Association of comorbidities with home care service utilization of patients with heart failure while receiving telehealth.

PubMed

Radhakrishnan, Kavita; Jacelon, Cynthia S; Bigelow, Carol; Roche, Joan P; Marquard, Jenna L; Bowles, Kathryn H

2013-01-01

Comorbidities adversely impact heart failure (HF) outcomes. Telehealth can assist healthcare providers, especially nurses, in guiding their patients to follow the HF regimen. However, factors, including comorbidity patterns, that act in combination with telehealth to reduce home care nursing utilization are still unclear. The purpose of this article was to examine the association of the comorbidity characteristics of HF patients with nursing utilization along with withdrawal from telehealth service during an episode of tele-home care. A descriptive, correlational study design using retrospective chart review was used. The sample comprised Medicare patients admitted to a New England home care agency who had HF as a diagnosis and had used telehealth from 2008 to 2010. The electronic documentation at the home care agency served as the data source, which included Outcome and Assessment Information Set data of patients with HF. Logistic and multiple regression analyses were used to analyze data. The sample consisted of 403 participants, of whom 70% were older than 75 years, 55% were female, and 94% were white. Comorbidities averaged 5.19 (SD, 1.92), ranging from 1 to 11, and nearly 40% of the participants had 5 or more comorbidities. The mean (SD) nursing contacts in the sample was 9.9 (4.7), ranging from 1 to 26, and 52 (12.7%) patients withdrew from telehealth service. For patients with HF on telehealth, comorbidity characteristics of anemia, anxiety, musculoskeletal, and depression were significantly associated with nursing utilization patterns, and renal failure, cancer, and depression comorbidities were significantly associated with withdrawal from telehealth service. Knowledge of the association of comorbidity characteristics with the home care service utilization patterns of patients with HF on telehealth can assist the home health nurse to develop a tailored care plan that attains optimal patient outcomes. Knowledge of such associations would also focus home care resources, avoiding redundancy of resource utilization in this era of strained healthcare resources.

Personal Characteristics and Experience of Primary Care Predicting Frequent Use of Emergency Department: A Prospective Cohort Study.

PubMed

Hudon, Catherine; Sanche, Steven; Haggerty, Jeannie L

2016-01-01

A small number of patients frequently using the emergency department (ED) account for a disproportionate amount of the total ED workload and are considered using this service inappropriately. The aim of this study was to identify prospectively personal characteristics and experience of organizational and relational dimensions of primary care that predict frequent use of ED. This study was conducted among parallel cohorts of the general population and primary care patients (N = 1,769). The measures were at baseline (T1), 12 (T2) and 24 months (T3): self-administered questionnaire on current health, health behaviours and primary care experience in the previous year. Use of medical services was confirmed using administrative databases. Mixed effect logistic regression modeling identified characteristics predicting frequent ED utilization. A higher likelihood of frequent ED utilization was predicted by lower socioeconomic status, higher disease burden, lower perceived organizational accessibility, higher number of reported healthcare coordination problems and not having a complete annual check-up, above and beyond adjustment for all independent variables. Personal characteristics such as low socioeconomic status and high disease burden as well as experience of organizational dimensions of primary care such as low accessibility, high healthcare coordination problems and low comprehensiveness of care are prospectively associated with frequent ED utilization. Interventions developed to prevent inappropriate ED visits, such as case management for example, should tailor low socioeconomic status and patients with high disease burden and should aim to improve experience of primary care regarding accessibility, coordination and comprehensiveness.

Outpatient Health Care Utilization of Suicide Decedents in Their Last Year of Life

ERIC Educational Resources Information Center

Liu, Hui-Li; Chen, Lih-Hwa; Huang, Shiuh-Ming

2012-01-01

The characteristics of health care utilization during the last year of life by Taiwanese who died by suicide were analyzed. The degree of health services utilization was evaluated by extracting the data of National Health Insurance (NHI) outpatient cohort records in 2006. A total of 4,406 fatal suicide cases were matched with the 17,587,901…

Plan characteristics and SSI enrollees' access to and quality of care in four TennCare MCOs.

PubMed

Hill, Steven C; Wooldridge, Judith

2002-10-01

To assess hypotheses about which managed care organization (MCO) characteristics affect access to care and quality of care--including access to specialists, providers' knowledge about disability, and coordination of care--for people with disabilities. Survey of blind/disabled Supplemental Security Income (SSI) enrollees in four MCOs serving TennCare, Tennessee's Medicaid managed care program, in Memphis, conducted from 1998 through spring 1999. We compared enrollee reports of access and quality across the four MCOs using regression methods, and we use case study methods to assess whether patterns both within and across MCOs are consistent with the hypotheses. We conducted computer-assisted telephone surveys and used regression analysis to compare access and quality controlling for enrollee characteristics. Although the four MCOs' characteristics varied, access to providers, coordination of care, and access to some services were generally similar across MCOs. Enrollees in one plan, the only MCO with a larger provider network and that paid physicians on a fee-for-service basis, reported their providers were more knowledgeable, and they had more secondary preventive care visits. Differences found in access to specialists and delays in approving care appear to be unrelated to characteristics reported by the MCOs, but instead may be related to how tightly utilization is reviewed. Plan networks, financial incentives, utilization management methods, and state requirements are important areas for further study, and, in the meantime, ongoing monitoring of SSI enrollees in each MCO may be important for detecting problems and successes.

Relationship of Somatic Symptoms With Depression Severity, Quality of Life, and Health Resources Utilization in Patients With Major Depressive Disorder Seeking Primary Health Care in Spain

PubMed Central

García-Campayo, Javier; Ayuso-Mateos, José Luis; Caballero, Luis; Romera, Irene; Aragonés, Enric; Rodríguez-Artalejo, Fernando; Quail, Deborah; Gilaberte, Inmaculada

2008-01-01

Objective: To investigate the relationship between the characteristics of somatic symptoms and depression severity, quality of life (QOL), and health resources utilization in patients with major depressive disorder (MDD) in primary care setting. Method: This cross-sectional, nationwide epidemiologic study, carried out in 1150 primary care patients with DSM-IV–defined MDD, evaluated the characteristics of somatic symptoms by means of the Standardized Polyvalent Psychiatric Interview. Depression severity and QOL were evaluated by means of the Zung Self-Rating Depression Scale (SDS) and the Physical and Mental Component Summaries of the Medical Outcomes Study 12-item Short-Form Health Survey. Health resources utilization was measured in terms of doctor consultations and hospitalizations. The associations were assessed by means of adjusted analyses. The study was carried out from April 2004 to July 2004. Results: Disability associated with somatic symptoms and number of somatic symptoms were strongly associated with increased depression severity (2.45 and 0.29 increase in SDS score, respectively) and health resources utilization (odds ratios of 1.42 and 1.04, respectively). Associated disability, frequency, and persistence during leisure time of somatic symptoms were strongly associated with poorer QOL. In contrast, we found a weaker relationship between duration and intensity of somatic symptoms and depression severity, QOL, and health resources utilization. Conclusions: Of the studied somatic symptom characteristics, somatic symptom–associated disability and number of somatic symptoms are strongly associated with increased depression severity and health resources utilization, as well as with decreased QOL. Our results may help physicians identify relevant characteristics of somatic symptoms to more effectively diagnose and treat depression in primary care patients. PMID:19158973

Pediatric stroke: clinical characteristics, acute care utilization patterns, and mortality.

PubMed

Statler, Kimberly D; Dong, Li; Nielsen, Denise M; Bratton, Susan L

2011-04-01

Acute care utilization patterns are not well described but may help inform care coordination and treatment for pediatric stroke. The Kids Inpatient Database was queried to describe demographics and clinical characteristics of children with stroke, compare acute care utilization for hemorrhagic vs. ischemic stroke and Children's vs. non-Children's Hospitals, and identify factors associated with aggressive care and in-hospital mortality. Using a retrospective cohort of children hospitalized with stroke, demographics, predisposing conditions, and intensive (mechanical ventilation, advanced monitoring, and blood product administration) or aggressive (pharmacological therapy and/or invasive interventions) care were compared by stroke and hospital types. Factors associated with aggressive care or in-hospital mortality were explored using logistic regression. Hemorrhagic stroke comprised 43% of stroke discharges, was more common in younger children, and carried greater mortality. Ischemic stroke was more common in older children and more frequently associated with a predisposing condition. Rates of intensive and aggressive care were low (30% and 15%), similar by stroke type, and greater at Children's Hospitals. Older age, hemorrhagic stroke, predisposing condition, and treatment at a Children's Hospital were associated with aggressive care. Hemorrhagic stroke and aggressive care were associated with in-hospital mortality. Acute care utilization is similar by stroke type but both intensive and aggressive care are more common at Children's Hospitals. Mortality remains relatively high after pediatric stroke. Widespread implementation of treatment guidelines improved outcomes in adult stroke. Adoption of recently published treatment recommendations for pediatric stroke may help standardize care and improve outcomes.

Community characteristics affecting emergency department use by Medicaid enrollees.

PubMed

Lowe, Robert A; Fu, Rongwei; Ong, Emerson T; McGinnis, Paul B; Fagnan, Lyle J; Vuckovic, Nancy; Gallia, Charles

2009-01-01

In seeking to identify modifiable, system-level factors affecting emergency department (ED) use, we used a statewide Medicaid database to study community variation in ED use and ascertain community characteristics associated with higher use. This historical cohort study used administrative data from July 1, 2003 to December 31, 2004. Residence ZIP codes were used to assign all 555,219 Medicaid enrollees to 130 primary care service areas (PCSAs). PCSA characteristics studied included rural/urban status, presence of hospital(s), driving time to hospital, and several measures of primary care capacity. Statistical analyses used a 2-stage model. In the first stage (enrollee level), ED utilization rates adjusted for enrollee demographics and medical conditions were calculated for each PCSA. In the second stage (community level), a mixed effects linear model was used to determine the association between PCSA characteristics and ED use. ED utilization rates varied more than 20-fold among the PCSAs. Compared with PCSAs with primary care capacity less than need, PCSAs with capacity 1 to 2 times the need had 0.12 (95% CI: -0.044, -0.20) fewer ED visits/person/yr. Compared with PCSAs with the nearest hospital accessible within 10 minutes, PCSAs with the nearest hospital >30 minutes' drive had 0.26 (95% CI: -0.38, -0.13) fewer ED visits/person/yr. Within this Medicaid population, ED utilization was determined not only by patient characteristics but by community characteristics. Better understanding of system-level factors affecting ED use can enable communities to improve their health care delivery systems-augmenting access to care and reducing reliance on EDs.

Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis

PubMed Central

2013-01-01

Background The evaluation of all potential sources of low skilled maternal care utilization is crucial for Ethiopia. Previous studies have largely disregarded the contribution of different levels. This study was planned to assess the effect of individual, communal, and health facility characteristics in the utilization of antenatal, delivery, and postnatal care by a skilled provider. Methods A linked facility and population-based survey was conducted over three months (January - March 2012) in twelve “kebeles” of North Gondar Zone, Amhara Region. A total of 1668 women who had births in the year preceding the survey were selected for analysis. Using a multilevel modelling, we examined the effect of cluster variation and a number of individual, communal (kebele), and facility-related variables for skilled maternal care utilization. Result About 32.3%, 13.8% and 6.3% of the women had the chance to get skilled providers for their antenatal, delivery and postnatal care, respectively. A significant heterogeneity was observed among clusters for each indicator of skilled maternal care utilization. At the individual level, variables related to awareness and perceptions were found to be much more relevant for skilled maternal service utilization. Preference for skilled providers and previous experience of antenatal care were consistently strong predictors of all indicators of skilled maternal health care utilizations. Birth order, maternal education, and awareness about health facilities to get skilled professionals were consistently strong predictors of skilled antenatal and delivery care use. Communal factors were relevant for both delivery and postnatal care, whereas the characteristics of a health facility were more relevant for use of skilled delivery care than other maternity services. Conclusion Factors operating at individual and “kebele” levels play a significant role in determining utilization of skilled maternal health services. Interventions to create better community awareness and perception about skilled providers and their care, and ensuring the seamless performance of health care facilities have been considered crucial to improve skilled maternal services in the study area. Such interventions should target underprivileged women. PMID:23587369

Impact of Renal Disease on Patients with Hepatitis C: A Retrospective Analysis of Disease Burden, Clinical Outcomes, and Health Care Utilization and Cost.

PubMed

Solid, Craig A; Peter, Senaka A; Natwick, Tanya; Guo, Haifeng; Collins, Allan J; Arduino, Jean Marie

2017-01-01

Few studies explore the magnitude of the disease burden and health care utilization imposed by renal disease among patients with hepatitis C virus (HCV). We aimed to describe the characteristics, outcomes, and health care utilization and costs of patients with HCV with and without renal impairment. This retrospective analysis used 2 administrative claims databases: the US commercially insured population in Truven Health MarketScan® data (aged 20-64 years), and the US Medicare fee-for-service population in the Medicare 20% sample (aged ≥65 years). Baseline characteristics and comorbid conditions were identified from claims during 2011; patients were followed for up to 1 year (beginning January 1, 2012) to identify health outcomes of interest and health care utilization and costs. In the MarketScan and Medicare databases, 35,965 and 10,608 patients with HCV were identified, 8.5 and 26.5% with evidence of renal disease (chronic kidney disease [CKD] or end-stage renal disease [ESRD]). Most comorbid conditions and unadjusted outcome rates increased across groups from patients with no evidence of renal disease to non-ESRD CKD to ESRD. Health care utilization followed a similar pattern, as did the costs. Our findings suggest that HCV patients with concurrent renal disease have significantly more comorbidity, a higher likelihood of negative health outcomes, and higher health care utilization and costs. © 2017 S. Karger AG, Basel.

Individual and contextual factors influencing dental health care utilization by preschool children: a multilevel analysis

PubMed

Piovesan, Chaiana; Ardenghi, Thiago Machado; Mendes, Fausto Medeiros; Agostini, Bernardo Antonio; Michel-Crosato, Edgard

2017-03-30

The effect of contextual factors on dental care utilization was evaluated after adjustment for individual characteristics of Brazilian preschool children. This cross-sectional study assessed 639 preschool children aged 1 to 5 years from Santa Maria, a town in Rio Grande do Sul State, located in southern Brazil. Participants were randomly selected from children attending the National Children's Vaccination Day and 15 health centers were selected for this research. Visual examinations followed the ICDAS criteria. Parents answered a questionnaire about demographic and socioeconomic characteristics. Contextual influences on children's dental care utilization were obtained from two community-related variables: presence of dentists and presence of workers' associations in the neighborhood. Unadjusted and adjusted multilevel logistic regression models were used to describe the association between outcome and predictor variables. A prevalence of 21.6% was found for regular use of dental services. The unadjusted assessment of the associations of dental health care utilization with individual and contextual factors included children's ages, family income, parents' schooling, mothers' participation in their children's school activities, dental caries, and presence of workers' associations in the neighborhood as the main outcome covariates. Individual variables remained associated with the outcome after adding contextual variables in the model. In conclusion, individual and contextual variables were associated with dental health care utilization by preschool children.

Greater healthcare utilization and costs among Black persons compared to White persons with aphasia in the North Carolina stroke belt.

PubMed

Ellis, Charles; Hardy, Rose Y; Lindrooth, Richard C

2017-05-15

To examine racial differences in healthcare utilization and costs for persons with aphasia (PWA) being treated in acute care hospitals in North Carolina (NC). NC Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) data from 2011-2012 were analyzed to examine healthcare utilization and costs of care for stroke patients with aphasia. Analyses emphasized length of stay, charges and cost of general hospital services. Generalized linear models (GLM) were constructed to determine the impact of demographic characteristics, stroke/illness severity, and observed hospital characteristics on utilization and costs. Hospital fixed effects were included to yield within-hospital estimates of disparities. GLM models demonstrated that Blacks with aphasia experienced 1.9days longer lengths of stay compared to Whites with aphasia after controlling for demographic characteristics, 1.4days controlling for stroke/illness severity, 1.2days controlling for observed hospital characteristics, and ~1 extra day controlling for unobserved hospital characteristics. Similarly, Blacks accrued ~$2047 greater total costs compared to Whites after controlling for demographic characteristics, $1659 controlling for stroke/illness severity, $1338 controlling for observed hospital characteristics, and ~$1311 greater total costs after controlling for unobserved hospital characteristics. In the acute hospital setting, Blacks with aphasia utilize greater hospital services during longer hospitalizations and at substantially higher costs in the state of NC. A substantial portion of the adjusted difference was related to the hospital treating the patient. However, even after controlling for the hospital, the differences remained clinically and statistically significant. Copyright © 2017 Elsevier B.V. All rights reserved.

Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement.

PubMed

Snow, Richard; Granata, Jaymes; Ruhil, Anirudh V S; Vogel, Karen; McShane, Michael; Wasielewski, Ray

2014-10-01

Health-care costs following acute hospital care have been identified as a major contributor to regional variation in Medicare spending. This study investigated the associations of preoperative physical therapy and post-acute care resource use and its effect on the total cost of care during primary hip or knee arthroplasty. Historical claims data were analyzed using the Centers for Medicare & Medicaid Services Limited Data Set files for Diagnosis Related Group 470. Analysis included descriptive statistics of patient demographic characteristics, comorbidities, procedures, and post-acute care utilization patterns, which included skilled nursing facility, home health agency, or inpatient rehabilitation facility, during the ninety-day period after a surgical hospitalization. To evaluate the associations, we used bivariate and multivariate techniques focused on post-acute care use and total episode-of-care costs. The Limited Data Set provided 4733 index hip or knee replacement cases for analysis within the thirty-nine-county Medicare hospital referral cluster. Post-acute care utilization was a significant variable in the total cost of care for the ninety-day episode. Overall, 77.0% of patients used post-acute care services after surgery. Post-acute care utilization decreased if preoperative physical therapy was used, with only 54.2% of the preoperative physical therapy cohort using post-acute care services. However, 79.7% of the non-preoperative physical therapy cohort used post-acute care services. After adjusting for demographic characteristics and comorbidities, the use of preoperative physical therapy was associated with a significant 29% reduction in post-acute care use, including an $871 reduction of episode payment driven largely by a reduction in payments for skilled nursing facility ($1093), home health agency ($527), and inpatient rehabilitation ($172). The use of preoperative physical therapy was associated with a 29% decrease in the use of any post-acute care services. This association was sustained after adjusting for comorbidities, demographic characteristics, and procedural variables. Health-care providers can use this methodology to achieve an integrative, cost-effective, patient care pathway using preoperative physical therapy. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

Examining differences in characteristics between patients receiving primary care from nurse practitioners or physicians using Medicare Current Beneficiary Survey data and Medicare claims data.

PubMed

Loresto, Figaro L; Jupiter, Daniel; Kuo, Yong-Fang

2017-06-01

Few studies have examined differences in functional, cognitive, and psychological factors between patients utilizing only nurse practitioners (NPs) and those utilizing only primary care medical doctors (PCMDs) for primary care. Patients utilizing NP-only or PCMD-only models for primary care will be characterized and compared in terms of functional, cognitive, and psychological factors. Cohorts were obtained from the Medicare Current Beneficiary Survey linked to Medicare claims data. Weighted analysis was conducted to compare the patients within the two care models in terms of functional, cognitive, and psychological factors. From 2007 to 2013, there was a 170% increase in patients utilizing only NPs for primary care. In terms of health status, patients utilizing only NPs in their primary care were not statistically different from patients utilizing only PCMDs. There is a perception that NPs, as compared with PCMDs, tend to provide care to healthier patients. Our results are contrary to this perception. In terms of health status, NP-only patients are similar to PCMD-only patients. Results of this study may inform research comparing NP-only care and PCMD-only care using Medicare and the utilization of NPs in primary care. ©2017 American Association of Nurse Practitioners.

Geographical, Ethnic and Socio-Economic Differences in Utilization of Obstetric Care in the Netherlands.

PubMed

Posthumus, Anke G; Borsboom, Gerard J; Poeran, Jashvant; Steegers, Eric A P; Bonsel, Gouke J

2016-01-01

All women in the Netherlands should have equal access to obstetric care. However, utilization of care is shaped by demand and supply factors. Demand is increased in high risk groups (non-Western women, low socio-economic status (SES)), and supply is influenced by availability of hospital facilities (hospital density). To explore the dynamics of obstetric care utilization we investigated the joint association of hospital density and individual characteristics with prototype obstetric interventions. A logistic multi-level model was fitted on retrospective data from the Netherlands Perinatal Registry (years 2000-2008, 1.532.441 singleton pregnancies). In this analysis, the first level comprised individual maternal characteristics, the second of neighbourhood SES and hospital density. The four outcome variables were: referral during pregnancy, elective caesarean section (term and post-term breech pregnancies), induction of labour (term and post-term pregnancies), and birth setting in assumed low-risk pregnancies. Higher hospital density is not associated with more obstetric interventions. Adjusted for maternal characteristics and hospital density, living in low SES neighbourhoods, and non-Western ethnicity were generally associated with a lower probability of interventions. For example, non-Western women had considerably lower odds for induction of labour in all geographical areas, with strongest effects in the more rural areas (non-Western women: OR 0.78, 95% CI 0.77-0.80, p<0.001). Our results suggest inequalities in obstetric care utilization in the Netherlands, and more specifically a relative underservice to the deprived, independent of level of supply.

Medicare home health: a description of total episodes of care.

PubMed

Branch, L G; Goldberg, H B; Cheh, V A; Williams, J

1993-01-01

The purpose of this study was to present descriptive information on the characteristics of 2,873 Medicare home health clients, to quantify systematically their patterns of service utilization and allowed charges during a total episode of care, and to clarify the bivariate associations between client characteristics and utilization. The model client was female, 75-84 years of age, living with a spouse, and frail based on a variety of indicators. The mean total episode was approximately 23 visits, with allowed charges of $1,238 (1986 dollars). Specific subgroups of clients, defined by their morbidities and frailties, used identifiable clusters of services. Implications for case-mix models and implications for capitation payments under health care reform are discussed.

Patterns in Home Care Use in Manitoba

ERIC Educational Resources Information Center

Mitchell, Lori; Roos, Noralou, P.; Shapiro, Evelyn

2005-01-01

Administrative home care data from the Manitoba Support Services Payroll (MSSP) system for fiscal years 1995/1996 to 1998/1999 were utilized to study home care client characteristics and changes in home care use over time. Patterns in home care access and use after hospitalization, before admission to a nursing home, and before death were…

Symptomatic Avascular Necrosis: An Understudied Risk Factor for Acute Care Utilization by Patients with SCD

PubMed Central

Yu, Tiffany; Campbell, Timothy; Ciuffetelli, Isabella; Haywood, Carlton; Carroll, C. Patrick; Resar, Linda M.S.; Strouse, John J.; Lanzkron, Sophie

2016-01-01

Objectives Sickle cell disease (SCD) is associated with high healthcare utilization rates and poor outcomes in a subset of patients, although the underlying factors that predict this phenotype are poorly understood. Prior studies suggest that comorbid avascular necrosis (AVN) contributes to high healthcare utilization. We sought to clarify whether AVN independently predicts acute care utilization in adults with SCD and to identify characteristics of those with AVN that predict higher utilization. Methods We reviewed the medical records of 87 patients with SCD with symptomatic AVN and compared acute care utilization and clinical characteristics with 87 sex- and age-matched patients with SCD without symptomatic AVN. Patients with ≥2 years of follow-up were included. Outcomes were compared using bivariate analysis and multivariate regression. Results Our study included 1381 follow-up years, with a median of 7 years per patient. The AVN cohort had greater median rates of urgent care visits (3.2/year vs 1.3/year; P = 0.0155), admissions (1.3/year vs 0.4/year; P = 0.0002), and admission days (5.1 days/year vs 1.8 days/year; P = 0.0007). History of high utilization (odds ratio [OR] 4.28; P = 0.001), acute chest syndrome (OR 3.12; P = 0.005), pneumonia (OR 3.20; P = 0.023), hydroxyurea therapy (OR 2.23; P = 0.0136), and long-term transfusion (OR 2.33; P = 0.014) were associated with AVN. In a median regression model, AVN, acute chest syndrome, and pneumonia were independently associated with greater urgent care visits and admissions. Conclusions Symptomatic AVN was found to be an independent risk factor for acute care utilization in patients with SCD. Because this is a potentially modifiable factor, further studies are urgently needed to determine whether AVN prevention/early treatment interventions will alter utilization and improve outcomes for patients with SCD. PMID:27598353

Symptomatic Avascular Necrosis: An Understudied Risk Factor for Acute Care Utilization by Patients with SCD.

PubMed

Yu, Tiffany; Campbell, Timothy; Ciuffetelli, Isabella; Haywood, Carlton; Carroll, Christopher Patrick; Resar, Linda; Strouse, John J; Lanzkron, Sophie

2016-09-01

Sickle cell disease (SCD) is associated with high healthcare utilization rates and poor outcomes in a subset of patients, although the underlying factors that predict this phenotype are poorly understood. Prior studies suggest that comorbid avascular necrosis (AVN) contributes to high healthcare utilization. We sought to clarify whether AVN independently predicts acute care utilization in adults with SCD and to identify characteristics of those with AVN that predict higher utilization. We reviewed the medical records of 87 patients with SCD with symptomatic AVN and compared acute care utilization and clinical characteristics with 87 sex- and age-matched patients with SCD without symptomatic AVN. Patients with ≥2 years of follow-up were included. Outcomes were compared using bivariate analysis and multivariate regression. Our study included 1381 follow-up years, with a median of 7 years per patient. The AVN cohort had greater median rates of urgent care visits (3.2/year vs 1.3/year; P = 0.0155), admissions (1.3/year vs 0.4/year; P = 0.0002), and admission days (5.1 days/year vs 1.8 days/year; P = 0.0007). History of high utilization (odds ratio [OR] 4.28; P = 0.001), acute chest syndrome (OR 3.12; P = 0.005), pneumonia (OR 3.20; P = 0.023), hydroxyurea therapy (OR 2.23; P = 0.0136), and long-term transfusion (OR 2.33; P = 0.014) were associated with AVN. In a median regression model, AVN, acute chest syndrome, and pneumonia were independently associated with greater urgent care visits and admissions. Symptomatic AVN was found to be an independent risk factor for acute care utilization in patients with SCD. Because this is a potentially modifiable factor, further studies are urgently needed to determine whether AVN prevention/early treatment interventions will alter utilization and improve outcomes for patients with SCD.

Variation in intensive care unit utilization and mortality after blunt splenic injury.

PubMed

Kaufman, Elinore J; Wiebe, Douglas J; Martin, Niels D; Pascual, Jose L; Reilly, Patrick M; Holena, Daniel N

2016-06-15

Although trauma patients are frequently cared for in the intensive care unit (ICU), admission triage criteria are unclear and may vary among providers and institutions. The benefits of close monitoring must be weighed against the economic and opportunity costs of an ICU admission. We conducted a retrospective cohort study of patients treated for blunt splenic injuries from 2011-2014 at 30 level I and II Pennsylvania trauma centers. We used multivariable logistic regression to assess the relationship between ICU admission and mortality, adjusting for patient characteristics, injury characteristics, and physiology. We calculated center-level observed-to-expected ratios for ICU utilization and mortality and evaluated correlations with Spearman's rho. We compared the proportion of patients receiving critical care procedures, such as mechanical ventilation or central line placement between high and low-ICU-utilization centers. Of 2587 patients with blunt splenic injuries, 63.9% (1654) were admitted to the ICU. Median injury severity score was 17 overall, 13 for non-ICU patients and 17 for ICU patients (P < 0.001). In multivariable logistic regression, ICU admission was not significantly associated with mortality. Center-level risk-adjusted ICU admission rates ranged from 17.9%-87.3%. Risk-adjusted mortality rates ranged from 1.2%-9.6%. There was no correlation between observed-to-expected ratios for ICU utilization and mortality (Spearman's rho = -0.2595, P = 0.2103). Proportionately fewer ICU patients received critical care procedures at high-utilization centers than at low-utilization centers. Risk-adjusted ICU utilization rates for splenic trauma varied widely among trauma centers, with no clear relationship to mortality. Standardizing ICU admission criteria could improve resource utilization without increasing mortality. Copyright © 2016 Elsevier Inc. All rights reserved.

Microbial Characteristics of Nosocomial Infections and Their Association with the Utilization of Hand Hygiene Products: A Hospital-Wide Analysis of 78,344 Cases.

PubMed

Liu, Song; Wang, Meng; Wang, Gefei; Wu, Xiuwen; Guan, Wenxian; Ren, Jianan

Nosocomial infections are the main adverse events during health care delivery. Hand hygiene is the fundamental strategy for the prevention of nosocomial infections. Microbial characteristics of nosocomial infections in the Asia-Pacific region have not been investigated fully. Correlation between the use of hand hygiene products and the incidence of nosocomial infections is still unknown. This study investigates the microbial characteristics of nosocomial infections in the Asia-Pacific region and analyzes the association between the utilization of hand hygiene products and the incidence of nosocomial infections. A total of 78,344 patients were recruited from a major tertiary hospital in China. Microbial characteristics of major types of nosocomial infections were described. The association between the utilization of hand hygiene products and the incidence of nosocomial infections was analyzed using correlation and regression models. The overall incidence of nosocomial infections was 3.04%, in which the incidence of surgical site infection was 1%. Multi-drug resistance was found in 22.8% of all pathogens, in which multi-drug-resistant Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus were 56.6% and 54.9%, respectively. The utilization of hand hygiene products (including hand sanitizer, soap and paper towel) was associated negatively with the incidence of surgical site infection in surgical departments and the incidence of nosocomial infections in non-intensive care unit (ICU) departments (especially in surgical departments). Regression analysis further identified that higher utilization of hand hygiene products correlated with decreased incidence of major types of nosocomial infections. Multi-drug-resistant organisms are emerging in Asia-Pacific health care facilities. Utilization of hand hygiene products is associated with the incidence of nosocomial infections.

Racial Differences in Chronic Conditions and Sociodemographic Characteristics Among High-Utilizing Veterans.

PubMed

Breland, Jessica Y; Chee, Christine Pal; Zulman, Donna M

2015-06-01

African-Americans are disproportionally represented among high-risk, high-utilizing patients. To inform program development for this vulnerable population, the current study describes racial variation in chronic conditions and sociodemographic characteristics among high-utilizing patients in the Veterans Affairs Healthcare System (VA). We identified the 5 % most costly Veterans who used inpatient or outpatient care at the VA during fiscal year 2010 (N = 237,691) based on costs of inpatient and outpatient care, pharmacy services, and VA-sponsored contract care. Patient costs and characteristics were abstracted from VA outpatient and inpatient data files. Racial differences in sociodemographic characteristics (age, sex, marital support, homelessness, and health insurance status) were assessed with chi-square tests. Racial differences in 32 chronic condition diagnoses were calculated as relative risk ratios. African-Americans represented 21 % of high-utilizing Veterans. African-Americans had higher rates of homelessness (26 vs. 10 %, p < 0.001) and lower rates of supplemental health insurance (44 vs. 58 %, p < 0.001). The mean number of chronic conditions was similar across race. However, there were racial differences in the prevalence of specific chronic conditions, including a higher prevalence of HIV/AIDS (95 % confidence interval (CI) 4.86, 5.50) and schizophrenia (95 % CI 1.94, 2.07) and a lower prevalence of ischemic heart disease (95 % CI 0.57, 0.59) and bipolar disorder (95 % CI 0.78, 0.85) among African-American high-utilizing Veterans. Racial disparities among high-utilizing Veterans may differ from those found in the general population. Interventions should devote attention to social, environmental, and mental health issues in order to reduce racial disparities in this vulnerable population.

Characteristics Associated with Home- and Community-Based Service Utilization for Medicare Managed Care Consumers

ERIC Educational Resources Information Center

Alkema, Gretchen E.; Reyes, Judy Y.; Wilber, Kathleen H.

2006-01-01

Purpose: We identified the types of home-and community-based services (HCBS) that high-risk older adults in Medicare managed care used, and we examined participant characteristics associated with service use in six areas: overall service use, four specific categories of HCBS, and referrals to insured medical services. Design and Methods: We used…

Explaining public satisfaction with health-care systems: findings from a nationwide survey in China.

PubMed

Munro, Neil; Duckett, Jane

2016-06-01

To identify factors associated with health-care system satisfaction in China. Recent research suggests that socio-demographic characteristics, self-reported health, income and insurance, ideological beliefs, health-care utilization, media use and perceptions of services may affect health-care system satisfaction, but the relative importance of these factors is poorly understood. New data from China offer the opportunity to test theories about the sources of health-care system satisfaction. Stratified nationwide survey sample analysed using multilevel logistic regression. 3680 Chinese adults residing in family dwellings between 1 November 2012 and 17 January 2013. Satisfaction with the way the health-care system in China is run. We find only weak associations between satisfaction and socio-demographic characteristics, self-reported health and income. We do, however, find that satisfaction is strongly associated with having insurance and belief in personal responsibility for meeting health-care costs. We also find it is negatively associated with utilization, social media use, perceptions of access as unequal and perceptions of service providers as unethical. To improve satisfaction, Chinese policymakers - and their counterparts in countries with similar health-care system characteristics - should improve insurance coverage and the quality of health services, and tackle unethical medical practices. © 2015 The Authors. Health Expectations published by John Wiley & Sons Ltd.

End-of-Life Care Planning in Accountable Care Organizations: Associations with Organizational Characteristics and Capabilities.

PubMed

Ahluwalia, Sangeeta C; Harris, Benjamin J; Lewis, Valerie A; Colla, Carrie H

2018-06-01

To measure the extent to which accountable care organizations (ACOs) have adopted end-of-life (EOL) care planning processes and characterize those ACOs that have established processes related to EOL. This study uses data from three waves (2012-2015) of the National Survey of ACOs. Respondents were 397 ACOs participating in Medicare, Medicaid, and commercial ACO contracts. This is a cross-sectional survey study using multivariate ordered logit regression models. We measured the extent to which the ACO had adopted EOL care planning processes as well as organizational characteristics, including care management, utilization management, health informatics, and shared decision-making capabilities, palliative care, and patient-centered medical home experience. Twenty-one percent of ACOs had few or no EOL care planning processes, 60 percent had some processes, and 19.6 percent had advanced processes. ACOs with a hospital in their system (OR: 3.07; p = .01), and ACOs with advanced care management (OR: 1.43; p = .02), utilization management (OR: 1.58, p = .00), and shared decision-making capabilities (OR: 16.3, p = .000) were more likely to have EOL care planning processes than those with no hospital or few to no capabilities. There remains considerable room for today's ACOs to increase uptake of EOL care planning, possibly by leveraging existing care management, utilization management, and shared decision-making processes. © Health Research and Educational Trust.

Socio-economic and locational determinants of accessibility and utilization of primary health-care.

PubMed

Field, K S; Briggs, D J

2001-09-01

Differences in levels of utilization vary and are a function of socio-economic and geographical factors. This paper presents the results of a questionnaire study involving twelve GP practices in Northamptonshire, UK, of factors which affect access and utilization in asthmatics and diabetics; these groups were selected to control for differences in utilization behaviour, as a result of different aetiologies. The questionnaire sought data on: residential location of patients, utilization characteristics of primary health-care, personal circumstances and mobility and hindrances to access and utilization. Key themes were identified relating to age, gender, social class, employment, ethnicity and proximity to the GP surgery. The young, elderly and females report higher rates of utilization, as do nonmanual workers and those who are unemployed. However, accessibility and utilization vary greatly in response to mobility and locational characteristics; these variations tend to be masked by data on overall rates of usage. Optimal scaling techniques were used to investigate the interactions between the factors affecting accessibility and utilization, and to characterize patients in terms of their levels of utilization. Results confirmed that current service provision afforded a differential level of service to patients, which does not directly reflect their level of need.

Evaluating the Impact of Integrated Care on Service Utilization in Serious Mental Illness.

PubMed

Waters, Heidi C; Furukawa, Michael F; Jorissen, Shari L

2018-06-14

Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality, and use of high-cost healthcare services including hospitalizations and emergency department visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study assessed whether there was a predictive relationship between integrated healthcare clinic enrollment and inpatient and emergency department utilization for consumers with SMI when controlling for demographic characteristics and disease severity. While findings indicated no statistically significant impact of integrated care clinic enrollment on utilization, the sample had lower levels of utilization than would have been expected. Since policy and payment structures continue to support integrated care models, further research on different programs are encouraged, as each setting and practice pattern is unique.

A Cross-Sectional Analytic Study of Postpartum Health Care Service Utilization in the Philippines

PubMed Central

Yamashita, Tadashi; Suplido, Sherri Ann; Ladines-Llave, Cecilia; Tanaka, Yuko; Senba, Naomi; Matsuo, Hiroya

2014-01-01

Background The maternal mortality ratio in the Philippines remains high; thus, it will be difficult to achieve the Millennium Development Goals 5 by 2015. Approximately two-thirds of all maternal deaths occur during the postpartum period. Therefore, we conducted the present study to examine the current state of postpartum health care service utilization in the Philippines, and identify challenges to accessing postpartum care. Methods A questionnaire and knowledge test were distributed to postpartum women in the Philippines. The questionnaire collected demographical characteristics and information about their utilization of health care services during pregnancy and the postpartum period. The knowledge test consisted of 11 questions regarding 6 topics related to possible physical and mental symptoms after delivery. Sixty-four questionnaires and knowledge tests were analyzed. Results The mean time of first postpartum health care visit was 5.1±5.2 days after delivery. Postpartum utilization of health care services was significantly correlated with delivery location (P<0.01). Women who delivered at home had a lower rate of postpartum health care service utilization than women who delivered at medical facilities. The majority of participants scored low on the knowledge test. Conclusion We found inadequate postpartum health care service utilization, especially for women who delivered at home. Our results also suggest that postpartum women lack knowledge about postpartum health concerns. In the Philippines, Barangay health workers may play a role in educating postpartum women regarding health care service utilization to improve their knowledge of possible concerns and their overall utilization of health care services. PMID:24465626

Early detection of cervical cancer according to the discourses of primary care midwives in Segovia, Spain.

PubMed

Otero, Laura; Sanz, Belén; Blasco, Teresa

2011-10-01

To analyze the discourses of primary care midwives on access to and utilization of the Cervical Cancer Prevention Program. A qualitative study was conducted in an area of low population density with a high proportion of rural population in Segovia, Spain, between 2008 and 2009. Semi-structured interviews were carried out. Ten primary care midwives were interviewed covering the 16 basic health districts of the city. Data analysis was based on grounded theory methodology. Access to and utilization of the Cervical Cancer Prevention Program was associated with attendance to midwife visits, women's experiences with cervical smears and their perception of risk of cervical cancer. Geographic distance to the health center, difficult access to immigrant women who have no health insurance, and being unaware of the program offered are some of the perceived barriers. Social exclusion is also perceived as a barrier of access to and utilization of the program. The recommendation to participate in the program made by the primary care physician was identified as the main facilitator. The midwives perceived inequalities in access to and utilization of the Cervical Cancer Prevention Program that are associated to individual characteristics of women, and contextual characteristics such as the geographical environment where they live and Program's infrastructure. There is inequality of access to care of underrepresented groups of women such as immigrant women and those residing in rural areas.

Coping with Mental Illness in the Family.

ERIC Educational Resources Information Center

Hatfield, Agnes B.

Utilizing the conceptual framework of coping theory, 30 family care-givers of mentally ill family members were interviewed to determine the relationship between coping effectiveness and such variables as patient characteristics, factors of the care-givers life situation, and the availability and adequacy of community supports. Care-givers were…

Prevalence of Intimate Partner Violence among Women Veterans who Utilize Veterans Health Administration Primary Care.

PubMed

Kimerling, Rachel; Iverson, Katherine M; Dichter, Melissa E; Rodriguez, Allison L; Wong, Ava; Pavao, Joanne

2016-08-01

The objectives of this study were to identify the prevalence of past-year intimate partner violence (IPV) among women Veterans utilizing Veterans Health Administration (VHA) primary care, and to document associated demographic, military, and primary care characteristics. This was a retrospective cohort design, where participants completed a telephone survey in 2012 (84% participation rate); responses were linked to VHA administrative data for utilization in the year prior to the survey. A national stratified random sample of 6,287 women Veteran VHA primary care users participated in the study. Past-year IPV was assessed using the HARK screening tool. Self-report items and scales assessed demographic and military characteristics. Primary care characteristics were assessed via self-report and VHA administrative data. The prevalence of past-year IPV among women Veterans was 18.5% (se = 0.5%), with higher rates (22.2% - 25.5%) among women up to age 55. Other demographic correlates included indicators of economic hardship, lesbian or bisexual orientation, and being a parent/guardian of a child less than 18 years old. Military correlates included service during Vietnam to post-Vietnam eras, less than 10 years of service, and experiences of Military Sexual Trauma (MST). Most (77.3%, se = 1.2%) women who experienced IPV identified a VHA provider as their usual provider. Compared with women who did not report past-year IPV, women who reported IPV had more primary care visits, yet experienced lower continuity of care across providers. The high prevalence of past-year IPV among women beyond childbearing years, the majority of whom primarily rely on VHA as a source of health care, reinforces the importance of screening all women for IPV in VHA primary care settings. Key considerations for service implementation include sensitivity with respect to sexual orientation, race/ethnicity, and other aspects of diversity, as well as care coordination and linkages with social services and MST-related care.

Quality of Care: A National Sample.

ERIC Educational Resources Information Center

Ferrari, Monica

This survey of 25 day care centers in 5 regions of Italy was designed to determine the characteristics of competent centers and the effects of differing local regulations on the quality of care provided. The Infant and Toddler Environment Rating Scale (ITERS) and a questionnaire were utilized to assess the quality of the day care centers in the…

A Study Identifying the Components of a Quality Child Care Center.

ERIC Educational Resources Information Center

Panetta, Sandra J.

Specific characteristics of a quality day care center are identified through a survey of parents, teachers, and directors utilizing or working in day care centers. The introduction to this descriptive research study offers background information on the history of the child care movement in America and a review of related research projects. A…

Centralized care management support for "high utilizers" in primary care practices at an academic medical center.

PubMed

Williams, Brent C; Paik, Jamie L; Haley, Laura L; Grammatico, Gina M

2014-01-01

Although evidence of effectiveness is limited, care management based outside primary care practices or hospitals is receiving increased attention. The University of Michigan (UM) Complex Care Management Program (CCMP) provides care management for uninsured and underinsured, high-utilizing patients in multiple primary care practices. To inform development of optimal care management models, we describe the CCMP model and characteristics and health care utilization patterns of its patients. Of a consecutive series of 49 patients enrolled at CCMP in 2011, the mean (SD) age was 48 (+/- 14); 23 (47%) were women; and 29 (59%) were White. Twenty-eight (57%) had two or more chronic medical conditions, 39 (80%) had one or more psychiatric condition, 28 (57%) had a substance abuse disorder, and 11 (22%) were homeless. Through phone, e-mail, and face-to-face contact with patients and primary care providers (PCPs), care managers coordinated health and social services and facilitated access to medical and mental health care. Patients had a mean (SD) number of hospitalizations and emergency room (ER) visits in 6 months prior to enrollment of2.2 (2.5) and 4.2 (4.3), respectively, with a nonstatistically significant decrease in hospitalizations, hospital days, and emergency room visits in 6 months following enrollment in CCMP. Centralized care management support for primary care practices engages high-utilizing patients with complex medical and behavioral conditions in care management that would be difficult to provide through individual practices and may decrease health care utilization by these patients.

Anticipatory Guidance about Child Diet and Physical Activity for Latino Farmworker Mothers

PubMed Central

Arcury, Thomas A.; Skelton, Joseph A.; Ip, Edward H.; Suerken, Cynthia K.; Trejo, Grisel; Quandt, Sara A.

2016-01-01

Background This analysis describes farmworker child health care utilization, anticipatory guidance for child weight, and the association of anticipatory guidance with personal characteristics, practice characteristics, and child’s health care utilization. Methods Data are from interviews conducted with 221 North Carolina Latino farmworker mothers with a child aged 4–5 years. Results Half of the children were healthy weight, 19.0% were overweight, and 28.5% were obese. Most (56.4%) had been with the usual practice for two years or longer; most had well-child visits less frequently than once per year (71.5%). Fewer children with well-child visits than without were obese (14.8% vs. 35.5%; p=.01). More children with obesity than with healthy weight or overweight received guidance messages; more children without a well-child care visit in the past 12 months received guidance messages. Conclusions Health care providers are addressing anticipatory guidance when the opportunity arises. Creative approaches to address disparate primary care for farmworker families are important. PMID:27524752

Association of Inpatient Antimicrobial Utilization Measures with Antimicrobial Stewardship Activities and Facility Characteristics of Veterans Affairs Medical Centers.

PubMed

Graber, Christopher J; Jones, Makoto M; Chou, Ann F; Zhang, Yue; Goetz, Matthew Bidwell; Madaras-Kelly, Karl; Samore, Matthew H; Glassman, Peter A

2017-05-01

Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable. Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable. To determine associations between ASPs and facility characteristics, and inpatient antimicrobial utilization measures in the Veterans Affairs (VA) system in 2012. In 2012, VA administered a survey on antimicrobial stewardship practices to designated ASP contacts at VA acute care hospitals. From the survey, we identified 34 variables across 3 domains (evidence, organizational context, and facilitation) that were assessed using multivariable least absolute shrinkage and selection operator regression against 4 antimicrobial utilization measures from 2012: aggregate acute care antimicrobial use, antimicrobial use in patients with non-infectious primary discharge diagnoses, missed opportunities to convert from parenteral to oral antimicrobial therapy, and double anaerobic coverage. All 130 VA facilities with acute care services. Variables associated with at least 3 favorable changes in antimicrobial utilization included presence of postgraduate physician/pharmacy training programs, number of antimicrobial-specific order sets, frequency of systematic de-escalation review, presence of pharmacists and/or infectious diseases (ID) attendings on acute care ward teams, and formal ID training of the lead ASP pharmacist. Variables associated with 2 unfavorable measures included bed size, the level of engagement with VA Antimicrobial Stewardship Task Force online resources, and utilization of antimicrobial stop orders. Formalization of ASP processes and presence of pharmacy and ID expertise are associated with favorable utilization. Systematic de-escalation review and order set establishment may be high-yield interventions. Journal of Hospital Medicine 2017;12:301-309. © 2017 Society of Hospital Medicine

[Association between Service Utilization Patterns and Frailty in the Elderly Certified at the Support Level in the Long-term Care Insurance System].

PubMed

Yoshiyuki, Noriko; Kono, Ayumi; Soga, Tomoko; Kanaya, Yukiko; Hotta, Kuniko

2016-01-01

This cross-sectional study clarified the association between service utilization patterns and frailty in the elderly certified at the support level in Japan's long-term care insurance (LTCI) system. We analyzed 710 subjects who completed in-home assessments and interviews from 1,033 elderly aged 65 and over living in Izumiotsu who had been certified at the LTCI support level in August 2014. The long-term service utilization data were collected from the local governmental office. Frailty was examined by the in-home structured assessment conducted by local health and welfare professionals. As frailty indicators, we measured subjects' frailty using the Kaigo-Yobo-Checklist (CL frailty), handgrip strength, body mass index, depression, and cognitive function. Long-term service utilization patterns were classified into five patterns: (1) home helper service only, (2) day care service only, (3) home helper and day care service, (4) one or more other services (using at least one other service regardless of home helper or day care), and (5) no service utilization. Odds ratios (ORs) of each frailty indicator were estimated by service utilization patterns by using logistic regression analyses adjusted for demographic characteristics, with the other services group as the reference category. Out of 710 subjects (100%), the proportions of the service utilization patterns were as follows: home helper service only, 17.9%; day care service only, 15.6%; home helper and day care service, 13.1%; one or more other services, 27.0%; and no service utilization, 26.3%. The logistic regression analyses showed that compared with the one or more other services group, the day care service only group had lower odds of CL frailty (OR=0.57, 95% confidence interval (CI)=0.34 to 0.95) and lower odds of low handgrip strength (OR=0.59, 95% CI=0.35 to 1.00). The no service utilization group had lower odds of CL frailty (OR=0.50, 95% CI=0.32 to 0.79) and lower odds of low handgrip strength (OR=0.58, 95% CI=0.37 to 0.91). The home helper service only group had higher odds of low handgrip strength (OR=1.91, 95% CI=1.11 to 3.29). Long-term service utilization patterns of the elderly certified at the support level in the LTCI system were associated with frailty. Classifying frailty characteristics by long-term service utilization patterns may be considered as a method to provide community-based resources and support for older adults in the community.

Understanding observed and unobserved health care access and utilization disparities among US Latino adults.

PubMed

Vargas Bustamante, Arturo; Fang, Hai; Rizzo, John A; Ortega, Alexander N

2009-10-01

This study hypothesizes that differences in health care access and utilization exist across Latino adults (>18 years), with U.S. Latino adults of Mexican ancestry demonstrating the worst patterns of access and utilization. The analyses use the National Health Interview Survey (NHIS) data from 1999 to 2007 (N = 33,908). The authors first estimate the disparities in health care access and utilization among different categories of Latinos. They also implement Blinder-Oaxaca techniques to decompose disparities into observed and unobserved components, comparing Latinos of Mexican ancestry with non-Mexican Latinos. Latinos of Mexican ancestry consistently demonstrate lower health care access and utilization patterns than non-Mexican Latinos. Health insurance and region of residence were the most important factors that explained observable differences. In contrast, language and citizenship status were relatively unimportant. Although a significant share of these disparities may be explained by observed characteristics, disparities because of unobserved heterogeneity among the different Latino cohorts are also considerable.

Dental care utilization and expenditures in children with special health care needs.

PubMed

Beil, Heather; Mayer, Michelle; Rozier, R Gary

2009-09-01

The authors compared children with special health care needs (CSHCN) and children without special health care needs (SHCN) with respect to the odds, amount and determinants of having any dental care and dental care expenditures. The authors assessed data from the 2004 Medical Expenditures Panel Survey, Agency for Healthcare Research and Quality, to identify a sample of 8,518 children aged 2 to 17 years. The authors used logistic regression to determine the effect of having SHCN on the probability of having any dental care expenditure, for total dental care expenditures and procedure-specific expenditures. They tested the modifying effect between CSHCN and other variables on the probability of having any dental care expenditure. Compared with children without SHCN, CSHCN did not differ in the probability (odds ratio = 0.91, 95 percent confidence interval [CI] = 0.76 to 1.09) or amount (beta = 30.17, 95 percent CI = -162.93 to 223.27) of total dental care expenditures. Likewise, CSHCN did not differ in their likelihood of having undergone a preventive, restorative, diagnostic or other procedure. Known determinants of dental care utilization did not modify the relationships between having SCHN and any dental care expenditure. Despite the reported difficulty in CSHCN's accessing dental care, the authors found that CSHCN had dental care utilization and expenditures that were comparable with those of children without SHCN. Furthermore, the association of CSHCN status and any dental care expenditure was not modified by known determinants of dental care utilization. Future research should focus on characterizing risk for dental disease among CSHCN more accurately and identifying factors that affect dental care utilization in CSHCN, including provider and parent characteristics. The study results highlight low rates of dental care utilization among all young children, including CSHCN. Efforts to increase dental care utilization among children are warranted and need to include broad-based provider and parent initiatives.

Preventive care utilization: Association with individual- and workgroup-level policy and practice perceptions.

PubMed

Sabbath, Erika L; Sparer, Emily H; Boden, Leslie I; Wagner, Gregory R; Hashimoto, Dean M; Hopcia, Karen; Sorensen, Glorian

2018-06-01

Preventive medical care may reduce downstream medical costs and reduce population burden of disease. However, although social, demographic, and geographic determinants of preventive care have been studied, there is little information about how the workplace affects preventive care utilization. This study examines how four types of organizational policies and practices (OPPs) are associated with individual workers' preventive care utilization. We used data collected in 2012 from 838 hospital patient care workers, grouped in 84 patient care units at two hospitals in Boston. Via survey, we assessed individuals' perceptions of four types of OPPs on their work units. We linked the survey data to a database containing detailed information on medical expenditures. Using multilevel models, we tested whether individual-level perceptions, workgroup-average perceptions, and their combination were associated with individual workers' preventive care utilization (measured by number of preventive care encounters over a two-year period). Adjusting for worker characteristics, higher individual-level perceptions of workplace flexibility were associated with greater preventive care utilization. Higher average unit-level perceptions of people-oriented culture, ergonomic practices, and flexibility were associated with greater preventive care utilization. Overall, we find that workplace policies and practices supporting flexibility, ergonomics, and people-oriented culture are associated with positive preventive care-seeking behavior among workers, with some policies and practices operating at the individual level and some at the group level. Improving the work environment could impact employers' health-related expenditures and improve workers' health-related quality of life. Copyright © 2018 Elsevier Inc. All rights reserved.

Intensive Care Unit Utilization Among Medicare Patients Hospitalized with Non-ST-Segment Elevation Myocardial Infarction

PubMed Central

Fanaroff, Alexander C; Peterson, Eric D; Chen, Anita Y; Thomas, Laine; Doll, Jacob D; Fordyce, Christopher B; Newby, L Kristin; Amsterdam, Ezra A; Kosiborod, Mikhail N; de Lemos, James A; Wang, Tracy Y

2018-01-01

Importance Intensive care unit (ICU) utilization may have important implications for the care and outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI). Objectives To examine inter-hospital variation in ICU utilization in the United States for older adults with hemodynamically stable NSTEMI and outcomes associated with ICU utilization among patients with at low, moderate, or high mortality risk. Design, Settings and Participants Retrospective analysis of 28,018 Medicare patients ≥65 years old admitted with NSTEMI to 346 hospitals participating in ACTION Registry-GWTG between April 1, 2011 and December 31, 2012. Patients with cardiogenic shock or cardiac arrest on presentation were excluded. Exposure Hospitals with high (>70% NSTEMI patients treated in an ICU during the index hospitalization), intermediate (30–70%), or low (< 30%) ICU utilization rates Main Outcome and Measure 30-day mortality Results Of NSTEMI patients ≥ 65 years old, 11,934 (43%) had an ICU stay. The proportion of NSTEMI patients treated in the ICU varied across hospitals (median 38% [26%, 54%]), but there were no significant differences in hospital characteristics or NSTEMI patient characteristics between hospitals with high, intermediate, or low ICU utilization rates. Compared with high ICU utilization hospitals, hospitals with low or intermediate ICU utilizations rates were only marginally more selective of higher risk patients, as determined by ACTION in-hospital mortality risk score or initial troponin level. Thirty-day mortality rates did not significantly differ based on hospital ICU utilization (high vs. low: 8.7% vs. 8.7%, adjusted OR 0.91, 95% CI 0.76–1.08; intermediate vs. low: 9.6% vs. 8.7%, adjusted OR 1.06, 95% CI 0.94–1.20). The relationship between hospital ICU utilization and mortality was similar in analyses stratified by low, moderate, or high ACTION risk score categories (adjusted interaction p 0.86). Conclusions and Relevance ICU utilization for older NSTEMI patients varied significantly among hospitals. This variability was not explained by hospital characteristics nor driven by patient risk. Post-MI mortality did not significantly differ among hospitals with high, intermediate, or low ICU utilization. PMID:27806171

Characteristics of private-sector managed care for mental health and substance abuse treatment.

PubMed

Garnick, D W; Hendricks, A M; Dulski, J D; Thorpe, K E; Horgan, C

1994-12-01

This study examined diversity during the late 1980s in managed care programs for mental health, alcohol abuse, and drug abuse to identify ways in which research can generate more meaningful data on the effectiveness of utilization review programs. Telephone interviews were conducted with representatives of utilization review programs for employee health insurance plans in 31 firms that employed 2.1 million people in 1990. Questions addressed qualifications of personnel, clinical criteria to authorize care, integration with employee assistance plans, penalties for not complying with utilization review procedures, outpatient review, and carve out of mental health and substance abuse review. Large variations in utilization review programs were found. Programs employed a range of review personnel and used a variety of clinical criteria to authorize care. More than two-thirds did not carve out mental health and substance abuse review from medical-surgical review. Some firms' employee assistance plans were integrated with utilization review programs, while others remained unintegrated. Penalties for not following program procedures varied widely, as did review of outpatient services. Because of trends toward even more diversity in utilization review programs in the 1990s, research that identifies the specific features of managed care programs that hold most promise for controlling costs while maintaining quality of care will increasingly be needed.

Migraine disability, healthcare utilization, and expenditures following treatment in a tertiary headache center.

PubMed

Freitag, Frederick G; Lyss, Heidi; Nissan, George R

2013-10-01

Headache is among the most common disabling pain complaints. While many patients are managed in primary care or referral neurology practices, some patients have refractive situations that necessitate referral to a tertiary headache center. Increasing frequency of headache is strongly associated with increasing disability and workplace absenteeism as well as increased healthcare utilization. Previous studies have demonstrated that headache care in a dedicated tertiary center is associated with a decrease in headache frequency and improvement in other characteristics that persist over extended periods of time. Previous studies have not examined the impact of this treatment on subsequent healthcare utilization and associated expenditures. In this study we examined the changes in healthcare utilization and expenditures as well as the impact on disability and workplace productivity with treatment in a tertiary headache care center that used initial treatment settings of inpatient and outpatient care and considered the difference between those with episodic migraine and those with chronic migraine and its complications. Tertiary care was found to produce positive reductions in disability, healthcare utilization, and expenditures. These results suggest that earlier tertiary-level intervention may avoid the complications of migraine that occur in some patients and the increasing costs and utilization of care associated with higher disability.

Migraine disability, healthcare utilization, and expenditures following treatment in a tertiary headache center

PubMed Central

Lyss, Heidi; Nissan, George R.

2013-01-01

Headache is among the most common disabling pain complaints. While many patients are managed in primary care or referral neurology practices, some patients have refractive situations that necessitate referral to a tertiary headache center. Increasing frequency of headache is strongly associated with increasing disability and workplace absenteeism as well as increased healthcare utilization. Previous studies have demonstrated that headache care in a dedicated tertiary center is associated with a decrease in headache frequency and improvement in other characteristics that persist over extended periods of time. Previous studies have not examined the impact of this treatment on subsequent healthcare utilization and associated expenditures. In this study we examined the changes in healthcare utilization and expenditures as well as the impact on disability and workplace productivity with treatment in a tertiary headache care center that used initial treatment settings of inpatient and outpatient care and considered the difference between those with episodic migraine and those with chronic migraine and its complications. Tertiary care was found to produce positive reductions in disability, healthcare utilization, and expenditures. These results suggest that earlier tertiary-level intervention may avoid the complications of migraine that occur in some patients and the increasing costs and utilization of care associated with higher disability. PMID:24082410

Barriers to using skilled birth attendants' services in mid- and far-western Nepal: a cross-sectional study.

PubMed

Choulagai, Bishnu; Onta, Sharad; Subedi, Narayan; Mehata, Suresh; Bhandari, Gajananda P; Poudyal, Amod; Shrestha, Binjwala; Mathai, Matthews; Petzold, Max; Krettek, Alexandra

2013-12-23

Skilled birth attendants (SBAs) provide important interventions that improve maternal and neonatal health and reduce maternal and neonatal mortality. However, utilization and coverage of services by SBAs remain poor, especially in rural and remote areas of Nepal. This study examined the characteristics associated with utilization of SBA services in mid- and far-western Nepal. This cross-sectional study examined three rural and remote districts of mid- and far-western Nepal (i.e., Kanchanpur, Dailekh and Bajhang), representing three ecological zones (southern plains [Tarai], hill and mountain, respectively) with low utilization of services by SBAs. Enumerators assisted a total of 2,481 women. All respondents had delivered a baby within the past 12 months. We used bivariate and multivariate analyses to assess the association between antenatal and delivery care visits and the women's background characteristics. Fifty-seven percent of study participants had completed at least four antenatal care visits and 48% delivered their babies with the assistance of SBAs. Knowing the danger signs of pregnancy and delivery (e.g., premature labor, prolonged labor, breech delivery, postpartum hemorrhage, severe headache) associated positively with four or more antenatal care visits (OR = 1.71; 95% CI: 1.41-2.07). Living less than 30 min from a health facility associated positively with increased use of both antenatal care (OR = 1.44; 95% CI: 1.18-1.77) and delivery services (OR = 1.25; CI: 1.03-1.52). Four or more antenatal care visits was a determining factor for the utilization of SBAs. Less than half of the women in our study delivered babies with the aid of SBAs, indicating a need to increase utilization of such services in rural and remote areas of Nepal. Distance from health facilities and inadequate transportation pose major barriers to the utilization of SBAs. Providing women with transportation funds before they go to a facility for delivery and managing transportation options will increase service utilization. Moreover, SBA utilization associates positively with women's knowledge of pregnancy danger signs, wealth quintile, and completed antenatal care visits. Nepal's health system must develop strategies that generate demand for SBAs and also reduce financial, geographic and cultural barriers to such services.

Determinants of Utilization of Eye Care Services in a Rural Adult Population of a Developing Country

PubMed Central

Olusanya, Bolutife A.; Ashaye, Adeyinka O.; Owoaje, Eme T.; Baiyeroju, Aderonke M.; Ajayi, Benedictus G.

2016-01-01

Purpose: To describe the factors that determine the utilization of eye care services in a rural community in South-Western Nigeria. Methods: A descriptive cross-sectional survey using a multistage sampling technique was conducted. The main outcome measure was self-reported previous consultation of an orthodox medical facility for eye care. Results: The study sample included 643 participants. Only 122 (19%) respondents had previously visited orthodox facilities in search of eye care and 24% of those with presenting visual acuity <6/18 had sought eye care. Characteristics associated with previous utilization of eye care services were age of =70 years (odds ratio [OR] ≥ 1.7, P = 0.02); male gender (OR = 1.5, P = 0.04); literacy (OR = 1.7, P = 0.007); and residing close to an eye care facility (OR = 2.8, P < 0.001). Blind respondents were three times more likely to seek eye care (P < 0.001). Regression analysis revealed that factors associated with increased likelihood of utilization of eye care services included age ≥70 years; literacy; residence close to an eye facility; being diabetic or hypertensive; history of ocular symptoms, and blindness. Conclusions: These findings suggest that a significant proportion (75%) of adults in the study area are not utilizing eye care services and that blindness is an important determinant of utilization of eye care services. Health education and awareness campaigns about the importance and benefits of seeking eye care early, and the provision of community-based eye care programs are essential to boost the uptake of eye care services in this community as well as other rural areas of West Africa. PMID:26957847

What Is Lean Management in Health Care? Development of an Operational Definition for a Cochrane Systematic Review.

PubMed

Rotter, Thomas; Plishka, Christopher; Lawal, Adegboyega; Harrison, Liz; Sari, Nazmi; Goodridge, Donna; Flynn, Rachel; Chan, James; Fiander, Michelle; Poksinska, Bonnie; Willoughby, Keith; Kinsman, Leigh

2018-01-01

Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization's mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.

Primary care practice organization influences colorectal cancer screening performance.

PubMed

Yano, Elizabeth M; Soban, Lynn M; Parkerton, Patricia H; Etzioni, David A

2007-06-01

To identify primary care practice characteristics associated with colorectal cancer (CRC) screening performance, controlling for patient-level factors. Primary care director survey (1999-2000) of 155 VA primary care clinics linked with 38,818 eligible patients' sociodemographics, utilization, and CRC screening experience using centralized administrative and chart-review data (2001). Practices were characterized by degrees of centralization (e.g., authority over operations, staffing, outside-practice influence); resources (e.g., sufficiency of nonphysician staffing, space, clinical support arrangements); and complexity (e.g., facility size, academic status, managed care penetration), adjusting for patient-level covariates and contextual factors. Chart-based evidence of CRC screening through direct colonoscopy, sigmoidoscopy, or consecutive fecal occult blood tests, eliminating cases with documented histories of CRC, polyps, or inflammatory bowel disease. After adjusting for sociodemographic characteristics and health care utilization, patients were significantly more likely to be screened for CRC if their primary care practices had greater autonomy over the internal structure of care delivery (p<.04), more clinical support arrangements (p<.03), and smaller size (p<.001). Deficits in primary care clinical support arrangements and local autonomy over operational management and referral procedures are associated with significantly lower CRC screening performance. Competition with hospital resource demands may impinge on the degree of internal organization of their affiliated primary care practices.

Internalized HIV and Drug Stigmas: Interacting Forces Threatening Health Status and Health Service Utilization Among People with HIV Who Inject Drugs in St. Petersburg, Russia

PubMed Central

Burke, Sara E.; Dovidio, John F.; Levina, Olga S.; Uusküla, Anneli; Niccolai, Linda M.; Heimer, Robert

2016-01-01

Marked overlap between the HIV and injection drug use epidemics in St. Petersburg, Russia, puts many people in need of health services at risk for stigmatization based on both characteristics simultaneously. The current study examined the independent and interactive effects of internalized HIV and drug stigmas on health status and health service utilization among 383 people with HIV who inject drugs in St. Petersburg. Participants self-reported internalized HIV stigma, internalized drug stigma, health status (subjective rating and symptom count), health service utilization (HIV care and drug treatment), sociodemographic characteristics, and health/behavioral history. For both forms of internalized stigma, greater stigma was correlated with poorer health and lower likelihood of service utilization. HIV and drug stigmas interacted to predict symptom count, HIV care, and drug treatment such that individuals internalizing high levels of both stigmas were at elevated risk for experiencing poor health and less likely to access health services. PMID:26050155

Characteristics of Young Adults Enrolled Through the Affordable Care Act-Dependent Coverage Expansion.

PubMed

Han, Xuesong; Zhu, Shiyun; Jemal, Ahmedin

2016-12-01

The purpose of this study was to examine sociodemographic and health care-related characteristics of young adults covered through the Affordable Care Act (ACA)-dependent coverage expansion. Our sample consisted of 36,802 young adults aged 19-25 years from 2011 to 2014 National Health Interview Survey. Sociodemographic differences among young adults with the four insurance types were described: privately insured under parents, privately insured under self/spouse, publicly insured, and uninsured. Multivariable logistic models were fitted to compare those covered under parent with those covered through other traditional insurance types, in terms of the following outcomes: health status, health behaviors, insurance history and experience, access to care, care utilization, and receipt of preventive service, controlling for sociodemographic factors. Young adults who were covered under their parents' insurance were most likely to be college students and non-Hispanic whites. These young adults also had more stable insurance, better access to care, better care utilization patterns, and reported better health status, compared to their peers. The beneficiaries of the ACA-dependent coverage expansion were more likely to be college students from families with high socioeconomic status. Coverage under parents was associated with improved access to care and health outcomes among young adults. The enrollees through the ACA represent the healthiest subgroup of young adults and those with the best care utilization patterns, suggesting that the added cost relative to premium for insurers from this population will likely be minimal. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Integration of data from a safety net health care system into the Vaccine Safety Datalink.

PubMed

Hambidge, Simon J; Ross, Colleen; Shoup, Jo Ann; Wain, Kris; Narwaney, Komal; Breslin, Kristin; Weintraub, Eric S; McNeil, Michael M

2017-03-01

In 2013 the Institute of Medicine suggested that the Vaccine Safety DataLink (VSD) should broaden its population by including data of more patients from low income and racially and ethnically diverse backgrounds. In response, Kaiser Permanente Colorado (KPCO) partnered with Denver Health (DH), an integrated safety net health care system, to explore the integration of DH data. We compared three different methods (reference date of September 1, 2013): "Empanelment" (any patient who has had a primary care visit in the past 18months), "Proxy-enrollment" (two health care visits in 3years separated by 90days), and "Enrollment" in a managed care plan. For each of these methods, we compared cohort size, vaccination rates, socio-demographic characteristics, and health care utilization. The empaneled population at DH provided the best comparison to KPCO. DH's empaneled population was 111,330 (57,173 adults; 54,157 children), while KPCO had 436,290 empaneled patients (336,462 adults; 99,828 children). Vaccination rates in both health care systems for empaneled patients were comparable. Two year-old up-to-date coverage rates were 83.2% (KPCO) and 86.9% (DH); rates for adolescent Tdap and MCV4 were 85.5% (KPCO) and 90.6% (DH). There were significant differences in the two populations in age, gender, race, preferred language, and % Federal Poverty Level (FPL) (DH 70.7%<100% FPL; KPCO 17.4%), as well as in healthcare utilization - for example pediatric emergency department utilization was twice as high at DH. Using a cohort of "empaneled" patients, it is possible to integrate data from a safety net health care system that does not have a uniform managed care population into the VSD, and to compare vaccination rates, socio-demographic characteristics, and health care utilization across the two systems. The KPCO-DH collaboration may serve as a model for incorporating data from a safety net healthcare system into the VSD. Copyright © 2017 Elsevier Ltd. All rights reserved.

Births: Final Data for 2001.

ERIC Educational Resources Information Center

Martin, Joyce A.; Hamilton, Brady E.; Ventura, Stephanie J.; Menacker, Fay; Park, Melissa M.; Sutton, Paul D.

2002-01-01

This report presents 2001 data on U.S. births according to maternal demographics (age, live-birth order, marital status, race, Hispanic origin, and educational attainment); maternal characteristics (medical risk factors, weight gain, and tobacco and alcohol use); pregnant women's medical care utilization (prenatal care, obstetric procedures,…

Insurer market structure and variation in commercial health care spending.

PubMed

McKellar, Michael R; Naimer, Sivia; Landrum, Mary B; Gibson, Teresa B; Chandra, Amitabh; Chernew, Michael

2014-06-01

To examine the relationship between insurance market structure and health care prices, utilization, and spending. Claims for 37.6 million privately insured employees and their dependents from the Truven Health Market Scan Database in 2009. Measures of insurer market structure derived from Health Leaders Inter study data. Regression models are used to estimate the association between insurance market concentration and health care spending, utilization, and price, adjusting for differences in patient characteristics and other market-level traits. Insurance market concentration is inversely related to prices and spending, but positively related to utilization. Our results imply that, after adjusting for input price differences, a market with two equal size insurers is associated with 3.9 percent lower medical care spending per capita (p = .002) and 5.0 percent lower prices for health care services relative to one with three equal size insurers (p < .001). Greater fragmentation in the insurance market might lead to higher prices and higher spending for care, suggesting some of the gains from insurer competition may be absorbed by higher prices for health care. Greater attention to prices and utilization in the provider market may need to accompany procompetitive insurance market strategies. © Health Research and Educational Trust.

Application of the Andersen's health care utilization framework to secondary complications of spinal cord injury: a scoping review.

PubMed

Guilcher, Sara J T; Craven, B Cathy; McColl, Mary Ann; Lemieux-Charles, Louise; Casciaro, Tiziana; Jaglal, Susan B

2012-01-01

The purpose of this scoping review was to identify research priority areas related to secondary complications and associated health care use for individuals with spinal cord injury (SCI). Peer-reviewed journals were identified using CINAHL, MEDLINE, PubMed, Embase, Social Sciences Abstracts, Social Works Abstract and PsycInfo search engines. Key references were hand searched. A total of 289 abstracts were identified from the initial search strategy. We removed studies that did not measure health care and those that did not involve analytical investigation. The selected 31 studies were reviewed in detail using a coding template based on the domains and sub-components of the Andersen model (i.e. environmental, population characteristics, health behavior and outcome). Most studies measured predisposing characteristics (e.g., age, gender) and need characteristics (e.g., level of injury). There was a notable absence of environmental characteristics (e.g., health system, neighborhood variables), enabling characteristics and health behaviors (beyond diet and nutrition). We identified a gap in the SCI literature. Future research should focus on longitudinal study designs with more representation of non-traumatic spinal cord injury, as well as utilizing more advanced statistical analyses (i.e., multivariate level) to adjust for confounding variables.

Improving surgeon utilization in an orthopedic department using simulation modeling

PubMed Central

Simwita, Yusta W; Helgheim, Berit I

2016-01-01

Purpose Worldwide more than two billion people lack appropriate access to surgical services due to mismatch between existing human resource and patient demands. Improving utilization of existing workforce capacity can reduce the existing gap between surgical demand and available workforce capacity. In this paper, the authors use discrete event simulation to explore the care process at an orthopedic department. Our main focus is improving utilization of surgeons while minimizing patient wait time. Methods The authors collaborated with orthopedic department personnel to map the current operations of orthopedic care process in order to identify factors that influence poor surgeons utilization and high patient waiting time. The authors used an observational approach to collect data. The developed model was validated by comparing the simulation output with the actual patient data that were collected from the studied orthopedic care process. The authors developed a proposal scenario to show how to improve surgeon utilization. Results The simulation results showed that if ancillary services could be performed before the start of clinic examination services, the orthopedic care process could be highly improved. That is, improved surgeon utilization and reduced patient waiting time. Simulation results demonstrate that with improved surgeon utilizations, up to 55% increase of future demand can be accommodated without patients reaching current waiting time at this clinic, thus, improving patient access to health care services. Conclusion This study shows how simulation modeling can be used to improve health care processes. This study was limited to a single care process; however the findings can be applied to improve other orthopedic care process with similar operational characteristics. PMID:29355193

The impact of complex chronic diseases on care utilization among assisted living residents

PubMed Central

McNabney, Matthew K.; Onyike, Chiadi; Johnston, Deirdre; Mayer, Lawrence; Lyketsos, Constantine; Brandt, Jason; Rosenblatt, Adam; Samus, Quincy

2014-01-01

Purpose Many residents of assisted living (AL) have chronic diseases that are difficult to manage, including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM). We estimated the amount and intensity of care delivered by the staff for residents with these conditions. Methods We performed a secondary data analysis from the Maryland Assisted Living (MDAL) Study (399 residents, 29 facilities). In-person assessments included measures of cognition, function, depression, and general medical health. Diagnosis of CHF, COPD, and DM, as well as current medications was abstracted from AL medical charts. Measures of care utilization were operationalized at the resident level as: 1) minutes per day of direct care (caregiver activity scale [CAS]), 2) subjective staff ratings of care burden, and 3) assigned AL “level of care” (based on state regulatory criteria). Results In best fit regression models, CHF and DM were not significant predictors of the evaluated care utilization measures; however, COPD was independently associated with increased minutes per day of direct care – 34% of the variance in the caregiver activity scale was explained by degree of functional dependency, cognitive impairment, age, and presence of COPD. Functional dependency, depressive symptoms, and age explained almost a quarter (23%) of the variance of staff care burden rating. For the AL level of care intensity rating, degree of functional dependency, level of cognition, and age were significant correlates, together explaining about 28% of the variance. Conclusion The presence of COPD was a significant predictor of time per day of direct care. However, CHF and DM were not correlates of care utilization measures. Functional and cognitive impairment was associated with measures of care utilization, reiterating the importance of these characteristics in the utilization and intensity of care consumed by AL residents. Further study of this population could reveal other forms and amounts of care utilization. PMID:24139207

Health care resource utilization and characteristics of patients with eosinophilic asthma in secondary health care in Finland.

PubMed

Mäkelä, Mika J; Christensen, Helene Nordahl; Karlsson, Antti; Rastogi, Sarang; Kettunen, Kirsi

2018-01-01

Background : Eosinophilic airway inflammation is common in asthma patients and appears to be associated with severe exacerbations and loss of asthma control. Objective : To describe the resource utilization and clinical characteristics of patients with eosinophilic asthma. Design : Asthma patients ≥18 years with ≥1 blood eosinophil count in secondary care (South West Finland) during 2003‒2013 were included. Clinical characteristics (age, lung function, body mass index, and comorbidities) and asthma-related resource utilization (hospital admissions, outpatient visits, and emergency room [ER] visits) were retrieved. Resource utilization rates were compared for patients with blood eosinophil ≤ or >300 cells/μL, using adjusted negative binomial regression models. Results : Overall, 4,357 eligible patients were identified (mean age 60 years, females 68%), of which 1,927 (44%) had >300 eosinophil cells/μL blood. Patients with ≤300 and >300 eosinophil counts, exhibited similar clinical characteristics, including advanced age, poor lung function, and overweight. Comorbidities such as pneumonia, sinusitis, and nasal polyps, were more frequent among those with >300 eosinophil cells/μL blood compared with patients with lower counts. Eosinophil counts >300 cells/μL were associated with greater hospital admissions (rate ratio [RR] [95% confidence interval CI]: 1.13 [1.02;1.24]) and outpatient visits (RR [95% CI]: 1.11 [1.03;1.20]) compared with patients with lower eosinophil counts. Rates of ER visits were similar between the patient groups (RR [95% CI]: 0.99 [0.87;1.12]). Conclusions : Hospital admissions and outpatient visits occurred more often for patients with eosinophil counts >300 cells/µL, than for patients with lower eosinophil counts. Routine blood eosinophil screening might be useful to identify patients with an eosinophilic phenotype eligible for more targeted treatments.

Patient characteristics as predictors of primary health care preferences: a systematic literature analysis

PubMed Central

Jung, Hans Peter; Baerveldt, Cor; Olesen, Frede; Grol, Richard; Wensing, Michel

2003-01-01

Abstract Objective To identify associations between various cultural and demographic factors and patients’ primary health care preferences. Search strategy Searches were performed in MEDLINE (1966–December 2000), PsycINFO (1977–May 2001) and Sociological Abstracts (1963–December 2000). Identified papers were checked for more papers. Inclusion criteria Studies with a focus on primary health care or health care in general, asking patients about preferences with regard to health care, reporting quantitative results and examining the relations between specific patient characteristics and patient preferences. Data extraction and synthesis Data were extracted from studies using a scoring form to register what methods were used, which patient characteristics were analysed and which patient characteristics significantly influenced patients’ preferences with regard to different aspects of health care (P < 0.05). Main results A total of 145 studies were included with 2276 comparisons between subgroups of patients. Of all the comparisons, 607 (27%) showed a significant association between patient characteristics and preferences with regard to primary health care. Age and economic status significantly related to patient preferences in 38 and 33% of the comparisons, respectively. Education, health status, family situation, sex, and utilization of health care related significantly to patient preferences in less than 25% of the comparisons. Conclusions This review of the literature showed patient characteristics to be an important determinant of preferences regarding many aspects of primary health care defined as general practice care or health care, in general. All of the patient characteristics examined here showed at least some significant associations with preferences for primary health care. PMID:12752744

Resource utilization of patients with hypochondriacal health anxiety and somatization.

PubMed

Barsky, A J; Ettner, S L; Horsky, J; Bates, D W

2001-07-01

To examine the resource utilization of patients with high levels of somatization and health-related anxiety. Consecutive patients on randomly chosen days completed a self-report questionnaire assessing somatization and health-related, hypochondriacal anxiety. Their medical care utilization in the year preceding and following completion of the questionnaire was obtained from an automated patient record. The utilization of patients above and below a predetermined threshold on the questionnaire was then compared. Eight hundred seventy-six patients attending a primary care clinic in a large, urban, teaching hospital. Number of ambulatory physician visits (primary care and specialist), outpatient costs (total, physician services, and laboratory procedures), proportion of patients hospitalized, and proportion of patients receiving emergency care. Patients in the uppermost 14% of the clinic population on somatization and hypochondriacal health anxiety had appreciably and significantly higher utilization in the year preceding and the year following completion of the somatization questionnaire than did the rest of the patients in the clinic. After adjusting for group differences in sociodemographic characteristics and medical comorbidity, significant differences in utilization remained. In the year preceding the assessment of somatization, their adjusted total outpatient costs were $1,312 (95% CI $1154, $1481) versus $954 (95% CI $868, $1057) for the remainder of the patients and the total number of physician visits was 9.21 (95% CI 7.94, 10.40) versus 6.33 (95% CI 5.87, 6.90). In the year following the assessment of somatization, those above the threshold had adjusted total outpatient costs of $1,395 (95% CI $1243, $1586) versus $1,145 (95% CI $1038, $1282), 9.8 total physician visits (95% CI 8.66, 11.07) versus 7.2 (95% CI 6.62, 7.77), and had a 24% (95% CI 19%, 30%) versus 17% (95% CI 14%, 20%) chance of being hospitalized. Primary care patients who somatize and have high levels of health-related anxiety have considerably higher medical care utilization than nonsomatizers in the year before and after being assessed. This differential persists after adjusting for differences in sociodemographic characteristics and medical morbidity.

Births: Final Data for 2000.

ERIC Educational Resources Information Center

Martin, Joyce A.; Hamilton, Brady E.; Ventura, Stephanie J.; Menacker, Fay; Park, Melissa M.

2002-01-01

This report presents 2000 data on U.S. births, highlighting maternal demographics (e.g., age, race, Hispanic origin, marital status, and educational attainment); maternal characteristics (medical risk factors, weight gain, and tobacco and alcohol use); medical care utilization during pregnancy women (e.g., prenatal care, labor and/or delivery…

Women's autonomy and maternal healthcare service utilization in Ethiopia.

PubMed

Tiruneh, Fentanesh Nibret; Chuang, Kun-Yang; Chuang, Ying-Chih

2017-11-13

Most previous studies on healthcare service utilization in low-income countries have not used a multilevel study design to address the importance of community-level women's autonomy. We assessed whether women's autonomy, measured at both individual and community levels, is associated with maternal healthcare service utilization in Ethiopia. We analyzed data from the 2005 and 2011 Ethiopia Demographic and Health Surveys (N = 6058 and 7043, respectively) for measuring women's decision-making power and permissive gender norms associated with wife beating. We used Spearman's correlation and the chi-squared test for bivariate analyses and constructed generalized estimating equation logistic regression models to analyze the associations between women's autonomy indicators and maternal healthcare service utilization with control for other socioeconomic characteristics. Our multivariate analysis showed that women living in communities with a higher percentage of opposing attitudes toward wife beating were more likely to use all three types of maternal healthcare services in 2011 (adjusted odds ratios = 1.21, 1.23, and 1.18 for four or more antenatal care visits, health facility delivery, and postnatal care visits, respectively). In 2005, the adjusted odds ratios were 1.16 and 1.17 for four or more antenatal care visits and health facility delivery, respectively. In 2011, the percentage of women in the community with high decision-making power was positively associated with the likelihood of four or more antenatal care visits (adjusted odds ratio = 1.14). The association of individual-level autonomy on maternal healthcare service utilization was less profound after we controlled for other individual-level and community-level characteristics. Our study shows that women's autonomy was positively associated with maternal healthcare service utilization in Ethiopia. We suggest addressing woman empowerment in national policies and programs would be the optimal solution.

Improvements in prenatal insurance coverage and utilization of care in California: an unsung public health victory.

PubMed

Rittenhouse, Diane R; Braveman, Paula; Marchi, Kristen

2003-06-01

To examine trends in prenatal insurance coverage and utilization of care in California over two decades in the context of expansions in Medi-Cal (California's Medicaid) and other public efforts to increase prenatal care utilization. Retrospective univariate and bivariate analysis of prenatal care coverage and utilization data from 10,192,165 California birth certificates, 1980-99; descriptive analysis of California poverty and unemployment data from the U.S. Census Bureau Current Population Survey; review of public health and social policy literature. The proportion of mothers with Medi-Cal coverage for prenatal care increased from 28.2 to 47.5% between 1989 and 1994, and the proportion uninsured throughout pregnancy decreased from 13.2 to 3.2%. Since the mid-1990s, fewer than 3% of women have had no insurance coverage for prenatal care. Between 1989 and 1999, the proportion of women with first trimester initiation of prenatal care increased from 72.6 to 83.6%, reversing the previous decade's trend, and the proportion of women with adequate numbers of visits rose from 70.7 to 83.1%. Improvements in utilization measures were greater among disadvantaged social groups. Improvements in California during the 1990s coincided with a multifaceted public health effort to increase both prenatal care coverage and utilization, and do not appear to be explained by changes in the economy, maternal characteristics, the overall organization/delivery of health care, or other social policies. While this ecologic study cannot produce definitive conclusions regarding causality, these results suggest an important victory for public health in California.

Pulmonary rehabilitation in COPD - available resources and utilization in Swedish primary and secondary care.

