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Jiménez J, Kress M, Long T, Katz M. NYC Care: A Large Health Care Access Program for Uninsured New York City Residents. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:E239-E246. [PMID: 38833664 DOI: 10.1097/phh.0000000000001915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
CONTEXT Millions of people living in the United States are excluded from health insurance due to income or immigration status. These 2 groups are more likely to lack access to health care or a regular source of care. PROGRAM NYC Health + Hospitals is addressing this need with NYC Care, a health care access program. The program is designed to be the single point of access for uninsured care citywide and includes a membership card, a 24-hour customer service line, and direct access to primary care medical homes. Health care is coordinated across NYC Health + Hospitals using integrated electronic referrals and a medical record system. IMPLEMENTATION The program uses a single enrollment process across safety net health care resources of NYC Health + Hospitals. A 24-hour call center was established to answer questions, make primary care appointments, and make warm handoffs to enrollment staff. Once eligibility is confirmed and patients are enrolled, they are mailed a membership card, a member handbook, and offered a primary care appointment. A multipronged public awareness campaign including citywide, multilingual marketing and outreach via community-based organizations was essential to build trust. OUTCOMES NYC Care had 119 203 members at the end of June 2023. Fifty-eight percent had not seen a primary care doctor in the NYC Health + Hospitals system in the prior 36 months. In total, 76 439 had completed 1 or more primary care visits; 53.1% of enrollees with diabetes had improved hemoglobin A 1c , and 73.4% of enrollees with hypertension had improved blood pressure control after 6 months of enrollment. DISCUSSION NYC Care demonstrates that municipalities can improve access to care for the uninsured by simplifying steps to affordable health care services, connecting patients directly to patient-centered medical homes, and improving the patient experience. A comprehensive public awareness campaign is also crucial.
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Affiliation(s)
- Jonathan Jiménez
- NYC Health + Hospitals, Duke University School of Medicine, Durham, North Carolina (Dr Jiménez); NYC Health + Hospitals, New York (Ms Kress and Dr Katz); and Health + Hospitals, NYU Grossman School of Medicine, New York (Dr Long)
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Eisinger EC, Chen AT, Ramadan OI, Morgan AU, Delgado MK, Kaufman EJ. Health Care Use Among Patients Retroactively Insured via a Hospital-Based Insurance Linkage Program. J Gen Intern Med 2024; 39:1977-1984. [PMID: 38483779 PMCID: PMC11306664 DOI: 10.1007/s11606-024-08712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE Over 25% of the 27 million uninsured individuals in the United States are eligible for Medicaid. Many hospitals have insurance linkage programs that assist eligible patients with enrollment, but little is known about the impact of these programs on care utilization. This research assessed health care utilization and health outcomes among patients enrolled in Medicaid via a hospital-based insurance linkage program. METHODS This retrospective cohort study included adults aged 18-64 admitted to the hospital from 2016 to 2021. Those who obtained insurance retroactively via insurance linkage (RI) were compared with those who presented with Medicaid (MI) or remained uninsured (UI). The primary outcome was the presence of at least one visit with a primary care provider (PCP) in the 12 months following index admission. Secondary outcomes included having an assigned PCP, ED revisits, and hospital readmissions. For patients with diabetes and hypertension, 12-month hemoglobin A1c (HbA1c) and blood pressure (BP) readings were tracked. RESULTS Of 3882 patients admitted with no insurance, 2905 (74.8%) were enrolled in insurance (RI). In multivariable analysis, RI patients were 14% more likely (OR 1.14, p = 0.020) to have completed at least one PCP visit by 12 months after index admission compared to those with preexisting Medicaid (MI), and uninsured patients were 29% less likely (OR 0.71, p = 0.003). MI and RI patients also had more ED revisits (p < 0.001) and greater 12-month reductions in blood pressure (p < 0.001) compared with uninsured patients. CONCLUSION Hospital-based insurance linkage reached three-quarters of uninsured patients and was associated with increased utilization of acute and outpatient health care services. An acute care encounter represents an opportunity to connect patients to insurance, a key step toward improving their health outcomes.
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Affiliation(s)
- Ella C Eisinger
- The Center for Surgical Health, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Angela T Chen
- The Center for Surgical Health, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Health Care Management Department, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Omar I Ramadan
- The Center for Surgical Health, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna U Morgan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M Kit Delgado
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elinore J Kaufman
- The Center for Surgical Health, University of Pennsylvania, Philadelphia, PA, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Trauma, Surgical Critical Care & Emergency Surgery, Penn Presbyterian Medical Center, Philadelphia, PA, USA.
