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Denham A, Hill EL, Raven M, Mendoza M, Raz M, Veazie PJ. Is the emergency department used as a substitute or a complement to primary care in Medicaid? HEALTH ECONOMICS, POLICY, AND LAW 2024; 19:73-91. [PMID: 37870129 DOI: 10.1017/s1744133123000270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Policies to decrease low-acuity emergency department (ED) use have traditionally assumed that EDs are a substitute for unavailable primary care (PC). However, such policies can exacerbate ED overcrowding, rather than ameliorate it, if patients use EDs to complement, rather than substitute, their PC use. We tested whether Medicaid managed care enrolees visit the ED for nonemergent and PC treatable conditions to substitute for or to complement PC. Based on consumer choice theory, we modelled county-level monthly ED visit rate as a function of PC supply and used 2012-2015 New York Statewide Planning and Research Cooperative System (SPARCS) outpatient data and non-linear least squares method to test substitution vs complementarity. In the post-Medicaid expansion period (2014-2015), ED and PC are substitutes state-wide, but are complements in highly urban and poorer counties during nights and weekends. There is no evidence of complementarity before the expansion (2012-2013). Analyses by PC provider demonstrate that the relationship between ED and PC differs depending on whether PC is provided by physicians or advanced practice providers. Policies to reduce low-acuity ED use via improved PC access in Medicaid are likely to be most effective if they focus on increasing actual appointment availability, ideally by physicians, in areas with low PC provider supply. Different aspects of PC access may be differently related to low-acuity ED use.
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Affiliation(s)
- Alina Denham
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115, USA
| | - Elaine L Hill
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, USA
| | - Maria Raven
- Department of Emergency Medicine, School of Medicine, University of California, San Francisco, USA
| | - Michael Mendoza
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, USA
- Department of Family Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, USA
| | - Mical Raz
- Department of History, University of Rochester, Rochester, USA
- Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, USA
| | - Peter J Veazie
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, USA
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2
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Horner-Johnson W, Lindner S, Levy A, Hall J, Kurth N, Garcia E, Frame A, Phillips K, Momany E, Lurie M, Shin Y, Lauer E, Kunte P, Silverstein R, Okoro C, McDermott S. Time trends in emergency department use among adults with intellectual and developmental disabilities. Disabil Health J 2022; 15:101225. [PMID: 34782255 PMCID: PMC10950032 DOI: 10.1016/j.dhjo.2021.101225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/21/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Emergency Department (ED) visits are common among adults with intellectual and developmental disabilities (IDD). However, little is known about how ED use has varied over time in this population, or how it has been affected by recent Medicaid policy changes. OBJECTIVE To examine temporal trends in ED use among adult Medicaid members with IDD in eight states that ranged in the extent to which they had implemented state-level Medicaid policy changes that might affect ED use. METHODS We conducted repeated cross-sectional analyses of 2010-2016 Medicaid claims data. Quarterly analyses included adults ages 18-64 years with IDD (identified by diagnosis codes) who were continuously enrolled in Medicaid for the past 12 months. We assessed change in number of ED visits per 1000 member months from 2010 to 2016 overall and interacted with state level policy changes such as Medicaid expansion. RESULTS States with no Medicaid expansion experienced an increase in ED visits (linear trend coefficient: 1.13, p < 0.01), while states operating expansion via waiver had a much smaller (non-significant) increase, and states with ACA-governed expansion had a decrease in ED visits (linear trend coefficient: 1.17, p < 0.01). Other policy changes had limited or no association with ED visits. CONCLUSIONS Medicaid expansion was associated with modest reduction or limited increase in ED visits compared to no expansion. We found no consistent decrease in ED visits in association with other Medicaid policy changes.
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Affiliation(s)
- Willi Horner-Johnson
- Institute on Development and Disability, Oregon Health & Science University, Portland, OR, USA.