PubMed

Sundh, Josefin; Lindgren, Helena; Hasselgren, Mikael; Montgomery, Scott; Janson, Christer; Ställberg, Björn; Lisspers, Karin

2017-01-01

Pulmonary rehabilitation is effective in all stages of COPD. The availability and utilization of pulmonary rehabilitation resources, and the characteristics of COPD patients receiving rehabilitation, were investigated in primary and secondary care in central Sweden. Data on available pulmonary rehabilitation resources were collected using questionnaires, to 14 hospitals and 54 primary health care centers, and information on utilization of different rehabilitation professionals was obtained from questionnaires completed by 1,329 COPD patients from the same centers. Multivariable logistic regression examined associations with having received rehabilitation in the previous year. In primary care, nurse-based asthma/COPD clinics were common (87%), with additional separate access to other rehabilitation professionals. In secondary care, rehabilitation was more often offered as part of a multidisciplinary teamwork (71%). In total, 36% of the patients met an asthma/COPD nurse in the previous year. Utilization was lower in primary than in secondary care for physiotherapists (7% vs 16%), occupational therapists (3% vs 10%), nutritionists (5% vs 13%), and counselors (1% vs 4%). A higher COPD Assessment Test score and frequent exacerbations were associated with higher utilization of all rehabilitation professionals. Pulmonary rehabilitation resources are available but underutilized, and receiving rehabilitation is more common in severe COPD. Treatment recommendations need to be better implemented, especially in mild and moderate COPD.

Describing care coordination of gynecologic oncology in western healthcare settings: a rapid review.

PubMed

Grant, Sean; Motala, Aneesa; Chrystal, Joya G; Shanman, Roberta; Zuchowski, Jessica; Zephyrin, Laurie; Cordasco, Kristina M

2018-05-23

Caring for women with gynecologic malignancies requires multidisciplinary communication and coordination across multiple providers. This article discusses a rapid review of the literature on characteristics of care coordination for gynecologic malignancies. Five electronic databases (from inception through March 2015) were searched for empirical studies on coordinated care models for female adults with gynecologic malignancies. A single reviewer extracted and synthesized information on how care was coordinated, how care teams made decisions, who performed what tasks, how care teams communicated information to coordinate care, and potential impact of the characteristic on delivering coordinated care. From 26 included studies, predominant characteristics of coordinated care were identified: multidisciplinary teams, patient navigators, scheduled follow-ups, survivorship care plans, and colocated services. Decision-making was best documented for studies that utilized teams that had periodic scheduled meetings with set agendas and consistent procedures. Providers' roles in coordinating care were numerous, reflecting professional backgrounds: oncologists had most authority in making treatment decisions; radiologists and pathologists shared vital biomedical information; and nurses coordinated care and communicated with patients. Communication tools and strategies across studies included having shared medical records, integrated treatment plans, and telephone-based or teleconferencing communication. There was limited information available on the impact of characteristics and accompanying strategies or tools. Several characteristics of care coordination models for gynecologic cancers have been published in the literature. Further investigation is needed to understand the relative effectiveness of these ways to coordinate care.

Cost and utilisation of hospital based delivery care in Empowered Action Group (EAG) states of India.

PubMed

Mohanty, Sanjay K; Srivastava, Akanksha

2013-10-01

Large scale investment in the National Rural Health Mission is expected to increase the utilization and reduce the cost of maternal care in public health centres in India. The objective of this paper is to examine recent trends in the utilization and cost of hospital based delivery care in the Empowered Action Group (EAG) states of India. The unit data from the District Level Household Survey 3, 2007-2008 is used in the analyses. The coverage and the cost of hospital based delivery at constant price is analyzed for five consecutive years preceding the survey. Descriptive and multivariate analyses are used to understand the socio-economic differentials in cost and utilization of delivery care. During 2004-2008, the utilization of delivery care from public health centres has increased in all the eight EAG states. Adjusting for inflation, the household cost of delivery care has declined for the poor, less educated and in public health centres in the EAG states. The cost of delivery care in private health centres has not shown any significant changes across the states. Results of the multivariate analyses suggest that time, state, place of residence, economic status; educational attainment and delivery characteristics of mother are significant predictors of hospital based delivery care in India. The study demonstrates the utility of public spending on health care and provides a thrust to the ongoing debate on universal health coverage in India.

Home health care and patterns of subsequent VA and medicare health care utilization for veterans.

PubMed

Van Houtven, Courtney Harold; Jeffreys, Amy S; Coffman, Cynthia J

2008-10-01

The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HHC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched controls. We also consider crossover between the VA and Medicare. This is a retrospective study using propensity score and stratified analysis to control for selection bias on observable characteristics. We examined the full cohort of 2002 VA HHC users (n = 24,169) and a 2:1 sample of age- and race-based nonusers (n = 53,356). Utilization measures included VA and Medicare outpatient, inpatient, nursing home, and hospice use, as well as VA home-based primary care, respite care, and adult day health care. VA HHC users had a higher absolute probability of outpatient use by around 3%, of inpatient use by 12%, and nursing home use by 6% than their propensity-score-matched controls. Veterans who used HHC services had a higher rate of VA service use in the subsequent year than controls did, even after we adjusted for differences in observed health status, eligibility advantages, and supplemental insurance status. High utilization for VA home health users spilled over into high Medicare utilization.

Characteristics of health plans that treat psychiatric patients.

PubMed

Zarin, D A; West, J C; Pincus, H A; Tanielian, T L

1999-01-01

Nationally representative data regarding the organizational, financial, and procedural features of health plans in which psychiatric patients receive treatment indicate that fewer privately insured, Medicaid, and Medicare managed care enrollees receive care from a psychiatrist than is true for "nonmanaged" enrollees. Financial considerations were reported to adversely affect treatment for one-third of all patients. Although utilization management techniques and financial/resource constraints commonly applied to patients in both managed and nonmanaged plans, performance-based incentives were rare in nonmanaged plans. The traditional health plan categories provide limited information to identify salient plan characteristics and guide policy decisions regarding the provision of care.

Workplace characteristics and work-to-family conflict: does caregiving frequency matter?

PubMed

Brown, Melissa; Pitt-Catsouphes, Marcie

2013-01-01

Many workers can expect to provide care to an elder relative at some point during their tenure in the workforce. This study extends previous research by exploring whether caregiving frequency (providing care on a regular, weekly basis vs. intermittently) moderates the relationship between certain workplace characteristics and work-to-family conflict. Utilizing a sample of 465 respondents from the National Study of the Changing Workforce (Families and Work Institute, 2008), results indicate that access to workplace flexibility has a stronger effect on reducing work-to-family conflict among intermittent caregivers than among those who provide care regularly.

Frailty and its prediction of disability and health care utilization: the added value of interviews and physical measures following a self-report questionnaire.

PubMed

Gobbens, Robbert J J; van Assen, Marcel A L M

2012-01-01

To establish whether the prediction of the adverse outcomes disability and six indicators of health care utilization one and two years later by the three frailty domains (physical, psychological, social) of the Tilburg Frailty Indicator (TFI) is improved by adding interview and physical measures of frailty. A representative sample of 245 Dutch community-dwelling persons aged 75 years and older (response rate 53%) participated in 2008, one year later in 2009 (n=179, 73%) and again two years later in 2010 (n=141, 58%). Frailty was assessed with the TFI, an easy to administer self-report measure. Disability was measured using the Groningen Activity Restriction Scale (GARS). Indicators of health care utilization were: visit to a general practitioner (gp), contacts with health care professionals (hcps), hospital admission, receiving personal care, receiving nursing care, and receiving informal care. After controlling for background characteristics, the TFI predicted disability and the indicators of health care utilization. Interviews and physical measures of frailty improved the prediction of disability. The Hospital Anxiety and Depression Scale (HADS-A) improved the prediction of contacts with hcps, but the interview and physical measures of frailty did not improve the predictions of the other indicators of health care utilization. Assessment by the self-report TFI is sufficient for predicting six indicators of health care utilization, but for predicting disability the use of both the TFI and the Timed Up & Go (TUG) test is recommended. It is advisable assessing all three frailty domains when examining frailty and its prediction of adverse outcomes. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Measuring and Explaining Socioeconomic Inequalities in Public Healthcare Utilization in Western Iran: Evidence from a Cross-sectional Survey.

PubMed

Rezaeian, Shahab; Hajizadeh, Mohammad; Rezaei, Satar; Ahmadi, Sina; Kazemi Karyani, Ali; Salimi, Yahya

2018-05-14

Equity in healthcare utilization is a major health policy goal in all healthcare systems. This study aimed to examine socioeconomic inequalities in public healthcare utilization in Kermanshah City, western Iran. A cross-sectional study. Using convenience sampling method, 2040 adult aged 18-65 yr were enrolled from Kermanshah City in 2017. A self-administrated questionnaire was used to collect data on socio-demographic characteristics, socioeconomic status, behavioral factors, and utilization of public healthcare services (inpatient and outpatient care) over the period between from May to Aug 2017. The concentration index (C) was used to measure and decompose socioeconomic inequalities in the utilization inpatient and outpatient care in public sector. The indirect standardization method was used to estimate the horizontal inequity (HI) indices in inpatient and outpatient care use. The utilization outpatient (C=-0.121, 95% CI: -0.171, -0.071) and inpatient care in public sector (C=-0.165, 95% CI: -0.229, -0.101) were concentrated among the poor in Kermanshah, Iran. Socioeconomic status, health-related quality of life, marital status and having a chronic health condition were the main determinants of socioeconomic-related inequalities in the utilization of inpatient and outpatient care in public sector among adults. The distributions of outpatient (HI=-0.045, CI: -0.093 to 0.003) and inpatient care (HI= -0.044 95% CI: -0.102, 0.014) in Kermanshah were pro-poor. These results were not statistically significant (P<0.05). The utilization of public healthcare services in Iran are pro-poor. The pro-poor distribution of inpatient and outpatient care in public facilities calls for initiatives to increase the allocation of resources to public facilities in Iran that may greatly benefit the health outcomes of the poor.

Variation in ICU Utilization and Mortality After Blunt Splenic Injury

PubMed Central

Kaufman, Elinore J.; Wiebe, Douglas J.; Martin, Niels D.; Pascual, Jose L.; Reilly, Patrick M.; Holena, Daniel N.

2016-01-01

Background While trauma patients are frequently cared for in the ICU, admission triage criteria are unclear and may vary among providers and institutions. The benefits of close monitoring must be weighed against the economic and opportunity costs of an ICU admission. Materials and Methods We conducted a retrospective cohort study of patients treated for blunt splenic injuries at 30 level I and II Pennsylvania trauma centers, 2011–2014. We used multivariable logistic regression to assess the relationship between ICU admission and mortality, adjusting for patient characteristics, injury characteristics, and physiology. We calculated center-level observed-to-expected ratios for ICU utilization and mortality and evaluated correlations with Spearman’s rho. We compared the proportion of patients receiving critical care procedures, such as mechanical ventilation or central line placement, between high- and low-ICU-utilization centers. Results Of 2,587 patients with blunt splenic injuries, 63.9% (1,654) were admitted to the ICU. Median injury severity score (ISS) was 17 overall, 13 for non-ICU patients and 17 for ICU patients (p < 0.001). In multivariable logistic regression, ICU admission was not significantly associated with mortality. Center-level risk-adjusted ICU admission rates ranged from 17.9% to 87.3%. Risk-adjusted mortality rates ranged from 1.2% to 9.6%. There was no correlation between O:E ratios for ICU utilization and mortality (rs = −0.2595, p=0.2103). Proportionately fewer ICU patients at high-utilization centers received critical care procedures than at low-utilization centers. Conclusions Risk-adjusted ICU utilization rates for splenic trauma varied widely among trauma centers, with no clear relationship to mortality. Standardizing ICU admission criteria could improve resource utilization without increasing mortality. PMID:27363642

Barriers to using skilled birth attendants’ services in mid- and far-western Nepal: a cross-sectional study

PubMed Central

2013-01-01

Background Skilled birth attendants (SBAs) provide important interventions that improve maternal and neonatal health and reduce maternal and neonatal mortality. However, utilization and coverage of services by SBAs remain poor, especially in rural and remote areas of Nepal. This study examined the characteristics associated with utilization of SBA services in mid- and far-western Nepal. Methods This cross-sectional study examined three rural and remote districts of mid- and far-western Nepal (i.e., Kanchanpur, Dailekh and Bajhang), representing three ecological zones (southern plains [Tarai], hill and mountain, respectively) with low utilization of services by SBAs. Enumerators assisted a total of 2,481 women. All respondents had delivered a baby within the past 12 months. We used bivariate and multivariate analyses to assess the association between antenatal and delivery care visits and the women’s background characteristics. Results Fifty-seven percent of study participants had completed at least four antenatal care visits and 48% delivered their babies with the assistance of SBAs. Knowing the danger signs of pregnancy and delivery (e.g., premature labor, prolonged labor, breech delivery, postpartum hemorrhage, severe headache) associated positively with four or more antenatal care visits (OR = 1.71; 95% CI: 1.41-2.07). Living less than 30 min from a health facility associated positively with increased use of both antenatal care (OR = 1.44; 95% CI: 1.18-1.77) and delivery services (OR = 1.25; CI: 1.03-1.52). Four or more antenatal care visits was a determining factor for the utilization of SBAs. Conclusions Less than half of the women in our study delivered babies with the aid of SBAs, indicating a need to increase utilization of such services in rural and remote areas of Nepal. Distance from health facilities and inadequate transportation pose major barriers to the utilization of SBAs. Providing women with transportation funds before they go to a facility for delivery and managing transportation options will increase service utilization. Moreover, SBA utilization associates positively with women’s knowledge of pregnancy danger signs, wealth quintile, and completed antenatal care visits. Nepal’s health system must develop strategies that generate demand for SBAs and also reduce financial, geographic and cultural barriers to such services. PMID:24365039

Validity of the AUDIT-C screen for at-risk drinking among students utilizing university primary care.

PubMed

Campbell, Clare E; Maisto, Stephen A

2018-03-22

Research is needed to establish the psychometric properties of brief screens in university primary care settings. This study aimed to assess the construct validity of one such screen, the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), for detecting at-risk drinking among students who have utilized on-campus primary care. 389 students recently seen in university primary care completed a confidential online survey in December 2014. Bivariate correlations between the AUDIT-C and measures of alcohol consumption and negative drinking consequences provided concurrent evidence for construct validity. Receiver Operating Characteristic curve analyses determined optimal cut-off scores for at-risk drinking. The AUDIT-C significantly correlated with measures of alcohol consumption and negative drinking consequences (p < .001). Analyses support optimal AUDIT-C cut-off scores of 5 for females and 7 for males. The AUDIT-C is a valid screen for at-risk drinking among students who utilize university primary care.

Hospital Characteristics Associated With Postdischarge Hospital Readmission, Observation, and Emergency Department Utilization.

PubMed

Horwitz, Leora I; Wang, Yongfei; Altaf, Faseeha K; Wang, Changqin; Lin, Zhenqiu; Liu, Shuling; Grady, Jacqueline; Bernheim, Susannah M; Desai, Nihar R; Venkatesh, Arjun K; Herrin, Jeph

2018-04-01

Whether types of hospitals with high readmission rates also have high overall postdischarge acute care utilization (including emergency department and observation care) is unknown. Cross-sectional analysis. Nonfederal United States acute care hospitals. Using methodology established by the Centers for Medicare & Medicaid Services, we calculated each hospital's "excess days in acute care" for fee-for-service (FFS) Medicare beneficiaries aged over 65 years discharged after hospitalization for acute myocardial infarction, heart failure (HF), or pneumonia, representing the mean difference between predicted and expected total days of acute care utilization in the 30 days following hospital discharge, per 100 discharges. We assessed the multivariable association of 8 hospital characteristics with excess days in acute care and the proportion of hospitals with each characteristic that were statistical outliers (95% credible interval estimate does not include 0). We included 2184 hospitals for acute myocardial infarction [228 (10.4%) better than expected, 549 (25.1%) worse than expected], 3720 hospitals for HF [484 (13.0%) better and 840 (22.6%) worse], and 4195 hospitals for pneumonia [673 (16.0%) better, 1005 (24.0%) worse]. Results for all conditions were similar. Worse than expected outliers for pneumonia included: 18.8% of safety net hospitals versus 26.1% of nonsafety net hospitals; 16.7% of public hospitals versus 33.1% of for-profit hospitals; 19.5% of nonteaching hospitals versus 52.2% of major teaching hospitals; 7.9% of rural hospitals versus 42.1% of large urban hospitals; 5.9% of hospitals with 24-<50 beds versus 58% of hospitals with >500 beds; and 29.0% of hospitals with nurse-to-bed ratios >1.0-1.5 versus 21.7% of hospitals with ratios >2.0. Including emergency department and observation stays in measures of postdischarge utilization produces similar results as measuring only readmissions in that major teaching, urban and for-profit hospitals still perform disproportionately poorly versus nonteaching or public hospitals. However, it enables identification of more outliers and a more granular assessment of the association of hospital factors and outcomes.

Characteristics of an external employee assistance programme in Japan.

PubMed

Muto, Takashi; Fujimori, Yuiko; Suzuki, Keiko

2004-12-01

Mental health care is now a major occupational health issue in Japan. Although realizing effective use of external employee assistance programmes (EAPs) has been identified as crucial for mental health care, few scientific papers describe or analyse the characteristics of EAPs in Japan. This study sought to clarify the characteristics of an external EAP in Japan. The characteristics of an external EAP were clarified in terms of programme description and utilization. A total of 10,260 counselling sessions from 1996 to 2000 were used for utilization analysis. The EAP studied had contracts with 133 organizations, half of which were health insurance societies. The EAP provided employees and family members with free, confidential counselling. Annual mean utilization rate per 1000 individuals increased from 1.3 in 1996 to 2.7 in 2000. Less than one-third of counselling sessions were for work-related mental health issues, and male users (30%) consulted significantly more often than female users (14%) for such problems. Among men, career development issues were most common, while job dissatisfaction was highest among women. Absenteeism, depression and fatigue were the most frequently observed problems in both sexes. EAP use in Japan is rising. The majority of its use is for non-work-related health issues. Male users were more likely to consult for work-related mental health problems.

Health Service Utilization of Children in Delaware Foster Care, 2013-2014.

PubMed

Knight, Erin K; McDuffie, May Joan; Gifford, Katie; Zorc, Catherine

2016-02-01

Children in foster care represent some of the most vulnerable children in the U.S. Their higher prevalence of a range of physical and behavioral health problems can lead to greater health care utilization and higher costs. However, many children in foster care have undiagnosed conditions and unmet needs. The purpose of this study was to provide a description of health services accessed by children in foster care in Delaware. The data serves as a baseline and informs current efforts to improve the health care of children in foster care. We analyzed rates of emergency room visits, behavioral health visits, hospitalizations, and costs of care for children in foster care and made comparisons with other children participating in Medicaid. We also looked at utilization before and after entry into care and assessed rates of appropriate medical screening for children on entering foster care. This study was conducted as part of a larger analysis guided by the Delaware Task Force on the Health of Children in Foster Care with funding appropriated by the Delaware General Assembly. Using a unique identification number, we linked Medicaid claims data with demographic information and characteristics associated with foster care from the Delaware Department of Services for Children, Youth and Their Families. We examined diagnoses, patterns of utilization, and costs for children in foster care (n = 1,458) and a comparable cohort of other children in Medicaid (n = 124,667) during fiscal years 2013 and 2014. Compared with other children in Medicaid, children in foster care had similar rates of emergency department utilization, but relatively high rates of outpatient behavioral health visits. Similarly, compared with other children in Medicaid, those in foster care had particularly high rates of psychotropic drug utilization. Entry into foster care was associated with increased utilization of overall health care services, including receipt of well-child care. However, just 31 percent of those new to foster care met the recommended guidelines for a preventive screening in their first 30 days. Because of the challenges in meeting screening policies for children entering foster care, collaboration among providers, state administrators, and policymakers is essential to guide improvement. Specifically, stakeholders should look for ways to improve the timeliness of preventive screenings and coordination of care. The high rate of behavioral health visits suggests the need to improve integration of behavioral health care into primary care.

Insurer Market Structure and Variation in Commercial Health Care Spending

PubMed Central

McKellar, Michael R; Naimer, Sivia; Landrum, Mary B; Gibson, Teresa B; Chandra, Amitabh; Chernew, Michael

2014-01-01

Objective To examine the relationship between insurance market structure and health care prices, utilization, and spending. Data Sources Claims for 37.6 million privately insured employees and their dependents from the Truven Health Market Scan Database in 2009. Measures of insurer market structure derived from Health Leaders Inter study data. Methods Regression models are used to estimate the association between insurance market concentration and health care spending, utilization, and price, adjusting for differences in patient characteristics and other market-level traits. Results Insurance market concentration is inversely related to prices and spending, but positively related to utilization. Our results imply that, after adjusting for input price differences, a market with two equal size insurers is associated with 3.9 percent lower medical care spending per capita (p = .002) and 5.0 percent lower prices for health care services relative to one with three equal size insurers (p < .001). Conclusion Greater fragmentation in the insurance market might lead to higher prices and higher spending for care, suggesting some of the gains from insurer competition may be absorbed by higher prices for health care. Greater attention to prices and utilization in the provider market may need to accompany procompetitive insurance market strategies. PMID:24303879

Fairness and Eligibility to Long-Term Care: An Analysis of the Factors Driving Inequality and Inequity in the Use of Home Care for Older Europeans.

PubMed

Ilinca, Stefania; Rodrigues, Ricardo; Schmidt, Andrea E

2017-10-14

In contrast with the case of health care, distributional fairness of long-term care (LTC) services in Europe has received limited attention. Given the increased relevance of LTC in the social policy agenda it is timely to evaluate the evidence on inequality and horizontal inequity by socio-economic status (SES) in the use of LTC and to identify the socio-economic factors that drive them. We address both aspects and reflect on the sensitivity of inequity estimates to adopting different definitions of legitimate drivers of care need. Using Survey of Health, Ageing and Retirement in Europe (SHARE)data collected in 2013, we analyse differences in home care utilization between community-dwelling Europeans in nine countries. We present concentration indexes and horizontal inequity indexes for each country and results from a decomposition analysis across income, care needs, household structures, education achievement and regional characteristics. We find pro-poor inequality in home care utilization but little evidence of inequity when accounting for differential care needs. Household characteristics are an important contributor to inequality, while education and geographic locations hold less explanatory power. We discuss the findings in light of the normative assumptions surrounding different definitions of need in LTC and the possible regressive implications of policies that make household structures an eligibility criterion to access services.

Patterns of Mental Health Care Utilization Among Sexual Orientation Minority Groups.

PubMed

Platt, Lisa F; Wolf, Julia Kay; Scheitle, Christopher P

2018-01-01

Prior studies of the utilization of mental health professionals by sexual minority populations have relied on data that are now dated or not nationally representative. These studies have also provided mixed findings regarding gender differences in the utilization of mental health professionals among sexual minority individuals. Using data from the 2013-2015 National Health Interview Surveys, this study investigates (1) how sexual minority individuals compare to heterosexual participants in their utilization of mental health professionals; and (2) gender differences in that utilization. The results indicate sexual minority individuals utilize mental health care professionals at higher rates than heterosexual individuals even after controlling for measures of mental health and other demographic characteristics; this is true for both men and women. However, gender moderates the sexual minority effect on utilization rates. Sexual minority men utilize mental health professionals at a high rate, such that their utilization rates are similar to sexual minority women, contrary to the gender gap seen among heterosexuals.

Characteristics and Health Behavior of the Aged Population

ERIC Educational Resources Information Center

German, Pearl S.

1975-01-01

Reports that the elderly appear most influenced in health attitudes and behaviors by various factors within the setting so those who identify a major source of care tend to be higher utilizers, do less "shopping-around," and exhibit less negative behaviors such as needing care without seeking it. Discussion of the article follows. (Author)

Individual determinants of research utilization by nurses: a systematic review update.

PubMed

Squires, Janet E; Estabrooks, Carole A; Gustavsson, Petter; Wallin, Lars

2011-01-05

Interventions that have a better than random chance of increasing nurses' use of research are important to the delivery of quality patient care. However, few reports exist of successful research utilization in nursing interventions. Systematic identification and evaluation of individual characteristics associated with and predicting research utilization may inform the development of research utilization interventions. To update the evidence published in a previous systematic review on individual characteristics influencing research utilization by nurses. As part of a larger systematic review on research utilization instruments, 12 online bibliographic databases were searched. Hand searching of specialized journals and an ancestry search was also conducted. Randomized controlled trials, clinical trials, and observational study designs examining the association between individual characteristics and nurses' use of research were eligible for inclusion. Studies were limited to those published in the English, Danish, Swedish, and Norwegian languages. A vote counting approach to data synthesis was taken. A total of 42,770 titles were identified, of which 501 were retrieved. Of these 501 articles, 45 satisfied our inclusion criteria. Articles assessed research utilization in general (n = 39) or kinds of research utilization (n = 6) using self-report survey measures. Individual nurse characteristics were classified according to six categories: beliefs and attitudes, involvement in research activities, information seeking, education, professional characteristics, and socio-demographic/socio-economic characteristics. A seventh category, critical thinking, emerged in studies examining kinds of research utilization. Positive relationships, at statistically significant levels, for general research utilization were found in four categories: beliefs and attitudes, information seeking, education, and professional characteristics. The only characteristic assessed in a sufficient number of studies and with consistent findings for the kinds of research utilization was attitude towards research; this characteristic had a positive association with instrumental and overall research utilization. This review reinforced conclusions in the previous review with respect to positive relationships between general research utilization and: beliefs and attitudes, and current role. Furthermore, attending conferences/in-services, having a graduate degree in nursing, working in a specialty area, and job satisfaction were also identified as individual characteristics important to research utilization. While these findings hold promise as potential targets of future research utilization interventions, there were methodological problems inherent in many of the studies that necessitate their findings be replicated in further research using more robust study designs and multivariate assessment methods.

Individual determinants of research utilization by nurses: a systematic review update

PubMed Central

2011-01-01

Background Interventions that have a better than random chance of increasing nurses' use of research are important to the delivery of quality patient care. However, few reports exist of successful research utilization in nursing interventions. Systematic identification and evaluation of individual characteristics associated with and predicting research utilization may inform the development of research utilization interventions. Objective To update the evidence published in a previous systematic review on individual characteristics influencing research utilization by nurses. Methods As part of a larger systematic review on research utilization instruments, 12 online bibliographic databases were searched. Hand searching of specialized journals and an ancestry search was also conducted. Randomized controlled trials, clinical trials, and observational study designs examining the association between individual characteristics and nurses' use of research were eligible for inclusion. Studies were limited to those published in the English, Danish, Swedish, and Norwegian languages. A vote counting approach to data synthesis was taken. Results A total of 42,770 titles were identified, of which 501 were retrieved. Of these 501 articles, 45 satisfied our inclusion criteria. Articles assessed research utilization in general (n = 39) or kinds of research utilization (n = 6) using self-report survey measures. Individual nurse characteristics were classified according to six categories: beliefs and attitudes, involvement in research activities, information seeking, education, professional characteristics, and socio-demographic/socio-economic characteristics. A seventh category, critical thinking, emerged in studies examining kinds of research utilization. Positive relationships, at statistically significant levels, for general research utilization were found in four categories: beliefs and attitudes, information seeking, education, and professional characteristics. The only characteristic assessed in a sufficient number of studies and with consistent findings for the kinds of research utilization was attitude towards research; this characteristic had a positive association with instrumental and overall research utilization. Conclusions This review reinforced conclusions in the previous review with respect to positive relationships between general research utilization and: beliefs and attitudes, and current role. Furthermore, attending conferences/in-services, having a graduate degree in nursing, working in a specialty area, and job satisfaction were also identified as individual characteristics important to research utilization. While these findings hold promise as potential targets of future research utilization interventions, there were methodological problems inherent in many of the studies that necessitate their findings be replicated in further research using more robust study designs and multivariate assessment methods. PMID:21208425

Reduced mortality: the unexpected impact of a telephone-based care management intervention for older adults in managed care.

PubMed

Alkema, Gretchen E; Wilber, Kathleen H; Shannon, George R; Allen, Douglas

2007-08-01

This analysis evaluated mortality over 24 months for Medicare managed care members who participated in the Care Advocate Program (CA Program) designed to link those with high health care utilization to home- and community-based services. Secondary data from the CA Program, part of the California HealthCare Foundation's Elders in Managed Care Initiative. Randomized-control trial in which participants (N=781) were randomly assigned to intent-to-treat (ITT) and control groups. ITT group received telephonic social care management and 12 months of follow-up. Various multivariate analyses were used to evaluate mortality risk throughout multiple study periods controlling for sociodemographic characteristics, health status, and health care utilization. Older adults (65+) enrolled in a Medicare managed care plan who had high health care utilization in the previous year. ITT group had a significantly lower odds of mortality throughout the study (OR=0.55; p=.005) and during the care management intervention (OR=0.45; p=.006), whereas differential risk in the postintervention period was not statistically significant. Other significant predictors of mortality were age, gender, three chronic conditions (cancer, heart disease, and kidney disease), and emergency room utilization. Findings suggest that the care advocate model of social care management affected mortality while the program was in progress, but not after completion of the intervention phase. Key model elements accounted for the findings, which include individualized targeting, assessment, and monitoring; consumer choice, control, and participant self-management; and bridging medical and social service delivery systems through direct linkages and communication.

Pulmonary rehabilitation in COPD – available resources and utilization in Swedish primary and secondary care

PubMed Central

Sundh, Josefin; Lindgren, Helena; Hasselgren, Mikael; Montgomery, Scott; Janson, Christer; Ställberg, Björn; Lisspers, Karin

2017-01-01

Introduction Pulmonary rehabilitation is effective in all stages of COPD. The availability and utilization of pulmonary rehabilitation resources, and the characteristics of COPD patients receiving rehabilitation, were investigated in primary and secondary care in central Sweden. Materials and methods Data on available pulmonary rehabilitation resources were collected using questionnaires, to 14 hospitals and 54 primary health care centers, and information on utilization of different rehabilitation professionals was obtained from questionnaires completed by 1,329 COPD patients from the same centers. Multivariable logistic regression examined associations with having received rehabilitation in the previous year. Results In primary care, nurse-based asthma/COPD clinics were common (87%), with additional separate access to other rehabilitation professionals. In secondary care, rehabilitation was more often offered as part of a multidisciplinary teamwork (71%). In total, 36% of the patients met an asthma/COPD nurse in the previous year. Utilization was lower in primary than in secondary care for physiotherapists (7% vs 16%), occupational therapists (3% vs 10%), nutritionists (5% vs 13%), and counselors (1% vs 4%). A higher COPD Assessment Test score and frequent exacerbations were associated with higher utilization of all rehabilitation professionals. Conclusion Pulmonary rehabilitation resources are available but underutilized, and receiving rehabilitation is more common in severe COPD. Treatment recommendations need to be better implemented, especially in mild and moderate COPD. PMID:28652722

Medical Resource Utilization by Taiwanese Psychiatric Inpatients under the National Health Insurance System.

PubMed

Lee, Chiachi Bonnie; Li, Chung-Yi; Lin, Chih-Ming

2016-12-01

The length of stay in Taiwan's psychiatric facilities is unusually long compared with that of other countries. To identify factors associated with the high length of stay in the acute and chronic psychiatric wards of a public psychiatric hospital. The present study consisted of 912 inpatients discharged from a public psychiatric hospital in Northern Taiwan in 2005. Demographic characteristics, discharge diagnoses, and medical resource utilization were retrieved from the inpatient claim data of the National Health Insurance Database. Multivariate logistic regression models were performed to identify significant predictors for a long length of stay (LOS). Covariate adjusted odds ratios and a 95% confidence interval (CI) were applied to explore the effects of financial barriers, demographic, and diagnostic characteristics, and readmission for medical care. A median LOS of 35.0 days and median medical charge of USD 3,271.50 were reported. A greater likelihood of a high degree of medical care was found among patients who were exempt from copayments, were diagnosed with schizophrenia, had a co-morbidity factor, and were admitted from emergency visits. The results showed that patients in the 45--60 year age group had a higher risk of long LOS than those in the 18--30 year age group. A longer LOS in Taiwan might reflect more free access to hospitals and further extensive utilization of medical facilities under the National Health Insurance system. It was noted that age, sex, disease characteristics, and insurance policies were associated with a high medical utilization. However, the lack of a copayment may partially explain the long LOS in our study. Other causes, such as inadequate supplies of resources for psychiatric services, may also deserve closer study. A failure to adjust for potentially confounding factors might limit interpretation of the observed relationship between such potential factors and medical resource utilization. These findings support the future planning of specific care policies in mental health services in Taiwan. While an exemption in copayment aims to remove financial barriers for indigent people, it contributed to the extended LOS. To make psychiatric care more efficient, facilities in the community must be strengthened, patients must be directed to appropriate care to avoid emergency check-ins, and the reimbursement policy must be geared to facilitate the efficient delivery of care. Our study calls for further research on the role of resource allocation, incentives for efficient delivery of care, and the frequency of hospitalization, in particular, on the long LOS of psychiatric patients in Taiwan.

Use of hospital-based health care services among children aged 1 through 9 years who were born very preterm - a population-based study.

PubMed

Klitkou, Søren T; Iversen, Tor; Stensvold, Hans J; Rønnestad, Arild

2017-08-17

Very preterm (VPT) children, with a birth weight below 1500 g or delivered before 32 weeks of gestational age, are at increased risk of poorer long-term health outcomes and higher rates of hospitalization in childhood. However, considerable variation exists in the need for in-hospital care within this population. We assessed the utilization and distribution of hospital-based care from ages 1 through 9 years for a nationwide population. This was a population-based cohort of VPT children born in the period 2001-2009. We evaluated their utilization of hospital care in 2008-2010, when aged 1-9 years old. Outcomes were the incidence of hospital admissions and outpatient visits. We used Poisson regression models with multiple imputation of missing data. Children born VPT had more hospital admissions compared with the general population of children aged 1-9 years. The rates of hospital admissions and outpatient visits were strongly related to clinical characteristics of the child at birth and age at admission/outpatient visit but to only a variable and minor degree to characteristics pertaining to maternal health, the sociodemographic factors, and geographical proximity to hospital services. Prior to this study, hospital utilization during the period 5-9 years old has been poorly documented. We found that excess utilization of hospital resources on average declines with increasing age. We also noted substantial differences in the use of hospital care across age groups and clinical factors for VPT children. The added information from the health status of mothers, social background, and geographic measures of access was limited.

Skilled Antenatal Care Service Utilization and Its Association with the Characteristics of Women's Health Development Team in Yeky District, South-West Ethiopia: A Multilevel Analysis.

PubMed

Girmaye, Melese; Berhan, Yifru

2016-07-01

In response to high maternal and perinatal morbidities and mortalities in Ethiopia, "Women's Health Development Army" was established to enhance utilization of skilled maternity services including antenatal care (ANC). However, its effect on skilled ANC service utilization is not well measured. Our study was aimed to assess skilled antenatal care service utilization and its association with the characteristics of women's health development team (WHDT). A community based cross sectional study was conducted from January to February 2015. A multi-stage cluster sampling technique was applied, and a total of 748 women (15-49 years) who gave birth in one year preceding the study were included in the study. Data were entered into EPI info version 7 statistical software and exported to STATA version 11 for analysis. Bivariate and multilevel mixed effects analysis techniques were applied to check for association of selected independent variables with utilization of skilled ANC. About 71% women received skilled ANC service at least once. A significant heterogeneity was observed between WHDTs for skilled ANC utilization. Level-1 predictors of skilled ANC utilization were: preference of skilled personnel (AOR=11.0; 95%, CI, 3.02-40.04), awareness about places where to get skilled providers (AOR=51.6; 95% CI, 13.92-,190.97) and listening to radio (AOR=5.7; 95% CI, 1.46-21.94). Distance of WHDT within 2 km radius from the nearest health facility (HF) was the only level-2 significant predictor of skilled ANC service utilization (AOR=8.28; 95%CI, 1.08-62.20). Skilled ANC service utilization is the joint effect of individual and WHDT characters. Awareness and perception creation towards skilled maternity service utilization need to be enhanced. Facilities and transport services should be more accessible towards WHDTs.

Oral health care utilization by US rural residents, National Health Interview Survey 1999.

PubMed

Vargas, Clemencia M; Dye, Bruce A; Hayes, Kathy

2003-01-01

To compare the dental care utilization practices of rural and urban residents in the United States. Data on dental care utilization from the 1999 National Health Interview Survey for persons 2 years of age and older (n=42, 139) were analyzed by rural/urban status. Percentages and 95 percent confidence intervals were calculated to produce national estimates for having had a visit in the past year, the number of visits, reasons given for last dental visit and for not visiting a dentist, unmet dental needs, and private dental insurance. Rural residents were more likely to report that their last dental visit was because something was "bothering or hurting" (23.3% vs 17.6%) and that they had unmet dental needs (10.1% vs 7.5%). Urban residents were more likely to report having a dental visit in the past year (57.7% vs 66.5%) and having private dental insurance (32.7% vs 37.2%), compared to rural residents. There were no significant differences in most reasons given for not visiting the dentist between rural and urban respondents. Dental care utilization characteristics differ between rural and urban residents in the United States, with rural residents tending to underutilize dental care.

Exploring the relationship between caring, love and intimacy in nursing.

PubMed

Dowling, Maura

This article uses the five distinct perspectives on caring proposed by Morse et al (1990) to illustrate the relationship between love, intimacy and caring. Two distinct types of love, namely Agape (altruism/charity) and filia (brother love) are utilized in nursing. Only some caring relationships with patients reach an intimate level, and this is determined by patient characteristics to which the nurse responds. It is concluded that caring as a moral imperative is the most relevant to discussions on caring in nursing and the perspective on which the other four viewpoints hinge.

Implementation and Operational Research: Affordable Care Act Implementation in a California Health Care System Leads to Growth in HIV-Positive Patient Enrollment and Changes in Patient Characteristics.

PubMed

Satre, Derek D; Altschuler, Andrea; Parthasarathy, Sujaya; Silverberg, Michael J; Volberding, Paul; Campbell, Cynthia I

2016-12-15

This study examined implementation of the Affordable Care Act (ACA) in relation to HIV-positive patient enrollment in an integrated health care system; as well as changes in new enrollee characteristics, benefit structure, and health care utilization after key ACA provisions went into effect in 2014. This mixed-methods study was set in Kaiser Permanente Northern California (KPNC). Qualitative interviews with 29 KPNC leaders explored planning for ACA implementation. Quantitative analyses compared newly enrolled HIV-positive patients in KPNC between January and December 2012 ("pre-ACA," N = 661) with newly enrolled HIV-positive patients between January and December 2014 ("post-ACA," N = 880) on demographics; medical, psychiatric, and substance use disorder diagnoses; HIV clinical indicators; and type of health care utilization. Interviews found that ACA preparation focused on enrollment growth, staffing, competition among health plans, concern about cost sharing, and HIV pre-exposure prophylaxis (PrEP) services. Quantitative analyses found that post-ACA HIV-positive patient enrollment grew. New enrollees in 2014 were more likely than 2012 enrollees to be enrolled in high-deductible plans (P < 0.01) or through Medicaid (P < 0.01), and marginally more likely to have better HIV viral control (P < 0.10). They also were more likely to be diagnosed with asthma (P < 0.01) or substance use disorders (P < 0.05) and to have used primary care health services in the 6 months postenrollment (P < 0.05) than the pre-ACA cohort. As anticipated by KPNC interviewees, ACA implementation was followed by HIV-positive patient enrollment growth and changing benefit structures and patient characteristics. Although HIV viral control improved, comorbid diagnosis findings reinforced the importance of coordinated health care.

The Characteristics and Utilization Pattern of an Admission Cohort of Nursing Home Patients (II).

ERIC Educational Resources Information Center

Liu, Korbin; Manton, Kenneth G.

1984-01-01

Projects utilization history of a synthetic cohort of nursing home admissions in 1976 by normalizing length of stay (LOS) specific discharge rates derived from life tables to an estimated 1.1 million persons. Results focus on the LOS distribution, discharge status, and total days of nursing home care used. (Author/JAC)

Health services utilization for people with HIV infection: comparison of a population targeted for outreach with the U.S. population in care.

PubMed

Cunningham, William E; Sohler, Nancy L; Tobias, Carol; Drainoni, Mari-lynn; Bradford, Judith; Davis, Cynthia; Cabral, Howard J; Cunningham, Chinazo O; Eldred, Lois; Wong, Mitchell D

2006-11-01

Many persons with HIV infection do not receive consistent ambulatory medical care and are excluded from studies of patients in medical care. However, these hard-to-reach groups are important to study because they may be in greatest need of services. This study compared the sociodemographic, clinical, and health care utilization characteristics of a multisite sample of HIV-positive persons who were hard to reach with a nationally representative cohort of persons with HIV infection who were receiving care from known HIV providers in the United States and examined whether the independent correlates of low ambulatory utilization differed between the 2 samples. We compared sociodemographic, clinical, and health care utilization characteristics in 2 samples of adults with HIV infection: 1286 persons from 16 sites across the United States interviewed in 2001-2002 for the Targeted HIV Outreach and Intervention Initiative (Outreach), a study of underserved persons targeted for supportive outreach services; and 2267 persons from the HIV Costs and Services Utilization Study (HCSUS), a probability sample of persons receiving care who were interviewed in 1998. We conducted logistic regression analyses to identify differences between the 2 samples in sociodemographic and clinical associations with ambulatory medical visits. Compared with the HCSUS sample, the Outreach sample had notably greater proportions of black respondents (59% vs. 32%, P = 0.0001), Hispanics (20% vs. 16%), Spanish-speakers (9% vs. 2%, P = 0.02), those with low socioeconomic status (annual income < Dollars 10,000 75% vs. 45%, P = 0.0001), the unemployed, and persons with homelessness, no insurance, and heroin or cocaine use (58% vs. 47%, P = 0.05). They also were more likely to have fewer than 2 ambulatory visits (26% vs. 16%, P = 0.0001), more likely to have emergency room visits or hospitalizations in the prior 6 months, and less likely to be on antiretroviral treatment (82% vs. 58%, P = 0.0001). Nearly all these differences persisted after stratifying for level of ambulatory utilization (fewer than 2 vs. 2 or more in the last 6 months). In multivariate analysis, several variables showed significantly different associations in the 2 samples (interacted) with low ambulatory care utilization. The variables with significant interactions (P values for interaction shown below) had very different adjusted odds ratios (and 95% confidence intervals) for low ambulatory care utilization: age greater than 50 (Outreach 0.55 [0.35-0.88], HCSUS 1.17 [0.65-2.11)], P = 0.05), Hispanic ethnicity (Outreach 0.81 [0.39-1.69], HCSUS 2.34 [1.56-3.52], P = 0.02), low income (Outreach 0.73 [0.56-0.96], HCSUS 1.35 [1.04-1.75], P = 0.002), and heavy alcohol use (Outreach 1.74 [1.23-2.45], HCSUS 1.00 [0.73-1.37], P = 0.02). Having CD4 count less than 50 was associated with elevated odds of low ambulatory medical visits in the Outreach sample (1.53 [1.00-2.36], P = 0.05). Compared with HCSUS, the Outreach sample had far greater proportions of traditionally vulnerable groups, and were less likely to be in care if they had low CD4 counts. Furthermore, heavy alcohol use was only associated with low ambulatory utilization in Outreach. Generalizing from in care populations may not be warranted, while addressing heavy alcohol use may be effective at improving utilization of care for hard-to-reach HIV-positive populations.

Assessing the representativeness of physician and patient respondents to a primary care survey using administrative data.

PubMed

Li, Allanah; Cronin, Shawna; Bai, Yu Qing; Walker, Kevin; Ammi, Mehdi; Hogg, William; Wong, Sabrina T; Wodchis, Walter P

2018-05-30

QUALICOPC is an international survey of primary care performance. QUALICOPC data have been used in several studies, yet the representativeness of the Canadian QUALICOPC survey is unknown, potentially limiting the generalizability of findings. This study examined the representativeness of QUALICOPC physician and patient respondents in Ontario using health administrative data. This representativeness study linked QUALICOPC physician and patient respondents in Ontario to health administrative databases at the Institute for Clinical Evaluative Sciences. Physician respondents were compared to other physicians in their practice group and all Ontario primary care physicians on demographic and practice characteristics. Patient respondents were compared to other patients rostered to their primary care physicians, patients rostered to their physicians' practice groups, and a random sample of Ontario residents on sociodemographic characteristics, morbidity, and health care utilization. Standardized differences were calculated to compare the distribution of characteristics across cohorts. QUALICOPC physician respondents included a higher proportion of younger, female physicians and Canadian medical graduates compared to other Ontario primary care physicians. A higher proportion of physician respondents practiced in Family Health Team models, compared to the provincial proportion for primary care physicians. QUALICOPC patient respondents were more likely to be older and female, with significantly higher levels of morbidity and health care utilization, compared with the other patient groups examined. However, when looking at the QUALICOPC physicians' whole rosters, rather than just the patient survey respondents, the practice profiles were similar to those of the other physicians in their practice groups and Ontario patients in general. Comparisons revealed some differences in responding physicians' demographic and practice characteristics, as well as differences in responding patients' characteristics compared to the other patient groups tested, which may have resulted from the visit-based sampling strategy. Ontario QUALICOPC physicians had similar practice profiles as compared to non-participating physicians, providing some evidence that the participating practices are representative of other non-participating practices, and patients selected by visit-based sampling may also be representative of visiting patients in other practices. Those using QUALICOPC data should understand this limited representativeness when generalizing results, and consider the potential for bias in their analyses.

Patients' Interpersonal Communication Experiences in the Context of Type 2 Diabetes Care.

PubMed

Peltola, Maija; Isotalus, Pekka; Åstedt-Kurki, Päivi

2018-03-01

The aim of our study is to determine the relational communication characteristics of professional-patient communication situations that have either facilitated or impeded patients' self-management. Conducted from the perspective of Finnish patients in the context of type 2 diabetes care, we used as our research methods an open e-survey and semistructured interviews. Data were analyzed using inductive qualitative content analysis. The critical incident technique was utilized throughout in all these methods. The results show that both positive and negative experiences described by patients were connected to four multidimensional relational communication characteristics: (a) building trust in the other party in the professional-patient relationship, (b) willingness to communicate, (c) emotional presence, and (d) appropriateness. Although the findings support the recommendations of earlier studies concerning individually tailored patient-centered care, acknowledging the characteristics in question can be used as a communication frame for constructing significant care relationships from the perspective of patients' self-management.

Comparative evaluation of two asthma care quality measures among Medicaid beneficiaries.

PubMed

Samnaliev, Mihail; Baxter, Jeffrey D; Clark, Robin E

2009-05-01

The relative performance of asthma care quality measures has not been evaluated in Medicaid populations. Using complete claims and pharmaceutical data for 19,076 patients with persistent asthma (based on Health Effectiveness and Data Information Set criteria) in five Medicaid populations, we compared the following two measures of asthma care quality: filling prescriptions for controller asthma medications within 1 year and the ratio of controller medication to the total number of asthma medication prescriptions filled within 1 year. We calculated whether meeting each quality measure was associated with decreased odds of emergency department (ED) treatment episodes. We then compared the odds ratios, receiver operating characteristic (ROC) curves, and deviances between models, using each measure to predict ED utilization in Medicaid populations. Although meeting each measure was associated with lower odds of ED utilization, this decrease was larger if the controller asthma medication measure was met rather than the ratio measure. Additionally, models using the controller medication measure had greater areas under the ROC curve and smaller deviances than models using the ratio measure. Both administrative measures of asthma care quality were associated with lower odds of ED utilization. The controller medication measure of asthma care quality may be better than the ratio measure in relation to emergency asthma care utilization by Medicaid beneficiaries.

Association between Electronic Health Records and Health Care Utilization

PubMed Central

Edwards, A.; Kern, L.M.

2015-01-01

Summary Background The federal government is investing approximately $20 billion in electronic health records (EHRs), in part to address escalating health care costs. However, empirical evidence that provider use of EHRs decreases health care costs is limited. Objective To determine any association between EHRs and health care utilization. Methods We conducted a cohort study (2008–2009) in the Hudson Valley, a multi-payer, multiprovider community in New York State. We included 328 primary care physicians in predominantly small practices (median practice size four primary care physicians), who were caring for 223,772 patients. Data from an independent practice association was used to determine adoption of EHRs. Claims data aggregated across five commercial health plans was used to characterize seven types of health care utilization: primary care visits, specialist visits, radiology tests, laboratory tests, emergency department visits, hospital admissions, and readmissions. We used negative binomial regression to determine associations between EHR adoption and each utilization outcome, adjusting for ten physician characteristics. Results Approximately half (48%) of the physicians were using paper records and half (52%) were using EHRs. For every 100 patients seen by physicians using EHRs, there were 14 fewer specialist visits (adjusted p < 0.01) and 9 fewer radiology tests (adjusted p = 0.01). There were no significant differences in rates of primary care visits, laboratory tests, emergency department visits, hospitalizations or readmissions. Conclusions Patients of primary care providers who used EHRs were less likely to have specialist visits and radiology tests than patients of primary care providers who did not use EHRs. PMID:25848412

Clinical characteristics, patterns of lipid-lowering medication use, and health care resource utilization and costs among patients with atherosclerotic cardiovascular disease

PubMed Central

Power, Thomas P; Zhao, Zhenxiang; Bonine, Nicole Gidaya; Cziraky, Mark J; Grabner, Michael; Barron, John J; Quimbo, Ralph; Vangerow, Burkhard; Toth, Peter P

2018-01-01

Purpose The aim of this study was to investigate real-world patient characteristics, medication use, and health care resource utilization (HCRU) and costs among patients with clinical atherosclerotic cardiovascular disease (ASCVD) as defined by 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, to examine burden of disease and unmet needs, such as potential undertreatment. Patients and methods This retrospective cohort study utilized a nationally representative managed care database to identify newly diagnosed ASCVD patients between January 1, 2007, and November 30, 2012 (index = first ASCVD diagnosis date) in the USA. Patients had ≥12-month pre-index (baseline) and ≥12-month post-index (follow-up) health plan enrollment and no baseline lipid-lowering medication (LLM). Patient characteristics, LLM utilization patterns, HCRU, and costs were examined for all patients and by subgroups based on LLM use pattern and/or follow-up low-density lipoprotein cholesterol (LDL-C) levels. Results A total of 128,017 ASCVD patients were identified with a mean (SD) age of 59 (13) years, 43.1% female, and 48.8% with ≥36-month follow-up. Within 12-month follow-up, 10.6% had high-intensity statins and 56.9% had no LLM fills. Baseline mean (SD) all-cause costs were $8,852 ($25,608). At 12-month follow-up, mean (SD) all-cause and ASCVD-related costs were $31,443 ($54,040) and $20,289 ($45,159), respectively. The 36-month analyses showed similar distributions. Multivariable analyses showed that age, gender, region, health insurance type, baseline comorbidities, baseline use of specific medications, baseline lipid profiles, and index ASCVD type were significantly associated with all-cause and ASCVD-related health care costs. Conclusion Patients have nonoptimal treatment for ASCVD and substantial HCRU and costs associated with residual risk. Unmet needs and cost burdens of ASCVD patients merit additional investigation. PMID:29440909

Impacts of the Affordable Care Act on Community Health Centers: Characteristics of New Patients and Early Changes in Delivery of Care.

PubMed

Hatch, Brigit; Smith, Ning; McBurnie, Mary Ann; Quach, Thu; Mayer, Kenneth H; Dunne, Mary J; Cottrell, Erika

2018-05-15

The aim of this study was to assess the impact of the Affordable Care Act (ACA) on community health centers (CHCs). Using electronic health records from the Community Health Applied Research Network, we assessed new patient characteristics, office visit volume, and payer distribution among CHC patients before and after ACA implementation, 2011-2014 (n = 442 455). New patients post-ACA were younger, more likely to be female and have chronic health conditions, and utilized more primary care (P < .05 for each). Post-ACA, clinics delivered 19% more office visits and more visits were reimbursed by Medicaid. The support of CHCs is needed to meet increased demand post-ACA.

Active Redesign of a Medicaid Care Management Strategy for Greater Return on Investment: Predicting Impactability.

PubMed

DuBard, C Annette; Jackson, Carlos T

2018-04-01

Care management of high-cost/high-needs patients is an increasingly common strategy to reduce health care costs. A variety of targeting methodologies have emerged to identify patients with high historical or predicted health care utilization, but the more pertinent question for program planners is how to identify those who are most likely to benefit from care management intervention. This paper describes the evolution of complex care management targeting strategies in Community Care of North Carolina's (CCNC) work with the statewide non-dual Medicaid population, culminating in the development of an "Impactability Score" that uses administrative data to predict achievable savings. It describes CCNC's pragmatic approach for estimating intervention effects in a historical cohort of 23,455 individuals, using a control population of 14,839 to determine expected spending at an individual level, against which actual spending could be compared. The actual-to-expected spending difference was then used as the dependent variable in a multivariate model to determine the predictive contribution of a multitude of demographic, clinical, and utilization characteristics. The coefficients from this model yielded the information required to build predictive models for prospective use. Model variables related to medication adherence and historical utilization unexplained by disease burden proved to be more important predictors of impactability than any given diagnosis or event, disease profile, or overall costs of care. Comparison of this approach to alternative targeting strategies (emergency department super-utilizers, inpatient super-utilizers, or patients with highest Hierarchical Condition Category risk scores) suggests a 2- to 3-fold higher return on investment using impactability-based targeting.

Patients' experiences in different models of community health centers in southern China.

PubMed

Wang, Harry H X; Wong, Samuel Y S; Wong, Martin C S; Wei, Xiao Lin; Wang, Jia Ji; Li, Donald K T; Tang, Jin Ling; Gao, Gemma Y; Griffiths, Sian M

2013-01-01

Current health care reforms in China have an overall goal of strengthening primary care through the establishment and expansion of primary care networks based on community health centers (CHCs). Implementation in urban areas has led to the emergence of different models of ownership and management. The objective of this study was to evaluate the primary care experiences of patients in the Pearl River Delta as measured by the Primary Care Assessment Tool (PCAT) and the relationships with ownership and management in the 3 different models we describe. This cross-sectional study was conducted on-site at CHCs in 3 cities within the Pearl River Delta, China, using a multistage cluster sampling method. A validated Mandarin Chinese version of the PCAT-Adult Edition (short version) was adopted to collect information from adult patients regarding their experiences with primary care sources. PCAT scores for individual primary care attributes and total primary care assessment scores were assessed with respect to sociodemographic characteristics, health characteristics, and health care service utilization across 3 primary care models. One thousand four hundred forty (1,440) primary care patients responded to the survey, for an overall response rate of 86.1%. Respondents gave government-owned and -managed CHCs the highest overall PCAT scores when compared with CHCs either managed by hospitals (95.18 vs 90.81; P = .005) or owned by private and social entities (95.18 vs 90.69; P =.007) as a result of better first-contact care (better first-contact utilization) and coordination of care (better service coordination and information system). Factors that were positively and significantly associated with higher overall assessment scores included the presence of a chronic condition (P <.001), having medical insurance (P = .006), and a self-reported good health status (P <.001). This study suggests that government-owned and -managed CHCs may be able to provide better first-contact care in terms of utilization and coordination of care, and may be better at solving the problem of underutilization of the CHCs as the first-contact point of care, one key problem facing the reforms in China.

Applying RUG-III in Japanese Long-Term Care Facilities.

ERIC Educational Resources Information Center

Ikegami, Naoki; And Others

1994-01-01

Tested U.S. nursing home case-mix system, Resource Utilization Groups, Version III (RUG-III) in Japanese long-term care facilities. Measured staff time and resident characteristics for 871 patients. Found acceptable reliability for items defining RUG-III, and system explained 44% of variance in wage-weighted staff time (cost). Japanese and U.S.…

Mental Health Impact of the Iraq and Afghanistan Conflicts: A Review of U.S. Research, Service Provision, and Programmatic Responses

DTIC Science & Technology

2011-04-01

McFall, M. (2008). Characteristics of deployed Operation Iraqi Freedom military personnel who seek mental health care. Military Medi- cine , 173 , 155...Analysis of VA Health care Utilization among US Global War on Terrorism (GWOT) Veterans . Washington, DC: Department of Veterans Affairs. Kang, H.K

Cost of health care utilization among homeless frequent emergency department users.

PubMed

Mitchell, Matthew S; León, Casey L K; Byrne, Thomas H; Lin, Wen-Chieh; Bharel, Monica

2017-05-01

Research demonstrates that homelessness is associated with frequent use of emergency department (ED) services, yet prior studies have not adequately examined the relationship between frequent ED use and utilization of non-ED health care services among those experiencing homelessness. There has also been little effort to assess heterogeneity among homeless individuals who make frequent use of ED services. To address these gaps, the present study used Medicaid claims data from 2010 to estimate the association between the number of ED visits and non-ED health care costs for a cohort of 6,338 Boston Health Care for the Homeless Program patients, and to identify distinct subgroups of persons in this cohort who made frequent use of ED services based on their clinical and demographic characteristics. A series of gamma regression models found more frequent ED use to be associated with higher non-ED costs, even after adjusting for demographic and clinical characteristics. Latent class analysis was used to examine heterogeneity among frequent ED users, and the results identified 6 characteristically distinct subgroups among these persons. The subgroup of persons with trimorbid illness had non-ED costs that far exceeded members of all 5 other subgroups. Study findings reinforce the connection between frequent ED use and high health care costs among homeless individuals and suggest that different groups of homeless frequent ED users may benefit from interventions that vary in terms of their composition and intensity. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Hospital differences in special care nursery use for newborns of gestational diabetic mothers.

PubMed

Danilack, Valery A; Muri, Janet H; Savitz, David A; Caldwell, Donna L; Wood, Carolyn L

2016-09-01

Relatively healthy newborns of mothers with gestational diabetes mellitus (GDM) sometimes receive unwarranted surveillance. We studied the relationship between hospital characteristics and special care nursery use and total length of stay among GDM deliveries. We identified GDM deliveries at 44 USA member hospitals of the National Perinatal Information Center from 2007 to 2011. To study low risk, relatively healthy newborns with presumed discretion in special care nursery use, we analyzed 43 444 singleton newborns with only minor or moderate complications and WHO were not preterm or low birthweight. Among eligible newborns, 6% received special care, but this ranged from 1% to 16% across 44 hospitals studied. Unadjusted associations suggested special care nursery use was highest in academic teaching hospitals, the Midwest, hospitals with ≥40% Medicaid births, and hospitals with a high supply of special care nursery beds. However, after controlling for clustering within hospitals, there were no significant associations between hospital characteristics and special care nursery use or length of stay. Hospital-level variation in special care nursery use and length of stay of relatively healthy newborns of mothers with GDM is unexplained by hospital characteristics and suggests other operational or management factors impacting utilization of newborn care resources.

The effect of health and dental insurance on US children's dental care utilization for urgent and non-urgent dental problems - 2008.

PubMed

Naavaal, Shillpa; Barker, Laurie K; Griffin, Susan O

2017-12-01

We examined the association between utilization of care for a dental problem (utilization-DP) and parent-reported dental problem (DP) urgency among children with DP by type of health care insurance coverage. We used weighted 2008 National Health Interview Survey data from 2,834 children, aged 2-17 years with at least one DP within the 6 months preceding survey. Explanatory variables were selected based on Andersen's model of healthcare utilization. Need was considered urgent if DP included toothache, bleeding gums, broken or missing teeth, broken or missing filling, or decayed teeth and otherwise as non-urgent. The primary enabling variable, insurance, had four categories: none, private health no dental coverage (PHND), private health and dental (PHD), or Medicaid/State Children's Health Insurance Program (SCHIP). Predisposing variables included sociodemographic characteristics. We used bivariate and multivariate analyses to identify explanatory variables' association with utilization-DP. Using logistic regression, we obtained adjusted estimates of utilization-DP by urgency for each insurance category. In bivariate analyses, utilization-DP was associated with both insurance and urgency. In multivariate analyses, the difference in percent utilizing care for an urgent versus non-urgent DP among children covered by Medicaid/SCHIP was 32 percentage points; PHD, 25 percentage points; PHND, 12 percentage points; and no insurance, 14 percentage points. The difference in utilization by DP urgency was higher for children with Medicaid/SCHIP compared with either PHND or uninsured children. Expansion of Medicaid/SCHIP may permit children to receive care for urgent DPs who otherwise may not, due to lack of dental insurance. © 2016 American Association of Public Health Dentistry.

Utilization of acute care among patients with ESRD discharged home from skilled nursing facilities.

PubMed

Hall, Rasheeda K; Toles, Mark; Massing, Mark; Jackson, Eric; Peacock-Hinton, Sharon; O'Hare, Ann M; Colón-Emeric, Cathleen

2015-03-06

Older adults with ESRD often receive care in skilled nursing facilities (SNFs) after an acute hospitalization; however, little is known about acute care use after SNF discharge to home. This study used Medicare claims for North and South Carolina to identify patients with ESRD who were discharged home from a SNF between January 1, 2010 and August 31, 2011. Nursing Home Compare data were used to ascertain SNF characteristics. The primary outcome was time from SNF discharge to first acute care use (hospitalization or emergency department visit) within 30 days. Cox proportional hazards models were used to identify patient and facility characteristics associated with the outcome. Among 1223 patients with ESRD discharged home from a SNF after an acute hospitalization, 531 (43%) had at least one rehospitalization or emergency department visit within 30 days. The median time to first acute care use was 37 days. Characteristics associated with a shorter time to acute care use were black race (hazard ratio [HR], 1.25; 95% confidence interval [95% CI], 1.04 to 1.51), dual Medicare-Medicaid coverage (HR, 1.24; 95% CI, 1.03 to 1.50), higher Charlson comorbidity score (HR, 1.07; 95% CI, 1.01 to 1.12), number of hospitalizations during the 90 days before SNF admission (HR, 1.12; 95% CI, 1.03 to 1.22), and index hospital discharge diagnoses of cellulitis, abscess, and/or skin ulcer (HR, 2.59; 95% CI, 1.36 to 4.45). Home health use after SNF discharge was associated with a lower rate of acute care use (HR, 0.72; 95% CI, 0.59 to 0.87). There were no statistically significant associations between SNF characteristics and time to first acute care use. Almost one in every two older adults with ESRD discharged home after a post-acute SNF stay used acute care services within 30 days of discharge. Strategies to reduce acute care utilization in these patients are needed. Copyright © 2015 by the American Society of Nephrology.

Differences across health care systems in outcome and cost-utility of surgical and conservative treatment of chronic low back pain: a study protocol

PubMed Central

Melloh, Markus; Röder, Christoph; Elfering, Achim; Theis, Jean-Claude; Müller, Urs; Staub, Lukas P; Aghayev, Emin; Zweig, Thomas; Barz, Thomas; Kohlmann, Thomas; Wieser, Simon; Jüni, Peter; Zwahlen, Marcel

2008-01-01

Background There is little evidence on differences across health care systems in choice and outcome of the treatment of chronic low back pain (CLBP) with spinal surgery and conservative treatment as the main options. At least six randomised controlled trials comparing these two options have been performed; they show conflicting results without clear-cut evidence for superior effectiveness of any of the evaluated interventions and could not address whether treatment effect varied across patient subgroups. Cost-utility analyses display inconsistent results when comparing surgical and conservative treatment of CLBP. Due to its higher feasibility, we chose to conduct a prospective observational cohort study. Methods This study aims to examine if 1. Differences across health care systems result in different treatment outcomes of surgical and conservative treatment of CLBP 2. Patient characteristics (work-related, psychological factors, etc.) and co-interventions (physiotherapy, cognitive behavioural therapy, return-to-work programs, etc.) modify the outcome of treatment for CLBP 3. Cost-utility in terms of quality-adjusted life years differs between surgical and conservative treatment of CLBP. This study will recruit 1000 patients from orthopaedic spine units, rehabilitation centres, and pain clinics in Switzerland and New Zealand. Effectiveness will be measured by the Oswestry Disability Index (ODI) at baseline and after six months. The change in ODI will be the primary endpoint of this study. Multiple linear regression models will be used, with the change in ODI from baseline to six months as the dependent variable and the type of health care system, type of treatment, patient characteristics, and co-interventions as independent variables. Interactions will be incorporated between type of treatment and different co-interventions and patient characteristics. Cost-utility will be measured with an index based on EQol-5D in combination with cost data. Conclusion This study will provide evidence if differences across health care systems in the outcome of treatment of CLBP exist. It will classify patients with CLBP into different clinical subgroups and help to identify specific target groups who might benefit from specific surgical or conservative interventions. Furthermore, cost-utility differences will be identified for different groups of patients with CLBP. Main results of this study should be replicated in future studies on CLBP. PMID:18534034

Racial, Ethnic, and Gender Disparities in Health Care Access and Use Among U.S. Adults With Serious Psychological Distress.

PubMed

Weissman, Judith; Russell, David; Jay, Melanie; Malaspina, Dolores

2018-05-01

This study compared health care access and utilization among adults with serious psychological distress by race-ethnicity and gender in years surrounding implementation of the Affordable Care Act. Data for adults ages 18 to 64 with serious psychological distress in the 2006-2015 National Health Interview Survey (N=8,940) were analyzed by race-ethnicity and gender on access and utilization indicators: health insurance coverage, insufficient money to buy medications, delay in health care, insufficient money for health care, visited a doctor more than ten times in the past 12 months, change in place of health care, change in place of health care because of insurance, saw a mental health provider in the past 12 months, and insufficient money for mental health care. The proportions of white and black adults with serious psychological distress were largest in the South, the region with the largest proportion of persons with serious psychological distress and no health coverage. Multivariate models that adjusted for health coverage, sociodemographic characteristics, health conditions, region, and year indicated that whites were more likely than blacks to report insufficient money for medications and mental health care and delays in care. A greater proportion of whites used private coverage, compared with blacks and Hispanics, and blacks were more likely than all other racial-ethnic groups to have Medicaid. More research is needed on health care utilization among adults with serious psychological distress. In this group, whites and those with private coverage reported poor utilization, compared with other racial-ethnic groups and those with Medicaid, respectively.

Short-Term Absenteeism and Health Care Utilization Due to Lower Extremity Injuries Among Novice Runners: A Prospective Cohort Study.

PubMed

Smits, Dirk-Wouter; Huisstede, Bionka; Verhagen, Evert; van der Worp, Henk; Kluitenberg, Bas; van Middelkoop, Marienke; Hartgens, Fred; Backx, Frank

2016-11-01

To describe absenteeism and health care utilization (HCU) within 6 weeks after occurrence of running-related injuries (RRIs) among novice runners and to explore differences relating to injury and personal characteristics. Prospective cohort study. Primary care. One thousand six hundred ninety-six novice runners (18-65 years) participating in a 6-week running program ("Start-to-Run"). Injury characteristics were assessed by weekly training logs and personal characteristics by a baseline questionnaire. Data on absenteeism and HCU were collected using questionnaires at 2 and 6 weeks after the RRI occurred. A total of 185 novice runners (11%) reported an RRI during the 6-week program. Of these injured novice runners, 78% reported absence from sports, whereas only 4% reported absence from work. Fifty-one percent of the injured novice runners visited a health care professional, mostly physical therapists (PTs) rather than physicians. Absenteeism was more common among women than men and was also more common with acute RRIs than gradual-onset RRIs. As regards HCU, both the variety of professionals visited and the number of PT visits were higher among runners with muscle-tendon injuries in the ankle/foot region than among those with other RRIs. Among novice runners sustaining an RRI during a 6-week running program, over three quarters reported short-term absence from sports, whereas absence from work was very limited, and over half used professional health care. Both absence and HCU are associated with injury characteristics. In future running promotion programs (eg in Start-to-Run programs), specific attention should be paid to acute injuries and to muscle-tendon injuries in the ankle/foot region.

The impact of national health insurance on the utilization of health care services by pregnant women: the case in Taiwan.

PubMed

Chen, L M; Wen, S W; Li, C Y

2001-03-01

Substantially increased funding for health care services occurred in Taiwan after the implementation of a national health insurance plan in 1995. This study attempts to examine the impact of this national health insurance plan on the utilization of prenatal and intrapartum care services. Nationally representative surveys of all pregnant women in Taiwan in 1989 (1,662 participants) and in 1996 (3,626 participants) were included in the analysis. We first compared the distribution of birth characteristics between the two surveys. We then calculated the rate of utilization of various prenatal and intrapartum care services in the two surveys in the overall sample and in subsamples, stratified by maternal education, age, and parity. The utilization of most prenatal and intrapartum care services, especially the complicated laboratory tests, increased in 1996 compared to 1989. For example, the proportion of women who received amniocentesis increased from 1.62% in 1989 to 5.60% in 1996 and German measles testing increased from 5.96% to 27.11%. By contrast, the proportion of women who received consultation services was stable over time, or for family planning, consultation declined from 33.21% to 27.00%. These changes in utilization over time were consistently observed across different maternal education, age, and parity groups. The utilization of prenatal and intrapartum care services, especially for the more expensive services, has substantially increased in Taiwan since the implementation of the national health insurance. For countries considering similar national health insurance plan, it may be helpful to consider cost-containing measures before the implementation of such a plan.

Reducing Inpatient Hospital and Emergency Room Utilization Among Nursing Home Residents.

PubMed

Haber, Susan G; Wensky, Suzanne G; McCall, Nancy T

2017-04-01

To examine the association among nursing home residents between strength of relationship with a primary care provider (PCP) and inpatient hospital and emergency room (ER) utilization. Medicare administrative data for beneficiaries residing in a nursing home between July 2007 and June 2009 were used in multivariate analyses controlling for beneficiary, nursing home, and market characteristics to assess the association between two measures-percentage of months with a PCP visit and whether the patient maintained the same usual source of care after nursing home admission-and hospital admissions and ER visits for all causes and for ambulatory care sensitive conditions (ACSCs). Both measures of strength of patient-provider relationships were associated with fewer inpatient admissions and ER visits, except regularity of PCP visits and ACSC ER visits. Policy makers should consider increasing the strength of nursing home resident and PCP relationships as one strategy for reducing inpatient and ER utilization.

Predictors of medical and mental health care use in patients with irritable bowel syndrome in the United States.

PubMed

Gudleski, Gregory D; Satchidanand, Nikhil; Dunlap, Laura J; Tahiliani, Varnita; Li, Xiaohua; Keefer, Laurie; Lackner, Jeffrey M

2017-01-01

Because health care demand among IBS patients imposes a heavy economic burden, identifying high utilizers has potential for improving quality and efficiency of care. Previous research has not identified reliable predictors of utilization of IBS patients. We sought to identify factors predictive of health care utilization among severe IBS patients. 291 IBS patients completed testing whose content mapped onto the Andersen model of health care utilization. 2-stage hurdle models were used to determine predictors of health care use (probability and frequency). Separate analyses were conducted for mental health and medical services. Whether patients used any medical care was predicted by diet and insurance status. Tobacco use, education, and health insurance predicted the probability of using mental health care. The frequency of medical care was associated with alcohol use and physical health status, while frequency of mental health services was associated with marital status, tobacco use, education, distress, stress, and control beliefs over IBS symptoms. For IBS patients, the demand for health care involves a complex decision-making process influenced by many factors. Particularly strong determinants include predisposing characteristics (e.g., dietary pattern, tobacco use) and enabling factors (e.g., insurance coverage) that impede or facilitate demand. Which factors impact use depends on whether the focus is on the decision to use care or how much care is used. Decisions to use medical and mental health care are not simply influenced by symptom-specific factors but by a variety of lifestyle (e.g., dietary pattern, education, smoking) and economic (e.g., insurance coverage) factors. Copyright © 2016 Elsevier Ltd. All rights reserved.

Impact of HMO ownership on management processes and utilization outcomes.

PubMed

Ahern, M; Molinari, C

2001-05-01

To examine the effects of health maintenance organization (HMO) ownership characteristics on selected utilization outcomes and management processes affecting utilization. We used 1995 HMO data from the American Association of Health Plans. Using regression analysis, we examined the relation between HMO utilization (hospital discharges, days, and average length of stay; cardiac catheterization procedures; and average cost of outpatient prescriptions) and the structural characteristics of HMOs: ownership type (insurance company, hospital, physician, independent, and national managed care company), HMO size, for-profit status, model type, geographic region, and payer mix. HMO ownership type is significantly associated with medical management processes, including risk sharing by providers, risk sharing by consumers, and other management strategies. Relative to hospital-owned HMOs, insurance company-owned HMOs have fewer hospital discharges, fewer hospital days, and longer lengths of stay. National managed care organization-owned HMOs have fewer cardiac catheterizations and lower average outpatient prescription costs. Independently owned HMOs have more cardiac catheterizations. For-profit HMOs have lower prescription costs. Relative to hospital-owned HMOs, insurance company-owned HMOs are more likely to use hospital risk sharing and provider capitation and less likely to use out-of-pocket payments for hospital use and a closed formulary. National managed care organization-owned HMOs are less likely to use provider capitation, out-of-pocket payments for hospital use, catastrophic case management, and hospital risk sharing. Physician-hospital-owned HMOs are less likely to use catastrophic case management. For-profit HMOs are more likely to use hospital risk sharing and catastrophic case management. HMO ownership type affects utilization outcomes and management strategies.

Is quality of care a key predictor of perinatal health care utilization and patient satisfaction in Malawi?

PubMed

Creanga, Andreea A; Gullo, Sara; Kuhlmann, Anne K Sebert; Msiska, Thumbiko W; Galavotti, Christine

2017-05-22

The Malawi government encourages early antenatal care, delivery in health facilities, and timely postnatal care. Efforts to sustain or increase current levels of perinatal service utilization may not achieve desired gains if the quality of care provided is neglected. This study examined predictors of perinatal service utilization and patients' satisfaction with these services with a focus on quality of care. We used baseline, two-stage cluster sampling household survey data collected between November and December, 2012 before implementation of CARE's Community Score Card© intervention in Ntcheu district, Malawi. Women with a birth during the last year (N = 1301) were asked about seeking: 1) family planning, 2) antenatal, 3) delivery, and 4) postnatal care; the quality of care received; and their overall satisfaction with the care received. Specific quality of care items were assessed for each type of service, and up to five such items per type of service were used in analyses. Separate logistic regression models were fitted to examine predictors of family planning, antenatal, delivery, and postnatal service utilization and of complete satisfaction with each of these services; all models were adjusted for women's socio-demographic characteristics, perceptions of the closest facility to their homes, service use indicators, and quality of care items. We found higher levels of perinatal service use than previously documented in Malawi (baseline antenatal care 99.4%; skilled birth attendance 97.3%; postnatal care 77.5%; current family planning use 52.8%). Almost 73% of quality of perinatal care items assessed were favorably reported by > 90% of women. Women reported high overall satisfaction (≥85%) with all types of services examined, higher for antenatal and postnatal care than for family planning and delivery care. We found significant associations between perceived and actual quality of care and both women's use and satisfaction with the perinatal health services received. Quality of care is a key predictor of perinatal health service utilization and complete patient satisfaction with such services in Malawi. The current heightened attention toward perinatal health services and outcomes should be coupled with efforts to improve the actual quality of care offered to women in this country.

Health insurance and health services utilization in Ireland.

PubMed

Harmon, C; Nolan, B

2001-03-01

The numbers buying private health insurance in Ireland have continued to grow, despite a broadening in entitlement to public care. About 40% of the population now have insurance, although everyone has entitlement to public hospital care. In this paper, we examine in detail the growth in insurance coverage and the factors underlying the demand for insurance. Attitudinal responses reveal the importance of perceptions about waiting times for public care, as well as some concerns about the quality of that care. Individual characteristics, such as education, age, gender, marital status, family composition and income all influence the probability of purchasing private insurance. We also examine the relationship between insurance and utilization of hospital in-patient services. The positive effect of private insurance appears less than that of entitlement to full free health care from the state, although the latter is means-tested, and may partly represent health status. Copyright 2001 John Wiley & Sons, Ltd.

The effects of health sector market factors and vulnerable group membership on access to alcohol, drug, and mental health care.

PubMed

Stockdale, Susan E; Tang, Lingqi; Zhang, Lily; Belin, Thomas R; Wells, Kenneth B

2007-06-01

This study adapts Andersen's Behavioral Model to determine if health sector market conditions affect vulnerable subgroups' use of alcohol, drug, and mental health services (ADM) differently than the general population, focusing specifically on community-level predisposing and enabling characteristics. Wave 2 data (2000-2001) from the Health Care for Communities study, supplemented with cases from wave 1 (1997-1998), were merged with area characteristics taken from Census, Area Resource File (ARF), and other data sources. The study used four-level hierarchical logistic regression to examine access to ADM care from any provider and specialty ADM access. Interactions between community-level predisposing and enabling vulnerability characteristics with individual race/ethnicity, age, income category, and insurance type were explored. Nonwhites, the poor, uninsured, and elderly had lower likelihoods of service use, but interactions between race/ethnicity, income, age and insurance status with community-level vulnerability factors were not statistically significant for any service use. For ADM specialty care, those with Medicare, Medicaid, private fully managed, and private partially managed insurance, the likelihood of utilization was higher in areas with higher HMO penetration. However, for those with other insurance or no insurance plan, the likelihood of utilization was lower in areas with higher HMO penetration. Community-level enabling factors explain part of the effect of disadvantaged status but, with the exception of the effect of HMO penetration on the relationship between insurance and specialty care use, do not modify any of the residual individual-level effects of disadvantage. Interventions targeting both structural and individual levels may be necessary to address the problem of health disparities. More research with longitudinal data is necessary to sort out the causal direction of social context and ADM access outcomes, and whether policy interventions to change health sector market conditions can shift ADM treatment utilization.

Understanding the health care utilization of children who require medical technology: A descriptive study of children who require tracheostomies.

PubMed

Spratling, Regena

2017-04-01

Children who require medical technology have complex chronic illnesses. This medical technology, including ventilators, oximeters, tracheostomy tubes, and feeding tubes, allows children and their families to live at home; however, the management of the children's care by informal caregivers is complex with the need for intensive, specialized care. The purpose of this study was to examine the sociodemographic and clinical characteristics that affect health care utilization in a population of children who require medical technology. A retrospective electronic health record (EHR) review was completed on the EHR records on 171 children who require medical technology, specifically tracheostomies, at an outpatient technology dependent pulmonary clinic over a three year period (January 2010-December 2012). Descriptive statistics were used to analyze sociodemographic and clinical characteristics, including medical diagnoses, and emergency department (ED) visits and hospitalizations. Of the 171 children requiring medical technology studied, there were numerous medical diagnoses (n=791), 99% had chronic illnesses affecting two or more body systems, and 88% required two or more technologies, including a tracheostomy and a feeding tube. In addition, 91% of the children had at least one ED visit or hospitalization and were treated in the ED approximately three times over the three year period. The findings from this study noted an increased utilization of health care by these children, and identified common symptoms and medical technologies for which caregivers may need interventions, focusing on education in managing symptoms and medical technology prior to presentation to the ED or hospital. Copyright © 2017 Elsevier Inc. All rights reserved.

Predictors of Health-Care Utilization Among Children 6–59 Months of Age in Zambézia Province, Mozambique

PubMed Central

Bayham, Mary; Blevins, Meridith; Lopez, Melanie; Olupona, Omo; González-Calvo, Lazaro; Ndatimana, Elisée; Green, Ann F.; Moon, Troy D.

2017-01-01

Globally, approximately 5.9 million children under 5 years of age died in 2015, a reduction of over 50% since 1990. Millennium Development Goal 4 established the goal of reducing child mortality by two-thirds by 2015. Multiple countries have surpassed this goal; however, regional and within-country inequities exist. We sought to study determinants of health-care utilization among children 6–59 months of age with fever, diarrhea, and respiratory symptoms in Zambézia Province, Mozambique. We conducted a population-based cross-sectional survey of female heads of household between April and May 2014. Mobile teams conducted interviews in 262 enumeration areas, with three distinct districts being oversampled for improved precision. Descriptive statistics and logistic regression using Stata 13.1 and R 3.2.2 were used to examine factors associated with health-care utilization. A total of 2,317 children were evaluated in this study. Mothers' median age was 26 years, whereas child median age was 24 months. The proportion of children reporting fever, diarrhea, or respiratory illness in the prior 30 days was 44%, 22%, and 22%, respectively. Health-care utilization varied with 65% seeking health care for fever, compared with 57% for diarrhea and 25% for respiratory illness. In multivariable logistic regression, the characteristics most associated with health-care utilization across illnesses were delivery of last child at a facility, higher maternal education, and household ownership of a radio. The decision or ability to use health care is a multifaceted behavior swayed by societal norms, values, socioeconomics, and perceived need. Recognizing the predictors of a particular population may offer useful information to increase uptake in health-care services. PMID:27821686

Use and Characteristics of Electronic Health Record Systems among Office-Based Physician Practices: United States, ...

MedlinePlus

... on Vital and Health Statistics Annual Reports Health Survey Research Methods Conference Reports from the National Medical Care Utilization and Expenditure Survey Clearinghouse on Health Indexes Statistical Notes for Health ...

Patient and Physician Characteristics Associated with the Provision of Weight Loss Counseling in Primary Care

PubMed Central

Dutton, Gareth R.; Herman, Katharine G.; Tan, Fei; Goble, Mary; Dancer-Brown, Melissa; Van Vessem, Nancy; Ard, Jamy D.

2013-01-01

Background A variety of physician and patient characteristics may influence whether weight loss counseling occurs in primary care encounters. Objectives This study utilized a cross-sectional survey of primary care patients, which examined patient characteristics, physician characteristics, and characteristics of the physician-patient relationship associated with weight loss counseling and recommendations provided by physicians. Participants Participants (N=143, mean age=46.8 years, mean BMI=36.9 kg/m2, 65% Caucasian) were overweight and obese primary care patients participating in a managed care weight loss program. Measures Participants completed self-report surveys in the clinic prior to the initial weight loss session. Surveys included items assessing demographic/background characteristics, weight, height, and a health care questionnaire evaluating whether their physician had recommended weight loss, the frequency of their physicians’ weight loss counseling, and whether their physician had referred them for obesity treatment. Results Patient BMI and physician sex were most consistently associated with physicians’ weight loss counseling practices. Patients seen by female physicians were more likely to be told that they should lose weight, received more frequent obesity counseling, and were more likely to have been referred for obesity treatment by their physician. Length and frequency of physician-patient contacts were unrelated to the likelihood of counseling. Conclusions These findings add to previous evidence suggesting possible differences in the weight loss counseling practices of male and female physicians, although further research is needed to understand this potential difference between physicians. PMID:24743007

Health information technology interventions enhance care completion, engagement in HIV care and treatment, and viral suppression among HIV-infected patients in publicly funded settings.

PubMed

Shade, Starley B; Steward, Wayne T; Koester, Kimberly A; Chakravarty, Deepalika; Myers, Janet J

2015-04-01

The National HIV/AIDS Strategy (NHAS) emphasizes the use of technology to facilitate coordination of comprehensive care for people with HIV. We examined the effect of six health information technology (HIT) interventions in a Ryan White-funded Special Projects of National Significance (SPNS) on care completion services, engagement in HIV care, and viral suppression. Interventions included use of surveillance data to identify out-of-care individuals, extending access to electronic health records to support service providers, use of electronic laboratory ordering and prescribing, and development of a patient portal. Data from a sample of electronic patient records from each site were analyzed to assess changes in utilization of comprehensive care (prevention screening, support service utilization), engagement in primary HIV medical care (receipt of services and use of antiretroviral therapy), and viral suppression. We used weighted generalized estimating equations to estimate outcomes while accounting for the unequal contribution of data and differences in the distribution of patient characteristics across sites and over time. We observed statistically significant changes in the desired direction in comprehensive care utilization and engagement in primary care outcomes targeted by each site. Five of six sites experienced statistically significant increases in viral suppression. These results provide additional support for the use of HIT as a valuable tool for achieving the NHAS goal of providing comprehensive care for all people living with HIV. HIT has the potential to increase utilization of services, improve health outcomes for people with HIV, and reduce community viral load and subsequent transmission of HIV. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com For affiliation see end of article.

Organizational context and taxonomy of health care databases.

PubMed

Shatin, D

2001-01-01

An understanding of the organizational context and taxonomy of health care databases is essential to appropriately use these data sources for research purposes. Characteristics of the organizational structure of the specific health care setting, including the model type, financial arrangement, and provider access, have implications for accessing and using this data effectively. Additionally, the benefit coverage environment may affect the utility of health care databases to address specific research questions. Coverage considerations that affect pharmacoepidemiologic research include eligibility, the nature of the pharmacy benefit, and regulatory aspects of the treatment under consideration.

The ecology of medical care in Beijing.

