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Myroniuk TW, Teti M, Schatz E, David I. Similarities in COVID-19 Mortality Between Canadian Provinces and American States Before Vaccines Were Available. CANADIAN STUDIES IN POPULATION 2023; 50:2. [PMID: 36974079 PMCID: PMC10034245 DOI: 10.1007/s42650-023-00073-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 03/02/2023] [Indexed: 03/25/2023]
Abstract
Canada and the USA are often compared for their markedly different approaches to health care despite cultural similarities and sharing the world's longest international boundary. The period between the onset of the COVID-19 pandemic in January 2020 and the availability of a vaccine in December 2020 offers an ideal opportunity to compare subnational Canadian and American pandemic mortality. Preventing the spread of COVID-19 was through compliance with health orders and best practices; treatment was only available to those admitted to hospitals and whose lives were at risk. Using publicly available data from the Johns Hopkins University 2019 Novel Coronavirus Visual Dashboard, we seek to uncover if there were any similarities in Canadian provinces' and American states' monthly COVID-19 mortality per 100,000 people, building on a broader scientific push towards understanding the successes and failures of different health systems in the pandemic. The similar province and state cumulative COVID-19 mortality rate trajectories identified in our analyses do not amount to intuitive comparative jurisdictions which suggests the importance of identifying localized pandemic responses.
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Affiliation(s)
- Tyler W. Myroniuk
- Department of Public Health, University of Missouri, Columbia, MO USA
| | - Michelle Teti
- Department of Public Health, University of Missouri, Columbia, MO USA
| | - Enid Schatz
- Department of Public Health, University of Missouri, Columbia, MO USA
| | - Ifeolu David
- Department of Health and Rehabilitation Sciences, University of Missouri, Columbia, MO USA
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2
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Zajacova A, Siddiqi A. A comparison of health and socioeconomic gradients in health between the United States and Canada. Soc Sci Med 2022; 306:115099. [PMID: 35779499 PMCID: PMC9383268 DOI: 10.1016/j.socscimed.2022.115099] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 10/18/2022]
Abstract
Data from the early 2000s indicated worse overall health and larger socioeconomic (SES) health inequalities in the U.S. than in Canada. Yet, sociopolitical contexts, health levels, and SES-health inequalities have changed in both countries during the intervening two decades. Drawing on new data, we update the comparison of health levels and SES-health gradients between the two countries. Analyses, focused on self-rated health, are based on two complementary sets of data sources: Resilience and Recovery (RR) data, a harmonized U.S.-Canada survey of social conditions collected in 2020 (N = 3743); and a pair of leading nationally representative health data sources from each country: the National Health Interview Surveys (NHIS, N = 104,027) and the Canadian Community Health Survey (CCHS, N = 97,605), both collected in 2017-2018. Health levels and disparities, net of demographic and socioeconomic covariates, were estimated using modified Poisson models for relative comparisons; descriptives and predicted levels of fair/poor health show the comparisons from absolute perspective. Both data sources show that U.S. adults continue to have significantly worse health than Canadians; the disadvantage may be due to SES differences between the two populations. However, the two data sources yield conflicting findings on SES-health inequalities: the RR data indicate no difference between the two countries in socioeconomic health gradients, while the NHIS/CCHS data show a significantly steeper gradient in the U.S. than in Canada for both education and income. Canadian adults continue to report better health than their U.S. peers, but it is unclear whether health inequalities remain smaller as well. We discuss potential reasons for the conflicting findings and call for a large new cross-national data collection, which will enable scholars and policymakers to better understand health and wellbeing in the U.S. and Canadian contexts.
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Affiliation(s)
- Anna Zajacova
- 5330 Social Science Centre, University of Western Ontario, London, ON, N6A 5C2, Canada.
| | - Arjumand Siddiqi
- University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada
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3
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Boatswain-Kyte A, Esposito T, Trocmé N. Impacts of race on family reunification: A longitudinal study comparing exits from Quebec's child welfare system. CHILD ABUSE & NEGLECT 2022; 125:105483. [PMID: 35065474 DOI: 10.1016/j.chiabu.2022.105483] [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: 09/15/2021] [Revised: 12/21/2021] [Accepted: 01/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In the United States, Black children spend more time in out-of-home placement than other children and are less likely to experience family reunification following involvement with child welfare services. Within Canada, very few studies have examined Black children's exits from the child welfare system and factors influencing their service trajectory. OBJECTIVE This study, the first of its kind in Canada, uses longitudinal clinical administrative data to examine reunification outcomes for Black children following placement in out-of-home care. PARTICIPANTS AND SETTING The study population includes 1395 children receiving ongoing child welfare services in Quebec between April 1, 2002 and March 31, 2011. METHODS A longitudinal research design from anonymized clinical administrative data extracted from a single child welfare agency in Montreal. Survival analysis using a Kaplan Meier and Cox proportional hazard regression examined the trajectory and chances of family reunification from the point of each child's initial placement. RESULTS Black children spend longer lengths of time in out-of-home placement and are less likely to experience family reunification when compared to other children. Poorer reunification outcomes for Black children were associated with placement instability, the age of the child and reasons for child welfare involvement. CONCLUSIONS While we tend to prioritize prevention services for vulnerable communities, this study indicates that attention must be given to services all throughout Black children's service trajectory to ensure that these children are able to exit the child welfare system in a timely manner.