| | - Stephan Lindner
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, USA
| | - Anna Levy
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, USA
| | - Jean Hall
- Institute for Health and Disability Policy Studies, University of Kansas, Lawrence, KS, USA
| | - Noelle Kurth
- Institute for Health and Disability Policy Studies, University of Kansas, Lawrence, KS, USA
| | - Erika Garcia
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Alice Frame
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Kimberly Phillips
- Institute on Disability, University of New Hampshire, Durham, NH, USA
| | | | - Melissa Lurie
- New York State Department of Health, Albany, NY, USA
| | - Yejee Shin
- New York State Department of Health, Albany, NY, USA
| | - Emily Lauer
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Shrewsbury, MA, USA
| | - Parag Kunte
- Commonwealth Medicine, University of Massachusetts Medical School, Shrewsbury, MA, USA
| | - Robin Silverstein
- Montana Department of Public Health & Human Services, Helena, MT, USA
| | - Catherine Okoro
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, USA
| | - Suzanne McDermott
- School of Public Health & Health Policy, City University of New York, New York, NY, USA
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3
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Rucker AC, Watson A, Badolato G, Boyle M, Hendrix C, Jarvis L, Patel SJ, Goyal MK. Predictors of Elevated Social Risk in Pediatric Emergency Department Patients and Families. Pediatr Emerg Care 2022; 38:e910-e917. [PMID: 34225329 DOI: 10.1097/pec.0000000000002489] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to identify predictors of high unmet social needs among pediatric emergency department (ED) patients. We hypothesized that obesity, frequent nonurgent visits, reported food insecurity, or an at-risk chief complaint (CC) would predict elevated social risk. METHODS We administered a tablet-based survey assessing unmet social needs in 13 domains to caregivers of patients aged 0 to 17 years presenting to an urban pediatric ED. Responses were used to tabulate a social risk score (SRS). We performed multivariable logistic regression to measure associations between a high SRS (≥3) and obesity, frequent nonurgent visits, food insecurity, or an at-risk CC (physical abuse, sexual abuse, assault, mammalian bites, reproductive/sexual health complaints, intoxication, ingestion/poisoning, psychiatric/behavioral complaints, or any complaint triaged as "least urgent"). RESULTS Five hundred seventy caregivers completed the survey. Eighty-one percent reported at least one unmet social need, and 33% identified ≥3 social needs. Caregivers of patients with an at-risk CC had twice the odds of a high SRS (adjusted odds ratio [aOR], 1.8; 95% confidence interval [CI], 1.0-3.3). Caregivers of patients reporting food insecurity had 4 times the odds of a high SRS (aOR, 4.3; 95% CI, 2.5-7.3). Neither obesity (aOR, 1.5; 95% CI, 0.9-2.6) nor frequent nonurgent visits (aOR, 0.9; 95% CI, 0.4-1.9) were predictive of a high SRS. CONCLUSIONS Unmet social needs are prevalent among caregivers of pediatric ED patients, supporting universal screening in this population. Patients with an at-risk CC or reported food insecurity might benefit from proactive intervention. Future studies should examine optimal methods for ED-based interventions that address social determinants of health.
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Affiliation(s)
| | - Ar'Reon Watson
- Department of Psychiatry, Center for Child and Human Development, Georgetown University, Washington, DC
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Morisod K, Luta X, Marti J, Spycher J, Malebranche M, Bodenmann P. Measuring Health Equity in Emergency Care Using Routinely Collected Data: A Systematic Review. Health Equity 2022; 5:801-817. [PMID: 35018313 PMCID: PMC8742300 DOI: 10.1089/heq.2021.0035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Achieving equity in health care remains a challenge for health care systems worldwide and marked inequities in access and quality of care persist. Identifying health care equity indicators is an important first step in integrating the concept of equity into assessments of health care system performance, particularly in emergency care. Methods: We conducted a systematic review of administrative data-derived health care equity indicators and their association with socioeconomic determinants of health (SEDH) in emergency care settings. Following PRISMA-Equity reporting guidelines, Ovid MEDLINE, EMBASE, PubMed, and Web of Science were searched for relevant studies. The outcomes of interest were indicators of health care equity and the associated SEDH they examine. Results: Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care-sensitive condition-related ED visits were the two most frequently used equity indicators. The studies analyzed equity based on seven SEDH: social deprivation, income, education level, social class, insurance coverage, health literacy, and financial and nonfinancial barriers. Despite some conflicting results, all identified SEDH are associated with inequalities in access to and use of emergency care. Conclusion: The use of administrative data-derived indicators in combination with identified SEDH could improve the measurement of health care equity in emergency care settings across health care systems worldwide. Using a combination of indicators is likely to lead to a more comprehensive, well-rounded measurement of health care equity than using any one indicator in isolation. Although studies analyzed focused on emergency care settings, it seems possible to extrapolate these indicators to measure equity in other areas of the health care system. Further studies elucidating root causes of health inequities in and outside the health care system are needed.