PubMed

Shao, Shuang; Zhao, Feifei; Wang, Jing; Feng, Lei; Lu, Xiaoqin; Du, Juan; Yan, Yuxiang; Wang, Chao; Fu, Yinghong; Wu, Jingjing; Yu, Xinwei; Khoo, Kaykeng; Wang, Youxin; Wang, Wei

2013-01-01

We presented the pattern of health care consumption, and the utilization of available resources by describing the ecology of medical care in Beijing on a monthly basis and by describing the socio-demographic characteristics associated with receipt care in different settings. A cohort of 6,592 adults, 15 years of age and older were sampled to estimate the number of urban-resident adults per 1,000 who visited a medical facility at least once in a month, by the method of three-stage stratified and cluster random sampling. Separate logistic regression analyses assessed the association between those receiving care in different types of setting and their socio-demographic characteristics. On average per 1,000 adults, 295 had at least one symptom, 217 considered seeking medical care, 173 consulted a physician, 129 visited western medical practitioners, 127 visited a hospital-based outpatient clinic, 78 visited traditional Chinese medical practitioners, 43 visited a primary care physician, 35 received care in an emergency department, 15 were hospitalized. Health care seeking behaviors varied with socio-demographic characteristics, such as gender, age, ethnicity, resident census register, marital status, education, income, and health insurance status. In term of primary care, the gate-keeping and referral roles of Community Health Centers have not yet been fully established in Beijing. This study represents a first attempt to map the medical care ecology of Beijing urban population and provides timely baseline information for health care reform in China.

Children With Intellectual Disability and Hospice Utilization: The Moderating Effect of Residential Care.

PubMed

Lindley, Lisa C

2017-01-01

Children with intellectual disability commonly lack access to pediatric hospice care services. Residential care may be a critical component in providing access to hospice care for children with intellectual disability. This research tested whether residential care intensifies the relationship between intellectual disability and hospice utilization (ie, hospice enrollment, hospice length of stay), while controlling for demographic characteristics. Multivariate regression analyses were conducted using 2008 to 2010 California Medicaid claims data. The odds of children with intellectual disability in residential care enrolling in hospice care were 3 times higher than their counterparts in their last year of life, when controlling for demographics. Residential care promoted hospice enrollment among children with intellectual disability. The interaction between intellectual disability and residential care was not related to hospice length of stay. Residential care did not attenuate or intensify the relationship between intellectual disability and hospice length of stay. The findings highlight the important role of residential care in facilitating hospice enrollment for children with intellectual disability. More research is needed to understand the capability of residential care staff to identify children with intellectual disability earlier in their end-of-life trajectory and initiate longer hospice length of stays.

Racial Differences in Predictors of Dental Care Use

PubMed Central

Gilbert, Gregg H; Shah, Ging R; Shelton, Brent J; Heft, Marc W; Bradford, Edward H; Chavers, L Scott

2002-01-01

Objective To test five hypotheses that non-Hispanic African Americans (AAs) and non-Hispanic whites (NHWs) differ in responsiveness to new dental symptoms by seeking dental care, and differ in certain predictors of dental care utilization. Data Sources/Study Setting Florida Dental Care Study, comprising AAs and NHWs 45 years old or older, who had at least one tooth, and who lived in north Florida. Study Design We used a prospective cohort design. The key outcome of interest was whether dental care was received in a given six-month period, after adjusting for the presence of certain time-varying and fixed characteristics. Data Collection/Extraction Methods In-person interviews were conducted at baseline and 24 months after baseline, with six-monthly telephone interviews in between. Principal Findings African Americans were less likely to seek dental care during follow-up, with or without adjusting for key predisposing, enabling, and oral health need characteristics. African Americans were more likely to be problem-oriented dental attenders, to be unable to pay an unexpected $500 dental bill, and to report postbaseline dental problems. However, the effect of certain postbaseline dental signs and symptoms on postbaseline dental care use differed between AAs and NHWs. Although financial circumstance was predictive for both groups, it was more salient for NHWs in separate NHW and AA regressions. Frustration with past dental care, propensity to use a homemade remedy, and dental insurance were significant predictors among AAs, but not among NHWs. The NHWs were much more likely to have sought care for preventive reasons. Conclusions Racial differences in responsiveness to new dental symptoms by seeking dental care were evident, as were differences in other predictors of dental care utilization. These differences may contribute to racial disparities in oral health. PMID:12546283

The potential influence of regionalization strategies on delivery of care for elective total joint arthroplasty.

PubMed

Dy, Christopher J; Marx, Robert G; Ghomrawi, Hassan M K; Pan, Ting Jung; Westrich, Geoffrey H; Lyman, Stephen

2015-01-01

Regionalization of total joint arthroplasty (TJA) to high volume hospitals (HVHs) may affect access to care and complication risk. Using administrative data, 2,560,314 patients who underwent primary total hip or knee arthroplasty from 1991 to 2006 were categorized by whether an HVH (>200 annual TJAs) was available locally. Associations among patient characteristics, hospital utilization, and in-hospital complications were estimated using regression modeling. The complication risk was higher (Odds Ratio 1.18 [95% CI: 1.16, 1.20]) if patients went to a local low volume hospital. Black and Medicaid patients were more likely to utilize the local low volume hospital than a local HVH. Utilizing a local HVH is associated with lower complication risks. However, patients from vulnerable groups were less likely to utilize these patterns. Copyright © 2014 Elsevier Inc. All rights reserved.

Does Medicaid Managed Care Help Equalize Racial and Ethnic Disparities in Utilization?

PubMed

Marton, James; Yelowitz, Aaron; Shores, Meredith; Talbert, Jeffery C

2016-06-01

To estimate the impact of different forms of Medicaid managed care (MMC) delivery on racial and ethnic disparities in utilization. Longitudinal, administrative data on 101,649 children in Kentucky continuously enrolled in Medicaid between January 1997 and June 1999. Outcomes considered are monthly professional, outpatient, and inpatient utilization. We apply an intent-to-treat, instrumental variables analysis using the staggered geographic implementation of MMC to create treatment and control groups of children. The implementation of MMC reduced monthly professional visits by a smaller degree for non-whites than whites (3.8 percentage points vs. 6.2 percentage points), thereby helping to equalize the initial racial/ethnic disparity in utilization. The Passport MMC program in the Louisville-centered region statistically significantly reduced disparities for professional visits (closing the gap by 8.0 percentage points), while the Kentucky Health Select MMC program in the Lexington-centered region did not. No substantive impact on disparities was found for either outpatient or inpatient utilization in either program. We find evidence that MMC has the possibility to reduce racial/ethnic disparities in professional utilization. More work is needed to determine which managed care program characteristics drive this result. © 2015 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust.

Inequalities in maternal health care utilization in Benin: a population based cross-sectional study.

PubMed

Yaya, Sanni; Uthman, Olalekan A; Amouzou, Agbessi; Ekholuenetale, Michael; Bishwajit, Ghose

2018-05-31

Ensuring equitable access to maternal health care including antenatal, delivery, postnatal services and fertility control methods, is one of the most critical challenges for public health sector. There are significant disparities in maternal health care indicators across many geographical locations, maternal, economic, socio-demographic factors in many countries in sub-Sahara Africa. In this study, we comparatively explored the utilization level of maternal health care, and examined disparities in the determinants of major maternal health outcomes. This paper used data from two rounds of Benin Demographic and Health Survey (BDHS) to examine the utilization and disparities in factors of maternal health care indicators using logistic regression models. Participants were 17,794 and 16,599 women aged between15-49 years in 2006 and 2012 respectively. Women's characteristics were reported in percentage, mean and standard deviation. Mean (±SD) age of the participants was 29.0 (±9.0) in both surveys. The percentage of at least 4 ANC visits was approximately 61% without any change between the two rounds of surveys, facility based delivery was 93.5% in 2012, with 4.9% increase from 2006; postnatal care was currently 18.4% and contraceptive use was estimated below one-fifth. The results of multivariable logistic regression models showed disparities in maternal health care service utilization, including antenatal care, facility-based delivery, postnatal care and contraceptive use across selected maternal factors. The current BHDS showed age, region, religion were significantly associated with maternal health care services. Educated women, those from households of high wealth index and women currently working were more likely to utilize maternal health care services, compared to women with no formal education, from poorest households or not currently employed. Women who watch television (TV) were 1.31 (OR = 1.31; 95% CI = 1.13-1.52), 1.69 (OR = 1.69; 95% CI = 1.20-2.37) and 1.38 (OR = 1.38; 95% CI = 1.16-1.65) times as likely to utilize maternal health care services after adjusting for other covariates. The findings would guide stakeholders to address inequalities in maternal health care services. More so, health care programmes and policies should be strengthened to enhance accessibility as well as improve the utilization of maternal care services, especially for the disadvantaged, uneducated and those who live in hard-to-reach rural areas in Benin. The Benin government needs to create strategies that cover both the supply and demand side factors at attain the universal health coverage.

Regional differences of maternal health care utilization in China.

PubMed

Tang, Mengsha; Wang, Debin; Hu, Hong; Wang, Guoping; Li, Rongjie

2015-03-01

To describe regional differences in maternal health care (MHC) utilization in China. Cross-sectional comparisons of 4 MHC utilization indicators, namely, early (13 weeks within pregnancy) examinations rate (EER), prenatal examination (>4 times) rate (PER), hospital delivery rate (HDR), and postnatal visit (>1 time) rate (PVR), using index of dissimilarity (ID), linear correlation analysis, and geographical mapping. Significant differences existed across regions in all the indicators (P < .01). All the IDs for rural areas were higher than that for urban areas. The IDs for major regions ranged from 0.01 to 0.27. Linear correlation coefficients between MHC utilization indicators by regions varied from 0.007 to 0.889 (in absolute value, P < .05). Characteristic formats of geographical distribution were found with PER, EER, HDR, and PVR being in "high-plateau," "low-plateau," and "shifting" patterns, respectively. There exist substantial regional discrepancies in MHC utilization in China and future MHC-related policies should take account regional context. © 2013 APJPH.

Exploring the link between ambulatory care and avoidable hospitalizations at the Veteran Health Administration.

PubMed

Pracht, Etienne E; Bass, Elizabeth

2011-01-01

This paper explores the link between utilization of ambulatory care and the likelihood of rehospitalization for an avoidable reason in veterans served by the Veteran Health Administration (VA). The analysis used administrative data containing healthcare utilization and patient characteristics stored at the national VA data warehouse, the Corporate Franchise Data Center. The study sample consisted of 284 veterans residing in Florida who had been hospitalized at least once for an avoidable reason. A bivariate probit model with instrumental variables was used to estimate the probability of rehospitalization. Veterans who had at least 1 ambulatory care visit per month experienced a significant reduction in the probability of rehospitalization for the same avoidable hospitalization condition. The findings suggest that ambulatory care can serve as an important substitute for more expensive hospitalization for the conditions characterized as avoidable. © 2011 National Association for Healthcare Quality.

Time Costs of Fertility Care: The Hidden Hardship of Building a Family

PubMed Central

Wu, Alex K; Elliott, Peter; Katz, Patricia P.; Smith, James F.

2013-01-01

Objective To determine the time infertile couples spend seeking and utilizing fertility care. Design Prospective cohort. Setting 8 community and academic infertility practices. Patients 319 couples presenting for a fertility evaluation. Interventions Face-to-face and telephone interviews and questionnaires. Main Outcome Measures Participants recorded diaries of time spent on provider visits, travel, telephone, and miscellaneous activities. Participants also recorded time off of work due to the physical and mental stress related to fertility care. Linear regression was used to assess relationship between fertility characteristics and time spent pursuing care. Results Diaries were completed by 319 subjects. Over an 18 month time period, the average time spent on fertility care was 125 hours, equating to 15.6 days, assuming an 8 hour work day. For couples utilizing cycle-based treatments (CBT), overall time spent pursuing care averaged 142 hours versus 58 hours for couples using other therapies, with the majority of time spent on provider visits (73 hours). After multivariable adjustment for clinical and sociodemographic characteristics, possessing a college degree and intensity of fertility treatment were independently associated with increased time spent pursuing fertility care. Furthermore, couples that spent the most time on care were significantly more likely to experience fertility related stress. Conclusions Over the course of 18 months of observation, couples pursuing fertility treatment dedicated large amounts of time to attaining their family building goals. This burden on couples adds to the already significant financial and emotional burdens of fertility treatment and provides new insight into the difficulties these couples face. PMID:23454007

Are community-living and institutionalized dementia patients cared for differently? Evidence on service utilization and costs of care from German insurance claims data

PubMed Central

2013-01-01

Background Dementia patients are often cared for in institutional arrangements, which are associated with substantial spending on professional long-term care services. Nevertheless, there is little evidence on the exact cost differences between community-based and institutional dementia care, especially when it comes to the distinct health care services. Adopting the perspective of the German social security system, which combines Statutory Health Insurance and Compulsory Long-Term Care Insurance (payer perspective), our study aimed to compare community-living and institutionalized dementia patients regarding their health care service utilization profiles and to contrast the respective expenditures. Methods We analysed 2006 claims data for 2,934 institutionalized and 5,484 community-living individuals stratified by so-called care levels, which reflect different needs for support in activities of daily living. Concordant general linear models adjusting for clinical and demographic differences were run for each stratum separately to estimate mean per capita utilization and expenditures in both settings. Subsequently, spending for the community-living and the institutionalized population as a whole was compared within an extended overall model. Results Regarding both settings, health and long-term care expenditures rose the higher the care level. Thus, long-term care spending was always increased in nursing homes, but health care spending was comparable. However, the underlying service utilization profiles differed, with nursing home residents receiving more frequent visits from medical specialists but fewer in-hospital services and anti-dementia drug prescriptions. Altogether, institutional care required additional yearly per capita expenses of ca. €200 on health and ca. €11,200 on long-term care. Conclusion Community-based dementia care is cost saving from the payer perspective due to substantially lower long-term care expenditures. Health care spending is comparable but community-living and institutionalized individuals present characteristic service utilization patterns. This apparently reflects the existence of setting-specific care strategies. However, the bare economic figures do not indicate whether these different concepts affect the quality of care provision and disregard patient preferences and caregiver-related aspects. Hence, additional research combining primary and secondary data seems to be required to foster both, sound allocation of scarce resources and the development of patient-centred dementia care in each setting. PMID:23286826

Are community-living and institutionalized dementia patients cared for differently? Evidence on service utilization and costs of care from German insurance claims data.

PubMed

Schwarzkopf, Larissa; Menn, Petra; Leidl, Reiner; Graessel, Elmar; Holle, Rolf

2013-01-03

Dementia patients are often cared for in institutional arrangements, which are associated with substantial spending on professional long-term care services. Nevertheless, there is little evidence on the exact cost differences between community-based and institutional dementia care, especially when it comes to the distinct health care services. Adopting the perspective of the German social security system, which combines Statutory Health Insurance and Compulsory Long-Term Care Insurance (payer perspective), our study aimed to compare community-living and institutionalized dementia patients regarding their health care service utilization profiles and to contrast the respective expenditures. We analysed 2006 claims data for 2,934 institutionalized and 5,484 community-living individuals stratified by so-called care levels, which reflect different needs for support in activities of daily living. Concordant general linear models adjusting for clinical and demographic differences were run for each stratum separately to estimate mean per capita utilization and expenditures in both settings. Subsequently, spending for the community-living and the institutionalized population as a whole was compared within an extended overall model. Regarding both settings, health and long-term care expenditures rose the higher the care level. Thus, long-term care spending was always increased in nursing homes, but health care spending was comparable. However, the underlying service utilization profiles differed, with nursing home residents receiving more frequent visits from medical specialists but fewer in-hospital services and anti-dementia drug prescriptions. Altogether, institutional care required additional yearly per capita expenses of ca. €200 on health and ca. €11,200 on long-term care. Community-based dementia care is cost saving from the payer perspective due to substantially lower long-term care expenditures. Health care spending is comparable but community-living and institutionalized individuals present characteristic service utilization patterns. This apparently reflects the existence of setting-specific care strategies. However, the bare economic figures do not indicate whether these different concepts affect the quality of care provision and disregard patient preferences and caregiver-related aspects. Hence, additional research combining primary and secondary data seems to be required to foster both, sound allocation of scarce resources and the development of patient-centred dementia care in each setting.

Physical and sexual violence and health care utilization in HIV-infected persons with alcohol problems

PubMed Central

LIEBSCHUTZ, J. M.; GEIER, J. L.; HORTON, N. J.; CHUANG, C. H.; SAMET, J. H.

2016-01-01

We examined interpersonal violence and its association with health care utilization and substance use severity among a cohort of 349 HIV-infected men and women with histories of alcohol problems assessed biannually up to 36 months. Data included demographics, lifetime interpersonal violence histories, age at first violence exposure, recent violence (prior six months), substance use severity and health care utilization (ambulatory visits, Emergency Department (ED) visits, hospitalizations) and adherence to HIV medication. Kaplan-Meier survival curves estimated the proportion of subjects experiencing recent violence. Generalized estimating equation regression models evaluated the relationship between recent violence, utilization and substance use severity over time, controlling for demographics, CD4 counts and depressive symptoms. Subject characteristics included: 79% male; mean age 41 years; 44% black, 33% white and 23% other. Eighty percent of subjects reported lifetime interpersonal violence: 40% physical violence alone, and 40% sexual violence with or without physical violence. First violence occurred prior to age 13 in 46%. Twenty-four (41%) of subjects reported recent violence by 24 and 36 months, respectively. In multivariate analyses, recent violence was associated with more ambulatory visits, ED visits and hospitalizations and worse substance use severity, but not medication adherence. Due to the high incidence and associated increased health care services utilization, violence prevention interventions should be considered for HIV-infected patients with a history of alcohol problems. PMID:16036243

Family planning advice and postpartum contraceptive use among low-income women in Mexico.

PubMed

Barber, Sarah L

2007-03-01

In Mexico, family planning advice has been incorporated into the clinical guidelines for prenatal care. However, the relationship between women's receipt of family planning advice during prenatal care and subsequent contraceptive use has not been evaluated. Data were collected in 2003 and 2004 in 17 Mexican states from 2,238 urban low-income women postpartum. Participating women reported on prenatal services received and contraceptive use. Logistic and multinomial logistic regression models evaluated whether receiving family planning advice during prenatal care predicted current contraceptive use, after quality of care in the community, service utilization, delivery characteristics, household socioeconomic characteristics, and maternal and infant characteristics were controlled for. Overall, 47% of women used a modern contraceptive method. Women who received family planning advice during prenatal care were more likely to use a contraceptive than were those who did not receive such advice (odds ratio, 2.2). Women who received family planning advice had a higher probability of using condoms (relative risk ratio, 2.3) and IUDs (5.2), and of undergoing sterilization (1.4), than of using no method. Integrating family planning advice into prenatal care may be an important strategy for reaching women when their demand for contraception is high.

Clinical and health care use characteristics of patients newly starting allopurinol, febuxostat, and colchicine for the treatment of gout.

PubMed

Kim, Seoyoung C; Schmidt, Bernhard M W; Franklin, Jessica M; Liu, Jun; Solomon, Daniel H; Schneeweiss, Sebastian

2013-12-01

Gout is a common form of inflammatory arthritis with an increasing prevalence in developed countries. It is well known that many patients with gout have significant comorbidities and high health care utilization. We aimed to describe the clinical characteristics and health care utilization patterns in patients with gout who were newly prescribed allopurinol, febuxostat, or colchicine. We used US insurance claims data (2009-2011) to conduct a population-based cohort study. There were 25,051 allopurinol, 4,288 febuxostat, and 6,238 colchicine initiators. The mean age was 53 years and 83-87% were men. More than one-half of the patients had hypertension and hyperlipidemia, 20% had diabetes mellitus, and 10% had cardiovascular disease. The mean uric acid level was similar across the groups at baseline, ranging from 8.1-8.5 mg/dl. Compared with allopurinol or colchicine initiators, febuxostat initiators had more comorbidities and greater health care utilization, including outpatient, inpatient, or emergency room visits, both at baseline and during followup. Use of gout-related drugs such as opioids, steroids, and nonsteroidal antiinflammatory drugs was most common in febuxostat initiators and least common in colchicine initiators. The median daily doses at both the start and end of treatment were 300 mg for allopurinol, 40 mg for febuxostat, and 1.2 mg for colchicine. The doses of allopurinol and febuxostat were rarely increased during followup. Patients who started allopurinol, febuxostat, or colchicine for gout generally had hyperuricemia and multiple comorbidities. Febuxostat initiators had more comorbidities and greater use of health care resources and gout-related drugs than the other groups. Overall, the doses of allopurinol or febuxostat remained unchanged over time. Copyright © 2013 by the American College of Rheumatology.

Study of Dynamic Characteristics of Aeroelastic Systems Utilizing Randomdec Signatures

NASA Technical Reports Server (NTRS)

Chang, C. S.

1975-01-01

The feasibility of utilizing the random decrement method in conjunction with a signature analysis procedure to determine the dynamic characteristics of an aeroelastic system for the purpose of on-line prediction of potential on-set of flutter was examined. Digital computer programs were developed to simulate sampled response signals of a two-mode aeroelastic system. Simulated response data were used to test the random decrement method. A special curve-fit approach was developed for analyzing the resulting signatures. A number of numerical 'experiments' were conducted on the combined processes. The method is capable of determining frequency and damping values accurately from randomdec signatures of carefully selected lengths.

Regional health care planning: a methodology to cluster facilities using community utilization patterns

PubMed Central

2013-01-01

Background Community-based health care planning and regulation necessitates grouping facilities and areal units into regions of similar health care use. Limited research has explored the methodologies used in creating these regions. We offer a new methodology that clusters facilities based on similarities in patient utilization patterns and geographic location. Our case study focused on Hospital Groups in Michigan, the allocation units used for predicting future inpatient hospital bed demand in the state’s Bed Need Methodology. The scientific, practical, and political concerns that were considered throughout the formulation and development of the methodology are detailed. Methods The clustering methodology employs a 2-step K-means + Ward’s clustering algorithm to group hospitals. The final number of clusters is selected using a heuristic that integrates both a statistical-based measure of cluster fit and characteristics of the resulting Hospital Groups. Results Using recent hospital utilization data, the clustering methodology identified 33 Hospital Groups in Michigan. Conclusions Despite being developed within the politically charged climate of Certificate of Need regulation, we have provided an objective, replicable, and sustainable methodology to create Hospital Groups. Because the methodology is built upon theoretically sound principles of clustering analysis and health care service utilization, it is highly transferable across applications and suitable for grouping facilities or areal units. PMID:23964905

Regional health care planning: a methodology to cluster facilities using community utilization patterns.

PubMed

Delamater, Paul L; Shortridge, Ashton M; Messina, Joseph P

2013-08-22

Community-based health care planning and regulation necessitates grouping facilities and areal units into regions of similar health care use. Limited research has explored the methodologies used in creating these regions. We offer a new methodology that clusters facilities based on similarities in patient utilization patterns and geographic location. Our case study focused on Hospital Groups in Michigan, the allocation units used for predicting future inpatient hospital bed demand in the state's Bed Need Methodology. The scientific, practical, and political concerns that were considered throughout the formulation and development of the methodology are detailed. The clustering methodology employs a 2-step K-means + Ward's clustering algorithm to group hospitals. The final number of clusters is selected using a heuristic that integrates both a statistical-based measure of cluster fit and characteristics of the resulting Hospital Groups. Using recent hospital utilization data, the clustering methodology identified 33 Hospital Groups in Michigan. Despite being developed within the politically charged climate of Certificate of Need regulation, we have provided an objective, replicable, and sustainable methodology to create Hospital Groups. Because the methodology is built upon theoretically sound principles of clustering analysis and health care service utilization, it is highly transferable across applications and suitable for grouping facilities or areal units.

Stratified cost-utility analysis of C-Leg versus mechanical knees: Findings from an Italian sample of transfemoral amputees.

PubMed

Cutti, Andrea Giovanni; Lettieri, Emanuele; Del Maestro, Martina; Radaelli, Giovanni; Luchetti, Martina; Verni, Gennero; Masella, Cristina

2017-06-01

The fitting rate of the C-Leg electronic knee (Otto-Bock, D) has increased steadily over the last 15 years. Current cost-utility studies, however, have not considered the patients' characteristics. To complete a cost-utility analysis involving C-Leg and mechanical knee users; "age at the time of enrollment," "age at the time of first prosthesis," and "experience with the current type of prosthesis" are assumed as non-nested stratification parameters. Cohort retrospective. In all, 70 C-Leg and 57 mechanical knee users were selected. For each stratification criteria, we evaluated the cost-utility of C-Leg versus mechanical knees by computing the incremental cost-utility ratio, that is, the ratio of the "difference in cost" and the "difference in utility" of the two technologies. Cost consisted of acquisition, maintenance, transportation, and lodging expenses. Utility was measured in terms of quality-adjusted life years, computed on the basis of participants' answers to the EQ-5D questionnaire. Patients over 40 years at the time of first prosthesis were the only group featuring an incremental cost-utility ratio (88,779 €/quality-adjusted life year) above the National Institute for Health and Care Excellence practical cost-utility threshold (54,120 €/quality-adjusted live year): C-Leg users experience a significant improvement of "mobility," but limited outcomes on "usual activities," "self-care," "depression/anxiety," and reduction of "pain/discomfort." The stratified cost-utility results have relevant clinical implications and provide useful information for practitioners in tailoring interventions. Clinical relevance A cost-utility analysis that considered patients characteristics provided insights on the "affordability" of C-Leg compared to mechanical knees. In particular, results suggest that C-Leg has a significant impact on "mobility" for first-time prosthetic users over 40 years, but implementation of specific low-cost physical/psychosocial interventions is required to retun within cost-utility thresholds.

Understanding the context of healthcare utilization: assessing environmental and provider-related variables in the behavioral model of utilization.

PubMed Central

Phillips, K A; Morrison, K R; Andersen, R; Aday, L A

1998-01-01

OBJECTIVE: The behavioral model of utilization, developed by Andersen, Aday, and others, is one of the most frequently used frameworks for analyzing the factors that are associated with patient utilization of healthcare services. However, the use of the model for examining the context within which utilization occurs-the role of the environment and provider-related factors-has been largely neglected. OBJECTIVE: To conduct a systematic review and analysis to determine if studies of medical care utilization that have used the behavioral model during the last 20 years have included environmental and provider-related variables and the methods used to analyze these variables. We discuss barriers to the use of these contextual variables and potential solutions. DATA SOURCES: The Social Science Citation Index and Science Citation Index. We included all articles from 1975-1995 that cited any of three key articles on the behavioral model, that included all articles that were empirical analyses and studies of formal medical care utilization, and articles that specifically stated their use of the behavioral model (n = 139). STUDY DESIGN: Design was a systematic literature review. DATA ANALYSIS: We used a structured review process to code articles on whether they included contextual variables: (1) environmental variables (characteristics of the healthcare delivery system, external environment, and community-level enabling factors); and (2) provider-related variables (patient factors that may be influenced by providers and provider characteristics that interact with patient characteristics to influence utilization). We also examined the methods used in studies that included contextual variables. PRINCIPAL FINDINGS: Forty-five percent of the studies included environmental variables and 51 percent included provider-related variables. Few studies examined specific measures of the healthcare system or provider characteristics or used methods other than simple regression analysis with hierarchical entry of variables. Only 14 percent of studies analyzed the context of healthcare by including both environmental and provider-related variables as well as using relevant methods. CONCLUSIONS: By assessing whether and how contextual variables are used, we are able to highlight the contributions made by studies using these approaches, to identify variables and methods that have been relatively underused, and to suggest solutions to barriers in using contextual variables. PMID:9685123

Measuring utilization and impact of home care services: a systems model approach for cost effectiveness.

PubMed

Day, S R

1984-01-01

The relevance of home care research to policy questions is discussed as framework for study on "effects" (precursors and sequelae) of home care. This study used a large, multi-service agency's longitudinal (8-year) case records (N = 2436) to examine a system model for relationships among entry characteristics, utilization of services, and need for services upon discharge from home care. Deducing case-mix from utilization patterns, pay plan at entry was identified as best of the available predictors of both duration and intensity (using multivariate analysis). Duration and intensity, dual contributors to "total visits," were found to vary inversely and were predicted by different entering pay plans. While 1/3 of all cases were discharged to informal or self care, that was the most prevalent exit status of the clients (49%) who entered directly from hospital care. The methods used in disaggregating and analyzing these retrospectively-coded case records suggest that home services research: 1. distinguish type, intensity, and duration as components of "total visits" which combine to account for costs of care; 2. find concomitants of functional level (such as pay plan) which are accessible for designating case mix for purpose of projecting service use; 3. measure effectiveness in terms relevant to stated objectives of the long term care system, which need to acknowledge mortality and to separate service needs at entry room those at exist from the series of formal and informal providers on a continuum of care.

Patterns of Cost for Patients Dying in the Intensive Care Unit and Implications for Cost Savings of Palliative Care Interventions

PubMed Central

Benkeser, David; Coe, Norma B.; Engelberg, Ruth A.; Teno, Joan M.; Curtis, J. Randall

2016-01-01

Abstract Background: Terminal intensive care unit (ICU) stays represent an important target to increase value of care. Objective: To characterize patterns of daily costs of ICU care at the end of life and, based on these patterns, examine the role for palliative care interventions in enhancing value. Design: Secondary analysis of an intervention study to improve quality of care for critically ill patients. Setting/Patients: 572 patients who died in the ICU between 2003 and 2005 at a Level-1 trauma center. Methods: Data were linked with hospital financial records. Costs were categorized into direct fixed, direct variable, and indirect costs. Patterns of daily costs were explored using generalized estimating equations stratified by length of stay, cause of death, ICU type, and insurance status. Estimates from the literature of effects of palliative care interventions on ICU utilization were used to simulate potential cost savings under different time horizons and reimbursement models. Main Results: Mean cost for a terminal ICU stay was 39.3K ± 45.1K. Direct fixed costs represented 45% of total hospital costs, direct variable costs 20%, and indirect costs 34%. Day of admission was most expensive (mean 9.6K ± 7.6K); average cost for subsequent days was 4.8K ± 3.4K and stable over time and patient characteristics. Conclusions: Terminal ICU stays display consistent cost patterns across patient characteristics. Savings can be realized with interventions that align care with patient preferences, helping to prevent unwanted ICU utilization at end of life. Cost modeling suggests that implications vary depending on time horizon and reimbursement models. PMID:27813724

Rural health care bypass behavior: how community and spatial characteristics affect primary health care selection.

PubMed

Sanders, Scott R; Erickson, Lance D; Call, Vaughn R A; McKnight, Matthew L; Hedges, Dawson W

2015-01-01

(1) To assess the prevalence of rural primary care physician (PCP) bypass, a behavior in which residents travel farther than necessary to obtain health care, (2) To examine the role of community and non-health-care-related characteristics on bypass behavior, and (3) To analyze spatial bypass patterns to determine which rural communities are most affected by bypass. Data came from the Montana Health Matters survey, which gathered self-reported information from Montana residents on their health care utilization, satisfaction with health care services, and community and demographic characteristics. Logistic regression and spatial analysis were used to examine the probability and spatial patterns of bypass. Overall, 39% of respondents bypass local health care. Similar to previous studies, dissatisfaction with local health care was found to increase the likelihood of bypass. Dissatisfaction with local shopping also increases the likelihood of bypass, while the number of friends in a community, and commonality with community reduce the likelihood of bypass. Other significant factors associated with bypass include age, income, health, and living in a highly rural community or one with high commuting flows. Our results suggest that outshopping theory, in which patients bundle services and shopping for added convenience, extends to primary health care selection. This implies that rural health care selection is multifaceted, and that in addition to perceived satisfaction with local health care, the quality of local shopping and levels of community attachment also influence bypass behavior. © 2014 National Rural Health Association.

Association Between Facility-Level Utilization of Non-pharmacologic Chronic Pain Treatment and Subsequent Initiation of Long-Term Opioid Therapy.

PubMed

Carey, Evan P; Nolan, Charlotte; Kerns, Robert D; Ho, P Michael; Frank, Joseph W

2018-05-01

Expert guidelines recommend non-pharmacologic treatments and non-opioid medications for chronic pain and recommend against initiating long-term opioid therapy (LTOT). We examined whether veterans with incident chronic pain receiving care at facilities with greater utilization of non-pharmacologic treatments and non-opioid medications are less likely to initiate LTOT. Retrospective cohort study PARTICIPANTS: Veterans receiving primary care from a Veterans Health Administration facility with incident chronic pain between 1/1/2010 and 12/31/2015 based on either of 2 criteria: (1) persistent moderate-to-severe patient-reported pain and (2) diagnoses "likely to represent" chronic pain. The independent variable was facility-level utilization of pain-related treatment modalities (non-pharmacologic, non-opioid medications, LTOT) in the prior calendar year. The dependent variable was patient-level initiation of LTOT (≥ 90 days within 365 days) in the subsequent year, adjusting for patient characteristics. Among 1,094,569 veterans with incident chronic pain from 2010 to 2015, there was wide facility-level variation in utilization of 10 pain-related treatment modalities, including initiation of LTOT (median, 16%; range, 5-32%). Veterans receiving care at facilities with greater utilization of non-pharmacologic treatments were less likely to initiate LTOT in the year following incident chronic pain. Conversely, veterans receiving care at facilities with greater non-opioid and opioid medication utilization were more likely to initiate LTOT; this association was strongest for past year facility-level LTOT initiation (adjusted rate ratio, 2.10; 95% confidence interval, 2.06-2.15, top vs. bottom quartile of facility-level LTOT initiation in prior calendar year). Facility-level utilization patterns of non-pharmacologic, non-opioid, and opioid treatments for chronic pain are associated with subsequent patient-level initiation of LTOT among veterans with incident chronic pain. Further studies should seek to understand facility-level variation in chronic pain care and to identify facility-level utilization patterns that are associated with improved patient outcomes.

[Dependency levels and health care services' utilization in psychiatric hospitals in Aragon (Spain)].

PubMed

de Miguel, Marcos; Torrijos, Mónica; Abad, José María; Lou, Marta Luz

2004-01-01

To determine the characteristics of patients living in psychiatric hospitals in Aragon, to assess their dependency levels, and to analyze health care services' utilization by these patients. We performed a cross-sectional study between July 1 and November 31. The questionnaire used was the Resident Assessment Instrument- Mental Health (RAI-MH). The sample consisted of 437 patients living in public psychiatric hospitals in Aragon. These hospitals provide care to chronically mentally ill patients and to patients undergoing rehabilitation. The Resource Utilization Group (RUG-I) system was used to classify patients by their dependency levels for activities of daily life (ADL). Of the 437 patients, 259 (59.3%) were men with a mean age of 62.2 years. A total of 82.1% of the patients were classified as RUG-I group 1. Patients in groups 1 and 2 required more formal health care services. At least one visit by a psychiatrist was required by 25.3% of patients in group 1 and by 15.2% of those in group 2 compared with no visits by the other groups. Nursing interventions were more frequently required by patients in the more dependent groups. All of the of patients in groups 2 to 8 needed daily physical assistance for ADL vs. 26.3% of those in group 1. In the multivariate analysis, predictive variables were the hospital and type of unit. There is wide variation in health care services' utilization by patients living in psychiatric hospitals, which is related to dependency levels. Many psychiatric patients do not need formal psychiatric care. Health care professionals should assess the real needs of patients to provide each of them with appropriate care.

Health care service utilization and associated factors among heroin users in northern Taiwan.

PubMed

Chen, Yi-Chih; Chen, Chih-Ken; Lin, Shih-Ku; Chiang, Shu-Chuan; Su, Lien-Wen; Wang, Liang-Jen

2013-11-01

Due to the needs of medical care, the probability of using health care service from heroin users is high. This cross-sectional study investigated the frequency and correlates of health service utilization among heroin users. From June to September 2006, 124 heroin users (110 males and 14 females, mean age: 34.2 ± 8.3 years) who entered two psychiatric hospitals (N = 83) and a detention center (N = 41) in northern Taiwan received a face-to-face interview. Therefore, socio-demographic characteristics, patterns of drug use, psychiatric comorbidities, blood-borne infectious diseases and health service utilization were recorded. The behaviors of health service utilization were classified into the frequency of out-patient department visit and hospitalization, as well as the purchase of over-the-counter drugs. During 12 months prior to interview, 79.8% of the participants attended health care service at least once. The rate of having any event in out-patients service visit, hospitalization, and over-the-counter drugs were 66.1%, 29.8% and 25.8% respectively. The frequency of health service utilization was associated with numerous factors. Among these factors, patients who were recruited from hospital and having a mood disorder were conjoint predictors of out-patient department visit, hospitalization and purchase of over-the-counter drugs. According to the results of this study, social education and routine screening for mood disorders can help heroin users to obtain adequate health care service. The findings of this study are useful references for targeting the heroin users for whom a successful intervention represents the greatest cost benefit. © 2013 Elsevier Ltd. All rights reserved.

A longitudinal model of the dynamics between HMOs' consumer-friendliness and preventive health care utilization.

PubMed

Xiao, Qian; Savage, Grant T; Zhuang, Weiling

2014-01-01

This study aims at replicating and extending Xiao and Savage's (2008) research to understand the multidimensional aspect of HMOs distinguished by HMOs' consumer-friendliness, and their relationship to consumers' preventive care utilization. This study develops a dynamic model to consider both concurrent and time lagging effects of HMOs' consumer-friendliness. Our data analysis discloses similar relationship patterns as revealed by Xiao and Savage. Additionally, our findings reveal the time-series changes of the influence of HMOs' consumer-friendliness that either the effects of early experienced HMOs' consumer-friendliness wear out totally or HMOs' consumer-friendly characteristics on the concurrent term contain most of the explanatory power.

The use of dental care facilities and oral health: a multilevel approach of schoolchildren in the Brazilian context.

PubMed

Antunes, José Leopoldo; Peres, Marco Aurélio; Jahn, Graciela Medeiros Jabôr; Levy, Bárbara Bianca da Silva

2006-01-01

To appraise the association between dental care utilisation and gingival status in the Brazilian context, controlling for covariates on socio-demographic characteristics and dentofacial anomalies (12-year-old children). A survey of oral health comprising 5780 schoolchildren in 35 towns of the state of São Paulo, Brazil, provided primary information regarding the assessment of the community periodontal index. The survey also provided information on socio-demographic characteristics and the dental aesthetic index of participants. The utilization of dental services was measured at the town-level, in terms of the dental care index (F/DMFT ratio). Multilevel models of logistic regression fitted the adjustment of covariates for gingival bleeding on probing and calculus. Almost 32% of the children examined presented unhealthy gingival conditions, with a significantly poorer profile for boys, black children and those enrolled in public schools than for their counterparts. Several dentofacial anomalies associated with unhealthy gingival status: crowding of the incisal segments, maxillary and mandibular irregularity, antero posterior molar relation, maxillary overjet and vertical anterior openbite. Towns with a higher dental care index presented a lower proportion of children with gingival bleeding and calculus. This study confirmed previous observations of boys, blacks and children enrolled in public schools as presenting poorer oral health status than their counterparts in the Brazilian context. The utilization of dental services was significantly associated with improved profile of gingival status of participating towns, and this association is unlikely to be due to insufficient control of confounding on socio-demographic characteristics and dentofacial anomalies.

Differences Among Older Adults in the Types of Dental Services Used in the United States

PubMed Central

Manski, Richard J.; Hyde, Jody Schimmel; Chen, Haiyan; Moeller, John F.

2016-01-01

The purpose of this article is to explore differences in the socioeconomic, demographic characteristics of older adults in the United States with respect to their use of different types of dental care services. The 2008 Health and Retirement Study (HRS) collected information about patterns of dental care use and oral health from individuals aged 55 years and older in the United States. We analyze these data and explore patterns of service use by key characteristics before modeling the relationship between service use type and those characteristics. The most commonly used service category was fillings, inlays, or bonding, reported by 43.6% of those with any utilization. Just over one third of those with any utilization reported a visit for a crown, implant, or prosthesis, and one quarter reported a gum treatment or tooth extraction. The strongest consistent predictors of use type are denture, dentate, and oral health status along with dental insurance coverage and wealth. Our results provide insights into the need for public policies to address inequalities in access to dental services among an older US population. Our findings show that lower income, less wealthy elderly with poor oral health are more likely to not use any dental services rather than using only preventive dental care, and that cost prevents most non-users who say they need dental care from going to the dentist. These results suggest a serious access problem and one that ultimately produces even worse oral health and expensive major procedures for this population in the future. PMID:27284127

Exploring the usefulness of comprehensive care plans for children with medical complexity (CMC): a qualitative study.

PubMed

Adams, Sherri; Cohen, Eyal; Mahant, Sanjay; Friedman, Jeremy N; Macculloch, Radha; Nicholas, David B

2013-01-19

The Medical Home model recommends that Children with Special Health Care Needs (CSHCN) receive a medical care plan, outlining the child's major medical issues and care needs to assist with care coordination. While care plans are a primary component of effective care coordination, the creation and maintenance of care plans is time, labor, and cost intensive, and the desired content of the care plan has not been studied. The purpose of this qualitative study was to understand the usefulness and desired content of comprehensive care plans by exploring the perceptions of parents and health care providers (HCPs) of children with medical complexity (CMC). This qualitative study utilized in-depth semi-structured interviews and focus groups. HCPs (n = 15) and parents (n = 15) of CMC who had all used a comprehensive care plan were recruited from a tertiary pediatric academic health sciences center. Themes were identified through grounded theory analysis of interview and focus group data. A multi-dimensional model of perceived care plan usefulness emerged. The model highlights three integral aspects of the care plan: care plan characteristics, activating factors and perceived outcomes of using a care plan. Care plans were perceived as a useful tool that centralized and focused the care of the child. Care plans were reported to flatten the hierarchical relationship between HCPs and parents, resulting in enhanced reciprocal information exchange and strengthened relationships. Participants expressed that a standardized template that is family-centered and includes content relevant to both the medical and social needs of the child is beneficial when integrated into overall care planning and delivery for CMC. Care plans are perceived to be a useful tool to both health care providers and parents of CMC. These findings inform the utility and development of a comprehensive care plan template as well as a model of how and when to best utilize care plans within family-centered models of care.

Can differences in breast cancer utilities explain disparities in breast cancer care?

PubMed

Schleinitz, Mark D; DePalo, Dina; Blume, Jeffrey; Stein, Michael

2006-12-01

Black, older, and less affluent women are less likely to receive adjuvant breast cancer therapy than their counterparts. Whereas preference contributes to disparities in other health care scenarios, it is unclear if preference explains differential rates of breast cancer care. To ascertain utilities from women of diverse backgrounds for the different stages of, and treatments for, breast cancer and to determine whether a treatment decision modeled from utilities is associated with socio-demographic characteristics. A stratified sample (by age and race) of 156 English-speaking women over 25 years old not currently undergoing breast cancer treatment. We assessed utilities using standard gamble for 5 breast cancer stages, and time-tradeoff for 3 therapeutic modalities. We incorporated each subject's utilities into a Markov model to determine whether her quality-adjusted life expectancy would be maximized with chemotherapy for a hypothetical, current diagnosis of stage II breast cancer. We used logistic regression to determine whether socio-demographic variables were associated with this optimal strategy. Median utilities for the 8 health states were: stage I disease, 0.91 (interquartile range 0.50 to 1.00); stage II, 0.75 (0.26 to 0.99); stage III, 0.51 (0.25 to 0.94); stage IV (estrogen receptor positive), 0.36 (0 to 0.75); stage IV (estrogen receptor negative), 0.40 (0 to 0.79); chemotherapy 0.50 (0 to 0.92); hormonal therapy 0.58 (0 to 1); and radiation therapy 0.83 (0.10 to 1). Utilities for early stage disease and treatment modalities, but not metastatic disease, varied with socio-demographic characteristics. One hundred and twenty-two of 156 subjects had utilities that maximized quality-adjusted life expectancy given stage II breast cancer with chemotherapy. Age over 50, black race, and low household income were associated with at least 5-fold lower odds of maximizing quality-adjusted life expectancy with chemotherapy, whereas women who were married or had a significant other were 4-fold more likely to maximize quality-adjusted life expectancy with chemotherapy. Differences in utility for breast cancer health states may partially explain the lower rate of adjuvant therapy for black, older, and less affluent women. Further work must clarify whether these differences result from health preference alone or reflect women's perceptions of sources of disparity, such as access to care, poor communication with providers, limitations in health knowledge or in obtaining social and workplace support during therapy.

Where's the evidence? a systematic review of economic analyses of residential aged care infrastructure.

PubMed

Easton, Tiffany; Milte, Rachel; Crotty, Maria; Ratcliffe, Julie

2017-03-21

Residential care infrastructure, in terms of the characteristics of the organisation (such as proprietary status, size, and location) and the physical environment, have been found to directly influence resident outcomes. This review aimed to summarise the existing literature of economic evaluations of residential care infrastructure. A systematic review of English language articles using AgeLine, CINAHL, Econlit, Informit (databases in Health; Business and Law; Social Sciences), Medline, ProQuest, Scopus, and Web of Science with retrieval up to 14 December 2015. The search strategy combined terms relating to nursing homes, economics, and older people. Full economic evaluations, partial economic evaluations, and randomised trials reporting more limited economic information, such as estimates of resource use or costs of interventions were included. Data was extracted using predefined data fields and synthesized in a narrative summary to address the stated review objective. Fourteen studies containing an economic component were identified. None of the identified studies attempted to systematically link costs and outcomes in the form of a cost-benefit, cost-effectiveness, or cost-utility analysis. There was a wide variation in approaches taken for valuing the outcomes associated with differential residential care infrastructures: 8 studies utilized various clinical outcomes as proxies for the quality of care provided, and 2 focused on resident outcomes including agitation, quality of life, and the quality of care interactions. Only 2 studies included residents living with dementia. Robust economic evidence is needed to inform aged care facility design. Future research should focus on identifying appropriate and meaningful outcome measures that can be used at a service planning level, as well as the broader health benefits and cost-saving potential of different organisational and environmental characteristics in residential care. International Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42015015977 .

Implications of workforce and financing changes for primary care practice utilization, revenue, and cost: a generalizable mathematical model for practice management.

PubMed

Basu, Sanjay; Landon, Bruce E; Song, Zirui; Bitton, Asaf; Phillips, Russell S

2015-02-01

Primary care practice transformations require tools for policymakers and practice managers to understand the financial implications of workforce and reimbursement changes. To create a simulation model to understand how practice utilization, revenues, and expenses may change in the context of workforce and financing changes. We created a simulation model estimating clinic-level utilization, revenues, and expenses using user-specified or public input data detailing practice staffing levels, salaries and overhead expenditures, patient characteristics, clinic workload, and reimbursements. We assessed whether the model could accurately estimate clinic utilization, revenues, and expenses across the nation using labor compensation, medical expenditure, and reimbursements databases, as well as cost and revenue data from independent practices of varying size. We demonstrated the model's utility in a simulation of how utilization, revenue, and expenses would change after hiring a nurse practitioner (NP) compared with hiring a part-time physician. Modeled practice utilization and revenue closely matched independent national utilization and reimbursement data, disaggregated by patient age, sex, race/ethnicity, insurance status, and ICD diagnostic group; the model was able to estimate independent revenue and cost estimates, with highest accuracy among larger practices. A demonstration analysis revealed that hiring an NP to work independently with a subset of patients diagnosed with diabetes or hypertension could increase net revenues, if NP visits involve limited MD consultation or if NP reimbursement rates increase. A model of utilization, revenue, and expenses in primary care practices may help policymakers and managers understand the implications of workforce and financing changes.

Community health workers and health care delivery: evaluation of a women's reproductive health care project in a developing country.

PubMed

Wajid, Abdul; White, Franklin; Karim, Mehtab S

2013-01-01

As part of the mid-term evaluation of a Women's Health Care Project, a study was conducted to compare the utilization of maternal and neonatal health (MNH) services in two areas with different levels of service in Punjab, Pakistan. A cross-sectional survey was conducted to interview Married Women of Reproductive Age (MWRA). Information was collected on MWRA knowledge regarding danger signs during pregnancy, delivery, postnatal periods, and MNH care seeking behavior. After comparing MNH service utilization, the two areas were compared using a logistic regression model, to identify the association of different factors with the intervention after controlling for socio-demographic, economic factors and distance of the MWRA residence to a health care facility. The demographic characteristics of women in the two areas were similar, although socioeconomic status as indicated by level of education and better household amenities, was higher in the intervention area. Consequently, on univariate analysis, utilization of MNH services: antenatal care, TT vaccination, institutional delivery and use of modern contraceptives were higher in the intervention than control area. Nonetheless, multivariable analysis controlling for confounders such as socioeconomic status revealed that utilization of antenatal care services at health centers and TT vaccination during pregnancy are significantly associated with the intervention. Our findings suggest positive changes in health care seeking behavior of women and families with respect to MNH. Some aspects of care still require attention, such as knowledge about danger signs and neonatal care, especially umbilical cord care. Despite overall success achieved so far in response to the Millennium Development Goals, over the past two decades decreases in maternal mortality are far from the 2015 target. This report identifies some of the key factors to improving MNH and serves as an interim measure of a national and global challenge that remains a work in progress.

Community Health Workers and Health Care Delivery: Evaluation of a Women's Reproductive Health Care Project in a Developing Country

PubMed Central

Wajid, Abdul; White, Franklin; Karim, Mehtab S.

2013-01-01

Background As part of the mid-term evaluation of a Women's Health Care Project, a study was conducted to compare the utilization of maternal and neonatal health (MNH) services in two areas with different levels of service in Punjab, Pakistan. Methods A cross-sectional survey was conducted to interview Married Women of Reproductive Age (MWRA). Information was collected on MWRA knowledge regarding danger signs during pregnancy, delivery, postnatal periods, and MNH care seeking behavior. After comparing MNH service utilization, the two areas were compared using a logistic regression model, to identify the association of different factors with the intervention after controlling for socio-demographic, economic factors and distance of the MWRA residence to a health care facility. Results The demographic characteristics of women in the two areas were similar, although socioeconomic status as indicated by level of education and better household amenities, was higher in the intervention area. Consequently, on univariate analysis, utilization of MNH services: antenatal care, TT vaccination, institutional delivery and use of modern contraceptives were higher in the intervention than control area. Nonetheless, multivariable analysis controlling for confounders such as socioeconomic status revealed that utilization of antenatal care services at health centers and TT vaccination during pregnancy are significantly associated with the intervention. Conclusions Our findings suggest positive changes in health care seeking behavior of women and families with respect to MNH. Some aspects of care still require attention, such as knowledge about danger signs and neonatal care, especially umbilical cord care. Despite overall success achieved so far in response to the Millennium Development Goals, over the past two decades decreases in maternal mortality are far from the 2015 target. This report identifies some of the key factors to improving MNH and serves as an interim measure of a national and global challenge that remains a work in progress. PMID:24086541

Physician behavior as a determinant of utilization patterns: the case of abortion.

PubMed Central

Nathanson, C A; Becker, M H

1978-01-01

Health services utilization may be influenced by the structure of the health system and the behavior of health professionals as well as by the actions of individual patients. This research examines the responses of obstetricians toward women seeking abortion. The population for this study includes all obstetrician-gynecologists with any private practice in Maryland during 1975 (473). Each responding physician (443) was presented with a case history vignette describing, in a telephone interview, a woman who is pregnant and considering an abortion. The sociodemographic characteristics of the woman were systematically varied to determine effects of patient attributes on physicians' patient management decisions. Decisions to refer the patient or to participate personally in her care were found to be associated most strongly with the patients' financial resources. Three hundred and twelve obstetricians returned a mail questionnaire, probing their own attitudes and characteristics. Physicians' liberal or conservative attitudes toward expansion of reproductive health care services and their level of disturbance by the abortion procedure were also influential in these patient management decisions. Simultaneous examination of both patient and physician characteristics indicated that the former had the greater weight in accounting for referral decisions. PMID:717619

Regional variation in health care utilization in Sweden - the importance of demand-side factors.

PubMed

Johansson, Naimi; Jakobsson, Niklas; Svensson, Mikael

2018-06-04

Differences in health care utilization across geographical areas are well documented within several countries. If the variation across areas cannot be explained by differences in medical need, it can be a sign of inefficiency or misallocation of public health care resources. In this observational, longitudinal panel study we use regional level data covering the 21 Swedish regions (county councils) over 13 years and a random effects model to assess to what degree regional variation in outpatient physician visits is explained by observed demand factors such as health, demography and socio-economic factors. The results show that regional mortality, as a proxy for population health, and demography do not explain regional variation in visits to primary care physicians, but explain about 50% of regional variation in visits to outpatient specialists. Adjusting for socio-economic and basic supply-side factors explains 33% of the regional variation in primary physician visits, but adds nothing to explaining the variation in specialist visits. 50-67% of regional variation remains unexplained by a large number of observable regional characteristics, indicating that omitted and possibly unobserved factors contribute substantially to the regional variation. We conclude that variations in health care utilization across regions is not very well explained by underlying medical need and demand, measured by mortality, demographic and socio-economic factors.

Effect of Direct-to-Consumer Advertising on Statin Use in the United States.

PubMed

Chang, Hsien-Yen; Murimi, Irene; Daubresse, Matthew; Qato, Dima M; Emery, Sherry L; Alexander, G Caleb

2017-08-01

The value of direct-to-consumer advertising (DTCA) of prescription drugs is widely debated, as is the effect of DTCA on prescription sales and health care utilization. We examined the association between DTCA intensity for statin medications and prescription sales and cholesterol-related health care utilization. We conducted an ecological study for 75 designated market areas from 2005 to 2009 in the United States using linked data regarding televised DTCA volume, non-DTCA marketing and promotion, retail, mail order and long-term care prescription drug sales, prescription drug and ambulatory care health care utilization, and contextual factors such as health care density and socioeconomic status. Main outcomes and measures were volume of sales, number of dispensed prescriptions, and high cholesterol-related outpatient visits. Analyses were conducted in 2016. The intensity of rosuvastatin and atorvastatin ad exposures per household varied substantially across designated market areas. After adjustment for socioeconomic, demographic, and clinical characteristics, each 100-unit increase in advertisement viewership was associated with a 2.22% [95% confidence interval (CI), 0.30%-4.19%] increase in statin sales. Similar patterns were observed between DTCA and statin dispensing among the commercially insured. DTCA was associated with increases in high cholesterol-related outpatient visits among adults 18-45 years of age (3.15% increase in visits per 100-unit increase in viewership, 95% CI, 0.98%-5.37%) but not among those 46-65 years of age (0.51%, 95% CI, -1.49% to 2.55%). DTCA for statins is associated with increases in statin utilization and hyperlipidemia-related outpatient visits, especially for young adults.

Physician organization care management capabilities associated with effective inpatient utilization management: a fuzzy set qualitative comparative analysis.

PubMed

Sheehy, Thomas J; Thygeson, N Marcus

2014-12-03

We studied the relationship between physician organization (PO) care management capabilities and inpatient utilization in order to identify PO characteristics or capabilities associated with low inpatient bed-days per thousand. We used fuzzy-set qualitative comparative analysis (fsQCA) to conduct an exploratory comparative case series study. Data about PO capabilities were collected using structured interviews with medical directors at fourteen California POs that are delegated to provide inpatient utilization management (UM) for HMO members of a California health plan. Health plan acute hospital claims from 2011 were extracted from a reporting data warehouse and used to calculate inpatient utilization statistics. Supplementary analyses were conducted using Fisher's Exact Test and Student's T-test. POs with low inpatient bed-days per thousand minimized length of stay and surgical admissions by actively engaging in concurrent review, discharge planning, and surgical prior authorization, and by contracting directly with hospitalists to provide UM-related services. Disease and case management were associated with lower medical admissions and readmissions, respectively, but not lower bed-days per thousand. Care management methods focused on managing length of stay and elective surgical admissions are associated with low bed-days per thousand in high-risk California POs delegated for inpatient UM. Reducing medical admissions alone is insufficient to achieve low bed-days per thousand. California POs with high bed-days per thousand are not applying care management best practices.

Outpatient health care utilization of suicide decedents in their last year of life.

PubMed

Liu, Hui-Li; Chen, Lih-Hwa; Huang, Shiuh-Ming

2012-08-01

The characteristics of health care utilization during the last year of life by Taiwanese who died by suicide were analyzed. The degree of health services utilization was evaluated by extracting the data of National Health Insurance (NHI) outpatient cohort records in 2006. A total of 4,406 fatal suicide cases were matched with the 17,587,901 subjects in the NHI beneficiary registry file. Rate of visit of the suicide decedents for all NHI outpatient services during their last year before death was 85%, and that for mental disorders service only was 30.2%. Average number of visits per person-year of the suicide decedents was 24.5 visits per year, two times higher than that of the survivors. The average numbers of visits (ANV) of male suicide decedents who used the mental disorders services was increased 6.8 times compared to that for all survivors. The increase in female decedents, in contrast, was 2.7 times. The increase in ANV for 15-24 age group was 14.6 times, significantly higher than that for the other age groups (<4 times). Effective prediction or prevention of potential suicides through increased awareness and surveillance of medical care resource utilization is possible, especially for male and young adult patients under mental disorder health care. © 2012 The American Association of Suicidology.

Families at financial risk due to high ratio of out-of-pocket health care expenditures to total income.

PubMed

Bennett, Kevin J; Dismuke, Clara E

2010-05-01

High out-of-pocket expenditures for health care can put individuals and families at financial risk. Several groups, including racial/ethnic minority groups, the uninsured, rural residents, and those in poorer health are at risk for this increased burden. The analysis utilized 2004-2005 MEPS data. The dependent variables were the out-of-pocket health care spending to total income ratios for total spending, office-based visits, and prescription drugs. Multivariate analyses with instrumental variables controlled for respondent characteristics. Gender, age, rurality, insurance coverage, health status, and health care utilization were all associated with higher out-of-pocket to income ratios. Certain groups, such as women, the elderly, those in poor health, and rural residents, are at a greater financial risk due to their higher out-of-pocket to total income spending ratios. Policymakers must be aware of these increased risks in order to provide adequate resources and targeted interventions to alleviate some of this burden.

Patterns of service use in two types of managed behavioral health care plans.

PubMed

Merrick, Elizabeth L; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M; Azzone, Vanessa; McCann, Bernard; Ritter, Grant; Zolotusky, Galima; McGuire, Thomas G; Reif, Sharon

2010-01-01

The study examined service use patterns by level of care in two managed care plans offered by a national managed behavioral health care organization (MBHO): an employee assistance program (EAP) combined with a standard behavioral health plan (integrated plan) and a standard behavioral health plan. The cross-sectional analysis used 2004 administrative data from the MBHO. Utilization of 11 specific service categories was compared. The weighted sample reflected exact matching on sociodemographic characteristics (unweighted N=710,014; weighted N=286,750). A larger proportion of enrollees in the integrated plan than in the standard plan used outpatient mental health and substance abuse office visits (including EAP visits) (p<.01) and substance abuse intensive outpatient or day treatment (p<.05), and the proportion using residential substance abuse rehabilitation was lower (p<.05). The integrated and standard products had distinct utilization patterns in this large MBHO. In particular, greater use of certain outpatient services was observed in the integrated plan.

Factors affecting the use of prenatal care by non-western women in industrialized western countries: a systematic review.

PubMed

Boerleider, Agatha W; Wiegers, Therese A; Manniën, Judith; Francke, Anneke L; Devillé, Walter L J M

2013-03-27

Despite the potential of prenatal care for addressing many pregnancy complications and concurrent health problems, non-western women in industrialized western countries more often make inadequate use of prenatal care than women from the majority population do. This study aimed to give a systematic review of factors affecting non-western women's use of prenatal care (both medical care and prenatal classes) in industrialized western countries. Eleven databases (PubMed, Embase, PsycINFO, Cochrane, Sociological Abstracts, Web of Science, Women's Studies International, MIDIRS, CINAHL, Scopus and the NIVEL catalogue) were searched for relevant peer-reviewed articles from between 1995 and July 2012. Qualitative as well as quantitative studies were included. Quality was assessed using the Mixed Methods Appraisal Tool. Factors identified were classified as impeding or facilitating, and categorized according to a conceptual framework, an elaborated version of Andersen's healthcare utilization model. Sixteen articles provided relevant factors that were all categorized. A number of factors (migration, culture, position in host country, social network, expertise of the care provider and personal treatment and communication) were found to include both facilitating and impeding factors for non-western women's utilization of prenatal care. The category demographic, genetic and pregnancy characteristics and the category accessibility of care only included impeding factors.Lack of knowledge of the western healthcare system and poor language proficiency were the most frequently reported impeding factors. Provision of information and care in women's native languages was the most frequently reported facilitating factor. The factors found in this review provide specific indications for identifying non-western women who are at risk of not using prenatal care adequately and for developing interventions and appropriate policy aimed at improving their prenatal care utilization.

Factors affecting the use of prenatal care by non-western women in industrialized western countries: a systematic review

PubMed Central

2013-01-01

Background Despite the potential of prenatal care for addressing many pregnancy complications and concurrent health problems, non-western women in industrialized western countries more often make inadequate use of prenatal care than women from the majority population do. This study aimed to give a systematic review of factors affecting non-western women’s use of prenatal care (both medical care and prenatal classes) in industrialized western countries. Methods Eleven databases (PubMed, Embase, PsycINFO, Cochrane, Sociological Abstracts, Web of Science, Women’s Studies International, MIDIRS, CINAHL, Scopus and the NIVEL catalogue) were searched for relevant peer-reviewed articles from between 1995 and July 2012. Qualitative as well as quantitative studies were included. Quality was assessed using the Mixed Methods Appraisal Tool. Factors identified were classified as impeding or facilitating, and categorized according to a conceptual framework, an elaborated version of Andersen’s healthcare utilization model. Results Sixteen articles provided relevant factors that were all categorized. A number of factors (migration, culture, position in host country, social network, expertise of the care provider and personal treatment and communication) were found to include both facilitating and impeding factors for non-western women’s utilization of prenatal care. The category demographic, genetic and pregnancy characteristics and the category accessibility of care only included impeding factors. Lack of knowledge of the western healthcare system and poor language proficiency were the most frequently reported impeding factors. Provision of information and care in women’s native languages was the most frequently reported facilitating factor. Conclusion The factors found in this review provide specific indications for identifying non-western women who are at risk of not using prenatal care adequately and for developing interventions and appropriate policy aimed at improving their prenatal care utilization. PMID:23537172

Quality of life of persons with severe mental illness living in an intermediate care facility.

PubMed

Anderson, R L; Lewis, D A

2000-04-01

This study examined resident characteristics, clinical factors, and mental health service utilization associated with quality of life (QOL) for residents living in an Intermediate Care Facility (ICF). This study also utilized published literature to compare the QOL of ICF residents to persons with psychiatric disorders living in other residential settings. Chart review and interviews were used to study 100 randomly selected residents living in an ICF with a chart diagnosis of schizophrenia. Multivariate analyses suggest that higher levels of QOL are associated with reports that psychological problems did not interfere with work and activities and with lower levels of being a danger to others. Also, a comparison of the QOL scores reported by ICF residents to other published mentally ill populations suggests that residents of the ICF report somewhat higher QOL scores than state hospital patients, but lower scores as compared to other community samples. Data provide insight into the types of problems faced by residents of an intermediate care facility. These findings have implications for understanding the importance of mental health service utilization on QOL.

[Data on palliative care in Germany : Which data sources are available and what do they tell?

PubMed

Prütz, Franziska; Saß, Anke-Christine

2017-01-01

Palliative care is more and more in the focus of politics and the public. Although provision and utilization of palliative care have increased considerably in recent years, there is still a great need for palliative services and a comprehensive supply has not yet been achieved. Reliable and continually available data are indispensable to describe developments in Germany, to identify existing gaps in palliative care provision, and to assess the impact of relevant policies. In this article, we present a systematic outline of publicly available data sources on palliative care in Germany and point out their potentials and limitations. We show that mainly data on palliative care provision are available. Data on utilization are basically limited to inpatient and specialized outpatient palliative care ("spezialisierte ambulante Palliativversorgung", SAPV). Periodical analyses of routine data, e. g. from statutory health insurances or from the Association of Statutory Health Insurance Physicians, would be helpful to fill these data gaps. Monitoring the sociodemographic characteristics of users of palliative care could also be of major interest. Another important indicator is the place of death. The difference between the places where people die and where they wish to die indicates that there is a continuous need to strengthen outpatient structures of palliative care.

Investigations of the pediatric hospice care in Taiwan: 2005 to 2010.

PubMed

Kang, Shih-Chao; Hwang, Shinn-Jang; Wang, Wei-Shu

2014-08-01

The utilization of pediatric hospice care remains unclear in Taiwan. Data were analyzed from the claims of hospice admissions in patients aged 18 years or younger using the National Health Insurance Research Database from 2005 to 2010. A total of 91 patients and 136 admissions were enrolled (male-female = 50:41; mean 11.6 years old). In all, 62 patients were admitted once, including 47 patients who died. All the patients had cancer, with brain cancer (40.7%) accounting the most . Among acute comorbidities, neurological complications (16.2%) were mostly accounted. Family physicians provided most (64.7%) of the hospice services. Hospice stay ≤3 days correlated positively with death in hospices (odds ratio = 2.922, 95% confidence interval = 1.268-6.730). Pediatric hospice care revealed characteristics different from adults. Underlying late referrals were prevalent. There is space to promote the utilization of hospices for terminally ill pediatric patients. © The Author(s) 2013.

Appointment "no-shows" are an independent predictor of subsequent quality of care and resource utilization outcomes.

PubMed

Hwang, Andrew S; Atlas, Steven J; Cronin, Patrick; Ashburner, Jeffrey M; Shah, Sachin J; He, Wei; Hong, Clemens S

2015-10-01

Identifying individuals at high risk for suboptimal outcomes is an important goal of healthcare delivery systems. Appointment no-shows may be an important risk predictor. To test the hypothesis that patients with a high propensity to "no-show" for appointments will have worse clinical and acute care utilization outcomes compared to patients with a lower propensity. We calculated the no-show propensity factor (NSPF) for patients of a large academic primary care network using 5 years of outpatient appointment data. NSPF corrects for patients with fewer appointments to avoid over-weighting of no-show visits in such patients. We divided patients into three NSPF risk groups and evaluated the association between NSPF and clinical and acute care utilization outcomes after adjusting for baseline patient characteristics. A total of 140,947 patients who visited a network practice from January 1, 2007, through December 31, 2009, and were either connected to a primary care physician or to a primary care practice, based on a previously validated algorithm. Outcomes of interest were incomplete colorectal, cervical, and breast cancer screening, and above-goal hemoglobin A1c (HbA1c) and low-density lipoprotein (LDL) levels at 1-year follow-up, and hospitalizations and emergency department visits in the subsequent 3 years. Compared to patients in the low NSPF group, patients in the high NSPF group (n=14,081) were significantly more likely to have incomplete preventive cancer screening (aOR 2.41 [2.19-.66] for colorectal, aOR 1.85 [1.65-.08] for cervical, aOR 2.93 [2.62-3.28] for breast cancer), above-goal chronic disease control measures (aOR 2.64 [2.22-3.14] for HbA1c, aOR 1.39 [1.15-1.67] for LDL], and increased rates of acute care utilization (aRR 1.37 [1.31-1.44] for hospitalization, aRR 1.39 [1.35-1.43] for emergency department visits). NSPF is an independent predictor of suboptimal primary care outcomes and acute care utilization. NSPF may play an important role in helping healthcare systems identify high-risk patients.

Focused maternity care in Ghana: results of a cluster analysis.

PubMed

Ayanore, Martin Amogre; Pavlova, Milena; Groot, Wim

2016-08-17

Ghana missed out in attaining Millennium Development Goal 5 in 2015. The provision of adequate prenatal and postnatal care remains problematic, with poor evidence on women's views on met and unmet maternity care needs across all regions in Ghana. This paper examines maternal care utilization in Ghana by applying WHO indicators for focused maternal care utilization. Two-step cluster analysis segregated women into groups based on the components of the maternity care used. Using cluster membership variables as dependent variables, we applied multinomial and binary regression to examine associations of care use with individual, household and regional characteristics. We identified three patterns of care use: adequate, less and least adquate care. The presence of a female and skilled provider is an indicator of adequate care. Women in Volta, Upper West, Northern and Western regions received less adequate care compared with other regions. Supply-related factors (drugs availability, distance/transport, health insurance ownership, rural residence) were associated with adequacy of care. The lack of female autonomy, widowed/divorced women, age and parity were associated with less adequate care. Care patterns were distinctively associated with the quality of health care support (skilled and female attendant) instead of with the number of visits made to the facility. Across regions and within rural settings, disparities exist, often compounded by supply-related factors. Efforts to address skilled workforce shortages, greater accountability for quality and equity, improving women motivation for care seeking and active participation are important for maternity care in Ghana.

Associations of frailty with health care costs--results of the ESTHER cohort study.

PubMed

Bock, Jens-Oliver; König, Hans-Helmut; Brenner, Hermann; Haefeli, Walter E; Quinzler, Renate; Matschinger, Herbert; Saum, Kai-Uwe; Schöttker, Ben; Heider, Dirk

2016-04-14

The concept of frailty is rapidly gaining attention as an independent syndrome with high prevalence in older adults. Thereby, frailty is often related to certain adverse outcomes like mortality or disability. Another adverse outcome discussed is increased health care utilization. However, only few studies examined the impact of frailty on health care utilization and corresponding costs. The aim of this study was therefore to investigate comprehensively the relationship between frailty, health care utilization and costs. Cross sectional data from 2598 older participants (57-84 years) recruited in the Saarland, Germany, between 2008 and 2010 was used. Participants passed geriatric assessments that included Fried's five frailty criteria: weakness, slowness, exhaustion, unintentional weight loss, and physical inactivity. Health care utilization was recorded in the sectors of inpatient treatment, outpatient treatment, pharmaceuticals, and nursing care. Prevalence of frailty (≥3 symptoms) was 8.0%. Mean total 3-month costs of frail participants were €3659 (4 or 5 symptoms) and €1616 (3 symptoms) as compared to €642 of nonfrail participants (no symptom). Controlling for comorbidity and general socio-demographic characteristics in multiple regression models, the difference in total costs between frail and non-frail participants still amounted to €1917; p < .05 (4 or 5 symptoms) and €680; p < .05 (3 symptoms). Among the 5 symptoms of frailty, weight loss and exhaustion were significantly associated with total costs after controlling for comorbidity. The study provides evidence that frailty is associated with increased health care costs. The analyses furthermore indicate that frailty is an important factor for health care costs independent from pure age and comorbidity. Costs were rather attributable to frailty (and comorbidity) than to age. This stresses that the overlapping concepts of multimorbidity and frailty are both necessary to explain health care use and corresponding costs among older adults.

National trends in anterior cervical fusion procedures.

PubMed

Marawar, Satyajit; Girardi, Federico P; Sama, Andrew A; Ma, Yan; Gaber-Baylis, Licia K; Besculides, Melanie C; Memtsoudis, Stavros G

2010-07-01

Population-based database analysis. To analyze trends in patient- and healthcare-system-related characteristics, utilization and outcomes associated with anterior cervical spine fusions. Anterior cervical decompression and spine fusion (ACDF) is one of the most commonly performed surgical procedures of the spine. However, few data analyzing trends in patient- and healthcare-system-related characteristics, utilization and outcomes exist. Data from 1990 to 2004 collected in the National Hospital Discharge Survey were accessed. ACDF procedures were identified. Five-year periods of interest (POI) were created for temporal analysis and changes in the prevalence and utilization of this procedure as well as in patient- and healthcare-system-related variables were examined. The changes in the occurrence of procedure-related complications were evaluated. An estimated total of 771,932 discharges after ACDF were identified. Temporally, an almost 8-fold increase in total prevalence was accompanied by a similar increase in utilization (23/100.000 civilians/POI to 157/100.000/civilians/POI). The highest increase in utilization was observed in those > or =65 years (28-fold). Average age increased from 47.2 years to 50.5 years over time. Length of hospital stay decreased from 5.17 days to 2.38 days. Overall procedure-related complication rates decreased from 4.6% to 3.03%. The prevalence of hypertension, diabetes mellitus, hypercholesterolemia, obesity, pulmonary, and coronary artery increased over time among patients undergoing ACDF. Despite limitations inherent to secondary analysis of large databases, we identified a number of significant changes in the utilization, demographics, and outcomes associated with ACDF, which can be used to assess the effect of changes in medical care, direct health care resources, and future research. The effect of the increased prevalence of comorbidities on medical practice remains to be evaluated. Further studies are necessary to evaluate causal relationships.

Impact of value based breast cancer care pathway implementation on pre-operative breast magnetic resonance imaging utilization.

PubMed

McCray, Devina K S; Grobmyer, Stephen R; Pederson, Holly J

2017-02-01

Bilateral breast magnetic resonance imaging (MRI) is commonly used in the diagnostic workup of breast cancer (BC) to assess extent of disease and identify occult foci of disease. However, evidence for routine use of pre-operative MRI is lacking. Breast MRI is costly and can lead to unnecessary tests and treatment delays. Clinical care pathways (care paths) are value-based guidelines, which define management recommendations derived by expert consensus and available evidence based data. At Cleveland Clinic, care paths created for newly diagnosed BC patients recommend selective use of pre-operative MRI. We evaluated the number of pre-operative MRIs ordered before and after implementing an institution wide BC care paths in April 2014. A retrospective review was conducted of BC cases during the years 2012, 2014, and part of 2015. Patient, tumor and treatment characteristics were collected. Pre-operative MRI utilization was compared before and after care path implementation. We identified 1,515 BC patients during the study period. Patients were more likely to undergo pre-operative MRI in 2012 than 2014 (OR: 2.77; P<0.001; 95% CI: 1.94-3.94) or 2015 (OR: 4.14; P<0.001; 95% CI: 2.51-6.83). There was a significant decrease in pre-operative MRI utilization between 2012 and 2014 (P<0.001) after adjustment for pre-operative MRIs ordered for care path indications. Implementation of online BC care paths at our institution was associated with a decreased use of pre-operative MRI overall and in patients without a BC care path indication, driving value based care through the reduction of pre-operative breast MRIs.

Characteristics of nurses who use social media.

PubMed

Kung, Ying Mai; Oh, Sanghee

2014-02-01

Social media are changing the ways people communicate and influencing their approaches to meeting their healthcare needs. The Institute of Medicine recommends utilization of information technologies to improve the delivery of patient-centered care. Little is known about how nurses have adopted the use of social media, however. The researchers conducted an online survey to provide a preliminary review of the characteristics of nurses who do and do not use social media. Also, nurses' preferences for using six different types of social media were analyzed and reported. Nurses from 43 states participated in this study, and the sample represented mostly advanced practice nurses who utilized the Internet regularly and confidently. About 94% of the participants indicated that they use social media, whereas fewer than 1% of the participants reported that they do not know how to use social media. Among those who use social media, social networking sites (90.33%) and podcasts (76.24%) were the most popular, followed by social question and asking sites (37.86%), blogs (31.85%), Twitter (19.06%), and SlideShare (9.92%). Social media can be a powerful tool to reach an intended audience quickly and globally. More research is needed to understand how nurses utilize social media to improve the delivery of patient-centered care.

Health Care Utilization and Costs After Initiating Budesonide/Formoterol Combination or Fluticasone/Salmeterol Combination Among COPD Patients New to ICS/LABA Treatment.

PubMed

Davis, Jill R; Kern, David M; Williams, Setareh A; Tunceli, Ozgur; Wu, Bingcao; Hollis, Sally; Strange, Charlie; Trudo, Frank

2016-03-01

Chronic obstructive pulmonary disease (COPD) affects approximately 15 million people in the United States and accounts for approximately $36 billion in economic burden, primarily due to medical costs. To address the increasing clinical and economic burden, the Global Initiative for Chronic Obstructive Lung Disease emphasizes the use of therapies that help prevent COPD exacerbations, including inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA). To evaluate health care costs and utilization among COPD patients newly initiating ICS/LABA combination therapy with budesonide/formoterol (BFC) or fluticasone/salmeterol (FSC) in a managed care system. COPD patients aged 40 years and older who initiated BFC (160/4.5 μg) or FSC (250/50 μg) treatment between March 1, 2009, and March 31, 2012, were identified using claims data from major U.S. health plans. BFC and FSC patients were propensity score matched (1:1) on age, sex, prior asthma diagnosis, prior COPD-related health care utilization, and respiratory medication use. COPD-related, pneumonia-related, and all-cause costs and utilization were analyzed during the 12-month follow-up period. Post-index costs were assessed with generalized linear models (GLMs) with gamma distribution. Health care utilization data were analyzed via logistic regression (any event vs. none) and GLMs with negative binomial distribution (number of visits) and were adjusted for the analogous pre-index variable as well as pre-index characteristics that remained imbalanced after matching. After matching, each cohort had 3,697 patients balanced on age (mean 64 years), sex (female 52% BFC and 54% FSC), asthma and other comorbid conditions, prior COPD-related health care utilization, and respiratory medication use. During the 12-month follow-up, COPD-related costs averaged $316 less for BFC versus FSC patients ($4,326 vs. $4,846; P = 0.003), reflecting lower inpatient ($966 vs. $1,202; P < 0.001), pharmacy ($1,482 vs. $1,609; P = 0.002), and outpatient/office ($1,378 vs. $1,436; P = 0.048) costs, but higher emergency department ($257 vs. $252; P = 0.033) costs. Pneumonia-related health care costs were also lower on average for BFC patients ($2,855 vs. $3,605; P < 0.001). Similarly, initiating BFC was associated with lower all-use health care costs versus initiating FSC ($21,580 vs. $24,483; P < 0.001, respectively). No differences in health care utilization were found between the 2 groups. In this study, although no difference was observed in rates of health care utilization, COPD patients initiating BFC treatment incurred lower average COPD-related, pneumonia-related, and all-cause costs versus FSC initiators, which was driven by cumulative differences in inpatient, outpatient, and pharmacy costs.

ICU nurses' oral-care practices and the current best evidence.

PubMed

DeKeyser Ganz, Freda; Fink, Naomi Farkash; Raanan, Ofra; Asher, Miriam; Bruttin, Madeline; Nun, Maureen Ben; Benbinishty, Julie

2009-01-01

The purpose of this study was to describe the oral-care practices of ICU nurses, to compare those practices with current evidence-based practice, and to determine if the use of evidence-based practice was associated with personal demographic or professional characteristics. A national survey of oral-care practices of ICU nurses was conducted using a convenience sample of 218 practicing ICU nurses in 2004-05. The survey instrument included questions about demographic and professional characteristics and a checklist of oral-care practices. Nurses rated their perceived level of priority concerning oral care on a scale from 0 to 100. A score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the current best evidence. This score was then statistically analyzed using ANOVA to determine differences of EBP based on demographic and professional characteristics. The most commonly used equipment was gauze pads (84%), followed by tongue depressors (55%), and toothbrushes (34%). Chlorhexidine was the most common solution used (75%). Less than half (44%) reported brushing their patients' teeth. The majority performed an oral assessment before beginning oral care (71%); however, none could describe what assessment tool was used. Only 57% of nurses reported documenting their oral care. Nurses rated oral care of intubated patients with a priority of 67+/-27.1. Wide variations were noted within and between units in terms of which techniques, equipment, and solutions were used. No significant relationships were found between the use of an evidence-based protocol and demographic and professional characteristics or with the priority given to oral care. While nurses ranked oral care a high priority, many did not implement the latest evidence into their current practice. The level of research utilization was not related to personal or professional characteristics. Therefore attempts should be made to encourage all ICU nurses to introduce and use evidence-based, oral-care protocols. Practicing ICU nurses in this survey were often not adhering to the latest evidence-based practice and therefore need to be educated and encouraged to do so in order to improve patient care.

Case-mix groups for VA hospital-based home care.

PubMed

Smith, M E; Baker, C R; Branch, L G; Walls, R C; Grimes, R M; Karklins, J M; Kashner, M; Burrage, R; Parks, A; Rogers, P

1992-01-01

The purpose of this study is to group hospital-based home care (HBHC) patients homogeneously by their characteristics with respect to cost of care to develop alternative case mix methods for management and reimbursement (allocation) purposes. Six Veterans Affairs (VA) HBHC programs in Fiscal Year (FY) 1986 that maximized patient, program, and regional variation were selected, all of which agreed to participate. All HBHC patients active in each program on October 1, 1987, in addition to all new admissions through September 30, 1988 (FY88), comprised the sample of 874 unique patients. Statistical methods include the use of classification and regression trees (CART software: Statistical Software; Lafayette, CA), analysis of variance, and multiple linear regression techniques. The resulting algorithm is a three-factor model that explains 20% of the cost variance (R2 = 20%, with a cross validation R2 of 12%). Similar classifications such as the RUG-II, which is utilized for VA nursing home and intermediate care, the VA outpatient resource allocation model, and the RUG-HHC, utilized in some states for reimbursing home health care in the private sector, explained less of the cost variance and, therefore, are less adequate for VA home care resource allocation.

Health care utilization and costs among medical-aid enrollees, the poor not enrolled in medical-aid, and the near poor in South Korea.

PubMed

Choi, Jae Woo; Park, Eun-Cheol; Chun, Sung-Youn; Han, Kyu-Tae; Han, Euna; Kim, Tae Hyun

2015-11-14

Although government has implemented medical-aid policy that provides assistance to the poor with almost free medical services, there are low-income people who do not receive necessary medical services in Korea. The aim of this study is to highlight the characteristics of Medical-Aid enrollees, the poor not enrolled in Medical-Aid, and the near poor and their utilization and costs for health care. This study draws on the 2012 Korea Welfare Panel Study (KOWEPS), a nationally representative dataset. We divided people with income less than 120% of the minimum cost of living (MCL) into three groups (n = 2,784): the poor enrolled in Medical-Aid, the poor not enrolled in Medical-Aid (at or below 100% of MCL), and the near poor (100-120% of MCL). Using a cross-sectional design, this study provides an overview of health care utilization and costs of these three groups. The findings of the study suggest that significantly lower health care utilization was observed for the poor not enrolled in Medical-Aid compared to those enrolled in Medical-Aid. On the other hand, two groups (the poor not enrolled in Medical-Aid, the near poor) had higher health care costs, percentage of medical expenses to income compared to Medical-Aid. Given the particularly low rate of the population enrolled in Medical-Aid, similarly economically vulnerable groups are more likely to face barriers to needed health services. Meeting the health needs of these groups is an important consideration.

Drug Usage and Health Characteristics in Non-Institutionalized Mexican-American Elderly.

ERIC Educational Resources Information Center

Vener, A. M.; And Others

1980-01-01

Results of in-depth interviews with 32 elderly Mexican Americans revealed minimal potential hazardous drug interactions. Mexican Americans showed a disinclination to utilize over-the-counter drugs to alleviate minor ailments. Professionals involved in health care delivery systems for the aging should become aware of the special needs of ethnic…

Health care costs in the elderly in Germany: an analysis applying Andersen’s behavioral model of health care utilization

PubMed Central

2014-01-01

Background To analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen’s behavioral model of health care utilization, in the German elderly population. Methods Using a cross-sectional design, cost data of 3,124 participants aged 57–84 years in the 8-year-follow-up of the ESTHER cohort study were analyzed. Health care utilization in a 3-month period was assessed retrospectively through an interview conducted by trained study physicians at respondents’ homes. Unit costs were applied to calculate health care costs from the societal perspective. Socio-demographic and health-related variables were categorized as predisposing, enabling, or need factors as defined by the Andersen model. Multimorbidity was measured by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Mental health status was measured by the SF-12 mental component summary (MCS) score. Sector-specific costs were analyzed by means of multiple Tobit regression models. Results Mean total costs per respondent were 889 € for the 3-month period. The CIRS-G score and the SF-12 MCS score representing the need factor in the Andersen model were consistently associated with total, inpatient, outpatient and nursing costs. Among the predisposing factors, age was positively associated with outpatient costs, nursing costs, and total costs, and the BMI was associated with outpatient costs. Conclusions Multimorbidity and mental health status, both reflecting the need factor in the Andersen model, were the dominant predictors of health care costs. Predisposing and enabling factors had comparatively little impact on health care costs, possibly due to the characteristics of the German social health insurance system. Overall, the variables used in the Andersen model explained only little of the total variance in health care costs. PMID:24524754

Health care costs in the elderly in Germany: an analysis applying Andersen's behavioral model of health care utilization.