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Affiliation(s)
- Alicia Boatswain-Kyte
- School of Social Work, McGill University, 3506 University Street, Montreal, QC H3A 2A7, Canada.
| | - Tonino Esposito
- Université de Montreal, École de travail social, 3150 rue Jean-Brillant, Montréal, QC H3T 1N8, Canada.
| | - Nico Trocmé
- School of Social Work, McGill University, 3506 University Street, Montreal, QC H3A 2A7, Canada.
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4
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Miller DAA, Ronis ST, Slaunwhite AK. The Impact of Demographic, Clinical, and Institutional Factors on Psychiatric Inpatient Length-of-Stay. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:683-694. [PMID: 33386529 DOI: 10.1007/s10488-020-01104-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 01/14/2023]
Abstract
The average length of inpatient stay (LOS) for psychiatric care has declined substantially across Canada and the United States during the past two decades. Although LOS is based presumably on patient, hospital, and community factors, there is little understanding of how such factors are linked with LOS. The purpose of this study was to explore potential individual and systemic factors associated with LOS in a large-scale, longitudinal dataset. Study participants consisted of individuals 11 years of age and older admitted for psychiatric conditions to a New Brunswick hospital between April 1, 2003 and March 31, 2014 (N = 51,865). The study used a retrospective cohort design examining data from the New Brunswick Discharge Abstract Database, administrative data comprised of all inpatient admissions across provincial hospitals. Hierarchical regression analysis was used to estimate the association of individual, facility, and system-level factors with psychiatric LOS. Results indicated that hospital-level factors and individual-level characteristics (i.e., discharge disposition, aftercare referral, socioeconomic status (SES)) account for significant variability in LOS. Consistent with extant literature, our results found that hospital, clinical, and individual factors together are associated with LOS. Furthermore, our results highlight demographic factors surrounding living situation and available financial supports, as well as the match or mismatch between preferred language and language in which services are offered.
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Affiliation(s)
- David A A Miller
- Department of Psychology, University of New Brunswick, 38 Dineen Dr, Keirstead Hall, Fredericton, NB, E3B 5A3, Canada
| | - Scott T Ronis
- Department of Psychology, University of New Brunswick, 38 Dineen Dr, Keirstead Hall, Fredericton, NB, E3B 5A3, Canada.
| | - Amanda K Slaunwhite
- BC Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
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Yunus SZSA, Puteh SEW, Ali AM, Daud F. The Covid Impact to Public Healthcare Utilization Among Urban Low-Income Subsidized Community in Klang Valley Malaysia. Health Serv Res Manag Epidemiol 2021; 8:23333928211002407. [PMID: 33796627 PMCID: PMC7975447 DOI: 10.1177/23333928211002407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Appropriate level of healthcare utilization is one of the aims in translating health system inputs into improving the outcome of population health. Healthcare utilization services in Malaysia remains relatively low as compared to the rate in most high-income countries and some gaps exist across socioeconomic status. After the financial handouts deemed Household Living Aid (HLA) to low-income earners, Malaysia has recently implemented a financial health protection scheme toward for low-income group known as PeKa B40 to improve their access for healthcare services. This study aims to determine the healthcare utilization among the low-income population living in urban Klang Valley, and to explore the relationship between healthcare utilization with the demographic characteristics of this population. MATERIAL AND METHODS A cross-sectional study using face to face structured questionnaire. All 447 respondents included were low-income earners enrolled in the HLA. Chi-square analysis and multiple logistic regression were used to examine association between the risk factors and healthcare utilization. RESULTS The response rate was 93.5%. The healthcare utilization among the respondents during the partial lockdown period was 19.5% and 33.1% during the recovery lockdown period. Enrollment in the PeKa B40 scheme among the 7.6% respondents was not associated with healthcare utilization. After controlling for the variables, those aged 60 years and above [AOR: 1.87; 95% (CI): (1.07; 3.27)], self-rated poor health status [AOR: 2.16; 95% (CI): (1.07; 4.34)], having NCDs [AOR: 4.21; 95% (CI): (2.23; 7.94)], and being hospitalized in the past 12 months [AOR: 3.54; 95% (CI): (1.46; 8.62)], were more likely to utilize healthcare services as compared to their counterparts. CONCLUSION The results from this study is valuable for policy recommendations to improve on the coverage of the PeKa B40 scheme and healthcare access for the low-income population especially during the pandemic.
