiovascular disease (CVD) disproportionately affects racial minorities in the US. Aspirin is recommended for primary prevention in persons at high CVD risk. Prior evidence revealed racial and gender disparities in aspirin use for primary prevention. Objectives: To describe recent trends in aspirin use for primary prevention by race and gender to identify factors associated with differences in aspirin use. Methods: Data from the National Health and Nutrition Examination Surveys, 2011-2018, were analyzed. Participants aged 40-79 years, without prior history of CVD were included. Logistic regression was used to assess the association of aspirin use with comorbidities and sociodemographic factors. Results: Among 11212 participants, 47.0% were men; the mean (SD) age was 55.8 (9.79) years; 33.1% were non-Hispanic Whites (W), 23.7% non-Hispanic Blacks (B), and 13.1% Hispanics (H). Aspirin use was more prevalent among W (37.8%) compared to B (26.5%) and H (11.5%) ( P -value Conclusions: Aspirin use for primary prevention remains prevalent among W compared to others and among men compared to women. However, after adjusting for several covariates, the effects of race were removed but the gender differences remained. The persistent gender gap in aspirin use for primary prevention requires further explanation, and for those at high risk, intervention.

Importance: African Americans (AA) have a 20% higher risk of CVD death than Whites. Treating hypercholesterolemia (HC) is paramount in CVD primary prevention. Some evidence showed that AA have a lower risk of HC compared to whites. Methods: A cross-sectional study using the 2017-18 National Health and Nutrition Examination Surveys data. Logistic regression analysis was used to compare the prevalence of diagnosed HC in AA and whites aged 18-80 years old. Serum total cholesterol (TC) and high-density lipoprotein (HDL) levels were compared by multiple linear regression. Results: Among 2549 participants, 51.7% were females, and 63.4% were white. The mean (SD) age was 51.6 (19.1) years. AA had a 24 % reduced risk of HC diagnosis than whites after adjusting for age, Body Mass Index (BMI), diabetes, hypertension, and smoking; OR [95%CI]= 0.767 [0.621, 0.923]. There was no difference in TC level (p=0.7242), while HDL was higher among AA (p Conclusion: Consistent with some evidence, AA had a lower prevalence of HC diagnosis and higher HDL levels.

Background Emerging literature shows increased drug use during the COVID-19 pandemic. However, limited research has examined the change in marijuana use among persons living with HIV (PLWH). This study aimed to investigate how marijuana use changed in a cohort of PLWH during the first year of the pandemic and identify factors associated with the change. Method 222 PLWH (mean age = 50.2 ± 11.2, 50.9 % female, 14.5 % Hispanic, 64.7 % Black, 15.8 % White, 5 % other, 80.2 % persons using marijuana [at least weekly use], 19.8 % persons not using marijuana) completed a baseline survey on demographics and behavioral/health characteristics between 2018 and 2020 and a brief phone survey between May and October 2020 that assessed changes in marijuana use and overall/mental health, and perceived risks/benefits of marijuana use during the COVID-19 pandemic. Results During the pandemic, 64/222(28.8 %) of the whole sample reported increased marijuana use, 36(16.2 %) reported decreased use, and 122(55 %) reported no change. Multinomial logistic regression results indicated that: Compared to those reporting no change, increased marijuana use during the pandemic was associated with more frequent marijuana use and PTSD symptoms at baseline, worsened mental health during the pandemic, and not perceiving marijuana use as a risk factor for COVID-19 infection. More frequent marijuana use at baseline was the only factor significantly associated with decreased marijuana use during the pandemic. Conclusion The COVID-19 pandemic has resulted in changes in marijuana use among a considerable proportion (45 %) of PLWH. Future research is needed to understand the temporality of the increases in marijuana use with worsening mental health.