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Perez GK, Rabin JT, Tandon M, Strauss NM, Irwin K, Philpotts L, Ostroff J, Park ER. Do Tobacco Treatment Trials Address Disparities in Smoking Outcomes Among Black and Hispanic Cancer Patients? A Systematic Review of Smoking Cessation Interventions for Black and Hispanic Patients Diagnosed with Cancer. J Racial Ethn Health Disparities 2024; 11:2390-2406. [PMID: 37468742 PMCID: PMC11236890 DOI: 10.1007/s40615-023-01705-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 05/30/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To characterize the representation of Black and Hispanic cancer patients in tobacco treatment trials, and to offer recommendations for future research. METHODS We conducted two systematic searches of the literature (2018, 2021) using 5 databases (MEDLINE via EBSCO, Pubmed, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE)) to examine the prevalence of tobacco trials that included Black or Hispanic cancer patients. Two coders independently screened all articles at title, abstract, and full-text to identify eligible trials. Information about the proportion of Black and Hispanic patients included, trial design features, and whether the authors analyzed outcomes for Black and Hispanic patients were documented. RESULTS Of 4682 identified studies, only 10 published trials included and reported on the rates of Black or Hispanic cancer patients enrolled in their tobacco trial. The proportion of enrolled Black cancer patients ranged from 2 to 55.6%. Only our studies documented enrollment rates for Hispanics, and rates were less than 6%. None of the studies offered strategies to promote or the accrual of Black or Hispanic patients. DISCUSSION There remains a large gap in the literature regarding the reach and efficacy of tobacco treatment for Black and Hispanic cancer patients. Black and Hispanic cancer patients remain largely under-represented in tobacco cessation trials, limiting the applicability of existing, evidence-based treatments. To optimize intervention generalizability, future studies should emphasize the targeted recruitment and engagement of these patients in tobacco trials.
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Affiliation(s)
- Giselle K Perez
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA.
- Health Promotion and Resilience Intervention Research Program, 100 Cambridge Street, 16th floor, Boston, MA, 02114, USA.
| | - Julia T Rabin
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | | | | | - Kelly Irwin
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
- Health Promotion and Resilience Intervention Research Program, 100 Cambridge Street, 16th floor, Boston, MA, 02114, USA
| | - Lisa Philpotts
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Jamie Ostroff
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elyse R Park
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
- Health Promotion and Resilience Intervention Research Program, 100 Cambridge Street, 16th floor, Boston, MA, 02114, USA
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Raven MC. Improving Cancer Outcomes Among Unhoused Patients-Lessons From the Veterans Health Administration. JAMA Netw Open 2023; 6:e2349096. [PMID: 38127354 DOI: 10.1001/jamanetworkopen.2023.49096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Maria C Raven
- UCSF Department of Emergency Medicine, University of California, San Francisco Benioff Housing and Homelessness Initiative, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
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Brush PL, Tomlak A, Pohl N, Lee Y, Narayanan R, Meade MH, Lambrechts MJ, Lawall CL, Weber J, Syal A, O'Connor P, Canseco JA, Kaye ID, Kurd MF, Vaccaro AR, Kepler CK, Hilibrand AS, Schroeder GD. Utilization of In-Hospital Orthopaedic Spine Consultations: Evaluating the Impact of Health Care Policy. Am J Med Qual 2023; 38:300-305. [PMID: 37908033 DOI: 10.1097/jmq.0000000000000155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Access to specialty and private practice providers has been a divisive policy issue over the last decade, complicated by the conflict between a reduction in government-funded health care reimbursement and the need for health care providers to sustain a financially sound practice. This study evaluates the orthopedic spine consult service at an academic tertiary care center at 2 separate time points over a 5-year period to better understand the impact of decreasing orthopedic reimbursement rates and the increasing prevalence of federally supported medical insurance on the access to specialty care. In total 500 patients in 2017 and 480 patients in 2021 were included for the final analysis. A higher percentage of consults in 2021 came from the emergency department (74.0% versus 60.4%, P < 0.001); however, the emergency department saw fewer spinal cord injuries (11.9% versus 21.4%, P < 0.001), and the spinal cord injuries were less severe (3.1% versus 6.2% Association Impairment Scale A or B, P = 0.034). A smaller percentage of patients in 2021 went on to receive orthopedic spine surgery following consultation (35.2% versus 43.8%, P = 0.007), and those receiving surgery had an operation performed farther out from the initial consultation (4.73 versus 4.09 days, P < 0.001). Additionally, fewer patients with Medicare insurance (23.5% versus 30.8%) and more patients with Medicaid insurance (20.2% versus 12.4%) were seen in 2021 compared with 2017 (P = 0.003). Overall, this study found an increased proportion of Medicaid patients seen by the spine consult service but a decrease in the acuity of consults. Measures to improve access to health insurance under the Affordable Care Act have revealed the complexity of this issue in health care. This study's findings have demonstrated that while more patients did have insurance coverage following the Affordable Care Act, they still face a barrier to accessing outpatient orthopedic spine providers.