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Affiliation(s)
| | - Sharifa Ezat Wan Puteh
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia
(UKM), Kuala Lumpur, Malaysia
| | - Adliah Mhd Ali
- Center of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia
(UKM), Kuala Lumpur, Malaysia
| | - Faiz Daud
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia
(UKM), Kuala Lumpur, Malaysia
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Miller DAA, Ronis ST, Slaunwhite AK, Audas R, Richard J, Tilleczek K, Zhang M. Longitudinal examination of youth readmission to mental health inpatient units. Child Adolesc Ment Health 2020; 25:238-248. [PMID: 32516481 DOI: 10.1111/camh.12371] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Significant barriers exist for youth in obtaining mental health services. These barriers are exacerbated by growing demand, attributed partially to children and adolescents who have repeat hospital admissions. The purpose of this study was to identify demographic, socioeconomic and clinical predictors of readmission to inpatient psychiatric services in New Brunswick, Canada. METHOD Key demographic, support and clinical predictors of readmission were identified. The New Brunswick Discharge Abstract Database (DAD) was used to compile a cohort of all children and adolescents ages 3-19 years with psychiatric hospital admissions between 1 April 2003 and 31 March 2014 (N = 3825). Primary analyses consisted of Kaplan-Meier survival methods with log-rank tests to assess time-to-readmission variability, and Cox regression to identify significant predictors of readmission. RESULTS In total, 27.8% of admitted children and adolescents experienced at least one readmission within the 10-year period, with 57.3% readmitted to hospital within 90 days following discharge. Bivariate results indicated that male, upper-middle socioeconomic status (SES) youths aged 11-15 years from nonrural communities were most likely to be readmitted. Notable predictors of increased readmission likelihood were older age, being male, higher SES, referral to care by medical practitioner, discharge to another health facility, psychosis, and previous psychiatric admission. CONCLUSION A significant portion of the variance in readmission was accounted for by youth demographic characteristics (i.e. age, SES, geographic location) and various support structures, including referrals to inpatient care and aftercare support services. KEY PRACTITIONER MESSAGE Readmission to inpatient psychiatric care among youth is affected by a number of multifaceted risk factors across individual, environmental and clinical domains. This study used provincial population-scale longitudinal administrative data to demonstrate the influence of various individual and demographic factors on likelihood of readmission, which is notably absent from the majority of studies that make use of smaller, short-term data samples. Ensuring that multiple factors outside of the clinical context are considered when examining readmission among youth may contribute to a more thorough understanding of youth hospitalization patterns.
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Affiliation(s)
- David A A Miller
- Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
| | - Scott T Ronis
- Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
| | - Amanda K Slaunwhite
- BC Centre for Disease Control, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Rick Audas
- Division of Community Health and Humanities, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jacques Richard
- École de Psychologie, Université de Moncton, Moncton, NB, Canada
| | - Kate Tilleczek
- Faculty of Education, York University, Toronto, ON, Canada
| | - Michael Zhang
- Sobey School of Business, Saint Mary's University, Halifax, NS, Canada
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Bozic K, Yu H, Zywiel MG, Li L, Lin Z, Simoes JL, Dorsey Sheares K, Grady J, Bernheim SM, Suter LG. Quality Measure Public Reporting Is Associated with Improved Outcomes Following Hip and Knee Replacement. J Bone Joint Surg Am 2020; 102:1799-1806. [PMID: 33086347 DOI: 10.2106/jbjs.19.00964] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Given the inclusion of orthopaedic quality measures in the Centers for Medicare & Medicaid Services national hospital payment programs, the present study sought to assess whether the public reporting of total hip arthroplasty (THA) and total knee arthroplasty (TKA) risk-standardized readmission rates (RSRRs) and complication rates (RSCRs) was temporally associated with a decrease in the rates of these outcomes among Medicare beneficiaries. METHODS Annual trends in national observed and hospital-level RSRRs and RSCRs were evaluated for patients who underwent hospital-based inpatient hip and/or knee replacement procedures from fiscal year 2010 to fiscal year 2016. Hospital-level rates were calculated with use of the same measures and methodology that were utilized in public reporting. Annual trends in the distribution of hospital-level outcomes were then examined with use of density plots. RESULTS Complication and readmission rates and variation declined steadily from fiscal year 2010 to fiscal year 2016. Reductions of 33% and 25% were noted in hospital-level RSCRs and RSRRs, respectively. The interquartile range decreased by 18% (relative reduction) for RSCRs and by 34% (relative reduction) for RSRRs. The frequency of risk variables in the complication and readmission models did not systematically change over time, suggesting no evidence of widespread bias or up-coding. CONCLUSIONS This study showed that hospital-level complication and readmission rates following THA and TKA and the variation in hospital-level performance declined during a period coinciding with the start of public reporting and financial incentives associated with measurement. The consistently decreasing trend in rates of and variation in outcomes suggests steady improvements and greater consistency among hospitals in clinical outcomes for THA and TKA patients in the 2016 fiscal year compared with the 2010 fiscal year. The interactions between public reporting, payment, and hospital coding practices are complex and require further study. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/standards
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/standards
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Female
- Humans
- Male
- Medicare/statistics & numerical data
- Patient Readmission/statistics & numerical data
- Public Reporting of Healthcare Data