PubMed

Heider, Dirk; Matschinger, Herbert; Müller, Heiko; Saum, Kai-Uwe; Quinzler, Renate; Haefeli, Walter Emil; Wild, Beate; Lehnert, Thomas; Brenner, Hermann; König, Hans-Helmut

2014-02-14

To analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen's behavioral model of health care utilization, in the German elderly population. Using a cross-sectional design, cost data of 3,124 participants aged 57-84 years in the 8-year-follow-up of the ESTHER cohort study were analyzed. Health care utilization in a 3-month period was assessed retrospectively through an interview conducted by trained study physicians at respondents' homes. Unit costs were applied to calculate health care costs from the societal perspective. Socio-demographic and health-related variables were categorized as predisposing, enabling, or need factors as defined by the Andersen model. Multimorbidity was measured by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Mental health status was measured by the SF-12 mental component summary (MCS) score. Sector-specific costs were analyzed by means of multiple Tobit regression models. Mean total costs per respondent were 889 € for the 3-month period. The CIRS-G score and the SF-12 MCS score representing the need factor in the Andersen model were consistently associated with total, inpatient, outpatient and nursing costs. Among the predisposing factors, age was positively associated with outpatient costs, nursing costs, and total costs, and the BMI was associated with outpatient costs. Multimorbidity and mental health status, both reflecting the need factor in the Andersen model, were the dominant predictors of health care costs. Predisposing and enabling factors had comparatively little impact on health care costs, possibly due to the characteristics of the German social health insurance system. Overall, the variables used in the Andersen model explained only little of the total variance in health care costs.

Can the Medical-nursing Combined Care Promote the Accessibility of Health Services for the Elderly in Nursing Home? A Study Protocol of Analysis of the Effectiveness Regarding Health Service Utilization, Health Status and Satisfaction with Care.

PubMed

Bao, J; Wang, X-J; Yang, Y; Dong, R-Q; Mao, Z-F

2015-12-01

Currently, segmentation of healthcare and daily care for the elderly living in nursing homes usually results in the elderly not getting medical treatment timely and effectively. The medical-nursing combined care, which has been put into practice in several areas in China, is developed to enhance the accessibility of healthcare for the elderly. The aim of the study is to explore the effectiveness of the new care service, based on Andersen model, regarding health service utilization, health status and service satisfaction. The effectiveness of medical-nursing combined care will be measured in a cross-sectional study in nine nursing homes in Jianghan District, Wuhan, China, with 1067 old residents expected to participate. The questionnaire containing items of demographics, health service use, service satisfaction and instrument of SF-36 V2 is developed based on the conceptual framework of Andersen behaviour model of health service utilization. Descriptive analysis, variance analysis, multiple factors analysis, and correlation analysis will be performed to compare the sociological characteristics, health service use, health status and service satisfaction of the elderly living in different modes of nursing homes, to explore the influence factors of care effectiveness, as well as to study the relationship between health behaviour and health outcomes. The study design of analysing the effects of medical-nursing combined care and performing the horizontal comparison among the nursing homes under the framework of Andersen model is blazing new trails. Recruitment and design of questionnaire are important issues. Successful data collection and quality control are also necessary. Taking these into account, this study is estimated to provide evidence for the effectiveness of medical-nursing combined care service in China.

Factors contributing to practice variation in post-stroke rehabilitation.

PubMed Central

Lee, A J; Huber, J H; Stason, W B

1997-01-01

OBJECTIVE: To analyze geographic variability in the utilization and cost of post-stroke medical care using multiple linear regression. DATA SOURCES/STUDY SETTING: A 20 percent random sample of Medicare beneficiaries with an admission to an acute care hospital for stroke during the first six months of 1991, supplemented by data from their Medicare claims and beneficiary records, the Medicare Cost Reports for hospitals and nursing homes, and the Area Resource File. STUDY DESIGN: Weighted least squares regression is used to analyze variations in post-stroke practice patterns across 151 MSAs (Metropolitan Statistical Areas). Average post-stroke costs, utilization rates, and facility lengths of stay are regressed on patient and market characteristics. DATA COLLECTION/EXTRACTION METHODS: For a six-month post-stroke interval, beneficiary-level post-stroke costs and service utilization are averaged by MSA. Variables describing market conditions are then added to these MSA-level records. PRINCIPAL FINDINGS: Patient variables rarely explain more than a third of practice variation, and often they explain substantially less than that. Market variables (with some exception) tend to be relatively less important. Finally, one-half to two-thirds of the practice variation across MSAs is unexplained by the patient and market factors measured in our data. CONCLUSIONS: A substantial portion of inter-MSA variability in utilization and intensity of post-stroke rehabilitation services cannot be explained by differences in patient characteristics. Given the large practice differences observed across MSAs, it seems unlikely that unmeasured patient differences can account for much more of the practice differences. PMID:9180616

Characteristics of US Adults Who Have Positive and Negative Perceptions of Doctors of Chiropractic and Chiropractic Care.

PubMed

Weeks, William B; Goertz, Christine M; Meeker, William C; Marchiori, Dennis M

2016-01-01

The purpose of this study was to compare characteristics, likelihood to use, and actual use of chiropractic care for US survey respondents with positive and negative perceptions of doctors of chiropractic (DCs) and chiropractic care. From a 2015 nationally representative survey of 5422 adults (response rate, 29%), we used respondents' answers to identify those with positive and negative perceptions of DCs or chiropractic care. We used the χ(2) test to compare other survey responses for these groups. Positive perceptions of DCs were more common than those for chiropractic care, whereas negative perceptions of chiropractic care were more common than those for DCs. Respondents with negative perceptions of DCs or chiropractic care were less likely to know whether chiropractic care was covered by their insurance, more likely to want to see a medical doctor first if they were experiencing neck or back pain, less likely to indicate that they would see a DC for neck or back pain, and less likely to have ever seen a DC as a patient, particularly in the recent past. Positive perceptions of chiropractic care and negative perceptions of DCs appear to have greater influence on DC utilization rates than their converses. We found that US adults generally perceive DCs in a positive manner but that a relatively high proportion has negative perceptions of chiropractic care, particularly the costs and number of visits required by such care. Characteristics of respondents with positive and negative perceptions were similar, but those with positive perceptions were more likely to plan to use-and to have already received-chiropractic care. Copyright © 2016 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

Patterns of leisure time and non-leisure time physical activity of Korean immigrant women.

PubMed

Choi, Jiwon; Wilbur, Joellen; Kim, Mi Ja

2011-02-01

Our purpose in this study was to examine the patterns of physical activity and demographic characteristics associated with those patterns in Korean immigrants in the United States. Participants were 197 women, and the International Physical Activity Questionnaire was utilized. The inactive pattern was the most frequent pattern in all domains of physical activity except household physical activity. There were differences among the patterns of physical activity that were associated with variations in demographic characteristics. Health care providers who serve immigrants should assess physical activity level and demographic characteristics of the immigrants to enhance their physical activity.

Predicting risk of entry into foster care from early childhood experiences: A survival analysis using LONGSCAN data.

PubMed

English, Diana J; Thompson, Richard; White, Catherine Roller

2015-07-01

This study examined whether a multi-domain model of maltreatment informed by an ecological framework-including factors related to the child, caregiver, family, neighborhood, and dimensions of maltreatment experience-predicted entry into foster care between the ages of 4 and 18 among children with no prior foster care experience. To determine which factors predict entry into foster care, secondary data analyses were conducted utilizing a sub-sample from LONGSCAN (Longitudinal Studies of Child Abuse and Neglect) of 942 children and their primary caregivers. Results demonstrate that there are important predictors for entry into out-of-home placement across multiple ecological domains. Characteristics related to child, caregiver, and family characteristics, and neighborhood context, as well as dimensions of maltreatment (particularly emotional maltreatment), predicted risk of placement in out-of-home care. Implications for child welfare practice are discussed. This examination of the effects of multiple ecological domains adds to our understanding of children's risk of removal and entry into out-of-home placement. Copyright © 2015 Elsevier Ltd. All rights reserved.

Language and use of cancer screening services among border and non-border Hispanic Texas women.

PubMed

Fernández, Leticia E; Morales, Alfonso

2007-06-01

Compared to other groups, Mexican American women screen less frequently for cervical and breast cancer. The most significant barriers reported by previous researchers include not having a usual source of care, lacking health insurance and English-language difficulties. In this paper we document and examine the factors associated with disparities in cancer screening between border and non-border residents by language of interview (Spanish or English) among Texas Hispanic women. We hypothesize that, controlling for socioeconomic and demographic characteristics, border residents are more likely to utilize screening services than non-border residents because of the greater presence of bilingual services in border counties. We follow the framework of the Behavioral Model for Vulnerable Populations proposed by Gelberg et al. (Health Services Research, vol. 34, no. 6, pp. 1273-1302, 2000). This model conceptualizes use of health care as an outcome of the interplay of predisposing, enabling and need factors and recognizes that vulnerable groups face additional barriers to health care utilization. Data come from the 2000, 2002 and 2004 Texas Behavioral Risk Factor Surveillance surveys. Group differences in cancer screenings are explained largely by socioeconomic characteristics and structural barriers to access. The significance of language of interview and of border residence disappear after controlling for factors such as health insurance, income and a usual source of care. Women who selected to be interviewed in Spanish were less likely to report age-appropriate cancer examinations, health insurance and a regular health care provider than those who selected to be interviewed in English. Disparities in cancer screenings among vulnerable Hispanic populations could be reduced by promoting the establishment of a regular health care provider.

Relevant patient characteristics for guiding tailored integrated diabetes primary care: a systematic review.

PubMed

Hertroijs, Dorijn F L; Elissen, Arianne M J; Brouwers, Martijn C G J; Schaper, Nicolaas C; Ruwaard, Dirk

2018-02-06

Aim To identify which patient-related effect modifiers influence the outcomes of integrated care programs for type 2 diabetes in primary care. Integrated care is a widespread management strategy for the treatment of type 2 diabetes. However, most integrated care programs are not tailored to patients' needs, preferences and abilities. There is increasing consensus that such a patient-centered approach could improve the management of type 2 diabetes. Thus far, it remains unclear which patient-related effect modifiers should guide such an approach. PubMed, CINAHL and EMBASE were searched for empirical studies published after 1998. A systematic literature review was conducted according to the PRISMA guidelines. Findings In total, 23 out of 1015 studies were included. A total of 21 studies measured the effects of integrated diabetes care programs on hemoglobin A1c (HbA1c) and three on low-density lipoprotein cholesterol, systolic blood pressure and health-care utilization. In total, 49 patient characteristics were assessed as potential effect modifiers with HbA1c as an outcome, of which 46 were person or health-related and only three were context-related. Younger age, insulin therapy and longer disease duration were associated with higher HbA1c levels in cross-sectional and longitudinal studies. Higher baseline HbA1c was associated with higher HbA1c at follow-up in longitudinal studies. Information on context- and person-related characteristics was limited, but is necessary to help identify the care needs of individual patients and implement an effective integrated type 2 diabetes tailored care program.

Family characteristics and the use of maternal health services: a population-based survey in Eastern China.

PubMed

Zhang, Ling; Xue, Chengbing; Wang, Youjie; Zhang, Liuyi; Liang, Yuan

2016-01-01

Despite the benefits of maternal health services, these services are often underutilized, especially in the developing countries. The aim of the present study is to provide insight regarding factors affecting maternal health services use from the family perspective. We use data from the fourth National Health Services Survey in Jiangsu province of Eastern China to investigate the effect of family characteristics on the use of maternal health services. Family characteristics included whether or not living with parents, age of husband, husband's education, and husband's work status as well as family economic status. Demographic variables, social and environmental factors, and previous reproductive history were taken as potential confounders. Multiple logistic regression models were used to examine the independent effects of the family characteristic variables on maternal health service utilization. The data indicate that the percentages of prenatal care, postnatal visits and hospital delivery were 85.44, 65.12 and 99.59 % respectively. Living with parents was associated with less use of prenatal care and husband's age, education and employment status had no effect on the use of prenatal care after adjusting for potential confounding variables. Our findings suggest that maternal health education (especially the role of prenatal care) needs to be extended beyond the expectant mothers themselves to their parents and husbands. The difference of health care delivery as a result of traditional family culture may highlight the differences in factors influencing the use of postnatal visits and those influencing the use of prenatal care; which may be worthy of further study.

Medicare Utilization and Expenditures Around Incident Dementia in a Multiethnic Cohort.

PubMed

Zhu, Carolyn W; Cosentino, Stephanie; Ornstein, Katherine; Gu, Yian; Scarmeas, Nikolaos; Andrews, Howard; Stern, Yaakov

2015-11-01

Few studies have examined patterns of health care utilization and costs during the period around incident dementia. Participants were drawn from the Washington Heights-Inwood Columbia Aging Project, a multiethnic, population-based, prospective study of cognitive aging of Medicare beneficiaries in a geographically defined area of northern Manhattan. Medicare utilization and expenditure were examined in individuals with clinically diagnosed dementia from 2 years before until 2 years after the initial diagnosis. A sample of non-demented individuals who were matched on socio-demographic and clinical characteristics at study enrollment was used as controls. Multivariable regression analysis estimated effects on Medicare utilization and expenditures associated with incident dementia. During the 2 years before incident dementia, rates of inpatient admissions and outpatient visits were similar between dementia patients and non-demented controls, but use of home health and skilled nursing care and durable medical equipment were already higher in dementia patients. Results showed a small but significant excess increase associated with incident dementia in inpatient admissions but not in other areas of care. In the 2 years before incident dementia, total Medicare expenditures were already higher in dementia patients than in non-demented controls. But we found no excess increases in Medicare expenditures associated with incident dementia. Demand for medical care already is increasing and costs are higher at the time of incident dementia. There was a small but significant excess risk of inpatient admission associated with incident dementia. Published by Oxford University Press on behalf of the Gerontological Society of America 2015.

Expanding health insurance to increase health care utilization: will it have different effects in rural vs. urban areas?

PubMed

Erlyana, Erlyana; Damrongplasit, Kannika Kampanya; Melnick, Glenn

2011-05-01

This study investigates the importance of medical fee and distance to health care provider on individual's decision to seek care in developing countries. The estimation method used a mixed logit model applied to data from the third wave of the Indonesian family life survey (2000). The key variables of interest include medical fee and distance to different types of health care provider and individual characteristic variables. Urban dweller's decision to choose health care providers are sensitive to the monetary cost of medical care as measured by medical fee but they are not sensitive to distance. For those who reside in rural area, they are sensitive to the non-medical component cost of care as measured by travel distance but they are not sensitive to medical fee. As a result of those findings, policy makers should consider different sets of policy instruments when attempting to expand health service's usage in urban and rural areas of Indonesia. To increase access in urban areas, we recommend expansion of health insurance coverage in order to lower out-of-pocket medical expenditures. As for rural areas, expansion of medical infrastructures to reduce commuting distance and costs will be needed to increase utilization. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Developing a Web Platform to Support a Community of Practice: A Mixed Methods Study in Pediatric Physiotherapy.

PubMed

Pratte, Gabrielle; Hurtubise, Karen; Rivard, Lisa; Berbari, Jade; Camden, Chantal

2018-01-01

Web platforms are increasingly used to support virtual interactions between members of communities of practice (CoP). However, little is known about how to develop these platforms to support the implementation of best practices for health care professionals. The aim of this article is to explore pediatric physiotherapists' (PTs) perspectives regarding the utility and usability of the characteristic of a web platform developed to support virtual communities of practice (vCoP). This study adopted an explanatory sequential mixed methods design. A web platform supporting the interactions of vCoP members was developed for PTs working with children with developmental coordination disorder. Specific strategies and features were created to support the effectiveness of the platform across three domains: social, information-quality, and system-quality factors. Quantitative data were collected from a cross-sectional survey (n = 41) after 5 months of access to the web platform. Descriptive statistics were calculated. Qualitative data were also collected from semistructured interviews (n = 9), which were coded, interpreted, and analyzed by using Boucher's Web Ergonomics Conceptual Framework. The utility of web platform characteristics targeting the three key domain factors were generally perceived positively by PTs. However, web platform usability issues were noted by PTs, including problems with navigation and information retrieval. Web platform aiming to support vCoP should be carefully developed to target potential users' needs. Whenever possible, users should co-construct the web platform with vCoP developers. Moreover, each of the developed characteristics (eg, newsletter, search function) should be evaluated in terms of utility and usability for the users.

Cost-Effectiveness and Cost-Utility of Internet-Based Computer Tailoring for Smoking Cessation

PubMed Central

Evers, Silvia MAA; de Vries, Hein; Hoving, Ciska

2013-01-01

Background Although effective smoking cessation interventions exist, information is limited about their cost-effectiveness and cost-utility. Objective To assess the cost-effectiveness and cost-utility of an Internet-based multiple computer-tailored smoking cessation program and tailored counseling by practice nurses working in Dutch general practices compared with an Internet-based multiple computer-tailored program only and care as usual. Methods The economic evaluation was embedded in a randomized controlled trial, for which 91 practice nurses recruited 414 eligible smokers. Smokers were randomized to receive multiple tailoring and counseling (n=163), multiple tailoring only (n=132), or usual care (n=119). Self-reported cost and quality of life were assessed during a 12-month follow-up period. Prolonged abstinence and 24-hour and 7-day point prevalence abstinence were assessed at 12-month follow-up. The trial-based economic evaluation was conducted from a societal perspective. Uncertainty was accounted for by bootstrapping (1000 times) and sensitivity analyses. Results No significant differences were found between the intervention arms with regard to baseline characteristics or effects on abstinence, quality of life, and addiction level. However, participants in the multiple tailoring and counseling group reported significantly more annual health care–related costs than participants in the usual care group. Cost-effectiveness analysis, using prolonged abstinence as the outcome measure, showed that the mere multiple computer-tailored program had the highest probability of being cost-effective. Compared with usual care, in this group €5100 had to be paid for each additional abstinent participant. With regard to cost-utility analyses, using quality of life as the outcome measure, usual care was probably most efficient. Conclusions To our knowledge, this was the first study to determine the cost-effectiveness and cost-utility of an Internet-based smoking cessation program with and without counseling by a practice nurse. Although the Internet-based multiple computer-tailored program seemed to be the most cost-effective treatment, the cost-utility was probably highest for care as usual. However, to ease the interpretation of cost-effectiveness results, future research should aim at identifying an acceptable cutoff point for the willingness to pay per abstinent participant. PMID:23491820

Socio-Demographic Determinants of Maternal Health-Care Service Utilization Among Rural Women in Anambra State, South East Nigeria

PubMed Central

Emelumadu, OF; Ukegbu, AU; Ezeama, NN; Kanu, OO; Ifeadike, CO; Onyeonoro, UU

2014-01-01

Background: Although, antenatal care (ANC) attendance in sub Saharan Africa is high, however this does not always translate into quality ANC care service utilization. Aim: This study therefore is aimed at exploring pattern of maternal health (MH) services utilization and the socio-demographic factors influencing it in Anambra State, South East Nigeria. Subjects and Methods: A total of 310 women of reproductive age with a previous history of gestation attending ANC services between September, 2007 and August, 2008 in selected Primary Health Centers in Anambra State were studied. Responses were elicited from the study participants using a pre-tested, semi-structured interviewer-administered questionnaire. Data collected were analyzed using Statistical Package for Social Sciences (SPSS) version 17 (SPSS Inc, Chicago Illinois, USA). Association between socio-demographic characteristics and pattern of utilization of ANC and delivery services was measured using χ2-test, Regression analysis was done to identify factors associated with utilization of MH services. P < 0.05 was assumed to be significant. Results: Use of health facility was 293 (97.0%) and 277 (92,7%) out 302 women for ANC and delivery services respectively. Most women attended their first ANC consultation during the preceding pregnancy was after the first trimester and about 31% (94/298) of them had <4 ANC visits prior to delivery. Socio-demographic factors were found to be significantly associated with places where MH care services are accessed. Parity was found to be associated with timing of ANC booking and number of ANC attendance (χ2 = 9.49, P = 0.05). Odds of utilizing formal health facility for MH services were found to be significantly associated with increasing age (P < 0.01) and educational status of mothers (P < 0.001). Conclusions: The study revealed high maternal service utilization and 10% fetal loss, hence the need to address the gaps of late ANC booking and low ANC visits. PMID:24971212

Socioeconomic Disparities in Maternity Care among Indian Adolescents, 1990–2006

PubMed Central

Kumar, Chandan; Rai, Rajesh Kumar; Singh, Prashant Kumar; Singh, Lucky

2013-01-01

Background India, with a population of more than 1.21 billion, has the highest maternal mortality in the world (estimated to be 56000 in 2010); and adolescent (aged 15–19) mortality shares 9% of total maternal deaths. Addressing the maternity care needs of adolescents may have considerable ramifications for achieving the Millennium Development Goal (MDG)–5. This paper assesses the socioeconomic differentials in accessing full antenatal care and professional attendance at delivery by adolescent mothers (aged 15–19) in India during 1990–2006. Methods and Findings Data from three rounds of the National Family Health Survey of India conducted during 1992–93, 1998–99, and 2005–06 were analyzed. The Cochran-Armitage and Chi-squared test for linear and non-linear time trends were applied, respectively, to understand the trend in the proportion of adolescent mothers utilizing select maternity care services during 1990–2006. Using pooled multivariate logistic regression models, the probability of select maternal healthcare utilization among women by key socioeconomic characteristics was appraised. After adjusting for potential socio-demographic and economic characteristics, the likelihood of adolescents accessing full antenatal care increased by only 4% from 1990 to 2006. However, the probability of adolescent women availing themselves of professional attendance at delivery increased by 79% during the same period. The study also highlights the desolate disparities in maternity care services among adolescents across the most and the least favoured groups. Conclusion Maternal care interventions in India need focused programs for rural, uneducated, poor adolescent women so that they can avail themselves of measures to delay child bearing, and for better antenatal consultation and delivery care in case of pregnancy. This study strongly advocates the promotion of a comprehensive ‘adolescent scheme’ along the lines of ‘Continuum of Maternal, Newborn and Child health Care’ to address the unmet need of reproductive and maternal healthcare services among adolescent women in India. PMID:23894412

Variation in the utilization of reconstruction following mastectomy in elderly women.

PubMed

In, Haejin; Jiang, Wei; Lipsitz, Stuart R; Neville, Bridget A; Weeks, Jane C; Greenberg, Caprice C

2013-06-01

Regardless of their age, women who choose to undergo postmastectomy reconstruction report improved quality of life as a result. However, actual use of reconstruction decreases with increasing age. Whereas this may reflect patient preference and clinical factors, it may also represent age-based disparity. Women aged 65 years or older who underwent mastectomy for DCIS/stage I/II breast cancer (2000-2005) were identified in the SEER-Medicare database. Overall and institutional rates of reconstruction were calculated. Characteristics of hospitals with higher and lower rates of reconstruction were compared. Pseudo-R² statistics utilizing a patient-level logistic regression model estimated the relative contribution of institution and patient characteristics. A total of 19,234 patients at 716 institutions were examined. Overall, 6 % of elderly patients received reconstruction after mastectomy. Institutional rates ranged from zero to >40 %. Whereas 53 % of institutions performed no reconstruction on elderly patients, 5.6 % performed reconstructions on more than 20 %. Although patient characteristics (%ΔR² = 70 %), and especially age (%ΔR² = 34 %), were the primary determinants of reconstruction, institutional characteristics also explained some of the variation (%ΔR² = 16 %). This suggests that in addition to appropriate factors, including clinical characteristics and patient preferences, the use of reconstruction among older women also is influenced by the institution at which they receive care. Variation in the likelihood of reconstruction by institution and the association with structural characteristics suggests unequal access to this critical component of breast cancer care. Increased awareness of a potential age disparity is an important first step to improve access for elderly women who are candidates and desire reconstruction.

Variation in the Utilization of Reconstruction Following Mastectomy in Elderly Women

PubMed Central

In, Haejin; Jiang, Wei; Lipsitz, Stuart R.; Neville, Bridget A.; Weeks, Jane C.; Greenberg, Caprice C.

2014-01-01

Background Regardless of their age, women who choose to undergo postmastectomy reconstruction report improved quality of life as a result. However, actual use of reconstruction decreases with increasing age. Whereas this may reflect patient preference and clinical factors, it may also represent age-based disparity. Methods Women aged 65 years or older who underwent mastectomy for DCIS/stage I/II breast cancer (2000–2005) were identified in the SEER-Medicare database. Overall and institutional rates of reconstruction were calculated. Characteristics of hospitals with higher and lower rates of reconstruction were compared. Pseudo-R2 statistics utilizing a patient-level logistic regression model estimated the relative contribution of institution and patient characteristics. Results A total of 19,234 patients at 716 institutions were examined. Overall, 6 % of elderly patients received reconstruction after mastectomy. Institutional rates ranged from zero to >40 %. Whereas 53 % of institutions performed no reconstruction on elderly patients, 5.6 % performed reconstructions on more than 20 %. Although patient characteristics (%ΔR2 = 70 %), and especially age (%ΔR2 = 34 %), were the primary determinants of reconstruction, institutional characteristics also explained some of the variation (%ΔR2 = 16 %). This suggests that in addition to appropriate factors, including clinical characteristics and patient preferences, the use of reconstruction among older women also is influenced by the institution at which they receive care. Conclusions Variation in the likelihood of reconstruction by institution and the association with structural characteristics suggests unequal access to this critical component of breast cancer care. Increased awareness of a potential age disparity is an important first step to improve access for elderly women who are candidates and desire reconstruction. PMID:23263733

Coverage and Preventive Screening

PubMed Central

Meeker, Daniella; Joyce, Geoffrey F; Malkin, Jesse; Teutsch, Steven M; Haddix, Anne C; Goldman, Dana P

2011-01-01

Context Preventive care has been shown as a high-value health care service. Many employers now offer expanded coverage of preventive care to encourage utilization. Objective To determine whether expanding coverage is an effective means to encourage utilization. Design Comparison of screening rates before and after introduction of deductible-free coverage. Setting People insured through large corporations between 2002 and 2006. Patients or Other Participants Preferred Provider Organization (PPO) enrollees from an employer introducing deductible-free coverage, and a control group enrolled in a PPO from a second employer with no policy change. Main Outcome Measures Adjusted probability of endoscopy, fecal occult blood test (FOBT), lipid screens, mammography, and Papanicolaou (pap) smears. Intervention Introduction of first-dollar coverage (FDC) of preventive services in 2003. Results After adjusting for demographics and secular trends, there were between 23 and 78 additional uses per 1,000 eligible patients of covered preventive screens (lipid screens, pap smears, mammograms, and FOBT), with no significant changes in the control group or in a service without FDC (endoscopy). Conclusions FDC improves utilization modestly among healthy individuals, particularly those in lower deductible plans. Compliance with guidelines can be encouraged by lowering out-of-pocket costs, but patients' predisposing characteristics merit attention. PMID:21029084

Disaster and subsequent healthcare utilization: a longitudinal study among victims, their family members, and control subjects.

PubMed

Dorn, Tina; Yzermans, C Joris; Kerssens, Jan J; Spreeuwenberg, Peter M M; van der Zee, Jouke

2006-06-01

The impact of disasters on primary healthcare utilization is largely unknown. Moreover, it is often overlooked how disaster affects those closest to the primary victims, their family members. The objective of this study was to examine the long-term effects of a catastrophic fire on primary healthcare utilization. We conducted a prospective, population-based cohort study covering 1 year pre- and 3 years postfire. Utilization data were extracted from primary care records. Subjects consisted of 286 disaster victims, 802 family members of disaster victims, 3722 community control subjects, and 10,230 patients from a national reference population. As outcome measures, we studied 1) the annual number of contacts in primary care and 2) the annual number of contacts for problems related to mental health. Determinants are injury characteristics of victims and bereavement. All analyses control for age, gender, and insurance status. Being an uninjured victim who witnessed the disaster increases the number of contacts by a factor of 1.55 during the first year postfire (95% confidence interval [CI], 1.35-1.78). Uninjured victims contact the family practitioner more often for mental health-related problems than adolescent community control subjects (incidence rate ratio [IRR], 4.54; 95% CI, 1.69-12.20). In adult family members, the loss of a child predicts overall utilization (IRR, 1.88; 95% CI, 1.35-2.63) and utilization for mental health (IRR, 8.69; 95% CI, 2.10-35.92) during the first year postfire. Attention should be paid to the primary care needs of bereaved individuals and those who have witnessed the disaster.

Working With Socially and Medically Complex Patients: When Care Transitions Are Circular, Overlapping, and Continual Rather Than Linear and Finite.

PubMed

Roberts, Shauna R; Crigler, Jane; Ramirez, Cristina; Sisco, Deborah; Early, Gerald L

2015-01-01

The care coordination program described here evolved from 5 years of trial and learning related to how to best serve our high-cost, high-utilizing, chronically ill, urban core patient population. In addition to medical complexity, they have daily challenges characteristic of persons served by Safety-Net health systems. Many have unstable health insurance status. Others have insecure housing. A number of patients have a history of substance use and mental illness. Many have fractured social supports. Although some of the best-known care transition models have been successful in reducing rehospitalizations and cost among patients studied, these models were developed for a relatively high functioning patient population with social support. We describe a successful approach targeted at working with patients who require a more intense and lengthy care coordination intervention to self-manage and reduce the cost of caring for their medical conditions. Using a diverse team and a set of replicable processes, we have demonstrated statistically significant reduction in the use of hospital and emergency services. Our intervention leverages the strengths and resilience of patients, focuses on trust and self-management, and targets heterogeneous "high-utilizer" patients with medical and social complexity.

Assessing Telemedicine Utilization by Using Medicaid Claims Data.

PubMed

Douglas, Megan Daugherty; Xu, Junjun; Heggs, Akilah; Wrenn, Glenda; Mack, Dominic H; Rust, George

2017-02-01

This study characterized telemedicine utilization among Medicaid enrollees by patients' demographic characteristics, geographic location, enrollment type, eligibility category, and clinical conditions. This study used 2008-2009 Medicaid claims data from 28 states and the District of Columbia to characterize telemedicine claims (indicated by GT for professional fee claims or Q3014 for facility fees) on the basis of patients' demographic characteristics, geographic location, enrollment type, eligibility category, and clinical condition as indicated by ICD-9 codes. States lacking Medicaid telemedicine reimbursement policies were excluded. Chi-square tests were used to compare telemedicine utilization rates and one-way analysis of variance was used to estimate mean differences in number of telemedicine encounters among subgroups. A total of 45,233,602 Medicaid enrollees from the 22 states with telemedicine reimbursement policies were included in the study, and .1% were telemedicine users. Individuals ages 45 to 64 (16.4%), whites (11.3%), males (8.5%), rural residents (26.0%), those with managed care plans (7.9%), and those categorized as aged, blind, and disabled (28.1%) were more likely to receive telemedicine (p<.001). Nearly 95% of telemedicine claims were associated with a behavioral health diagnosis, of which over 50% were for bipolar disorder and attention-deficit disorder or attention-deficit hyperactivity disorder (29.3% and 23.4%, respectively). State-level variation was high, ranging from .0 to 59.91 claims per 10,000 enrollees (Arkansas and Arizona, respectively). Despite the touted potential for telemedicine to improve health care access, actual utilization of telemedicine in Medicaid programs was low. It was predominantly used to treat behavioral health diagnoses. Reimbursement alone is insufficient to support broad utilization for Medicaid enrollees.

Assessing Telemedicine Utilization by Using Medicaid Claims Data

PubMed Central

Douglas, Megan Daugherty; Xu, Junjun; Heggs, Akilah; Wrenn, Glenda; Mack, Dominic H.; Rust, George

2017-01-01

Objective This study characterized telemedicine utilization among Medicaid enrollees by patients’ demographic characteristics, geographic location, enrollment type, eligibility category, and clinical conditions. Methods This study used 2008–2009 Medicaid claims data from 28 states and the District of Columbia to characterize telemedicine claims (indicated by GT for professional fee claims or Q3014 for facility fees) on the basis of patients’ demographic characteristics, geographic location, enrollment type, eligibility category, and clinical condition as indicated by ICD-9 codes. States lacking Medicaid telemedicine reimbursement policies were excluded. Chi-square tests were used to compare telemedicine utilization rates and one-way analysis of variance was used to estimate mean differences in number of telemedicine encounters among subgroups. Results A total of 45,233,602 Medicaid enrollees from the 22 states with telemedicine reimbursement policies were included in the study, and .1% were telemedicine users. Individuals ages 45 to 64 (16.4%), whites (11.3%), males (8.5%), rural residents (26.0%), those with managed care plans (7.9%), and those categorized as aged, blind, and disabled (28.1%) were more likely to receive telemedicine (p<.001). Nearly 95% of telemedicine claims were associated with a behavioral health diagnosis, of which over 50% were for bipolar disorder and attention-deficit disorder or attention-deficit hyperactivity disorder (29.3% and 23.4%, respectively). State-level variation was high, ranging from .0 to 59.91 claims per 10,000 enrollees (Arkansas and Arizona, respectively). Conclusions Despite the touted potential for telemedicine to improve health care access, actual utilization of telemedicine in Medicaid programs was low. It was predominantly used to treat behavioral health diagnoses. Reimbursement alone is insufficient to support broad utilization for Medicaid enrollees. PMID:27691381

Favorable Cardiovascular Health Is Associated With Lower Health Care Expenditures and Resource Utilization in a Large US Employee Population: The Baptist Health South Florida Employee Study.

PubMed

Osondu, Chukwuemeka U; Aneni, Ehimen C; Valero-Elizondo, Javier; Salami, Joseph A; Rouseff, Maribeth; Das, Sankalp; Guzman, Henry; Younus, Adnan; Ogunmoroti, Oluseye; Feldman, Theodore; Agatston, Arthur S; Veledar, Emir; Katzen, Barry; Calitz, Chris; Sanchez, Eduardo; Lloyd-Jones, Donald M; Nasir, Khurram

2017-03-13

To examine the association of favorable cardiovascular health (CVH) status with 1-year health care expenditures and resource utilization in a large health care employee population. Employees of Baptist Health South Florida participated in a health risk assessment from January 1 through September 30, 2014. Information on dietary patterns, physical activity, blood pressure, blood glucose level, total cholesterol level, and smoking were collected. Participants were categorized into CVH profiles using the American Heart Association's ideal CVH construct as optimal (6-7 metrics), moderate (3-5 metrics), and low (0-2 metrics). Two-part econometric models were used to analyze health care expenditures. Of 9097 participants (mean ± SD age, 42.7±12.1 years), 1054 (11.6%) had optimal, 6945 (76.3%) had moderate, and 1098 (12.1%) had low CVH profiles. The mean annual health care expenditures among those with a low CVH profile was $10,104 (95% CI, $8633-$11,576) compared with $5824 (95% CI, $5485-$6164) and $4282 (95% CI, $3639-$4926) in employees with moderate and optimal CVH profiles, respectively. In adjusted analyses, persons with optimal and moderate CVH had a $2021 (95% CI, -$3241 to -$801) and $940 (95% CI, -$1560 to $80) lower mean expenditure, respectively, than those with low CVH. This trend remained even after adjusting for demographic characteristics and comorbid conditions as well as across all demographic subgroups. Similarly, health care resource utilization was significantly lower in those with optimal CVH profiles compared with those with moderate or low CVH profiles. Favorable CVH profile is associated with significantly lower total medical expenditures and health care utilization in a large, young, ethnically diverse, and fully insured employee population. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Auditing Practice Style Variation in Pediatric Inpatient Asthma Care.

PubMed

Silber, Jeffrey H; Rosenbaum, Paul R; Wang, Wei; Ludwig, Justin M; Calhoun, Shawna; Guevara, James P; Zorc, Joseph J; Zeigler, Ashley; Even-Shoshan, Orit

2016-09-01

Asthma is the most prevalent chronic illness among children, remaining a leading cause of pediatric hospitalizations and representing a major financial burden to many health care systems. To implement a new auditing process examining whether differences in hospital practice style may be associated with potential resource savings or inefficiencies in treating pediatric asthma admissions. A retrospective matched-cohort design study, matched for asthma severity, compared practice patterns for patients admitted to Children's Hospital Association hospitals contributing data to the Pediatric Hospital Information System (PHIS) database. With 3 years of PHIS data on 48 887 children, an asthma template was constructed consisting of representative children hospitalized for asthma between April 1, 2011, and March 31, 2014. The template was matched with either a 1:1, 2:1, or 3:1 ratio at each of 37 tertiary care children's hospitals, depending on available sample size. Treatment at each PHIS hospital. Cost, length of stay, and intensive care unit (ICU) utilization. After matching patients (n = 9100; mean [SD] age, 7.1 [3.6] years; 3418 [37.6%] females) to the template (n = 100, mean [SD] age, 7.2 [3.7] years; 37 [37.0%] females), there was no significant difference in observable patient characteristics at the 37 hospitals meeting the matching criteria. Despite similar characteristics of the patients, we observed large and significant variation in use of the ICUs as well as in length of stay and cost. For the same template-matched populations, comparing utilization between the 12.5th percentile (lower eighth) and 87.5th percentile (upper eighth) of hospitals, median cost varied by 87% ($3157 vs $5912 per patient; P < .001); total hospital length of stay varied by 47% (1.5 vs 2.2 days; P < .001); and ICU utilization was 254% higher (6.5% vs 23.0%; P < .001). Furthermore, the patterns of resource utilization by patient risk differed significantly across hospitals. For example, as patient risk increased one hospital displayed significantly increasing costs compared with their matched controls (comparative cost difference: lowest risk, -34.21%; highest risk, 53.27%; P < .001). In contrast, another hospital displayed significantly decreasing costs relative to their matched controls as patient risk increased (comparative cost difference: lowest risk, -10.12%; highest risk, -16.85%; P = .01). For children with asthma who had similar characteristics, we observed different hospital resource utilization; some values differed greatly, with important differences by initial patient risk. Through the template matching audit, hospitals and stakeholders can better understand where this excess variation occurs and can help to pinpoint practice styles that should be emulated or avoided.

Using Electronic Health Record (EHR) “Big Data” to Examine the Influence of Nurse Continuity on a Hospital-Acquired Never Event

PubMed Central

STIFTER, Janet; YAO, Yingwei; LODHI, Muhammad Kamran; LOPEZ, Karen Dunn; KHOKHAR, Ashfaq; WILKIE, Diana J.; KEENAN, Gail M.

2015-01-01

Background There is little research demonstrating the influence of nurse continuity on patient outcomes despite an intuitive belief that continuity of care makes a difference in care outcomes. Objective To examine the influence of nurse continuity (the number of consecutive care days by the same/consistent RN[s]) on the prevention of hospital-acquired pressure ulcers (HAPU). Method A secondary use of data from the Hands on Automated Nursing Data System (HANDS) was performed for this comparative study. The HANDS is a nursing plan of care (POC) “big data” database containing 42,403 episodes documented by 787 nurses, on 9 units, in four hospitals and includes nurse staffing and patient characteristics. Via data mining, we created an analytic dataset of 840 care episodes, 210 with and 630 without HAPUs, matched by nursing unit, patient age, and patient characteristics. Logistic regression analysis determined the influence of nurse continuity and additional nurse-staffing variables on the presence of HAPUs. Results Poor nurse continuity (Continuity Index=.21-.42 [1.0=optimal continuity]) was noted on all nine study units. Nutrition, mobility, perfusion, hydration, and skin problems on admission as well as patient age were associated with HAPUs (p<.001). Controlling for patient characteristics, nurse continuity and the interactions between nurse continuity and other nurse-staffing variables were not significantly associated with HAPU development. Discussion Patient characteristics including nutrition, mobility, and perfusion were associated with HAPUs, but nurse continuity was not. One study implication is that to reduce the incidence of HAPUs the most effective resource utilization might be in the continued development of best practices to address patient characteristics that lead to pressure ulcer vulnerability rather than a focus on nurse staffing. PMID:26325278

Patients' experiences of shared decision making in primary care practices in the United kingdom.

PubMed

Fullwood, Catherine; Kennedy, Anne; Rogers, Anne; Eden, Martin; Gardner, Caroline; Protheroe, Joanne; Reeves, David

2013-01-01

Shared decision making (SDM) and patient self-management support are key components of US and UK policy for chronic disease management, whereby SDM is seen as enhancing physician-patient negotiation around self-management. The WISE trial is implementing training in self-management support for primary care physicians in one UK region. This article describes preintervention levels of patient-reported SDM and explores how this varies with patient and practice characteristics. We analyzed baseline data from a cluster randomized controlled trial for 2965 patients with diabetes, chronic obstructive pulmonary disease, and irritable bowel syndrome (IBS) from 29 family practices. Patient-level measures included self-report of chronic conditions, SDM (Health Care Climate Questionnaire [HCCQ]), health status, and demographic characteristics. Area and practice characteristics included chronic disease workload and socioeconomic deprivation. The mean SDM score was 75 (out of 100), but the range was wide. The mean score was lower for IBS patients but did not vary with other disease conditions. Younger patients and those with poorer health status reported lower degrees of SDM. No associations were found with practice characteristics. The study was restricted to one socioeconomically deprived region, and hence results may not be nationally representative of the United Kingdom. Ceiling effects on SDM scores may limit the utility of the HCCQ. Lower ratings from some patient groups may reflect differences in expectations rather than differences in physician behavior. Overall levels of SDM were high, and no patient or practice characteristic represented a serious barrier to SDM. However, we cannot say to what extent SDM in this chronic population addressed self-management issues rather than clinical care. More nuanced measures of SDM are required that distinguish between different forms of care.

Medicaid Managed Care Structures and Care Coordination.

PubMed

Gilchrist-Scott, Douglas H; Feinstein, James A; Agrawal, Rishi

2017-09-01

Child enrollment in Medicaid managed care (MMC) has expanded dramatically, primarily through state mandates. Care coordination is a key metric in MMC evaluation because it drives much of the proposed cost savings and may be associated with improved health outcomes and utilization. We evaluated the relationships between enrollment in 2 MMC structures, primary care case management (PCCM) and health maintenance organization (HMO) and access to and receipt of care coordination by children. Using data from the 2011/2012 National Survey of Children's Health and the Medicaid Statistical Information System state data mart, we conducted a retrospective, cross-sectional analysis of the relationships between fee-for-service, PCCM or HMO enrollment, and access to and receipt of care coordination. State-level univariate analyses and individual and state multilevel multivariable analyses evaluated correlations between MMC enrollment and care coordination, controlling for demographic characteristics and state financing levels. In univariate and multilevel multivariable analyses, the PCCM penetration rate was significantly associated with increased access to care coordination (adjusted odds ratio: 1.23, P = .034) and receipt of care coordination (adjusted odds ratio: 1.37, P = .02). The HMO penetration rate was significantly associated with lower access to care coordination (adjusted odds ratio: 0.85, P = .05) and receipt of care coordination (adjusted odds ratio: 0.71, P < .001). Fee-for-service served as the referent. State utilization of MMC varied widely. These data suggest that care coordination may be more effective in PCCM than HMO structures. States should consider care coordination outcomes when structuring their Medicaid programs. Copyright © 2017 by the American Academy of Pediatrics.

Comparison of public and private care management agencies under public long-term care insurance in Japan: a cross-sectional study.

PubMed

Yoshioka, Yoji; Tamiya, Nanako; Kashiwagi, Masayo; Sato, Mikiya; Okubo, Ichiro

2010-01-01

Long-Term Care Insurance (LTCI), which started in April 2000, allowed private business corporations to provide long-term care services which had been provided by social welfare corporations or public agencies in the previous long-term care scheme. This study compared differences in care management plans for community-dwelling frail elderly people between public care management agencies and private care management agencies. The subjects were 309 community-dwelling frail elderly people living in a suburban city with a population of approximately 55,000 and who had been using community-based long-term care services of the LTCI for 6 months from April 2000. The characteristics of the care management agencies (public/private) were identified using a claims database. After comparing profiles of users and their care mix between those managed by public agencies and by private agencies, the effect of the characteristics of care management agencies on LTCI service use was examined. Public care management agencies favored younger subjects (P = 0.003), male subjects (P = 0.006) and people with a higher need for care (P = 0.02) than private agencies. The number of service items used was significantly larger in public agencies than in their private counterparts. In multivariate regression analysis, the utilization of community-based long-term care service was significantly greater among beneficiaries managed by private agencies than those managed by public agencies (P = 0.02). Private care management agencies play an important role in promoting the use of care services, but their quality of care plans might be questionable.

Health Literacy Among a Formerly Incarcerated Population Using Data from the Transitions Clinic Network.

PubMed

Hadden, Kristie B; Puglisi, Lisa; Prince, Latrina; Aminawung, Jenerius A; Shavit, Shira; Pflaum, David; Calderon, Joe; Wang, Emily A; Zaller, Nickolas

2018-06-25

Health literacy is increasingly understood to be a mediator of chronic disease self-management and health care utilization. However, there has been very little research examining health literacy among incarcerated persons. This study aimed to describe the health literacy and relevant patient characteristics in a recently incarcerated primary care patient population in 12 communities in 6 states and Puerto Rico. Baseline data were collected from 751 individuals through the national Transitions Clinic Network (TCN), a model which utilizes a community health worker (CHW) with a previous history of incarceration to engage previously incarcerated people with chronic medical diseases in medical care upon release. Participants in this study completed study measures during or shortly after their first medical visit in the TCN. Data included demographics, health-related survey responses, and a measure of health literacy, The Newest Vital Sign (NVS). Bivariate and linear regression models were fit to explore associations among health literacy and the time from release to first clinic appointment, number of emergency room visits before first clinic appointment and confidence in adhering to medication. Our study found that almost 60% of the sample had inadequate health literacy. Inadequate health literacy was associated with decreased confidence in taking medications following release and an increased likelihood of visiting the emergency department prior to primary care. Early engagement may improve health risks for this population of individuals that is at high risk of death, acute care utilization, and hospitalization following release.

Nurses' caring and empathy in Jordanian psychiatric hospitals: A national survey.

PubMed

Alhadidi, Majdi M B; Abdalrahim, Maysoon S; Al-Hussami, Mahmoud

2016-08-01

Nurses working in psychiatric hospitals need to acquire the skills of therapeutic communication and empathy, and have higher levels of caring. The present study aims to investigate the level of caring and empathy among nurses working in psychiatric hospitals. A cross-sectional survey was utilized to collect data from 205 nurses recruited from three psychiatric hospitals in Jordan. The Background Information Questionnaire, Modified Caring Dimensions Inventory, and Toronto Empathy Questionnaire were administered to the recruited participants. The findings revealed that the sampled nurses had a high level of caring and empathy. Significant correlations were found between caring and having a specialized training in mental health nursing, and having organizational and managerial support. However, no significant correlations were found between empathy and participants' characteristics. Specialized training in mental health nursing, having organizational and managerial support, and empathy were found predictors for caring. © 2016 Australian College of Mental Health Nurses Inc.

Socioeconomic inequalities of outpatient and inpatient service utilization in China: personal and regional perspectives.

PubMed

Zhu, Dawei; Guo, Na; Wang, Jian; Nicholas, Stephen; Chen, Li

2017-12-04

China's health system has shown remarkable progress in health provision and health outcomes in recent decades, however inequality in health care utilization persists and poses a serious social problem. While government pro-poor health policies addressed affordability as the major obstacle to equality in health care access, this policy direction deserves further examination. Our study examines the issue of health care inequalities in China, analyzing both regional and individual socioeconomic factors associated with the inequality, and provides evidence to improve governmental health policies. The China Health and Nutrition Survey (CHNS) 1991-2011 data were used to analyze the inequality of health care utilization. The random effects logistic regression technique was used to model health care utilization as the dependent variable, and income and regional location as the independent variables, controlling for individuals' age, gender, marital status, education, health insurance, body mass index (BMI), and period variations. The dynamic trend of 1991-2011 regional disparities was estimated using an interaction term between the regional group dummy and the wave dummy. The probability of using outpatient service and inpatient services during the previous 4 weeks was 8.6 and 1.1% respectively. Compared to urban residents, suburban (OR: 0.802, 95% CI: 0.720-0.893), town (OR: 0.722, 95% CI: 0.648-0.804), rich (OR: 0.728, 95% CI: 0.656-0.807) and poor village (OR: 0.778, 95% CI: 0.698-0.868) residents were less likely to use outpatient service; and rich (OR: 0.609, 95% CI: 0.472-0.785) and poor village (OR: 0.752, 95% CI: 0. 576-0.983) residents were less likely to use inpatient health care. But the differences between income groups were not significant, except the differences between top and bottom income group in outpatient service use. Regional location was a more important factor than individual characteristics in determining access to health care. Besides demand-side subsidies, Chinese policy makers should pay enhanced attention to health care resource allocation to address inequity in health care access.

Disparities in mobile phone access and maternal health service utilization in Nigeria: a population-based survey.

PubMed

Jennings, Larissa; Omoni, Adetayo; Akerele, Akunle; Ibrahim, Yisa; Ekanem, Ekpenyong

2015-05-01

Mobile communication technologies may reduce maternal health disparities related to cost, distance, and infrastructure. However, the ability of mHealth initiatives to accelerate maternal health goals requires in part that women with the greatest health needs have access to mobile phones. This study examined if women with limited mobile phone access have differential odds of maternal knowledge and health service utilization as compared to female mobile phone users who are currently eligible to participate in maternal mHealth programs. Using household survey data from Nigeria, multivariable logistic regressions were used to examine the odds of maternal knowledge and service utilization by mobile phone strata. Findings showed that in settings with unequal access to mobile phones, mHealth interventions may not reach women who have the poorest maternal knowledge and care-seeking as these women often lacked mobile connectivity. As compared to mobile users, women without mobile phone access had significantly lower odds of antenatal care utilization (OR=0.48, 95%CI: 0.36-0.64), skilled delivery (OR=0.56, 95%CI: 0.45-0.70), and modern contraceptive use (OR=0.50, 95%CI: 0.33-0.76) after adjusting for demographic characteristics. They also had significantly lower knowledge of maternal danger signs (OR=0.69, 95%CI: 0.53-0.90) and knowledge of antenatal (OR=0.46, 95%CI: 0.36-0.59) and skilled delivery care benefits (OR=0.62, 95%CI: 0.47-0.82). No differences were observed by mobile phone strata in uptake of emergency obstetric care, postnatal services, or breastfeeding. As maternal mHealth strategies are increasingly utilized, more efforts are needed to improve women's access to mobile phones and minimize potential health inequities brought on by health systems and technological barriers in access to care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Urban women's use of rural-based health care services: the case of Igbo women in Aba City, Nigeria.

PubMed

Izugbara, C Otutubikey; Afangideh, A Isong

2005-03-01

This study addresses the quest for rural-based health care services among women in urban Nigeria relying on a large qualitative database obtained from 63 Igbo women living in Aba, Nigeria. Results indicate that urban Igbo women of different socioeconomic and demographic characteristics utilize the services of different rural-based health care providers-indigenous healers, traditional birth attendants (TBAs), faith/spiritual, western-trained doctors and nurses as well as chemist shopkeepers-for conditions ranging from infertility, through child birthing and abortions, to swollen body, epilepsy, bone setting, and stubborn skin diseases. Major attractions to rural-based therapists were the failure of urban-based health services to provide cure, perceived mystical nature of conditions, need to conceal information on therapeutic progress and/or the nature of specific disease conditions, belief in rural-based therapists' ability to cure condition, and affordability of the services of rural-based health care providers. Findings underscore the critical implications of service characteristics, cultural beliefs, and the symbolic content of place(s) for care seekers' patterns of resort. We suggest that need exists for policies and programs aimed at making health care services in urban Nigeria more responsive to care seekers' socioeconomic and cultural sensitivities, integrating informal health care providers into Nigeria's health care system, and strengthening public health education in Nigeria.

[Dementia in families with a Turkish migration background. Organization and characteristics of domestic care arrangements].

PubMed

Mogar, M; von Kutzleben, M

2015-07-01

Until recently public health and health services research has not been concerned with people suffering from dementia with a Turkish migration background as a priority. There is little evidence about the situation of this population; however, it is known that these individuals almost always live with their families and are cared for by their families generally without seeking professional support. The aim of this study was to gain insight into the organization and characteristics of home-based care arrangements for people suffering from dementia with a Turkish migration background from the family carer's perspective. Interviews with seven family carers. The principles of the grounded theory served as a framework for data analysis. Unconditional commitment to caring for a family member with dementia was identified as the main characteristic of care arrangements in families with a Turkish migration background. Dementia is not a factor that has an impact on the decision of families to assume care responsibility for an affected family member and there is a lack of knowledge about dementia in general. There are various inhibiting factors for the utilization of formal services and the family carers in this sample complained that the available services are not culturally sensitive. There seems to be an extensive need for information and counselling regarding care dependency and dementia among the Turkish community. To provide personal-centred care and relief to these families in the future, efforts should be made to adapt the current care system to the specific needs and demands of this population. Cultural sensitivity in general and individual subjective needs of persons with a Turkish migration background affected by dementia should be taken into account.

Clinical and health care use characteristics of patients newly prescribed allopurinol, febuxostat and colchicine for gout

PubMed Central

Kim, Seoyoung C.; Schmidt, Bernhard M.W.; Franklin, Jessica M.; Liu, Jun; Solomon, Daniel H.; Schneeweiss, Sebastian

2014-01-01

Background Gout is a common inflammatory arthritis with the increasing prevalence in the developed countries. It is well-known that many patients with gout have significant comorbidities and high health care utilization. Methods Using US insurance claims data (2009–2011), a population-based cohort study was conducted to describe clinical characteristics and health care utilization patterns in patients with gout newly prescribed allopurinol, febuxostat or colchicine. Results There were 25,051 allopurinol, 4,288 febuxostat and 6,238 colchicine initiators. Mean age was 53 years and 83%–87% were male. More than half of patients had hypertension and hyperlipidemia, 20% had diabetes and 10% cardiovascular disease. The mean uric acid level (mg/dl) was similar at baseline ranging from 8.1 to 8.5 across the groups. Compared to allopurinol or colchicine initiators, febuxostat initiators had more comorbidities and greater health care uses including outpatient, inpatient or emergency room visits, both at baseline and during the follow-up. Use of gout related drugs, such as opioids, steroids and non-steroidal anti-inflammatory drugs, was most common in febuxostat and least common in colchicine initiators. The median daily dose at both start and end of treatment was 300mg for allopurinol, 40mg for febuxostat, and 1.2mg for colchicine. The dosage of allopurinol and febuxostat was rarely increased during the follow-up. Conclusion Patients who started allopurinol, febuxostat or colchicine for gout generally had hyperuricemia and multiple comorbidities. Febuxostat initiators had more comorbidities and greater use of health care resources and gout-related drugs than other groups. Overall, the dosages of allopurinol or febuxostat remained unchanged over time. PMID:23861232

Exploring Characteristics and Health Care Utilization Trends Among Individuals Who Fall in the Health Insurance Assistance Gap in a Medicaid Nonexpansion State.

PubMed

Edward, Jean; Mir, Nageen; Monti, Denise; Shacham, Enbal; Politi, Mary C

2017-11-01

States that did not expand Medicaid under the Affordable Care Act (ACA) in the United States have seen a growth in the number of individuals who fall in the assistance gap, defined as having incomes above the Medicaid eligibility limit (≥44% of the federal poverty level) but below the lower limit (<100%) to be eligible for tax credits for premium subsidies or cost-sharing reductions in the marketplace. The purpose of this article is to present findings from a secondary data analysis examining the characteristics of those who fell in the assistance gap ( n = 166) in Missouri, a Medicaid nonexpansion state, by comparing them with those who did not fall in the assistance gap ( n = 157). Participants completed online demographic questionnaires and self-reported measures of health and insurance status, health literacy, numeracy, and health insurance literacy. A select group completed a 1-year follow-up survey about health insurance enrollment and health care utilization. Compared with the nonassistance gap group, individuals in the assistance gap were more likely to have lower levels of education, have at least one chronic condition, be uninsured at baseline, and be seeking health care coverage for additional dependents. Individuals in the assistance gap had significantly lower annual incomes and higher annual premiums when compared with the nonassistance gap group and were less likely to be insured through the marketplace or other private insurance at the 1-year follow-up. Findings provide several practice and policy implications for expanding health insurance coverage, reducing costs, and improving access to care for underserved populations.

Assessment of medical care by elderly people: general satisfaction and physician quality.

PubMed Central

Lee, Y; Kasper, J D

1998-01-01

OBJECTIVE: To identify personal characteristics and factors related to health and patterns of healthcare utilization associated with the elderly people's satisfaction with medical care. DATA SOURCES/STUDY SETTING: Data from the 1991 Medicare Current Beneficiary Survey (MCBS) on 8,859 persons age 65 and over living in the community. STUDY DESIGN: Items reflecting general satisfaction with care and views of physician quality are examined and, based on factor analysis, grouped in dimensions of two (global quality, access) and three (technical skills, interpersonal manner, information-giving), respectively. The relationship of high levels of satisfaction in each dimension to personal characteristics of elderly people, and to measures of access and utilization, is assessed using logistic regression. PRINCIPAL FINDINGS: While satisfaction is high, with over 90 percent surveyed expressing some satisfaction, there is substantial variation with less likelihood of high satisfaction among those 80 or older, with less education and income and in poorer health. Longer waiting time at visits and less frequent visits are factors in lower satisfaction as well. A favorable perception of physician quality, especially regarding technical skills, appears to play a significant role in satisfaction with global quality of care. CONCLUSIONS: Studies of patient satisfaction in elderly people are rare. Some factors expected to be related to positive assessment based on earlier studies, were, e.g., better health and shorter waiting time, while others were not, e.g., increasing age. Elderly people appear to place greater importance on physician technical skills, as opposed to interpersonal dimensions, in assessing global quality. These findings suggest the need for a better understanding of how elderly people evaluate care and what they value in interactions with the healthcare system. Images Figure 1 PMID:9460484

The experience of adverse childhood experiences and dental care in childhood.

PubMed

Crouch, Elizabeth; Radcliff, Elizabeth; Nelson, Joni; Strompolis, Melissa; Martin, Amy

2018-06-06

Routine preventive dental care is important to overall child health and well-being. However, the experience of adversity in childhood may prevent children from getting adequate preventive care. This study seeks to explore how the prevalence of adverse childhood experiences (ACEs) and the role of a protective adult may be associated with dental care utilization in childhood. Data from the 2016 South Carolina Behavioral Risk Factor Surveillance System (SC BRFSS), which interviews adults eighteen year of age and older, were used in this study. Dental care utilization in childhood was measured as the adult retrospectively reported frequency of dental care in childhood: at least once every 2 years (adequate dental care) or less often than every 2 years (inadequate dental care). ACEs were determined by asking about each of respondent's childhood exposure to eleven childhood experiences, including divorce, parental incarceration, domestic violence, drug and alcohol abuse, mental illness and emotional, physical or sexual abuse. The presence of a protective adult in childhood included respondents who had an adult who made them feel safe and protected during childhood. Descriptive and bivariate statistics explored differences in the adequacy of child dental care by ACE exposure, the presence of a protective adult and selected demographic characteristics. Multivariate regression models were used to examine the impact of counts and types of ACEs and the presence of a protective adult with inadequate childhood dental care. The unweighted study sample included 7079 respondents ageing from 18 to 79 years of age Sampling weights were used for all analyses. Among all respondents, 71.7% reported receiving adequate dental care during childhood; 28.3% responded that they received inadequate dental care. Adjusting for sociodemographic characteristics, respondents who experienced four or more ACEs had a higher likelihood of inadequate dental care than respondents who reported no ACEs (aOR 2.79; 95% CI 2.77-2.82). The odds of reporting inadequate dental care were lower among those grew up with an adult who made them feel safe and protected (aOR 0.38; 95% CI 0.37-0.39). The presence of protective factors may mitigate the effects of ACEs on paediatric dental care. This research contributes to the literature through the further identification of the role of dentists in identifying signs of abuse and neglect. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Survivorship care planning in skin cancer: An unbiased statistical approach to identifying patterns of care-plan use.

PubMed

Benci, Joseph L; Minn, Andy J; Vachani, Carolyn C; Bach, Christina; Arnold-Korzeniowski, Karen; Hampshire, Margaret K; Metz, James M; Hill-Kayser, Christine E

2018-01-01

Nearly 1 in 5 Americans will develop skin cancer, and as a result, survivors of skin cancer compose one of the largest groups of cancer survivors. Survivorship care plans (SCPs) are an important tool for improving patient outcomes and provide critical information to both survivors and health care professionals. Recent efforts have been made to expand SCP utilization; however, which patients currently receive SCPs is poorly understood. This study used 596 individuals with a diagnosis of melanoma (n = 391) or nonmelanoma skin cancer (n = 205) who had used an Internet-based SCP tool from May 2010 to December 2016 to model the patient and provider characteristics that determine SCP utilization. Survivors were predominantly white (95.3%) and female (56.5%). Survivors who received a treatment summary were more likely to also receive an SCP. University and nonuniversity cancer centers used SCPs at a higher rate than other care settings. Survivors whose care was managed by a team rather than just an individual physician were also more likely to receive an SCP. Survivors older than 70 years at diagnosis were almost twice as likely to receive a plan as survivors who were diagnosed at a younger age. With a convenience sample of skin cancer survivors, it is possible to model factors that predict the receipt of SCPs. Important variables include the diagnosis age, treatment setting, physician type, and treatment-summary utilization. A closer examination of these variables identified several disparities in care-plan use and, therefore, opportunities to improve the distribution of SCPs. Further validation in additional cohorts of survivors is necessary to confirm these conclusions. Cancer 2018;124:183-91. © 2017 American Cancer Society. © 2017 American Cancer Society.

Utilization of inpatient care from private hospitals: trends emerging from Kerala, India.

PubMed

Dilip, T R

2010-09-01

There is a gap in knowledge on the overall role and characteristics of private health care providers in India. This research is aimed at understanding changes in the consumption of inpatient care services from private hospitals between 1986 and 2004, with a particular focus on equitable outreach. Secondary analysis of National Sample Survey data on the utilization of inpatient care services in Kerala is performed for the periods 1986-87, 1995-96 and 2004. Household survey data are examined to understand the users of the private health system as there are limitations in obtaining reliable data from unregulated private health care providers. The annual hospitalization rate increased from 69 per 1000 population in 1986-87 to 126 per 1000 population by 2004. The proportion of persons seeking care from private rather than government hospitals increased from 55% in 1986-87 to 65% by 2004. Concentration indices revealed that the year 1995-96 witnessed the highest income inequality in hospitalization rates. A decline both in hospitalization rates and in the relative preference for private hospitals over government hospitals among the poorest two quintiles between 1986-87 and 1995-96 indicates that the poor avoided inpatient treatment. The rich-poor divide in care seeking from private hospitals was moderated by 2004. Improvements in the purchasing power of the population, and the strategy of private hospitals in this highly competitive market to generate revenue from the poorer quintiles by offering different pricing options, have reduced the observed rich-poor divide in the consumption of inpatient treatment from this sector. However, while this gap in utilization has closed, the burden of out-of-pocket expenditure is higher among the poor.

Challenges in the Management of Geriatric Trauma: A Case Report.

PubMed

Gaebel, Ashley; Keiser, Megan

This article describes geriatric trauma and commonly associated difficulties emphasizing both the epidemiology and assessment of geriatric trauma. There is little data guiding decisions for trauma patients 65 years or older, as there are many unique characteristics to the geriatric population, including comorbidities, medications, and the aging physiology. The geriatric population in the United States has been steadily climbing for the last 20 years and is projected to continue on this trend. Although each patient presents differently, there remains a need for the consistent utilization of standard guidelines to help dictate care for geriatric patients, particularly for patients not receiving care at a trauma center. This review uses a case study about an elderly woman with many comorbidities, followed by a comprehensive discussion of geriatric trauma and the challenges that result from a lack of guideline utilization to direct management.

Prevalence, characteristics, and acute care utilization of disabled older adults with an absence of help for activities of daily living: Findings from a nationally representative survey.

PubMed

Wang, Hui-Hsuan; Shyu, Yea-Ing Lotus; Chang, Hsing-Yi; Bai, Yuh-Bin; Stanaway, Fiona; Lin, Jen-Der; Li, Chia-Lin

2016-01-01

The aim of this study was to investigate the prevalence, characteristics, and acute care utilization of community dwelling disabled older adults with an absence of help for activities of daily living (ADL). We analyzed cross-sectional data from a nationally representative sample of people aged 65 years and over (n=2904) participating in the 2009 National Health Interview Survey in Taiwan. Disability was defined as self-reporting a lot of difficulty or complete inability to carry out one or more ADL tasks. Participants with disability were asked whether they received help in the form of personal assistance or assistive devices to complete ADL tasks, with a yes response indicating the presence of help and a no response indicating the absence of help. Hospitalization and emergency department visits was assessed as a dichotomous variable (any or none), respectively. An absence of available help for ADL disability was reported in 16.6% of disabled older adults. Disabled older adults reporting an absence of help were more likely to be female. After adjustment for other factors, compared to older adults without disability, older adults with disability not receiving help for ADL tasks were highly related to hospitalization (OR=4.57; 95%CI=[1.51-13.82]) and emergency department visits (OR=3.52; 95%CI=[1.15-10.76]) during the past year, respectively. We found that there is high prevalence of absence of help to perform ADL tasks in older adults with disability, and that this absence of help for ADL disability is associated with a greater burden of acute care utilization than those without disability. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Utility and direct costs: ankylosing spondylitis compared with rheumatoid arthritis.

PubMed

Verstappen, S M M; Jacobs, J W G; van der Heijde, D M; van der Linden, Sj; Verhoef, C M; Bijlsma, J W J; Boonen, A

2007-06-01

To compare utility and disease-specific direct costs between patients with ankylosing spondylitis (AS) and patients with rheumatoid arthritis (RA) in the Netherlands. Patients with AS and those with RA completed questions on disease characteristics, the EuroQol-5D (EQ-5D) to assess utility, and questionnaire resource utilisation. Resource utilisation was assessed prospectively in AS, but retrospectively in RA. True cost estimates (2003) were used to calculate the costs. Differences in disease characteristics between AS and RA were described, and determinants of EQ-5D utility and costs were explored by Cox proportional hazard regressions. 576 patients with RA and 132 with AS completed the questionnaires. EQ-5D utility (0.63 vs 0.7) was lower, and annual direct costs higher in RA (euro5167 vs euro2574). In multivariate Cox proportional hazard regressions, there was no difference in utility between the diagnostic groups, but patients with RA incurred higher direct costs after controlling for age, gender and disease duration. In patients with RA and patients with AS, who are under the care of a rheumatologist, utility is equally reduced, but healthcare costs are higher in RA after controlling for age, gender and disease duration. These data can be helpful to provide insights into the differences and similarities between the healthcare needs of both patient groups and to identify issues for further research and for policy in healthcare organisations.

Exploring the Association of Hospice Care on Patient Experience and Outcomes of Care

PubMed Central

Kleinpell, Ruth; Vasilevskis, Eduard E.; Fogg, Louis; Ely, E. Wesley

2016-01-01

Objective To examine the association of the use of hospice care on patient experience and outcomes of care. Promoting high-value, safe, and effective care is an international healthcare imperative. However, the extent to which hospice care may improve the value of care is not well characterized. Methods A secondary analysis of variations in care was conducted using the Dartmouth Atlas Report, matched to the American Hospital Association Annual Survey Database to abstract organizational characteristics for 236 US hospitals to examine the relationship between hospice utilization and a number of variables that represent care value including hospital care intensity index, hospital deaths, ICU deaths, patient satisfaction, and a number of patient quality indicators. Structural equation modeling was used to demonstrate the effect of hospice use on patient experience of care variables, clinical outcomes of care variables, and efficiency of care variables. Results Hospice admissions in the last 6 months of life were correlated with a number of variables including increases in patient satisfaction ratings (r=0.448, p=0.01) and better pain control (r=0.491, p=0.01), and reductions in hospital days (r=−0.517, p=0.01), fewer deaths in the hospital (r=−0.842, p=0.01), and fewer deaths occurring with an ICU admission during hospitalization (r=−0.358, p=0.01). The structural equation model identified use of hospice care was inversely related to both hospital mortality (−.885) and ICU mortality rate (−.457). Conclusions The results of this investigation demonstrate that greater utilization of hospice care during the last 6-months of life is associated with improved patient experience of care including satisfaction and pain control, as well as clinical outcomes of care including decreased ICU and hospital mortality. PMID:27531840

The influence of mistrust, racism, religious participation, and access to care on patient satisfaction for African American men: the North Carolina-Louisiana Prostate Cancer Project.

PubMed

Moore, Angelo D; Hamilton, Jill B; Knafl, George J; Godley, P A; Carpenter, William R; Bensen, Jeannette T; Mohler, James L; Mishel, Merle

2013-01-01

The purpose of this study was to explore whether a particular combination of individual characteristics influences patient satisfaction with the health care system among a sample of African American men in North Carolina with prostate cancer. Patient satisfaction may be relevant for improving African American men's use of regular care, thus improving the early detection of prostate cancer and attenuating racial disparities in prostate cancer outcomes. This descriptive correlation study examined relationships of individual characteristics that influence patient satisfaction using data from 505 African American men from North Carolina, who prospectively enrolled in the North Carolina-Louisiana Prostate Cancer Project from September 2004 to November 2007. Analyses consisted of univariate statistics, bivariate analysis, and multiple regression analysis. The variables selected for the final model were: participation in religious activities, mistrust, racism, and perceived access to care. In this study, both cultural variables, mistrust (p=<.0001, F=95.58) and racism (p=<.002, F=5.59), were significantly negatively associated with patient satisfaction and accounted for the majority of the variability represented by individual characteristics. Mistrust and racism are cultural factors that are extremely important and have been negatively associated with patient satisfaction and decreased desires to utilize health care services for African American men. To overcome barriers in seeking health care services, health care providers need to implement a patient-centered approach by creating a clinical environment that demonstrates cultural competence and eliminating policies, procedures, processes, or personnel that foster mistrust and racism.

A Healthcare Utilization Analysis Framework for Hot Spotting and Contextual Anomaly Detection

PubMed Central

Hu, Jianying; Wang, Fei; Sun, Jimeng; Sorrentino, Robert; Ebadollahi, Shahram

2012-01-01

Patient medical records today contain vast amount of information regarding patient conditions along with treatment and procedure records. Systematic healthcare resource utilization analysis leveraging such observational data can provide critical insights to guide resource planning and improve the quality of care delivery while reducing cost. Of particular interest to providers are hot spotting: the ability to identify in a timely manner heavy users of the systems and their patterns of utilization so that targeted intervention programs can be instituted, and anomaly detection: the ability to identify anomalous utilization cases where the patients incurred levels of utilization that are unexpected given their clinical characteristics which may require corrective actions. Past work on medical utilization pattern analysis has focused on disease specific studies. We present a framework for utilization analysis that can be easily applied to any patient population. The framework includes two main components: utilization profiling and hot spotting, where we use a vector space model to represent patient utilization profiles, and apply clustering techniques to identify utilization groups within a given population and isolate high utilizers of different types; and contextual anomaly detection for utilization, where models that map patient’s clinical characteristics to the utilization level are built in order to quantify the deviation between the expected and actual utilization levels and identify anomalies. We demonstrate the effectiveness of the framework using claims data collected from a population of 7667 diabetes patients. Our analysis demonstrates the usefulness of the proposed approaches in identifying clinically meaningful instances for both hot spotting and anomaly detection. In future work we plan to incorporate additional sources of observational data including EMRs and disease registries, and develop analytics models to leverage temporal relationships among medical encounters to provide more in-depth insights. PMID:23304306

A healthcare utilization analysis framework for hot spotting and contextual anomaly detection.

PubMed

Hu, Jianying; Wang, Fei; Sun, Jimeng; Sorrentino, Robert; Ebadollahi, Shahram

2012-01-01

Patient medical records today contain vast amount of information regarding patient conditions along with treatment and procedure records. Systematic healthcare resource utilization analysis leveraging such observational data can provide critical insights to guide resource planning and improve the quality of care delivery while reducing cost. Of particular interest to providers are hot spotting: the ability to identify in a timely manner heavy users of the systems and their patterns of utilization so that targeted intervention programs can be instituted, and anomaly detection: the ability to identify anomalous utilization cases where the patients incurred levels of utilization that are unexpected given their clinical characteristics which may require corrective actions. Past work on medical utilization pattern analysis has focused on disease specific studies. We present a framework for utilization analysis that can be easily applied to any patient population. The framework includes two main components: utilization profiling and hot spotting, where we use a vector space model to represent patient utilization profiles, and apply clustering techniques to identify utilization groups within a given population and isolate high utilizers of different types; and contextual anomaly detection for utilization, where models that map patient's clinical characteristics to the utilization level are built in order to quantify the deviation between the expected and actual utilization levels and identify anomalies. We demonstrate the effectiveness of the framework using claims data collected from a population of 7667 diabetes patients. Our analysis demonstrates the usefulness of the proposed approaches in identifying clinically meaningful instances for both hot spotting and anomaly detection. In future work we plan to incorporate additional sources of observational data including EMRs and disease registries, and develop analytics models to leverage temporal relationships among medical encounters to provide more in-depth insights.

The Effects of HMO Penetration on Preventable Hospitalizations

PubMed Central

Zhan, Chunliu; Miller, Marlene R; Wong, Herbert; Meyer, Gregg S

2004-01-01

Objective To examine the effects of health maintenance organization (HMO) penetration on preventable hospitalizations. Data Source Hospital inpatient discharge abstracts for 932 urban counties in 22 states from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), hospital data from American Hospital Association (AHA) annual survey, and population characteristics and health care capacity data from Health Resources and Services Administration (HRSA) Area Resource File (ARF) for 1998. Methods Preventable hospitalizations due to 14 ambulatory care sensitive conditions were identified using the Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators. Multiple regressions were used to determine the association between preventable hospitalizations and HMO penetration while controlling for demographic and socioeconomic characteristics and health care capacity of the counties. Principal Findings A 10 percent increase in HMO penetration was associated with a 3.8 percent decrease in preventable hospitalizations (95 percent confidence interval, 2.0 percent–5.6 percent). Advanced age, female gender, poor health, poverty, more hospital beds, and fewer primary care physicians per capita were significantly associated with more preventable hospitalizations. Conclusions Our study suggests that HMO penetration has significant effects in reducing preventable hospitalizations due to some ambulatory care sensitive conditions. PMID:15032958

Research without billing data. Econometric estimation of patient-specific costs.

PubMed

Barnett, P G

1997-06-01

This article describes a method for computing the cost of care provided to individual patients in health care systems that do not routinely generate billing data, but gather information on patient utilization and total facility costs. Aggregate data on cost and utilization were used to estimate how costs vary with characteristics of patients and facilities of the US Department of Veterans Affairs. A set of cost functions was estimated, taking advantage of the department-level organization of the data. Casemix measures were used to determine the costs of acute hospital and long-term care. Hospitalization for medical conditions cost an average of $5,642 per US Health Care Financing Administration diagnosis-related group weight; surgical hospitalizations cost $11,836. Nursing home care cost $197.33 per day, intermediate care cost $280.66 per day, psychiatric care cost $307.33 per day, and domiciliary care cost $111.84 per day. Outpatient visits cost an average of $90.36. These estimates include the cost of physician services. The econometric method presented here accounts for variation in resource use caused by casemix that is not reflected in length of stay and for the effects of medical education, research, facility size, and wage rates. Data on non-Veteran's Affairs hospital stays suggest that the method accounts for 40% of the variation in acute hospital care costs and is superior to cost estimates based on length of stay or diagnosis-related group weight alone.

Annual Report on Children's Health Care: Dental and Orthodontic Utilization and Expenditures for Children, 2010-2012.

PubMed

Berdahl, Terceira; Hudson, Julie; Simpson, Lisa; McCormick, Marie C

2016-01-01

To examine general dental and orthodontic utilization and expenditures by health insurance status, public health insurance eligibility, and sociodemographic characteristics among children aged 0 to 17 years using data from 2010-2012. Nationally representative data from the Medical Expenditure Panel Survey (2010-2012) provided data on insurance status, public health insurance eligibility, and visits to dental providers for both general dental care and orthodontic care. Overall, 41.9% of US children reported an annual dental office-based visit for general (nonorthodontic) dental care. Fewer Hispanic (34.7%) and non-Latino black children (34.8%) received dental care compared to non-Hispanic whites (47.3%) and Asians (40.3%). Children living in families with the lowest income were also the least likely to have a visit (32.9%) compared to children in the highest-income families (54.7%). Among children eligible for public coverage, Medicaid-eligible children had the lowest percentage of preventive dental visits (29.2%). Socioeconomic and racial/ethnic disparities in use and expenditures for orthodontic care are much greater than those for general and preventive dental care. Average expenditures for orthodontic care were $1,823, of which 56% ($1,023) was paid out of pocket by families. Our findings provide a baseline assessment for examining trends in the future, especially as coverage patterns for children may change as the Affordable Care Act is implemented and the future of the State Child Health Insurance Program remains uncertain beyond 2017. Published by Elsevier Inc.

Use of medical care for chest pain: differences between blacks and whites.

PubMed

Strogatz, D S

1990-03-01

Data from a 1980, community-based survey of adult residents of Edgecombe County, North Carolina were analyzed to examine differences between Blacks and Whites in the reported use of medical care after experiencing chest pain. Of all adults (N = 302) with chest pain in the year prior to interview, 49 percent of Blacks and 27 percent of Whites did not see a physician following the chest pain (difference = 22%, 95% CI = 12, 33). A multivariable analysis found that although the association between race and utilization was reduced at poverty levels of income, it was not explained by differences in demographic characteristics, health status or other dimensions of access to care.

Use of medical care for chest pain: differences between blacks and whites.

PubMed Central

Strogatz, D S

1990-01-01

Data from a 1980, community-based survey of adult residents of Edgecombe County, North Carolina were analyzed to examine differences between Blacks and Whites in the reported use of medical care after experiencing chest pain. Of all adults (N = 302) with chest pain in the year prior to interview, 49 percent of Blacks and 27 percent of Whites did not see a physician following the chest pain (difference = 22%, 95% CI = 12, 33). A multivariable analysis found that although the association between race and utilization was reduced at poverty levels of income, it was not explained by differences in demographic characteristics, health status or other dimensions of access to care. PMID:2305907

Give me a break! Informal caregiver attitudes towards respite care.

PubMed

van Exel, Job; de Graaf, Gjalt; Brouwer, Werner

2008-10-01

Because informal health care is now recognized to be indispensable to health care systems, different forms of respite care have been developed and publicly funded that supposedly alleviate caregivers' perceived burdens and help prolong the care giving task. Nonetheless, the use of respite care services is low even among substantially strained caregivers. To throw light on this low usage, this paper explores the associations between attitudes towards respite care, characteristics of the care giving situation, and the need and use of respite care. The survey, administered to a sample of 273 informal caregivers, addressed caregiver, care recipient, and care giving situation characteristics, as well as the familiarity and use of respite care services. It also included a sub-set of 12 statements eliciting attitudes towards respite care from an earlier study [Van Exel NJA, De Graaf G, Brouwer WBF. Care for a break? An investigation of informal caregivers' attitudes toward respite care using Q-methodology. Health Policy 2007;83(2/3):332-42]. Associations between variables were measured using univariate statistics and multinomial logistic regression. We found three caregiver attitudes, distributed fairly equally in the sample, that are apparently associated with caregiver educational level, employment status, health and happiness, as well as care recipient gender, duration and intensity of care giving, relationship, co-residence, need for surveillance, and subjective burden and process utility of care giving. However, the relation between attitude and familiarity with and use of respite care services is ambiguous. Although further exploration is needed of the mix of Q-methodology and survey analysis, the overall results indicate that a considerable portion of the caregiver population needs but does not readily ask for support or respite care. This finding has important policy implications in the context of an ageing population.

The primary-specialty care interface in chronic diseases: patient and practice characteristics associated with co-management.

PubMed

Larochelle, Jean-Louis; Feldman, Debbie Ehrmann; Levesque, Jean-Frederic

2014-11-01

Specialist physicians may act either as consultants or co-managers for patients with chronic diseases along with their primary healthcare (PHC) physician. We assessed factors associated with specialist involvement. We used questionnaire and administrative data to measure co-management and patient and PHC practice characteristics in 702 primary care patients with common chronic diseases. Analysis included multilevel logistic regressions. In all, 27% of the participants were co-managed. Persons with more severe chronic diseases and lower health-related quality of life were more likely to be co-managed. Persons who were older, had a lower socioeconomic status, resided in rural regions and who were followed in a PHC practice with an advanced practice nurse were less likely to be co-managed. Co-management of patients with chronic diseases by a specialist is associated with higher clinical needs but demonstrates social inequalities. PHC practices more adapted to chronic care may help optimize specialist resources utilization. Copyright © 2014 Longwoods Publishing.

The Primary-Specialty Care Interface in Chronic Diseases: Patient and Practice Characteristics Associated with Co-Management

PubMed Central

Larochelle, Jean-Louis; Feldman, Debbie Ehrmann; Levesque, Jean-Frederic

2014-01-01

Objective: Specialist physicians may act either as consultants or co-managers for patients with chronic diseases along with their primary healthcare (PHC) physician. We assessed factors associated with specialist involvement. Methods: We used questionnaire and administrative data to measure co-management and patient and PHC practice characteristics in 702 primary care patients with common chronic diseases. Analysis included multilevel logistic regressions. Results In all, 27% of the participants were co-managed. Persons with more severe chronic diseases and lower health-related quality of life were more likely to be co-managed. Persons who were older, had a lower socioeconomic status, resided in rural regions and who were followed in a PHC practice with an advanced practice nurse were less likely to be co-managed. Discussion: Co-management of patients with chronic diseases by a specialist is associated with higher clinical needs but demonstrates social inequalities. PHC practices more adapted to chronic care may help optimize specialist resources utilization. PMID:25617515

Linkage of the Canadian Study of Health and Aging to provincial administrative health care databases in Nova Scotia.

PubMed

Yip, A M; Kephart, G; Rockwood, K

2001-01-01

The Canadian Study of Health and Aging (CSHA) was a cohort study that included 528 Nova Scotian community-dwelling participants. Linkage of CSHA and provincial Medical Services Insurance (MSI) data enabled examination of health care utilization in this subsample. This article discusses methodological and ethical issues of database linkage and explores variation in the use of health services by demographic variables and health status. Utilization over 24 months following baseline was extracted from MSI's physician claims, hospital discharge abstracts, and Pharmacare claims databases. Twenty-nine subjects refused consent for access to their MSI file; health card numbers for three others could not be retrieved. A significant difference in healthcare use by age and self-rated health was revealed. Linkage of population-based data with provincial administrative health care databases has the potential to guide health care planning and resource allocation. This process must include steps to ensure protection of confidentiality. Standard practices for linkage consent and routine follow-up should be adopted. The Canadian Study of Health and Aging (CSHA) began in 1991-92 to explore dementia, frailty, and adverse health outcomes (Canadian Study of Health and Aging Working Group, 1994). The original CSHA proposal included linkage to provincial administrative health care databases by the individual CSHA study centers to enhance information on health care utilization and outcomes of study participants. In Nova Scotia, the Medical Services Insurance (MSI) administration, which drew the sampling frame for the original CSHA, did not retain the list of corresponding health card numbers. Furthermore, consent for this access was not asked of participants at the time of the first interview. The objectives of this study reported here were to examine the feasibility and ethical considerations of linking data from the CSHA to MSI utilization data, and to explore variation in health services use by demographic and health status characteristics in the Nova Scotia community cohort.

Does Orthopaedic Outpatient Care Reduce Emergency Department Utilization After Total Joint Arthroplasty?