Medical marijuana (MMJ) is legal in the state of Florida for the treatment of specific qualifying medical conditions.1,2 As of July 2020, over 2,450 physicians are authorized to order MMJ, and 360,000 patients are registered in Florida’s MMJ program.3 With this rapid uptake come concerns regarding physicians’ knowledge about MMJ,4–7 and the lack of preparing physicians-in-training to manage MMJ.4,7,8 We conducted a state-wide survey of certified MMJ providers in Florida. The survey was developed by the Consortium for Medical Marijuana Clinical Outcomes research team. The aim of the survey was to inform physicians of the mission of the consortium, which is to support and disseminate research. The survey items were developed accordingly, and the survey was pilot tested with a small group of physicians. We identified all physicians licensed to certify patients for MMJ who care currently practicing in the State of Florida (n=1609), to investigate their information sources and training needs regarding MMJ. The survey was disseminated via mail and email, including a $40 incentive for survey completion. Preliminary responses from 51 (5%) providers (mean age 56, 74% male) are summarized here. The sample included providers from 22 Florida counties and represented a broad range of medical specialties. The majority (92%) practiced in both medical marijuana and traditional medical practice. To learn about MMJ, 98% used research articles, 90% used online sources, 86% learned from dispensary staff, 84% learned from discussions with other providers, 72% used books, 65% used conferences, 61% used magazines, and 35% had a personal experience with marijuana. The sources most cited as “very useful” were conferences (51%), research articles (50%), discussions with other providers (47%), and online sources (47%). Topics rated as a high priority for training included drug-MMJ interactions (80%), strategies to help patients reduce their use of opioids or other drugs (80%), information about the selection of doses and CBD: THC ratios (80%), evidence for managing specific medical conditions or symptoms (78%), information about the effect of different phytocannabinoids and terpenes (75%), advantages and disadvantages of specific modes of delivery (71%), general updates on research findings (71%), educational information about the endocannabinoid system (67%), the safety of medical marijuana use (55%), identification and management of cannabis use disorder (51%), and comparison of products available in different dispensaries (49%). The majority of providers either strongly agreed or agreed (77%) that they could provide better care if they knew which products their patients receive at dispensaries. Physicians use a blend of primary research, online sources, and exchanges with colleagues to learn about MMJ. Perceived needs for more pharmacological information and indication-specific detail for treatment regimen were high. Most physicians believe that details on dispensed MMJ would improve patient care.

Background: Medical cannabis is available to patients by physician order in two-thirds of the United States (U.S.) as of 2020, but remains classified as an illicit substance by federal law. States that permit medical cannabis ordered by a physician typically require a diagnosed medical condition that is considered qualifying by respective state law. Objectives: To identify and map the most recently (2016-2019) published clinical and scientific literature across approved conditions for medical cannabis, and to evaluate the quality of identified recent systematic reviews. Methods: Literature search was conducted from five databases (PubMed, Embase, Web of Science, Cochrane, and ClinicalTrials.gov), with expansion and update from the National Academies of Sciences, Engineering, and Medicine’s (NASEM) comprehensive evidence review through 2016 of the health effects of cannabis on several conditions. Following consultation with experts and stakeholders, 11 conditions were identified for evidence evaluation: amyotrophic lateral sclerosis (ALS), autism, cancer, chronic pain, Crohn’s disease, epilepsy, glaucoma, HIV/AIDS, multiple sclerosis (MS), Parkinson’s disease, and posttraumatic stress disorder (PTSD). The following exclusion criteria were imposed: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome, intervention, sample size, study setting, and reported effect size. Studies classified as systematic reviews with or without meta-analysis were graded using the AMSTAR-2 tool by two raters to evaluate the quality of evidence, with additional raters to resolve cases of evidence grade disagreement. Results: A total of 438 studies were included after screening. Five completed randomized controlled trials (RCTs) were identified, and an additional 11 trials were ongoing, and 1 terminated. Cancer, chronic pain, and epilepsy were the most researched topic areas, representing more than two-thirds of all reviewed studies. The quality of evidence assessment for each condition suggests that few high-quality systematic reviews are available for most conditions, with the exceptions of MS, epilepsy, and chronic pain. In those areas, findings on chronic pain are mostly in alignment with the previous literature, suggesting that cannabis or cannabinoids are potentially beneficial in treating chronic neuropathic pain. In epilepsy, findings suggest that cannabidiol is potentially effective in reducing seizures in pediatric patients with drug-resistant Dravet and Lennox-Gastaut syndromes. In MS, recent high-quality systematic reviews did not include new RCTs, and are therefore not substantially expanding the evidence base. In sum, the most recent clinical evidence suggests that for most of the conditions assessed, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic pain), with the higher quality of evidence for epilepsy driven by FDA-approved formulations for cannabis-based seizure treatments. Conclusion: The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.

Several factors, including the lack of a systematic cannabis use assessment within healthcare systems, have led to significant under-documentation of cannabis use and its correlates in medical records, the unpreparedness of clinicians, and poor quality of cannabis-related electronic health record data, limiting its utilization in research. Multiple steps are required to overcome the existing knowledge gaps and accommodate the health needs implied by the increasing cannabis use prevalence. These steps include (1) enhancing clinician and patient education on the importance of cannabis use assessment and documentation, (2) implementing a standardized approach for comprehensive cannabis use assessment within and across healthcare systems, (3) improving documentation of cannabis use and its correlates in medical records and electronic health records by building in prompts, (4) developing and validating reliable computable phenotypes of cannabis use, (5) conducting research utilizing electronic health data to study a wide array of related health outcomes, (6) and establishing evidence-based guidelines to inform clinical practices and policies. Integrating comprehensive cannabis use assessment and documentation within healthcare systems is necessary to enhance patient care and improve the quality of electronic health databases. Employing electronic health record data in cannabis-related research is crucial to accelerate research in light of the existing knowledge gaps on a wide array of health outcomes. Thus, improving and modernizing cannabis use assessment and documentation in healthcare is an integral step on which research conduct and evidence generation primarily rely.