- Quality Improvement/statistics & numerical data
- United States
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Affiliation(s)
- Kevin Bozic
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, Texas
| | - Huihui Yu
- Yale-New Haven Health System Center for Outcome Research and Evaluation, New Haven, Connecticut
| | - Michael G Zywiel
- Division of Orthopaedic Surgery and Institute of Health Policy, Management, and Evaluation, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Li Li
- Beigene Corporation, Beijing, China
| | - Zhenqiu Lin
- Yale-New Haven Health System Center for Outcome Research and Evaluation, New Haven, Connecticut
| | - Jaymie L Simoes
- Yale-New Haven Health System Center for Outcome Research and Evaluation, New Haven, Connecticut
| | - Karen Dorsey Sheares
- Yale-New Haven Health System Center for Outcome Research and Evaluation, New Haven, Connecticut
- Department of Pediatrics (K.D.S.) and Section of Rheumatology, Department of Medicine (L.G.S.), Yale University School of Medicine, New Haven, Connecticut
| | - Jacqueline Grady
- Yale-New Haven Health System Center for Outcome Research and Evaluation, New Haven, Connecticut
| | - Susannah M Bernheim
- Yale-New Haven Health System Center for Outcome Research and Evaluation, New Haven, Connecticut
| | - Lisa G Suter
- Yale-New Haven Health System Center for Outcome Research and Evaluation, New Haven, Connecticut
- Department of Pediatrics (K.D.S.) and Section of Rheumatology, Department of Medicine (L.G.S.), Yale University School of Medicine, New Haven, Connecticut
- Veterans Affairs Connecticut Health System, West Haven, Connecticut
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Mensa Sorato M, Davari M, Abdollahi Asl A, Soleymani F, Kebriaeezadeh A. Why healthcare market needs government intervention to improve access to essential medicines and healthcare efficiency: a scoping review from pharmaceutical price regulation perspective. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2020. [DOI: 10.1111/jphs.12379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Background
Access to quality essential medicines at affordable price to patients in the healthcare market is one of the main goals of universal health coverage and health-related sustainable development goals. Healthcare market is imperfect, and the government cannot ensure access to essential medicines if the market is left to operate under invisible hand control. This scoping review was conducted with intention to provide the clear picture on impact of pharmaceutical price regulation on access to essential medicines, drug innovation and launching.
Methods
We searched articles written in the English language since January 2000 from PubMed, Embase, Scopus, Ovid/Medline and Google scholar with systematic search query.
Results
Access to essential medicines, which is defined in terms of availability, affordability, accessibility, acceptability and quality of drugs, can be improved by pharmaceutical price regulation. Countries can use different price regulation strategies based on their healthcare objectives and priority healthcare needs. Country-specific pharmaceutical price regulation could not significantly affect drug innovation and launching. However, supportive strategies such as open public funding for drug innovation research, providing innovation awards and strong patent rights can counterbalance the effect of price regulation on innovation and drug development research in developed countries.
Conclusion
Regulating pharmaceutical pricing system is one of the key strategies to ensure access to essential medicines. Countries that have implemented pharmaceutical price regulation system (Germany, the UK, Canada and Iran) have achieved better access to essential medicines. However, the US and Ethiopian health systems that are unregulated concerning pharmaceutical pricing had a great challenge of affordability of essential medicines. Therefore, setting country-specific pharmaceutical price regulation system along with additional strategies to improve drug innovation is critical to ensure access to essential medicines.
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Affiliation(s)
- Mende Mensa Sorato
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Davari
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Abdollahi Asl
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Soleymani
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Kebriaeezadeh
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Walston Z, McLester C, McLester J. Effect of Low Back Pain Chronicity on Patient Outcomes Treated in Outpatient Physical Therapy: A Retrospective Observational Study. Arch Phys Med Rehabil 2019; 101:861-869. [PMID: 31874155 DOI: 10.1016/j.apmr.2019.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the potential relationship between physical therapy (PT) treatment outcomes and chronicity of low back pain (LBP) in the outpatient setting. DESIGN Retrospective observational study. SETTING Outpatient PT clinics across 11 states. PARTICIPANTS A total of 11,941 patients with LBP provided with PT services and discharged from care between January 1, 2017, and December 31, 2018. MAIN OUTCOME MEASURES Focus on Therapeutic Outcome Low Back Functional Status (FS) Patient-Reported Outcome Measure (PROM) was the primary outcomes measure used. It assesses the patients' perceived physical abilities for patients experiencing LBP impairments. It determined a functional score on a linear metric ranging from 0 (low functioning) to 100 (high functioning). The difference in score between the intake FS and final FS score produced the FS change, which represented the overall improvement of the episode of care. RESULTS The mean FS change was 16.997 (n=11,945). Patients with chronic symptoms (>90-d duration) had an FS change of 15.920 (n=7264) across 14.63 visits. Patients with subacute symptoms (15-90d) had an FS change of 21.66 (n=3631) across 14.05. Patients with acute symptoms (0-14d) had an FS change of 29.32 (n=1050) across 13.66 visits. Stepwise regression analysis revealed a significant â for chronicity (-4.155) with all models. CONCLUSIONS Overall, this study shows patients experiencing shorter duration of LBP symptoms before starting a PT episode of care experience significantly better outcomes than patients who waited. Furthermore, the number of treatment session and duration of care was similar between groups, indicating potential ineffective or insufficient care was provided for patients with chronic pain.