PubMed

Chaudhary, Muhammad Ali; Lange, Jeffrey K; Pak, Linda M; Blucher, Justin A; Barton, Lauren B; Sturgeon, Daniel J; Koehlmoos, Tracey; Haider, Adil H; Schoenfeld, Andrew J

2018-05-22

Emergency department (ED) visits after elective surgical procedures are a potential target for interventions to reduce healthcare costs. More than 1 million total joint arthroplasties (TJAs) are performed each year with postsurgical ED utilization estimated in the range of 10%. We asked whether (1) outpatient orthopaedic care was associated with reduced ED utilization and (2) whether there were identifiable factors associated with ED utilization within the first 30 and 90 days after TJA. An analysis of adult TRICARE beneficiaries who underwent TJA (2006-2014) was performed. TRICARE is the insurance program of the Department of Defense, covering > 9 million beneficiaries. ED use within 90 days of surgery was the primary outcome and postoperative outpatient orthopaedic care the primary explanatory variable. Patient demographics (age, sex, race, beneficiary category), clinical characteristics (length of hospital stay, prior comorbidities, complications), and environment of care were used as covariates. Logistic regression adjusted for all covariates was performed to determine factors associated with ED use. We found that orthopaedic outpatient care (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.68-0.77) was associated with lower odds of ED use within 90 days. We also found that index hospital length of stay (OR, 1.07; 95% CI, 1.04-1.10), medical comorbidities (OR, 1.16; 95% CI, 1.08-1.24), and complications (OR, 2.47; 95% CI, 2.24-2.72) were associated with higher odds of ED use. When considering that at 90 days, only 3928 patients sustained a complication, a substantial number of ED visits (11,486 of 15,414 [75%]) after TJA may be avoidable. Enhancing access to appropriate outpatient care with improved discharge planning may reduce ED use after TJA. Further research should be directed toward unpacking the situations, outside of complications, that drive patients to access the ED and devise interventions that could mitigate such behavior. Level III, therapeutic study.

Opinion versus practice regarding the use of rehabilitation services in home care: an investigation using machine learning algorithms.

PubMed

Cheng, Lu; Zhu, Mu; Poss, Jeffrey W; Hirdes, John P; Glenny, Christine; Stolee, Paul

2015-10-09

Resources for home care rehabilitation are limited, and many home care clients who could benefit do not receive rehabilitation therapy. The interRAI Contact Assessment (CA) is a new screening instrument comprised of a subset of interRAI Home Care (HC) items, designed to be used as a preliminary assessment to identify which potential home care clients should be referred for a full assessment, or for services such as rehabilitation. We investigated which client characteristics are most relevant in predicting rehabilitation use in the full interRAI HC assessment. We applied two algorithms from machine learning and data mining - the LASSO and the random forest - to frequency matched interRAI HC and service utilization data for home care clients in Ontario, Canada. Analyses confirmed the importance of functional decline and mobility variables in targeting rehabilitation services, but suggested that other items in use as potential predictors may be less relevant. Six of the most highly ranked items related to ambulation. Diagnosis of cancer was highly associated with decreased rehabilitation use; however, cognitive status was not. Inconsistencies between variables considered important for classifying clients who need rehabilitation and those identified in this study based on use may indicate a discrepancy in the client characteristics considered relevant in theory versus actual practice.

Can the Medical-nursing Combined Care Promote the Accessibility of Health Services for the Elderly in Nursing Home? A Study Protocol of Analysis of the Effectiveness Regarding Health Service Utilization, Health Status and Satisfaction with Care

PubMed Central

Bao, J; Wang, X-J; Yang, Y; Dong, R-Q; Mao, Z-F

2015-01-01

ABSTRACT Background: Currently, segmentation of healthcare and daily care for the elderly living in nursing homes usually results in the elderly not getting medical treatment timely and effectively. The medical-nursing combined care, which has been put into practice in several areas in China, is developed to enhance the accessibility of healthcare for the elderly. The aim of the study is to explore the effectiveness of the new care service, based on Andersen model, regarding health service utilization, health status and service satisfaction. Methods: The effectiveness of medical-nursing combined care will be measured in a cross-sectional study in nine nursing homes in Jianghan District, Wuhan, China, with 1067 old residents expected to participate. The questionnaire containing items of demographics, health service use, service satisfaction and instrument of SF-36 V2 is developed based on the conceptual framework of Andersen behaviour model of health service utilization. Descriptive analysis, variance analysis, multiple factors analysis, and correlation analysis will be performed to compare the sociological characteristics, health service use, health status and service satisfaction of the elderly living in different modes of nursing homes, to explore the influence factors of care effectiveness, as well as to study the relationship between health behaviour and health outcomes. Conclusion: The study design of analysing the effects of medical-nursing combined care and performing the horizontal comparison among the nursing homes under the framework of Andersen model is blazing new trails. Recruitment and design of questionnaire are important issues. Successful data collection and quality control are also necessary. Taking these into account, this study is estimated to provide evidence for the effectiveness of medical-nursing combined care service in China. PMID:27398940

Primary care in the United States: practice-based innovations and factors that influence adoption.

PubMed

Goldberg, Debora Goetz

2012-01-01

This study aims to explore the use of specific innovations in primary care practices. The research seeks to examine whether a relationship exists between environmental factors and organizational characteristics and the level of innovation in primary care practices in Virginia. The study utilized multiple secondary data sets and an organizational survey of primary care practices to define the external environment and the level of innovation. Institutional theory was used to explain the connection between innovations in primary care practices and institutional forces within the environment. Resource dependency theory was used to explain motivators for change based on a dependence on scarce financial, human, and information resources. Results show a positive association between organizational size, organizational relationships, and stakeholder expectations on the level of innovation. A negative association was found between competition and the level of innovation. No relationship was found between degree of Medicare and managed care penetration and innovation, nor between knowledge of, and difficulty complying with, payer organization requirements and innovation. Primary care physician practices exist in a market-driven environment characterized by high pressure from regulatory sources, decreasing reimbursement levels, increasing rate of change in technologies, and increasing patient and community expectations. This study contributes new information on the relationship between organizational characteristics, the external environment and specific innovations in primary care practices. Information on the contributing factors to innovation in primary care is important for improving delivery of health care services and the ability of these practices to survive.

Racial and ethnic disparities in antidepressant drug use.

PubMed

Chen, Jie; Rizzo, John A

2008-12-01

Little is known about racial and ethnic disparities in health care utilization, expenditures and drug choice in the antidepressant market. This study investigates factors associated with the racial and ethnic disparities in antidepressant drug use. We seek to determine the extent to which disparities reflect differences in observable population characteristics versus heterogeneity across racial and ethnic groups. Among the population characteristics, we are interested in identifying which factors are most important in accounting for racial and ethnic disparities in antidepressant drug use. Using Medical Expenditure Panel Survey (MEPS) data from 1996-2003, we have an available sample of 10,416 Caucasian, 1,089 African American and 1,539 Hispanic antidepressant drug users aged 18 to 64 years. We estimate individual out-of-pocket payments, total prescription drug expenditures, drug utilization, the probability of taking generic versus brand name antidepressants, and the share of drugs that are older types of antidepressants (e.g., TCAs and MAOIs) for these individuals during a calendar year. Blinder-Oaxaca decomposition techniques are employed to determine the extent to which disparities reflect differences in observable population characteristics versus unobserved heterogeneity across racial and ethnic groups. Caucasians have the highest antidepressant drug expenditures and utilization. African-Americans have the lowest drug expenditures and Hispanics have the lowest drug utilization. Relative to Caucasians and Hispanics, African-Americans are more likely to purchase generics and use a higher share of older drugs (e.g., TCAs and MAOIs). Differences in observable characteristics explain most of the racial/ethnic differences in these outcomes, with the exception of drug utilization. Differences in health insurance and education levels are particularly important factors in explaining disparities. In contrast, differences in drug utilization largely reflect unobserved heterogeneity across these population groups. Substantive racial and ethnic disparities exist in all dimensions of antidepressant drug use examined. Observable population characteristics account for most of the differences in the expenditures, with health insurance and education key factors driving differences in spending. Observable characteristics are also important in explaining racial and ethnic disparities in the probability of purchasing generics and new vs old antidepressant drugs used. Differences in total utilization are not well-explained by observable characteristics, and may reflect unobserved heterogeneity such as unobserved physician-patient relationships, mistrust, and cultural factors. Reducing differences in observable characteristics such as health insurance and education will mitigate racial and ethnic disparities in expenditures on antidepressant drug use and in the types of antidepressant used (e.g., generics vs. brands; new vs old). But these factors will have less influence in reducing racial and ethnic disparities in overall antidepressant drug utilization. To limit differences in overall antidepressant drug use, policymakers must take into account cultural factors and other sources of heterogeneity.

Patterns of post-acute health care utilization after a severe traumatic brain injury: Results from the PariS-TBI cohort.

PubMed

Jourdan, Claire; Bayen, Eleonore; Darnoux, Emmanuelle; Ghout, Idir; Azerad, Sylvie; Ruet, Alexis; Vallat-Azouvi, Claire; Pradat-Diehl, Pascale; Aegerter, Philippe; Weiss, Jean-Jacques; Azouvi, Philippe

2015-01-01

To assess brain injury services utilization and their determinants using Andersen's model. Prospective follow-up of the PariS-TBI inception cohort. Out of 504 adults with severe traumatic brain injury (TBI), 245 survived and 147 received a 4-year outcome assessment (mean age 33 years, 80% men). Provision rates of medical, rehabilitation, social and re-entry services and their relations to patients' characteristics were assessed. Following acute care discharge, 78% of patients received physiotherapy, 61% speech/cognitive therapy, 50% occupational therapy, 41% psychological assistance, 63% specialized medical follow-up, 21% community re-entry assistance. Health-related need factors, in terms of TBI severity, were the main predictors of services. Provision of each therapy was significantly associated with corresponding speech, motor and psychological impairments. However, care provision did not depend on cognitive impairments and cognitive therapy was related to pre-disposing and geographical factors. Community re-entry assistance was provided to younger and more independent patients. These quantitative findings illustrate strengths and weaknesses of late brain injury care provision in urban France and highlight the need to improve treatment of cognitive impairments.

Prediction of community mental health service utilization by individual and ecological level socio-economic factors.

PubMed

Donisi, Valeria; Tedeschi, Federico; Percudani, Mauro; Fiorillo, Andrea; Confalonieri, Linda; De Rosa, Corrado; Salazzari, Damiano; Tansella, Michele; Thornicroft, Graham; Amaddeo, Francesco

2013-10-30

Individuals with a more deprived socioeconomic status (SES) are more likely to have higher rates of psychiatric morbidity and use of psychiatric services. Such service use is also influenced by socioeconomic factors at the ecological level. The aim of this article is to investigate the influence of these variables on service utilization. All patients in contact with three Italian community psychiatric services (CPS) were included. Community and hospital contacts over 6 months were investigated. Socio-economic characteristics were described using a SES Index and two new Resources Accessibility Indexes. Low SES was found to be associated with more community service contacts. When other individual and ecological variables were controlled for, SES was negatively associated only with the number of home visits, which was about half the rate in deprived areas. An association between service utilization and the resources of the catchment area was also detected. The economic crisis in Europe is increasing inequality of access, so paying attention to SES characteristics at both the individual and the ecological levels is likely to become increasingly important in understanding patterns of psychiatric service utilization and planning care accordingly. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Patient dissatisfaction in China: What matters.

PubMed

Pan, Jay; Liu, Dan; Ali, Shehzad

2015-10-01

Patient satisfaction is a focal concern of health-care delivery and an expected outcome of medical care. Recently, the violent conflict between doctors and patients in China has intensified. Patient dissatisfaction has been recognized as an important concern and an urgent issue in the reform of China's health care. The objectives of this study are to investigate the determinants of patient dissatisfaction attributed to patient, hospital, and health-care market characteristics, as well as to explore the major determinants in the context of China. Data from 2007 to 2010 Urban Resident Basic Medical Insurance Survey (URBMIS) are used in this study. A total of 13,336 patients are selected conditional on health-care utilization. Analysis of satisfaction is based on outpatient utilization (last 2 weeks' reference, 6393 individuals) and inpatient utilization (last 1-year reference, 6943 individuals). Satisfaction was measured as ordinal variables (scales 1-5). Ordinary least squares (OLS) regression and an ordered probit model are applied to investigate the determinants. Blinder-Oaxaca decomposition is further employed to detect the proportion each predictor's contribution. The results indicate that patients' gender, education, and insurance status are significantly related to patient satisfaction. Higher-level hospitals are found to negatively correlate with patient satisfaction. Lower competition in providers' market and a higher market share of private hospitals are found to positively correlate with patient dissatisfaction. Meanwhile, the survey indicates that "medical charges too expensive" is chiefly responsible for patient dissatisfaction. Our study provides empirical evidence on the determinants of patient dissatisfaction in China. In particular, the results indicate that establishing a high competition among various providers in the health-care market will act as a "double-edged sword," with great policy implications. Copyright © 2015 Elsevier Ltd. All rights reserved.

The influence of military service on outpatient care use among racial/ethnic groups in Department of Veterans Affairs medical centers.

PubMed

Harada, Nancy D; Villa, Valentine M; Damron-Rodriguez, JoAnn; Washington, Donna; Makinodan, Takashi; Dhanani, Shawkat; Shon, Herbert; Liu, Honghu; Andersen, Ronald

2002-07-01

This study examines race-specific military service effects on outpatient care utilization in the Department of Veterans Affairs (VA) using data from the 1992 National Survey of Veterans. The study population consisted of 4,791 male veterans. After controlling for predisposing, enabling, and need variables, black veterans were 3.7 times more likely than white veterans to use VA outpatient care. Veterans discharged from the military for medical release were less likely to use VA outpatient care (odds ratio = 0.76) than veterans discharged at the end of their normal terms. Hispanic veterans discharged for medical release were 5.3 times more likely than white veterans discharged for the same reason to use VA outpatient care. Korean conflict and mixed war period veterans were more likely to use VA outpatient care than World War II veterans. Racial/ethnic differences in military service characteristics influence the use of VA outpatient care and should be understood in delivering outpatient care to veterans.

Pre-fracture individual characteristics associated with high total health care costs after hip fracture.

PubMed

Schousboe, J T; Paudel, M L; Taylor, B C; Kats, A M; Virnig, B A; Dowd, B E; Langsetmo, L; Ensrud, K E

2017-03-01

Older women with pre-fracture slow walk speed, high body mass index, and/or a high level of multimorbidity have significantly higher health care costs after hip fracture compared to those without those characteristics. Studies to investigate if targeted health care interventions for these individuals can reduce hip fracture costs are warranted. The aim of this study is to estimate the associations of individual pre-fracture characteristics with total health care costs after hip fracture, using Study of Osteoporotic Fractures (SOF) cohort data linked to Medicare claims. Our study population was 738 women age 70 and older enrolled in Medicare Fee for Service (FFS) who experienced an incident hip fracture between January 1, 1992 and December 31, 2009. We assessed pre-fracture individual characteristics at SOF study visits and estimated costs of hospitalizations, skilled nursing facility and inpatient rehabilitation stays, home health care visits, and outpatient utilization from Medicare FFS claims. We used generalized linear models to estimate the associations of predictor variables with total health care costs (2010 US dollars) after hip fracture. Median total health care costs for 1 year after hip fracture were $35,536 (inter-quartile range $24,830 to $50,903). Multivariable-adjusted total health care costs for 1 year after hip fracture were 14 % higher ($5256, 95 % CI $156 to $10,356) in those with walk speed <0.6 m/s compared to ≥1.0 m/s, 25 % higher ($9601, 95 % CI $3314 to $16,069) in those with body mass index ≥30 kg/m 2 compared to 20 to 24.9 mg/kg 2 , and 21 % higher ($7936, 95 % CI $346 to $15,526) for those with seven or more compared to no comorbid medical conditions. Pre-fracture poor mobility, obesity, and multiple comorbidities are associated with higher total health care costs after hip fracture in older women. Studies to investigate if targeted health care interventions for these individuals can reduce the costs of hip fractures are warranted.

Utilization of focused antenatal care in Zambia: examining individual- and community-level factors using a multilevel analysis.

PubMed

Chama-Chiliba, Chitalu M; Koch, Steven F

2015-02-01

We examine the individual- and community-level factors associated with the utilization of antenatal care, following the adoption of the focused antenatal care (FANC) approach in Zambia. Using the 2007 Zambia Demographic and Health Survey, linked with administrative and health facility census data, we specify two multilevel logistic models to assess the factors associated with (1) the inadequate use of antenatal care (ANC) (defined as three or fewer visits) and (2) the non-use of ANC in the first trimester of pregnancy. Although all women in the selected sample had at least one ANC visit, 40% did not have the minimum number required (four), whereas more than 80% of the initial check-ups did not occur in the first trimester. At the individual level, the woman's employment status, quality of ANC received and the husband's educational attainment are negatively associated, while parity, the household childcare burden and wealth are positively associated with inadequate utilization of ANC. Both individual- and community-level characteristics influence inadequate use and non-use of ANC in the first trimester; however, community-level factors are relatively stronger in rural areas. The results suggest that improving the content of care during ANC visits may foster adequate use of ANC and encourage early initiation of ANC visits. Furthermore, health promotion programmes need to further encourage male involvement in pregnant women's decision to seek ANC to encourage adequate use of services. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Mental health outcomes of burn: A longitudinal population-based study of adults hospitalized for burns.

PubMed

Logsetty, Sarvesh; Shamlou, Amir; Gawaziuk, Justin P; March, Justin; Doupe, Malcolm; Chateau, Dan; Hoppensack, Mike; Khan, Sazzadul; Medved, Maria; Leslie, William D; Enns, Murray W; Stein, Murray B; Asmundson, Gordon J G; Sareen, Jitender

2016-06-01

This study investigates the increased risk of mental health outcomes and health care utilization associated with burn with two year of follow-up using a longitudinal population-based matched cohort design. Adult burn survivors (n=157) were identified from a provincial burn registry and matched 1:5 with non-burn control subjects from the general population (matching variables age and gender). The prevalence of mental health outcomes and the rates of health care utilization between the groups were compared for the 2years pre and post index date using anonymously linked population-based administrative health care data. Rates were adjusted for age, gender and sociodemographic characteristics. While the burn cohort had an increased prevalence of mental health problems after burn compared to the control cohort, the burn group also had an increased prevalence of pre-burn depression (16.6% vs 7.8%; p=0.0005) and substance use disorders (8.9% vs 3.2%; p=0.001) when compared to controls. Once the pre-existing prevalence of mental illness was taken into account there was no significant change in the prevalence of mental health problems when comparing the burn group to controls over time. Although burns may not increase rates of mental health issues and health care utilization, burn survivors are a vulnerable group who already demonstrate increased rates of psychopathology and need for care. The present study highlights the importance of assessment and treatment of mental health outcomes in this population. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Artificial neural network predictions of lengths of stay on a post-coronary care unit.

PubMed

Mobley, B A; Leasure, R; Davidson, L

1995-01-01

To create and validate a model that predicts length of hospital unit stay. Ex post facto. Seventy-four independent admission variables in 15 general categories were utilized to predict possible stays of 1 to 20 days. Laboratory. Records of patients discharged from a post-coronary care unit in early 1993. An artificial neural network was trained on 629 records and tested on an additional 127 records of patients. The absolute disparity between the actual lengths of stays in the test records and the predictions of the network averaged 1.4 days per record, and the actual length of stay was predicted within 1 day 72% of the time. The artificial neural network demonstrated the capacity to utilize common patient admission characteristics to predict lengths of stay. This technology shows promise in aiding timely initiation of treatment and effective resource planning and cost control.

Barriers and facilitators to care for the terminally ill: a cross-country case comparison study of Canada, England, Germany, and the United States.

PubMed

Klinger, Christopher A; Howell, Doris; Zakus, David; Deber, Raisa B

2014-02-01

Why do many patients not die at their preferred location? Analyze system-level characteristics influencing the ability to implement best practices in delivering care for terminally ill adults (barriers and facilitators). Cross-country comparison study from a "most similar-most different" perspective, triangulating evidence from a scoping review of the literature, document analyses, and semi-structured key informant interviews. Case study of Canada, England, Germany, and the United States. While similar with regard to leading causes of death, patient needs, and potential avenues to care, different models of service provision were employed in the four countries studied. Although hospice and palliative care services were generally offered with standard care along the disease continuum and in various settings, and featured common elements such as physical, psycho-social, and spiritual care, outcomes (access, utilization, etc.) varied across jurisdictions. Barriers to best practice service provision included legislative (including jurisdictional), regulatory (e.g. education and training), and financial issues as well as public knowledge and perception ("giving up hope") challenges. Advance care planning, dedicated and stable funding toward hospice and palliative care, including caregiver benefits, population aging, and standards of practice and guidelines to hospice and palliative care, were identified as facilitators. Successful implementation of effective and efficient best practice approaches to care for the terminally ill, such as shared care, requires concerted action to align these system-level characteristics; many factors were identified as being essential but not sufficient. Policy implementation needs to be tailored to the respective health-care system(s), monitored, and fine-tuned.

HIV patients' experiences with inpatient and outpatient care: results of a national survey.

PubMed

Wilson, Ira B; Ding, Lin; Hays, Ron D; Shapiro, Martin F; Bozzette, Samuel A; Cleary, Paul D

2002-12-01

Little is known about HIV patients' care experiences. To assess HIV patients' experiences with inpatient and outpatient care, and to assess the relationship and relative influence of patient characteristics and site of care on care experiences. Cohort study. Patients with HIV receiving care outside of emergency rooms, prisons, or the military throughout the continental United States. One thousand seventy-four patients provided ratings of an inpatient stay and 2204 rated an outpatient visit; 818 patients provided evaluations of both inpatient and outpatient care. A national probability sample of persons in care for HIV from the HIV Cost and Services Utilization Study. Outcome variables were rates of problems with, and global ratings of, inpatient and outpatient care. Mean problem rates were 20.9% and 8.4% (lower score means fewer problems) for inpatient and outpatient care, respectively. On 9 of 10 of the individual inpatient report items, 15% or more of respondents reported problems. Global ratings of inpatient and outpatient care were 65.3 and 75.0 (0-100 scale, higher scores indicate better ratings), respectively. In multivariable models that controlled for site effects, the only patient characteristic that was consistently associated with problem rates and global ratings of care was mental health (P <0.0001 for both inpatient and outpatient care). Models including site effects explained two to four times as much variance as models excluding site effects. Inpatients with HIV reported higher problem rates with inpatient than outpatient care. Better provider-patient communication during inpatient stays is needed. For both inpatient and outpatient care, quality improvement efforts may be most productively focused on providers and processes of care at sites rather than on specific patient subgroups.

Prevalence and correlates of special health care needs in a population cohort of Australian children at school entry.

PubMed

Goldfeld, Sharon; O'Connor, Meredith; Sayers, Mary; Moore, Tim; Oberklaid, Frank

2012-05-01

Children with special health care needs are an important population for educational and health service providers. Accurate information about the prevalence and characteristics of these children and their families is needed to inform the planning and development of systems of care, yet data in Australia are currently lacking. This study utilizes population-level data from the Australian Early Development Index, a teacher-rated checklist, to provide estimates of the prevalence and developmental and demographic characteristics of Australian children with special health care needs on entrance to school. Four percent of children were reported with established special health care needs, and a further 18% were identified by teachers as "of concern." These children showed higher rates of vulnerability across all domains of development. Although children with established special health care needs were represented across demographic profiles, proportions were greater among boys, those from lower socioeconomic status communities, and Indigenous and older children. In contrast, those living in more remote settings were as likely to be identified as "of concern" as their peers but were less likely to have established special health care needs. These findings have important implications for service provision and policy development. There are substantial opportunities to reorient schooling and early childhood systems to better detect and accommodate the needs of these children.

Health Status and Health Care Experiences among Homeless Patients in Federally Supported Health Centers: Findings from the 2009 Patient Survey

PubMed Central

Lebrun-Harris, Lydie A; Baggett, Travis P; Jenkins, Darlene M; Sripipatana, Alek; Sharma, Ravi; Hayashi, A Seiji; Daly, Charles A; Ngo-Metzger, Quyen

2013-01-01

Objective To examine health status and health care experiences of homeless patients in health centers and to compare them with their nonhomeless counterparts. Data Sources/Study Setting Nationally representative data from the 2009 Health Center Patient Survey. Study Design Cross-sectional analyses were limited to adults (n = 2,683). We compared sociodemographic characteristics, health conditions, access to health care, and utilization of services among homeless and nonhomeless patients. We also examined the independent effect of homelessness on health care access and utilization, as well as factors that influenced homeless patients' health care experiences. Data Collection Computer-assisted personal interviews were conducted with health center patients. Principal Findings Homeless patients had worse health status—lifetime burden of chronic conditions, mental health problems, and substance use problems—compared with housed respondents. In adjusted analyses, homeless patients had twice the odds as housed patients of having unmet medical care needs in the past year (OR = 1.98, 95 percent CI: 1.24–3.16) and twice the odds of having an ED visit in the past year (OR = 2.00, 95 percent CI: 1.37–2.92). Conclusions There is an ongoing need to focus on the health issues that disproportionately affect homeless populations. Among health center patients, homelessness is an independent risk factor for unmet medical needs and ED use. PMID:23134588

Factors predicting a home death among home palliative care recipients

PubMed Central

Ko, Ming-Chung; Huang, Sheng-Jean; Chen, Chu-Chieh; Chang, Yu-Ping; Lien, Hsin-Yi; Lin, Jia-Yi; Woung, Lin-Chung; Chan, Shang-Yih

2017-01-01

Abstract Awareness of factors affecting the place of death could improve communication between healthcare providers and patients and their families regarding patient preferences and the feasibility of dying in the preferred place. This study aimed to evaluate factors predicting home death among home palliative care recipients. This is a population-based study using a national representative sample retrieved from the National Health Insurance Research Database. Subjects receiving home palliative care, from 2010 to 2012, were analyzed to evaluate the association between a home death and various characteristics related to illness, individual, and health care utilization. A multiple-logistic regression model was used to assess the independent effect of various characteristics on the likelihood of a home death. The overall rate of a home death for home palliative care recipients was 43.6%. Age; gender; urbanization of the area where the patients lived; illness; the total number of home visits by all health care professionals; the number of home visits by nurses; utilization of nasogastric tube, endotracheal tube, or indwelling urinary catheter; the number of emergency department visits; and admission to intensive care unit in previous 1 year were not significantly associated with the risk of a home death. Physician home visits increased the likelihood of a home death. Compared with subjects without physician home visits (31.4%) those with 1 physician home visit (53.0%, adjusted odds ratio [AOR]: 3.23, 95% confidence interval [CI]: 1.93–5.42) and those with ≥2 physician home visits (43.9%, AOR: 2.23, 95% CI: 1.06–4.70) had higher likelihood of a home death. Compared with subjects with hospitalization 0 to 6 times in previous 1 year, those with hospitalization ≥7 times in previous 1 year (AOR: 0.57, 95% CI: 0.34–0.95) had lower likelihood of a home death. Among home palliative care recipients, physician home visits increased the likelihood of a home death. Hospitalizations ≥7 times in previous 1 year decreased the likelihood of a home death. PMID:29019887

Rural-urban analyses of health-related quality of life among people with multiple sclerosis.

PubMed

Buchanan, Robert J; Zhu, Li; Schiffer, Randolph; Radin, Dagmar; James, Wesley

2008-01-01

Health-related quality of life (HRQOL) is a multi-dimensional construct including aspects of life quality or function that are affected by physical health and symptoms, psychosocial factors, and psychiatric conditions. HRQOL gives a broader measure of the burden of disease than physical impairment or disability levels. To identify factors associated with HRQOL among people with multiple sclerosis (MS) utilizing the SF-8 Health Survey. Data presented in this study were collected in a survey of 1,518 people with MS living in all 50 states. The survey sample was randomly selected from the database of the National Multiple Sclerosis Society, using ZIP codes to recruit the survey sample. A multiple linear regression model was employed to analyze the survey data, with the Physical Component Summary and the Mental Component Summary of the SF-8 the dependent variables. Independent variables were demographic characteristics, MS-disease characteristics, and health services utilized. People with MS in rural areas tended to report lower physically related HRQOL. Worsening MS symptoms were associated with reduced physical and mental dimensions of HRQOL. In addition, people with MS who received a diagnosis of depression tended to have reduced physical and mental dimensions of HRQOL. Receiving MS care at an MS clinic was associated with better physically related HRQOL, while having a neurologist as principal care physician was associated with better mental-related HRQOL. The challenge is to increase the access that people living with MS in rural areas have to MS-focused specialty care.

Addressing Medicaid Expansion from the Perspective of Patient Experience in Hospitals.

PubMed

Liu, Sandra S; Wen, Yu-Ping; Mohan, Soumya; Bae, Jaeyong; Becker, Edmund R

2016-10-01

More Medicaid holders are entering the healthcare system consequential to Medicaid expansion. Their experience has financial consequences for hospitals and crucial implications for the provision of patient-centered care. This study examined how the hospital characteristics, especially the rates of Medicaid coverage and racial/ethnic minorities, impact the quality of inpatient care. Using data for years 2009-2011 for 870 observations of California hospitals, and data collected from patients via the Hospital Consumer Assessment of Healthcare Providers and Systems survey coupled with data from the Healthcare Cost and Utilization Project and American Hospital Association Annual Survey, we used a generalized estimating equation approach to evaluate patients' experience with hospital care. Our multivariate model includes a comprehensive set of characteristics capturing market, structural, process, and patient demographics associated with the patient's hospital stay. The findings indicate that high concentrations of Medicaid patients in the hospital negatively impact the perceived patient experience. In addition, all things being equal, hospitals with higher concentrations of Hispanic, Black, and Asian patients received lower patient satisfaction results on 28 of the 30 regression coefficients capturing patient satisfaction, with 22 of the 30 negative coefficients statistically significant. Hospitals serving higher concentrations of Medicaid patients and more racial/ethnic diverse patients experienced a less satisfactory patient experience than patients utilizing other payers or patients who were White. Our research magnifies the challenge for addressing the disparities that exist in healthcare. Further research is called for clarifying the underlying reasons for these disparities and the optimal strategies for addressing these problems.

Parental Immigration Status is Associated with Children’s Health Care Utilization: Findings from the 2003 New Immigrant Survey of US Legal Permanent Residents

PubMed Central

Fuentes-Afflick, Elena; Curry, Leslie A.; Krumholz, Harlan M.; Desai, Mayur M.

2014-01-01

Our objective was to examine the association between parental immigration status and child health and health care utilization. Using data from a national sample of immigrant adults who had recently become legal permanent residents (LPR), children (n = 2,170) were categorized according to their parents’ immigration status prior to LPR: legalized, mixed-status, refugee, temporary resident, or undocumented. Logistic regression with generalized estimating equations was used to compare child health and health care utilization by parental immigration status over the prior 12 months. Nearly all children in the sample were reported to be in good to excellent health. Children whose parents had been undocumented were least likely to have had an illness that was reported to have required medical attention (5.4 %). Children whose parents had been either undocumented or temporary residents were most likely to have a delayed preventive annual exam (18.2 and 18.7 %, respectively). Delayed dental care was most common among children whose parents had come to the US as refugees (29.1 %). Differences in the preventive annual exam remained significant after adjusting for socioeconomic characteristics. Parental immigration status before LPR was not associated with large differences in reported child health status. Parental immigration status before LPR was associated with the use of preventive annual exams and dental services. However, no group of children was consistently disadvantaged with respect to all measures. PMID:23329165

Parental immigration status is associated with children's health care utilization: findings from the 2003 new immigrant survey of US legal permanent residents.

PubMed

Yun, Katherine; Fuentes-Afflick, Elena; Curry, Leslie A; Krumholz, Harlan M; Desai, Mayur M

2013-12-01

Our objective was to examine the association between parental immigration status and child health and health care utilization. Using data from a national sample of immigrant adults who had recently become legal permanent residents (LPR), children (n = 2,170) were categorized according to their parents' immigration status prior to LPR: legalized, mixed-status, refugee, temporary resident, or undocumented. Logistic regression with generalized estimating equations was used to compare child health and health care utilization by parental immigration status over the prior 12 months. Nearly all children in the sample were reported to be in good to excellent health. Children whose parents had been undocumented were least likely to have had an illness that was reported to have required medical attention (5.4 %). Children whose parents had been either undocumented or temporary residents were most likely to have a delayed preventive annual exam (18.2 and 18.7 %, respectively). Delayed dental care was most common among children whose parents had come to the US as refugees (29.1 %). Differences in the preventive annual exam remained significant after adjusting for socioeconomic characteristics. Parental immigration status before LPR was not associated with large differences in reported child health status. Parental immigration status before LPR was associated with the use of preventive annual exams and dental services. However, no group of children was consistently disadvantaged with respect to all measures.

HCFA and the states: politics and intergovernmental leverage.

PubMed

Gormley, W T; Boccuti, C

2001-06-01

In this article, we seek to explain variations in the Health Care Financing Administration's (HCFA) relationship to state governments. After reviewing several alternative models of the policy-making process, we argue that the utility of each model depends on certain issue characteristics, especially salience and conflict. We further argue that HCFA's choice of intergovernmental tools, rooted in a political setting, depends on the same issue characteristics. We illustrate our arguments by examining HCFA's behavior during the Clinton administration and by focusing on four cases: HMO performance measurement, nursing home regulation, lead screening for children, and the Children's Health Insurance Program (CHIP).

Experimental investigation of recirculating cells in laminar coaxial jets.

NASA Technical Reports Server (NTRS)

Warpinski, N. R.; Nagib, H. M.; Lavan, Z.

1972-01-01

Utilizing several unique means of introducing smoke into the flow field for careful visualization in addition to hot-wire techniques, experiments are performed in a specially designed facility producing laminar flows up to considerably high Reynolds numbers. Characteristics of the cells and the flow conditions that bring them about are documented by smoke photographs in the Reynolds number velocity ratio plane and the results are compared to previous analytical predictions. The cells are found to fall into three categories with different flow characteristics involving unsteadiness in position, and shear layer instabilities which result in higher mixing with the outer streams.-

Using Blocked Fractional Factorial Designs to Construct Discrete Choice Experiments for Health Care Studies

PubMed Central

Jaynes, Jessica; Wong, Weng Kee; Xu, Hongquan

2016-01-01

Discrete choice experiments (DCEs) are increasingly used for studying and quantifying subjects preferences in a wide variety of health care applications. They provide a rich source of data to assess real-life decision making processes, which involve trade-offs between desirable characteristics pertaining to health and health care, and identification of key attributes affecting health care. The choice of the design for a DCE is critical because it determines which attributes’ effects and their interactions are identifiable. We apply blocked fractional factorial designs to construct DCEs and address some identification issues by utilizing the known structure of blocked fractional factorial designs. Our design techniques can be applied to several situations including DCEs where attributes have different number of levels. We demonstrate our design methodology using two health care studies to evaluate (1) asthma patients’ preferences for symptom-based outcome measures, and (2) patient preference for breast screening services. PMID:26823156

Projecting the Demand for Dental Care in 2040.

PubMed

Manski, Richard J; Meyerhoefer, Chad D

2017-08-01

The purpose of this study was to provide a forward-thinking assessment of the underlying factors likely to impact trends in dental care demand and the need for dental providers in 2020, 2025, and beyond. Dental workforce trends and their likely impact on the need for dentists are a function of predicted dental care demand, which will in turn be determined by the size and characteristics of our population size, economic outlook, the state of public and private dental care insurance, trends in dental care delivery, professionally determined dental care need, and population health beliefs. Projecting rates of dental care utilization far into the future is difficult because projections must be made using historical data, and established trends may not persist if there is structural change in the future. Nonetheless, when structural change occurs, it does not typically affect all aspects of the economy, so there is value in describing the likely future impact of current trends. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

Utilization of surgery, chemotherapy, radiation therapy, and hospice at the end of life for patients diagnosed with metastatic melanoma.

PubMed

Huo, Jinhai; Du, Xianglin L; Lairson, David R; Chan, Wenyaw; Jiang, Jing; Buchholz, Thomas A; Guadagnolo, B Ashleigh

2015-06-01

To examine the patterns of utilization of radiation therapy, chemotherapy, surgery, and hospice at the end-of-life care for patients diagnosed with metastatic melanoma. We identified 816 Medicare beneficiaries toward who were 65 years of age or older, with pathologically confirmed metastatic malignant melanoma between January 1, 2000, and December 31, 2007. We evaluated trends and associations between sociodemographic and health service characteristics and the use of hospice care, chemotherapy, surgery, and radiation therapy. We found increasing use of surgery for patients with metastatic melanoma from 13% in 2000 to 30% in 2007 (P=0.03 for trend), and no significant fluctuation in the use of chemotherapy (P=0.43) or radiation therapy (P=0.46). Older patients were less likely to receive radiation therapy or chemotherapy. The use of hospice care increased from 61% in 2000 to 79% in 2007 (P=0.07 for trend). Enrollment in short-term (1 to 3 d) hospice care use increased, whereas long-term hospice care (≥4 d) remained stable. Patients living in the SEER (Surveillance, Epidemiology and End Results) northeast and south regions were less likely to undergo surgery. Patients enrolled in long-term hospice care used significantly less chemotherapy, surgery, and radiation therapy. Surgery and hospice care use increased over the years of this study, whereas the use of chemotherapy and radiation therapy remained consistent for patients diagnosed with metastatic melanoma.

The effect of physician practice organization on efficient utilization of hospital resources.

PubMed

Burns, L R; Chilingerian, J A; Wholey, D R

1994-12-01

This study examines variations in the efficient use of hospital resources across individual physicians. The study is conducted over a two-year period (1989-1990) in all short-term general hospitals with 50 or more beds in Arizona. We examine hospital discharge data for 43,625 women undergoing cesarean sections and vaginal deliveries without complications. These data include physician identifiers that permit us to link patient information with information on physicians provided by the state medical association. The study first measures the contribution of physician characteristics to the explanatory power of regression models that predict resource use. It then tests hypothesized effects on resource utilization exerted by two sets of physician level factors: physician background and physician practice organization. The latter includes effects of hospital practice volume, concentration of hospital practice, percent managed care patients in one's hospital practice, and diversity of patients treated. Efficiency (inefficiency) is measured as the degree of variation in patient charges and length of stay below (above) the average of treating all patients with the same condition in the same hospital in the same year with the same severity of illness, controlling for discharge status and the presence of complications. After controlling for patient factors, physician characteristics explain a significant amount of the variability in hospital charges and length of stay in the two maternity conditions. Results also support hypotheses that efficiency is influenced by practice organization factors such as patient volume and managed care load. Physicians with larger practices and a higher share of managed care patients appear to be more efficient. The results suggest that health care reform efforts to develop physician-hospital networks and managed competition may promote greater parsimony in physicians' practice behavior.

The effect of physician practice organization on efficient utilization of hospital resources.

PubMed Central

Burns, L R; Chilingerian, J A; Wholey, D R

1994-01-01

OBJECTIVE. This study examines variations in the efficient use of hospital resources across individual physicians. DATA SOURCES AND SETTING. The study is conducted over a two-year period (1989-1990) in all short-term general hospitals with 50 or more beds in Arizona. We examine hospital discharge data for 43,625 women undergoing cesarean sections and vaginal deliveries without complications. These data include physician identifiers that permit us to link patient information with information on physicians provided by the state medical association. STUDY DESIGN. The study first measures the contribution of physician characteristics to the explanatory power of regression models that predict resource use. It then tests hypothesized effects on resource utilization exerted by two sets of physician level factors: physician background and physician practice organization. The latter includes effects of hospital practice volume, concentration of hospital practice, percent managed care patients in one's hospital practice, and diversity of patients treated. Efficiency (inefficiency) is measured as the degree of variation in patient charges and length of stay below (above) the average of treating all patients with the same condition in the same hospital in the same year with the same severity of illness, controlling for discharge status and the presence of complications. PRINCIPAL FINDINGS. After controlling for patient factors, physician characteristics explain a significant amount of the variability in hospital charges and length of stay in the two maternity conditions. Results also support hypotheses that efficiency is influenced by practice organization factors such as patient volume and managed care load. Physicians with larger practices and a higher share of managed care patients appear to be more efficient. CONCLUSIONS. The results suggest that health care reform efforts to develop physician-hospital networks and managed competition may promote greater parsimony in physicians' practice behavior. PMID:8002351

Horizontal inequity in public health care service utilization for non-communicable diseases in urban Vietnam

PubMed Central

Kien, Vu Duy; Van Minh, Hoang; Giang, Kim Bao; Weinehall, Lars; Ng, Nawi

2014-01-01

Background A health system that provides equitable health care is a principal goal in many countries. Measuring horizontal inequity (HI) in health care utilization is important to develop appropriate and equitable public policies, especially policies related to non-communicable diseases (NCDs). Design A cross-sectional survey of 1,211 randomly selected households in slum and non-slum areas was carried out in four urban districts of Hanoi city in 2013. This study utilized data from 3,736 individuals aged 15 years and older. Respondents were asked about health care use during the previous 12 months; information included sex, age, and self-reported NCDs. We assessed the extent of inequity in utilization of public health care services. Concentration indexes for health care utilization and health care needs were constructed via probit regression of individual utilization of public health care services, controlling for age, sex, and NCDs. In addition, concentration indexes were decomposed to identify factors contributing to inequalities in health care utilization. Results The proportion of healthcare utilization in the slum and non-slum areas was 21.4 and 26.9%, respectively. HI in health care utilization in favor of the rich was observed in the slum areas, whereas horizontal equity was achieved among the non-slum areas. In the slum areas, we identified some key factors that affect the utilization of public health care services. Conclusion Our results suggest that to achieve horizontal equity in utilization of public health care services, policy should target preventive interventions for NCDs, focusing more on the poor in slum areas. PMID:25095780

Comprehensive care programs for patients with multiple chronic conditions: a systematic literature review.

PubMed

de Bruin, Simone R; Versnel, Nathalie; Lemmens, Lidwien C; Molema, Claudia C M; Schellevis, François G; Nijpels, Giel; Baan, Caroline A

2012-10-01

To provide insight into the characteristics of comprehensive care programs for patients with multiple chronic conditions and their impact on patients, informal caregivers, and professional caregivers. Systematic literature search in multiple electronic databases for English language papers published between January 1995 and January 2011, supplemented by reference tracking and a manual search on the internet. Wagner's chronic care model (CCM) was used to define comprehensive care. After inclusion, the methodological quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions. Forty-two publications were selected describing thirty-three studies evaluating twenty-eight comprehensive care programs for multimorbid patients. Programs varied in the target patient groups, implementation settings, number of included interventions, and number of CCM components to which these interventions related. Moderate evidence was found for a beneficial effect of comprehensive care on inpatient healthcare utilization and healthcare costs, health behavior of patients, perceived quality of care, and satisfaction of patients and caregivers. Insufficient evidence was found for a beneficial effect of comprehensive care on health-related quality of life in terms of mental functioning, medication use, and outpatient healthcare utilization and healthcare costs. No evidence was found for a beneficial effect of comprehensive care on cognitive functioning, depressive symptoms, functional status, mortality, quality of life in terms of physical functioning, and caregiver burden. Because of the heterogeneity of comprehensive care programs, it is as yet too early to draw firm conclusions regarding their effectiveness. More rigorous evaluation studies are necessary to determine what constitutes best care for the increasing number of people with multiple chronic conditions. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Practice patterns in spine radiograph utilization among doctors of chiropractic enrolled in a provider network offering complementary care in the United States.

PubMed

Bussières, André E; Sales, Anne E; Ramsay, Timothy; Hilles, Steven; Grimshaw, Jeremy M

2013-01-01

Nonspecific back pain is associated with high use of diagnostic imaging in primary care, yet current evidence suggests that routine imaging of the spine is unnecessary. The objective of this study is to describe current practice patterns in spine radiograph utilization among doctors of chiropractic enrolled in an American provider network. A cross-sectional analysis of administrative claims data from one of the largest providers of complementary health care networks for health plans in the United States was performed. Survey data containing provider demographics were linked with routinely collected data on spine radiograph utilization and patient characteristics aggregated at the provider level. We calculated rates and variations of spine radiographs over 12 months. Negative binomial regression was performed to identify significant predictors of high radiograph utilization and to estimate the associated incidence risk ratio. Complete data for 6946 doctors of chiropractic and 249193 adult patients were available for analyses. In 2010, claims were paid for a total of 91542 new patient examinations and 23369 spine radiographs (including 17511 ordered within 5 days of initial patient examination). The rate of spine radiographs within 5 days of an initial patient visit was 204 per 1000 new patient examinations. Significant predictors of higher radiograph utilization rates included the following: practicing in the Midwest or South US census regions, practicing in an urban or suburban setting, chiropractic school attended, and being a male provider in full-time practice with more than 20 years of experience. Chiropractic school attended and practice location were the most influential predictors of spine radiograph utilization among network chiropractors. This information may help to inform the development and evaluation of a tailored intervention to address overuse of radiograph utilization. Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Economic and financial outcomes in transplantation: whose dime is it anyway?

PubMed

Axelrod, David A

2013-04-01

Organ transplant is a resource-intensive service that has been subjected to increasing scrutiny in this era of cost containment. A detailed understanding of the economic (societal) and financial (transplant provider) implications of organ quality, recipient characteristics, and allocation policy is vital for the transplant professionals. Prior studies of kidney transplant economics demonstrate significant cost savings achieved by eliminating the need for long-term dialysis. However, transplant providers are experiencing higher financial costs because of changes in recipient characteristics and broader use of marginal organs. Liver transplantation economics are also more challenging because of the severity of illness-based organ allocation. Furthermore, the use of more allografts recovered from donors after cardiac death has been demonstrated to increase costs with minimal benefits. Finally, successful long-term mechanical support devices have fundamentally changed the economic implications of advanced heart failure care. Although care for end-stage organ failure through transplant is one of the landmark accomplishments of 20th century medicine, maintaining or expanding access to transplant care is threatened by the high cost of care. Novel strategies are vital to reduce the financial burden faced by the centers that transplant high-risk patients and utilize lower quality organs.

Clinical characteristics and service use of persons with mental illness living in an intermediate care facility.

PubMed

Anderson, R L; Lewis, D A

1999-10-01

The study examined the characteristics of residents living in a 450-bed intermediate care facility for persons with severe mental illness in Illinois and sought to determine the factors predicting their utilization of mental health services. Data on 100 randomly selected residents with a chart diagnosis of schizophrenia were collected using chart review and interviews. Data for 78 residents whose diagnosis of schizophrenia or schizoaffective disorder was confirmed using the Structured Clinical Interview for DSM-IV were included in the analyses. Fifty-three percent of the residents used facility-based specialty mental health services beyond medication management, such as group therapy or a day program. Persons with the least severe psychiatric illnesses and with higher levels of motivation for overall care used the most mental health services. Thirty-five percent of the residents had been discharged to an inpatient psychiatric unit during the previous year. Residents most likely to be discharged to those settings were young men with a history of homelessness who refused facility-based health services. Despite recent policy-driven efforts to improve care in this intermediate care facility for persons with mental illness, the facility continues to have problems addressing the mental health needs of the residents.

Considerations in reporting palliative care clinical trials: Standardizing information reported and authorship practices

PubMed Central

LeBlanc, Thomas W.; Abernethy, Amy P.; Currow, David C.; Kutner, Jean S.

2014-01-01

Purpose of Review The nature of palliative care practice, especially the reliance on referrals and differing models of service delivery, poses unique challenges for the creation and interpretation of an evidence base, frequently limiting the applicability of data to patient care. Here we discuss two core aspects of clinical trials reporting in palliative medicine: 1) proposed standards governing the collection and reporting of data, and 2) rules governing authorship and publication. Recent Findings Existing literature often inadequately describes the characteristics of patients, caregivers, clinicians, systems, and interventions included in studies, thereby limiting the utility of results. Summary A generalizability framework is needed to ensure a robust evidence base that advances practice. Lessons learned through the development of research cooperative groups in palliative care reinforce the importance of an authorship protocol for large trials and working groups. PMID:23080306

Explaining the increased health care expenditures associated with gastroesophageal reflux disease among elderly Medicare beneficiaries with chronic obstructive pulmonary disease: a cost-decomposition analysis.

PubMed

Ajmera, Mayank; Raval, Amit D; Shen, Chan; Sambamoorthi, Usha

2014-01-01

To estimate excess health care expenditures associated with gastroesophageal reflux disease (GERD) among elderly individuals with chronic obstructive pulmonary disease (COPD) and examine the contribution of predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors to the excess expenditures, using the Blinder-Oaxaca linear decomposition technique. This study utilized a cross-sectional, retrospective study design, using data from multiple years (2006-2009) of the Medicare Current Beneficiary Survey linked with fee-for-service Medicare claims. Presence of COPD and GERD was identified using diagnoses codes. Health care expenditures consisted of inpatient, outpatient, prescription drugs, dental, medical provider, and other services. For the analysis, t-tests were used to examine unadjusted subgroup differences in average health care expenditures by the presence of GERD. Ordinary least squares regressions on log-transformed health care expenditures were conducted to estimate the excess health care expenditures associated with GERD. The Blinder-Oaxaca linear decomposition technique was used to determine the contribution of predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors, to excess health care expenditures associated with GERD. Among elderly Medicare beneficiaries with COPD, 29.3% had co-occurring GERD. Elderly Medicare beneficiaries with COPD/GERD had 1.5 times higher ($36,793 vs $24,722 [P<0.001]) expenditures than did those with COPD/no GERD. Ordinary least squares regression revealed that individuals with COPD/GERD had 36.3% (P<0.001) higher expenditures than did those with COPD/no GERD. Overall, 30.9% to 43.6% of the differences in average health care expenditures were explained by differences in predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors between the two groups. Need factors explained up to 41% of the differences in average health care expenditures between the two groups. Among elderly Medicare beneficiaries with COPD, the presence of GERD was associated with higher expenditures. Need factors primarily contributed to the differences in average health care expenditures, suggesting that the comanagement of chronic conditions may reduce excess health care expenditures associated with GERD.

Predictors of resource utilization in transsphenoidal surgery for Cushing disease.

PubMed

Little, Andrew S; Chapple, Kristina

2013-08-01

The short-term cost associated with subspecialized surgical care is an increasingly important metric and economic concern. This study sought to determine factors associated with hospital charges in patients undergoing transsphenoidal surgery for Cushing disease in an effort to identify the drivers of resource utilization. The authors analyzed the Nationwide Inpatient Sample (NIS) hospital discharge database from 2007 to 2009 to determine factors that influenced hospital charges in patients who had undergone transsphenoidal surgery for Cushing disease. The NIS discharge database approximates a 20% sample of all inpatient admissions to nonfederal US hospitals. A multistep regression model was developed that adjusted for patient demographics, acuity measures, comorbidities, hospital characteristics, and complications. In 116 hospitals, 454 transsphenoidal operations were performed. The mean hospital charge was $48,272 ± $32,060. A multivariate regression model suggested that the primary driver of resource utilization was length of stay (LOS), followed by surgeon volume, hospital characteristics, and postoperative complications. A 1% increase in LOS increased hospital charges by 0.60%. Patient charges were 13% lower when performed by high-volume surgeons compared with low-volume surgeons and 22% lower in large hospitals compared with small hospitals. Hospital charges were 12% lower in cases with no postoperative neurological complications. The proposed model accounted for 46% of hospital charge variance. This analysis of hospital charges in transsphenoidal surgery for Cushing disease suggested that LOS, hospital characteristics, surgeon volume, and postoperative complications are important predictors of resource utilization. These findings may suggest opportunities for improvement.

Predicting Health Care Utilization in Marginalized Populations: Black, Female, Street-based Sex Workers

PubMed Central

Varga, Leah M.; Surratt, Hilary L.

2014-01-01

Background Patterns of social and structural factors experienced by vulnerable populations may negatively affect willingness and ability to seek out health care services, and ultimately, their health. Methods The outcome variable was utilization of health care services in the previous 12 months. Using Andersen’s Behavioral Model for Vulnerable Populations, we examined self-reported data on utilization of health care services among a sample of 546 Black, street-based female sex workers in Miami, Florida. To evaluate the impact of each domain of the model on predicting health care utilization, domains were included in the logistic regression analysis by blocks using the traditional variables first and then adding the vulnerable domain variables. Findings The most consistent variables predicting health care utilization were having a regular source of care and self-rated health. The model that included only enabling variables was the most efficient model in predicting health care utilization. Conclusions Any type of resource, link, or connection to or with an institution, or any consistent point of care contributes significantly to health care utilization behaviors. A consistent and reliable source for health care may increase health care utilization and subsequently decrease health disparities among vulnerable and marginalized populations, as well as contribute to public health efforts that encourage preventive health. PMID:24657047

[Management characteristics in charity hospitals in Brazil].

PubMed

Lima, Sheyla Maria Lemos; Barbosa, Pedro Ribeiro; Portela, Margareth C; Ugá, Maria Alicia Dominguez; Vasconcellos, Miguel Murat; Gerschman, Silvia

2004-01-01

This paper presents the management characteristics of charity hospitals in Brazil, based on data from a national survey developed in 2001. The sample accounted for the random inclusion of 66 Brazilian Unified Health System (SUS) inpatient care providers with less than 599 beds and all 26 hospitals with at least 599 beds. It also included 10 institutions assumed as non-providers of services to the SUS. The analyses are descriptive, focusing on the classification of the hospitals according to their managerial development level, as well as selected issues regarding the utilization of specific managerial technologies, human resources, technical services, and services contracting. Distinct managerial levels were identified, but it is important to note that 83% of the SUS providers with less than 599 beds were classified as having incipient management. The authors discuss implications of the findings for inpatient care policies, considering the importance of charity hospitals for the Brazilian Health System.

Drug therapy problems and medication discrepancies during care transitions in super-utilizers.

PubMed

Surbhi, Satya; Munshi, Kiraat D; Bell, Paula C; Bailey, James E

First, to investigate the prevalence and types of drug therapy problems and medication discrepancies among super-utilizers, and associated patient characteristics. Second, to examine the outcomes of pharmacist recommendations and estimated cost avoidance through care transitions support focused on medication management. Retrospective analysis of the pharmacist-led interventions as part of the SafeMed Program. A large nonprofit health care system serving the major medically underserved areas in Memphis, Tennessee. Three hundred seventy-four super-utilizing SafeMed participants with multiple chronic conditions and polypharmacy. Comprehensive medication review, medication therapy management, enhanced discharge planning, home visits, telephone follow-up, postdischarge medication reconciliation, and care coordination with physicians. Types of drug therapy problems, outcomes of pharmacist recommendations, estimated cost avoided, medication discrepancies, and self-reported medication adherence. Prevalence of drug therapy problems and postdischarge medication discrepancies was 80.7% and 75.4%, respectively. The most frequently occurring drug therapy problems were enrollee not receiving needed medications (33.4%), underuse of medications (16.9%), and insufficient dose or duration (11.2%). Overall 50.8% of the pharmacist recommendations were accepted by physicians and patients, resulting in an estimated cost avoidance of $293.30 per drug therapy problem identified. Multivariate analysis indicated that participants with a higher number of comorbidities were more likely to have medication discrepancies (odds ratio 1.23 [95% CI 1.05-1.44]). Additional contributors to postdischarge medication discrepancies were difficulty picking up and paying for medications and not being given necessary prescriptions before discharge. Drug therapy problems and medication discrepancies are common in super-utilizers with multiple chronic conditions and polypharmacy during transitions of care, and greater levels of comorbidity magnify risk. Pharmacist-led interventions in the SafeMed Program have demonstrated success in resolving enrollees' medication-related issues, resulting in substantial estimated cost savings. Preliminary evidence suggests that the SafeMed model's focus on medication management has great potential to improve outcomes while reducing costs for vulnerable super-utilizing populations nationwide. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

A Practice-Based Evaluation of Distress Screening Protocol Adherence and Medical Service Utilization.

PubMed

Zebrack, Brad; Kayser, Karen; Bybee, Deborah; Padgett, Lynne; Sundstrom, Laura; Jobin, Chad; Oktay, Julianne

2017-07-01

Background: This study examined the extent to which cancer programs demonstrated adherence to their own prescribed screening protocol, and whether adherence to that protocol was associated with medical service utilization. The hypothesis is that higher rates of service utilization are associated with lower rates of adherence to screening protocols. Methods: Oncology social workers at Commission on Cancer-accredited cancer programs reviewed electronic health records (EHRs) in their respective cancer programs during a 2-month period in 2014. Rates of overall adherence to a prescribed distress screening protocol were calculated based on documentation in the EHR that screening adherence and an appropriate clinical response had occurred. We examined documentation of emergency department (ED) use and hospitalization within 2 months after the screening visit. Results: Review of 8,409 EHRs across 55 cancer centers indicated that the overall adherence rate to screening protocols was 62.7%. The highest rates of adherence were observed in Community Cancer Programs (76.3%) and the lowest rates were in NCI-designated Cancer Centers (43.3%). Rates of medical service utilization were significantly higher than expected when overall protocol adherence was lacking. After controlling for patient and institutional characteristics, risk ratios for ED use (0.82) and hospitalization (0.81) suggest that when overall protocol adherence was documented, 18% to 19% fewer patients used these medical services. Conclusions: The observed associations between a mandated psychosocial care protocol and medical service utilization suggest opportunities for operational efficiencies and costs savings. Further investigations of protocol integrity, as well as the clinical care models by which psychosocial care is delivered, are warranted. Copyright © 2017 by the National Comprehensive Cancer Network.

The impact of race and ethnicity on mortality and healthcare utilization in alcoholic hepatitis: a cross-sectional study.

PubMed

May, Folasade P; Rolston, Vineet S; Tapper, Elliot B; Lakshmanan, Ashwini; Saab, Sammy; Sundaram, Vinay

2016-10-10

Alcoholic Hepatitis (AH) is major source of alcohol-related mortality and health care expenditures in the United States. There is insufficient information regarding the role of race and ethnicity on healthcare utilization and outcomes for patients with AH. We aimed to determine whether there are racial/ethnic differences in resource utilization and inpatient mortality in patients hospitalized with AH. We analyzed data from the Nationwide Inpatient Sample (NIS), years 2008-2011. We calculated demographic, clinical, and healthcare utilization characteristics by race. We then performed logistic regression and generalized linear modeling with gamma distribution (log link), respectively, to determine predictors of inpatient morality and total hospital costs (THC). We identified 11,304 AH patients from 2008 to 2011. Mean age was 47.0 years, and 62.1 % were male, 61.9 % were white, 9.8 % were black, and 9.7 % were Hispanic. Mean LOS was 6.3 days and significantly longer in whites (6.5 d) than both blacks (5.4 d) and Hispanics (5.9 d). In adjusted models, inpatient mortality was lower for blacks than for whites (adj. OR = 0.50; 95 % CI = 0.32-0.78). THC was significantly higher for Hispanics than whites (fold increase = 1.25; 95 % CI = 1.01-1.49). We identified differences in healthcare utilization and mortality by race/ethnicity. THC was significantly higher among Hispanics than for whites and blacks. We also demonstrated lower inpatient mortality in blacks compared to whites. These variations may implicate racial and ethnic differences in access to care, quality of care, severity of AH on presentation, or other factors.

Cost Sharing, Health Care Expenditures, and Utilization: An International Comparison.

PubMed

Perkowski, Patryk; Rodberg, Leonard

2016-01-01

Health systems implement cost sharing to help reduce health care expenditure and utilization by discouraging the use of unnecessary health care services. We examine cost sharing in 28 countries in the Organisation for Economic Co-operation and Development from 1999 through 2009 in the areas of medical care, hospital care, and pharmaceuticals. We investigate associations between cost sharing, health care expenditures, and health care utilization and find no significant association between cost sharing and health care expenditures or utilization in these countries. © The Author(s) 2015.

The effect of pregnancy intention on important maternal behaviors and satisfaction with care in a socially and economically at-risk population.

PubMed

Humbert, Larry; Saywell, Robert M; Zollinger, Terrell W; Priest, Caitlin F; Reger, Michael K; Kochhar, Komal

2011-10-01

This study examined the association of pregnancy intention with maternal behaviors and the woman's perceived satisfaction with her prenatal and delivery care. Face-to-face interviews with 478 primarily Medicaid eligible women in Indianapolis, Indiana during their postpartum hospital stay were conducted to assess their degree of satisfaction with prenatal care and pregnancy intention, stratified into wanting to be pregnant now, later or never. Behaviors and characteristics influencing utilization of prenatal care were obtained from linked birth certificate data. A greater proportion of younger women (15-29) wanted to be pregnant later, a greater proportion of African-Americans never wanted to be pregnant, a greater proportion of divorced and never married women wanted to be pregnant later or never, and as parity increased the percentage of women never wanting to be pregnant increased. Multivariate analyses found that women never wanting to be pregnant were twice as likely to underutilize prenatal care, twice as likely to smoke while pregnant, half as likely to utilize WIC services and half as likely to recommend their providers to pregnant friends or relatives compared to women with a planned pregnancy, controlling for confounding variables. Finally, women wanting to be pregnant later were half as likely to rate their overall hospital care and prenatal care provider as high. Providers assessing their patients' pregnancy intention could better identify those women needing additional support services to adopt healthier behaviors and improve satisfaction with care. This study also demonstrated the value of more specific definitions of pregnancy intention.

Changing Patterns of Mental Health Care Use: The Role of Integrated Mental Health Services in Veteran Affairs Primary Care.

PubMed

Leung, Lucinda B; Yoon, Jean; Rubenstein, Lisa V; Post, Edward P; Metzger, Maureen E; Wells, Kenneth B; Sugar, Catherine A; Escarce, José J

2018-01-01

Aiming to foster timely, high-quality mental health care for Veterans, VA's Primary Care-Mental Health Integration (PC-MHI) embeds mental health specialists in primary care and promotes care management for depression. PC-MHI and patient-centered medical home providers work together to provide the bulk of mental health care for primary care patients with low-to-moderate-complexity mental health conditions. This study examines whether increasing primary care clinic engagement in PC-MHI services is associated with changes in patient health care utilization and costs. We performed a retrospective longitudinal cohort study of primary care patients with identified mental health needs in 29 Southern California VA clinics from October 1, 2008 to September 30, 2013, using electronic administrative data (n = 66,638). We calculated clinic PC-MHI engagement as the proportion of patients receiving PC-MHI services among all primary care clinic patients in each year. Capitalizing on variation in PC-MHI engagement across clinics, our multivariable regression models predicted annual patient use of 1) non-primary care based mental health specialty (MHS) visits, 2) total mental health visits (ie, the sum of MHS and PC-MHI visits), and 3) health care utilization and costs. We controlled for year- and clinic-fixed effects, other clinic interventions, and patient characteristics. Median clinic PC-MHI engagement increased by 8.2 percentage points over 5 years. At any given year, patients treated at a clinic with 1 percentage-point higher PC-MHI engagement was associated with 0.5% more total mental health visits (CI, 0.18% to 0.90%; P = .003) and 1.0% fewer MHS visits (CI, -1.6% to -0.3%; P = .002); this is a substitution rate, at the mean, of 1.5 PC-MHI visits for each MHS visit. There was no PC-MHI effect on other health care utilization and costs. As intended, greater clinic engagement in PC-MHI services seems to increase realized accessibility to mental health care for primary care patients, substituting PC-MHI for MHS visits, without increasing acute care use or total costs. Thus, PC-MHI services within primary care clinics may improve mental health care value at the patient population level. More research is needed to understand the relationship between clinic PC-MHI engagement and clinical quality of mental health care. © Copyright 2018 by the American Board of Family Medicine.

Place of death and health care utilization for people in the last 6 months of life in Switzerland: a retrospective analysis using administrative data

PubMed Central

2013-01-01

Background There is a growing interest in examining the current state of care and identifying opportunities for improving care and reducing costs at the end of life. The aim of this study is to examine patterns of health care use at the end of life and place of death and to describe the basic characteristics of the decedents in the last six months of their life. Methods The empirical analysis is based on data from 58,732 Swiss residents who died between 2007 and 2011. All decedents had mandatory health insurance with Helsana Group, the largest health insurer in Switzerland. Descriptive statistical techniques were used to provide a general profile of the study population and determinants of the outcome for place of death were analyzed with an econometric approach. Results There were substantial and significant differences in health care utilization in the last six months of life between places of death. The mean numbers of consultations with a general practitioner or a specialist physician as well as the number of different medications and the number of hospital days was consistently highest for the decedents who died in a hospital. We found death occurred in Switzerland most frequently in hospitals (38.4% of all cases) followed by nursing homes (35.1%) and dying at home (26.6%). The econometric analysis indicated that the place of death is significantly associated with age, sex, region and multiple chronic conditions. Conclusions The importance of nursing homes and patients’ own homes as place of death will continue to grow in the future. Knowing the determinants of place of death and patterns of health care utilization of decedents can help decision makers on the allocation of these needed health care services in Switzerland. PMID:23530717

Chronic obstructive pulmonary disease self-management activation research trial (COPD-SMART): results of recruitment and baseline patient characteristics.

PubMed

Russo, Rennie; Coultas, David; Ashmore, Jamile; Peoples, Jennifer; Sloan, John; Jackson, Bradford E; Uhm, Minyong; Singh, Karan P; Blair, Steven N; Bae, Sejong

2015-03-01

To describe the recruitment methods, study participation rate, and baseline characteristics of a representative sample of outpatients with COPD eligible for pulmonary rehabilitation participating in a trial of a lifestyle behavioral intervention to increase physical activity. A patient registry was developed for recruitment using an administrative database from primary care and specialty clinics of an academic medical center in northeast Texas for a parallel group randomized trial. The registry was comprised of 5582 patients and over the course of the 30 month recruitment period 325 patients were enrolled for an overall study participation rate of 35.1%. After a 6-week COPD self-management education period provided to all enrolled patients, 305 patients were randomized into either usual care (UC; n=156) or the physical activity self-management intervention (PASM; n=149). There were no clinically significant differences in demographics, clinical characteristics, or health status indicators between the randomized groups. The results of this recruitment process demonstrate the successful use of a patient registry for enrolling a representative sample of outpatients eligible for pulmonary rehabilitation with COPD from primary and specialty care. Moreover, this approach to patient recruitment provides a model for future studies utilizing administrative databases and electronic health records. Published by Elsevier Inc.

Organizational Characteristics of Veterans Affairs Clinics With High and Low Utilization of Clozapine.

PubMed

Gören, Jessica L; Rose, Adam J; Engle, Ryann L; Smith, Eric G; Christopher, Melissa L D; Rickles, Nathaniel M; Semla, Todd P; McCullough, Megan B

2016-11-01

Twenty to thirty percent of patients with schizophrenia experience treatment resistance. Clozapine is the only medication proven effective for treatment-resistant schizophrenia. However, in most settings less than 25% of patients with treatment-resistant schizophrenia receive clozapine. This study was conducted to identify facilitators of and barriers to clozapine use to inform development of interventions to maximize appropriate clozapine utilization. Seventy semistructured phone interviews were conducted with key informants of clozapine processes at U.S. Department of Veterans Affairs medical centers in various U.S. regions, including urban and rural areas, with high (N=5) and low (N=5) rates of clozapine utilization. Interviewees included members of mental health leadership, psychiatrists, clinical pharmacists, and advanced practice nurses. Interviews were analyzed by using an emergent thematic strategy to identify barriers and facilitators related to clozapine prescribing. High utilization was associated with integration of nonphysician psychiatric providers and clear organizational processes and infrastructure for treatment of severe mental illness, for example, use of clozapine clinics and mental health intensive case management. Low utilization was associated with a lack of champions to support clozapine processes and with limited-capacity care systems. Obstacles identified at both high- and low-utilization sites included complex, time-consuming paperwork; reliance on a few individuals to facilitate processes; and issues related to transportation for patients living far from care facilities. Implementation efforts to organize, streamline, and simplify clozapine processes; development of a multidisciplinary clozapine clinic; increased capacity of existing clinics; and provision of transportation are reasonable targets to increase clozapine utilization.

Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention.

PubMed

Morriss, Richard; Kai, Joe; Atha, Christopher; Avery, Anthony; Bayes, Sara; Franklin, Matthew; George, Tracey; James, Marilyn; Malins, Samuel; McDonald, Ruth; Patel, Shireen; Stubley, Michelle; Yang, Min

2012-07-06

The top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of attendance last more than two years, they may become persistent (persistent frequent or regular attendance). However, there is no long-term study of the economic impact or clinical characteristics of regular attendance in primary care. Cognitive behaviour formulation and treatment (CBT) for regular attendance as a motivated behaviour may offer an understanding of the development, maintenance and treatment of regular attendance in the context of their health problems, cognitive processes and social context. A case control design will compare the clinical characteristics, patterns of health care use and economic costs over the last 10 years of 100 regular attenders (≥30 appointments with general practitioner [GP] over 2 years) with 100 normal attenders (6-22 appointments with GP over 2 years), from purposefully selected primary care practices with differing organisation of care and patient demographics. Qualitative interviews with regular attending patients and practice staff will explore patient barriers, drivers and experiences of consultation, and organisation of care by practices with its challenges. Cognitive behaviour formulation analysed thematically will explore the development, maintenance and therapeutic opportunities for management in regular attenders. The feasibility, acceptability and utility of CBT for regular attendance will be examined. The health care costs, clinical needs, patient motivation for consultation and organisation of care for persistent frequent or regular attendance in primary care will be explored to develop training and policies for service providers. CBT for regular attendance will be piloted with a view to developing this approach as part of a multifaceted intervention.

[Gingival health of adolescents and the utilization of dental services, state of São Paulo, Brazil].

PubMed

Antunes, José Leopoldo Ferreira; Peres, Marco Aurélio; Frias, Antonio Carlos; Crosato, Edgard Michel; Biazevic, Maria Gabriela Haye

2008-04-01

To evaluate the association between gingival health conditions and dental service utilization. An epidemiological survey of the oral health of 1,799 adolescents was carried out in 35 cities of the state of São Paulo, in 2002. Gingival health was assessed through the prevalence of gingival bleeding on probing and dental calculus (community periodontal index), and dental occlusion was assessed through the dental aesthetic index. The utilization of dental services was measured by means of the dental care index (F/DMFT) for each city. Multilevel logistic regression analysis was used to adjust explanatory models to factors associated with the outcome variables of interest. The prevalence of gingival bleeding on probing was 21.5%, whereas dental calculus was prevalent in 19.4%. Male participants, who were either black or dark-skinned, lived in crowded homes, in rural areas, and showed schooling delay, were at a significantly higher risk than their respective counterparts. The following dental occlusion characteristics were also associated with unhealthy gum: incisor segment crowding, vertical anterior open bite, and antero-posterior molar relationship. Cities with a higher utilization of dental services showed a smaller proportion of adolescents with gingival bleeding and dental calculus. The utilization of dental services was significantly associated with better gingival health conditions (gingival bleeding and dental calculus). This association did not depend on contextual and individual sociodemographic characteristics or dental occlusion.

A qualitative analysis of job burnout in eating disorder treatment providers.

PubMed

Warren, Cortney S; Schafer, Kerri J; Crowley, Mary Ellen; Olivardia, Roberto

2012-01-01

Although job burnout is common in mental health care settings, almost no research has examined burnout in eating disorder treatment providers. Using qualitative methodology, this study examined a) perceived contributors of burnout, b) efforts to manage burnout, and c) recommendations for avoiding burnout in a sample of professional eating disorder treatment providers. Recruited via professional organizations, 298 participants completed an online questionnaire designed by the authors. Qualitative responses were coded and grouped into themes. Results indicated that almost all participants worried about their patients' health, which frequently resulted in negative affect (e.g., anxiety, sadness). The most frequently cited contributors to burnout were common characteristics of eating pathology (e.g., chronicity, relapse, symptom severity); patient characteristics (e.g., personality conflict); work-related factors (e.g., time demands); and, financial issues (e.g., inadequate compensation). To avoid burnout, over 90% of participants engaged in self-care behaviors (e.g., exercise, social support). Early-career practitioners were encouraged to utilize supervision, create a work/life balance, engage in self-care, and limit caseloads. These results suggest that supervision and training of eating disorder treatment providers should include burnout management.

Institutional delivery and postnatal care services utilizations in Abuna Gindeberet District, West Shewa, Oromiya Region, Central Ethiopia: A Community-based cross sectional study.

PubMed

Darega, Birhanu; Dida, Nagasa; Tafese, Fikru; Ololo, Shimeles

2016-07-07

Delivery at health institutions under the care of trained health-care providers and utilization of postnatal cares services plays vital roles in promoting child survival and reducing the risk of maternal mortality. More than 80 % of maternal deaths can be prevented if pregnant women access to essential maternity cares like antenatal care, institutional delivery and postnatal care services. Thus, this study aimed to assess institutional delivery and postnatal care services utilizations in Abuna Gindeberet District, West Shewa, Oromiya Regional State, Ethiopia. A community-based cross-sectional study design was employed among 703 randomly identified mothers of Abuna Gindeberet district in March, 2013. Data were collected through interviewer-administered questionnaires and analyzed using SPSS version 16.0. Descriptive, bivariate and multivariate analyses were used to determine prevalence and to identify associated factors with institutional delivery and postnatal care, considering p-value of less than 0.05 as significant. The results were presented in a narrative forms, tables and graphs. One hundred one (14.4 %) of mothers gave birth to their last baby in health institutions. From 556 (79.1 %) of respondents who heard about postnatal care services, only 223 (31.7 %) of them utilized postnatal care services for their recent childbirth. From the total postnatal care users, 204 (91.5 %) of them took the services from health extension workers. Decision-making styles, household distances from health institutions, household being model family and ANC services utilizations were found to be statistically significant with both institutional delivery and postnatal care services utilizations. But educational status of husbands was statistically significant with only postnatal care services utilizations. Both institutional delivery and postnatal care services utilizations from health institutions were low. Decision-making styles, household distances from health institutions, household being model family and ANC services utilizations were the common factors that affect institutional delivery and postnatal care services utilizations from health institutions. Therefore, giving attention to the identified factors could improve and sustain institutional delivery and postnatal care services utilizations from health institutions.

Health Care Engagement Among LGBT Older Adults: The Role of Depression Diagnosis and Symptomatology.

PubMed

Shiu, Chengshi; Kim, Hyun-Jun; Fredriksen-Goldsen, Karen

2017-02-01

Optimal engagement in health care plays a critical role in the success of disease prevention and treatment, particularly for older adults who are often in greater need of health care services. However, to date, there is still limited knowledge about the relationship between depression and health care engagement among lesbian, gay, bisexual, and transgender (LGBT) older adults. This study utilized data from Aging with Pride: National Health, Aging, Sexuality/Gender Study, from the 2014 survey with 2,450 LGBT adults 50 years old and older. Multiple-variable regression was utilized to evaluate relationships between three indicators of health care engagement and four depression groups after controlling for background characteristics and discrimination in health care. Health care engagement indicators were "not using preventive care," "not seeking care when needed," and "difficulty in adhering to treatments." Depression groups were defined by depression diagnosis and symptomatology, including Diagnosed-Symptomatic group (Diag-Sympt), Diagnosed-Nonsymptomatic group (Diag-NoSympt), Nondiagnosed-Symptomatic group (NoDiag-Sympt), and Nondiagnosed-Nonsymptomatic group (NoDiag-NoSympt). Depression groups displayed different patterns and levels of health care engagement. The Diag-Sympt group displayed the highest "difficulty in adhering to treatments." Diag-NoSympt group displayed the lowest "not using preventive care." The NoDiag-Sympt group reported the highest "not using preventive care" and "not seeking care when needed." The NoDiag-NoSympt group had the lowest "not seeking care when needed" and "difficulty in adhering to treatments." Depression diagnosis and symptomatology are jointly associated with health care engagement among LGBT older adults. Interventions aiming to promote health care engagement among this population should simultaneously consider both depression diagnosis and symptomatology. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The influence of intrinsic and extrinsic job values on turnover intention among continuing care assistants in Nova Scotia.

PubMed

Dill, Donna M; Keefe, Janice M; McGrath, Daniel S

2012-01-01

This article examines the influence that intrinsic and extrinsic job values have on the turnover intention of continuing care assistants (CCAs) who work either in home care or facility-based care in Nova Scotia (n = 188). Factor analysis of job values identified three latent job values structures: "compensation and commitment," "flexibility and opportunity," and "positive work relationships." Using binary logistic regression, we examined the predictive utility of these factors on two indices of turnover intention. Regression results indicate that, in general, job values constructs did not significantly predict turnover intention when controlling for demographics and job characteristics. However, a trend was found for the "positive work relationships" factor in predicting consideration of changing employers. In addition, CCAs who work in facility-based care were significantly more likely to have considered leaving their current employer. With projected increases in the demand for these workers in both home and continuing care, more attention is needed to identify and address factors to reduce turnover intention.

Barrio Adentro and the reduction of health inequalities in Venezuela: an appraisal of the first years.

PubMed

Armada, Francisco; Muntaner, Caries; Chung, Haejoo; Williams-Brennan, Leslie; Benach, Joan

2009-01-01

This article presents an update on the characteristics and performance of Venezuela's Bolivarian health care system, Barrio Adentro (Inside the Neighborhood). During its first five years of existence, Barrio Adentro has improved access and utilization of health services by reaching approximately 17 million impoverished and middle-class citizens all over Venezuela. This was achieved in approximately two years and provides an example of an immense "South-South" cooperation and participatory democracy in health care. Popular participation was achieved with the Comités de Salud (health committees) and more recently with the Consejos Comunales (community councils), while mostly Cuban physicians provided medical care. Examination of a few epidemiological indicators for the years 2004 and 2005 of Barrio Adentro reveals the positive impact of this health care program, in particular its primary care component, Barrio Adentro I. Continued political commitment and realistic evaluations are needed to sustain and improve Barrio Adentro, especially its primary care services.

[Ophthalmologic healthcare utilization of people in need of long-term care : Analyses of health insurance data of the AOK Baden-Württemberg].

PubMed

Schuster, Alexander K; Pick, Julia; Saalmann, Frauke; Pfeiffer, Norbert

2018-04-10

Eye diseases causing visual impairment increase with age. Thus, seeking eye care has a higher probability in older people. In this study, the rate of utilization of outpatient eye care services in Germany was analyzed. The analyses focused on older persons and persons in need of either home-based or facility-based long-term care. A descriptive secondary data analysis of health insurance data of the AOK Baden-Württemberg from 2016 was conducted. The study population comprised all insured persons on 1 January 2016. The cohort of older persons (60 years+) was further stratified by the type of care (home-based/facility-based) and the level of care (0-3). The utilization of outpatient eye care services was defined by the reimbursement for an ophthalmologist's provision of service. While 39.3% of the study population 60+ years old sought eye care, the utilization rate was lower among people in need of home-based (33.0%) and facility-based care (19.3%). The utilization rates showed comparable age-dependent patterns, except for persons in need of facility-based care where rates were similar for all age groups. Utilization rates were negatively associated with increasing care levels. Only people with care level 0 showed lower utilization rates than people with care level 1. Utilization rates of eye healthcare services among older persons are considerably influenced by the need of long-term care, by the form of care as well as by the level of care.

Quadrivalent human papillomavirus vaccine uptake in adolescent boys and maternal utilization of preventive care and history of sexually transmitted infections.

PubMed

Hechter, Rulin C; Chao, Chun; Sy, Lina S; Ackerson, Bradley K; Slezak, Jeff M; Sidell, Margo A; Jacobsen, Steven J

2013-09-01

We examined whether maternal utilization of preventive care and history of sexually transmitted infections (STIs) predicted quadrivalent human papillomavirus vaccine (HPV4) uptake among adolescent boys 1 year following the recommendation for permissive use of HPV4 for males. We linked maternal information with electronic health records of 254 489 boys aged 9 to 17 years who enrolled in Kaiser Permanente Southern California health plan from October 21, 2009, through December 21, 2010. We used multivariable Poisson regression with robust error variance to examine whether HPV4 initiation was associated with maternal uptake of influenza vaccine, Papanicolaou (Pap) screening, and history of STIs. We identified a modest but statistically significant association between initiation of HPV4 series and maternal receipt of influenza vaccine (rate ratio [RR] = 1.16; 95% confidence interval [CI] = 1.07, 1.26) and Pap screening (RR = 1.13; 95% CI = 1.01, 1.26). Boys whose mothers had a history of genital warts were more likely to initiate HPV4 (RR = 1.47; 95% CI = 0.93, 2.34), although the association did not reach statistical significance (P = .1). Maternal utilization of preventive care and history of genital warts may influence HPV4 uptake among adolescent boys. The important role of maternal health characteristics and health behaviors needs be considered in intervention efforts to increase vaccine uptake among boys.

Critical illness among adults with cystic fibrosis in Texas, 2004-2013: Patterns of ICU utilization, characteristics, and outcomes.

PubMed

Oud, Lavi

2017-01-01

Available reports on critically ill adults with cystic fibrosis (CF) suggest improving short-term outcomes. However, there is marked heterogeneity in reported findings, with studies mostly based on single-centered data, limiting generalizability. We sought to examine population-level patterns of demand for critical care resources, and the characteristics, resource utilization, and outcomes of ICU-managed adults with CF. We used the Texas Inpatient Public Use Data File to identify ICU admissions with CF aged ≥18 years in Texas between 2004-2013. We examined ICU utilization at population level (using CF Foundation annual reports) and, among ICU admissions, socio-demographic characteristics, burden of comorbidities, organ failure, life-support utilization and hospital disposition. Linear regression and multilevel logistic regression were used to examine temporal trends and predictors of short-term mortality (hospital death and discharge to hospice), respectively. Of 9,579 hospitalizations of adults with CF, 1,249 (13%) were admitted to ICU. The incidence of ICU admission among adults with CF in Texas increased between 2004-2005 and 2012-2013 from 16.7 to 19.2 per 100 person-years (p = 0.0181), with ICU admissions aged ≥30 years accounting for 80.3% of the change. Among ICU admissions the following changes were noted between 2004-2005 and 2012-2013: any organ failure 30.2% vs. 56.3% (p = 0.0004), mechanical ventilation 11.5% vs. 19.2% (p = 0.0216), and hemodialysis 1.0% vs. 8.1% (p = 0.0007). Short-term mortality for the whole cohort and for those with mechanical ventilation was 11.4% and 41.8%, respectively, with corresponding home discharge among survivors 84% and 62.1%, respectively. Key predictors (adjusted odds ratios [aOR (95% CI)]) of short-term mortality included age ≥45 years (2.051 [1.231-3.415]), female gender (1.907 [1.237-2.941]), and mechanical ventilation (7.982 [5.001-12.739]). Adults with CF had high and rising population-level burden of critical illness. Although ICU admissions were increasingly older and sicker, the majority survived hospitalization, with most discharged home, supporting short-term benefits of critical care in the present cohort.

Electronic health records to support obesity-related patient care: Results from a survey of United States physicians.

PubMed

Bronder, Kayla L; Dooyema, Carrie A; Onufrak, Stephen J; Foltz, Jennifer L

2015-08-01

Obesity-related electronic health record functions increase the rates of measuring Body Mass Index, diagnosing obesity, and providing obesity services. This study describes the prevalence of obesity-related electronic health record functions in clinical practice and analyzes characteristics associated with increased obesity-related electronic health record sophistication. Data were analyzed from DocStyles, a web-based panel survey administered to 1507 primary care providers practicing in the United States in June, 2013. Physicians were asked if their electronic health record has specific obesity-related functions. Logistical regression analyses identified characteristics associated with improved obesity-related electronic health record sophistication. Of the 88% of providers with an electronic health record, 83% of electronic health records calculate Body Mass Index, 52% calculate pediatric Body Mass Index percentile, and 32% flag patients with abnormal Body Mass Index values. Only 36% provide obesity-related decision support and 17% suggest additional resources for obesity-related care. Characteristics associated with having a more sophisticated electronic health record include age ≤45years old, being a pediatrician or family practitioner, and practicing in a larger, outpatient practice. Few electronic health records optimally supported physician's obesity-related clinical care. The low rates of obesity-related electronic health record functions currently in practice highlight areas to improve the clinical health information technology in primary care practice. More work can be done to develop, implement, and promote the effective utilization of obesity-related electronic health record functions to improve obesity treatment and prevention efforts. Published by Elsevier Inc.

The health care burden of high grade chronic obstructive pulmonary disease in Korea: analysis of the Korean Health Insurance Review and Assessment Service data.