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Affiliation(s)
- Parker L Brush
- Department of Orthopaedic Spine Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Wang MC, Bangaru S, Zhou K. Care for Vulnerable Populations with Chronic Liver Disease: A Safety-Net Perspective. Healthcare (Basel) 2023; 11:2725. [PMID: 37893800 PMCID: PMC10606794 DOI: 10.3390/healthcare11202725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Safety-net hospitals (SNHs) and facilities are the cornerstone of healthcare services for the medically underserved. The burden of chronic liver disease-including end-stage manifestations of cirrhosis and liver cancer-is high and rising among populations living in poverty who primarily seek and receive care in safety-net settings. For many reasons related to social determinants of health, these individuals often present with delayed diagnoses and disease presentations, resulting in higher liver-related mortality. With recent state-based policy changes such as Medicaid expansion that impact access to insurance and critical health services, an overview of the body of literature on SNH care for chronic liver disease is timely and informative for the liver disease community. In this narrative review, we discuss controversies in the definition of a SNH and summarize the known disparities in the cascade of the care and management of common liver-related conditions: (1) steatotic liver disease, (2) liver cancer, (3) chronic viral hepatitis, and (4) cirrhosis and liver transplantation. In addition, we review the specific impact of Medicaid expansion on safety-net systems and liver disease outcomes and highlight effective provider- and system-level interventions. Lastly, we address remaining gaps and challenges to optimizing care for vulnerable populations with chronic liver disease in safety-net settings.
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Affiliation(s)
- Mark C Wang
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Saroja Bangaru
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Los Angeles General Medical Center, Los Angeles, CA 90033, USA
| | - Kali Zhou
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Los Angeles General Medical Center, Los Angeles, CA 90033, USA
- Research Center for Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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Low Rates of Hepatitis B Virus Treatment Among Treatment-Eligible Patients in Safety-Net Health Systems. J Clin Gastroenterol 2022; 56:360-368. [PMID: 33780210 DOI: 10.1097/mcg.0000000000001530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/10/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Timely initiation of antiviral therapy in chronic hepatitis B virus (CHB) reduces risk of disease progression. We evaluate overall treatment rates and predictors of treatment among treatment-eligible safety-net CHB patients. METHODS We retrospectively evaluated adults with CHB from 2010 to 2018 across 4 large safety-net health systems in the United States. CHB was identified with ICD-9/10 diagnosis coding and confirmed with laboratory data. Treatment eligibility was determined using American Association for the Study of Liver Diseases (AASLD) guidelines. Comparison of CHB treatment rates among treatment-eligible patients were performed using χ2 testing, Kaplan Meier methods and log-rank testing. Adjusted multivariate Cox proportional hazards models evaluated independent predictors of receiving treatment among eligible patients. RESULTS Among 5157 CHB patients (54.7% male, 34.6% African American, 22.3% Asian), 46.8% were treatment-eligible during the study period. CHB treatment rates were 48.4% overall and 37.3% among CHB patients without human immunodeficiency virus. Significantly lower odds of treatment were observed in females versus males (odds ratio: 0.40, 95% confidence interval: 0.33-0.49, P<0.001) and patients age 65 years or above versus age below 45 years (odds ratio: 0.68, 95% confidence interval: 0.51-0.92, P=0.012). Conversely, significantly greater odds of treatment were observed in African American and Asians versus non-Hispanic whites, CHB patients with indigent care versus commercially insured patients, and non-English speaking versus English speaking patients. CONCLUSION Among a large multicentered, safety-net cohort of CHB patients, 46.8% of treatment-eligible CHB patients overall and 37.3% of treatment-eligible CHB patients without human immunodeficiency virus received antiviral therapy. Improving CHB treatment rates among treatment-eligible patients represents "low hanging fruit," given the clear benefits of antiviral therapy in mitigating disease progression.