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Affiliation(s)
- Zachary Walston
- PT Solutions Physical Therapy, Atlanta, Georgia, United States.
| | | | - John McLester
- Kennesaw State University, Kennesaw, Georgia, United States
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Koball AM, Rasmussen C, Olson-Dorff D, Klevan J, Ramirez L, Domoff SE. The relationship between adverse childhood experiences, healthcare utilization, cost of care and medical comorbidities. CHILD ABUSE & NEGLECT 2019; 90:120-126. [PMID: 30776737 DOI: 10.1016/j.chiabu.2019.01.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/14/2019] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Prior research suggests that those experiencing adverse childhood experiences (ACEs) may be higher utilizers of the healthcare system. The frequency and financial impact of kept, cancelled and no-showed visits is largely unknown. OBJECTIVE To examine the impact of adverse childhood experiences (ACEs) on healthcare utilization in a sample of US adults. PARTICIPANTS AND SETTING Two thousand thirty-eight adult patients who completed an ACE screening within the behavioral health department of a medium sized, Midwestern healthcare system during 2015-2017 were included. METHODS Data was extracted retrospectively from 1-year post ACE screen. RESULTS Individuals with high ACEs (4+) made more but kept fewer appointments than those with no or moderate (1-3) ACEs (p < 0.0001). Individuals with high ACES had more late-cancelled and no-showed appointments compared to those with no ACEs (p's < .0001). Relationships were significant even after controlling for age, gender, and insurance type. Those with high ACEs had the greatest impact on potential lost revenue given that they late-cancelled and no-showed more appointments. Those with high ACEs also had more medical comorbidities, medications, and needed care coordinator than those with moderate or no ACEs (p's < .05) CONCLUSIONS: Results from this study should be used to inform providers and health care systems on the effects of adversity on patterns of utilization of health care and encourage innovative strategies to better address the needs of these patients.
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Affiliation(s)
- Afton M Koball
- Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, United States.
| | - Cary Rasmussen
- Gundersen Medical Foundation, 1836 South Avenue, La Crosse, WI, 54601, United States
| | - Denyse Olson-Dorff
- Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, United States
| | - Judy Klevan
- Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, United States
| | - Luis Ramirez
- Gundersen Medical Foundation, 1836 South Avenue, La Crosse, WI, 54601, United States
| | - Sarah E Domoff
- Central Michigan University, 1200 S Franklin St, Mount Pleasant, MI, 48859, United States
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Petrovic K, Doyle E, Lane A, Corcoran L. The Work of Preparing Canadian Nurses for A Licensure Exam Originating from the USA: A Nurse Educator’s Journey into the Institutional Organization of the NCLEX-RN. Int J Nurs Educ Scholarsh 2019; 16:ijnes-2018-0052. [DOI: 10.1515/ijnes-2018-0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/22/2019] [Indexed: 11/15/2022]
Abstract
Abstract
The licensing exam for registered nurses in Canada has recently been changed from a Canadian developed, owned and delivered exam to the National Council Licensure Examination for Registered Nurses (NCLEX-RN) which originates from the United States. Rationale for this exam change focused on transitioning to a computer-based exam that has increased writing dates, with increased security, validated psychometrics, increased exam result delivery, and an anticipated decrease in expense to students. Concerns have arisen around the acceptance, implementation and delivery of this exam to Canadian nursing students that reflects the broad Canadian landscape of education and nursing practice. The experience of a Canadian nurse educator in working to facilitate students’ transition to this exam is addressed using an institutional ethnographic lens. Finally, we come to conclusions about the importance of countries utilizing licensing exams that reflect their nursing education and practice
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Affiliation(s)
- Kristin Petrovic
- Faculty of Health Disciplines , Athabasca University , Athabasca , Alberta , Canada
| | - Emily Doyle
- Faculty of Health Disciplines , Athabasca University , Athabasca , Alberta , Canada
| | - Annette Lane
- Faculty of Health Disciplines , Athabasca University , Athabasca , Alberta , Canada
| | - Lynn Corcoran
- Faculty of Health Disciplines , Athabasca University , Athabasca , Alberta , Canada
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12
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Escobar KM, Murariu D, Munro S, Gorey KM. Care of acute conditions and chronic diseases in Canada and the United States: Rapid systematic review and meta-analysis. J Public Health Res 2019; 8:1479. [PMID: 30997359 PMCID: PMC6444377 DOI: 10.4081/jphr.2019.1479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/22/2019] [Indexed: 01/19/2023] Open
Abstract
This study tested the hypothesis that socioeconomically vulnerable Canadians with diverse acute conditions or chronic diseases have health care access and survival advantages over their counterparts in the USA. A rapid systematic review retrieved 25 studies (34 independent cohorts) published between 2003 and 2018. They were synthesized with a streamlined meta-analysis. Very low-income Canadian patients were consistently and highly advantaged in terms of health care access and survival compared with their counterparts in the USA who lived in poverty and/or were uninsured or underinsured. In aggregate and controlling for specific conditions or diseases and typically 4 to 9 comorbid factors or biomarkers, Canadians' chances of receiving better health care were estimated to be 36% greater than their American counterparts (RR=1.36, 95% CI 1.35-1.37). This estimate was significantly larger than that based on general patient or non-vulnerable population comparisons (RR=1.09, 95% CI 1.08-1.10). Contrary to prevalent political rhetoric, three studies observed that Americans experience more than twice the risk of long waits for breast or colon cancer care or of dying while they wait for an organ transplant (RR=2.36, 95% CI 2.09-2.66). These findings were replicated across externally valid national studies and more internally valid, metropolitan or provincial/state comparisons. Socioeconomically vulnerable Canadians are consistently and highly advantaged on health care access and outcomes compared to their American counterparts. Less vulnerable comparisons found more modest Canadian advantages. The Affordable Care Act ought to be fully supported including the expansion of Medicaid across all states. Canada's single payer system ought to be maintained and strengthened, but not through privatization.