PubMed

Kim, JinHee; Rhee, Chin Kook; Yoo, Kwang Ha; Kim, Young Sam; Lee, Sei Won; Park, Yong Bum; Lee, Jin Hwa; Oh, YeonMok; Lee, Sang Do; Kim, Yuri; Kim, KyungJoo; Yoon, HyoungKyu

2013-01-01

Patients with high grade chronic pulmonary obstructive disease (COPD) account for much of the COPD-related mortality and incur excessive financial burdens and medical care utilization. We aimed to determine the characteristics and medical care use of such patients using nationwide data from the Korean Health Insurance Review and Assessment Service in 2009. Patients with COPD were identified by searching with the International Classification of Diseases-10th Revision for those using medication. Patients with high grade COPD were selected based on their patterns of tertiary institute visits and medication use. The numbers of patients with high grade COPD increased rapidly in Korea during the study period, and they showed a high prevalence of comorbid disease. The total medical costs were over three times higher in patients with high grade COPD compared with those without it ($3,744 versus $1,183; P < 0.001). Medication costs comprised the largest portion of medical cost, but most impact came from hospitalization and exacerbation in both groups of patients. COPD grade and hospitalization in the previous year were the major factors affecting medical costs and days of utilizing health care resources. Patients with high grade COPD impose a high economic burden on the health care system in Korea. Prevention of progression to high grade COPD is important, both clinically and economically.

Predicting health care utilization in marginalized populations: Black, female, street-based sex workers.

PubMed

Varga, Leah M; Surratt, Hilary L

2014-01-01

Patterns of social and structural factors experienced by vulnerable populations may negatively affect willingness and ability to seek out health care services, and ultimately, their health. The outcome variable was utilization of health care services in the previous 12 months. Using Andersen's Behavioral Model for Vulnerable Populations, we examined self-reported data on utilization of health care services among a sample of 546 Black, street-based, female sex workers in Miami, Florida. To evaluate the impact of each domain of the model on predicting health care utilization, domains were included in the logistic regression analysis by blocks using the traditional variables first and then adding the vulnerable domain variables. The most consistent variables predicting health care utilization were having a regular source of care and self-rated health. The model that included only enabling variables was the most efficient model in predicting health care utilization. Any type of resource, link, or connection to or with an institution, or any consistent point of care, contributes significantly to health care utilization behaviors. A consistent and reliable source for health care may increase health care utilization and subsequently decrease health disparities among vulnerable and marginalized populations, as well as contribute to public health efforts that encourage preventive health. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Universal health coverage in emerging economies: findings on health care utilization by older adults in China, Ghana, India, Mexico, the Russian Federation, and South Africa

PubMed Central

Peltzer, Karl; Williams, Jennifer Stewart; Kowal, Paul; Negin, Joel; Snodgrass, James Josh; Yawson, Alfred; Minicuci, Nadia; Thiele, Liz; Phaswana-Mafuya, Nancy; Biritwum, Richard Berko; Naidoo, Nirmala; Chatterji, Somnath

2014-01-01

Background and objective The achievement of universal health coverage (UHC) in emerging economies is a high priority within the global community. This timely study uses standardized national population data collected from adults aged 50 and older in China, Ghana, India, Mexico, the Russian Federation, and South Africa. The objective is to describe health care utilization and measure association between inpatient and outpatient service use and patient characteristics in these six low- and middle-income countries. Design Secondary analysis of data from the World Health Organization’s Study on global AGEing and adult health Wave 1 was undertaken. Country samples are compared by socio-demographic characteristics, type of health care, and reasons for use. Logistic regressions describe association between socio-demographic and health factors and inpatient and outpatient service use. Results In the pooled multi-country sample of over 26,000 adults aged 50-plus, who reported getting health care the last time it was needed, almost 80% of men and women received inpatient or outpatient care, or both. Roughly 30% of men and women in the Russian Federation used inpatient services in the previous 3 years and 90% of men and women in India used outpatient services in the past year. In China, public hospitals were the most frequently used service type for 52% of men and 51% of women. Multivariable regression showed that, compared with men, women were less likely to use inpatient services and more likely to use outpatient services. Respondents with two or more chronic conditions were almost three times as likely to use inpatient services and twice as likely to use outpatient services compared with respondents with no reported chronic conditions. Conclusions This study provides a basis for further investigation of country-specific responses to UHC. PMID:25363363

Impact of a Step Therapy for Guanfacine Extended-Release on Medication Utilization and Health Care Expenditures Among Individuals Receiving Treatment for ADHD.

PubMed

Suehs, Brandon T; Sikirica, Vanja; Mudumby, Pallavi; Dufour, Robert; Patel, Nick C

2015-09-01

While step therapy (ST) policies are generally effective at reducing cost through the managed utilization of targeted medications, the clinical implications of ST policies are not clear and may vary across therapeutic areas. Guanfacine extended-release (GXR) is approved by the FDA for the treatment of attention-deficit/hyperactivity disorder (ADHD) as both monotherapy and adjunctive to stimulant treatment. At the introduction of GXR to the market, Humana implemented an ST policy on GXR requiring the documentation of previous treatment, intolerance, or contraindication to generic clonidine or guanfacine. To examine the impact of a GXR ST coverage determination (i.e., approved vs. denied) on medication utilization and health care costs among members of a commercial health plan with an ST policy for GXR.  This study was a retrospective cohort study of administrative claims data. Humana commercial members prescribed GXR who had an ST coverage determination review were identified. All members included in this analysis were required to be aged 6-17 years, have a diagnosis of ADHD or be receiving stimulant medication, have an ST coverage determination (index event) between September 1, 2009, and May 30, 2012, and have 6 months of pre- and post-index continuous enrollment. Members were assigned to either the approved or denied group based on the outcome of the ST coverage determination. Medical and pharmacy claims data were used to measure baseline demographic and clinical characteristics and to measure medication utilization and health care costs. Outcomes assessed during follow-up included ADHD medication use, proportion of days covered (PDC) with any ADHD medication treatment, time to first observed post-index ADHD treatment, and all-cause and mental health (MH)-related health care costs. Administrative costs associated with the coverage determination process were also estimated. Bivariate and multivariable adjusted analyses were conducted to compare medication utilization and health care costs between the approved and denied groups. A total of 642 members were included in the analysis (denied group n = 395 [61.5%], approved group n = 247 [38.5%]). The approved and denied groups were similar in terms of baseline demographics, provider characteristics, and baseline MH diagnoses, with the exception of anxiety disorders being more prevalent in the approved group compared with the denied group (18.2% vs. 10.6%, P = 0.006). A denied GXR coverage determination was associated with a greater percentage of members receiving no ADHD treatment post-index (13.9% vs. 3.2%, P  less than  0.001), greater mean [SD] number of days between index and first observed post-index ADHD medication claim (44.5 [59.6] vs. 17.6 [33.4], P  less than  0.001), and lower mean [SD] PDC with any ADHD medication post-index (0.59 [0.33] vs. 0.75 [0.26], P  less than  0.001). These findings remained statistically significant in multivariable regression models. Unadjusted pre-index median total health care costs and MH-related costs were greater among the approved group compared with the denied group (total health care: $1,582 vs. $1,465, P = 0.033; MH-related: $993 vs. $981, P = 0.020). Likewise, post-index median total health care and MH-related costs were greater among the approved group compared with the denied group (total: $2,056 vs. $1,420, P  less than  0.001; MH-related: $1,543 vs. $946, P  less than  0.001). After adjustment for potentially confounding covariates including pre-index costs, there were no statistically significant differences between the approved and denied groups in all-cause total health care (P = 0.393) or MH-related health care costs (P = 0.054).  The current study found that GXR coverage denial was associated with lower rate of ADHD medication utilization, greater delay in receiving ADHD medication, and lower PDC with ADHD medication. There were no differences observed between the approved and denied group in terms of all-cause total health care or MH-related total health care costs after controlling for potentially confounding variables. Prior to implementation in the ADHD therapeutic area and others, payers should consider the potentially unintended consequences of ST policies, including delay in treatment and undertreatment.

Assessing the Organizational Characteristics Influencing Quality Improvement Implementation in Saudi Hospitals.

PubMed

Shamsuddin Alaraki, Mohammad

The health care system in Saudi Arabia has serious problems with quality and safety that can be reduced through systematic quality improvement (QI) activities. Despite the use of different QI models to improve health care in Saudi hospitals during the last 2 decades, consistent improvements have not yet been achieved and the results are still far below expectations. This may reflect a problem in introducing and implementing the QI models in the local contexts. The objective of this study is to assess the extent of QI implementation in Saudi hospitals and to identify the organizational characteristics that make Saudi hospitals particularly challenging for QI. Understanding these characteristics can inform efforts to improve them and may lead to more successful implementation. A mixed-methods approach was conducted using 2 data collection tools: questionnaires and interviews. The quantitative phase (questionnaires) aimed to uncover the current level of QI implementation in Saudi hospital as measured by 7 critical dimensions adapted from the literature. The qualitative phase (interviews) aimed to understand the organizational characteristics that impede or underpin QI in Saudi hospitals. The QI implementation was found to be significantly poor across the 7 dimensions with average score ranging between 22.80 ± 0.57 and 2.11 ± 0.69 on a 5-point Likert scale and with P value of less than .05. We also found that the current level of QI implementation helped Saudi hospitals neither to improve "customer satisfaction" nor to achieve measurable improvements in "quality results" scoring significantly low at 2.11 ± 0.69 with P value of .000 and 2.47 ± 0.57 with P value of .000, respectively. Our study confirms the presence of a multitude of organizational barriers that impede QI in Saudi hospitals. These are related to organizational culture, human resources management, processes and systems, and structure. These 4 were found to have the strongest impact on QI in Saudi hospitals. It appears that the most important contributing factors to the successful implementation of QI in Saudi hospitals are proper human resources utilization and effective quality management. Through careful planning, change management, proper utilization of human resources, supportive quality information systems, focus on processes and systems, structural support, and an organizational culture that is compatible with QI philosophy, Saudi hospitals will be more capable in achieving sustained measureable improvements in the quality and safety of patient care.

Inpatient health care utilization by children and adolescents with systemic lupus erythematosus and kidney involvement.

PubMed

Tanzer, Marie; Tran, Cheryl; Messer, Kassandra L; Kroeker, Amber; Herreshoff, Emily; Wickman, Larysa; Harkness, Courtney; Song, Peter; Gipson, Debbie S

2013-03-01

To evaluate inpatient health care utilization for children with systemic lupus erythematosus (SLE) with and without kidney disease. The Healthcare Cost and Utilization Project Kids' Inpatient Database for the years 2000, 2003, and 2006 was used for this analysis. SLE hospitalizations from the 2006 cohort were identified and classified as those with versus without kidney involvement by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Analyses were performed to examine determinants of hospitalization charges and changes in charges over time. In the US, 7,390 SLE-related pediatric hospitalizations generated $267 million in total charges in 2006. Of these, 4,193 discharges had kidney involvement. The average hospitalization charge was greater for SLE patients with kidney involvement compared to those without kidney involvement ($43,100 versus $28,500; P < 0.0001). In multivariate analysis, kidney involvement remained a significant predictor of hospitalization charges, independent of demographic and hospital characteristics (P < 0.0001). SLE-associated acute kidney failure, transplant, and end-stage kidney disease resulted in greater hospitalization charges than SLE without kidney involvement by $74,900 (P < 0.0001), $32,700 (P = 0.0002), and $27,400 (P < 0.0001), respectively. In the US, >7,000 hospitalizations occurred in 2006 among children with SLE, with nearly 57% demonstrating kidney involvement. Kidney involvement is a major determinant of hospitalization charges for these children. This study represents one of the first large-scale assessments of in-hospital health care utilization by children with SLE. Copyright © 2013 by the American College of Rheumatology.

Rising utilization of inpatient pediatric asthma pathways.

PubMed

Kaiser, Sunitha V; Rodean, Jonathan; Bekmezian, Arpi; Hall, Matt; Shah, Samir S; Mahant, Sanjay; Parikh, Kavita; Morse, Rustin; Puls, Henry; Cabana, Michael D

2018-02-01

Clinical pathways are detailed care plans that operationalize evidence-based guidelines into an accessible format for health providers. Their goal is to link evidence to practice to optimize patient outcomes and delivery efficiency. It is unknown to what extent inpatient pediatric asthma pathways are being utilized nationally. (1) Describe inpatient pediatric asthma pathway design and implementation across a large hospital network. (2) Compare characteristics of hospitals with and without pathways. We conducted a descriptive, cross-sectional, survey study of hospitals in the Pediatric Research in Inpatient Settings Network (75% children's hospitals, 25% community hospitals). Our survey determined if each hospital used a pathway and pathway characteristics (e.g. pathway elements, implementation methods). Hospitals with and without pathways were compared using Chi-square tests (categorical variables) and Student's t-tests (continuous variables). Surveys were distributed to 3-5 potential participants from each hospital and 302 (74%) participants responded, representing 86% (106/123) of surveyed hospitals. From 2005-2015, the proportion of hospitals utilizing inpatient asthma pathways increased from 27% to 86%. We found variation in pathway elements, implementation strategies, electronic medical record integration, and compliance monitoring across hospitals. Hospitals with pathways had larger inpatient pediatric programs [mean 12.1 versus 6.1 full-time equivalents, p = 0.04] and were more commonly free-standing children's hospitals (52% versus 23%, p = 0.05). From 2005-2015, there was a dramatic rise in implementation of inpatient pediatric asthma pathways. We found variation in many aspects of pathway design and implementation. Future studies should determine optimal implementation strategies to better support hospital-level efforts in improving pediatric asthma care and outcomes.

Health care resource utilization and costs of California Medicaid patients with schizophrenia treated with paliperidone palmitate once monthly or atypical oral antipsychotic treatment.

PubMed

Pesa, Jacqueline A; Doshi, Dilesh; Wang, Li; Yuce, Huseyin; Baser, Onur

2017-04-01

To compare all-cause health care utilization and costs between patients with schizophrenia treated with once monthly paliperidone palmitate (PP1M; Invega Sustenna 1 ) and atypical oral antipsychotic therapy (OAT). This was a retrospective claims-based analysis among adult California Medicaid (Medi-Cal) patients with schizophrenia having ≥2 claims for PP1M or OAT from 1 July 2009 to 31 December 2013 and continuous health plan enrollment for ≥1 year pre- and post-index date (PP1M or OAT initiation date). Baseline characteristics were reported descriptively. Propensity score matching with a 1:1 greedy match method was used to create two matched cohorts. Treatment patterns, all-cause health care utilization, and costs for the 12 month follow-up period were compared between the two matched cohorts. Two well matched cohorts of 722 patients were produced with similar baseline characteristics. During the 12 month follow-up period, PP1M patients were significantly less likely to discontinue treatment (30.6% vs. 39.5%, p < .001) or switch to a new therapy (21.6% vs. 27.7%, p = .007). PP1M patients had fewer inpatient visits (5.0 vs. 7.9, p < .001), lower mean hospitalization days (15.0 vs. 27.7 days, p < .001) and inpatient costs ($5060 vs. $10,880, p < .001). While pharmacy costs were significantly higher in the PP1M cohort ($16,347 vs. $9115, p < .001), total costs were not significantly different between the matched cohorts ($25,546 vs. $25,307, p = 0.853). Patients with schizophrenia treated with PP1M had significantly fewer inpatient hospitalizations and associated costs with no significant difference in the total costs between the two cohorts. This study is subject to limitations associated with claims data such as miscoding, inability to examine clinical severity, etc.

Costs of care at the end of life among elderly patients with chronic kidney disease: patterns and predictors in a nationwide cohort study.

PubMed

Chen, Bradley; Fan, Victoria Y; Chou, Yiing-Jenq; Kuo, Chin-Chi

2017-01-26

Despite the urgent need for evidence to guide the end-of-life (EOL) care for patients with chronic kidney disease (CKD), we have limited knowledge of the costs and intensity of EOL care in this population. The present study examined patterns and predictors for EOL care intensity among elderly patients with CKD. We conducted a retrospective nationwide cohort study utilizing the Taiwan National Health Insurance (NHI) Research Database. A total of 65,124 CKD patients aged ≥ 60 years, who died in hospitals or shortly after discharge between 2002 and 2012 were analyzed. The primary outcomes were inpatient expenses and use of surgical interventions in the last 30 days of life. Utilization of intensive care unit (ICU), mechanical ventilation, resuscitation, and dialysis was also examined in a sub-sample of 2072 patients with detailed prescription data. Multivariate log-linear and logistic regression analyses were performed to assess patient-, physician-, and facility-specific predictors and the potential impact of a 2009 payment policy to reimburse hospice care for non-cancer patients. During the last 30 days of life, average inpatients costs for elderly CKD patients were approximately US$10,260, with 40.9% receiving surgical interventions, 40.2% experiencing ICU admission, 45.3% undergoing mechanical ventilation, 14.7% receiving resuscitation and 42.0% receiving dialysis. Significant variability was observed in the inpatient costs and use of intensive services. Costs were lower among individuals with the following characteristics: advanced age; high income; high Charlson Comorbidity Index scores; treatment by older physicians, nephrologists, and family medicine physicians; and treatment at local hospitals. Similar findings were obtained for the use of surgical interventions and other intensive services. A declining trend was detected in the costs of EOL care, use of surgical interventions and resuscitation between 2009 and 2012, which is consistent with the impact of a 2009 NHI payment policy to reimburse non-cancer hospice care. Overall EOL costs and rates of intensive service use among older patients with CKD were high, with significant variability across various patient and provider characteristics. Several opportunities exist for providers and policy makers to reduce costs and enhance the value of EOL care for this population.

Dental Care Utilization for Examination and Regional Deprivation

PubMed Central

Kim, Cheol-Sin; Han, Sun-Young; Lee, Seung Eun; Kang, Jeong-Hee; Kim, Chul-Woung

2015-01-01

Objectives: Receiving proper dental care plays a significant role in maintaining good oral health. We investigated the relationship between regional deprivation and dental care utilization. Methods: Multilevel logistic regression was used to identify the relationship between the regional deprivation level and dental care utilization purpose, adjusting for individual-level variables, in adults aged 19+ in the 2008 Korean Community Health Survey (n=220 258). Results: Among Korean adults, 12.8% used dental care to undergo examination and 21.0% visited a dentist for other reasons. In the final model, regional deprivation level was associated with significant variations in dental care utilization for examination (p<0.001). However, this relationship was not shown with dental care utilization for other reasons in the final model. Conclusions: This study’s findings suggest that policy interventions should be considered to reduce regional variations in rates of dental care utilization for examination. PMID:26265665

Evaluation of Geographic Indices Describing Health Care Utilization.

PubMed

Kim, Agnus M; Park, Jong Heon; Kang, Sungchan; Kim, Yoon

2017-01-01

The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization. We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates. In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index. Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.

Differences between immigrant and non-immigrant groups in the use of primary medical care; a systematic review

PubMed Central

Uiters, Ellen; Devillé, Walter; Foets, Marleen; Spreeuwenberg, Peter; Groenewegen, Peter P

2009-01-01

Background Studies on differences between immigrant and non-immigrant groups in health care utilization vary with respect to the extent and direction of differences in use. Therefore, our study aimed to provide a systematic overview of the existing research on differences in primary care utilization between immigrant groups and the majority population. Methods For this review PubMed, PsycInfo, Cinahl, Sociofile, Web of Science and Current Contents were consulted. Study selection and quality assessment was performed using a predefined protocol by 2 reviewers independently of each other. Only original, quantitative, peer-reviewed papers were taken into account. To account for this hierarchical structure, logistic multilevel analyses were performed to examine the extent to which differences are found across countries and immigrant groups. Differences in primary care use were related to study characteristics, strength of the primary care system and methodological quality. Results A total of 37 studies from 7 countries met all inclusion criteria. Remarkably, studies performed within the US more often reported a significant lower use among immigrant groups as compared to the majority population than the other countries. As studies scored higher on methodological quality, the likelihood of reporting significant differences increased. Adjustment for health status and use of culture-/language-adjusted procedures during the data collection were negatively related to reporting significant differences in the studies. Conclusion Our review underlined the need for careful design in studies of differences in health care use between immigrant groups and the majority population. The results from studies concerning differences between immigrant and the majority population in primary health care use performed within the US might be interpreted as a reflection of a weaker primary care system in the US compared to Europe and Canada. PMID:19426567

Nurses' work environment and intent to leave in Lebanese hospitals: implications for policy and practice.

PubMed

El-Jardali, Fadi; Alameddine, Mohamad; Dumit, Nuhad; Dimassi, Hani; Jamal, Diana; Maalouf, Salwa

2011-02-01

The dual burden of nursing shortages and poor work environments threatens quality of patient care and places additional pressures on resource-stretched health care systems, particularly in the Eastern Mediterranean Region (EMR). There is a paucity of research in the EMR examining the quality of nurses' work environment and its association to nurses' intent to leave their jobs/countries. Systematically examine the characteristics of nurses' work environment and their relation to nurses' intent to leave their jobs within the context of Lebanon. A secondary objective is to assess the utility and validity of the NWI-R within the context of the EMR. A cross-sectional survey design was utilized to survey a total of 1793 registered nurses in 69 Lebanese hospitals. The survey instrument included questions on nurses' background, hospital characteristics, intent to leave, and the Revised Nurse Working Index (NWI-R). Data analysis included descriptive statistics for demographic characteristics, t-test and ANOVA to assess differences in agreement scores, and a multinomial logistic regression model to predict intent to leave. Thematic analysis of open-ended questions was utilized to extract themes that fit under issues relating to nurses' work environment in Lebanese hospitals. The NWI-R subscale with the lowest mean score related to control. Younger nurses had lower scores on organizational support and career development. Regression analysis revealed that for every 1 point score decrease on career development there was a 93% increase in likelihood of reporting intent to leave country. Likewise, for every 1 point score decrease on participation there was an observed 51% and 53% increase in likelihood of reporting intent to leave country and hospital, respectively. Findings show that hospital characteristics (size, accreditation status and presence of a recruitment and retention strategy) were significantly associated with NWI-R subscales. Participation, control and career development were key work environment challenges contributing to the attrition on nurses from Lebanese hospitals. Although some of the issues identified are country specific, others would certainly be relevant to other countries in the EMR. Addressing these challenges would require a strong and coordinated action from governments, professional bodies, policy makers and health managers. Copyright © 2010 Elsevier Ltd. All rights reserved.

Factors associated with high-quality/low-cost hospital performance.

PubMed

Jiang, H Joanna; Friedman, Bernard; Begun, James W

2006-01-01

This study explores organizational and market characteristics associated with superior hospital performance in both quality and cost of care, using the Healthcare Cost and Utilization Project State Inpatient Databases for ten states in 1997 and 2001. After controlling for a variety of patient factors, we found that for-profit ownership, hospital competition, and the number of HMOs were positively associated with the likelihood of attaining high-quality/low-cost performance. Furthermore, we examined interactions between organizational and market characteristics and identified a number of significant interactions. For example, the positive likelihood associated with for-profit hospitals diminished in markets with high HMO penetration.

Nurses' characteristics and organisational factors associated with their assessments of individualised care in care institutions for older people.

PubMed

Rodríguez-Martín, Beatriz; Stolt, Minna; Katajisto, Jouko; Suhonen, Riitta

2016-06-01

Individualised care is considered a key attribute of the quality in clinical care. Despite the environment in which the care is delivered and the care providers can influence in this concept, perceptions of individuality in the care settings for older people are rarely studied. To identify nurses' characteristics and organisational factors associated with nurses' views about the provision of individualised care in care settings for older people. A cross-sectional multisite survey design. A multisite survey of nursing staff (N = 1513, n = 874, response rate 58%) working in 62 different units for older people in southwest Finland was carried out using self-administered questionnaires (The Individualised Care Scale-Nurse-B and a questionnaire gathering socio-demographic and organisational variables). Data were analysed using descriptive statistics, Spearman's correlation coefficients, paired-sample t-tests and one-way analyses of variance. Participants' perceptions about the level of individualised care provided to older people were generally positive (Mean 3.92, SD 0.56). In this regard, taking into account the patients' clinical situation (Mean 4.31, SD 0.53) and the support of older patients' decisional control (Mean 3.80, SD 0.71) obtained the highest scores. Regarding nurses' socio-demographic variables, a positive correlation between age and type of organisation with the assessments of individualised care provision was found. The findings of this study show that nurses' age and the type of organisation where the care is delivered have an impact on the perceptions of individualised care of nurses working in institutions for older people. The participants' assessments about individualised care delivery have practical utility as it may help managers better understand and develop areas that obtained the lowest scores. This information may lead to the reduction of barriers (structures and processes) that hinder individualised care delivery and facilitate programs aimed at developing professional environments that improve the delivery of older people's care. © 2015 Nordic College of Caring Science.

Public and private pregnancy care in Reggio Emilia Province: an observational study on appropriateness of care and delivery outcomes.

PubMed

Bonvicini, Laura; Candela, Silvia; Evangelista, Andrea; Bertani, Daniela; Casoli, Morena; Lusvardi, Annarella; Messori, Antonella; Giorgi Rossi, Paolo

2014-02-17

In industrialized countries, improvements have been made in both maternal and newborn health. While attention to antenatal care is increasing, excessive medicalization is also becoming more common.The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only. Observational population-based study. Reggio Emilia Province. 5957 women resident in the province who delivered between October 2010 and November 2011. CS frequency and ultrasound scan utilization, stillbirths, and other negative perinatal outcomes. Women in the study were searched in the public family and reproductive health clinic medical records to identify those cared for in the public system. Outcomes of the two antenatal care models were compared through multivariate logistic regression adjusting for maternal characteristics and, for CS only, by stratifying by Robson's Group. Compared to women cared for in private services (N = 3,043), those in public service (N = 2,369) were younger, less educated, more frequently non-Italian, and multiparous. The probability of CS was slightly higher for women cared for by private obstetricians than for those cared for in the public system (31.8% vs. 27.1%; adjusted odds ratio: 1.10; 95% CI: 0.93-1.29): The probability of having more than 3 ultrasound scans was higher in private care (89.6% vs. 49.8%; adjusted odds ratio: 5.11; 95% CI: 4.30-6.08). CS frequency was higher in private care for all Robson's classes except women who underwent CS during spontaneous labour. Among negative perinatal outcomes only a higher risk of pre-term birth was observed for pregnancies cared for in private services. The public model provides less medicalized and more guidelines-oriented care than does the private model, with no increase in negative perinatal outcomes.

The influence of economic incentives and regulatory factors on the adoption of treatment technologies: a case study of technologies used to treat heart attacks.

PubMed

Bech, Mickael; Christiansen, Terkel; Dunham, Kelly; Lauridsen, Jørgen; Lyttkens, Carl Hampus; McDonald, Kathryn; McGuire, Alistair

2009-10-01

The Technological Change in Health Care Research Network collected unique patient-level data on three procedures for treatment of heart attack patients (catheterization, coronary artery bypass grafts and percutaneous transluminal coronary angioplasty) for 17 countries over a 15-year period to examine the impact of economic and institutional factors on technology adoption. Specific institutional factors are shown to be important to the uptake of these technologies. Health-care systems characterized as public contract systems and reimbursement systems have higher adoption rates than public-integrated health-care systems. Central control of funding of investments is negatively associated with adoption rates and the impact is of the same magnitude as the overall health-care system classification. GDP per capita also has a strong role in initial adoption. The impact of income and institutional characteristics on the utilization rates of the three procedures diminishes over time.

Implementation of Patient-Centered Medical Homes in Adult Primary Care Practices.

PubMed

Alexander, Jeffrey A; Markovitz, Amanda R; Paustian, Michael L; Wise, Christopher G; El Reda, Darline K; Green, Lee A; Fetters, Michael D

2015-08-01

There has been relatively little empirical evidence about the effects of patient-centered medical home (PCMH) implementation on patient-related outcomes and costs. Using a longitudinal design and a large study group of 2,218 Michigan adult primary care practices, our study examined the following research questions: Is the level of, and change in, implementation of PCMH associated with medical surgical cost, preventive services utilization, and quality of care in the following year? Results indicated that both level and amount of change in practice implementation of PCMH are independently and positively associated with measures of quality of care and use of preventive services, after controlling for a variety of practice, patient cohort, and practice environmental characteristics. Results also indicate that lower overall medical and surgical costs are associated with higher levels of PCMH implementation, although change in PCMH implementation did not achieve statistical significance. © The Author(s) 2015.

Horizontal Inequity in Elderly Health Care Utilization: Evidence from India

PubMed Central

Rudra, Shalini; Subramanian, S V

2015-01-01

Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly. PMID:26617450

Does quality influence utilization of primary health care? Evidence from Haiti.

PubMed

Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Joseph, Jean Paul; Thermidor, Roody; Kruk, Margaret E

2018-06-20

Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti. We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery. Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure. Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

High utilizers of medical care: a crucial subgroup among somatizing patients.

PubMed

Hiller, Wolfgang; Fichter, Manfred M

2004-04-01

Patients with somatoform disorders (SFD) are likely to overutilize healthcare services. This study investigates (a) whether extraordinarily high medical costs can be predicted from patient characteristics or psychopathology, and (b) whether high-utilizing patients respond differently to cognitive-behavioral treatment. We compared 42 SFD high utilizers with 53 SFD average utilizers and 29 patients suffering from other than SFD mental disorders. High utilization was defined by healthcare expenditures of > or = 2500 euros during the past 2 years. Costs were computed from medical and billing records of health insurance companies. Somatization distress, hypochondriasis, depression, dysfunctional cognitions related to bodily symptoms, general psychopathology, personality profiles, and psychosocial disabilities were assessed before treatment. High utilizers had higher levels of self- and observer-rated illness behavior, self-perceived bodily weakness, and psychosocial disabilities. Although they did not report more somatization symptoms, their subjective symptom distress was higher. There were no differences between high and average utilizers concerning general psychopathology, DSM-IV comorbidity, and personality profiles. Treatment improvements were similar. High- and average-utilizing somatizers represent distinguishable subgroups. The results emphasize the importance of mechanisms specifically related to SFD and may enhance the early detection of patients who are likely to develop overutilization. Copyright 2004 Elsevier Inc.

Health care resource utilization and costs in a commercially insured population of patients with bipolar disorder type I and frequent psychiatric interventions.

PubMed

Bagalman, Erin; Muser, Erik; Choi, Jiyoon C; Durden, Emily; Macfadden, Wayne; Haskins, J Thomas; Dirani, Riad

2011-10-01

Bipolar disorder type I (BP-I) is one of the most expensive behavioral diagnoses in the United States. Characterizing patient populations that consume significant resources would be useful for designing and implementing additional resources and targeted interventions to reduce the costs of BP-I. This analysis compared the characteristics, health care resource utilization, and costs of commercially insured patients with BP-I (indicating a history of manic or mixed episodes) and frequent psychiatric interventions (FPIs) versus those without FPIs. This retrospective study used data from commercial insurance claims to identify adults with FPIs (≥2 clinically significant events [CSEs]) or without FPIs during a 12-month identification period (year 1). CSEs included emergency department (ED) visits or hospitalizations with a principal diagnosis of BP-I, the addition of a new medication to the observed treatment regimen, or a ≥50% increase in BP-I medication dose. Demographic and clinical characteristics were evaluated during the identification period, and health care resource utilization and costs were evaluated during a 12-month follow-up period (year 2). Data from 7620 patients with FPIs and 11,571 without FPIs were included (women, 67.1% and 59.9%, respectively; P < 0.001). Of patients with FPIs in the identification period, 22.2% continued to have FPIs in the follow-up period. In the follow-up period, the group with FPIs had a greater proportion of patients with psychiatric-related inpatient hospitalizations (14.6% vs 2.8%) and ED visits (11.6% vs 2.7%) [corrected], a longer mean hospital length of stay (11.74% vs 8.24 days) [corrected], and greater adjusted mean psychiatric-related costs ($6617 vs $3276) and all-cause health care costs ($14,091 vs $9357) compared with the group without FPIs (all, P < 0.001). The risks for a psychiatric-related hospitalization and an ED visit during the follow-up period were significantly greater in the group with FPIs compared with the group without (odds ratios, 4.86 and 3.76, respectively; both, P < 0.01). In this retrospective analysis, FPIs were associated with a greater number of FPIs during follow-up, ∼2-fold the psychiatric-related costs, and 1.5-fold the all-cause health care costs compared with no FPIs. These data highlight the economic burden of FPIs and the potential for health care cost reductions from improved management options in these patients. Copyright © 2011 Elsevier HS Journals, Inc. All rights reserved.

The Role of Vitality in the Relationship Between a Healthy Lifestyle and Societal Costs of Health Care and Lost Productivity: A Mediation Analysis.

PubMed

Hartman, L; van Dongen, J M; Hildebrandt, V H; Strijk, J E

2016-07-01

To examine the mediating effect of vitality in the relationship between healthy lifestyle characteristics and health-care and productivity-related costs. Observational prospective cohort study with 2 measurements. Online questionnaires were filled out in 2013 (T0) and 2014 (T1). A random sample of a Dutch online interview panel was obtained. Data of 4231 Dutch adults who had complete data at T0 and T1 were used in the present study. Participants were representative for the Dutch adult population in terms of age, gender, and having chronic disease(s). Healthy Lifestyle Index (HLI), vitality, and health-care and productivity-related costs. The HLI consisted of the sum of 6 healthy lifestyle characteristics, including a healthy BMI (yes/no), meeting physical activity, fruit, vegetable, and alcohol consumption guidelines (yes/no), and smoking status (yes: non or former smoker/no: current smoker). Health-care and productivity-related costs were measured using a utilization questionnaire. Linear regression analysis. The HLI was related to vitality. In addition, vitality was related to health-care costs and productivity-related costs. Furthermore, vitality was found to transmit 28.4% of the effect of HLI on health-care costs and 39.4% of the effect of HLI on productivity-related costs. Lifestyle was related to vitality and vitality to health-care and productivity-related costs. Vitality mediated the relationship between lifestyle and health-care and productivity-related costs. Therefore, we recommend to sustain and improve both vitality and lifestyle. © The Author(s) 2016.

A Decade in Dental Care Utilization among Adults and Children (2001–2010)

PubMed Central

Vujicic, Marko; Nasseh, Kamyar

2014-01-01

Objective To decompose the change in pediatric and adult dental care utilization over the last decade. Data 2001 through 2010 Medical Expenditure Panel Survey. Study Design The Blinder-Oaxaca decomposition was used to explain the change in dental care utilization among adults and children. Changes in dental care utilization were attributed to changes in explained covariates and changes due to movements in estimated coefficients. Controlling for demographics, overall health status, and dental benefits variables, we estimated year-specific logistic regression models. Outputs from these models were used to compute the Blinder-Oaxaca decomposition. Principal Findings Dental care utilization decreased from 40.5 percent in 2001 to 37.0 percent in 2010 for adults and increased from 43.2 percent in 2001 to 46.3 percent in 2010 for children (p < .05). Among adults, changes in insurance status, race, and income contributed to a decline in adult dental care utilization (−0.018, p < .01). Among children, changes in controlled factors did not substantially change dental care utilization, which instead may be explained by changes in policy, oral health status, or preferences. Conclusions Dental care utilization for adults has declined, especially among the poor and uninsured. Without further policy intervention, disadvantaged adults face increasing barriers to dental care. PMID:24299620

Does Phase I Trial Enrollment Preclude Quality End of Life Care?

PubMed Central

Levine, Deena R; Johnson, Liza-Marie; Mandrell, Belinda; Yang, Jie; West, Nancy; Hinds, Pamela S; Baker, Justin N

2015-01-01

BACKGROUND End-of-life care (EOLC) discussions and treatment-related decisions, including phase I trial enrollment, in patients with incurable disease are complex and can influence the quality of EOLC received. This study was conducted in pediatric oncology patients to determine if end-of-life characteristics differed between those who were and were not enrolled in a phase I trial. METHODS We reviewed medical records of 380 pediatric oncology patients (<22 years old at time of death) who died during a 3 ½ year period. 277 patients, with a diagnosis of a brain tumor or other solid tumor malignancy (n=103 hematologic malignancies excluded), were divided into two groups based on phase I trial enrollment; Phase I Cohort (PIC, n=120) and Non–Phase I Cohort (NPIC, n=157). EOLC characteristics of these two cohorts were compared by regression analysis and chi-square testing. RESULTS Comparison of patients in PIC and NPIC revealed no significant differences in a)demographics including: sex, race, religious affiliation, referral origin, diagnosis, or age at diagnosis, with the exception of age of death (P = 0.03) or in b)EOLC indices such as: utilization or timing of DNAR orders, hospice utilization or length of stay, forgoing life-sustaining therapies, location of death, time from first EOLC discussion to death and total number of EOLC discussions. CONCLUSION Our study of a large cohort of deceased pediatric cancer patients indicates that enrollment on a phase I trial does not affect EOLC characteristics, suggesting that quality EOLC can be delivered regardless of phase I trial participation. PMID:25557437

Regional Variation of Cost of Care in the Last 12 Months of Life in Switzerland: Small-area Analysis Using Insurance Claims Data.

PubMed

Panczak, Radoslaw; Luta, Xhyljeta; Maessen, Maud; Stuck, Andreas E; Berlin, Claudia; Schmidlin, Kurt; Reich, Oliver; von Wyl, Viktor; Goodman, David C; Egger, Matthias; Zwahlen, Marcel; Clough-Gorr, Kerri M

2017-02-01

Health care spending increases sharply at the end of life. Little is known about variation of cost of end of life care between regions and the drivers of such variation. We studied small-area patterns of cost of care in the last year of life in Switzerland. We used mandatory health insurance claims data of individuals who died between 2008 and 2010 to derive cost of care. We used multilevel regression models to estimate differences in costs across 564 regions of place of residence, nested within 71 hospital service areas. We examined to what extent variation was explained by characteristics of individuals and regions, including measures of health care supply. The study population consisted of 113,277 individuals. The mean cost of care during last year of life was 32.5k (thousand) Swiss Francs per person (SD=33.2k). Cost differed substantially between regions after adjustment for patient age, sex, and cause of death. Variance was reduced by 52%-95% when we added individual and regional characteristics, with a strong effect of language region. Measures of supply of care did not show associations with costs. Remaining between and within hospital service area variations were most pronounced for older females and least for younger individuals. In Switzerland, small-area analysis revealed variation of cost of care during the last year of life according to linguistic regions and unexplained regional differences for older women. Cultural factors contribute to the delivery and utilization of health care during the last months of life and should be considered by policy makers.

Choice of primary health care source in an urbanized low-income community in Singapore: a mixed-methods study.

PubMed

Wee, Liang En; Lim, Li Yan; Shen, Tong; Lee, Elis Yuexian; Chia, Yet Hong; Tan, Andrew Yen Siong; Koh, Gerald Choon-Huat

2014-02-01

Cost and misperceptions may discourage lower income Singaporeans from utilizing primary care. We investigated sources of primary care in a low-income Singaporean community in a mixed-methods study. Residents of a low-income public rental flat neighbourhood were asked for sociodemographic details and preferred source of primary care relative to their higher income neighbours. In the qualitative component, interviewers elicited, from patients and health care providers, barriers/enablers to seeking care from Western-trained doctors. Interviewees were selected via purposive sampling. Transcripts were analyzed thematically, and iterative analysis was carried out using established qualitative method. Participation was 89.8% (359/400). Only 11.1% (40/359) preferred to approach Western-trained doctors, 29.5% (106/359) preferred alternative medicine, 6.7% (24/359) approached family/friends and 52.6% (189/359) preferred self-reliance. Comparing against higher income neighbours, rental flat residents were more likely to turn to alternative medicine and family members but less likely to turn to Western-trained doctors (P < 0.001). For the qualitative component, a total of 20 patients and 9 providers were interviewed before data saturation was reached. Patient and provider comments fell into the following content areas: primary care characteristics, knowledge, costs, priorities, attitudes and information sources. Self-reliance was perceived as acceptable for 'small' illnesses but not for 'big' ones, communal spirit was cited as a reason for consulting family/friends and social distance from primary care practitioners was highlighted as a reason for not consulting Western-trained doctors. Western-trained physicians are not the first choice of lower income Singaporeans for seeking primary care. Knowledge, primary care characteristics and costs were identified as potential barriers/enablers.

Effect of acculturation and access to care on colorectal cancer screening in low-income Latinos.

PubMed

Savas, Lara S; Vernon, Sally W; Atkinson, John S; Fernández, Maria E

2015-06-01

Latinos have lower colorectal cancer screening (CRCS) and survival rates compared to other race/ethnic groups. This cross-sectional study examines relationships between acculturation, access to and utilization of healthcare services, and CRCS in low-income Latinos. Bilingual data collectors conducted structured interviews with 544 Latino men and women (>50 years) residing in the Texas-Mexico border area. Using a hierarchical logistic regression model, we examined the relationship between lifetime history of any CRCS test and indicators of acculturation, healthcare utilization and access to care, adjusting for socio-demographic characteristics. Survey results revealed a 34% prevalence of CRCS. Participants reporting a provider recommendation for screening, regular check-ups, higher acculturation level, and health insurance had significantly increased odds of CRCS. Findings indicate CRCS intervention research in Latinos should focus on (1) increasing physicians' recommendations for screening, (2) promoting regular check-ups, (3) and increasing CRC prevention efforts on less acculturated and uninsured groups.

General health and well-being among primary care patients aged 75+ years: Associations with living conditions, oral health and dependency.

PubMed

Brennan, David S; Keuskamp, Dominic; Balasubramanian, Madhan; Amarasena, Najith

2018-03-01

Our aim was to examine the associations between general health and well-being with living conditions, oral health and degree of dependency. We surveyed people from a primary care service and collected data on sociodemographic characteristics, general health, health utility, well-being, activities, living conditions and oral health impact. Overall, 459 participated (78% response rate). Poor general health was associated with decreased instrumental activities of daily living scores (18% of those with poor general health were independent vs 60% with good general health). Greater oral health impact was also related to poor general health. Health utility was lower for some dependency, for renting and oral health impact. Well-being was also lower for some dependency, for renting, not speaking English and oral health impact. In addition to the well-known association of poor general health with dependency, our results also illustrate the potential importance of living conditions and oral health. © 2017 AJA Inc.

Evaluation of Geographic Indices Describing Health Care Utilization

PubMed Central

Park, Jong Heon

2017-01-01

Objectives The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization. Methods We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates. Results In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index. Conclusions Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit. PMID:28173689

Determinants of postnatal care non-utilization among women in Nigeria.

PubMed

Somefun, Oluwaseyi Dolapo; Ibisomi, Latifat

2016-01-11

Although, there are several programs in place in Nigeria to ensure maternal and child health, maternal and neonatal mortality rates remain high with maternal mortality rates being 576/100,000 and neonatal mortality rates at 37/1000 live births (NDHS, 2013). While there are many studies on the utilization of maternal health services such as antenatal care and skilled delivery at birth, studies on postnatal care are limited. Therefore, the aim of this study is to examine the factors associated with the non-utilization of postnatal care among mothers in Nigeria using the Nigeria Demographic and Health Survey (NDHS) 2013. For analysis, the postnatal care uptake for 19,418 children born in the 5 years preceding the survey was considered. The dependent variable was a composite variable derived from a list of questions on postnatal care. A multinomial logistic regression model was applied to examine the adjusted and unadjusted determinants of non-utilization of postnatal care. Results from this study showed that 63% of the mothers of the 19,418 children did not utilize postnatal care services in the period examined. About 42% of the study population between 25 and 34 years did not utilize postnatal care and 61% of the women who did not utilize postnatal care had no education. Results from multinomial logistic regression show that antenatal care use, distance, education, place of delivery, region and wealth status are significantly associated with the non-utilization of postnatal care services. This study revealed the low uptake of postnatal care service in Nigeria. To increase mothers' utilization of postnatal care services and improve maternal and child health in Nigeria, interventions should be targeted at women in remote areas who don't have access to services and developing mobile clinics. In addition, it is crucial that steps should be taken on educating women. This would have a significant influence on their perceptions about the use of postnatal care services in Nigeria.

Traffic shaping and scheduling for OBS-based IP/WDM backbones

NASA Astrophysics Data System (ADS)

Elhaddad, Mahmoud S.; Melhem, Rami G.; Znati, Taieb; Basak, Debashis

2003-10-01

We introduce Proactive Reservation-based Switching (PRS) -- a switching architecture for IP/WDM networks based on Labeled Optical Burst Switching. PRS achieves packet delay and loss performance comparable to that of packet-switched networks, without requiring large buffering capacity, or burst scheduling across a large number of wavelengths at the core routers. PRS combines proactive channel reservation with periodic shaping of ingress-egress traffic aggregates to hide the offset latency and approximate the utilization/buffering characteristics of discrete-time queues with periodic arrival streams. A channel scheduling algorithm imposes constraints on burst departure times to ensure efficient utilization of wavelength channels and to maintain the distance between consecutive bursts through the network. Results obtained from simulation using TCP traffic over carefully designed topologies indicate that PRS consistently achieves channel utilization above 90% with modest buffering requirements.

Future directions: Integrated resource planning

NASA Astrophysics Data System (ADS)

Bauer, D. C.; Eto, J.

Integrated resource planning or IRP is the process for integrating supply- and demand-side resources to provide energy services at a cost that balances the interests of all stakeholders. It now is the resource planning process used by electric utilities in over 30 states. The goals of IRP have evolved from least cost planning and encouragement of demand-side management to broader, more complex issues including core competitive business activity, risk management and sharing, accounting for externalities, and fuel switching between gas and electricity. IRP processes are being extended to other interior regions of the country, to non-investor owned utilities, and to regional (rather than individual utility) planning bases, and to other fuels (natural gas). The comprehensive, multi-valued, and public reasoning characteristics of IRP could be extended to applications beyond energy, e.g., transportation, surface water management, and health care in ways suggested.

Provider perceptions of reproductive health service quality in jordanian public community health centers.

PubMed

Al-Qutob, Raeda; Nasir, Laeth S

2008-05-01

Enhancing the quality of reproductive health care delivery in developing countries is a key prerequisite to increased utilization and sustainability of these services in the target population. Our objective was to assess the perception of quality of reproductive health (RH) care services provided by Jordanian Ministry of Health community-based centers from the perspective of service providers in these settings. A purposeful nationwide sample of 50 primary health care providers took part in five focus group discussions with the purpose of exploring their perceptions of the quality of care provided by their centers and perceived barriers to the provision of quality RH care. Health care providers felt that the quality of RH care provided by their centers was suboptimal. Focus group participants reported numerous barriers to the provision of high quality-care in the clinical setting. These included issues related to patient overload, patient and physician characteristics, as well as problems inherent to supervisory and administrative functions. Exploring and aligning goals and expectations of RH care providers and administrators may result in improvements in the quality of RH care service delivery and morale in public health settings in Jordan, which is a requirement for public sector reform.

Evaluation of the treatment patterns and economic burden of dysmenorrhea in Japanese women, using a claims database.

PubMed

Akiyama, Sayako; Tanaka, Erika; Cristeau, Olivier; Onishi, Yoshie; Osuga, Yutaka

2017-01-01

This study aimed to describe treatment patterns and estimate health care resource utilization and associated costs among Japanese women with dysmenorrhea, using a claims database. This was a retrospective analysis using health insurance data from the Japan Medical Data Center, assessing female patients aged 18-49 years with newly diagnosed primary or secondary dysmenorrhea. Treatment pattern analyses focused on hormonal medications, analgesics, hemostatic agents, traditional Chinese medicine (TCM), and gynecological surgeries. Data were collected on health care resource utilization and costs associated with medications, imaging procedures, and inpatient and outpatient care in both patients and matched controls. The analysis included 6,315 women with dysmenorrhea (3,441 primary; 2,874 secondary). The most commonly prescribed initial therapies were low-dose estrogen progestins (LEPs, 37.7%) and TCM (30.0%), with substantial differences between primary (LEPs: 27.4%, TCM: 38.8%) and secondary (LEPs: 50.2%, TCM: 19.5%) dysmenorrhea cohorts. Surgery was conducted in <5% of all patients. Both primary and secondary cohorts of dysmenorrhea had significantly higher mean total health care costs compared to controls within the 1-year period following diagnosis (Case-primary: 191,680 JPY [1,916 USD]; secondary: 246,488 JPY [2,465 USD], Control-primary: 83,615 JPY [836 USD]; secondary: 90,711 JPY [907 USD]) ( p <0.0001). After adjusting for baseline characteristics, these costs were 2.2 and 2.9 times higher for primary and secondary dysmenorrhea cohorts, respectively, compared with matched controls, (both p <0.0001). The main driver of these excess costs was outpatient care, with eight additional physician visits per year among dysmenorrhea patients compared to controls ( p <0.0001). Considerable heterogeneity in treatment patterns was observed, with relatively low utilization of LEPs in patients with primary dysmenorrhea and those treated by internal medicine physicians. Total annual health care costs were approximately 2-3 times higher in patients with dysmenorrhea compared to women without the condition.

Evaluation of the treatment patterns and economic burden of dysmenorrhea in Japanese women, using a claims database

PubMed Central

Akiyama, Sayako; Tanaka, Erika; Cristeau, Olivier; Onishi, Yoshie; Osuga, Yutaka

2017-01-01

Purpose This study aimed to describe treatment patterns and estimate health care resource utilization and associated costs among Japanese women with dysmenorrhea, using a claims database. Methods This was a retrospective analysis using health insurance data from the Japan Medical Data Center, assessing female patients aged 18–49 years with newly diagnosed primary or secondary dysmenorrhea. Treatment pattern analyses focused on hormonal medications, analgesics, hemostatic agents, traditional Chinese medicine (TCM), and gynecological surgeries. Data were collected on health care resource utilization and costs associated with medications, imaging procedures, and inpatient and outpatient care in both patients and matched controls. Results The analysis included 6,315 women with dysmenorrhea (3,441 primary; 2,874 secondary). The most commonly prescribed initial therapies were low-dose estrogen progestins (LEPs, 37.7%) and TCM (30.0%), with substantial differences between primary (LEPs: 27.4%, TCM: 38.8%) and secondary (LEPs: 50.2%, TCM: 19.5%) dysmenorrhea cohorts. Surgery was conducted in <5% of all patients. Both primary and secondary cohorts of dysmenorrhea had significantly higher mean total health care costs compared to controls within the 1-year period following diagnosis (Case-primary: 191,680 JPY [1,916 USD]; secondary: 246,488 JPY [2,465 USD], Control-primary: 83,615 JPY [836 USD]; secondary: 90,711 JPY [907 USD]) (p<0.0001). After adjusting for baseline characteristics, these costs were 2.2 and 2.9 times higher for primary and secondary dysmenorrhea cohorts, respectively, compared with matched controls, (both p<0.0001). The main driver of these excess costs was outpatient care, with eight additional physician visits per year among dysmenorrhea patients compared to controls (p<0.0001). Conclusion Considerable heterogeneity in treatment patterns was observed, with relatively low utilization of LEPs in patients with primary dysmenorrhea and those treated by internal medicine physicians. Total annual health care costs were approximately 2–3 times higher in patients with dysmenorrhea compared to women without the condition. PMID:28579813

Do older patients utilize excess health care resources after liver transplantation?

PubMed

Shankar, Neil; AlBasheer, Mamoun; Marotta, Paul; Wall, William; McAlister, Vivian; Chandok, Natasha

2011-01-01

Liver transplantation is a highly effective treatment for end-stage liver disease. However, there is debate over the practice of liver transplantation in older recipients (age ≥ 60 years) given the relative shortage of donor grafts, worse post-transplantation survival, and concern that that older patients may utilize excess resources postoperatively, thus threatening the economic feasibility of the procedure. To determine if patients ≥ 60 years of age utilize more health resources following liver transplantation compared with younger patients. Consecutive adult patients who underwent primary liver transplantation (n = 208) at a single center were studied over a 2.5-year period. Data were collected on clinico-demographic characteristics and resource utilization. Descriptive statistics, including means, standard deviations, or frequencies were obtained for baseline variables. Patients were stratified into 2 groups: age ≥ 60 years (n = 51) and < 60 years (n = 157). The Chi-Square Test, Mantel-Haenszel Test, 2-sample test and odds ratios were calculated to ascertain associations between age and resource utilization parameters. Regression analyses were adjusted for model for end-stage liver disease score, location before surgery, diabetes mellitus, donor age, cold ischemia time, albumin, and diagnosis of hepatitis C. Recipients ≥ 60 years of age have similar lengths of hospitalization, re-operative rates, need for consultative services and readmission rates following liver transplantation, but have longer lengths of stay in the intensive care (hazard ratio 1.97, p = 0.03). Overall, liver transplant recipients ≥ 60 years of age utilize comparable resources following LT vs. younger recipients. Our findings have implications on cost-containment policies for liver transplantation.

Health-Care Utilization and Complications of Endoscopic Esophageal Dilation in a National Population

PubMed Central

Goyal, Abhinav; Chatterjee, Kshitij; Yadlapati, Sujani; Singh, Shailender

2017-01-01

Background/Aims Esophageal stricture is usually managed with outpatient endoscopic dilation. However, patients with food impaction or failure to thrive undergo inpatient dilation. Esophageal perforation is the most feared complication, and its risk in inpatient setting is unknown. Methods We used National Inpatient Sample (NIS) database for 2007–2013. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes were used to identify patients with esophageal strictures. Logistic regression was used to assess association between hospital/patient characteristics and utilization of esophageal dilation. Results There were 591,187 hospitalizations involving esophageal stricture; 4.2% were malignant. Endoscopic dilation was performed in 28.7% cases. Dilation was more frequently utilized (odds ratio [OR], 1.36; p<0.001), had higher in-hospital mortality (3.1% vs. 1.4%, p<0.001), and resulted in longer hospital stays (5 days vs. 4 days, p=0.01), among cases of malignant strictures. Esophageal perforation was more common in the malignant group (0.9% vs. 0.5%, p=0.007). Patients with malignant compared to benign strictures undergoing dilation were more likely to require percutaneous endoscopic gastrostomy or jejunostomy (PEG/J) tube (14.1% vs. 4.5%, p<0.001). Palliative care services were utilized more frequently in malignant stricture cases not treated with dilation compared to those that were dilated. Conclusions Inpatient endoscopic dilation was utilized in 29% cases of esophageal stricture. Esophageal perforation, although infrequent, is more common in malignant strictures. PMID:28301921

Equity in health care utilization in Chile.

PubMed

Núñez, Alicia; Chi, Chunhuei

2013-08-12

One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile.The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992-2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index.Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly.

Five-year trends in women veterans' use of VA maternity benefits, 2008-2012.

PubMed

Mattocks, Kristin M; Frayne, Susan; Phibbs, Ciaran S; Yano, Elizabeth M; Zephyrin, Laurie; Shryock, Holly; Haskell, Sally; Katon, Jodie; Sullivan, J Cherry; Weinreb, Linda; Ulbricht, Christine; Bastian, Lori A

2014-01-01

An increasing number of young women veterans are returning from war and military service and are seeking reproductive health care from the Veterans Health Administration (VHA). Many of these women seek maternity benefits from the VHA, and yet little is known regarding the number of women veterans utilizing VHA maternity benefits nor the characteristics of pregnant veterans using these benefits. In May 2010, VHA maternity benefits were expanded to include 7 days of infant care, which may serve to entice more women to use VHA maternity benefits. Understanding the changing trends in women veterans seeking maternity benefits will help the VHA to improve the quality of reproductive care over time. The goal of this study was to examine the trends in delivery claims among women veterans receiving VHA maternity benefits over a 5-year period and the characteristics of pregnant veterans utilizing VHA benefits. We undertook a retrospective, national cohort study of pregnant veterans enrolled in VHA care with inpatient deliveries between fiscal years (FY) 2008 and 2012. We included pregnant veterans using VHA maternity benefits for delivery. Measures included annualized numbers and rates of inpatient deliveries and delivery-related costs, as well as cesarean section rates as a quality indicator. During the 5-year study period, there was a significant increase in the number of deliveries to women veterans using VHA maternity benefits. The overall delivery rate increased by 44% over the study period from 12.4 to 17.8 deliveries per 1,000 women veterans. A majority of women using VHA maternity benefits were age 30 or older and had a service-connected disability. From FY 2008 to 2012, the VHA paid more than $46 million in delivery claims to community providers for deliveries to women veterans ($4,993/veteran). Over a 5-year period, the volume of women veterans using VHA maternity benefits increased by 44%. Given this sizeable increase, the VHA must increase its capacity to care for pregnant veterans and ensure care coordination systems are in place to address the needs of pregnant veterans with service-connected disabilities. Published by Elsevier Inc.

Diabetes Care Management Teams Did Not Reduce Utilization When Compared With Traditional Care: A Randomized Cluster Trial.

PubMed

Kearns, Patrick

2017-10-01

PURPOSE: Health services research evaluates redesign models for primary care. Care management is one alternative. Evaluation includes resource utilization as a criterion. Compare the impact of care-manager teams on resource utilization. The comparison includes entire panes of patients and the subset of patients with diabetes. DESIGN: Randomized, prospective, cohort study comparing change in utilization rates between groups, pre- and post-intervention. METHODOLOGY: Ten primary care physician panels in a safety-net setting. Ten physicians were randomized to either a care-management approach (Group 1) or a traditional approach (Group 2). Care managers focused on diabetes and the cardiovascular cluster of diseases. Analysis compared rates of hospitalization, 30-day readmission, emergency room visits, and urgent care visits. Analysis compared baseline rates to annual rates after a yearlong run-in for entire panels and the subset of patients with diabetes. RESULTS: Resource utilization showed no statistically significant change between baseline and Year 3 (P=.79). Emergency room visits and hospital readmission increased for both groups (P=.90), while hospital admissions and urgent care visits decreased (P=.73). Similarly, utilization was not significantly different for patients with diabetes (P=.69). CONCLUSIONS: A care-management team approach failed to improve resource utilization rates by entire panels and the subset of diabetic patients compared to traditional care. This reinforces the need for further evidentiary support for the care-management model's hypothesis in the safety net.

Influences of market competition on dental care utilization under the global budget payment system.

PubMed

Tsai, Wen-Chen; Kung, Pei-Tseng; Chang, Wei-Chieh

2007-12-01

The degrees of market competition usually influence providers' behaviors. This study investigated the influence of medical market competition on the utilization of dental care under the global budget payment system. This study also examined the relative factors that influence the utilization of dental care. This study used the healthcare sub-regions (HCSRs) in the healthcare net as the observation units. The dataset was the National Health Insurance dental care claim data from 1999 to 2002. The degree of market competition of dental care was measured by the Herfindahl Index (HI). The influences of medical market competition on the utilization of dental care were analyzed by multiple linear regression analysis. When the market had a higher degree of competition, people had a higher number of dental utilizations after controlling for the other variables. When market competition increased by 1%, annual expenditures and frequencies of dental care as well as frequencies of tooth-filling per person increased by 0.4%. Thirty-three percent of dental expenditures could be explained by increases in the degree of market competition. Females or highly educated people had a positive correlation with dental utilization. However, the agricultural population negatively correlated with dental utilization. Average household income had no significant relationship with the frequency of dental care but had a significant negative association with dental expenditures when dental care was covered by health insurance. After the global budget payment system for dental care was implemented, increases in dental care market competition led to the increase in utilization of dental care services.

The Patient-Centered Medical Home (PCMH) Framing Typology for Understanding the Structure, Function, and Outcomes of PCMHs.

PubMed

Kieber-Emmons, Autumn M; Miller, William L

2017-01-01

Patient-centered medical homes (PCHMs) aspire to transform today's challenged primary care services. However, it is unclear which PCMH characteristics produce specific outcomes of interest for care delivery. This study tested a novel typology of PCMH practice transformation, the PCMH framing typology, and evaluated measurable outcomes by each type. Using the Patient-Centered Primary Care Collaborative 2012 to 2013 Annual Review, this secondary analysis of the published PCMH literature extracted data from publications of 59 PCMHs. Each of the 59 sites was categorized as 1 of 4 PCMH types: add-on, renovated, hybrid, or integrated. Six outcome measures (cost reductions, decreased emergency department/hospital utilization, improved quality, improved access, increased preventive services, and improved patient satisfaction) were independently coded for each site. Practices were combined based on type, and mean outcomes scores for each measure were displayed on radar graphs for comparison. While each type showed a characteristic pattern of success, only the integrated type improved in all 6 outcomes. No type achieved high success in all measures. There seem to be 4 types of PCMH, each of which shows a distinctive outcomes profile. Within the PCMH framing typology, direction is emerging for how best to transform primary care to achieve the greatest success. © Copyright 2017 by the American Board of Family Medicine.

Medication Therapy Management after Hospitalization in CKD: A Randomized Clinical Trial.

PubMed

Tuttle, Katherine R; Alicic, Radica Z; Short, Robert A; Neumiller, Joshua J; Gates, Brian J; Daratha, Kenn B; Barbosa-Leiker, Celestina; McPherson, Sterling M; Chaytor, Naomi S; Dieter, Brad P; Setter, Stephen M; Corbett, Cynthia F

2018-02-07

CKD is characterized by remarkably high hospitalization and readmission rates. Our study aim was to test a medication therapy management intervention to reduce subsequent acute care utilization. The CKD Medication Intervention Trial was a single-blind (investigators), randomized clinical trial conducted at Providence Health Care in Spokane, Washington. Patients with CKD stages 3-5 not treated by dialysis who were hospitalized for acute illness were recruited. The intervention was designed to improve posthospitalization care by medication therapy management. A pharmacist delivered the intervention as a single home visit within 7 days of discharge. The intervention included these fundamental elements: comprehensive medication review, medication action plan, and a personal medication list. The primary outcome was a composite of acute care utilization (hospital readmissions and emergency department and urgent care visits) for 90 days after hospitalization. Baseline characteristics of participants ( n =141) included the following: age, 69±11 (mean±SD) years old; women, 48% (67 of 141); diabetes, 56% (79 of 141); hypertension, 83% (117 of 141); eGFR, 41±14 ml/min per 1.73 m 2 (serum creatinine-based Chronic Kidney Disease Epidemiology Collaboration equation); and urine albumin-to-creatinine ratio median, 43 mg/g (interquartile range, 8-528) creatinine. The most common primary diagnoses for hospitalization were the following: cardiovascular events, 36% (51 of 141); infections, 18% (26 of 141); and kidney diseases, 12% (17 of 141). The primary outcome occurred in 32 of 72 (44%) of the medication intervention group and 28 of 69 (41%) of those in usual care (log rank P =0.72). For only hospital readmission, the rate was 19 of 72 (26%) in the medication intervention group and 18 of 69 (26%) in the usual care group (log rank P =0.95). There was no between-group difference in achievement of guideline-based goals for use of renin-angiotensin system inhibition or for BP, hemoglobin, phosphorus, or parathyroid hormone. Acute care utilization after hospitalization was not reduced by a pharmacist-led medication therapy management intervention at the transition from hospital to home. Copyright © 2018 by the American Society of Nephrology.

Understanding dual enrollees' use of Medicare home health services: the effects of differences in Medicaid home care programs.

PubMed

Kenney, G; Rajan, S

2000-01-01

Both the Medicare and Medicaid programs have experienced considerable growth in spending on home care in recent years. As policymakers adopt measures (such as those legislated in the Balanced Budget Act of 1997) to curb the rate of spending growth on home care services, it is important to understand interactions between the Medicare and Medicaid home care programs in serving the dually enrolled population. This study examines the potential effects of the Medicaid home care program on Medicare home health utilization using multivariate models. The study relied on data from the Health Care Financing Administration's Medicare Current Beneficiary Survey (MCBS), a longitudinal survey of Medicare enrollees. The primary MCBS file used was from Round 1 of the survey, which was fielded between September and December 1991. The unit of analysis was individuals. The authors used descriptive and multivariate methods to explore the relationship between Medicare coverage and state home care program characteristics. Included were variables that have been found to be significant determinants of Medicare home health utilization in other studies as well as variables to indicate the availability and generosity of Medicaid home care services in each state represented in the survey. The findings were consistent with those of previous studies, in that dual enrollees were disproportionate users of Medicare home health services, accounting for only 16% of enrollees but receiving 40% of all visits. In addition, lower levels of Medicare home health use were observed in states with relatively higher Medicaid spending on home health and personal care services, but this relationship appeared to be heavily dominated by the inclusion of enrollees living in New York State. When individuals from New York were excluded from the analysis, we found a negative but statistically significant relationship between Medicaid outlays on home health and personal care services and Medicare home health utilization. Because the Medicare and Medicaid programs are interconnected through the sizable dual enrollee population, changes in one program are likely to have ramifications for the other. This study presents another step in exploring how the two programs interact and emphasizes the fact that costs can be shifted between the two programs as policy changes are made to control the rate of home care spending growth.

National Trends (2009-2013) for Palliative Care Utilization for Patients Receiving Prolonged Mechanical Ventilation.

PubMed

Chatterjee, Kshitij; Goyal, Abhinav; Kakkera, Krishna; Harrington, Sarah; Corwin, Howard L

2018-05-04

Patients requiring mechanical ventilation have high morbidity and mortality. Providing palliative care services has been suggested as a way to improve comprehensive management of critically ill patients. We examined the trend in the utilization of palliative care among adults who require prolonged mechanical ventilation. Primary objectives were to determine the trend in palliative care utilization over time, predictors for palliative care utilization, and palliative care impact on hospital length of stay. Retrospective, cross-sectional study. The National Inpatient Sample data between 2009 and 2013 was used for this study. Adults (age ≥ 18 yr) who underwent prolonged mechanical ventilation (≥ 96 consecutive hr) were studied. Palliative care and mechanical ventilation were identified using the corresponding International Classification of Diseases, 9th revision, Clinical Modification, codes. A total of 1,751,870 hospitalizations with prolonged mechanical ventilation were identified between 2009 and 2013. The utilization of palliative care increased yearly from 6.5% in 2009 to 13.1% in 2013 (p < 0.001). Among the mechanically ventilated patients who died, palliative care increased from 15.9% in 2009 to 33.3% in 2013 (p < 0.001). Median hospital length of stay for patients with and without palliative care was 13 and 17 days, respectively (p < 0.001). Patients discharged to either short- or long-term care facilities had a shorter length of stay if palliative care was provided (15 vs 19 d; p < 0.001). The factors associated with a higher palliative care utilization included older age, malignancy, larger hospitals in urban areas, and teaching hospitals. Non-Caucasian race was associated with lower palliative care utilization. Among patients who undergo prolonged mechanical ventilation, palliative care utilization is increasing, particularly in patients who die during hospitalization. Using palliative care for mechanically ventilated patients who are discharged to either short- or long-term care facilities is associated with a shorter hospital length of stay.

Mental health-care utilization in survivors of childhood cancer and siblings: the Swiss childhood cancer survivor study.

PubMed

Gianinazzi, Micol E; Rueegg, Corina S; von der Weid, Nicolas X; Niggli, Felix K; Kuehni, Claudia E; Michel, Gisela

2014-02-01

We aimed to (1) describe the utilization of mental health-care in survivors and siblings, the association with severity of distress, and visits to other professionals in distressed survivors not utilizing mental health-care; and (2) identify factors associated with utilization of mental health-care in distressed survivors. Within the Swiss Childhood Cancer Survivor Study, we sent postal questionnaires to all participants aged <16 years at diagnosis (1976-2003), who survived ≥5 years after diagnosis and were aged ≥16 years at study. Survivors and siblings could indicate if they utilized mental health-care in the past year. Psychological distress was assessed with the Brief Symptom Inventory-18 (BSI-18). Participants with scores T ≥ 57 on two of three scales or the Global Severity Index were considered distressed. We included 1,602 survivors and 703 siblings. Overall, 160 (10 %) and 53 (8 %), utilized mental health-care and 203 (14 %) and 127 (14 %) were considered distressed. Among these, 69 (34 %) survivors and 20 (24 %) siblings had utilized mental health-care. Participants with higher distress were more likely to utilize mental health-care. Distressed survivors not utilizing mental health-care were more likely to see a medical specialist than nondistressed. In the multivariable regression, factors associated with utilizing mental health-care were higher psychological distress and reporting late effects. Our results underline the importance of developing interventional programs and implementing psychological screening in follow-up of survivors. It is also important to systematically address siblings' needs. In follow-up, patients at risk should be informed about existing possibilities or advised to visit mental health professionals.

A multimethod investigation including direct observation of 3751 patient visits to 120 dental offices

PubMed Central

Wotman, Stephen; Demko, Catherine A; Victoroff, Kristin; Sudano, Joseph J; Lalumandier, James A

2010-01-01

This report defines verbal interactions between practitioners and patients as core activities of dental practice. Trained teams spent four days in 120 Ohio dental practices observing 3751 patient encounters with dentists and hygienists. Direct observation of practice characteristics, procedures performed, and how procedure and nonprocedure time was utilized during patient visits was recorded using a modified Davis Observation Code that classified patient contact time into 24 behavioral categories. Dentist, hygienist, and patient characteristics were gathered by questionnaire. The most common nonprocedure behaviors observed for dentists were chatting, evaluation feedback, history taking, and answering patient questions. Hygienists added preventive counseling. We distinguish between preventive procedures and counseling in actual dental offices that are members of a practice-based research network. Almost a third of the dentist’s and half of the hygienist’s patient contact time is utilized for nonprocedure behaviors during patient encounters. These interactions may be linked to patient and practitioner satisfaction and effectiveness of self-care instruction. PMID:23662080

Use of social media across US hospitals: descriptive analysis of adoption and utilization.

PubMed

Griffis, Heather M; Kilaru, Austin S; Werner, Rachel M; Asch, David A; Hershey, John C; Hill, Shawndra; Ha, Yoonhee P; Sellers, Allison; Mahoney, Kevin; Merchant, Raina M

2014-11-27

Use of social media has become widespread across the United States. Although businesses have invested in social media to engage consumers and promote products, less is known about the extent to which hospitals are using social media to interact with patients and promote health. The aim was to investigate the relationship between hospital social media extent of adoption and utilization relative to hospital characteristics. We conducted a cross-sectional review of hospital-related activity on 4 social media platforms: Facebook, Twitter, Yelp, and Foursquare. All US hospitals were included that reported complete data for the Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Systems survey and the American Hospital Association Annual Survey. We reviewed hospital social media webpages to determine the extent of adoption relative to hospital characteristics, including geographic region, urban designation, bed size, ownership type, and teaching status. Social media utilization was estimated from user activity specific to each social media platform, including number of Facebook likes, Twitter followers, Foursquare check-ins, and Yelp reviews. Adoption of social media varied across hospitals with 94.41% (3351/3371) having a Facebook page and 50.82% (1713/3371) having a Twitter account. A majority of hospitals had a Yelp page (99.14%, 3342/3371) and almost all hospitals had check-ins on Foursquare (99.41%, 3351/3371). Large, urban, private nonprofit, and teaching hospitals were more likely to have higher utilization of these accounts. Although most hospitals adopted at least one social media platform, utilization of social media varied according to several hospital characteristics. This preliminary investigation of social media adoption and utilization among US hospitals provides the framework for future studies investigating the effect of social media on patient outcomes, including links between social media use and the quality of hospital care and services.

Use of Social Media Across US Hospitals: Descriptive Analysis of Adoption and Utilization

PubMed Central

Griffis, Heather M; Kilaru, Austin S; Werner, Rachel M; Asch, David A; Hershey, John C; Hill, Shawndra; Ha, Yoonhee P; Sellers, Allison; Mahoney, Kevin

2014-01-01

Background Use of social media has become widespread across the United States. Although businesses have invested in social media to engage consumers and promote products, less is known about the extent to which hospitals are using social media to interact with patients and promote health. Objective The aim was to investigate the relationship between hospital social media extent of adoption and utilization relative to hospital characteristics. Methods We conducted a cross-sectional review of hospital-related activity on 4 social media platforms: Facebook, Twitter, Yelp, and Foursquare. All US hospitals were included that reported complete data for the Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Systems survey and the American Hospital Association Annual Survey. We reviewed hospital social media webpages to determine the extent of adoption relative to hospital characteristics, including geographic region, urban designation, bed size, ownership type, and teaching status. Social media utilization was estimated from user activity specific to each social media platform, including number of Facebook likes, Twitter followers, Foursquare check-ins, and Yelp reviews. Results Adoption of social media varied across hospitals with 94.41% (3351/3371) having a Facebook page and 50.82% (1713/3371) having a Twitter account. A majority of hospitals had a Yelp page (99.14%, 3342/3371) and almost all hospitals had check-ins on Foursquare (99.41%, 3351/3371). Large, urban, private nonprofit, and teaching hospitals were more likely to have higher utilization of these accounts. Conclusions Although most hospitals adopted at least one social media platform, utilization of social media varied according to several hospital characteristics. This preliminary investigation of social media adoption and utilization among US hospitals provides the framework for future studies investigating the effect of social media on patient outcomes, including links between social media use and the quality of hospital care and services. PMID:25431831

Trends in Preventable Inpatient and Emergency Department Utilization in California Between 2012 and 2015: The Role of Health Insurance Coverage and Primary Care Supply.

PubMed

Cunningham, Peter; Sheng, Yaou

2018-06-01

Expansions of health insurance coverage tend to increase hospital emergency department (ED) utilization and inpatient admissions. However, provisions in the Affordable Care Act that expanded primary care supply were intended in part to offset the potential for increased hospital utilization. To examine the association between health insurance coverage, primary care supply, and ED and inpatient utilization, and to assess how both factors contributed to trends in utilization in California between 2012 and 2015. Population-based measures of ED and inpatient utilization, insurance coverage, and primary care supply were constructed for California counties for the years 2012 through 2015. Fixed effects regression analysis is used to examine the association between health insurance coverage, primary care supply, and rates of preventable ED and inpatient utilization. Higher levels of Medicaid coverage in a county are associated with higher levels of preventable ED and inpatient utilization, although greater numbers of primary care practitioners and Federally Qualified Health Centers reduce this type of utilization. Increases in coverage accelerated a long-term increase in ED visits and prevented an even larger decrease in inpatient admissions, but changes in coverage do not fully explain these underlying trends. Increases in primary care supply offset the effects of coverage changes only modestly. Policymakers should not overstate the impact of the Affordable Care Act on increasing ED visits, and should focus on better understanding the underlying factors that are driving the trends.

Tobacco-Nicotine Education and Training for Health-Care Professional Students and Practitioners: A Systematic Review.

PubMed

Ye, Lisa; Goldie, Catherine; Sharma, Tanvi; John, Sheila; Bamford, Megan; Smith, Patricia M; Selby, Peter; Schultz, Annette S H

2018-04-02

The objective of this systematic review was to investigate what education and training characteristics prepares and supports health-care professionals (HCPs) in the delivery of competent and effective care to clients who use tobacco-nicotine. A search of eight bibliographic databases for English-language peer-reviewed publications from January 2006 to March 2015. Studies were included if they met the a priori inclusion criteria, which consisted of: (1) quantitative study design and (2) focus on tobacco-nicotine education or training for HCP students and practitioners. All studies were independently screened for inclusion by two reviewers. Data from included studies were extracted for study characteristics and key outcomes then critically appraised for methodological quality. Fifty-nine studies were included for narrative synthesis. Two categories emerged: (1) curriculum characteristics (n = 10) and (2) education and training interventions (n = 49). Included curriculum studies identified the following themes: content, intensity, competencies evaluation, and barriers. Study findings about education and training interventions were grouped by level of education (prelicensure, post-licensure, and faculty training), teaching modality, health discipline, and the associated HCP and client outcomes. This comprehensive review suggests that there is a lack of consistency in HCP tobacco-nicotine education and training characteristics. This paper provides valuable categorization of the most frequently utilized components of academic curriculum and discusses the interventions in relation to HCP and client outcomes. Gaps in the literature are highlighted, and the need for standardization of tobacco-nicotine training competencies and evaluation is discussed. Future research investigating the most effective approaches to training is needed. This systematic review summarizes existing tobacco-related curriculum components (content, intensity, competency evaluation, and barriers) and training interventions for health-care professionals worldwide and demonstrates that they are associated with positive health-care professional outcomes (knowledge, attitudes, behaviors, and skills) and client outcomes (quit attempts and smoking abstinence).

The Reduction in ED and Hospital Admissions in Medical Home Practices Is Specific to Primary Care-Sensitive Chronic Conditions.

PubMed

Green, Lee A; Chang, Hsiu-Ching; Markovitz, Amanda R; Paustian, Michael L

2018-04-01

To determine whether the Patient-Centered Medical Home (PCMH) transformation reduces hospital and ED utilization, and whether the effect is specific to chronic conditions targeted for management by the PCMH in our setting. All patients aged 18 years and older in 2,218 primary care practices participating in a statewide PCMH incentive program sponsored by Blue Cross Blue Shield of Michigan (BCBSM) in 2009-2012. Quantitative observational study, jointly modeling PCMH-targeted versus other hospital admissions and ED visits on PCMH score, patient, and practice characteristics in a hierarchical multivariate model using the generalized gamma distribution. Claims data and PCMH scores held by BCBSM. Both hospital and ED utilization were reduced proportionately to PCMH score. Hospital utilization was reduced by 13.9 percent for PCMH-targeted conditions versus only 3.8 percent for other conditions (p = .003), and ED utilization by 11.2 percent versus 3.7 percent (p = .010). Hospital PMPM cost was reduced by 17.2 percent for PCMH-targeted conditions versus only 3.1 percent for other conditions (p < .001), and ED PMPM cost by 9.4 percent versus 3.6 percent (p < .001). PCMH transformation reduces hospital and ED use, and the majority of the effect is specific to PCMH-targeted conditions. © Health Research and Educational Trust.

Missed or Delayed Medical Care Appointments by Older Users of Nonemergency Medical Transportation

PubMed Central

MacLeod, Kara E.; Ragland, David R.; Prohaska, Thomas R.; Smith, Matthew Lee; Irmiter, Cheryl; Satariano, William A.

2015-01-01

Purpose of the Study: This study identified factors associated with canceling nonemergency medical transportation appointments among older adult Medicaid patients. Design and Methods: Data from 125,913 trips for 2,913 Delaware clients were examined. Mediation analyses, as well as, multivariate logistic regressions were conducted. Results: Over half of canceled trips were attributed to client reasons (e.g., no show, refusal). Client characteristics (e.g., race, sex, functional status) were associated with cancelations; however, these differed based on the cancelation reason. Regularly scheduled trips were less likely to be canceled. Implications: The evolving American health care system may increase service availability. Additional policies can improve service accessibility and overcome utilization barriers. PMID:24558264

Development of out-of-hours primary care by general practitioners (GPs) in The Netherlands: from small-call rotations to large-scale GP cooperatives.

PubMed

van Uden, Caro J T; Giesen, Paul H J; Metsemakers, Job F M; Grol, Richard P T M

2006-09-01

Over the last 10 years, care outside office hours by primary care physicians in The Netherlands has experienced a radical change. While Dutch general practitioners (GPs) formerly performed these services in small-call rotations, care is nowadays delivered by large-scale GP cooperatives. We searched the literature for relevant studies on the effect of the out-of-hours care reorganization in The Netherlands. We identified research that included before- and afterintervention studies, descriptive studies, and surveys. These studies focused on the consequences of reorganizing several aspects of out-of-hours care, such as patient and GP satisfaction, patient characteristics, utilization of care, and costs. Various studies showed that the reorganization has successfully addressed many of the critical issues that Dutch GPs were confronted with delivering these services. GPs' job satisfaction has increased, and patients seem to be satisfied with current out-of-hours care. Several aspects of out-of-hours care are discussed, such as telephone triage, self referrals, and future expectations, which should receive extra attention by researchers and health policy makers in the near future.

Patient Care Utility Module for DEPMEDS Hospitals

DTIC Science & Technology

1991-06-05

identified in the patient care utility capability in Deployable Medical S-:tems (DEPMEDS) hospitals, especially in the Intensive Care Unit (ICU). A...identified in the patient care utility capability in Deployable Medical Systems (DEPMEDS) hospitals, especially in the Intensive Care Unit (ICU). A...REQUEST FROM DEFENSE MEDICAL STANDARDIZATION BOARD TO STUDY SPACE AROUND PATIENT BEDSIDE IN DEPHEDS HOSPITALS 28 DEFENSE MEDICAL STANDARDIZATION BOARD FONT

Capacity and Utilization in Health Care: The Effect of Empty Beds on Neonatal Intensive Care Admission

PubMed Central

Freedman, Seth

2016-01-01

Because geographic variation in medical care utilization is jointly determined by both supply and demand, it is difficult to empirically estimate whether capacity itself has a causal impact on utilization in health care. In this paper, I exploit short-term variation in Neonatal Intensive Care Unit (NICU) capacity that is unlikely to be correlated with unobserved demand determinants. I find that available NICU beds have little to no effect on NICU utilization for the sickest infants, but do increase utilization for those in the range of birth weights where admission decisions are likely to be more discretionary. PMID:27942353

The Effects of Quality of Care on Costs: A Conceptual Framework

PubMed Central

Nuckols, Teryl K; Escarce, José J; Asch, Steven M

2013-01-01

Context The quality of health care and the financial costs affected by receiving care represent two fundamental dimensions for judging health care performance. No existing conceptual framework appears to have described how quality influences costs. Methods We developed the Quality-Cost Framework, drawing from the work of Donabedian, the RAND/UCLA Appropriateness Method, reports by the Institute of Medicine, and other sources. Findings The Quality-Cost Framework describes how health-related quality of care (aspects of quality that influence health status) affects health care and other costs. Structure influences process, which, in turn, affects proximate and ultimate outcomes. Within structure, subdomains include general structural characteristics, circumstance-specific (e.g., disease-specific) structural characteristics, and quality-improvement systems. Process subdomains include appropriateness of care and medical errors. Proximate outcomes consist of disease progression, disease complications, and care complications. Each of the preceding subdomains influences health care costs. For example, quality improvement systems often create costs associated with monitoring and feedback. Providing appropriate care frequently requires additional physician visits and medications. Care complications may result in costly hospitalizations or procedures. Ultimate outcomes include functional status as well as length and quality of life; the economic value of these outcomes can be measured in terms of health utility or health-status-related costs. We illustrate our framework using examples related to glycemic control for type 2 diabetes mellitus or the appropriateness of care for low back pain. Conclusions The Quality-Cost Framework describes the mechanisms by which health-related quality of care affects health care and health status–related costs. Additional work will need to validate the framework by applying it to multiple clinical conditions. Applicability could be assessed by using the framework to classify the measures of quality and cost reported in published studies. Usefulness could be demonstrated by employing the framework to identify design flaws in published cost analyses, such as omitting the costs attributable to a relevant subdomain of quality. PMID:23758513

Health Disparities in Veterans: A Map of the Evidence.

PubMed

Kondo, Karli; Low, Allison; Everson, Teresa; Gordon, Christine D; Veazie, Stephanie; Lozier, Crystal C; Freeman, Michele; Motu'apuaka, Makalapua; Mendelson, Aaron; Friesen, Mark; Paynter, Robin; Friesen, Caroline; Anderson, Johanna; Boundy, Erin; Saha, Somnath; Quiñones, Ana; Kansagara, Devan

2017-09-01

Goals for improving the quality of care for all Veterans and eliminating health disparities are outlined in the Veterans Health Administration Blueprint for Excellence, but the degree to which disparities in utilization, health outcomes, and quality of care affect Veterans is not well understood. To characterize the research on health care disparities in the Veterans Health Administration by means of a map of the evidence. We conducted a systematic search for research studies published from 2006 to February 2016 in MEDLINE and other data sources. We included studies of Veteran populations that examined disparities in 3 outcome categories: utilization, quality of health care, and patient health. We abstracted data on study design, setting, population, clinical area, outcomes, mediators, and presence of disparity for each outcome category. We grouped the data by population characteristics including race, disability status, mental illness, demographics (age, era of service, rural location, and distance from care), sex identity, socioeconomic status, and homelessness, and created maps illustrating the evidence. We reviewed 4249 citations and abstracted data from 351 studies which met inclusion criteria. Studies examining disparities by race/ethnicity comprised by far the vast majority of the literature, followed by studies examining disparities by sex, and mental health condition. Very few studies examined disparities related to lesbian, gay, bisexual, or transgender identity or homelessness. Disparities findings vary widely by population and outcome. Our evidence maps provide a "lay of the land" and identify important gaps in knowledge about health disparities experienced by different Veteran populations.

