470. Changing Urgent Care Patterns of Diagnosing Coccidioidomycosis in a Highly Endemic Urban Population

Abstract Background We found previously (Pu et al. Clin Infect Dis, 2021: PubMed 32511677) that only 0.2% of ICD10 codes for coccidioidomycosis (CM) in our health care system were associated with patients (pts) managed at an urgent (UC) visit. Since 2020, during onboarding, quarterly meetings, and periodic emails, UC clinicians encouraged to test CM pneumonia (PNA). Methods For 2018 through 2021, Banner Health System increased clinics from 41 48, 89 193 (Nurse Practioners, 49.2% ± 2%, Physician Assistants, 39% MDs/DOs 13% 1%), total visits 787 1,290 thousand. Average 1.6 per pt. All UCs used a common electronic medical record (Cerner) the study period. Data downloaded January 2022 analyze clinician patterns coccidioidal serologic testing (CST, 98% EIAs), CST results, their relation codes. Results period, orders 8.0 19.0 10,000 (chi-squared p< 0.001). The percent >10 year 16% 78%, percentage 37% 67%. Percent positive CSTs highest August, November, December (27.4%) lowest April July (8.1%). PNA (J18.9 or J18.1) most frequently (374 1,872 tested), code Erythema nodosum (EN, L52, 176 pts) had positivity rate (61.4%, 27 44 tested). Only 6 pts both EN As indicated table, over time on first visits, decreased second when was negative. Testing also pats. Despite these favorable changes, still not done three quarters where recommended. Coccidioidal by month 2018-2021. Open circles are involved test; closed squares tests positive. Conclusion Routine quality improvement activities have significantly but partially improved rates located endemic area. Innovative strategies change clinical practices may be needed achieve greater success. Disclosures Authors: No reported disclosures.