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Hossain M, Dean EB, Kaliski D. Using Administrative Data to Examine Telemedicine Usage Among Medicaid Beneficiaries During the Coronavirus Disease 2019 Pandemic. Med Care 2022; 60:488-495. [PMID: 35679172 PMCID: PMC9172580 DOI: 10.1097/mlr.0000000000001723] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic necessitated the replacement of in-person physician consultations with telemedicine. During the pandemic, Medicaid covered the cost of telemedicine visits. OBJECTIVES The aim was to measure the adoption of telemedicine during the pandemic. We focus on key patient subgroups including those with chronic conditions, those living in urban versus rural areas, and different age groups. METHODS This study examined the universe of claims made by Florida Medicaid beneficiaries (n=2.4 million) between January 2019 and July 2020. Outpatient visits were identified as in-person or telemedicine. Telemedicine visits were classified into audio-visual or audio-only visits. RESULTS We find that telemedicine offsets much of the decline in in-person outpatient visits among Florida's Medicaid enrollees, however, uptake differs by enrollee type. High utilizers of care and beneficiaries with chronic conditions were significantly more likely to use telemedicine, while enrollees living in rural areas and health professional shortage areas were moderately less likely to use telemedicine. Elderly Medicaid recipients (dual-eligibles) used audio-only telemedicine visits at higher rates than other age groups, and the demand for these consultations is more persistent. CONCLUSIONS Telemedicine offset the decline in health care utilization among Florida's Medicaid-enrolled population during the novel coronavirus pandemic, with particularly high uptake among those with prior histories of high utilization. Audio-only visits are a potentially important method of delivery for the oldest Medicaid beneficiaries.
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Affiliation(s)
| | - Emma B Dean
- Department of Health Management and Policy, Miami Herbert Business School, University of Miami, Miami, FL
| | - Daniel Kaliski
- Department of Economics, Mathematics, and Statistics, Birkbeck, University of London, London, UK
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DeGuzman PB, Huang G, Lyons G, Snitzer J, Keim-Malpass J. Rural Disparities in Early Childhood Well Child Visit Attendance. J Pediatr Nurs 2021; 58:76-81. [PMID: 33370620 DOI: 10.1016/j.pedn.2020.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Children should attend well child visits (WCVs) during early childhood so that developmental disorders may be identified as early as possible, so treatment can begin. The aim of this research was to determine if rurality impacts access to WCV during early childhood, and if altering rurality measurement methods impacts outcomes. DESIGN AND METHODS We utilized a longitudinal correlational design with early childhood data gathered from the Virginia All Payer Claims Database, which contains claims data from Medicaid and the majority of Virginia commercial insurance payers (n = 6349). WCV attendance was evaluated against three rurality metrics: a traditional metric using Rural-Urban Commuting Area codes, a developed land variable, and a distance to care variable, at a zip code level. RESULTS Two of the rurality methods revealed that rural children attend fewer WCVs than their urban counterparts, (67% vs. 50% respectively, using a traditional metric; and a 0.035 increase in WCV attendance for every percent increase in developed land). Differences were attenuated by insurance payer; children with Medicaid attend fewer WCVs than those with private insurance. CONCLUSIONS Young children in rural Virginia attend fewer WCVs than their non-rural counterparts, placing them at higher risk for missing timely developmental disorder screenings. The coronavirus disease pandemic has been associated with an abrupt and significant reduction in vaccination rates, which likely indicates fewer WCVs and concomitant developmental screenings. Pediatric nurses should encourage families of young children to develop a plan for continued WCVs, so that early identification of developmental disorders can be achieved.