The health care burden of high grade chronic obstructive pulmonary disease in Korea: analysis of the Korean Health Insurance Review and Assessment Service data

PubMed Central

Kim, JinHee; Rhee, Chin Kook; Yoo, Kwang Ha; Kim, Young Sam; Lee, Sei Won; Park, Yong Bum; Lee, Jin Hwa; Oh, YeonMok; Lee, Sang Do; Kim, Yuri; Kim, KyungJoo; Yoon, HyoungKyu

2013-01-01

Background Patients with high grade chronic pulmonary obstructive disease (COPD) account for much of the COPD-related mortality and incur excessive financial burdens and medical care utilization. We aimed to determine the characteristics and medical care use of such patients using nationwide data from the Korean Health Insurance Review and Assessment Service in 2009. Materials and methods Patients with COPD were identified by searching with the International Classification of Diseases–10th Revision for those using medication. Patients with high grade COPD were selected based on their patterns of tertiary institute visits and medication use. Results The numbers of patients with high grade COPD increased rapidly in Korea during the study period, and they showed a high prevalence of comorbid disease. The total medical costs were over three times higher in patients with high grade COPD compared with those without it ($3,744 versus $1,183; P < 0.001). Medication costs comprised the largest portion of medical cost, but most impact came from hospitalization and exacerbation in both groups of patients. COPD grade and hospitalization in the previous year were the major factors affecting medical costs and days of utilizing health care resources. Conclusion Patients with high grade COPD impose a high economic burden on the health care system in Korea. Prevention of progression to high grade COPD is important, both clinically and economically. PMID:24277985

Nursing home case-mix reimbursement in Mississippi and South Dakota.

PubMed

Arling, Greg; Daneman, Barry

2002-04-01

To evaluate the effects of nursing home case-mix reimbursement on facility case mix and costs in Mississippi and South Dakota. Secondary data from resident assessments and Medicaid cost reports from 154 Mississippi and 107 South Dakota nursing facilities in 1992 and 1994, before and after implementation of new case-mix reimbursement systems. The study relied on a two-wave panel design to examine case mix (resident acuity) and direct care costs in 1-year periods before and after implementation of a nursing home case-mix reimbursement system. Cross-lagged regression models were used to assess change in case mix and costs between periods while taking into account facility characteristics. Facility-level measures were constructed from Medicaid cost reports and Minimum Data Set-Plus assessment records supplied by each state. Resident case mix was based on the RUG-III classification system. Facility case-mix scores and direct care costs increased significantly between periods in both states. Changes in facility costs and case mix were significantly related in a positive direction. Medicare utilization and the rate of hospitalizations from the nursing facility also increased significantly between periods, particularly in Mississippi. The case-mix reimbursement systems appeared to achieve their intended goals: improved access for heavy-care residents and increased direct care expenditures in facilities with higher acuity residents. However, increases in Medicare utilization may have influenced facility case mix or costs, and some facilities may have been unprepared to care for higher acuity residents, as indicated by increased rates of hospitalization.

Costs for a health coaching intervention for chronic care management.

PubMed

Wagner, Todd H; Willard-Grace, Rachel; Chen, Ellen; Bodenheimer, Thomas; Thom, David H

2016-04-01

Health coaches can help patients gain knowledge, skills, and confidence to manage their chronic conditions. Coaches may be particularly valuable in resource-poor settings, but they are not typically reimbursed by insurance, raising questions about their budgetary impact. The Health Coaching in Primary Care (HCPC) study was a randomized controlled trial that showed health coaches were effective at helping low-income patients improve control of their type 2 diabetes, hypertension, and/or hyperlipidemia at 12 months compared with usual care. We estimated the cost of employing 3 health coaches and mapped these costs to participants. We tested whether the added costs of the coaches were offset by any savings in healthcare utilization within 1 year. Healthcare utilization data were obtained from 5 sources. Multivariate models assessed differences in costs at 1 year controlling for baseline characteristics. Coaches worked an average of 9 hours with each participant over the length of the study. On average, the health coach intervention cost $483 per participant per year. The average healthcare costs for the coaching group was $3207 compared with $3276 for the control group (P = .90). There was no evidence that the coaching intervention saved money at 1 year. Health coaches have been shown to improve clinical outcomes related to chronic disease management. We found that employing health coaches adds an additional cost of $483 per patient per year. The data do not suggest that health coaches pay for themselves by reducing healthcare utilization in the first year.

Caregiver negative affect is a primary determinant of caregiver report of pediatric asthma quality of life.

PubMed

Price, Marcella R; Bratton, Donna L; Klinnert, Mary D

2002-12-01

Quality of life has increased in popularity as an outcome measure in health research. However, the measurement of quality of life has been questioned on methodologic grounds, as it often shows little association with objective measures of disease status. For this report we studied the determinants of pediatric asthma caregiver report of quality of life and its relationship to disease burden. Ninety-eight children who were admitted to a Pediatric Day Program for an asthma evaluation were enrolled in an outcome study. A complete set of medical records for the 2-year period before and after the admission was collected and systematically coded for health care utilization. Using the Pediatric Asthma Caregiver's Quality of Life Questionnaire, data were collected at baseline, discharge, and year after the admission. Caregiver negative affect (anxiety and depression), measured with the Brief Symptom Inventory, was also collected at baseline and discharge. Caregiver report of quality of life was unrelated to health care utilization at baseline but instead was significantly related to baseline caregiver negative affect. A significant relationship between health care utilization and quality of life was present at followup. The Emotional Function scale from the quality of life measure can account for most of the relationship between quality of life and negative affect. Caregiver affect may have a considerable influence on report of quality of life. Understanding the individual characteristics of the respondent is important when using a quality of life instrument as an outcome measure.

Quadrivalent Human Papillomavirus Vaccine Uptake in Adolescent Boys and Maternal Utilization of Preventive Care and History of Sexually Transmitted Infections

PubMed Central

Chao, Chun; Sy, Lina S.; Ackerson, Bradley K.; Slezak, Jeff M.; Sidell, Margo A.; Jacobsen, Steven J.

2013-01-01

Objectives. We examined whether maternal utilization of preventive care and history of sexually transmitted infections (STIs) predicted quadrivalent human papillomavirus vaccine (HPV4) uptake among adolescent boys 1 year following the recommendation for permissive use of HPV4 for males. Methods. We linked maternal information with electronic health records of 254 489 boys aged 9 to 17 years who enrolled in Kaiser Permanente Southern California health plan from October 21, 2009, through December 21, 2010. We used multivariable Poisson regression with robust error variance to examine whether HPV4 initiation was associated with maternal uptake of influenza vaccine, Papanicolaou (Pap) screening, and history of STIs. Results. We identified a modest but statistically significant association between initiation of HPV4 series and maternal receipt of influenza vaccine (rate ratio [RR] = 1.16; 95% confidence interval [CI] = 1.07, 1.26) and Pap screening (RR = 1.13; 95% CI = 1.01, 1.26). Boys whose mothers had a history of genital warts were more likely to initiate HPV4 (RR = 1.47; 95% CI = 0.93, 2.34), although the association did not reach statistical significance (P = .1). Conclusions. Maternal utilization of preventive care and history of genital warts may influence HPV4 uptake among adolescent boys. The important role of maternal health characteristics and health behaviors needs be considered in intervention efforts to increase vaccine uptake among boys. PMID:23865707

Equity in health care utilization in Chile

PubMed Central

2013-01-01

One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile. The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992–2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index. Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly. PMID:23937894

[Profile of the Emergency demand and influence of televised soccer games on an extra-hospital center in the Tafalla health care district. Navarre, Spain].

PubMed

Pérez-Ciordia, Ignacio; Catalán Fabo, Francisca; Zalacain Nicolay, Fernando; Barriendo Antoñanzas, Maite; Solaegui Diaz de Guereñu, Ramón; Guillén Grima, Francisco

2003-01-01

The demand placed on both hospital as well as extrahospital emergency care units currently continues to increase at a growing rate. This study has a twofold objective: the quantification and study of the personal characteristics of the users who are demanding emergency care and assessing whether televised soccer games have any bearing on the utilization of emergency care services. A longitudinal descriptive study (9,723 users demanding care) and study of cases and controls (1,284 users demanding care) according to whether or not a soccer game was being televised by means of a logistic regression model. The associations were quantified by means of the odds ratio (OR). Those dealt with by telephone or in infirmaries were not included in the study. A total 10.6% of the demand involved home visits, 4.8% of this total having been sent to hospital. A total 13.3% of the demand corresponds to individuals visiting from other healthcare districts, a total of 65 being overusers of emergency care (8 or more visits). The month of August (32.3%). Sundays (44.56%) and the 12:00 p.m.-2:00 p.m. timeframe (8.38%) are the times when the greatest demand for care occurs, the differences being statistically significant. Televised soccer games were associated to a 19.8% (p < 0.001) rise in demand as compared to the control period. A high degree of use of the extrahospital emergency care units has been found to exist, a major part of the demand being concentrated at highly specific points in time. A major degree of care is provided to those visiting from outside their own healthcare districts. Television soccer game broadcasts is associated with the greater utilization of the emergency care services.

Postnatal care utilization among urban women in northern Ethiopia: cross-sectional survey.

PubMed

Gebrehiwot, Genet; Medhanyie, Araya Abrha; Gidey, Gebreamlak; Abrha, Kidan

2018-05-30

Postnatal care service enables health professionals to identify post-delivery problems including potential complications for the mother with her baby and to provide treatments promptly. In Ethiopia, postnatal care service is made accessible to all women for free however the utilization of the service is very low. This study assessed the utilization of postnatal care services of urban women and the factors associated in public health facilities in Mekelle city, Tigrai Region, Northern Ethiopia. A facility based cross sectional study design was used to assess post natal service utilization. Using simple random sampling 367 women who visited maternal and child health clinics in Mekelle city for postnatal care services during January 27 to April 2014 were selected. Data was entered and analyzed using SPSS Version 20.0 software. A binary and multivariable logistic regression was used to identify risk factors associated with the outcome variables. P-value less than 0.05 is used to declare statistical significance. The prevalence of women who utilized postnatal care service was low (32.2%). Women who were private employees and business women were more likely to utilize postnatal care services (AOR = 6.46, 95% CI: 1.91-21.86) and (3.35, 95% CI: 1.10-10.19) respectively compared to house wives., Women who had history of one pregnancy were more likely to utilize the service (AOR = 3.19, 95% CI: 1.06-9.57) compared to women who had history of four and above pregnancies. Women who had knowledge of postnatal care service were also more likely to utilize postnatal care service (AOR = 14.46, 95% CI: 7.55-27.75) than women who lacked knowledge about the services. Postnatal care utilization in the study area is low. Knowledge on postnatal care services and occupation of women had positive impact on postnatal care service utilization. The Mekelle city administration health office and other stakeholders should support and encourage urban health extension workers and health facilities to strengthen providing health education to improve the knowledge of the women about the importance of postnatal care services.

Young adults' health care utilization and expenditures prior to the Affordable Care Act.

PubMed

Lau, Josephine S; Adams, Sally H; Boscardin, W John; Irwin, Charles E

2014-06-01

To examine young adults' health care utilization and expenditures prior to the Affordable Care Act. We used 2009 Medical Expenditure Panel Survey to (1) compare young adults' health care utilization and expenditures of a full-spectrum of health services to children and adolescents and (2) identify disparities in young adults' utilization and expenditures, based on access (insurance and usual source of care) and other sociodemographic factors, including race/ethnicity and income. Young adults had (1) significantly lower rates of overall utilization (72%) than other age groups (83%-88%, p < .001), (2) the lowest rate of office-based utilization (55% vs. 67%-77%, p < .001) and (3) higher rate of emergency room visits compared with adolescents (15% vs. 12%, p < .01). Uninsured young adults had high out-of-pocket expenses. Compared with the young adults with private insurance, the uninsured spent less than half on health care ($1,040 vs. $2,150/person, p < .001) but essentially the same out-of-pocket expenses ($403 vs. $380/person, p = .57). Among young adults, we identified significant disparities in utilization and expenditures based on the presence/absence of a usual source of care, race/ethnicity, home language, and sex. Young adults may not be utilizing the health care system optimally by having low rates of office-based visits and high rates of emergency room visits. The Affordable Care Act provision of insurance for those previously uninsured or under-insured will likely increase their utilization and expenditures and lower their out-of-pocket expenses. Further effort is needed to address noninsurance barriers and ensure equal access to health services. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Telephone Encounters Predict Future High Financial Expenditures in Inflammatory Bowel Disease Patients: A 3-Year Prospective Observational Study.

PubMed

Click, Benjamin; Anderson, Alyce M; Ramos Rivers, Claudia; Koutroubakis, Ioannis E; Hashash, Jana G; Dunn, Michael A; Schwartz, Marc; Swoger, Jason; Barrie, Arthur; Szigethy, Eva; Regueiro, Miguel; Schoen, Robert E; Binion, David G

2018-04-01

Telephone activity is essential in management of complex chronic diseases including inflammatory bowel disease (IBD). Telephone encounters logged in the electronic medical record have recently been proposed as a surrogate marker of disease activity and impending health care utilization; however, the association between telephone calls and financial expenditures has not been evaluated. We performed a 3-year prospective observational study of telephone encounters logged at a tertiary referral IBD center. We analyzed patient demographics, disease characteristics, comorbidities, clinical activity, and health care financial charges by telephone encounter frequency. Eight hundred one patients met inclusion criteria (52.3% female; mean age, 44.1 y), accounted for 12,669 telephone encounters, and accrued $70,513,449 in charges over 3 years. High telephone encounter frequency was associated with female gender (P=0.003), anxiety/depression (P<0.001), and prior IBD surgery (P<0.001). High telephone encounter categories had significantly more hospitalizations (P<0.001), IBD surgery (P<0.001), worse quality of life (P<0.001), more corticosteroid (P<0.001), biological (P<0.001), and opiate prescriptions (P<0.001). High telephone encounter frequency patients amassed higher total available charges in each year (P<0.001) and over the 3 years (P<0.001). Telephone encounters in 2009 (P=0.02) and 2010 (P<0.001) were significantly associated with financial charges the following year after controlling for demographic, utilization, and medication covariates. Increased telephone encounters are associated with significantly higher health care utilization and financial expenditures. Increased call frequency is predictive of future health care spending. Telephone encounters are a useful tool to identify patients at risk of clinical deterioration and large financial expense.

Moving beyond the Typologies of Managed Care: The Example of Health Plan Predictors of Screening Mammography

PubMed Central

Tye, Sherilyn; Phillips, Kathryn A; Liang, Su-Ying; Haas, Jennifer S

2004-01-01

Objectives To develop a framework of factors to characterize health plans, to identify how plan characteristics were measured in a national survey, and to apply our findings to an analysis of the predictors of screening mammography. Data Source The primary data were from the 1996 Medical Expenditure Panel Survey. Study Design Women ages 40+, with private insurance, and no history of breast cancer were included in the study (N=2,909). We used multivariate logistic regression to estimate mammography utilization in the past two years relative to health plan and demographic factors. Health plan measures included whether there is a defined provider network, whether coverage is restricted to a network, use of gatekeepers, level of cost containment, copayment and deductible amounts, coinsurance rate, and breadth of benefit coverage. Principal Findings We found no significant difference in reported mammography utilization using a dichotomous comparison of individuals enrolled in managed care versus indemnity plans. However, women in health plans with a defined provider network were more likely to report having received a mammogram in the past two years than those without networks (adjusted OR=1.21, 95 percent CI=1.07–1.36), and women in gatekeeper plans were more likely to report receiving mammography than those without gatekeepers (adjusted OR=1.18, 95 percent CI=1.03–1.36). Restricted out-of-network coverage, use of cost containment, enrollee cost sharing, and breadth of benefit coverage did not appear to affect mammography use. Conclusions It is important to examine the effect of individual health plan components on the utilization of health care, rather than use the traditional broader categorizations of managed versus nonmanaged care or simple health plan typologies. PMID:14965083

Comparison of health service use among veterans with methamphetamine versus alcohol use disorders.

PubMed

Morasco, Benjamin J; OʼNeil, Maya E; Duckart, Jonathan P; Ganzini, Linda

2014-01-01

Methamphetamine use disorders (MUD) are associated with severe health effects and psychiatric comorbidities, but little is known about the health care utilization of patients with MUD. The goal of this study was to describe health service use among veterans with MUD relative to a group of veterans with an alcohol use disorder (AUD). Using Veterans Affairs (VA) administrative data, we identified 718 patients who were diagnosed with MUD and had confirmatory drug testing. Data were compared with those of 744 patients who had diagnoses of an AUD also with confirmatory testing. We examined diagnoses and medical utilization for 5 years after their index date. Patients with MUD and laboratory-confirmed recent use were younger and more likely to be diagnosed with a mood disorder, posttraumatic stress disorder, and a psychotic-spectrum disorder (all P values < 0.05). After statistical controls, patients with MUD were more likely to have an inpatient hospitalization (80% vs 70%, odds ratio [OR] = 1.8; 95% confidence interval [CI] = 1.4-2.3), discharge from an inpatient admission against medical advice (23.4% vs 8.3%, OR = 2.6, 95% CI = 1.9-3.7), receive care at 3 or more VA medical centers (13.1% vs 5.4%, OR = 2.3, 95% CI = 1.5-3.5), have a behavioral flag in the medical record (5.6% vs 1.1%, OR = 4.6, 95% CI = 2.1-10.6), and have more total missed appointments in the 5-year study period (M = 33.1 vs M = 23.5, P < 0.001). Among veterans with substance use disorders, those with MUD and laboratory-confirmed recent use have additional behavioral, health care utilization, and psychiatric characteristics that need to be considered in developing programs of care.

Buprenorphine Treatment and Patient Use of Health Services after the Affordable Care Act in an Integrated Health Care System

PubMed Central

Campbell, Cynthia I.; Parthasarathy, Sujaya; Young-Wolff, Kelly C.; Satre, Derek D.

2017-01-01

Introduction The Affordable Care Act (ACA) was expected to benefit patients with substance use disorders, including opioid use disorders (OUDs). This study examined buprenorphine use and health services utilization by patients with OUDs pre- and post-ACA in a large health care system. Methods Using electronic health record data, we examined demographic and clinical characteristics (substance use, psychiatric and medical conditions) of two patient cohorts using buprenorphine: those newly enrolled in 2012 (“pre-ACA”, N=204) and in 2014 (“post-ACA”, N=258). Logistic and negative binomial regressions were used to model persistent buprenorphine use, and to examine whether persistent use was related to health services utilization. Results Buprenorphine patients were largely similar pre- and post-ACA, although more post-ACA patients had a marijuana use disorder (p<.01). Post-ACA patients were more likely to have high deductible benefit plans (p<.01). Use of psychiatry services was lower post-ACA (IRR: 0.56, p<.01), and high deductible plans were also related to lower use of psychiatry services (IRR: 0.30, p<.01). Conclusion The relationship between marijuana use disorder and prescription opioid use is complex, and deserves further study, particularly with increasingly widespread marijuana legalization. Access to psychiatry services may be more challenging for buprenorphine patients post-ACA, especially for patients with deductible plans. PMID:28426332

"Take the Volume Pledge" may result in disparity in access to care.

PubMed

Blanco, Barbara A; Kothari, Anai N; Blackwell, Robert H; Brownlee, Sarah A; Yau, Ryan M; Attisha, John P; Ezure, Yoshiki; Pappas, Sam; Kuo, Paul C; Abood, Gerard J

2017-03-01

"Take the Volume Pledge" proposes restricting pancreatectomies to hospitals that perform ≥20 per year. Our purpose was to identify those factors that characterize patients at risk for loss of access to pancreatic cancer care with enforcement of volume standards. Using the Healthcare Cost and Utilization Project State Inpatient Database from Florida, we identified patients who underwent pancreatectomy for pancreatic malignancy from 2007-2011. American Hospital Association and United States Census Bureau data were linked to patient-level data. High-volume hospitals were defined as performing ≥20 pancreatic resections per year. Univariable and multivariable statistics compared patient characteristics and utilization of high-volume hospitals. Classification and Regression Tree modeling was used to predict patients at risk for losing access to care. Our study included 1,663 patients. Five high-volume hospitals were identified, and they treated 1,056 (63.5%) patients. Patients residing far from high-volume hospitals, in areas with the highest population density, non-Caucasian ethnicity, and greater income had decreased odds of obtaining care at high-volume hospitals. Using these factors, we developed a Classification and Regression Tree-based predictive tool to identify these patients. Implementation of "Take the Volume Pledge" is an important step toward improving pancreatectomy outcomes; however, policymakers must consider the potential impact on limiting access and possible health disparities that may arise. Copyright © 2016 Elsevier Inc. All rights reserved.

[Current status of costs and utilizations of hospital based home health nursing care in Korea].

PubMed

Ryu, Hosihn

2006-12-01

The purpose of this study was to describe the current status of utilization and costs of home health nursing care by the levels of medical institutes in Korea. A secondary analysis of existing data was used from the national electronic data information(EDI) of 148 home health agencies for 6 months from May to Oct 2005 in total. The 148 agencies had multiple services in cerebral infaction, essential hypertension, sequela of cerebrovascular disease, type 2 diabetes mellitus, etc.. The highest 10 rankings of 76 categories of home health nursing services were composed of 96.4% of the total services, such as simple treatment, inflammatory treatment, urethra & bladder irrigation, inserting indwelling catheter etc., in that order. The highest 20 rankings of 226 categories of home examination services were composed of 77.0% of the total home examination services. In addition, the average cost of home health care per visit was 46,088 Won ( approximately 48 $, 1 $=960 Won). The costs ranged from 74,523 Won ( approximately 78 $, loss of chronic kidney function, N18) to 32,270 Won ( approximately 34 $, other cerebrovascular diseases, I67). Results suggest that client characteristics of hospital based HHNC are not different from community based HHNC or visiting nursing services for elderly. The national results will contribute to baseline data used to establish a policy for the home health nursing care system and education.

Spatial autocorrelation analysis of health care hotspots in Taiwan in 2006

PubMed Central

2009-01-01

Background Spatial analytical techniques and models are often used in epidemiology to identify spatial anomalies (hotspots) in disease regions. These analytical approaches can be used to not only identify the location of such hotspots, but also their spatial patterns. Methods In this study, we utilize spatial autocorrelation methodologies, including Global Moran's I and Local Getis-Ord statistics, to describe and map spatial clusters, and areas in which these are situated, for the 20 leading causes of death in Taiwan. In addition, we use the fit to a logistic regression model to test the characteristics of similarity and dissimilarity by gender. Results Gender is compared in efforts to formulate the common spatial risk. The mean found by local spatial autocorrelation analysis is utilized to identify spatial cluster patterns. There is naturally great interest in discovering the relationship between the leading causes of death and well-documented spatial risk factors. For example, in Taiwan, we found the geographical distribution of clusters where there is a prevalence of tuberculosis to closely correspond to the location of aboriginal townships. Conclusions Cluster mapping helps to clarify issues such as the spatial aspects of both internal and external correlations for leading health care events. This is of great aid in assessing spatial risk factors, which in turn facilitates the planning of the most advantageous types of health care policies and implementation of effective health care services. PMID:20003460

Postnatal Care Service Utilization and Associated Factors among Women Who Gave Birth in the Last 12 Months prior to the Study in Debre Markos Town, Northwestern Ethiopia: A Community-Based Cross-Sectional Study.

PubMed

Limenih, Miteku Andualem; Endale, Zerfu Mulaw; Dachew, Berihun Assefa

2016-01-01

Improving maternal and newborn health through proper postnatal care services under the care of skilled health personnel is the key strategy to reduce maternal and neonatal mortality. However, there were limited evidences on utilization of postnatal care services in Ethiopia. A community based cross-sectional study was conducted in Debremarkos town, Northwest Ethiopia. Cluster sampling technique was used to select 588 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with postnatal care utilization. Odds ratio with 95% confidence interval was computed to determine the level of significance. Postnatal care service utilization was found to be 33.5%. Awareness about maternal complication (AOR: 2.72, 95% CI (1.71, 4.34)), place of delivery of last child (AOR: 1.68, 95% CI: (1.01, 2.79)), outcome of birth (AOR: 2.71, 95% CI (1.19, 6.19)), delivery by cesarean section (AOR: 4.82, 95% CI (1.86, 12.54)), and delivery complication that occurred during birth (AOR: 2.58, 95% CI (1.56, 4.28)) were factors associated with postnatal care service utilization. Postnatal care service utilization was found to be low. Increasing awareness about postnatal care, preventing maternal and neonatal complication, and scheduling mothers based on the national postnatal care follow-up protocol would increase postnatal care service utilization.

The role of matched controls in building an evidence base for hospital-avoidance schemes: a retrospective evaluation.

PubMed

Steventon, Adam; Bardsley, Martin; Billings, John; Georghiou, Theo; Lewis, Geraint Hywel

2012-08-01

To test whether two hospital-avoidance interventions altered rates of hospital use: "intermediate care" and "integrated care teams." Linked administrative data for England covering the period 2004 to 2009. This study was commissioned after the interventions had been in place for several years. We developed a method based on retrospective analysis of person-level data comparing health care use of participants with that of prognostically matched controls. Individuals were linked to administrative datasets through a trusted intermediary and a unique patient identifier. Participants who received the intermediate care intervention showed higher rates of unscheduled hospital admission than matched controls, whereas recipients of the integrated care team intervention showed no difference. Both intervention groups showed higher rates of mortality than did their matched controls. These are potentially powerful techniques for assessing impacts on hospital activity. Neither intervention reduced admission rates. Although our analysis of hospital utilization controlled for a wide range of observable characteristics, the difference in mortality rates suggests that some residual confounding is likely. Evaluation is constrained when performed retrospectively, and careful interpretation is needed. © Health Research and Educational Trust.

The effect of an active shooter response intervention on hospital employees' response knowledge, perceived program usefulness, and perceived organizational preparedness.

PubMed

Landry, Gail; Zimbro, Kathie S; Morgan, Merri K; Maduro, Ralitsa S; Snyder, Tim; Sweeney, Nancy L

2018-04-02

Active shooter events occur frequently across the United States in a variety of locations, including health care facilities. Hospital health care worker response to an active shooter event may mean the difference in life or death for self or others. There is little research on how hospitals prepare nonmanagers to respond to active shooter events. We conducted a study to explore differences in knowledge, perceived organizational preparedness, and program utility following participation in an active shooter response program. Self-efficacy, personal characteristics, and professional characteristics were also explored. Program evaluation was conducted via a one-group pretest/posttest design. There was a significant increase in knowledge and perceived organizational preparedness postintervention. Trait-level self-efficacy did not have a significant effect on retained knowledge and perceived organizational preparedness. The current study is the first known to evaluate the efficacy of an active shooter response program for nonmanagers within an inpatient health care facility. Findings from this study may inform risk managers on how to educate employees on what to expect and how to react should an active shooter event occur. © 2018 American Society for Healthcare Risk Management of the American Hospital Association.

Dental caries in Victorian nursing homes.

PubMed

Silva, M; Hopcraft, M; Morgan, M

2014-09-01

The poor oral health of nursing home residents is the cause of substantial morbidity and has major implications relating to health care policy. The aim of this study was to measure dental caries experience in Australians living in nursing homes, and investigate associations with resident characteristics. Clinical dental examinations were conducted on 243 residents from 19 nursing homes in Melbourne. Resident characteristics were obtained from nursing home records and interviews with residents, family and nursing home staff. Two dental examiners assessed coronal and root dental caries using standard ICDAS-II criteria. Residents were elderly, medically compromised and functionally impaired. Most required assistance with oral hygiene and professional dental care was rarely utilized. Residents had high rates of coronal and root caries, with a mean 2.8 teeth with untreated coronal caries and 5.0 root surfaces with untreated root caries. Functional impairment and irregular professional dental care were associated with higher rates of untreated tooth decay. There were no significant associations with medical conditions or the number of medications taken. Nursing home residents have high levels of untreated coronal and root caries, particularly those with high needs due to functional impairment but poor access to professional services. © 2014 Australian Dental Association.

The effects of informal carers' characteristics on their information needs: The information needs state approach.

PubMed

Alzougool, Basil; Chang, Shanton; Gray, Kathleen

2017-09-01

There has been little research that provides a comprehensive account of the nature and aspects of information needs of informal carers. The authors have previously developed and validated a framework that accounts for major underlying states of information need. This paper aims to apply this framework to explore whether there are common demographic and socioeconomic characteristics that affect the information needs states of carers. A questionnaire about the information needs states was completed by 198 carers above 18 years old. We use statistical methods to look for similarities and differences in respondents' information needs states, in terms of the demographic and socioeconomic variables. At least one information needs state varies among carers, in terms of seven demographic and socioeconomic variables: the age of the patient(s) that they are caring for; the condition(s) of the patient(s) that they are caring for; the number of patients that they are caring for; their length of time as a carer; their gender; the country that they live in; and the population of the area that they live in. The findings demonstrate the utility of the information needs state framework. We outline some practical implications of the framework.

Characteristics of Medical Practices in Three Developed Managed Care Markets

PubMed Central

Landon, Bruce E; Normand, Sharon-Lise T; Frank, Richard; McNeil, Barbara J

2005-01-01

Objective To describe physician practices, ranging from solo and two-physician practices to large medical groups, in three geographically diverse parts of the country with strong managed care presences. Data Sources/Study Design Surveys of medical practices in three managed care markets conducted in 2000–2001. Study Design We administered questionnaires to all medical practices affiliated with two large health plans in Boston, MA, and Portland, OR, and to all practices providing primary care for cardiovascular disease patients admitted to five large hospitals in Minneapolis, MN. We offer data on how physician practices are structured under managed care in these geographically diverse regions of the country with a focus on the structural characteristics, financial arrangements, and care management strategies adopted by practices. Data Collection A two-staged survey consisting of an initial telephone survey that was undertaken using CATI (computerized assisted telephone interviewing) techniques followed by written modules triggered by specific responses to the telephone survey. Principal Findings We interviewed 468 practices encompassing 668 distinct sites of care (overall response rate 72 percent). Practices had an average of 13.9 member physicians (range: 1–125). Most (80.1 percent) medium- (four to nine physicians) and large-size (10 or more physicians) groups regularly scheduled meetings to discuss resource utilization and referrals. Almost 90 percent of the practices reported that these meetings occurred at least once per month. The predominant method for paying practices was via fee-for-service payments. Most other payments were in the form of capitation. Overall, 75 percent of physician practices compensated physicians based on productivity, but there was substantial variation related to practice size. Nonetheless, of the practices that did not use straight productivity methods (45 percent of medium-sized practices and 54 percent of large practices), most used arrangements consisting of combinations of salary and productivity formulas. Conclusions We found diversity in the characteristics and capabilities of medical practices in these three markets with high managed care involvement. Financial practices of most practices are geared towards rewarding productivity, and care management practices and capabilities such as electronic medical records remain underdeveloped. PMID:15960686

Characteristics of medical practices in three developed managed care markets.

PubMed

Landon, Bruce E; Normand, Sharon-Lise T; Frank, Richard; McNeil, Barbara J

2005-06-01

To describe physician practices, ranging from solo and two-physician practices to large medical groups, in three geographically diverse parts of the country with strong managed care presences. Surveys of medical practices in three managed care markets conducted in 2000-2001. We administered questionnaires to all medical practices affiliated with two large health plans in Boston, MA, and Portland, OR, and to all practices providing primary care for cardiovascular disease patients admitted to five large hospitals in Minneapolis, MN. We offer data on how physician practices are structured under managed care in these geographically diverse regions of the country with a focus on the structural characteristics, financial arrangements, and care management strategies adopted by practices. A two-staged survey consisting of an initial telephone survey that was undertaken using CATI (computerized assisted telephone interviewing) techniques followed by written modules triggered by specific responses to the telephone survey. We interviewed 468 practices encompassing 668 distinct sites of care (overall response rate 72 percent). Practices had an average of 13.9 member physicians (range: 1-125). Most (80.1 percent) medium- (four to nine physicians) and large-size (10 or more physicians) groups regularly scheduled meetings to discuss resource utilization and referrals. Almost 90 percent of the practices reported that these meetings occurred at least once per month. The predominant method for paying practices was via fee-for-service payments. Most other payments were in the form of capitation. Overall, 75 percent of physician practices compensated physicians based on productivity, but there was substantial variation related to practice size. Nonetheless, of the practices that did not use straight productivity methods (45 percent of medium-sized practices and 54 percent of large practices), most used arrangements consisting of combinations of salary and productivity formulas. We found diversity in the characteristics and capabilities of medical practices in these three markets with high managed care involvement. Financial practices of most practices are geared towards rewarding productivity, and care management practices and capabilities such as electronic medical records remain underdeveloped.

Determinants of postnatal care utilization in urban community among women in Debre Birhan Town, Northern Shewa, Ethiopia.

PubMed

Angore, Banchalem Nega; Tufa, Efrata Girma; Bisetegen, Fithamlak Solomon

2018-04-19

Reducing maternal mortality and improving maternal health care through increased utilization of postnatal care utilization is a global and local priority. However studies that have been carried out in Ethiopia regarding determinants are limited. So This study aims to assess the magnitude of postnatal care utilization and its determinants in Debre Birhan Town, North Ethiopia. A community-based cross-sectional study was conducted from March 1 to April 25, 2015, in Debre Birhan Town. Data were collected through face-to-face interviews using structured pre-tested questionnaires. The data were entered and cleaned in Epi Info version 3.5 and analyzed using SPSS version 20. Bivariate and multiple logistic regression analyses were used. Variable with p value less than or equal to 0.2 at bivariate analysis were entered into multiple logistic regression. Significance was declared at 0.05 in multiple logistic regressions and considered to be an independent factor. From the total respondents, we found that 327 (83.3%) mothers utilized the postnatal care services. Single mothers were less likely to utilize postnatal care services than those mothers who are married and live together [adjusted odds ratio (AOR) = 0.06, 95% CI (0.01, 0.45)]. This study revealed that respondent's knowledge about postnatal care services is an important predictor of postnatal care utilization [AOR = 0.03, 95% CI (0.00, 0.44)] and mothers who delivered in a health care facility were more likely to receive PNC than mothers who did not deliver in a health care facility [AOR = 0.65, 95% CI (0.58, 0.94)]. The postnatal care utilization rate in Debre Birhan town was 83.3%. Marital status, maternal knowledge, and place of delivery were predictors of postnatal care service utilization. So specific attention should be directed towards the improvement of women's education since the perception of the need for PNC services were positively correlated with the mother's education.

The Effects of Geography and Spatial Behavior on Health Care Utilization among the Residents of a Rural Region

PubMed Central

Arcury, Thomas A; Gesler, Wilbert M; Preisser, John S; Sherman, Jill; Spencer, John; Perin, Jamie

2005-01-01

Objective This analysis determines the importance of geography and spatial behavior as predisposing and enabling factors in rural health care utilization, controlling for demographic, social, cultural, and health status factors. Data Sources A survey of 1,059 adults in 12 rural Appalachian North Carolina counties. Study Design This cross-sectional study used a three-stage sampling design stratified by county and ethnicity. Preliminary analysis of health services utilization compared weighted proportions of number of health care visits in the previous 12 months for regular check-up care, chronic care, and acute care across geographic, sociodemographic, cultural, and health variables. Multivariable logistic models identified independent correlates of health services utilization. Data Collection Methods Respondents answered standard survey questions. They located places in which they engaged health related and normal day-to-day activities; these data were entered into a geographic information system for analysis. Principal Findings Several geographic and spatial behavior factors, including having a driver's license, use of provided rides, and distance for regular care, were significantly related to health care utilization for regular check-up and chronic care in the bivariate analysis. In the multivariate model, having a driver's license and distance for regular care remained significant, as did several predisposing (age, gender, ethnicity), enabling (household income), and need (physical and mental health measures, number of conditions). Geographic measures, as predisposing and enabling factors, were related to regular check-up and chronic care, but not to acute care visits. Conclusions These results show the importance of geographic and spatial behavior factors in rural health care utilization. They also indicate continuing inequity in rural health care utilization that must be addressed in public policy. PMID:15663706

The changing pattern of prenatal care utilization in the United States, 1981-1995, using different prenatal care indices.

PubMed

Kogan, M D; Martin, J A; Alexander, G R; Kotelchuck, M; Ventura, S J; Frigoletto, F D

1998-05-27

Two measures traditionally used to examine adequacy of prenatal care indicate that prenatal care utilization remained unchanged through the 1980s and only began to rise slightly in the 1990s. In recent years, new measures have been developed that include a category for women who receive more than the recommended amount of care (intensive utilization). To compare the older and newer indices in the monitoring of prenatal care trends in the United States from 1981 to 1995, for the overall population and for selected subpopulations. Second, to examine factors associated with receiving intensive utilization. Cross-sectional and trend analysis of national birth records. The United States. All live births between 1981 and 1995 (N=54 million). Trends in prenatal care utilization, according to 4 indices (the older indices: the Institute of Medicine Index and the trimester that care began, and the newer indices: the R-GINDEX and the Adequacy of Prenatal Care Utilization Index). Multiple logistic regression was used to assess the risk of intensive prenatal care use in 1981 and 1995. The newer indices showed a steadily increasing trend toward more prenatal care use throughout the study period (R-GINDEX, intensive or adequate use, 32.7% in 1981 to 47.1 % in 1995; the Adequacy of Prenatal Care Utilization Index, intensive use, 18.4% in 1981 to 28.8% in 1995), especially for intensive utilization. Women having a multiple birth were much more likely to have had intensive utilization in 1995 compared with 1981 (R-GINDEX, 22.8% vs 8.5%). Teenagers were more likely to begin care later than adults, but similar proportions of teens and adults had intensive utilization. Intensive use among low-risk women also increased steadily each year. Factors associated with a greater likelihood of receiving intensive use in 1981 and 1995 were having a multiple birth, primiparity, being married, and maternal age of 35 years or older. The proportion of women who began care early and received at least the recommended number of visits increased between 1981 and 1995. This change was undetected by more traditional prenatal care indices. These increases have cost and practice implications and suggest a paradox since previous studies have shown that rates of preterm delivery and low birth weight did not improve during this time.

Utilization of smoking cessation medication benefits among medicaid fee-for-service enrollees 1999-2008.

PubMed

Kahende, Jennifer; Malarcher, Ann; England, Lucinda; Zhang, Lei; Mowery, Paul; Xu, Xin; Sevilimedu, Varadan; Rolle, Italia

2017-01-01

To assess state coverage and utilization of Medicaid smoking cessation medication benefits among fee-for-service enrollees who smoked cigarettes. We used the linked National Health Interview Survey (survey years 1995, 1997-2005) and the Medicaid Analytic eXtract files (1999-2008) to assess utilization of smoking cessation medication benefits among 5,982 cigarette smokers aged 18-64 years enrolled in Medicaid fee-for-service whose state Medicaid insurance covered at least one cessation medication. We excluded visits during pregnancy, and those covered by managed care or under dual enrollment (Medicaid and Medicare). Multivariate logistic regression was used to determine correlates of cessation medication benefit utilization among Medicaid fee-for-service enrollees, including measures of drug coverage (comprehensive cessation medication coverage, number of medications in state benefit, varenicline coverage), individual-level demographics at NHIS interview, age at Medicaid enrollment, and state-level cigarette excise taxes, statewide smoke-free laws, and per-capita tobacco control funding. In 1999, the percent of smokers with ≥1 medication claims was 5.7% in the 30 states that covered at least one Food and Drug Administration (FDA)-approved cessation medication; this increased to 9.9% in 2008 in the 44 states that covered at least one FDA-approved medication (p<0.01). Cessation medication utilization was greater among older individuals (≥ 25 years), females, non-Hispanic whites, and those with higher educational attainment. Comprehensive coverage, the number of smoking cessation medications covered and varenicline coverage were all positively associated with utilization; cigarette excise tax and per-capita tobacco control funding were also positively associated with utilization. Utilization of medication benefits among fee-for-service Medicaid enrollees increased from 1999-2008 and varied by individual and state-level characteristics. Given that the Affordable Care Act bars state Medicaid programs from excluding any FDA-approved cessation medications from coverage as of January 2014, monitoring Medicaid cessation medication claims may be beneficial for informing efforts to increase utilization and maximize smoking cessation.

Utilization of palliative care services for cardiac arrest patients undergoing therapeutic hypothermia: A retrospective analysis.

PubMed

Zern, Emily K; Young, Michael N; Triana, Taylor; Xu, Meng; Holmes, Benjamin; Borges, Nyal; McPherson, John A; Karlekar, Mohana B

2017-03-01

Palliative care (PC) services are integral to the care of patients with advanced medical illnesses. Given the significant morbidity and mortality associated with cardiac arrest, we sought to measure the use and impact of PC in the care of patients treated with therapeutic hypothermia (TH). We conducted a retrospective study of 317 consecutive patients undergoing TH after cardiac arrest. We compared intensive care unit (ICU) characteristics and clinical outcomes of subjects who received PC consultation (n=125) to those who did not (n=192). The proportion of TH patients with PC consultations increased to greater than 60% by 2013, corresponding to our institution's expansion of PC services, development of a dedicated PC unit, and integration of this service into our published TH protocol. In the TH population, time to return of spontaneous circulation (ROSC) was associated with higher inpatient mortality (p<0.001) and placement of a PC consult (p=0.011). TH patients who received PC consultation had longer ICU stays (p=0.034), more ventilator days (p<0.001), and higher inpatient mortality (p<0.001). When these measures were analyzed cohort-wide comparing all TH patients pre- and post-2013, at which time the frequency of PC consultation had dramatically increased, there were no statistically significant differences in ICU care or outcomes. In our population of cardiac arrest patients undergoing TH, the utilization of PC services has increased over time, particularly for those patients with high morbidity and mortality. Future randomized studies may further delineate optimal patient selection for PC consultation to better facilitate goals of care discussions and timely medical decision-making. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Medical Costs and Healthcare Utilization among Cancer Decedents in the Last Year of Life in 2009.

PubMed

Hwang, Inuk; Shin, Dong Wook; Kang, Kyoung Hee; Yang, Hyung Kook; Kim, So Young; Park, Jong-Hyock

2016-01-01

The purpose of this study was to evaluate the cancer care cost during the last year of life of patients in Korea. We studied the breakdown of spending on the components of cancer care. Cancer decedents in 2009 were identified from the Korean Central Cancer Registry and linked with the Korean National Health Insurance Claims Database. The final number of patients included in the study was 70,558. In 2009, the average cancer care cost during the last year of life was US $15,720. Patients under age 20 spent US $53,890 while those 70 or over spent US $11,801. Those with leukemia incurred the highest costs (US $43,219) while bladder cancer patients spent the least (US $13,155). General costs, drugs other than analgesics, and test fees were relatively high (29.7%, 23.8%, and 20.7% of total medical costs, respectively). Analgesic drugs, rehabilitation, and psychotherapy were still relatively low (4.3%, 0.7%, and 0.1%, respectively). Among the results of multiple regression analysis, few were notable. Age was found to be negatively related to cancer care costs while income level was positively associated. Those classified under distant Surveillance, Epidemiology, and End Results stages of cancer and higher comorbidity level also incurred higher cancer care costs. Average cancer care costs varied significantly by patient characteristics. However, the study results suggest an underutilization of support services likely due to lack of alternative accommodations for terminal cancer patients. Further examination of utilization patterns of healthcare resources will help provide tailored evidence for policymakers in efforts to reduce the burdens of cancer care.

Managed care and inpatient mortality in adults: effect of primary payer.

PubMed

Hines, Anika L; Raetzman, Susan O; Barrett, Marguerite L; Moy, Ernest; Andrews, Roxanne M

2017-02-08

Because managed care is increasingly prevalent in health care finance and delivery, it is important to ascertain its effects on health care quality relative to that of fee-for-service plans. Some stakeholders are concerned that basing gatekeeping, provider selection, and utilization management on cost may lower quality of care. To date, research on this topic has been inconclusive, largely because of variation in research methods and covariates. Patient age has been the only consistently evaluated outcome predictor. This study provides a comprehensive assessment of the association between managed care and inpatient mortality for Medicare and privately insured patients. A cross-sectional design was used to examine the association between managed care and inpatient mortality for four common inpatient conditions. Data from the 2009 Healthcare Cost and Utilization Project State Inpatient Databases for 11 states were linked to data from the American Hospital Association Annual Survey Database. Hospital discharges were categorized as managed care or fee for service. A phased approach to multivariate logistic modeling examined the likelihood of inpatient mortality when adjusting for individual patient and hospital characteristics and for county fixed effects. Results showed different effects of managed care for Medicare and privately insured patients. Privately insured patients in managed care had an advantage over their fee-for-service counterparts in inpatient mortality for acute myocardial infarction, stroke, pneumonia, and congestive heart failure; no such advantage was found for the Medicare managed care population. To the extent that the study showed a protective effect of privately insured managed care, it was driven by individuals aged 65 years and older, who had consistently better outcomes than their non-managed care counterparts. Privately insured patients in managed care plans, especially older adults, had better outcomes than those in fee-for-service plans. Patients in Medicare managed care had outcomes similar to those in Medicare FFS. Additional research is needed to understand the role of patient selection, hospital quality, and differences among county populations in the decreased odds of inpatient mortality among patients in private managed care and to determine why this result does not hold for Medicare.

The care dependency scale for measuring basic human needs: an international comparison.

PubMed

Dijkstra, Ate; Yönt, Gülendam Hakverdioğlu; Korhan, Esra Akin; Muszalik, Marta; Kędziora-Kornatowska, Kornelia; Suzuki, Mizue

2012-10-01

To report a study conducted to compare the utility of the care dependency scale across four countries. The care dependency scale provides a framework for assessing the needs of institutionalized patients for nursing care. Henderson's components of nursing care have been used to specify the variable aspects of the concept of care dependency and to develop the care dependency scale items. The study used a cross-cultural survey design. Patients were recruited from four different countries: Japan, The Netherlands, Poland and Turkey. In each of the participating countries, basic human needs were assessed by nurses using a translated version of the original Dutch care dependency scale. Psychometric properties in terms of reliability and validity of the care dependency scale have been assessed using Cronbach's alpha, Guttman's lambda-2, inter-item correlation and principal components analysis. Data were collected in 2008 and 2009. High internal consistency values were demonstrated. Principal component analysis confirmed the one-factor model reported in earlier studies. Outcomes confirm Henderson's idea that human needs are fundamental appearing in every patient-nurse relationship, independent of the patient's age, the type of care setting and/or cultural background. The psychometric characteristics of the care dependency scale make this instrument very useful for comparative research across countries. © 2012 Blackwell Publishing Ltd.

Characteristics, Access, Utilization, Satisfaction, and Outcomes of Healthy Start Participants in Eight Sites

PubMed Central

O’Neil, So; Cook, Benjamin; Trebino, Lisa; Walker, Deborah Klein

2009-01-01

To describe the characteristics, access, utilization, satisfaction, and outcomes of Healthy Start participants in eight selected sites, a survey of Healthy Start participants with infants ages 6–12-months-old at time of interview was conducted between October 2006 and January 2007. The response rate was 66% (n = 646), ranging from 37% in one site to >70% in seven sites. Healthy Start participants’ outcomes were compared to two national benchmarks. Healthy Start participants reported that they were satisfied with the program (>90% on five measures). Level of unmet need was 6% or less for most services, except for dental appointments (11%), housing (13%), and child care (11%). Infants had significantly better access to medical care than did their mothers, with higher rates of insurance coverage, medical homes, and checkups, and fewer unmet needs for health care. Healthy Start participants’ rates of ever breastfeeding (72%) and putting infants to sleep on their backs (70%) were at or near the Healthy People 2010 objectives, and considerably higher than rates among low-income mothers in the ECLS. The high rate of health education (>90%) may have contributed to these outcomes. Elimination of smoking among Healthy Start participants (46%) fell short of the Healthy People 2010 objective (99%). The low-birth weight (LBW) rate among Black Healthy Start participants (14%) was three times higher than the rate for Whites and Hispanics (5% each). Overall, the LBW rate in the eight sites (7.5%) was similar to the rate for low-income mothers in the ECLS, but both rates were above the Healthy People 2010 objective (5%). Challenges remain in reducing disparities in maternal and child health outcomes. Further attention to risk factors associated with LBW (especially smoking) may help close the gaps. The life course theory suggests that improved outcomes may require longer-term investments. Healthy Start’s emerging focus on interconception care has the potential to address longer-term needs of participants. PMID:19590941

42 CFR 456.381 - Reports of evaluations and plans of care.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care... evaluation and plan of care must be entered in the applicant's or recipient's record— (a) At the time of... plan. Utilization Review (UR) Plan: General Requirement ...

42 CFR 456.381 - Reports of evaluations and plans of care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care... evaluation and plan of care must be entered in the applicant's or recipient's record— (a) At the time of... plan. Utilization Review (UR) Plan: General Requirement ...

Perceived Health Status and Utilization of Specialty Care: Racial and Ethnic Disparities in Patients with Chronic Diseases

ERIC Educational Resources Information Center

Glover, Saundra; Bellinger, Jessica D.; Bae, Sejong; Rivers, Patrick A.; Singh, Karan P.

2010-01-01

Objective: The objective of this study is to determine racial and ethnic variations in specialty care utilization based on (a) perceived health status and (b) chronic disease status. Methods: Variations in specialty care utilization, by perceived health and chronic disease status, were examined using the Commonwealth Fund Health Care Quality…

Social relationships and physician utilization among older adults-A systematic review.

PubMed

Bremer, Daniel; Inhestern, Laura; von dem Knesebeck, Olaf

2017-01-01

In older age health needs and demand for health services utilization increase. Individual's social relationships can play a decisive role regarding the utilization of outpatient health care services. This systematic review examines the associations of structural and functional dimensions of social relationships with outpatient health services use of older adults. The databases PubMed, CINAHL, SocINDEX, PsycINFO, International Bibliography of the Social Sciences (IBSS), Sociological Abstracts, and Applied Social Sciences Index and Abstracts (ASSIA) were searched in February 2016. The methodological and reporting quality of the articles was assessed and the results were synthesized descriptively and systematically. Out of 1.392 hits, 36 articles (35 studies) were included in the systematic review. The methodological and reporting quality of the included articles was reasonable. Various structural and functional characteristics of social relationships were associated with the use (yes/no) and the frequency of using outpatient care among older adults. The majority of the associations between structural dimensions of social relationships and the use of physicians were positive and moderate in strength. The associations between functional dimensions of social relationships and the probability of using physician services were inconsistent and varied in strength. For the most part, social relationship variables assigned to the structural dimension were positively and weakly to moderately associated with the frequency of physician visits. Functional aspects of social relationships also tended to have positive associations with the frequency of physician utilization. The associations were weak to moderate in strength. Measuring social relationships and their influence on health services use is a challenging methodological endeavor indicated by the inconclusive results. The results suggest that the outpatient care utilization behavior of older individuals being structurally and functionally integrated in social relationships is different to older adults being socially isolated or having no social support. All in all, the current status of quantitative data was insufficient. Future health services research should accentuate social ties in more detail, especially according to quality aspects of social relationships.

Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention

PubMed Central

2012-01-01

Background The top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of attendance last more than two years, they may become persistent (persistent frequent or regular attendance). However, there is no long-term study of the economic impact or clinical characteristics of regular attendance in primary care. Cognitive behaviour formulation and treatment (CBT) for regular attendance as a motivated behaviour may offer an understanding of the development, maintenance and treatment of regular attendance in the context of their health problems, cognitive processes and social context. Methods/design A case control design will compare the clinical characteristics, patterns of health care use and economic costs over the last 10 years of 100 regular attenders (≥30 appointments with general practitioner [GP] over 2 years) with 100 normal attenders (6–22 appointments with GP over 2 years), from purposefully selected primary care practices with differing organisation of care and patient demographics. Qualitative interviews with regular attending patients and practice staff will explore patient barriers, drivers and experiences of consultation, and organisation of care by practices with its challenges. Cognitive behaviour formulation analysed thematically will explore the development, maintenance and therapeutic opportunities for management in regular attenders. The feasibility, acceptability and utility of CBT for regular attendance will be examined. Discussion The health care costs, clinical needs, patient motivation for consultation and organisation of care for persistent frequent or regular attendance in primary care will be explored to develop training and policies for service providers. CBT for regular attendance will be piloted with a view to developing this approach as part of a multifaceted intervention. PMID:22607525

NursesforTomorrow: a proactive approach to nursing resource analysis.

PubMed

Bournes, Debra A; Plummer, Carolyn; Miller, Robert; Ferguson-Paré, Mary

2010-03-01

This paper describes the background, development, implementation and utilization of NursesforTomorrow (N4T), a practical and comprehensive nursing human resources analysis method to capture regional, institutional and patient care unit-specific actual and predicted nurse vacancies, nurse staff characteristics and nurse staffing changes. Reports generated from the process include forecasted shortfalls or surpluses of nurses, percentage of novice nurses, occupancy, sick time, overtime, agency use and other metrics. Readers will benefit from a description of the ways in which the data generated from the nursing resource analysis process are utilized at senior leadership, program and unit levels to support proactive hiring and resource allocation decisions and to predict unit-specific recruitment and retention patterns across multiple healthcare organizations and regions.

A Description of the Practice Pattern Characteristics of Anesthesia Care In Small, Medium and Large Teaching and Non-Teaching Medical Treatment Facilities in the Air Force

DTIC Science & Technology

1998-10-01

Lidocaine and Rocuronium ; others, Bupivicaine, Cisatricurium and vi Remifentanyl are rarely used. Subarachniod block is the technique most utilized by all...Succinycholine by Air Force Anesthesia Providers......……................41 Figure 10. Use of Rocuronium by Air Force Anesthesia Providers...Succinylcholine’s quick onset and short duration of action, the newest of which is Rocuronium . Although Rocuronium approaches Succinycholine in quick onset its xlii

Persistent Super-Utilization of Acute Care Services Among Subgroups of Veterans Experiencing Homelessness.

PubMed

Szymkowiak, Dorota; Montgomery, Ann Elizabeth; Johnson, Erin E; Manning, Todd; O'Toole, Thomas P

2017-10-01

Acute health care utilization often occurs among persons experiencing homelessness. However, knowing which individuals will be persistent super-utilizers of acute care is less well understood. The objective of the study was to identify those more likely to be persistent super-utilizers of acute care services. We conducted a latent class analysis of secondary data from the Veterans Health Administration Corporate Data Warehouse, and Homeless Operations Management and Evaluation System. The study sample included 16,912 veterans who experienced homelessness and met super-utilizer criteria in any quarter between July 1, 2014 and December 31, 2015. The latent class analysis included veterans' diagnoses and acute care utilization. Medical, mental health, and substance use morbidity rates were high. More than half of the sample utilized Veterans Health Administration Homeless Programs concurrently with their super-utilization of acute care. There were 7 subgroups of super-utilizers, which varied considerably on the degree to which their super-utilization persisted over time. Approximately a third of the sample met super-utilizer criteria for ≥3 quarters; this group was older and disproportionately male, non-Hispanic white, and unmarried, with lower rates of post-9/11 service and higher rates of rural residence and service-connected disability. They were much more likely to be currently homeless with more medical, mental health, and substance use morbidity. Only a subset of homeless veterans were persistent super-utilizers, suggesting the need for more targeted interventions.

Does Access to Care Still Affect Health Care Utilization by Immigrants? Testing of an Empirical Explanatory Model of Health Care Utilization by Korean American Immigrants with High Blood Pressure

PubMed Central

Han, Hae-Ra; Lee, Jong-Eun; Kim, Ji-Yun; Kim, Kim B.; Ryu, Jai Poong; Kim, Miyong

2015-01-01

Despite well-known benefits of health care utilization for the effective management of chronic diseases, the underlying mechanism of understanding health care utilization in ethnic minority population has not been systematically explored. The purpose of this paper is to examine the predictive ability of a health care utilization model by analyzing the interplay between predisposing, enabling, and need factors. The sample consisted of hypertensive Korean American immigrants (KAIs) 40–64 years of age who participated in a self-help intervention for high blood pressure care (SHIP-HBP). Using structured questionnaires, data were collected from 445 KAIs at baseline and analyzed with path analysis. Insurance status and relevant medical history were not just strong direct effects but also carried the most total effect on the health care utilization of these patients. Life priorities, years of residence in the US and perceived income level exerted indirect effects through the participants’ insurance status. Our statistical analysis indicated a good fit for the proposed model (x2 = 28.4, P = 0.29; NFI = 0.91; CFI = 0.99; RMSEA = 0.02). Overall, the model explained 18% of the variance in health care utilization of hypertensive KAIs. These findings strongly support a need to improve access to health care for KAIs by introducing a variety of community resources and building sustainable community infrastructures. PMID:19649709

Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population

PubMed Central

Pasquale, Margaret K; Sun, Shawn X; Song, Frank; Hartnett, Heather J; Stemkowski, Stephen A

2012-01-01

Background Exacerbations of chronic obstructive pulmonary disease (COPD) lead to significant increases in resource utilization and cost to the health care system. COPD patients with chronic bronchitis and a history of exacerbations pose an additional burden to the system. This study examined health care utilization and cost among these patients. Methods For this retrospective analysis, data were extracted from a large national health plan with a predominantly Medicare population. This study involved patients who were aged 40–89 years, had been enrolled continuously for 24 months or more, had at least two separate insurance claims for COPD with chronic bronchitis (International Classification of Diseases, Ninth Revision, Clinical Modification code 491.xx), and had pharmacy claims for COPD maintenance medications between January 1, 2007, and March 31, 2009. Two years of data were examined for each patient; the index date was defined as the first occurrence of COPD. Baseline characteristics were obtained from the first year of data, with health outcomes tracked in the second year. Severe exacerbation was defined by COPD-related hospitalization or death; moderate exacerbation was defined by oral or parenteral corticosteroid use. Adjusted numbers of exacerbations and COPD-related costs per patient were estimated controlling for demographic and clinical characteristics. Results The final study sample involved 8554 patients; mean age was 70.1 ± 8.6 years and 49.8% of the overall population had exacerbation, 13.9% had a severe exacerbation only, 29.1% had a moderate exacerbation only, and 6.8% had both a severe and moderate exacerbation. COPD-related mean annual costs were $4069 (all figures given in US dollars) for the overall population and $6381 for patients with two or more exacerbations. All-cause health care costs were $18,976 for the overall population and $23,901 for patients with history of two or more exacerbations. Severity of exacerbations, presence of cardiovascular disease, diabetes, and long-term oxygen use were associated with higher adjusted costs. Conclusions The results indicate that despite treatment with maintenance medications, COPD patients continue to have exacerbations resulting in higher costs. New medications and disease management interventions are warranted to reduce the severity and frequency of exacerbations and the related cost impact of the disease. PMID:23152680

Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population.

PubMed

Pasquale, Margaret K; Sun, Shawn X; Song, Frank; Hartnett, Heather J; Stemkowski, Stephen A

2012-01-01

Exacerbations of chronic obstructive pulmonary disease (COPD) lead to significant increases in resource utilization and cost to the health care system. COPD patients with chronic bronchitis and a history of exacerbations pose an additional burden to the system. This study examined health care utilization and cost among these patients. For this retrospective analysis, data were extracted from a large national health plan with a predominantly Medicare population. This study involved patients who were aged 40-89 years, had been enrolled continuously for 24 months or more, had at least two separate insurance claims for COPD with chronic bronchitis (International Classification of Diseases, Ninth Revision, Clinical Modification code 491.xx), and had pharmacy claims for COPD maintenance medications between January 1, 2007, and March 31, 2009. Two years of data were examined for each patient; the index date was defined as the first occurrence of COPD. Baseline characteristics were obtained from the first year of data, with health outcomes tracked in the second year. Severe exacerbation was defined by COPD-related hospitalization or death; moderate exacerbation was defined by oral or parenteral corticosteroid use. Adjusted numbers of exacerbations and COPD-related costs per patient were estimated controlling for demographic and clinical characteristics. The final study sample involved 8554 patients; mean age was 70.1±8.6 years and 49.8% of the overall population had exacerbation, 13.9% had a severe exacerbation only, 29.1% had a moderate exacerbation only, and 6.8% had both a severe and moderate exacerbation. COPD-related mean annual costs were $4069 (all figures given in US dollars) for the overall population and $6381 for patients with two or more exacerbations. All-cause health care costs were $18,976 for the overall population and $23,901 for patients with history of two or more exacerbations. Severity of exacerbations, presence of cardiovascular disease, diabetes, and long-term oxygen use were associated with higher adjusted costs. The results indicate that despite treatment with maintenance medications, COPD patients continue to have exacerbations resulting in higher costs. New medications and disease management interventions are warranted to reduce the severity and frequency of exacerbations and the related cost impact of the disease.

Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness.

PubMed

Lavin, Kyle; Davydow, Dimitry S; Downey, Lois; Engelberg, Ruth A; Dunlap, Ben; Sibley, James; Lober, William B; Okimoto, Kelson; Khandelwal, Nita; Loggers, Elizabeth T; Teno, Joan M; Curtis, J Randall

2017-08-01

Little is known about psychiatric illness and utilization of end-of-life care. We hypothesized that preexisting psychiatric illness would increase hospital utilization at end of life among patients with chronic medical illness due to increased severity of illness and care fragmentation. We reviewed electronic health records to identify decedents with one or more of eight chronic medical conditions based on International Classification of Diseases-9 codes. We used International Classification of Diseases-9 codes and prescription information to identify preexisting psychiatric illness. Regression models compared hospital utilization among patients with and without psychiatric illness. Path analyses examined the effect of severity of illness and care fragmentation. Eleven percent of 16,214 patients with medical illness had preexisting psychiatric illness, which was associated with increased risk of death in nursing homes (P = 0.002) and decreased risk of death in hospitals (P < 0.001). In the last 30 days of life, psychiatric illness was associated with reduced inpatient and intensive care unit utilization but increased emergency department utilization. Path analyses confirmed an association between psychiatric illness and increased hospital utilization mediated by severity of illness and care fragmentation, but a stronger direct effect of psychiatric illness decreasing hospitalizations. Our findings differ from the increased hospital utilization for patients with psychiatric illness in circumstances other than end-of-life care. Path analyses confirmed hypothesized associations between psychiatric illness and increased utilization mediated by severity of illness and care fragmentation but identified more powerful direct effects decreasing hospital use. Further investigation should examine whether this effect represents a disparity in access to preferred care. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Medical team interdependence as a determinant of use of clinical resources.

PubMed Central

Sicotte, C; Pineault, R; Lambert, J

1993-01-01

OBJECTIVE. Our objective, based on organization theory, is to examine whether interdependence among physicians leads to coordination problems that in turn may explain variations observed in the use of clinical resources. DATA SOURCES/STUDY SETTING. Secondary data about episodes of in-hospital care were collected over a 14-month period in two midsize acute care hospitals located in two suburbs of Montreal, Quebec. STUDY DESIGN. Hierarchical regression analysis was used to assess the marginal effect of medical team interdependence on clinical resource utilization after taking into account the effect attributable to the nature of several morbidities taken as specific and distinct tasks. PRINCIPAL FINDINGS. Medical team interdependence is found within medical specialties as well as between specialties. The largest portion of resource utilization was explained by morbidity characteristics, whereas team interdependence had a weaker, but systematic effect for all morbidities studied (15 regression models out of 18 performed). Task coordination was found to become more difficult as the number of physicians coming from different specialties increased in the context of teamwork. CONCLUSIONS. Results suggest that team practice does not entirely overcome coordination problems inherent to task (morbidity) interdependence. In considering the individual (especially the attending) physician as the main factor responsible for resource utilization, other factors related to team practice may too readily be overlooked. PMID:8270423

Factors influencing healthcare utilization among children with pneumonia in Muntinlupa City, the Philippines.

PubMed

Kim, Soon Ae; Capeding, Maria Rosario Z; Kilgore, Paul E

2014-05-01

We evaluated the factors influencing healthcare utilization among children aged < 5 years with pneumonia symptoms in Muntinlupa City, the Philippines. We interviewed 1,330 caregivers from 190 households per district in seven districts from March to April, 2009 using a standardized questionnaire to obtain information about demographic characteristics, access to healthcare facilities, and potential barriers to healthcare utilization. The mean age of the children was 32 months; 54.7% were boys. Seventy-four point three percents (n = 972) of caregivers stated when their child had pneumonia symptoms they brought them to a government health center, 14.1% (n = 184) went to a private clinic, 8.0% (n = 104) went to a hospital, 3% (n = 40) were treated at home and 0.5% (n = 7) received traditional medicine from a local healer. Caregivers required an average of 12 minutes to reach a healthcare facility. Reasons given by caregivers for their choice of healthcare facility were low cost (47.5%), availability and accessibility to transportation (29.6%) and perceived good quality of care (16.5%). In conclusion, nearly three quarters of caregivers interviewed brought their child with pneumonia symptoms to a government health center for treatment. Cost was the main factor influencing choice, followed by transportation availability and quality of care.

Effect of private health insurance on health care utilization in a universal public insurance system: a case of South Korea.

PubMed

Jeon, Boyoung; Kwon, Soonman

2013-11-01

This study examined the effect of private health insurance (PHI) on health care utilization in South Korea using a nationally representative sample of 9512 adults participating in Korea Health Panel Survey (KHPS). We compared the health care utilization and subsequent expenditure according to whether or not and how many PHIs are purchased, controlling for the endogeneity of insurance purchase by propensity score matching method and Heckman-type treatment effect model. The results of this study show that the probability of any health care utilization, both outpatient care and inpatient care, is higher for the people who have PHI. For those who utilize health care, PHI has a positive impact on outpatient expenditure, but not on the number of outpatient visits. The effect of PHI on the number of inpatient days and expenditure is not statistically significant among the users of inpatient care. These results imply a need for policy options to mitigate the moral hazard effect of PHI in the outpatient care sector. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Impact of the health insurance scheme for stateless people on inpatient utilization in Kraburi Hospital, Thailand

PubMed Central

Suphanchaimat, Rapeepong; Prakongsai, Phusit; Limwattananon, Supon; Mills, Anne

2016-01-01

Objectives This study sought to investigate the impact of the Thai “Health Insurance for People with Citizenship Problems” (HI-PCP) on access to care for stateless patients, compared to Universal Coverage Scheme patients and the uninsured, using inpatient utilization as a proxy for impact. Methods Secondary data analysis of inpatient records of Kraburi Hospital, Ranong province, between 2009 (pre-policy) and 2012 (post-policy) was employed. Descriptive statistics and multivariate analysis by difference-in-difference model were performed. Results The volume of inpatient service utilization by stateless patients expanded after the introduction of the HI-PCP. However, this increase did not appear to stem from the HI-PCP per se. After controlling for key covariates, including patients’ characteristics, disease condition, and domicile, there was only a weak positive association between the HI-PCP and utilization. Critical factors contributing significantly to increased utilization were older age, proximity to the hospital, and presence of catastrophic illness. Conclusion A potential explanation for the insignificant impact of the HI-PCP on access to inpatient care of stateless patients is likely to be a lack of awareness of the existence of the scheme among the stateless population and local health staff. This problem is likely to have been accentuated by operational constraints in policy implementation, including the poor performance of local offices in registering stateless people. A key limitation of this study is a lack of data on patients who did not visit the health facility at the first opportunity. Further study of health-seeking behavior of stateless people at the household level is recommended. PMID:27942240

Longitudinal Analysis of Inpatient Care Utilization among People with Intellectual Disabilities: 1999-2002

ERIC Educational Resources Information Center

Loh, C.-H.; Lin, J.-D.; Choi, I.-C.; Yen, C.-F.; Hsu, S.-W.; Wu, J.-L.; Tang, C. C.

2007-01-01

Background: There has been no longitudinal study in Taiwan to identify the nature and the scale of medical care utilization of people with intellectual disabilities (IDs) up to the present. The aim of this study is to describe inpatient utilization among people under ID care in institutions in order to identify the pattern of medical care needs…

Weighting Primary Care Patient Panel Size: A Novel Electronic Health Record-Derived Measure Using Machine Learning.

PubMed

Rajkomar, Alvin; Yim, Joanne Wing Lan; Grumbach, Kevin; Parekh, Ami

2016-10-14

Characterizing patient complexity using granular electronic health record (EHR) data regularly available to health systems is necessary to optimize primary care processes at scale. To characterize the utilization patterns of primary care patients and create weighted panel sizes for providers based on work required to care for patients with different patterns. We used EHR data over a 2-year period from patients empaneled to primary care clinicians in a single academic health system, including their in-person encounter history and virtual encounters such as telephonic visits, electronic messaging, and care coordination with specialists. Using a combination of decision rules and k-means clustering, we identified clusters of patients with similar health care system activity. Phenotypes with basic demographic information were used to predict future health care utilization using log-linear models. Phenotypes were also used to calculate weighted panel sizes. We identified 7 primary care utilization phenotypes, which were characterized by various combinations of primary care and specialty usage and were deemed clinically distinct by primary care physicians. These phenotypes, combined with age-sex and primary payer variables, predicted future primary care utilization with R 2 of .394 and were used to create weighted panel sizes. Individual patients' health care utilization may be useful for classifying patients by primary care work effort and for predicting future primary care usage.

The Association Between Stimulant, Opioid, and Multiple Drug Use on Behavioral Health Care Utilization in a Safety-Net Health System.

PubMed

Calcaterra, Susan L; Keniston, Angela; Blum, Joshua; Crume, Tessa; Binswanger, Ingrid A

2015-01-01

Prior studies show an association between drug use and health care utilization. The relationship between specific drug type and emergent/urgent, inpatient, outpatient, and behavioral health care utilization has not been examined. We aimed to determine if multiple drug use was associated with increased utilization of behavioral health care. To assess health care utilization, we conducted a retrospective cohort study of patients who accessed health care at a safety-net medical center and affiliated clinics. Using electronic health records, we categorized patients who used stimulants, opioids, or multiple drugs based on urine toxicology screening tests and/or International Classification of Diseases, 9th Revision (ICD-9). Remaining patients were categorized as patients without identified drug use. Health care utilization by drug use group and visit type was determined using a negative binomial regression model. Associations were reported as incidence rate ratios. Utilization was described by rates of health care-related visits for inpatient, emergent/urgent, outpatient, and behavioral health care among patients who used drugs, categorized by drug types, compared with patients without identified drug use. Of 95,198 index visits, 4.6% (n=4340) were by patients who used drugs. Opioid and multiple drug users had significantly higher rates of behavioral health care visits than patients without identified drug use (opioid incidence rate ratio [IRR]=7.2; 95% confidence interval [CI]: 3.8-13.8; multiple drug use IRR=5.6, 95% CI: 3.3-9.7). Patients who used stimulants were less likely to use behavioral health services (IRR=1.3, 95% CI: 0.9-2.0) when compared with opioid and multiple drug users, but were more likely to use inpatient (IRR=1.6, 95% CI: 1.4-1.8) and emergent/urgent care (IRR=1.4, 95% CI: 1.3-1.5) services as compared with patients without identified drug use. Integrated medical and mental health care and drug treatment may reduce utilization of costly health care services and improve patient outcomes. How to capture and deliver primary care and behavioral health care to patients who use stimulants needs further investigation.

Public and private pregnancy care in Reggio Emilia Province: an observational study on appropriateness of care and delivery outcomes

PubMed Central

2014-01-01

Background In industrialized countries, improvements have been made in both maternal and newborn health. While attention to antenatal care is increasing, excessive medicalization is also becoming more common. The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only. Methods Design: Observational population-based study. Setting: Reggio Emilia Province. Population: 5957 women resident in the province who delivered between October 2010 and November 2011. Main outcome measures: CS frequency and ultrasound scan utilization, stillbirths, and other negative perinatal outcomes. Women in the study were searched in the public family and reproductive health clinic medical records to identify those cared for in the public system. Outcomes of the two antenatal care models were compared through multivariate logistic regression adjusting for maternal characteristics and, for CS only, by stratifying by Robson’s Group. Results Compared to women cared for in private services (N = 3,043), those in public service (N = 2,369) were younger, less educated, more frequently non-Italian, and multiparous. The probability of CS was slightly higher for women cared for by private obstetricians than for those cared for in the public system (31.8% vs. 27.1%; adjusted odds ratio: 1.10; 95% CI: 0.93–1.29): The probability of having more than 3 ultrasound scans was higher in private care (89.6% vs. 49.8%; adjusted odds ratio: 5.11; 95% CI: 4.30–6.08). CS frequency was higher in private care for all Robson’s classes except women who underwent CS during spontaneous labour. Among negative perinatal outcomes only a higher risk of pre-term birth was observed for pregnancies cared for in private services. Conclusions The public model provides less medicalized and more guidelines-oriented care than does the private model, with no increase in negative perinatal outcomes. PMID:24533853

42 CFR 456.380 - Individual written plan of care.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Plan of Care § 456.380 Individual written plan of care. (a) Before admission to an ICF or before... designed to meet the objectives of the plan of care; (5) Plans for continuing care, including review and...

42 CFR 456.380 - Individual written plan of care.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Plan of Care § 456.380 Individual written plan of care. (a) Before admission to an ICF or before... designed to meet the objectives of the plan of care; (5) Plans for continuing care, including review and...

42 CFR 456.380 - Individual written plan of care.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Plan of Care § 456.380 Individual written plan of care. (a) Before admission to an ICF or before... designed to meet the objectives of the plan of care; (5) Plans for continuing care, including review and...

Enhancing State Medical Home Capacity through a Care Coordination Technical Assistance Model.

PubMed

Berry, Susan; Barovechio, Patti; Mabile, Emily; Tran, Tri

2017-10-01

Introduction A practice-based care coordination (CC) model was developed by Louisiana's Title V Children's Special Health Services (CSHS) program to meet the overwhelming needs of the New Orleans post-Katrina population. The pilot clinic demonstrated an improvement in medical home (MH) capacity over the course of 3 months. The purpose of the current study is to evaluate the replicability of the model and sustainability of MH improvement over at least 2 years, while identifying factors that may modify the effect of the intervention. Methods The CSHS CC model utilizing a practice based care coordinator was implemented in 15 academic primary care pediatric clinics. Increase in MH capacity was determined using the MH Index-Short Version (MHI-SV) tool. Results The analysis of the MHI-SV scores for the ten clinics with >2 years of data demonstrated a significant improvement with each of the ten MHI-SV indicators. The mean clinic MHI-SV score improved from 19.70 to 34.15 on a scale of 10-50. Characteristics associated with the greatest MHI score improvement were rural geographic location, having an electronic health record, and using social workers or nurses as care coordinators. Characteristics associated with lower MHI scores were physician or care coordinator turnover and using stand-alone databases rather than tracking CC activities within the central patient record. Conclusion This study provides a flexible framework for implementing CC services in pediatric, family medicine, and medicine-pediatric practices, and demonstrates the value of CC as a driver for improvement in medical home capacity.

Predictors of adherence with self-care guidelines among persons with type 2 diabetes: results from a logistic regression tree analysis.

PubMed

Yamashita, Takashi; Kart, Cary S; Noe, Douglas A

2012-12-01

Type 2 diabetes is known to contribute to health disparities in the U.S. and failure to adhere to recommended self-care behaviors is a contributing factor. Intervention programs face difficulties as a result of patient diversity and limited resources. With data from the 2005 Behavioral Risk Factor Surveillance System, this study employs a logistic regression tree algorithm to identify characteristics of sub-populations with type 2 diabetes according to their reported frequency of adherence to four recommended diabetes self-care behaviors including blood glucose monitoring, foot examination, eye examination and HbA1c testing. Using Andersen's health behavior model, need factors appear to dominate the definition of which sub-groups were at greatest risk for low as well as high adherence. Findings demonstrate the utility of easily interpreted tree diagrams to design specific culturally appropriate intervention programs targeting sub-populations of diabetes patients who need to improve their self-care behaviors. Limitations and contributions of the study are discussed.

Factors influencing organizational adoption and implementation of clinical genetic services.

PubMed

Hamilton, Alison B; Oishi, Sabine; Yano, Elizabeth M; Gammage, Cynthia E; Marshall, Nell J; Scheuner, Maren T

2014-03-01

We sought to identify characteristics of genetic services that facilitate or hinder adoption. We conducted semi-structured key informant interviews in five clinical specialties (primary care, medical oncology, neurology, cardiology, pathology/laboratory medicine) within 13 Veterans Administration facilities. Genetic services (defined as genetic testing and consultation) were not typically characterized by informants (n = 64) as advantageous for their facilities or their patients; compatible with organizational norms of low cost and high clinical impact; or applicable to patient populations or norms of clinical care. Furthermore, genetic services had not been systematically adopted in most facilities because of their complexity: knowledge of and expertise on genetic testing was limited, and organizational barriers to utilization of genetic services were formidable. The few facilities that had some success with implementation of genetic services had knowledgeable clinicians interested in developing services and organizational-level facilitators such as accessible genetic test-ordering processes. Adoption and implementation of genetic services will require a multilevel effort that includes education of providers and administrators, opportunities for observing the benefits of genetic medicine, strategies for reducing the complexity of genomic medicine, expanded strategies for accessing genetics expertise and streamlining utilization, and resources dedicated to assessing the value of genetic information for the outcomes that matter to health-care organizations.

Ocular health assessment of cocoa farmers in a rural community in Ghana.

PubMed

Boadi-Kusi, Samuel Bert; Hansraj, Rekha; Kumi-Kyereme, Akwasi; Mashige, Khathutshelo Percy; Awusabo-Asare, Kofi; Ocansey, Stephen; Kyei, Samuel

2014-01-01

Cocoa farming provides employment for over 800,000 households in rural Ghana, with the country currently touted as the second largest producer of cocoa worldwide. Agriculture is one of the riskiest occupations for the eyes due to the numerous ocular hazards on farms. The authors conducted an ocular health assessment among cocoa farmers at Mfuom, a rural community in the Central Region of Ghana, to examine the ocular health status and the ocular safety measures used by cocoa farmers. A structured questionnaire was used to evaluate demographic characteristics, ocular injuries, and utilization of eye care services and ocular protection, and a clinical examination was used to evaluate their ocular status. Cocoa farmers were at high risk for ocular injuries and farm-related vision disorders and utilized eye care services and ocular protection poorly. Ocular condition identified were mainly refractive error (28.6%), cataract (20.0%), glaucoma (11.7%), conjunctivitis (13%), pterygium (2.7%), and cornea opacity (2.2%). There is a need for the introduction of an interventional eye care program to help address the ocular health challenges identified among the farmers. This can be done through collaborative efforts by educational institutions, government, and other role players in the agricultural industry to improve the quality of life of the vulnerable cocoa farmers in rural Ghana.

Controlling inpatient psychiatric utilization through managed care.

PubMed

Wickizer, T M; Lessler, D; Travis, K M

1996-03-01

There is little current understanding of how managed care strategies affect hospital inpatient psychiatric care for mentally ill patients. This study examined one prominent form of managed care, utilization management, which reviews requests for psychiatric care and authorizes provision of care deemed appropriate and clinically necessary. The authors analyzed data on 2,265 utilization management reviews conducted during 1989-1992 for patients insured by a single large commercial insurance company. Three utilization management procedures were examined: preadmission review, continued-stay review, and case management. The performance indicators analyzed included percent of admission requests granted, number of days requested and approved, and number of treatment extensions granted. Utilization management initially approved inpatient psychiatric treatment for nearly all (98.8%) of the patients but authorized, on average, only one-third of the days requested (6.9 versus 19.0). On average, 23.5 (total) days of care were requested and 16.8 days were approved. Care for patients with alcohol or drug dependence diagnoses was more restricted than was care for other patients. These data suggest that managed care does restrict inpatient psychiatric care, primarily by managing length of stay. The fact that almost all patients were approved for the same initial length of stay implies adherence to strict treatment protocols that do not distinguish among different clinical or patient factors. There is a need for careful study of the effects of managed care on outcomes and quality of psychiatric care.

Public health care and private insurance demand: the waiting time as a link.

PubMed

Jofre-Bonet, M

2000-01-01

This paper analyzes the effect of waiting times in the Spanish public health system on the demand for private health insurance. Expected utility maximization determines whether or not individuals buy a private health insurance. The decision depends not only on consumer's covariates such as income, socio-demographic characteristics and health status, but also on the quality of the treatment by the public provider. We interpret waiting time as a qualitative attribute of the health care provision. The empirical analysis uses the Spanish Health Survey of 1993. We cope with the absence of income data by using the Spanish Family Budget Survey of 1990-91 as a complementary data set, following the Arellano-Meghir method [4]. Results indicate that a reduction in the waiting time lowers the probability of buying private health insurance. This suggests the existence of a crowd-out in the health care provision market.

Clinical Quality Performance in U.S. Health Centers

PubMed Central

Shi, Leiyu; Lebrun, Lydie A; Zhu, Jinsheng; Hayashi, Arthur S; Sharma, Ravi; Daly, Charles A; Sripipatana, Alek; Ngo-Metzger, Quyen

2012-01-01

Objective To describe current clinical quality among the nation's community health centers and to examine health center characteristics associated with performance excellence. Data Sources National data from the 2009 Uniform Data System. Data Collection/Extraction Methods Health centers reviewed patient records and reported aggregate data to the Uniform Data System. Study Design Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance. Principal Findings Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well. Conclusions Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients. PMID:22594465

Demographic, Insurance, and Health Characteristics of Newly Enrolled HIV-Positive Patients After Implementation of the Affordable Care Act in California

PubMed Central

Parthasarathy, Sujaya; Altschuler, Andrea; Silverberg, Michael J.; Storholm, Erik; Campbell, Cynthia I.

2016-01-01

Objectives. To examine changes in HIV-positive patient enrollment in a large health care delivery system before and after key Affordable Care Act (ACA) provisions went into effect in 2014. Methods. Analyses compared HIV-positive patients newly enrolled in Kaiser Permanente Northern California between January and June 2012 (n = 339) to those newly enrolled between January and June 2014 through the California insurance exchange or via other mechanisms (n = 549). Results. After the ACA, the HIV-positive patient enrollment increased. These new enrollees were more likely to be male (93.6% vs 89.1%; P = .01), to be enrolled in high-deductible benefit plans (≥ $1000; 18.8% vs 5.5%; P = .01), and to have better HIV viral control (HIV RNA levels below limits of quantification 79.5% vs 73.6%; P = .05) compared with pre-ACA new enrollees. Among post-ACA new enrollees, there were more patients in the lowest and highest age groups. Post-ACA exchange enrollees (22%) were more likely to be male and to have high-deductible plans than those enrolled through other mechanisms. Conclusions. More men, higher deductibles, and better HIV viral control characterize newly enrolled HIV-positive patients after the ACA in California. Public health implications. Evolving characteristics of HIV-positive enrollees may affect HIV policy, patient care needs, and service utilization. PMID:27077361

Health Care Access and Utilization after the 2010 Pakistan Floods.

PubMed

Jacquet, Gabrielle A; Kirsch, Thomas; Durrani, Aqsa; Sauer, Lauren; Doocy, Shannon

2016-10-01

Introduction The 2010 floods submerged more than one-fifth of Pakistan's land area and affected more than 20 million people. Over 1.6 million homes were damaged or destroyed and 2,946 direct injuries and 1,985 deaths were reported. Infrastructure damage was widespread, including critical disruptions to the power and transportation networks. Hypothesis Damage and loss of critical infrastructure will affect the population's ability to seek and access adequate health care for years to come. This study sought to evaluate factors associated with access to health care in the aftermath of the 2010 Pakistan floods. A population-proportional, randomized cluster-sampling survey method with 80 clusters of 20 (1,600) households of the flood-affected population was used. Heads of households were surveyed approximately six months after flood onset. Multivariate analysis was used to determine significance. A total of 77.8% of households reported needing health services within the first month after the floods. Household characteristics, including rural residence location, large household size, and lower pre- and post-flood income, were significantly associated (P<.05) with inadequate access to health care after the disaster. Households with inadequate access to health care were more likely to have a death or injury in the household. Significantly higher odds of inadequate access to health care were observed in rural populations (adjusted OR 4.26; 95% CI, 1.89-9.61). Adequate health care access after the 2010 Pakistani floods was associated with urban residence location, suggesting that locating health care providers in rural areas may be difficult. Access to health services also was associated with post-flood income level, suggesting health resources are not readily available to households suffering great income losses. Jacquet GA , Kirsch T , Durrani A , Sauer L , Doocy S . Health care access and utilization after the 2010 Pakistan floods. Prehosp Disaster Med. 2016;31(5):485-491.

The effect of Channeling on in-home utilization and subsequent nursing home care: a simultaneous equation perspective.