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Emmons RP, Harris IM, Abdalla M, Afolabi TM, Barner AE, Baxter MV, Bisada M, Chase AM, Christenberry EJ, Cobb BT, Dang Y, Hickman CM, Mills AR, Wease H. Impact of remote delivery of clinical pharmacy services on health disparities and access to care. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Ila M. Harris
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Maha Abdalla
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | | | - Miriam Bisada
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | | | - Yen Dang
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | - Alex R. Mills
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Heather Wease
- American College of Clinical Pharmacy Lenexa Kansas USA
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Allen CD, Perreira KM. Commentary on the Affordable Care Act and Health Care Access and Utilization Among White, Asian, and Latino Immigrants in California. Med Care 2021; 59:759-761. [PMID: 34425582 DOI: 10.1097/mlr.0000000000001620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chenoa D Allen
- Department of Health Sciences, University of Missouri School of Health Professions, Columbia, MO
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina Medical School, Chapel Hill, NC
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Wong RJ, Hirode G. The Effect of Hospital Safety-Net Burden and Patient Ethnicity on In-Hospital Mortality Among Hospitalized Patients With Cirrhosis. J Clin Gastroenterol 2021; 55:624-630. [PMID: 33136780 DOI: 10.1097/mcg.0000000000001452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Over 2.1 million individuals in the United Stats have cirrhosis, including 513,000 with decompensated cirrhosis. Hospitals with high safety-net burden disproportionately serve ethnic minorities and have reported worse outcomes in surgical literature. No studies to date have evaluated whether hospital safety-net burden negatively affects hospitalization outcomes in cirrhosis. We aim to evaluate the impact of hospitals' safety-net burden and patients' ethnicity on in-hospital mortality among cirrhosis patients. METHODS Using National Inpatient Sample data from 2012 to 2016, the largest United States all-payer inpatient health care claims database of hospital discharges, cirrhosis-related hospitalizations were stratified into tertiles of safety-net burden: high (HBH), medium (MBH), and low (LBH) burden hospitals. Safety-net burden was calculated as percentage of hospitalizations per hospital with Medicaid or uninsured payer status. Multivariable logistic regression evaluated factors associated with in-hospital mortality. RESULTS Among 322,944 cirrhosis-related hospitalizations (63.7% white, 9.9% black, 15.6% Hispanic), higher odds of hospitalization in HBHs versus MBH/LBHs was observed in blacks (OR, 1.26; 95%CI, 1.17-1.35; P<0.001) and Hispanics (OR, 1.63; 95% CI, 1.50-1.78; P<0.001) versus whites. Cirrhosis-related hospitalizations in MBHs or HBHs were associated with greater odds of in-hospital mortality versus LBHs (HBH vs. LBH: OR, 1.05; 95% CI, 1.00-1.10; P=0.044). Greater odds of in-hospital mortality was observed in blacks (OR, 1.27; 95% CI, 1.21-1.34; P<0.001) versus whites. CONCLUSION Cirrhosis patients hospitalized in HBH experienced 5% higher mortality than those in LBH, resulting in significantly greater deaths in cirrhosis patients. Even after adjusting for safety-net burden, blacks with cirrhosis had 27% higher in-hospital mortality compared with whites.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA
| | - Grishma Hirode
- Toronto Centre for Liver Disease, University Health Network, Toronto General Hospital, University of Toronto, Canada
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Doran K, Barrett BA, Buchanan M. A Nurse-Run Public Health Clinic for Individuals Utilizing a Community Outreach Center. J Community Health Nurs 2021; 38:173-178. [PMID: 34148434 DOI: 10.1080/07370016.2021.1932951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article describes a nurse-run clinic for low-income individuals or individuals experiencing homelessness. We conducted a quality improvement project using data from 111 individuals over 194 visits. Thirty-seven percent of patients had difficulty managing their health and 22% reported being in an active health crisis. The visits resulted in patients leaving with their visit goal being met (86%), and 96% of nonemergent cases being diverted from the emergency room. The nurse-run clinic provided access to care and served as a safety net for a vulnerable population, providing support for this clinic model with this population.