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Affiliation(s)
| | | | - Sharon Munro
- Leddy Library, University of Windsor, ON, Canada
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Saeed S, Strumpf EC, Moodie EE, Young J, Nitulescu R, Cox J, Wong A, Walmsely S, Cooper C, Vachon ML, Martel-Laferriere V, Hull M, Conway B, Klein MB. Disparities in direct acting antivirals uptake in HIV-hepatitis C co-infected populations in Canada. J Int AIDS Soc 2018; 20. [PMID: 29116684 PMCID: PMC5810331 DOI: 10.1002/jia2.25013] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/25/2017] [Indexed: 12/27/2022] Open
Abstract
Background Direct acting antivirals (DAAs) have revolutionized hepatitis C (HCV) treatment with >90% cure rates even in real‐world studies, giving hope that HCV can be eliminated. However, for DAAs to have a population‐level impact on the burden of HCV disease, treatment uptake needs to be expanded. We investigated temporal trends in HCV treatment uptake and evaluated factors associated with second‐generation DAA initiation and efficacy among key HIV‐HCV co‐infected populations in Canada. Methods The Canadian HIV‐HCV Co‐Infection Cohort Study prospectively follows 1699 participants from 18 centres. Among HCV RNA+ participants, we determined the incidence of HCV treatment initiation per year overall and by key populations between 2007 and 2015. Key populations were based on World Health Organization (WHO) guidelines including: people who actively inject drugs (PWID) (reporting injection drug use, last 6 months); Indigenous people; women and men who have sex with men (MSM). Multivariate Cox models were used to estimate adjusted hazard ratios (aHR) and 2‐year probability of initiating second‐generation DAAs for each of the key populations. Results Overall, HCV treatment initiation rates increased from 8 (95% CI, 6–11) /100 person‐years in 2013 to 28 (95% CI, 23–33) /100 person‐years in 2015. Among 911 HCV RNA + participants, there were 202 second‐generation DAA initiations (93% with interferon‐free regimens). After adjustment (aHR, 95% CI), active PWID (0.60, 0.38–0.94 compared to people not injecting drugs) and more generally, people with lower income (<$18 000 CAD/year) (0.50, 0.35, 0.71) were less likely to initiate treatment. Conversely, MSM were more likely to initiate 1.95 (1.33, 2.86) compared to heterosexual men. In our cohort, the population profile with the lowest 2‐year probability of initiating DAAs was Indigenous, women who inject drugs (5%, 95% CI 3–8%). Not having any of these risk factors resulted in a 35% (95% CI 32–38%) probability of initiating DAA treatment. Sustained virologic response (SVR) rates were >82% in all key populations. Conclusion While treatment uptake has increased with the availability of second‐generation DAAs, marginalized populations, already engaged in care, are still failing to access treatment. Targeted strategies to address barriers are needed to avoid further health inequities and to maximize the public health impact of DAAs.