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Affiliation(s)
- Pamela B DeGuzman
- University of Virginia School of Nursing, VA, United States of America.
| | - Guoping Huang
- University of Virginia School of Architecture, Department of Urban and Environmental Planning, United States of America
| | - Genevieve Lyons
- University of Virginia School of Medicine, Department of Public Health Sciences, United States of America
| | - Joseph Snitzer
- University of Virginia School of Architecture, Department of Urban and Environmental Planning, United States of America
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McBain RK, Kareddy V, Cantor JH, Stein BD, Yu H. Systematic Review: United States Workforce for Autism-Related Child Healthcare Services. J Am Acad Child Adolesc Psychiatry 2020; 59:113-139. [PMID: 31150751 PMCID: PMC6883168 DOI: 10.1016/j.jaac.2019.04.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/11/2019] [Accepted: 05/21/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE A diversity of health professional disciplines provide services for children with autism spectrum disorder (ASD) in the United States. We conducted a systematic review examining the availability, distribution, and competencies of the US workforce for autism-related child health care services, and assess studies' strength of evidence. METHOD We searched PubMed, PsychINFO, Embase, and Google Scholar from 2008 to 2018 for relevant US-based studies. Two investigators independently screened and evaluated studies against a set of prespecified inclusion criteria and evaluated strength of evidence (SOE) using a framework designed to integrate a mixed-methods research. RESULTS Of 754 records identified, 33 studies (24 quantitative, 6 qualitative, and 3 mixed-methods) were included. Strength of evidence associated was low-to-moderate, with only 8 studies (24%) satisfying criteria for strong SOE. Geographies and provider cadres varied considerably. The most common specialties studied were pediatricians (n = 13), occupational therapists (n = 12), speech therapists (n = 11), physical therapists (n = 10), and child psychiatrists (n = 8). Topical areas included the following: provider availability by service area and care delivery model; qualitative assessments of provider availability and competency; role of insurance mandates in increasing access to providers: and disparities in access. Across provider categories, we found that workforce availability for autism-related services was limited in terms of overall numbers, time available, and knowledgeability. The greatest unmet need was observed among minorities and in rural settings. Most studies were short term, were limited in scope, and used convenience samples. CONCLUSION There is limited evidence to characterize the availability and distribution of the US workforce for autism-related child health care services. Existing evidence to date indicates significantly restricted availability.
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Affiliation(s)
| | | | | | | | - Hao Yu
- RAND Corporation, Pittsburgh, PA
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Graves JM, Mackelprang JL, Moore M, Abshire DA, Rivara FP, Jimenez N, Fuentes M, Vavilala MS. Rural-urban disparities in health care costs and health service utilization following pediatric mild traumatic brain injury. Health Serv Res 2019; 54:337-345. [PMID: 30507042 PMCID: PMC6407359 DOI: 10.1111/1475-6773.13096] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To compare health care costs and service utilization associated with mild traumatic brain injury (mTBI) in rural and urban commercially insured children. DATA SOURCE MarketScan Commercial Claims and Encounters Data, 2007-2011. STUDY DESIGN We compared health care costs and outpatient encounters for physical/occupational therapy, speech therapy, and psychiatry/psychology encounters 180 days after mTBI among rural versus urban children (<18 years). PRINCIPAL FINDINGS A total of 387 846 children had mTBI, with 13 percent residing in rural areas. Adjusted mean total health care costs in the 180 days after mTBI were $2778 (95% CI: 2660-2897) among rural children, compared to $2499 (95% CI: 2471-2528) among urban children (adjusted cost ratio 1.11, 95% CI 1.06-1.16). Rural-urban differences in utilization for specific services were also found. CONCLUSIONS Total health care costs were higher for rural compared to urban children despite lower utilization of certain services. Differences in health service utilization may exacerbate geographic disparities in adverse outcomes associated with mTBI.