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Affiliation(s)
- Kelly Doran
- Department of Family and Community Health, School of Nursing, University of Maryland, Baltimore, Maryland, United States
| | - Barbara A Barrett
- Department of Family and Community Health, School of Nursing, University of Maryland, Baltimore, Maryland, United States
| | - Marjorie Buchanan
- Senior Consultant Population Health Networks, Lewes, Delaware, United States
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Klein CJ, Dalstrom MD, Foulger R, Weinzimmer LG. Auto-assignment of providers in Medicaid Managed Care and factors influencing seasonal flu vaccine uptake: a retrospective analysis. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [PMCID: PMC8083665 DOI: 10.1093/jphsr/rmab012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
Over 50 million people in the USA are enrolled in a Medicaid Managed Care plan. If they do not select a primary care provider, they are auto-assigned to one. The impact of auto-assignment has largely been understudied outside the context of patient satisfaction with the insurance plan. The purpose of the study was to explore the association between auto-assignment and flu vaccination use, which will contribute to our understanding of factors influencing the COVID-19 vaccine uptake.
Methods
Retrospective data from the Enterprise Data Warehouse of a health system were obtained for adult Medicaid enrolees assigned to a Midwestern health system in 2019. Descriptive statistics, independent t-tests and tetrachoric correlations were used to explore the relationship between auto-assignment and flu vaccine receipt among a large sample of Illinois residents (N = 7224). The sample was then divided into those who chose their provider (n = 6027) and those who were auto-assigned (n = 1197).
Key findings
Individuals who selected their provider were deemed to have flu vaccine coverage over those who were auto-assigned (33.2% vs. 6.6%). Furthermore, among those who were auto-assigned, age, number of office visits and having chronic morbidities, including chronic obstructive pulmonary disease (P < 0.01), diabetes (P < 0.01) and heart failure (P < 0.01), were positively associated with flu vaccine receipt.
Conclusions
Individuals who are auto-assigned to a primary care provider are less likely to be flu vaccine recipients than those who choose their provider. This suggests that auto-assignment is a risk factor that influences vaccine receipt. This research provides perspectives for outreach efforts that target individuals who are auto-assigned to a provider.
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Affiliation(s)
- Colleen J Klein
- Center for Advanced Practice, OSF HealthCare, Peoria, IL, USA
| | | | - Roopa Foulger
- Data Delivery Analytics Department, OSF HealthCare, Peoria, IL, USA
| | - Laurence G Weinzimmer
- Caterpillar, Inc. Endowed Professor of Management; Foster College of Business, Bradley University, Peoria, IL, USA
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Hoadley A, Bass SB, Brujaha J, D'Avanzo PA, Kelly PJ. Healthcare beliefs, health information seeking, and healthcare setting preferences among women who inject drugs by community supervision status. HEALTH & JUSTICE 2021; 9:10. [PMID: 33864163 PMCID: PMC8052650 DOI: 10.1186/s40352-021-00135-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/05/2021] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Women on community supervision who inject drugs have significant unmet healthcare needs. However, it remains unclear how the intersection of community supervision and injection drug use influences healthcare experiences and service setting preferences. The present study examines whether the intersection of community supervision and injection drug use is associated with differences in women's healthcare beliefs, healthcare experiences, and service setting preferences. METHODS A secondary analysis was conducted on a previously collected sample of women who inject drugs recruited from a syringe exchange and social service organization for a cross-sectional survey. Participants (N = 64) were mostly White (75%), and more than a quarter were currently on probation or parole (26%). RESULTS Independent samples t-tests and chi-square tests revealed no significant differences on sociodemographic variables by community supervision status. There were no significant differences by community supervision status across seven indicators of healthcare confidence (ps > .05). However, results revealed significant differences in past experiences and beliefs about healthcare, health information seeking, and healthcare setting preferences by community supervision status (ps < .05), where women on community supervision less frequently sought health information and medical care outside of emergency departments. CONCLUSIONS Findings provide preliminary evidence about differences in the healthcare experiences and setting preferences of women who inject drugs on community supervision.
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Affiliation(s)
- Ariel Hoadley
- Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Ninth Floor, Philadelphia, PA, 19122, USA.
- Risk Communication Laboratory, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Ninth Floor, Philadelphia, PA, 19122, USA.
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Ninth Floor, Philadelphia, PA, 19122, USA
- Risk Communication Laboratory, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Ninth Floor, Philadelphia, PA, 19122, USA
| | - Jesse Brujaha
- Risk Communication Laboratory, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Ninth Floor, Philadelphia, PA, 19122, USA
| | - Paul A D'Avanzo
- Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Ninth Floor, Philadelphia, PA, 19122, USA
- Risk Communication Laboratory, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Ninth Floor, Philadelphia, PA, 19122, USA
| | - Patrick J Kelly
- Risk Communication Laboratory, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Ninth Floor, Philadelphia, PA, 19122, USA
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