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Affiliation(s)
- Sahar Saeed
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Division of Infectious Diseases/Chronic Viral Illness Service, Department of Medicine, Glen site, McGill University Health Centre, Montreal, QC, Canada
| | - Erin C Strumpf
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Economics, McGill University, Montreal, QC, Canada
| | - Erica Em Moodie
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Jim Young
- Division of Infectious Diseases/Chronic Viral Illness Service, Department of Medicine, Glen site, McGill University Health Centre, Montreal, QC, Canada
| | - Roy Nitulescu
- Division of Infectious Diseases/Chronic Viral Illness Service, Department of Medicine, Glen site, McGill University Health Centre, Montreal, QC, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Division of Infectious Diseases/Chronic Viral Illness Service, Department of Medicine, Glen site, McGill University Health Centre, Montreal, QC, Canada
| | | | - Sharon Walmsely
- University Health Network, Toronto, ON, Canada.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Curtis Cooper
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Mark Hull
- Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, BC, Canada
| | - Marina B Klein
- Division of Infectious Diseases/Chronic Viral Illness Service, Department of Medicine, Glen site, McGill University Health Centre, Montreal, QC, Canada.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
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Hilton R, Zheng Y, Fitzpatrick A, Serban N. Uncovering Longitudinal Health Care Behaviors for Millions of Medicaid Enrollees: A Multistate Comparison of Pediatric Asthma Utilization. Med Decis Making 2018; 38:107-119. [PMID: 29029580 PMCID: PMC5764816 DOI: 10.1177/0272989x17731753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND This study introduces a framework for analyzing and visualizing health care utilization for millions of children, with a focus on pediatric asthma, one of the major chronic respiratory conditions. METHODS The data source is the 2005 to 2012 Medicaid Analytic Extract claims for 10 Southeast states. The study population consists of Medicaid-enrolled children with persistent asthma. We translate multiyear, individual-level medical claims into sequences of discrete utilization events, which are modeled using Markov renewal processes and model-based clustering. Network analysis is used to visualize utilization profiles. The method is general, allowing the study of other chronic conditions. RESULTS The study population consists of 1.5 million children with persistent asthma. All states have profiles with high probability of asthma controller medication, as large as 60.6% to 90.2% of the state study population. The probability of consecutive asthma controller prescriptions ranges between 0.75 and 0.95. All states have utilization profiles with uncontrolled asthma with 4.5% to 22.9% of the state study population. The probability for controller medication is larger than for short-term medication after a physician visit but not after an emergency department (ED) visit or hospitalization. Transitions from ED or hospitalization generally have a lower probability into physician office (between 0.11 and 0.38) than into ED or hospitalization (between 0.20 and 0.59). CONCLUSIONS In most profiles, children who take asthma controller medication do so regularly. Follow-up physician office visits after an ED encounter or hospitalization are observed at a low rate across all states. Finally, all states have a proportion of children who have uncontrolled asthma, meaning they do not take controller medication while they have severe outcomes.
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Affiliation(s)
- Ross Hilton
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology
| | - Yuchen Zheng
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology
| | | | - Nicoleta Serban
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology
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Hilton RP, Zheng Y, Serban N. Modeling Heterogeneity in Healthcare Utilization Using Massive Medical Claims Data. J Am Stat Assoc 2017; 113:111-121. [PMID: 30294054 DOI: 10.1080/01621459.2017.1330203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We introduce a modeling approach for characterizing heterogeneity in healthcare utilization using massive medical claims data. We first translate the medical claims observed for a large study population and across five years into individual-level discrete events of care called utilization sequences. We model the utilization sequences using an exponential proportional hazards mixture model to capture heterogeneous behaviors in patients' healthcare utilization. The objective is to cluster patients according to their longitudinal utilization behaviors and to determine the main drivers of variation in healthcare utilization while controlling for the demographic, geographic, and health characteristics of the patients. Due to the computational infeasibility of fitting a parametric proportional hazards model for high-dimensional, large sample size data we use an iterative one-step procedure to estimate the model parameters and impute the cluster membership. The approach is used to draw inferences on utilization behaviors of children in the Medicaid system with persistent asthma across six states. We conclude with policy implications for targeted interventions to improve adherence to recommended care practices for pediatric asthma.
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Affiliation(s)
- Ross P Hilton
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology
| | - Yuchen Zheng
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology
| | - Nicoleta Serban
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology
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Scheim AI, Zong X, Giblon R, Bauer GR. Disparities in access to family physicians among transgender people in Ontario, Canada. Int J Transgend 2017. [DOI: 10.1080/15532739.2017.1323069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Ayden I. Scheim
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Xuchen Zong
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Rachel Giblon
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Greta R. Bauer
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
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Passmore SR, Toth A, Kanovsky J, Olin G. Initial integration of chiropractic services into a provincially funded inner city community health centre: a program description. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2015; 59:363-372. [PMID: 26816049 PMCID: PMC4711334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The burden of fees for chiropractic services rendered often falls on the patient and must be provided out-of-pocket regardless of their socioeconomic status and clinical need. Universal healthcare coverage reduces the financial barrier to healthcare utilization, thereby increasing the opportunity for the financially disadvantaged to have access to care. In 2011 the Canadian Province of Manitoba initiated a pilot program providing access to chiropractic care within the Mount Carmel Clinic (MCC), a non-secular, non-profit, inner city community health centre. OBJECTIVE To describe the initial integration of chiropractic services into a publically funded healthcare facility including patient demographics, referral patterns, treatment practices and clinical outcomes. METHOD A retrospective database review of chiropractic consultations in 2011 (N=177) was performed. RESULTS The typical patient referred for chiropractic care was a non-working (86%), 47.3(SD=16.8) year old, who self-identified as Caucasian (52.2%), or Aboriginal (35.8%) and female (68.3%) with a body mass index considered obese at 30.4(SD=7.0). New patient consultations were primarily referrals from other health providers internal to the MCC (71.2%), frequently primary care physicians (76%). Baseline to discharge comparisons of numeric rating scale scores for the cervical, thoracic, lumbar, sacroiliac and extremity regions all exceeded the minimally clinically important difference for reduction in musculoskeletal pain. Improvements occurred over an average of 12.7 (SD=14.3) treatments, and pain reductions were also statistically significant at p<0.05. CONCLUSION Chiropractic services are being utilized by patients, and referring providers. Clinical outcomes indicate that services rendered decrease musculoskeletal pain in an inner city population.