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Affiliation(s)
- Kevin Morisod
- Department of Vulnerabilities and Social Medicine, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Xhyljeta Luta
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Joachim Marti
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Jacques Spycher
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Mary Malebranche
- Department of Vulnerabilities and Social Medicine, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Medicine, University of Calgary, Calgary, Canada
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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5
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Lines LM, Cohen J, Kirschner J, Halpern MT, Kent EE, Mollica MA, Smith AW. Random survival forests using linked data to measure illness burden among individuals before or after a cancer diagnosis: Development and internal validation of the SEER-CAHPS illness burden index. Int J Med Inform 2021; 145:104305. [PMID: 33188949 PMCID: PMC7736519 DOI: 10.1016/j.ijmedinf.2020.104305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/03/2020] [Accepted: 10/16/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To develop and internally validate an illness burden index among Medicare beneficiaries before or after a cancer diagnosis. METHODS Data source: SEER-CAHPS, linking Surveillance, Epidemiology, and End Results (SEER) cancer registry, Medicare enrollment and claims, and Medicare Consumer Assessment of Healthcare Providers and Systems (Medicare CAHPS) survey data providing self-reported sociodemographic, health, and functional status information. To generate a score for everyone in the dataset, we tabulated 4 groups within each annual subsample (2007-2013): 1) Medicare Advantage (MA) beneficiaries or 2) Medicare fee-for-service (FFS) beneficiaries, surveyed before cancer diagnosis; 3) MA beneficiaries or 4) Medicare FFS beneficiaries surveyed after diagnosis. Random survival forests (RSFs) predicted 12-month all-cause mortality and drew predictor variables (mean per subsample = 44) from 8 domains: sociodemographic, cancer-specific, health status, chronic conditions, healthcare utilization, activity limitations, proxy, and location-based factors. Roughly two-thirds of the sample was held out for algorithm training. Error rates based on the validation ("out-of-bag," OOB) samples reflected the correctly classified percentage. Illness burden scores represented predicted cumulative mortality hazard. RESULTS The sample included 116,735 Medicare beneficiaries with cancer, of whom 73 % were surveyed after their cancer diagnosis; overall mean mortality rate in the 12 months after survey response was 6%. SEER-CAHPS Illness Burden Index (SCIBI) scores were positively skewed (median range: 0.29 [MA, pre-diagnosis] to 2.85 [FFS, post-diagnosis]; mean range: 2.08 [MA, pre-diagnosis] to 4.88 [MA, post-diagnosis]). The highest decile of the distribution had a 51 % mortality rate (range: 29-71 %); the bottom decile had a 1% mortality rate (range: 0-2 %). The error rate was 20 % overall (range: 9% [among FFS enrollees surveyed after diagnosis] to 36 % [MA enrollees surveyed before diagnosis]). CONCLUSIONS This new morbidity measure for Medicare beneficiaries with cancer may be useful to future SEER-CAHPS users who wish to adjust for comorbidity.
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Affiliation(s)
- Lisa M Lines
- Center for Advanced Methods Development, RTI International, Research Triangle Park, NC, United States; Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave. North, United States.
| | - Julia Cohen
- Center for Advanced Methods Development, RTI International, Research Triangle Park, NC, United States
| | - Justin Kirschner
- Center for Advanced Methods Development, RTI International, Research Triangle Park, NC, United States
| | - Michael T Halpern
- Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, United States
| | - Erin E Kent
- Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Michelle A Mollica
- Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, United States
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, United States
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6
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Myong C, Hull P, Price M, Hsu J, Newhouse JP, Fung V. The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts. PLoS One 2020; 15:e0243279. [PMID: 33270778 PMCID: PMC7714363 DOI: 10.1371/journal.pone.0243279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/18/2020] [Indexed: 11/24/2022] Open
Abstract
Importance Federally qualified health centers (FQHCs) receive federal funding to serve medically underserved areas and provide a range of services including comprehensive primary care, enabling services, and behavioral health care. Greater funding for FQHCs could increase the local availability of clinic-based care and help reduce more costly resource use, such as emergency department visits (ED). Objective To examine the impact of funding increases for FQHCs after the ACA on the use of FQHCs and EDs. Methods Retrospective study using the Massachusetts All Payer Claims Database (APCD) 2010–2013 that included APCD enrollees in 559 Massachusetts ZIP codes (N = 6,173,563 in 2010). We calculated shift-share predictions of changes in FQHC funding at the ZIP code-level for FQHCs that received Community Health Center funds in any year, 2010–13 (N = 31). Outcomes were the number of ZIP code enrollees with visits to FQHCs and EDs, overall and for emergent and non-emergent diagnoses. Results In 2010, 4% of study subjects visited a FQHC, and they were more likely to be younger, have Medicaid, and live in low-income areas. We found that a standard deviation increase in prior year FQHC funding (+31 percentage point (pp)) at the ZIP code level was associated with a 2.3pp (95% CI 0.7pp to 3.8pp) increase in enrollees with FQHC visits and a 1.3pp (95% CI -2.3pp to -0.3pp) decrease in enrollees with non-emergent ED visits, but no significant change in emergent ED visits (0.3pp, 95% CI -0.8pp to 1.4pp). Conclusions We found that areas exposed to greater FQHC funding increases had more growth in the number of enrollees seen by FQHCs and greater reductions in ED visits for non-emergent conditions. Investment in FQHCs could be a promising approach to increase access to care for underserved populations and reduce costly ED visits, especially for primary care treatable or non-emergent conditions.