Introduction: The efficacy of comprehensive Infection Prevention and Control Programs (IPCP) to reduce infection rates is well established. However, the evaluation of these programmes to achieve the best performance remains an issue. In this sense, researchers have worked on developing tools for evaluation IPC. Objectives: To compare three existing IPCP evaluation tools applied in healthcare facilities in Brazil. Methods: Cross-sectional, descriptive, quantitative approach, conducted using three tools concurrently. The tools were: 1.Infection Prevention and Control Programme Evaluation (IPCPE) from Australia; 2.Operating Guides of IPCP indicators (OGIPCP) from Brazil; 3.Assessment tool for hospital IPCP (IPCAF) from World Health Organization. Infection control practitioners (ICP) were recruited using snowball technique. Each ICP applied the tools to their setting. Data collection was performed by using a standardized semi-structured questionnaire, including 35 Likert scale items to inform the feasibility and comprehensiveness of tools. Results: Among invited ICP, 12 participants applied all evaluation tools. The average experience in infection prevention was 8 years (range 1.5 to 15 years). The average time to apply the evaluation tools were: IPCPE: 3h, OGIPCP: 1h, and IPCAF 1.5h. The majority of positive agreements regarding comprehensiveness were obtained by IPCPE (100% of positive agreement in 10 questions), followed by IPCAF (100% of positive agreement in 9 questions). Time spent applying the tools was only considered acceptable for OGIPCP and IPCAF. No tool achieved 100% agreement in 10 questions regarding comprehensiveness to assess the support of microbiology and other services to the IPCP, and links with public health. None of the tools achieved 100% agreement to recommend their use in extra-hospital settings such as primary care. Conclusion: Both IPCPE and IPCAF were considered as more comprehensive, but still lacking potential to access all relevant issues for IPCP. IPCAF and OGIPCP were considered less time consuming. Next, we will perform a qualitative approach to better understand the improvement gaps.

IMPACT: Identifying differential COVID-19 progression across the disease continuum may help policymakers and service providers better identify or predict gaps in services and resources and develop precision strategies to support COVID-19 patients where the need is mostly needed. OBJECTIVES/GOALS: Single institution studies have documented COVID-19 disproportionally affected US racial and ethnic minority groups compared to Whites. However, few population-wide data studied severity and death in multiracial populations. We aim to examine the current disparity in the COVID-19 continuum, including hospitalizations, severity, and death. METHODS/STUDY POPULATION: Data on 67,094 laboratory documented COVID-19 cases nested from the state-wide ‘OneFlorida’ research consortium through August 3, 2020, were assessed to decide differences and disparities in COVID-19 outcomes. A COVID-19 outcome continuum outlining the proportions of cases transitioning from diagnosis to death was constructed (Figure 1). OneFlorida partners provide health care to more than 40% of Floridians in the nation’s third-largest and very diverse state. OneFlorida partners encompass hospitals, practice/clinic settings, and physicians, which provide care for 15 million patients across all of Florida’s 67 counties. It is part of the Patient-Centered Outcomes Research Institute (PCORI). RESULTS/ANTICIPATED RESULTS: Among cases, 25,443 (37.9%) were non-Hispanic Whites, 11,709 (17.5%) were non-Hispanic Blacks, and 16,119 (24.0%) were Hispanics. Among COVID-19 patients, Blacks and Hispanics had a higher frequency of emergency department (ED) visits (45.7% and 46.0%, respectively), whereas admission rates were higher in Blacks (15.6%) and Whites (15.9%) than in Hispanics (11.5%). Blacks had the highest rates of intubation (3.6%) and in-hospital deaths (2.7%) compared to Whites (2.5% and 2.3%, respectively) and Hispanics (1.3% and 1.4%, respectively), Figure 1. When rates were indexed to the state census data, Blacks had the worst rates across the disease continuum (infection to death). In comparison, Hispanics had higher rates of ED visits but lower rates of intubation and death, Table 1. DISCUSSION/SIGNIFICANCE OF FINDINGS: Outcomes continuum is a useful tool at an individual-level to assess care outcomes and at population-level as a framework to analyze the proportion of population with COVID-19 that progress to each successive disease stage. This will help policymakers to better identify gaps in services and develop precision strategies to support COVID-19 patients.