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Affiliation(s)
- Steven R. Passmore
- University of Manitoba, College of Rehabilitation Sciences
- University of Manitoba, Faculty of Kinesiology & Recreation Management
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Socías ME, Koehoorn M, Shoveller J. Gender Inequalities in Access to Health Care among Adults Living in British Columbia, Canada. Womens Health Issues 2015; 26:74-9. [PMID: 26384547 DOI: 10.1016/j.whi.2015.08.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 07/13/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Existing literature is inconclusive as to whether disparities in access to health care between men and women are mainly driven by socioeconomic or gender inequalities. The aim of this study was to assess whether gender was independently associated with perceived unmet health care needs among a representative sample of British Columbia adults. METHODS Using data from the 2011/2012 Canadian Community Health Survey, logistic regression analyses were conducted to investigate the independent effect of gender on perceived unmet health care needs adjusting for potential individual and contextual confounders. RESULTS Among 12,252 British Columbia adults (51.9% female), the prevalence of perceived unmet health care needs was 12.0%, with a significantly greater percentage among women compared with men (13.7% vs. 10.1%; p < .001). After adjusting for multiple confounders, women had independently increased odds of perceived unmet health care needs (adjusted odds ratio, 1.37; 95% CI, 1.11-1.68). DISCUSSION The current study found that, among a representative sample of British Columbia adults and adjusting for various individual and contextual factors, female gender was associated independently with an increased odds of perceived unmet health care needs. CONCLUSION These findings suggest that within Canada's universal health system, gender further explains differences in health care access, over and above socioeconomic inequalities. Interventions within and outside the health sector are required to achieve equitable access to health care for all residents in British Columbia.
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Affiliation(s)
- M Eugenia Socías
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
| | - Mieke Koehoorn
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Shoveller
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Rasu RS, Bawa WA, Suminski R, Snella K, Warady B. Health Literacy Impact on National Healthcare Utilization and Expenditure. Int J Health Policy Manag 2015; 4:747-55. [PMID: 26673335 DOI: 10.15171/ijhpm.2015.151] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 08/10/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. We evaluated the impact of low health literacy (LHL) on healthcare utilization and healthcare expenditure. METHODS Database analysis used Medical Expenditure Panel Survey (MEPS) from 2005-2008 which provides nationally representative estimates of healthcare utilization and expenditure. Health literacy scores (HLSs) were calculated based on a validated, predictive model and were scored according to the National Assessment of Adult Literacy (NAAL). HLS ranged from 0-500. Health literacy level (HLL) and categorized in 2 groups: Below basic or basic (HLS <226) and above basic (HLS ≥226). Healthcare utilization expressed as a physician, nonphysician, or emergency room (ER) visits and healthcare spending. Expenditures were adjusted to 2010 rates using the Consumer Price Index (CPI). A P value of 0.05 or less was the criterion for statistical significance in all analyses. Multivariate regression models assessed the impact of the predicted HLLs on outpatient healthcare utilization and expenditures. All analyses were performed with SAS and STATA® 11.0 statistical software. RESULTS The study evaluated 22 599 samples representing 503 374 648 weighted individuals nationally from 2005-2008. The cohort had an average age of 49 years and included more females (57%). Caucasian were the predominant racial ethnic group (83%) and 37% of the cohort were from the South region of the United States of America. The proportion of the cohort with basic or below basic health literacy was 22.4%. Annual predicted values of physician visits, nonphysician visits, and ER visits were 6.6, 4.8, and 0.2, respectively, for basic or below basic compared to 4.4, 2.6, and 0.1 for above basic. Predicted values of office and ER visits expenditures were $1284 and $151, respectively, for basic or below basic and $719 and $100 for above basic (P < .05). The extrapolated national estimates show that the annual costs for prescription alone for adults with LHL possibly associated with basic and below basic health literacy could potentially reach about $172 billion. CONCLUSION Health literacy is inversely associated with healthcare utilization and expenditure. Individuals with below basic or basic HLL have greater healthcare utilization and expendituresspending more on prescriptions compared to individuals with above basic HLL. Public health strategies promoting appropriate education among individuals with LHL may help to improve health outcomes and reduce unnecessary healthcare visits and costs.
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Affiliation(s)
- Rafia S Rasu
- University of Kansas School of Pharmacy, Lawrence, KS, USA
| | | | - Richard Suminski
- Institute for Biobehavioral Health Research, National Development and Research Institutes (NDRI) New York, NY and Leawood, KS, USA
| | - Kathleen Snella
- Ben and Maytee Fisch College of Pharmacy, University of Texas at Tyler, Tyler, TX, USA
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