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Affiliation(s)
- Catherine Myong
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Peter Hull
- The Becker Friedman Institute, University of Chicago, Chicago, Illinois, United States of America
| | - Mary Price
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - John Hsu
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Joseph P. Newhouse
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Harvard Kennedy School, Cambridge, Massachusetts, United States of America
| | - Vicki Fung
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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7
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Impact of cash incentives for low-income individuals to seek a primary care visit on mental health outcomes: Evidence from a randomized controlled trial. Soc Sci Med 2020; 265:113515. [DOI: 10.1016/j.socscimed.2020.113515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/20/2020] [Accepted: 11/06/2020] [Indexed: 11/23/2022]
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8
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Mayfield CA, Geraci M, de Hernandez BU, Dulin M, Eberth JM, Merchant AT. Ambulatory care, insurance, and avoidable emergency department utilization in North Carolina. Am J Emerg Med 2020; 46:225-232. [PMID: 33071099 DOI: 10.1016/j.ajem.2020.07.034] [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: 05/25/2020] [Revised: 07/11/2020] [Accepted: 07/11/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine whether and how avoidable emergency department (ED) utilization is associated with ambulatory or primary care (APC) utilization, insurance, and interaction effects. DESIGN AND SAMPLE A cross-sectional analysis of electronic health records from 70,870 adults residing in Mecklenburg County, North Carolina, who visited an ED within a large integrated healthcare system in 2017. METHODS APC utilization was measured as total visits, categorized as: 0, 1, and > 1. Insurance was defined as the method of payment for the ED visit as: Medicaid, Medicare, private, or uninsured. Avoidable ED utilization was quantified as a score (aED), calculated as the sum of New York University Algorithm probabilities multiplied by 100. Quantile regression models were used to predict the 25th, 50th, 75th, 95th, and 99th percentiles of avoidable ED scores with APC visits and insurance as predictors (Model 1) and with an interaction term (Model 2). RESULTS Having >1 APC visit was negatively associated with aED at the lower percentiles and positively associated at higher percentiles. A higher aED was associated with having Medicaid insurance and a lower aED was associated with having private insurance, compared to being uninsured. In stratified models, having >1 APC visit was negatively associated with aED at the 25th percentile for the uninsured and privately insured, but positively associated with aED at higher percentiles among the uninsured, Medicaid-insured, and privately insured. CONCLUSIONS The association between APC utilization and avoidable ED utilization varied based on segments of the distribution of ED score and differed significantly by insurance type.
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Affiliation(s)
- Carlene A Mayfield
- Atrium Health, Department of Community Health, Charlotte, NC, United States of America.
| | - Marco Geraci
- University of South Carolina, Department of Epidemiology and Biostatistics, Arnold School of Public Health, Columbia, SC, United States of America
| | | | - Michael Dulin
- Academy for Population Health Innovation, University of North Carolina Charlotte and Mecklenburg County Health Department, Charlotte, NC, United States of America
| | - Jan M Eberth
- Rural and Minority Health Research Center, University of South Carolina, Department of Epidemiology and Biostatistics, Arnold School of Public Health, Columbia, SC, United States of America
| | - Anwar T Merchant
- University of South Carolina, Department of Epidemiology and Biostatistics, Arnold School of Public Health, Columbia, SC, United States of America
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9
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Rodday AM, Esham KS, Savidge N, Parsons SK. Patterns of healthcare utilization among patients with sickle cell disease hospitalized with pain crises. ACTA ACUST UNITED AC 2020; 1:438-447. [PMID: 34350423 PMCID: PMC8330517 DOI: 10.1002/jha2.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Vaso‐occlusive crises (VOC) are the hallmark of sickle cell disease (SCD). Adults experiencing VOC often have high rates of unexpected healthcare utilization. We characterized prior and future healthcare utilization among adults hospitalized with VOC at an urban, academic medical center. Methods We identified 449 VOC hospitalizations among 63 patients from 2013 to 2016. Patients were categorized based on receiving established care at the medical center and prior utilization: (a) not established (n = 21); (b) newly established (n = 10); (c) established with low utilization in past 12 months (<4 VOC hospitalizations) (n = 22); and (d) established with high utilization in past 12 months (≥4 VOC hospitalizations) (n = 10). Patient and hospitalization characteristics and future utilization were compared across categories. Results Median age was 26 years (Q1 = 22, Q3 = 29) and 55.6% were female. Established patients with high prior utilization tended to have higher median pain scores at admission (10, P = .08). Thirty‐day readmissions were highest in established patients with high prior utilization (P = .06), but 30‐day clinic visits were highest in established patients with low prior utilization (P = .08). Adjusted linear regression found that newly established patients (β = −4.6, P < .01) and established patients with low prior utilization (β = −5.6, P < .01) had fewer VOC hospitalizations in the ensuing 12 months than established patients with high prior utilization. Conclusion Among patients with SCD hospitalized for VOC, there was heterogeneity in healthcare utilization, with persistence in utilization over time for some patients. Efforts are needed to shift care from the acute setting to the outpatient clinic, which may lead to improved outcomes.