PubMed Central

Rabiner, D J; Stearns, S C; Mutran, E

1994-01-01

OBJECTIVE. This study explored the relationship between participation in a home/community-based long-term care case management intervention (known as the Channeling demonstration), use of formal in-home care, and subsequent nursing home utilization. STUDY DESIGN. Structural analysis of the randomized Channeling intervention was conducted to decompose the total effects of Channeling on nursing home use into direct and indirect effects. DATA COLLECTION METHOD. Secondary data analysis of the National Long-Term Care Data Set. PRINCIPAL FINDINGS. The use of formal in-home care, which was increased by the Channeling intervention, was positively associated with nursing home utilization at 12 months. However, the negative direct effect of Channeling on nursing home use was of sufficient magnitude to offset this positive indirect effect, so that a small but significant negative total effect of Channeling on subsequent nursing home utilization was found. CONCLUSIONS. This study shows why Channeling did not have a large total impact on nursing home utilization. The analysis did not provide evidence of direct substitution of in-home care for nursing home care because the direct reductions in nursing home utilization due to other aspects of Channeling (including, but not limited to case management) were substantially offset by the indirect increases in nursing home utilization associated with additional home care use. PMID:8002352

Health care economic analyses and value-based medicine.

PubMed

Brown, Melissa M; Brown, Gary C; Sharma, Sanjay; Landy, Jennifer

2003-01-01

Health care economic analyses are becoming increasingly important in the evaluation of health care interventions, including many within ophthalmology. Encompassed with the realm of health care economic studies are cost-benefit analysis, cost-effectiveness analysis, cost-minimization analysis, and cost-utility analysis. Cost-utility analysis is the most sophisticated form of economic analysis and typically incorporates utility values. Utility values measure the preference for a health state and range from 0.0 (death) to 1.0 (perfect health). When the change in utility measures conferred by a health care intervention is multiplied by the duration of the benefit, the number of quality-adjusted life-years (QALYs) gained from the intervention is ascertained. This methodology incorporates both the improvement in quality of life and/or length of life, or the value, occurring as a result of the intervention. This improvement in value can then be amalgamated with discounted costs to yield expenditures per quality-adjusted life-year ($/QALY) gained. $/QALY gained is a measure that allows a comparison of the patient-perceived value of virtually all health care interventions for the dollars expended. A review of the literature on health care economic analyses, with particular emphasis on cost-utility analysis, is included in the present review. It is anticipated that cost-utility analysis will play a major role in health care within the coming decade.

Health care access and utilization among children of single working and nonworking mothers in the United States.

PubMed

Clarke, Tainya C; Arheart, Kristopher L; Muennig, Peter; Fleming, Lora E; Caban-Martinez, Alberto J; Dietz, Noella; Lee, David J

2011-01-01

To examine indicators of health care access and utilization among children of working and nonworking single mothers in the United States, the authors used data on unmarried women participating in the 1997-2008 National Health Interview Survey who financially supported children under 18 years of age (n = 21,842). Stratified by maternal employment, the analyses assessed health care access and utilization for all children. Outcome variables included delayed care, unmet care, lack of prescription medication, no usual place of care, no well-child visit, and no doctor's visit. The analyses reveal that maternal employment status was not associated with health care access and utilization. The strongest predictors of low access/utilization included no health insurance and intermittent health insurance in the previous 12 months, relative to those with continuous private health insurance coverage (odds ratio ranges 3.2-13.5 and 1.3-10.3, respectively). Children with continuous public health insurance compared favorably with those having continuous private health insurance on three of six access/utilization indicators (odds ratio range 0.63-0.85). As these results show, health care access and utilization for the children of single mothers are not optimal. Passage of the U.S. Healthcare Reform Bill (HR 3590) will probably increase the number of children with health insurance and improve these indicators.

Children in Foster Care: Challenges in Meeting Their Health Care Needs through Medicaid. Policy Brief.

ERIC Educational Resources Information Center

Rosenbach, Margo

In order to address problems related to the health care of children in foster care, policymakers need detailed information about health status, health care utilization, and Medicaid expenditures. This policy brief summarizes a study examining health care utilization and expenditures paid by Medicaid for children in foster care in California,…

Births: final data for 2004.

PubMed

Martin, Joyce A; Hamilton, Brady E; Sutton, Paul D; Ventura, Stephanie J; Menacker, Fay; Kirmeyer, Sharon

2006-09-29

This report presents 2004 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal lifestyle and health characteristics (medical risk factors, weight gain, and tobacco use); medical care utilization by pregnant women (prenatal care, obstetric procedures, characteristics of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's state of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Descriptive tabulations of data reported on the birth certificates of the 4.1 million births that occurred in 2004 are presented. Denominators for population-based rates are post-censal estimates derived from the U.S. 2000 census. In 2004, 4,112,052 births were registered in the United States, less than 1 percent more than the number in 2003. The crude birth rate declined slightly; the general fertility rate increased by less than 1 percent. Childbearing among teenagers and women aged 20-24 years declined to record lows. Rates for women aged 25-34 and 45-49 years were unchanged, whereas rates for women aged 35-44 years increased. All measures of unmarried childbearing rose in 2004. Smoking during pregnancy continued to decline. No improvement was seen in the timely initiation of prenatal care. The cesarean delivery rate jumped 6 percent to another all-time high, whereas the rate of vaginal birth after previous cesarean fell by 13 percent. Preterm and low birthweight rates continued their steady rise. The twinning rate increased, but the rate of triplet and higher order multiple births was down slightly.

Seizure Action Plans Do Not Reduce Health Care Utilization in Pediatric Epilepsy Patients.

PubMed

Roundy, Lindsi M; Filloux, Francis M; Kerr, Lynne; Rimer, Alyssa; Bonkowsky, Joshua L

2016-03-01

Management of pediatric epilepsy requires complex coordination of care. We hypothesized that an improved seizure management care plan would reduce health care utilization and improve outcomes. The authors conducted a cohort study with historical controls of 120 epilepsy patients before and after implementation of a "Seizure Action Plan." The authors evaluated for differences in health care utilization including emergency department visits, hospitalizations, clinic visits, telephone calls, and the percentage of emergency department visits that resulted in hospitalization in patients who did or did not have a Seizure Action Plan. The authors found that there was no decrease in these measures of health care utilization, and in fact the number of follow-up clinic visits was increased in the group with Seizure Action Plans (4.2 vs 3.3, P = .006). However, the study was underpowered to detect smaller differences. This study suggests that pediatric epilepsy quality improvement measures may require alternative approaches to reduce health care utilization and improve outcomes. © The Author(s) 2015.

Travel distance and sociodemographic correlates of potentially avoidable emergency department visits in California, 2006-2010: an observational study.

PubMed

Chen, Brian K; Hibbert, James; Cheng, Xi; Bennett, Kevin

2015-03-21

Use of the hospital emergency department (ED) for medical conditions not likely to require immediate treatment is a controversial topic. It has been faulted for ED overcrowding, increased expenditures, and decreased quality of care. On the other hand, such avoidable ED utilization may be a manifestation of barriers to primary care access. A random 10% subsample of all ED visits with unmasked variables, or approximately 7.2% of all ED visits in California between 2006 and 2010 are used in the analysis. Using panel data methods, we employ linear probability and fractional probit models with hospital fixed effects to analyze the associations between avoidable ED utilization in California and observable patient characteristics. We also test whether shorter estimated road distances to the hospital ED are correlated with non-urgent ED utilization, as defined by the New York University ED Algorithm. We then investigate whether proximity of a Federally Qualified Health Center (FQHC) is correlated with reductions in non-urgent ED utilization among Medicaid patients. We find that relative to the reference group of adults aged 35-64, younger patients generally have higher scores for non-urgent conditions and lower scores for urgent conditions. However, elderly patients (≥65) use the ED for conditions more likely to be urgent. Relative to male and white patients, respectively, female patients and all identified racial and ethnic minorities use the ED for conditions more likely to be non-urgent. Patients with non-commercial insurance coverage also use the ED for conditions more likely to be non-urgent. Medicare and Medicaid patients who live closer to the hospital ED have higher probability scores for non-emergent visits. However, among Medicaid enrollees, those who live in zip codes with an FQHC within 0.5 mile of the zip code population centroid visit the ED for medical conditions less likely to be non-emergent. These patterns of ED utilization point to potential barriers to care among historically vulnerable groups, observable even when using rough estimates of travel distances and avoidable ED utilization.

Women's Healthcare Utilization Following Routine Screening for Past-Year Intimate Partner Violence in the Veterans Health Administration.

PubMed

Dichter, Melissa E; Sorrentino, Anneliese E; Haywood, Terri N; Bellamy, Scarlett L; Medvedeva, Elina; Roberts, Christopher B; Iverson, Katherine M

2018-06-01

Experience of intimate partner violence (IPV) can have adverse health impacts and has been associated with elevated rates of healthcare service utilization. Healthcare encounters present opportunities to identify IPV-related concerns and connect patients with services. The Veterans Health Administration (VHA) conducts IPV screening within an integrated healthcare system. The objectives of this study were to compare service utilization in the 6 months following IPV screening between those screening positive and negative for past-year IPV (IPV+, IPV-) and to examine the timing and types of healthcare services accessed among women screening IPV+. A retrospective chart review was conducted for 8888 female VHA patients across 13 VHA facilities who were screened for past-year IPV between April 2014 and April 2016. Demographic characteristics (age, race, ethnicity, marital status, veteran status), IPV screening response, and healthcare encounters (based on visit identification codes). In the 6 months following routine screening for past-year IPV, patients screening IPV+ were more likely to utilize outpatient care (aOR = 1.85 [CI 1.26, 2.70]), including primary care or psychosocial care, and to have an inpatient stay (aOR = 2.09 [CI 1.23, 3.57]), compared with patients screening IPV-. Among those with any utilization, frequency of outpatient encounters within the 6-month period following screening was higher among those screening IPV+ compared with those screening IPV-. The majority of patients screening positive for past-year IPV returned for an outpatient visit within a brief time frame following the screening visit (> 70% within 14 days, >95% within 6 months). More than one in four patients screening IPV+ had an emergency department visit within the 6 months following screening. Women who screen positive for past-year IPV have high rates of return to outpatient visits following screening, presenting opportunities for follow-up support. Higher rates of emergency department utilization and inpatient stays among women screening IPV+ may indicate adverse health outcomes related to IPV experience.

The association of food insecurity with health outcomes for adults with disabilities.

PubMed

Brucker, Debra L

2017-04-01

Adults with disabilities are more likely to live in households that are food insecure and are more likely to experience health disparities than adults without disabilities. Research examining the intersection of food insecurity and health outcomes for adults with disabilities has so far been lacking, however. The research presented here tests whether living in a food insecure household is associated with poorer self-reported health and mental health and different health care utilization, controlling for disability status and other sociodemographic characteristics. Multivariate regression analyses are conducted using linked data from the 2011 National Health Interview Survey and the 2012 Medical Expenditures Panel Survey. Adults with and without disabilities who live in food insecure households have higher odds of reporting fair or poor health or mental health in either the current year or the subsequent year. Health care utilization patterns differ for adults who are food insecure as well, both within and across years. Efforts to address health disparities among adults with disabilities should consider the possible additional impact of food insecurity on health outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

The role of rapid antigen testing for influenza in the era of molecular diagnostics.

PubMed

Dale, Suzanne E

2010-08-01

Rapid antigen testing for influenza has been both maligned and revered since its conception. Microbiologists have long lamented the lack of sensitivity of commercial rapid influenza detection tests (RIDTs), whereas many clinicians have eschewed their utility by emphasizing the value of definitely diagnosing influenza at the patient's bedside. RIDTs, although quick and easy to perform, are widely accepted as being less sensitive than traditional culture techniques and newer molecular methods, including reverse-transcription polymerase chain reaction (RT-PCR). Moreover, the performance characteristics of RIDTs vary widely, and their applications as clinical diagnostic tools are not well understood. In contrast, traditional techniques are time consuming and require significant expertise to perform. Often, the delay in diagnosing influenza through these methods has little impact on patient care. The benefits of achieving a diagnosis of influenza at the point of care are numerous and include increased access to appropriate antivirals, appropriate patient cohorting for infection control purposes, and better resource utilization. Therefore, it behooves the microbiology community to communicate these issues to clinicians and to work to improve the sensitivity of RIDTs.

The association between hospital outcomes and diagnostic imaging: early findings.

PubMed

Lee, David W; Foster, David A

2009-11-01

Resource use variation across the United States prompts the important question of whether "more is better" when it comes to health care services. The aim of this study was to examine correlations between the use of 4 common imaging modalities (CT, MR, ultrasound, and radiography) and in-hospital mortality and costs. Using clinical and utilization data for 1.1 million inpatient admissions at 102 US hospitals during 2007, two hospital-specific, risk-adjusted imaging utilization measures for each modality were constructed that controlled for patients' demographic and clinical characteristics and for hospital characteristics were constructed for each modality. First, logistic regression was used to estimate the odds that each type of imaging service would be provided during an admission. Second, the mean number of services per admission was estimated using output from a two-part ordinary least squares model. Hospital-specific, risk-adjusted inpatient mortality and total hospital costs were also computed, and correlations between the imaging utilization measures and the mortality and cost outcome measures were then assessed using Pearson's correlation coefficients (P < .05). The correlation analyses were weighted by hospital admission volume. Hospitals in which patients were more likely to receive imaging services during admissions had lower mortality, even after controlling for potential confounders. Correlation coefficients were -0.2 for all modalities (P = .02-.05). Weaker correlations existed between mean services per admission and mortality, while costs trended insignificantly higher with greater utilization. This study lays the foundation for further exploration of the relationship between resource use and the clinical and economic outcomes associated with imaging utilization.

Obstetric care practice in Birbhum District, West Bengal, India.

PubMed

Bharati, Susmita; Pal, Manoranjan; Bharati, Premananda

2007-08-01

The study area is the Birbhum district of the State of West Bengal in India. It is one of the backward districts in India. The paper investigates the existing pattern of obstetric health care practices and the factors associated with the utilization of such care. The present analysis includes 495 adult married women of both rural and urban areas of nine Blocks of Birbhum district. Besides performing chi2 tests to see the association of the relevant individual and household characteristics, logistic regression was also carried out to measure the effect of these characteristics on the use of obstetric health care. In Birbhum district of West Bengal 65 percent mothers go to doctors for antenatal check-up during their pregnancy, but only 26 percent mothers deliver their babies in institutions and 30 percent mothers get the help of professional health assistants during delivery. Educated women have emphasized role in the practice of obstetric health care. Husband's education and the standard of living of the family also have some effect on the practice of antenatal check up, place of delivery and assistance of health professional. While most of the family background variables have significant effect on the practice of antenatal check up, these variables do not have much effect on the choice of delivery or seeking assistance of health professionals. Contrary to the popular belief the working status of women does not have favourable influence on the obstetric health care practices. In developing countries like India, it is the poverty, which compels the women to take jobs-that too in low paid jobs especially in rural backward areas. The status of literacy of mothers and standard of living of the family are of prime importance in improving the obstetric health care practices.

Pediatric Dentist Density and Preventive Care Utilization for Medicaid Children.

PubMed

Heidenreich, James F; Kim, Amy S; Scott, JoAnna M; Chi, Donald L

2015-01-01

The purpose of this study was to evaluate county-level pediatric dentist density and dental care utilization for Medicaid-enrolled children. This was a cross-sectional analysis of 604,885 zero- to 17-year-olds enrolled in the Washington State Medicaid Program for 11-12 months in 2012. The relationship between county-level pediatric dentist density, defined as the number of pediatric dentists per 10,000 Medicaid-enrolled children, and preventive dental care utilization was evaluated using linear regression models. In 2012, 179 pediatric dentists practiced in 16 of the 39 counties in Washington. County-level pediatric dentist density varied from zero to 5.98 pediatric dentists per 10,000 Medicaid-enrolled children. County-level preventive dental care utilization ranged from 32 percent to 81 percent, with 62 percent of Medicaid-enrolled children utilizing preventive dental services. County-level density was significantly associated with county-level dental care utilization (Slope equals 1.67, 95 percent confidence interval equals 0.02, 3.32, P<.05). There is a significant relationship between pediatric dentist density and the proportion of Medicaid-enrolled children who utilize preventive dental care services. Policies aimed at improving pediatric oral health disparities should include strategies to increase the number of oral health care providers, including pediatric dentists, in geographic areas with large proportions of Medicaid-enrolled children.

Which veterans enroll in a VA health information exchange program?

PubMed

Dixon, Brian E; Ofner, Susan; Perkins, Susan M; Myers, Laura J; Rosenman, Marc B; Zillich, Alan J; French, Dustin D; Weiner, Michael; Haggstrom, David A

2017-01-01

To characterize patients who voluntarily enrolled in an electronic health information exchange (HIE) program designed to share data between Veterans Health Administration (VHA) and non-VHA institutions. Patients who agreed to participate in the HIE program were compared to those who did not. Patient characteristics associated with HIE enrollment were examined using a multivariable logistic regression model. Variables selected for inclusion were guided by a health care utilization model adapted to explain HIE enrollment. Data about patients' sociodemographics (age, gender), comorbidity (Charlson index score), utilization (primary and specialty care visits), and access (distance to VHA medical center, insurance, VHA benefits) were obtained from VHA and HIE electronic health records. Among 57 072 patients, 6627 (12%) enrolled in the HIE program during its first year. The likelihood of HIE enrollment increased among patients ages 50-64, of female gender, with higher comorbidity, and with increasing utilization. Living in a rural area and being unmarried were associated with decreased likelihood of enrollment. Enrollment in HIE is complex, with several factors involved in a patient's decision to enroll. To broaden HIE participation, populations less likely to enroll should be targeted with tailored recruitment and educational strategies. Moreover, inclusion of special populations, such as patients with higher comorbidity or high utilizers, may help refine the definition of success with respect to HIE implementation. Published by Oxford University Press on behalf of the American Medical Informatics Association 2016. This work is written by US Government employees and is in the public domain in the United States.

Personality traits and career satisfaction of health care professionals.

PubMed

Richardson, John D; Lounsbury, John W; Bhaskar, Tripti; Gibson, Lucy W; Drost, Adam W

2009-01-01

Based on Holland's theorizing that vocational satisfaction arises from a good match between one's personality and career choice, one purpose of the study was to examine broad and narrow personality traits that characterize health care workers in comparison with professionals from other occupations. Also investigated were ways in which characteristic traits of health care workers were related to career satisfaction. Professionals utilizing the services of eCareerfit.com responded to online surveys that have been demonstrated to produce reliable and valid measures of broad and narrow personality traits and levels of career satisfaction. An independent sample t test was used to compare means of health care workers with those from other occupations. Pearson product-moment correlations were then computed to assess relationships between the traits and career satisfaction of health care professionals. Two traits that were particularly strong among health care workers were also significantly correlated with career satisfaction: work drive and conscientiousness. Other traits were found to be significantly related to career satisfaction in health care but were not uniquely high in the sample of health care professionals. To increase career satisfaction of health care professionals and thus to improve retention rates, administrators should consider focusing on recruiting and selecting individuals with higher levels of key personality traits.

Impact of chiropractic services at an on-site health center.

PubMed

Kindermann, Sylvia L; Hou, Qingjiang; Miller, Ross M

2014-09-01

To compare the influence of employer-sponsored, on-site chiropractic care against community-obtained care on health care utilization. This was a retrospective claims analysis of members of a single employee health plan receiving chiropractic care on-site or off-site from 2010 to 2012. Utilization differences were evaluated by having 1 health care event or more, including radiology or clinical visits. There were 876 on-site and 759 off-site participants. The off-site group received more radiology services overall (55.5% vs 38.2%; P < 0.001) including magnetic resonance imaging, ultrasound, and radiograph (all P < 0.0001); had higher outpatient (P < 0.0001) and emergency department (P = 0.022) utilization; and demonstrated greater use of chiropractic care and physical therapy (both P < 0.0001). Compared with off-site care, on-site chiropractic services are associated with lower health care utilization. These results support the value of chiropractic services offered at on-site health centers.

The management of new primary care organizations: an international perspective.

PubMed

Meads, Geoffrey; Wild, Andrea; Griffiths, Frances; Iwami, Michiyo; Moore, Phillipa

2006-08-01

Management practice arising from parallel policies for modernizing health systems is examined across a purposive sample of 16 countries. In each, novel organizational developments in primary care are a defining feature of the proposed future direction. Semistructured interviews with national leaders in primary care policy development and local service implementation indicate that management strategies, which effectively address the organized resistance of medical professions to modernizing policies, have these four consistent characteristics: extended community and patient participation models; national frameworks for interprofessional education and representation; mechanisms for multiple funding and accountabilities; and the diversification of non-governmental organizations and their roles. The research, based on a two-year fieldwork programme, indicates that at the meso-level of management planning and practice, there is a considerable potential for exchange and transferable learning between previously unconnected countries. The effectiveness of management strategies abroad, for example, in contexts where for the first time alternative but comparable new primary care organizations are exercising responsibilities for local resource utilization, may be understood through the application of stakeholder analyses, such as those employed to promote parity of relationships in NHS primary care trusts.

Declining rates of work-related overexertion back injuries among union drywall installers in Washington State, 1989-2008: Improved work safety or shifting of care?

PubMed

Schoenfisch, Ashley L; Lipscomb, Hester J; Marshall, Stephen W; Casteel, Carri; Richardson, David B; Brookhart, M Alan; Cameron, Wilfrid

2014-02-01

Construction workers are at high risk of work-related musculoskeletal back disorders, and research suggests medical care and costs associated with these conditions may be covered by sources other than workers' compensation (WC). Little is known about the back injury experience and care seeking behavior among drywall installers, a high-risk workgroup regularly exposed to repetitive activities, awkward postures, and handling heavy building materials. Among a cohort of 24,830 Washington State union carpenters (1989-2008), including 5,073 drywall installers, we identified WC claims, visits for health care covered through union-provided health insurance and time at risk. Rates of work-related overexertion back injuries (defined using WC claims data) and health care utilization for musculoskeletal back disorders covered by private health insurance were examined and contrasted over time and by worker characteristics, stratified by type of work (drywall installation, other carpentry). Drywall installers' work-related overexertion back injury rates exceeded those of other carpenters (adjusted IRR 1.63, 95% CI 1.48-1.78). For both carpentry groups, rates declined significantly over time. In contrast, rates of private healthcare utilization for musculoskeletal back disorders were similar for drywall installers compared to other carpenters; they increased over time (after the mid-1990s), with increasing years in the union, and with increasing numbers of work-related overexertion back injuries. Observed declines over time in the rate of work-related overexertion back injury, as based on WC claims data, is encouraging. However, results add to the growing literature suggesting care for work-related conditions may be being sought outside of the WC system. © 2013 Wiley Periodicals, Inc.

Constructing a Measure of Private-pay Nursing Home Days.

PubMed

Thomas, Kali S; Silver, Benjamin; Gozalo, Pedro L; Dosa, David; Grabowski, David C; Makineni, Rajesh; Mor, Vincent

2018-05-01

Nursing home (NH) care is financed through multiple sources. Although Medicaid is the predominant payer for NH care, over 20% of residents pay out-of-pocket for their care. Despite this large percentage, an accepted measure of private-pay NH occupancy has not been established and little is known about the types of facilities and the long-term care markets that cater to this population. To describe 2 novel measures of private-pay utilization in the NH setting, including the proportion of privately financed residents and resident days, and examine their construct validity. Retrospective descriptive analysis of US NHs in 2007-2009. We used Medicare claims, Medicare Enrollment records, and the Minimum Data Set to create measures of private-pay resident prevalence and proportion of privately financed NH days. We compared our estimates of private-pay utilization to payer data collected in the NH annual certification survey and evaluated the relationships of our measures with facility characteristics. Our measures of private-pay resident prevalence and private-pay days are highly correlated (r=0.83, P<0.001 and r=0.83, P<0.001, respectively) with the rate of "other payer" reported in the annual certification survey. We also observed a significantly higher proportion of private-pay residents and days in higher quality facilities. This new methodology provides estimates of private-pay resident prevalence and resident days. These measures were correlated with estimates using other data sources and validated against measures of facility quality. These data set the stage for additional work to examine questions related to NH payment, quality of care, and responses to changes in the long-term care market.

Organization of care for persons with HIV-infection: a systematic review.

PubMed

Handford, Curtis D; Tynan, Anne-Marie; Agha, Ayda; Rzeznikiewiz, Damian; Glazier, Richard H

2017-07-01

The objective of this systematic review was to examine the effectiveness of the organization of care: case management, multidisciplinary care, multi-faceted treatment, hours of service, outreach programs and health information systems on medical, immunological, virological, psychosocial and economic outcomes for persons living with HIV/AIDS. We searched PubMed (MEDLINE) and 10 other electronic databases from 1 January 1980 to April, 2012 for both experimental and controlled observational studies. Thirty-three studies met the inclusion criteria. Eleven studies were randomized controlled trials (RCTs), three of which were conducted in low-middle income settings. Patient characteristics, study design, organization measures and outcomes data were abstracted independently by two reviewers from all studies. A risk of bias tool was applied to RCTs and a separate tool was used to assess the quality of observational studies. This review concludes that case management interventions were most consistently associated with improvements in immunological outcomes but case management demonstrates no clear association with other outcome measures. The same mixed results were also identified for multidisciplinary and multi-faceted care interventions. Eight studies with an outreach intervention were identified and demonstrated improvements or non-inferiority with respect to mortality, receipt of antiretroviral medications, immunological outcomes, improvements in healthcare utilization and lower reported healthcare costs when compared to usual care. Of the interventions examined in this review, sustained in-person case management and outreach interventions were most consistently associated with improved medical and economic outcomes, in particular antiretroviral prescribing, immunological outcomes and healthcare utilization. No firm conclusions can be reached about the impact of any one intervention on patient mortality.

Variation in teenage mothers' experiences of child care and other components of welfare reform: selection processes and developmental consequences.

PubMed

Yoshikawa, H; Rosman, E A; Hsueh, J

2001-01-01

Developmental evaluations of the current wave of welfare reform programs present challenges with regard to (1) assessing child outcomes; (2) accounting for heterogeneity among low-income families in both baseline characteristics and involvement in self-sufficiency activities and supports, and (3) development of alternatives to experimental approaches to causal inference. This study (N = 1,079) addresses these challenges by examining effects on 4- to 6-year-old children of different patterns of child care, self-sufficiency activities, and other service utilization indicators among experimental-group mothers in a 16-site welfare reform program. Outcomes in areas of cognitive ability and behavior problems were investigated. The study identified seven subgroups of participants engaging in different patterns of service utilization and activity involvement. A two-stage simultaneous equation methodology was used to account for selection, and effects on child cognitive ability of participation in specific patterns of services and activities were found. For example, children of mothers characterized by high levels of involvement in center-based child care, education, and job training showed higher levels of cognitive ability than children of mothers in groups characterized by high involvement in center-based care and education, or center-based care and job training. In addition, children of mothers in groups with high levels of involvement in any of these activities showed higher levels of cognitive ability than those with low levels of involvement. The bulk of selection effects occurred through site-level differences, rather than family-level socio-economic status or maternal depression indicators. Implications for welfare reform program and policy concerns are discussed.

Young Adults' Health Care Utilization and Expenditures Prior to the Affordable Care Act

PubMed Central

Lau, Josephine S.; Adams, Sally H.; Boscardin, W. John; Irwin, Charles E.

2014-01-01

Purpose Examine young adults' health care utilization and expenditures prior to the ACA. Methods We used 2009 Medical Expenditure Panel Survey (MEPS) to 1) compare young adults' health care utilization and expenditures of a full-spectrum of health services to children and adolescents and 2) identify disparities in young adults' utilization and expenditures, based on access (insurance and usual source of care) and other socio-demographic factors, including race/ethnicity and income. Results Young adults had: 1) significantly lower rates of overall utilization (72%) than other age groups (83-88%, P<.001) and 2), the lowest rate of office-based utilization (55% vs. 67-77%, P<.001) and higher rate of ER visits compared to adolescents (15% v. 12%, P<.01). Uninsured young adults had high out-of-pocket expenses. Compared to the young adults with private insurance, the uninsured spent less than half on health care ($1,040 vs. $2,150/ person, P<.001), but essentially the same out-of-pocket expenses ($403 vs. $380/person, p =.57). Among young adults, we identified significant disparities in utilization and expenditures based on the presence/absence of a usual source of care, race/ethnicity, home language and sex. Conclusions Young adults may not be utilizing the health care system optimally by having low rates of office-based visits and high rates of ER visits. The ACA provision of insurance for those previously uninsured or under-insured will likely increase their utilization and expenditures and lower their out-of-pocket expenses. Further effort is needed to address non-insurance barriers and ensure equal access to health services. PMID:24702839

Meningococcal vaccination in primary care amongst adolescents in North West England: an ecological study investigating associations with general practice characteristics.

PubMed

Blagden, Sarah; Hungerford, Daniel; Limmer, Mark

2018-01-27

In 2015 the meningococcal ACWY (MenACWY) vaccination was introduced amongst adolescents in England following increased incidence and mortality associated with meningococcal group W. MenACWY vaccination uptake data for 17-18 years old and students delivered in primary care were obtained for 20 National Health Service clinical commissioning groups (CCGs) via the ImmForm vaccination system. Data on general practice characteristics, encompassing demographics and patient satisfaction variables, were extracted from the National General Practice Profiles resource. Univariable analysis of the associations between practice characteristics and vaccination was performed, followed by multivariable negative binomial regression. Data were utilized from 587 general practices, accounting for ~8% of all general practices in England. MenACWY vaccination uptake varied from 20.8% to 46.8% across the CCGs evaluated. Upon multivariable regression, vaccination uptake increased with increasing percentage of patients from ethnic minorities, increasing percentage of patients aged 15-24 years, increasing percentage of patients that would recommend their practice and total Quality and Outcomes Framework achievement for the practice. Conversely, vaccination uptake decreased with increasing deprivation. This study has identified several factors independently associated with MenACWY vaccination in primary care. These findings will enable a targeted approach to improve general practice-level vaccination uptake. © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Validation of rheumatoid arthritis diagnoses in health care utilization data.

PubMed

Kim, Seo Young; Servi, Amber; Polinski, Jennifer M; Mogun, Helen; Weinblatt, Michael E; Katz, Jeffrey N; Solomon, Daniel H

2011-02-23

Health care utilization databases have been increasingly used for studies of rheumatoid arthritis (RA). However, the accuracy of RA diagnoses in these data has been inconsistent. Using medical records and a standardized abstraction form, we examined the positive predictive value (PPV) of several algorithms to define RA diagnosis using claims data: A) at least two visits coded for RA (ICD-9, 714); B) at least three visits coded for RA; and C) at least two visits to a rheumatologist for RA. We also calculated the PPVs for the subgroups identified by these algorithms combined with pharmacy claims data for at least one disease-modifying anti-rheumatic drug (DMARD) prescription. We invited 9,482 Medicare beneficiaries with pharmacy benefits in Pennsylvania to participate; 2% responded and consented for review of their medical records. There was no difference in characteristics between respondents and non-respondents. Using 'RA diagnosis per rheumatologists' as the gold standard, the PPVs were 55.7% for at least two claims coded for RA, 65.5% for at least three claims for RA, and 66.7% for at least two rheumatology claims for RA. The PPVs of these algorithms in patients with at least one DMARD prescription increased to 86.2%-88.9%. When fulfillment of 4 or more of the ACR RA criteria was used as the gold standard, the PPVs of the algorithms combined with at least one DMARD prescriptions were 55.6%-60.7%. To accurately identify RA patients in health care utilization databases, algorithms that include both diagnosis codes and DMARD prescriptions are recommended.

Disparities in attendance at diabetes self-management education programs after diagnosis in Ontario, Canada: a cohort study

PubMed Central

2013-01-01

Background Patients newly-diagnosed with diabetes require self-management education to help them understand and manage the disease. The goals of the study were to determine the frequency of diabetes self-management education program utilization by newly-diagnosed patients, and to evaluate whether there were any demographic or clinical disparities in utilization. Methods Using population-level health care data, all 46,553 adults who were diagnosed with any type of non-gestational diabetes in Ontario, Canada between January and June 2006 were identified. They were linked with a diabetes self-management education program registry to identify those who attended within 6 months of diagnosis. The demographic and clinical characteristics of attendees and non-attendees were compared. Results A total of 9,568 (20.6%) patients attended a diabetes self-management education program within 6 months of diagnosis. Younger age, increasing socioeconomic status, and the absence of mental health conditions or other medical comorbidity were associated with attendance. Patients living in rural areas, where access to physicians may be limited, were markedly more likely to attend. Recent immigrants were 40% less likely to attend self-management education programs than longer-term immigrants or nonimmigrants. Conclusion Only one in five newly-diagnosed diabetes patients attended a diabetes self-management education program. Demographic and clinical disparities in utilization persisted despite a publicly-funded health care system where patients could access these services without direct charges. Primary care providers and education programs must ensure that more newly-diagnosed diabetes patients receive self-management education, particularly those who are older, poorer, sicker, or recent immigrants. PMID:23360373

The Rising Rate of Rural Hospital Closures.

PubMed

Kaufman, Brystana G; Thomas, Sharita R; Randolph, Randy K; Perry, Julie R; Thompson, Kristie W; Holmes, George M; Pink, George H

2016-01-01

Since 2010, the rate of rural hospital closures has increased significantly. This study is a preliminary look at recent closures and a formative step in research to understand the causes and the impact on rural communities. The 2009 financial performance and market characteristics of rural hospitals that closed from 2010 through 2014 were compared to rural hospitals that remained open during the same period, stratified by critical access hospitals (CAHs) and other rural hospitals (ORHs). Differences were tested using Pearson's chi-square (categorical variables) and Wilcoxon rank test of medians. The relationships between negative operating margin and (1) market factors and (2) utilization/staffing factors were explored using logistic regression. In 2009, CAHs that subsequently closed from 2010 through 2014 had, in general, lower levels of profitability, liquidity, equity, patient volume, and staffing. In addition, ORHs that closed had smaller market shares and operated in markets with smaller populations compared to ORHs that remained open. Odds of unprofitability were associated with both market and utilization factors. Although half of the closed hospitals ceased providing health services altogether, the remainder have since converted to an alternative health care delivery model. Financial and market characteristics appear to be associated with closure of rural hospitals from 2010 through 2014, suggesting that it is possible to identify hospitals at risk of closure. As closure rates show no sign of abating, it is important to study the drivers of distress in rural hospitals, as well as the potential for alternative health care delivery models. © 2015 National Rural Health Association.

Impact of Predicting Health Care Utilization Via Web Search Behavior: A Data-Driven Analysis.

PubMed

Agarwal, Vibhu; Zhang, Liangliang; Zhu, Josh; Fang, Shiyuan; Cheng, Tim; Hong, Chloe; Shah, Nigam H

2016-09-21

By recent estimates, the steady rise in health care costs has deprived more than 45 million Americans of health care services and has encouraged health care providers to better understand the key drivers of health care utilization from a population health management perspective. Prior studies suggest the feasibility of mining population-level patterns of health care resource utilization from observational analysis of Internet search logs; however, the utility of the endeavor to the various stakeholders in a health ecosystem remains unclear. The aim was to carry out a closed-loop evaluation of the utility of health care use predictions using the conversion rates of advertisements that were displayed to the predicted future utilizers as a surrogate. The statistical models to predict the probability of user's future visit to a medical facility were built using effective predictors of health care resource utilization, extracted from a deidentified dataset of geotagged mobile Internet search logs representing searches made by users of the Baidu search engine between March 2015 and May 2015. We inferred presence within the geofence of a medical facility from location and duration information from users' search logs and putatively assigned medical facility visit labels to qualifying search logs. We constructed a matrix of general, semantic, and location-based features from search logs of users that had 42 or more search days preceding a medical facility visit as well as from search logs of users that had no medical visits and trained statistical learners for predicting future medical visits. We then carried out a closed-loop evaluation of the utility of health care use predictions using the show conversion rates of advertisements displayed to the predicted future utilizers. In the context of behaviorally targeted advertising, wherein health care providers are interested in minimizing their cost per conversion, the association between show conversion rate and predicted utilization score, served as a surrogate measure of the model's utility. We obtained the highest area under the curve (0.796) in medical visit prediction with our random forests model and daywise features. Ablating feature categories one at a time showed that the model performance worsened the most when location features were dropped. An online evaluation in which advertisements were served to users who had a high predicted probability of a future medical visit showed a 3.96% increase in the show conversion rate. Results from our experiments done in a research setting suggest that it is possible to accurately predict future patient visits from geotagged mobile search logs. Results from the offline and online experiments on the utility of health utilization predictions suggest that such prediction can have utility for health care providers.

Impact of Predicting Health Care Utilization Via Web Search Behavior: A Data-Driven Analysis

PubMed Central

Zhang, Liangliang; Zhu, Josh; Fang, Shiyuan; Cheng, Tim; Hong, Chloe; Shah, Nigam H

2016-01-01

Background By recent estimates, the steady rise in health care costs has deprived more than 45 million Americans of health care services and has encouraged health care providers to better understand the key drivers of health care utilization from a population health management perspective. Prior studies suggest the feasibility of mining population-level patterns of health care resource utilization from observational analysis of Internet search logs; however, the utility of the endeavor to the various stakeholders in a health ecosystem remains unclear. Objective The aim was to carry out a closed-loop evaluation of the utility of health care use predictions using the conversion rates of advertisements that were displayed to the predicted future utilizers as a surrogate. The statistical models to predict the probability of user’s future visit to a medical facility were built using effective predictors of health care resource utilization, extracted from a deidentified dataset of geotagged mobile Internet search logs representing searches made by users of the Baidu search engine between March 2015 and May 2015. Methods We inferred presence within the geofence of a medical facility from location and duration information from users’ search logs and putatively assigned medical facility visit labels to qualifying search logs. We constructed a matrix of general, semantic, and location-based features from search logs of users that had 42 or more search days preceding a medical facility visit as well as from search logs of users that had no medical visits and trained statistical learners for predicting future medical visits. We then carried out a closed-loop evaluation of the utility of health care use predictions using the show conversion rates of advertisements displayed to the predicted future utilizers. In the context of behaviorally targeted advertising, wherein health care providers are interested in minimizing their cost per conversion, the association between show conversion rate and predicted utilization score, served as a surrogate measure of the model’s utility. Results We obtained the highest area under the curve (0.796) in medical visit prediction with our random forests model and daywise features. Ablating feature categories one at a time showed that the model performance worsened the most when location features were dropped. An online evaluation in which advertisements were served to users who had a high predicted probability of a future medical visit showed a 3.96% increase in the show conversion rate. Conclusions Results from our experiments done in a research setting suggest that it is possible to accurately predict future patient visits from geotagged mobile search logs. Results from the offline and online experiments on the utility of health utilization predictions suggest that such prediction can have utility for health care providers. PMID:27655225

Nurses' experiences providing palliative care to individuals living in rural communities: aspects of the physical residential setting.

PubMed

Kaasalainen, S; Brazil, K; Williams, A; Wilson, D; Willison, K; Marshall, D; Taniguchi, A; Phillips, C

2014-01-01

Efforts are needed to improve palliative care in rural communities, given the unique characteristics and inherent challenges with respect to working within the physical aspects of residential settings. Nurses who work in rural communities play a key role in the delivery of palliative care services. Hence, the purpose of this study was to explore nurses' experiences of providing palliative care in rural communities, with a particular focus on the impact of the physical residential setting. This study was grounded in a qualitative approach utilizing an exploratory descriptive design. Individual telephone interviews were conducted with 21 community nurses. Data were analyzed by thematic content analysis. Nurses described the characteristics of working in a rural community and how it influences their perception of their role, highlighting the strong sense of community that exists but how system changes over the past decade have changed the way they provide care. They also described the key role that they play, which was often termed a 'jack of all trades', but focused on providing emotional, physical, and spiritual care while trying to manage many challenges related to transitioning and working with other healthcare providers. Finally, nurses described how the challenges of working within the physical constraints of a rural residential setting impeded their care provision to clients who are dying in the community, specifically related to the long distances that they travel while dealing with bad weather. These study findings contribute to our understanding of the experiences of nurses working in rural communities in terms of the provision of palliative care and the influence of the physical residential setting that surrounds them. These findings are important since nurses play a major role in caring for community-dwelling clients who are dying, but they are confronted with many obstacles. As such, these results may help inform future decisions about how to best improve access to important services and ways to support them while providing palliative care to rural individuals.

Comparison of telemedicine with in-person care for follow-up after elective neurosurgery: results of a cost-effectiveness analysis of 1200 patients using patient-perceived utility scores.

PubMed

Thakar, Sumit; Rajagopal, Niranjana; Mani, Subramaniyan; Shyam, Maya; Aryan, Saritha; Rao, Arun S; Srinivasa, Rakshith; Mohan, Dilip; Hegde, Alangar S

2018-05-01

OBJECTIVE The utility of telemedicine (TM) in neurosurgery is underexplored, with most of the studies relating to teletrauma or telestroke programs. In this study, the authors evaluate the cost-effectiveness of TM consultations for follow-up care of a large population of patients who underwent neurosurgical procedures. METHODS A decision-analytical model was used to assess the cost-effectiveness of TM for elective post-neurosurgical care patients from a predominantly nonurban cohort in West Bengal, India. The model compared TM care via a nodal center in West Bengal to routine, in-person, per-episode care at the provider site in Bangalore, India. Cost and effectiveness data relating to 1200 patients were collected for a 52-month period. The effectiveness of TM care was calculated using efficiency in terms of the percentage of successful TM consultations, as well as patient-perceived utility values for overall experience of the type of health care access that they received. Incremental cost-effectiveness ratio (ICER) analysis was done using the 4-quadrant charting of the cost-effectiveness plane. One-way sensitivity and tornado analyses were performed to identify thresholds where the care strategy would change. RESULTS The overall utility for the 3 TM scenarios was found to be higher (89%) than for the utility of routine care (80%). TM was found to be more cost-effective (Indian rupee [INR] 2630 per patient) compared to routine care (INR 6848 per patient). The TM strategy "dominates" that of routine care by being more effective and less expensive (ICER value of -39,400 INR/unit of effectiveness). Sensitivity analysis revealed that cost-effectiveness of TM was most sensitive to changes in the number of TM patients, utility and success rate of TM, and travel distance to the TM center. CONCLUSIONS TM care dominates the in-person care strategy by providing more effective and less expensive follow-up care for a remote post-neurosurgical care population in India. In the authors' setting, this benefit of TM is sustainable even if half the TM consultations turn out to be unsuccessful. The viability of TM as a cost-effective care protocol is attributed to a combination of factors, like an adequate patient volume utilizing TM, patient utility, success rate of TM, and the patient travel distance.

Provision of specific dental procedures by general dentists in the National Dental Practice-Based Research Network: questionnaire findings.

PubMed

Gilbert, Gregg H; Gordan, Valeria V; Korelitz, James J; Fellows, Jeffrey L; Meyerowitz, Cyril; Oates, Thomas W; Rindal, D Brad; Gregory, Randall J

2015-01-22

Objectives were to: (1) determine whether and how often general dentists (GDs) provide specific dental procedures; and (2) test the hypothesis that provision is associated with key dentist, practice, and patient characteristics. GDs (n = 2,367) in the United States National Dental Practice-Based Research Network completed an Enrollment Questionnaire that included: (1) dentist; (2) practice; and (3) patient characteristics, and how commonly they provide each of 10 dental procedures. We determined how commonly procedures were provided and tested the hypothesis that provision was substantively related to the three sets of characteristics. Two procedure categories were classified as "uncommon" (orthodontics, periodontal surgery), three were "common" (molar endodontics; implants; non-surgical periodontics), and five were "very common" (restorative; esthetic procedures; extractions; removable prosthetics; non-molar endodontics). Dentist, practice, and patient characteristics were substantively related to procedure provision; several characteristics seemed to have pervasive effects, such as dentist gender, training after dental school, full-time/part-time status, private practice vs. institutional practice, presence of a specialist in the same practice, and insurance status of patients. As a group, GDs provide a comprehensive range of procedures. However, provision by individual dentists is substantively related to certain dentist, practice, and patient characteristics. A large number and broad range of factors seem to influence which procedures GDs provide. This may have implications for how GDs respond to the ever-changing landscape of dental care utilization, patient population demography, scope of practice, delivery models and GDs' evolving role in primary care.

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

Income-related inequalities and inequities in health and health care utilization in Mexico, 2000-2006.

PubMed

Barraza-Lloréns, Mariana; Panopoulou, Giota; Díaz, Beatriz Yadira

2013-02-01

To measure income-related inequalities and inequities in the distribution of health and health care utilization in Mexico. The National Health Survey (NHS) 2000 and the National Health and Nutrition Survey (NHNS) 2006 were used to estimate concentration indices for health outcomes and health care utilization variables before and after standardization. The study analyzed 110 460 individuals 18 years or older for NHS 2000 and 124 149 individuals for NHNS 2006. Health status variables were self-assessed health, physical limitations, and chronic illness. Health care utilization included curative visits and dental, hospital, and preventive care. Individuals were ranked by three standard-of-living measures: household income, wealth, and expenditure. Other independent variables were area of residence, geographic region, education, employment, ethnicity, and health insurance. Decomposition analysis allowed for assessing the contributions of independent variables to the distribution of health care among individuals. The worse-off population reports less good self-assessed health and more physical limitations, whereas better-off individuals report more chronic illnesses. Utilization of curative visits and hospitalization is more concentrated among the better-off population. No significant changes in these results can be established between 2000 and 2006. According to available evidence, standard of living, health insurance, and education largely contribute to the inequitable distribution of health care. Despite improvements in health care utilization patterns, income-related health and health care inequities prevail. Equity remains a challenge for Mexico.

Effect of primary health care reforms in Turkey on health service utilization and user satisfaction.

PubMed

Hone, Thomas; Gurol-Urganci, Ipek; Millett, Christopher; Başara, Berrak; Akdağ, Recep; Atun, Rifat

2017-02-01

Strengthening primary health care (PHC) is considered a priority for efficient and responsive health systems, but empirical evidence from low- and middle-income countries is limited. The stepwise introduction of family medicine across all 81 provinces of Turkey (a middle-income country) between 2005 and 2010, aimed at PHC strengthening, presents a natural experiment for assessing the effect of family medicine on health service utilization and user satisfaction.The effect of health system reforms, that introduced family medicine, on utilization was assessed using longitudinal, province-level data for 12 years and multivariate regression models adjusting for supply-side variables, demographics, socio-economic development and underlying yearly trends. User satisfaction with primary and secondary care services was explored using data from annual Life Satisfaction Surveys. Trends in preferred first point of contact (primary vs secondary, public vs. private), reason for choice and health services issues, were described and stratified by patient characteristics, provider type, and rural/urban settings.Between 2002 and 2013, the average number of PHC consultations increased from 1.75 to 2.83 per person per year. In multivariate models, family medicine introduction was associated with an increase of 0.37 PHC consultations per person (P < 0.001), and slower annual growth in PHC and secondary care consultations. Following family medicine introduction, the growth of PHC and secondary care consultations per person was 0.08 and 0.30, respectively, a year. PHC increased as preferred provider by 9.5% over 7 years with the reasons of proximity and service satisfaction, which increased by 14.9% and 11.8%, respectively. Reporting of poor facility hygiene, difficulty getting an appointment, poor physician behaviour and high costs of health care all declined (P < 0.001) in PHC settings, but remained higher among urban, low-income and working-age populations. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Regional variation in post-stroke multidisciplinary rehabilitation care among veteran residents in community nursing homes.

PubMed

Jia, Huanguang; Pei, Qinglin; Sullivan, Charles T; Cowper Ripley, Diane C; Wu, Samuel S; Vogel, W Bruce; Wang, Xinping; Bidelspach, Douglas E; Hale-Gallardo, Jennifer L; Bates, Barbara E

2017-01-01

Effective post-acute multidisciplinary rehabilitation therapy improves stroke survivors' functional recovery and daily living activities. The US Department of Veterans Affairs (VA) places veterans needing post-acute institutional care in private community nursing homes (CNHs). These placements are made under the same rules and regulations across the VA health care system and through individual per diem contracts between local VA facilities and CNHs. However, there is limited information about utilization of these veterans' health services as well as the geographic variation of the service utilization. The aims of this study were to determine rehabilitation therapy and restorative nursing care utilization by veterans with stroke in VA-contracted CNHs and to assess risk-adjusted regional variations in the utilization of rehabilitation therapy and restorative nursing care. This retrospective study included all veterans diagnosed with stroke residing in VA-contracted CNHs between 2006 and 2009. Minimum Dataset (a health status assessment tool for CNH residents) for the study CNHs was linked with veterans' inpatient and outpatient data within the VA health care system. CNHs were grouped into five VA-defined geographic regions: the North Atlantic, Southeast, Midwest, Continental, and Pacific regions. A two-part model was applied estimating risk-adjusted utilization probability and average weekly utilization days. Two dependent variables were rehabilitation therapy and restorative nursing care utilization by veterans during their CNH stays. The study comprised 6,206 veterans at 2,511 CNHs. Rates for utilization of rehabilitation therapy and restorative nursing care were 75.7% and 30.1%, respectively. Veterans in North Atlantic and Southeast CNHs were significantly ( p <0.001) more likely to receive rehabilitation therapies than veterans from other regions. However, veterans in Southeast CNHs were significantly ( p <0.001) less likely to receive restorative nursing care compared with veterans in all other regions, before and after risk adjustment. The majority of veterans with stroke received rehabilitation therapy, and about one-third had restorative nursing care during their stay at VA-contracted CNHs. Significant regional variations in weekly days for rehabilitation therapy and restorative nursing care utilization were observed even after adjusting for potential risk factors.

Characteristics and spending patterns of high cost, non-elderly adults in Massachusetts.

PubMed

Figueroa, Jose F; Frakt, Austin B; Lyon, Zoe M; Zhou, Xiner; Jha, Ashish K

2017-12-01

Given that health care costs in Massachusetts continue to grow despite great efforts to contain them, we seek to understand characteristics and spending patterns of the costliest non-elderly adults in Massachusetts based on type of insurance. We used the Massachusetts All-Payer Claims Database (APCD) from 2012 and analyzed demographics, utilization patterns and spending patterns across payers (Medicaid, Medicaid managed care, and private insurers) for high cost patients (those in the top 10% of spending) and non-high cost patients (the remaining 90%). We identified 3,712,045 patients between the ages of 18-64 years in Massachusetts in 2012 who met our inclusion criteria. Of this group, 8.5% had Medicaid fee-for-service, 11.1% had Medicaid managed care, and 80.3% had private insurance. High cost patients accounted for 65% of total spending in our sample. We found that high cost patients were more likely to be older (median age 48 vs 40, p<0.001), female (60.2% vs. 51.2%, p<0.001), and have multiple chronic conditions (4.4 vs. 1.3, p<0.001) compared to non-high cost patient patients. Medicaid patients were the most likely to be designated high cost (18.1%) followed by Medicaid managed care (MCO) (13.9%) and private insurance (8.6%). High cost Medicaid patients also had the highest mean annual spending and incurred the most preventable spending compared to high cost MCO and high cost private insurance patients. We used 2012 claims data from Massachusetts to examine characteristics and spending patterns of the state's costliest patients based on type of insurance. Providers and policymakers seeking to reduce costs and increase value under delivery system reform may wish to target the Medicaid population. Copyright © 2017 Elsevier Inc. All rights reserved.

Access to Transportation and Health Care Utilization in a Rural Region

ERIC Educational Resources Information Center

Arcury, Thomas A.; Preisser, John S.; Gesler, Wilbert M.; Powers, James M.

2005-01-01

Access to transportation to transverse the large distances between residences and health services in rural settings is a necessity. However, little research has examined directly access to transportation in analyses of rural health care utilization. This analysis addresses the association of transportation and health care utilization in a rural…

Clinical Telemedicine Utilization in Ontario over the Ontario Telemedicine Network.

PubMed

O'Gorman, Laurel D; Hogenbirk, John C; Warry, Wayne

2016-06-01

Northern Ontario is a region in Canada with approximately 775,000 people in communities scattered across 803,000 km(2). The Ontario Telemedicine Network (OTN) facilitates access to medical care in areas that are often underserved. We assessed how OTN utilization differed throughout the province. We used OTN medical service utilization data collected through the Ontario Health Insurance Plan and provided by the Ministry of Health and Long Term Care. Using census subdivisions grouped by Northern and Southern Ontario as well as urban and rural areas, we calculated utilization rates per fiscal year and total from 2008/2009 to 2013/2014. We also used billing codes to calculate utilization by therapeutic area of care. There were 652,337 OTN patient visits in Ontario from 2008/2009 to 2013/2014. Median annual utilization rates per 1,000 people were higher in northern areas (rural, 52.0; urban, 32.1) than in southern areas (rural, 6.1; urban, 3.1). The majority of usage in Ontario was in mental health and addictions (61.8%). Utilization in other areas of care such as surgery, oncology, and internal medicine was highest in the rural north, whereas primary care use was highest in the urban south. Utilization was higher and therapeutic areas of care were more diverse in rural Northern Ontario than in other parts of the province. Utilization was also higher in urban Northern Ontario than in Southern Ontario. This suggests that telemedicine is being used to improve access to medical care services, especially in sparsely populated regions of the province.

Implementation of a guideline for low back pain management in primary care: a cost-effectiveness analysis.

PubMed

Becker, Annette; Held, Heiko; Redaelli, Marcus; Chenot, Jean F; Leonhardt, Corinna; Keller, Stefan; Baum, Erika; Pfingsten, Michael; Hildebrandt, Jan; Basler, Heinz-Dieter; Kochen, Michael M; Donner-Banzhoff, Norbert; Strauch, Konstantin

2012-04-15

Cost-effectiveness analysis alongside a cluster randomized controlled trial. To study the cost-effectiveness of 2 low back pain guideline implementation (GI) strategies. Several evidence-based guidelines on management of low back pain have been published. However, there is still no consensus on the effective implementation strategy. Especially studies on the economic impact of different implementation strategies are lacking. This analysis was performed alongside a cluster randomized controlled trial on the effectiveness of 2 GI strategies (physician education alone [GI] or physician education in combination with motivational counseling [MC] by practice nurses)--both compared with the postal dissemination of the guideline (control group, C). Sociodemographic data, pain characteristics, and cost data were collected by interview at baseline and after 6 and 12 months. low back pain-related health care costs were valued for 2004 from the societal perspective. For the cost analysis, 1322 patients from 126 general practices were included. Both interventions showed lower direct and indirect costs as well as better patient outcomes during follow-up compared with controls. In addition, both intervention arms showed superiority of cost-effectiveness to C. The effects attenuated when adjusting for differences of health care utilization prior to patient recruitment and for clustering of data. Trends in cost-effectiveness are visible but need to be confirmed in future studies. Researchers performing cost-evaluation studies should test for baseline imbalances of health care utilization data instead of judging on the randomization success by reviewing non-cost parameters like clinical data alone.

What makes migrant live-in home care workers in elder care be satisfied with their job?

PubMed

Iecovich, Esther

2011-10-01

The study aims to examine job satisfaction of migrant live-in home care workers who provide care to frail older adults and to examine the extent to which quality of relationships between the care provider and care recipient and workplace characteristics is associated with job satisfaction.  A convenience sample that included 335 dyads of Philippine workers and their frail care recipients were recruited through 2 national home care agencies and snowballing. Multiple regression analyses examined the extent to which workplace characteristics, quality of relationships, care recipient characteristics, and care worker characteristics explain job satisfaction. Scores for job satisfaction, quality of relationships, and workplace characteristics were strongly positive. Overall and intrinsic job satisfactions were explained by workers' qualifications, workplace characteristics, and quality of relationships from the perspective of care recipients, whereas satisfaction with benefits was affected by workplace characteristics and quality of relationships from the perspective of the care workers. Findings suggest that workers who were better qualified in terms of more years of formal education and more years as care workers and who reported improved workplace characteristics, in particular more job decision authority and variety, reported increased job satisfaction. Therefore, enabling migrant live-in care workers more job decision authority and variety may increase their job satisfaction. More research is needed to deepen our understanding of additional job-related characteristics that explain job satisfaction among this group of care workers.

Socioeconomic factors affecting patients’ utilization of primary care services at a Tertiary Teaching Hospital in Riyadh, Saudi Arabia

PubMed Central

Alsubaie, Abdulaziz M.; Almohaimede, Khaled A.; Aljadoa, Abdulrahman F.; Jarallah, Osamah J.; Althnayan, Yasser I.; Alturki, Yousef A.

2016-01-01

Background: Primary care services utilization is dependent on socioeconomic factors. It is proven that variation in socioeconomic factors result in discrepancies in the use of such services. Admittedly, research is limited on the socioeconomic factors affecting the utilization of primary care services in Saudi Arabia. Objectives: The aim of this research was to study the effect of the main socioeconomic factors affecting patients' utilization of primary care services at a tertiary teaching hospital, Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted from January to February 2014 in a primary care clinic of a tertiary teaching hospital in Riyadh city; subjects selected using a random consecutive sampling technique. A self-administered questionnaire in Arabic was given to the participants to collect the data which comprised sociodemographic data, utilization measures, and health needs. The data were analyzed using SPSS version 21. Results: A total of 358 subjects participated in the study. The main factors that best determine the utilization of primary health care clinic in a tertiary teaching hospital were the possession of a health insurance (P = 0.046, odds ratio [OR] = 8.333), and bad self-health-perception (P < 0.014, OR: 2.088). Chronic illness was also associated with higher utilization (OR = 2.003). Conclusion: Our results reveal that chronic health problems, self-health-perception, and health insurance are the most significant socioeconomic factors affecting the utilization of primary care services. PMID:26929723

Has income-related inequity in health care utilization and expenditures been improved? Evidence from the Korean National Health and Nutrition Examination Survey of 2005 and 2010.

PubMed

Kim, Eunkyoung; Kwon, Soonman; Xu, Ke

2013-09-01

The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea. We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners. The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010. We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.

Cross-Border Utilization of Health Care: Evidence from a Population-Based Study in South Texas

PubMed Central

Su, Dejun; Richardson, Chad; Wen, Ming; Pagán, José A

2011-01-01

Objective To assess the prevalence of health care utilization in Mexico by Texas border residents and to identify the main contributing factors to their cross-border utilization of health care services. Data and Methods This study used primary data from a population-based telephone survey that was conducted in the whole Texas border area in 2008. The survey included responses from 1,405 adults. Multivariate logistic regression models were estimated to determine predictors of utilizing a wide range of health care services in Mexico. Principal Findings Forty-nine percent of the sample reported having ever purchased medications in Mexico, followed by 41 percent for dentist visits, 37.3 percent for doctor visits, and 6.7 percent for inpatient care. The most significant predictors of health care utilization in Mexico were lack of U.S. health insurance coverage, dissatisfaction with the quality of U.S. health care, and poor self-rated health status. Conclusions The high prevalence of use of health care services in Mexico by Texas border residents is suggestive of unmet needs in health care on the U.S. side of the border. Addressing these unmet needs calls for a binational approach to improve the affordability, accessibility, and quality of health care in the U.S.–Mexico border region. PMID:21158855

Longitudinal analysis of inpatient care utilization among people with intellectual disabilities: 1999-2002.

PubMed

Loh, C-H; Lin, J-D; Choi, I-C; Yen, C-F; Hsu, S-W; Wu, J-L; Tang, C C

2007-02-01

There has been no longitudinal study in Taiwan to identify the nature and the scale of medical care utilization of people with intellectual disabilities (IDs) up to the present. The aim of this study is to describe inpatient utilization among people under ID care in institutions in order to identify the pattern of medical care needs and the factors affecting utilization in Taiwan. The subject cohort was 168 individuals with ID who were cared for by a large public disability institution from 1999 to 2002 in Taipei, Taiwan. On the examination of the inpatient care that these persons underwent, it was found that these individuals had a heightened need (inpatient rate: 10.1-14.9%) for inpatient care compared with the general population with disabilities (9.37%) in Taiwan. The main reasons for hospitalization were pneumonia, gastrointestinal disorders, cellulites, orthopaedic problems, epilepsy and bronchitis. Using the full model of Generalized Estimating Equations for inpatient care utilization, the factors including low income family, living in an institution, being a subject with cerebral palsy and being a high outpatient user all influenced the use of inpatient care. This study highlights that health authorities need to promote health planning more in order to ensure an excellent quality of health monitoring and health promotion among people with ID cared for by institutions.

Predictors of physical therapy clinic performance in the treatment of patients with low back pain syndromes.

PubMed

Resnik, Linda; Liu, Dawei; Mor, Vince; Hart, Dennis L

2008-09-01

Little is known about organizational and service delivery factors related to quality of care in physical therapy. This study sought to identify characteristics related to differences in practice outcomes and service utilization. The sample comprised 114 outpatient clinics and 1,058 therapists who treated 16,281 patients with low back pain syndromes during the period 2000-2001. Clinics participated with the Focus on Therapeutic Outcomes, Inc (FOTO) database. Hierarchical linear models were used to risk adjust treatment outcomes and number of visits per treatment episode. Aggregated residual scores from these models were used to classify each clinic into 1 of 3 categories in each of 3 types of performance groups: (1) effectiveness, (2) utilization, and (3) overall performance (ie, composite measure of effectiveness and utilization). Relationships between clinic classification and the following independent variables were examined by multinomial logistic regression: years of therapist experience, number of physical therapists, ratio of physical therapists to physical therapist assistants, proportion of patients with low back pain syndromes, number of new patients per physical therapist per month, utilization of physical therapist assistants, and setting. Clinics that were lower utilizers of physical therapist assistants were 6.6 times more likely to be classified into the high effectiveness group compared with the low effectiveness group, 6.7 times more likely to be classified in the low utilization group compared with the high utilization group, and 12.4 times more likely to be classified in the best performance group compared with the worst performance group. Serving a higher proportion of patients with low back pain syndromes was associated with an increased likelihood of being classified in the lowest or middle group. Years of physical therapist experience was inversely associated with being classified in the middle utilization group compared with the highest utilization group. These findings suggest that, in the treatment of patients with low back pain syndromes, clinics that are low utilizers of physical therapist assistants are more likely to provide superior care (ie, better patient outcomes and lower service use).

Determinants of psychology service utilization in a palliative care outpatient population.

PubMed

Azuero, Casey; Allen, Rebecca Sue; Kvale, Elizabeth; Azuero, Andres; Parmelee, Patricia

2014-06-01

Research has demonstrated that treating cancer patients' psychological and physical health leads to improved overall health. This may be especially true for palliative care patients facing serious illness. This study examines the proportion and determinants of psychology service utilization in an outpatient palliative care population. Data from an existing clinical database in an outpatient palliative clinic utilizing a collaborative care model to deliver psychology services were explored. This study was framed by Andersen's Behavioral Model of Health Service Use, which incorporates three main components: predisposing, enabling, and need factors to model health service utilization. The sample (N = 149) was majority middle aged, female, and White with a primary diagnosis of cancer. Cross-tabulations were conducted to determine how many patients who met screening criteria for depression or anxiety sought psychology services. Logistic regression analyses were conducted to assess for predisposing, enabling, and need factor determinants of psychology service utilization. Among patients who met criteria for moderate depression or anxiety, 50% did not access readily available psychology services. Enabling factors were the strongest determinant of psychology utilization. Factors associated with need for psychology services (i.e., emotional distress and psychological symptom burden) did not reach significance in determining psychology service use. This study extends current knowledge about psychology utilization to palliative care outpatients receiving care within a collaborative care model. Directions for future research include further investigation of care models that optimize enabling strategies to enhance access to these services, and examination of patient-reported barriers to receiving this care. Copyright © 2013 John Wiley & Sons, Ltd.

Prevalence and Factors Associated with the Utilization of Dental Care Services among Factory Workers in Nava Nakorn Industrial Estate, Pathumthani Province, Thailand.

PubMed

Jaidee, Jeeratip; Ratanasiri, Amornrat; Chatrchaiwiwatana, Supaporn; Soonthon, Surasak

2015-07-01

The present study aimed to find out the utilization prevalence of dental care services among factory workers over a period of one year and factors associated with utilization of dental care services. This was a cross-sectional analytic study. The study population was factory workers in Nava Nakorn Industrial Estate randomly sampled using Probability Proportion to Size Cluster Sampling Method. The tool was a questionnaire about utilization of dental care services. Among the sample group of 1,500 workers from 16 factories, almost 2/3 (63.9%) had never used any dental care services in the previous year while only 36.1% did. A multivariable logistic regression analysis showed that workplace, accommodation, tooth decay, toothache history, transportation, experience in using social security fund for dental care services, availability and accessibility of dental care services, brushing teeth regularly after meals, using dental care services regularly in a dental clinic, and agreement with the idea that a tooth extraction and medication by a dentist could reduce the risk of progression of disease, statistical significance (p-value < 0.05), were factors associated with the utilization of dental care services at R2 (The Nagelkerke R Square) 0.38. That the prevalence of the factory workers who did not use dental care services during the last one year was 63.9 percent. This study identified three groups of factors associated with the utilization of dental care services as: 1) Predisposing factors, 2) Enabling factors, and 3) Need factors.

The Brøset Violence Checklist: clinical utility in a secure psychiatric intensive care setting.

PubMed

Clarke, D E; Brown, A-M; Griffith, P

2010-09-01

Violence towards health-care workers, especially in areas such as mental health/psychiatry, has become increasingly common, with nursing staff suggesting that a fear of violence from their patients may affect the quality of care they provide. Structured clinical tools have the potential to assist health-care providers in identifying patients who have the potential to become violent or aggressive. The Brøset Violence Checklist (BVC), a six-item instrument that uses the presence or absence of three patient characteristics and three patient behaviours to predict the potential for violence within a subsequent 24-h period, was trialled for 3 months on an 11-bed secure psychiatric intensive care unit. Despite the belief on the part of some nurses that decisions related to risk for violence and aggression rely heavily on intuition, there was widespread acceptance of the tool. During the trial, use of seclusion decreased suggesting that staff were able to intervene before seclusion was necessary. The tool has since been implemented as a routine part of patient care on two units in a 92-bed psychiatric centre. Five-year follow-up data and implications for practice are presented.

Pediatric dentist density and preventive care utilization for Medicaid children

PubMed Central

Heidenreich, James F.; Kim, Amy S.; Scott, JoAnna M.; Chi, Donald L.

2014-01-01

Purpose This study evaluates the relationship between county-level pediatric dentist density and dental care utilization for Medicaid-enrolled children in Washington State. Methods This is a cross-sectional analysis of 604,885 children ages 0-17 enrolled in the Washington State Medicaid Program for ≥11 months in 2012. The relationship between county-level pediatric dentist density, defined as the number of pediatric dentists per 10,000 Medicaid-enrolled children, and preventive dental care utilization was evaluated using linear regression models. Results In 2012, 179 pediatric dentists practiced in 16 of the 39 counties in Washington. County-level pediatric dentist density varied from zero to 5.98 pediatric dentists per 10,000 Medicaid-enrolled children. County-level preventive dental care utilization ranged from 32 percent to 81 percent, with 62 percent of Medicaid-enrolled children in Washington utilizing preventive dental services. After adjusting for confounders, county-level density was significantly associated with county-level dental care utilization (β=1.67, 95 percent CI=0.02, 3.32, p=0.047). Conclusions There is a significant relationship between pediatric dentist density and the proportion of Medicaid-enrolled children who utilize preventive dental care services. Policies aimed at improving pediatric oral health disparities should include strategies to increase the number of oral health care providers, including pediatric dentists, in geographic areas with large proportions of Medicaid-enrolled children. PMID:26314606

The Effect of Free Adult Preventive Care Services on Subsequent Utilization of Inpatient Services in Taiwan.

PubMed

Tian, Wei-Hua

2016-07-01

The objective of this article is to investigate the relationship between the utilization of free adult preventive care services and subsequent utilization of inpatient services among elderly people under the National Health Insurance program in Taiwan. The study used secondary data from the 2005 Taiwan National Health Interview Survey and claim data from the 2006 Taiwan National Health Insurance Research Database for the elderly aged 65 or over. A bivariate probit model was used to avoid the possible endogeneity in individuals' utilization of free adult preventive care and inpatient services. This study finds that, when individuals had utilized the preventive care services in 2005, the probability that they utilized inpatient services in 2006 was significantly reduced by 13.89%. The findings of this study may provide a good reference for policy makers to guide the efficient allocation of medical resources through the continuous promotion of free adult preventive care services under the National Health Insurance program. © Australian Council for Educational Research 2016.

Utilization of dental health care services in context of the HIV epidemic- a cross-sectional study of dental patients in the Sudan.

PubMed

Nasir, Elwalid Fadul; Astrøm, Anne Nordrehaug; David, Jamil; Ali, Raouf Wahab

2009-11-16

HIV infected patients should be expected in the Sudanese dental health care services with an increasing frequency. Dental care utilization in the context of the HIV epidemic is generally poorly understood. Focusing on Sudanese dental patients with reported unknown HIV status, this study assessed the extent to which Andersen's model in terms of predisposing (socio-demographics), enabling (knowledge, attitudes and perceived risk related to HIV) and need related factors (oral health status) predict dental care utilization. It was hypothesized that enabling factors would add to the explanation of dental care utilization beyond that of predisposing and need related factors. Dental patients were recruited from Khartoum Dental Teaching Hospital (KDTH) and University of Science and Technology (UST) during March-July 2008. A total of 1262 patients (mean age 30.7, 56.5% females and 61% from KDTH) were examined clinically (DMFT) and participated in an interview. A total of 53.9% confirmed having attended a dental clinic for treatment at least once in the past 2 years. Logistic regression analysis revealed that predisposing factors; travelling inside Sudan (OR = 0.5) were associated with lower odds and females were associated with higher odds (OR = 2.0) for dental service utilization. Enabling factors; higher knowledge of HIV transmission (OR = 0.6) and higher HIV related experience (OR = 0.7) were associated with lower odds, whereas positive attitudes towards infected people and high perceived risk of contagion (OR = 1.3) were associated with higher odds for dental care utilization. Among need related factors dental caries experience was strongly associated with dental care utilization (OR = 4.8). Disparity in the history of dental care utilization goes beyond socio-demographic position and need for dental care. Public awareness of HIV infection control and confidence on the competence of dentists should be improved to minimize avoidance behaviour and help establish dental health care patterns in Sudan.

Income-related inequality in health and health care utilization in Chile, 2000-2009.

PubMed

Vásquez, Felipe; Paraje, Guillermo; Estay, Manuel

2013-02-01

To measure and explain income-related inequalities in health and health care utilization in the period 2000 - 2009 in Chile, while assessing variations within the country and determinants of inequalities. Data from the National Socioeconomic Characterization Survey for 2000, 2003, and 2009 were used to measure inequality in health and health care utilization. Income-related inequality in health care utilization was assessed with standardized concentration indices for the probability and total number of visits to specialized care, generalized care, emergency care, dental care, mental health care, and hospital care. Self-assessed health status and physical limitations were used as proxies for health care need. Standardization was performed with demographic and need variables. The decomposition method was applied to estimate the contribution of each factor used to calculate the concentration index, including ethnicity, employment status, health insurance, and region of residence. In Chile, people in lower-income quintiles report worse health status and more physical limitations than people in higher quintiles. In terms of health service utilization, pro-rich inequities were found for specialized and dental visits with a slight pro-rich utilization for general practitioners and all physician visits. All pro-rich inequities have decreased over time. Emergency room visits and hospitalizations are concentrated among lower-income quintiles and have increased over time. Higher education and private health insurance contribute to a pro-rich inequity in dentist, general practitioner, specialized, and all physician visits. Income contributes to a pro-rich inequity in specialized and dentist visits, whereas urban residence and economic activity contribute to a pro-poor inequity in emergency room visits. The pattern of health care utilization in Chile is consistent with policies implemented in the country and in the intended direction. The significant income inequality in the use of specialized and dental services, which favor the rich, deserves policy makers' attention and further investigation related to the quality of these services.

[Drug expenditure in primary care: associated variables and allocation of drug budgets according to health district].

PubMed

García-Sempere, A; Peiró, S

2001-01-01

Identify factors explaining variability in prescribing costs after reviewing ecological data related to costs and socio-demographic characteristics of the health care zones in the autonomous region of Valencia, and explore the usefulness of using the model to set prescribing budgets in basic healthcare zones. An ecological analysis of the value socio-demographic characteristics and use of healthcare services to explain prescribing costs in 1997. Development of a prediction model based on multiple linear regression in data for prescribing costs in 1997 and validation in data for 1998. Factors that correlated positively with prescribing costs were the percentage of inhabitants over the age of 80, the death rate, the percentage of inhabitants with only primary education or less, the percentage of inhabitants between the ages of 65 and 79 and the distance from the capital city. A multivariate model including the death rate, the percentage of inhabitants 80 years of age and older, the number of cars per 100 inhabitants and number of visits per inhabitant accounted for 44.5% of the variations in prescribing costs in 1997 and 32% in 1998. Socio-demographic factors and certain variables associated with health care utilization can be applied, within certain limitations, to set prescribing budgets in basic healthcare zones.

Anxiety and fear of cancer recurrence and its association with supportive care needs and health-care service utilization in cancer patients.

PubMed

Sarkar, Susanne; Sautier, Leon; Schilling, Georgia; Bokemeyer, Carsten; Koch, Uwe; Mehnert, Anja

2015-12-01

We investigated the relationship between fear of cancer recurrence (FCR), anxiety, supportive care needs, and utilization of health-care services in a mixed sample of 335 cancer patients. We used validated questionnaires including the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the General Anxiety Disorder Scale (GAD-7) and the Supportive Care Needs Survey (SCNS-SF34). Health-care services utilization was measured by a self-constructed questionnaire recording the use of 22 health and supportive care offers. In our sample, 3.9% of patients were classified as having high anxiety and 5.1% had high FCR. Patients reported the highest unmet supportive care needs in the domain health system and information followed by psychological needs. Integrated care and complementary support services were the most frequently used (32%) followed by medical (31%), psychological (23%), spiritual and religious (8%) and other support services (9%). Whereas anxiety was related to both unmet psychological and physical/daily living needs (p < 0.01), FCR was associated with unmet supportive care needs in all five domains further including needs with regard to health system and information, patient care, and sexuality (p < 0.01). However, higher levels of anxiety and FCR were not related to higher utilization of health-care services. Our findings show that FCR plays a significant role in unmet supportive care needs in cancer patients but not for health-care service utilization. We recommend that clinicians monitor supportive care needs in patients struggling with FCR and anxiety.

Prevalence of anxiety disorders among Finnish primary care high utilizers and validation of Finnish translation of GAD-7 and GAD-2 screening tools.

PubMed

Kujanpää, Tero; Ylisaukko-Oja, Tero; Jokelainen, Jari; Hirsikangas, Sari; Kanste, Outi; Kyngäs, Helvi; Timonen, Markku

2014-06-01

To analyse the prevalence of GAD and other anxiety disorders, as well as sensitivity and specificity of GAD-7 among high utilizers of health care. Four municipal health centres in Northern Finland. A psychiatric interview was conducted for 150 high utilizers of health care. Prevalence of GAD as well as sensitivity and specificity of GAD-7. The prevalence of GAD was 4% in this study group of Finnish high utilizers of health care. The sensitivity of GAD-7 was 100.0% (95% CI 54.1-100.0) and the specificity of GAD-7 was 82.6% (95% CI 75.4-88.4) with a cut-off point of 7 or more. GAD is rather common among high utilizers of primary care, although the prevalence of 4% is lower than that previously reported. GAD-7 is a valid and useful tool for detecting GAD among primary health care patients.

Utilization and intensity of outpatient care related to military sexual trauma for veterans from Afghanistan and Iraq.

PubMed

Turchik, Jessica A; Pavao, Joanne; Hyun, Jenny; Mark, Hanna; Kimerling, Rachel

2012-07-01

Little research has examined factors associated with the utilization of outpatient health care services related to sexual assault experiences. The Veterans Health Administration provides free outpatient treatment services to veterans who report military sexual trauma (MST); this system provides a unique opportunity to examine factors related to the utilization of mental health and non-mental health outpatient services by patients with sexual trauma. The current study examined sociodemographic, military service factors, and primary diagnoses related to utilization and utilization intensity of MST-related care among 4,458 Operation Enduring Freedom/Operation Iraqi Freedom Veterans in a 1-year period after reporting an experience of MST. Of the veterans who reported MST, 75.9% received MST-related care. The most notable factor that influenced receipt and intensity of MST-related care was gender, where male veterans used less care than female veterans. These results have important treatment implications for both veteran and civilian sexual trauma survivors.

Separate and Cumulative Effects of Adverse Childhood Experiences in Predicting Adult Health and Health Care Utilization

ERIC Educational Resources Information Center

Chartier, Mariette J.; Walker, John R.; Naimark, Barbara

2010-01-01

Objectives: Objectives of this population-based study were: (1) to examine the relative contribution of childhood abuse and other adverse childhood experiences to poor adult health and increased health care utilization and (2) to examine the cumulative effects of adverse childhood experiences on adult health and health care utilization. Methods:…

Differences in Health Care Costs and Utilization among Adults with Selected Lifestyle-Related Risk Factors.

ERIC Educational Resources Information Center

Tucker, Larry A.; Clegg, Alan G.

2002-01-01

Examined the relationship between lifestyle-related health risks and health care costs and utilization among young adults. Data collected at a primarily white collar worksite in over 2 years indicated that health risks, particularly obesity, stress, and general lifestyle, were significant predictors of health care costs and utilization among these…

Managed Care for Children: Effect on Access to Care and Utilization of Health Services.

ERIC Educational Resources Information Center

Szilagyi, Peter G.

1998-01-01

Reviews what is known about the effect of managed care on access to health services, as well as utilization of hospital care, emergency department visits, primary care services, and specialty pediatric services. The effect of managed care appears dependent on several factors and, thus, is likely to vary according to the population served. (SLD)

Determinants of prenatal care use: evidence from 32 low-income countries across Asia, Sub-Saharan Africa and Latin America.

PubMed

Guliani, Harminder; Sepehri, Ardeshir; Serieux, John

2014-08-01

While much has been written on the determinants of prenatal care attendance in low-income countries, comparatively little is known about the determinants of the frequency of prenatal visits in general and whether there are separate processes generating the decisions to use prenatal care and the frequency of use. Using the Demographic and Health Surveys data for 32 low-income countries (across Asia, Sub-Saharan Africa and Latin America) and appropriate two-part and multilevel models, this article empirically assesses the influence of a wide array of observed individual-, household- and community-level characteristics on a woman's decision to use prenatal care and the frequency of that use, while controlling for unobserved community level factors. The results suggest that, though both the decision to use care and the number of prenatal visits are influenced by a range of observed individual-, household- and community-level characteristics, the influence of these determinants vary in magnitude for prenatal care attendance and the frequency of prenatal visits. Despite remarkable consistency among regions in the association of individual, household and community indicators with prenatal care utilization, the estimated coefficients of the risk factors vary greatly across the three world regions. The strong influence of household wealth, education and regional poverty on the use of prenatal care suggests that safe motherhood programmes should be linked with the objectives of social development programmes such as poverty reduction, enhancing the status of women and increasing primary and secondary school enrolment rate among girls. Finally, the finding that teenage mothers and unmarried women and those with unintended pregnancies are less likely to use prenatal care and have fewer visits suggests that safe mother programmes need to pay particular attention to the disadvantaged and vulnerable subgroups of population whose reproductive health issues are often fraught with controversy. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Bypassing Primary Care Facilities for Childbirth: Findings from a Multilevel Analysis of Skilled Birth Attendance Determinants in Afghanistan.

PubMed

Tappis, Hannah; Koblinsky, Marge; Doocy, Shannon; Warren, Nicole; Peters, David H

2016-01-01

The objective of this study was to assess the association between health facility characteristics and other individual/household factors with a woman's likelihood of skilled birth attendance in north-central Afghanistan. Data from a 2010 household survey of 6879 households in 9 provinces of Afghanistan were linked to routine facility data. Hierarchical logistic regression models were used to assess determinants of skilled birth attendance. Women who reported having at least one antenatal visit with a skilled provider were 5.6 times more likely to give birth with a skilled attendant than those who did not. The odds of skilled birth attendance were 84% higher for literate women than those without literacy skills and 79% higher among women in the upper 2 wealth quintiles than women in the poorest quintile. This study did not show any direct linkages between facility characteristics and skilled birth attendance but provided insights into why studies assuming that women seek care at the nearest primary care facility may lead to misinterpretation of care-seeking patterns. Findings reveal a 36 percentage point gap between women who receive skilled antenatal care and those who received skilled birth care. Nearly 60% of women with a skilled attendant at their most recent birth bypassed the nearest primary care facility to give birth at a more distant primary care facility, hospital, or private clinic. Distance and transport barriers were reported as the most common reasons for home birth. Assumptions that women who give birth with a skilled attendant do so at the closest health facility may mask the importance of supply-side determinants of skilled birth attendance. More research based on actual utilization patterns, not assumed catchment areas, is needed to truly understand the factors influencing care-seeking decisions in both emergency and nonemergency situations and to adapt strategies to reduce preventable mortality and morbidity in Afghanistan. © 2016 by the American College of Nurse-Midwives.

Effect of laparoscopic surgery on health care utilization and costs in patients who undergo colectomy.

PubMed

Crawshaw, Benjamin P; Chien, Hung-Lun; Augestad, Knut M; Delaney, Conor P

2015-05-01

Laparoscopic colectomy is safe and effective in the treatment of many colorectal diseases. However, the effect of increasing use of laparoscopy on overall health care utilization and costs, especially in the long term, has not been thoroughly investigated. To evaluate the effect of laparoscopic vs open colectomy on short- and long-term health care utilization and costs. Retrospective multivariate regression analysis of national health insurance claims data was used to evaluate health care utilization and costs up to 1 year following elective colectomy. Data were obtained from the Truven Health Analytics MarketScan Commercial Claims and Encounters database. Patients aged 18 to 64 years who underwent elective laparoscopic or open colectomy from January 1, 2010, through December 31, 2010, were included. Patients with complex diagnoses that require increased non-surgery-related health care utilization, including malignant neoplasm, inflammatory bowel disease, human immunodeficiency virus, transplantation, and pregnancy, were excluded. Of 25 481 patients who underwent colectomy, 4160 were included in the study. Healthcare utilization, including office, hospital outpatient, and emergency department visits and inpatient services 90 and 365 days after the index procedure; total health care costs; and estimated days off from work owing to health care utilization. Of 25 481 patients who underwent colectomy, 4160 were included in the study (laparoscopic, 45.6%; open, 54.4%). The mean (SD) net and total payments were lower for laparoscopy ($23 064 [$14 558] and $24 196 [$14 507] vs $29 753 [$21 421] and $31 606 [$23 586]). In the first 90 days after surgery, an open approach was significantly associated with a 1.26-fold increase in health care costs (estimated, $1715; 95% CI, $338-$2853), increased use of heath care services, and more estimated days off from work (2.78 days; 95% CI, 1.93-3.59). Similar trends were found in the full postoperative year, with an estimated 1.18-fold increase (95% CI, 1.04-1.35) in health care expenditures and an increase of 1.15 times (95% CI, 1.08-1.23) the number of health care utilization days compared with laparoscopy. Laparoscopic colectomy results in a significant reduction in health care costs and utilization in the short- and long-term postoperative periods.

The Effect of Medicaid Physician Fee Increases on Health Care Access, Utilization, and Expenditures.

PubMed

Callison, Kevin; Nguyen, Binh T

2018-04-01

To evaluate the effect of Medicaid fee changes on health care access, utilization, and spending for Medicaid beneficiaries. We use the 2008 and 2012 waves of the Medical Expenditure Panel Survey linked to state-level Medicaid-to-Medicare primary care reimbursement ratios obtained through surveys conducted by the Urban Institute. We also incorporate data from the Current Population Survey and the Area Resource Files. Using a control group made up of the low-income privately insured, we conduct a difference-in-differences analysis to assess the relationship between Medicaid fee changes and access to care, utilization of health care services, and out-of-pocket medical expenditures for Medicaid enrollees. We find that an increase in the Medicaid-to-Medicare payment ratio for primary care services results in an increase in outpatient physician visits, emergency department utilization, and prescription fills, but only minor improvements in access to care. In addition, we report an increase in total annual out-of-pocket expenditures and spending on prescription medications. Compared to the low-income privately insured, increased primary care reimbursement for Medicaid beneficiaries leads to higher utilization and out-of-pocket spending for Medicaid enrollees. © Health Research and Educational Trust.