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Affiliation(s)
- Janessa M. Graves
- College of NursingHealth Sciences CampusWashington State UniversitySpokaneWashington
| | - Jessica L. Mackelprang
- Department of Psychological SciencesSchool of Health SciencesSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Megan Moore
- School of Social WorkUniversity of WashingtonHarborview Injury Prevention and Research Center (HIPRC)SeattleWashington
| | | | - Frederick P. Rivara
- Department of PediatricsSchool of MedicineUniversity of WashingtonHarborview Injury Prevention and Research Center (HIPRC)SeattleWashington
| | - Nathalia Jimenez
- Department of Anesthesiology and Pain MedicineSchool of MedicineUniversity of WashingtonSeattle Children's Research InstituteHarborview Injury Prevention and Research Center (HIPRC)SeattleWashington
| | - Molly Fuentes
- Department of Rehabilitation MedicineSchool of MedicineUniversity of WashingtonHarborview Injury Prevention and Research Center (HIPRC)Seattle Children's Research InstituteSeattleWashington
| | - Monica S. Vavilala
- Departments of Anesthesiology & Pain Medicine and PediatricsSchool of MedicineUniversity of WashingtonHarborview Injury Prevention and Research Center (HIPRC)SeattleWashington
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Colquitt G, Walker AD, Alfonso ML, Olivas M, Ugwu B, Dipita T. Parent Perspectives on Health and Functioning of School-Aged Adolescents With Disabilities. THE JOURNAL OF SCHOOL HEALTH 2018; 88:676-684. [PMID: 30133774 DOI: 10.1111/josh.12668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/31/2017] [Accepted: 11/20/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Youth living with disabilities are at risk of experiencing poor health outcomes. Coordinated school health programs have an opportunity to help youth with disabilities and their families through health education, health services, and community engagement. The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) as a framework to analyze factors related to health conditions. We used the ICF to examine parental perceptions of health and function among students with disabilities living in rural and urban areas. METHODS We surveyed parents (N = 71) using the parent-report versions of the Pediatric Outcomes Data Collection Instrument and Child Health and Illness Profile. From this group, parents were asked to volunteer to participate in in-depth, individual interviews (N = 18). The interviews were audio-recorded and transcribed verbatim. Researchers used the ICF linking rules to analyze and code the transcriptions. Emergent themes were assigned numerical ICF codes. RESULTS There were more similarities than differences among rural and urban families. Children living with disabilities face significant environmental barriers regardless of context. CONCLUSIONS Schools can facilitate education to improve the quality of life of parents and families of children with disabilities. School authorities should consider the many environmental barriers both urban and rural these families face in the community. The ICF can be used as a framework for program planning for community-based, health education for this population.
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Affiliation(s)
- Gavin Colquitt
- Georgia Southern University, Department of Health Sciences and Kinesiology, PO Box 8076, Statesboro, GA 30460
| | - Ashley D Walker
- Community Health Education & Behavior, Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA 30460
| | - Moya L Alfonso
- Community Health Behavior and Education, Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA 30460
| | - Maria Olivas
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA 30460
| | - Bethrand Ugwu
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA 30460
| | - Theophile Dipita
- Biostatistics Team 1, HFV-163, Office of New Animal Drug Evaluation, Center for Veterinary Medicine, U.S. Food & Drug Administration, 7500 Standish Place, Rockville, MD 20855
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Abstract
This study investigated the effects of a short-term family-centered workshop for children with developmental delays.This study was conducted in a rehabilitation outpatient clinic of a teaching hospital. We recruited 30 children with developmental delays and their parents as the study group and 57 age- and sex-matched children with typical development and their parents as the control group. The workshop was conducted for the children with developmental delays and their parents in the form of one 2-hour session per week for 6 weeks by health and education professionals by using a family-centered multidisciplinary approach. The Mandarin-Chinese Communicative Developmental Inventory and Peabody Developmental Motor Scales-Second Edition were used to assess the communication and motor skills of the children with developmental delays. The parent form of the Pediatric Outcomes Data Collection Instrument, Child Health Questionnaire, Pediatric Quality of Life (PedsQL) Inventory, and PedsQL Family Impact Module were administered to the parents of both groups.On study commencement, no significant differences were noted in functional performance and family impact between the children with developmental delays and those without delays. The children with developmental delays had lower health and health-related quality of life (HRQOL) scores than the children with typical development. Following the workshop, the study group exhibited significant improvements in physical health (94.2 vs 80.2, effect size: 1.00, P = .026), global function (94.8 vs 78.7, effect size: 0.88, P = .006), impact of the child's health on parental HRQOL (85.0 vs 70.4, effect size: 0.81, P = .043), and parental HRQOL (81.3 vs 65.0, effect size: 0.81, P = .015). No significant differences were recorded in function, health, HRQOL, or family impact between the children with developmental delays and those with typical development after 6 weeks.The multidisciplinary short-term family-centered workshop for children with developmental delays improved the children's physical health and global functional skills, and it reduced the impact of the child's health on parental HRQOL while also improving parental HRQOL.