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Affiliation(s)
- Angie Mae Rodday
- Tufts Medical Center, The Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Kimberly S Esham
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.,Tufts Medical Center, Hematology and Oncology, Boston, Massachusetts, USA
| | - Nicole Savidge
- Tufts Medical Center, The Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA
| | - Susan K Parsons
- Tufts Medical Center, The Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.,Tufts Medical Center, Hematology and Oncology, Boston, Massachusetts, USA
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10
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Cotti CD, Gordanier JM, Ozturk OD. Hunger pains? SNAP timing and emergency room visits. JOURNAL OF HEALTH ECONOMICS 2020; 71:102313. [PMID: 32305829 DOI: 10.1016/j.jhealeco.2020.102313] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 01/18/2020] [Accepted: 03/03/2020] [Indexed: 06/11/2023]
Abstract
This project uses quasi-random assignment of SNAP receipt dates linked to Medicaid healthcare records to examine whether ER use is affected by the timing of benefits. We find an increase in ER usage at the end of the benefit month, but only among older recipients. The estimated effect is much larger when the end of the benefit cycle coincides with the end of the calendar month, which is when other transfer payments are also depleted. This suggests that within this older group, increased food insecurity leads to increased ER utilization. Further, we find that the share of ER visitors that received SNAP benefits on the day of their ER visit is 3.1% lower than in the SNAP population. This is consistent with benefit receipt altering household behaviors and routines (notably, we observe, by increasing shopping), which may crowd out healthcare utilization. This particular effect is present across all age groups, although the magnitude is smallest for children.
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Affiliation(s)
- Chad D Cotti
- University of Wisconsin-Oshkosh, College of Business, 800 Algoma Blvd., Oshkosh, WI, 54901, United States.
| | - John M Gordanier
- University of South Carolina, Darla Moore School of Business, Economics Department, 1014 Greene Street, Columbia, SC, 29208, United States.
| | - Orgul D Ozturk
- University of South Carolina, Darla Moore School of Business, Economics Department, 1014 Greene Street, Columbia, SC, 29208, United States.
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Costs and Trends of Emergency Department Utilization Pre-ACA and Post-ACA: Evidence From a Rural Georgia Hospital. Med Care 2019; 57:407-409. [PMID: 30994524 DOI: 10.1097/mlr.0000000000001114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A high volume of emergency department (ED) visits in the rural United States may be the result of barriers to accessing primary care. The Affordable Care Act (ACA) increased the number of insured, which may improve patient access to primary care and therefore reduce ED utilization. The objective of this study is to estimate the trends and cost of ED utilization pre-ACA and post-ACA implementation in a rural United States. DATA AND METHODS We use 2009-2013 ED utilization data from a rural Georgia hospital to estimate trends and costs by demographic characteristics, referring source, and payor information. T tests and log-linear regression models are used to assess the sociodemographic factors impacting ED inflation-adjusted costs before (2009-2010) and after ACA (2011-2013) implementation. RESULTS During 2009-2013, 39,970 ED encounters were recorded with an average cost (AC) of $2002 per visit. Results indicate that during pre-ACA, on average, 8702 encounters were recorded per year with an AC of $1759. During post-ACA, there were 7521 annual visits, with an annual AC of $2241. Regression model results indicate that AC were significantly higher for men, older adults, nonblack patients, those with private insurance, and during the post-ACA period. CONCLUSIONS Results suggest that post-ACA, declining ED visits may be due to more patients with insurance accessing primary care instead of ED. We further hypothesize that increased AC during this period may be due to ED visits being of an emergent nature, which require more resources to treat. Further comprehensive investigation is warranted to study the impact of ACA on ED utilization for nonemergency purposes among rural and nonrural hospitals.
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