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Affiliation(s)
- Wen-Huei Hsieh
- Department of Child Care and Education, College of Human Ecology, Chang Gung University of Science and Technology
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University
| | - Ru-Lan Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Siriwardhana C, Lim E, Aggarwal L, Davis J, Hixon A, Chen JJ. Racial/Ethnic and County-level Disparity in Inpatient Utilization among Hawai'i Medicaid Population. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2018; 77:103-113. [PMID: 29761028 PMCID: PMC5945927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We investigated racial/ethnic and county-level disparities in inpatient utilization for 15 clinical conditions among Hawaii's Medicaid population. The study was conducted using inpatient claims data from more than 200,000 Hawai'i Medicaid beneficiaries, reported in the year 2010. The analysis was performed by stratifying the Medicaid population into three age groups: children and adolescent group (1-20 years), adult group (21-64 years), and elderly group (65 years and above). Among the differences found, Asians had a low probability of inpatient admissions compared to Whites for many disease categories, while Native Hawaiian/Pacific Islanders had higher probabilities than Whites, across all age groups. Pediatric and adult groups from Hawai'i County (Big Island) had lower probabilities for inpatient admissions compared to Honolulu County (O'ahu) for most disease conditions, but higher probabilities were observed for several conditions in the elderly group. Notably, the elderly population residing on Kaua'i County (Kaua'i and Ni'ihau islands) had substantially increased odds of hospital admissions for several disease conditions, compared to Honolulu.
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Affiliation(s)
- Chathura Siriwardhana
- Department of Complementary and Integrative Medicine, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (CS, EL, JD, JJC)
- Department of Family Medicine & Community Health, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (LA, AH)
| | - Eunjung Lim
- Department of Complementary and Integrative Medicine, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (CS, EL, JD, JJC)
- Department of Family Medicine & Community Health, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (LA, AH)
| | - Lovedhi Aggarwal
- Department of Complementary and Integrative Medicine, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (CS, EL, JD, JJC)
- Department of Family Medicine & Community Health, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (LA, AH)
| | - James Davis
- Department of Complementary and Integrative Medicine, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (CS, EL, JD, JJC)
- Department of Family Medicine & Community Health, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (LA, AH)
| | - Allen Hixon
- Department of Complementary and Integrative Medicine, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (CS, EL, JD, JJC)
- Department of Family Medicine & Community Health, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (LA, AH)
| | - John J Chen
- Department of Complementary and Integrative Medicine, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (CS, EL, JD, JJC)
- Department of Family Medicine & Community Health, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (LA, AH)
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Abstract
STUDY PURPOSE To examine therapy use and spending for Medicaid-enrolled infants and toddlers with developmental conditions. METHODS Sample infants and toddlers had a diagnosis (eg, cerebral palsy) or developmental delay (DD). Colorado Children's Medicaid administrative outpatient therapy claims (2006-2008) were used to estimate differences, by condition type and number of comorbid chronic conditions (CCCs), of any physical therapy (PT)/occupational therapy (OT) and Medicaid PT/OT spending. RESULTS The sample included 20 959 children. Children with at least 2 CCCs had higher odds of PT/OT than children with no CCC. Children with DD had 12-fold higher odds of having any PT/OT compared with children with diagnosis. Children with a DD and 2 CCCs had the highest PT/OT spending. CONCLUSIONS Medicaid PT/OT use and spending are higher for children with more CCCs and those with DD because children with DD receive more specialized PT/OT.
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Schaible BJ, Colquitt G, Li L, Caciula M, Moreau NG. Urban vs. rural differences in insurance coverage and impact on employment among families caring for a child with cerebral palsy. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1321159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Braydon J. Schaible
- Department of Biostatistics, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Gavin Colquitt
- School of Health and Kinesiology, Georgia Southern University, 1332 Southern Drive, Statesboro, GA 30458, USA
| | - Li Li
- School of Health and Kinesiology, Georgia Southern University, 1332 Southern Drive, Statesboro, GA 30458, USA
| | - Manuela Caciula
- School of Health and Kinesiology, Georgia Southern University, 1332 Southern Drive, Statesboro, GA 30458, USA
| | - Noelle G. Moreau
- Department of Physical Therapy, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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