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Farid AR, Hresko MT, Ghessese S, Linden GS, Wong S, Hedequist D, Birch C, Cook D, Flowers KM, Hogue GD. Validation of Examination Maneuvers for Adolescent Idiopathic Scoliosis in the Telehealth Setting. J Bone Joint Surg Am 2024:00004623-990000000-01229. [PMID: 39356742 DOI: 10.2106/jbjs.23.01146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
BACKGROUND Telehealth visits (THVs) have made it essential to adopt innovative ways to evaluate patients virtually. This study validates a novel THV approach that uses educational videos and an instructional datasheet, enabling parents to use smartphones to measure their child's scoliosis at home or in telehealth settings. METHODS We identified a prospective cohort of patients with adolescent idiopathic scoliosis (AIS) scheduled for follow-up care from March to July 2021. The angle of trunk rotation (ATR) was first measured at home by patients' guardians using instructional video guidance and a smartphone application with internal accelerometer software. The second measurement was made during a THV examination performed by caregivers with supervision by trained associates via a telehealth appointment. Lastly, the clinician measured the child's ATR during an in-person clinic visit. Intraclass correlation coefficients (ICCs) and interrater reliability were compared between in-person clinic measurements and (1) at-home and (2) THV measurements. Shoulder, lower back, and pelvic asymmetry were observed and quantified at home and virtually, and then were compared with in-person clinic evaluations using kappa values. Surveys were used to evaluate the experience of the patient/caregiver with the at-home and telehealth assessment tools. RESULTS Seventy-three patients were included (mean age, 14.1 years; 25% male). There was excellent agreement in the ATR measurements between THVs and in-person visits (ICC = 0.88; 95% confidence interval [CI] = 0.83 to 0.92). ATR agreement between at-home and in-person visits was also excellent, but slightly diminished (ICC = 0.76; 95% CI = 0.64 to 0.83). Agreement between THV and in-person measurements was significantly higher compared with that between at-home and in-person measurements (p = 0.04). There was poor agreement in lower back asymmetry between THV and in-person assessments (kappa = 0.37; 95% CI = 0.14 to 0.60); however, there was no significant agreement between at-home and in-person assessments (kappa = 0.06; 95% CI = -0.17 to 0.29). Patient/caregiver satisfaction surveys (n = 70) reported a median score of 4 ("good") for comfort with use of the technology, and a score of 3 ("neutral") for equivalence of THV and in-person evaluation. CONCLUSIONS There was a high level of agreement between telehealth and in-person spine measurements, suggesting that THVs may be reliably used to evaluate AIS, thus improving access to specialized care. LEVEL OF EVIDENCE Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alexander R Farid
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - M Timothy Hresko
- Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Semhal Ghessese
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gabriel S Linden
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Wong
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel Hedequist
- Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Craig Birch
- Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Danielle Cook
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kelsey Mikayla Flowers
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Grant D Hogue
- Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Haller K, Stolfi A, Duby J. Comparison of unmet health care needs in children with intellectual disability, autism spectrum disorder and both disorders combined. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:617-627. [PMID: 35357055 PMCID: PMC9314009 DOI: 10.1111/jir.12932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/11/2022] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The purpose of this study was to assess the unmet health care needs of children with intellectual disability (ID) compared with children with autism spectrum disorder (ASD) and whether access to health insurance coverage is a contributing factor. Children with ID may be masked in the health care system due to increased diagnosis and awareness of ASD. The needs, unmet needs and insurance coverage of children with ID alone, ASD alone, and co-occurring ID and ASD were assessed in this study. METHODS The 2016 to 2019 United States' Census Bureau National Survey of Children's Health was used to determine differences in unmet needs, care not received and health insurance coverage during the past year for children with ID and/or ASD. Adjusted odds ratios and 95% confidence intervals for care not received were determined controlling for sex, insurance, race, age and parents' highest education level. RESULTS Children with ID were nearly four times more likely not to receive needed medical care as children with ASD. Results were similar for unmet hearing and mental health care. Children with both ID and ASD were more likely to have unmet health care but less likely to have unmet medical care compared with children with ASD alone. There were no significant differences for unmet dental or vision care. Children with ID were 3.58 (95% confidence interval: 1.6-8.0) times more likely to have inconsistent health insurance compared with children with ASD. CONCLUSIONS Children with ID alone are more likely to have unmet medical, hearing and mental health care needs than children with ASD alone. Children with co-occurring ID and ASD have a large amount of general unmet health care needs but less unmet medical needs. Children with ID are less likely to have consistent health insurance than children with ASD. This hinders the ability of children with ID to receive quality care. Further research is needed to determine if the diagnosis of ASD in children in the United States is negatively affecting children with ID alone.
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Affiliation(s)
- K. Haller
- Department of PediatricsWright State University Boonshoft School of MedicineDaytonOHUSA
| | - A. Stolfi
- Department of PediatricsWright State University Boonshoft School of MedicineDaytonOHUSA
| | - J. Duby
- Department of PediatricsWright State University Boonshoft School of MedicineDaytonOHUSA
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Wright N, Scherdt M, Aebersold ML, McCullagh MC, Medvec BR, Ellimoottil C, Patel MR, Shapiro S, Friese CR. Rural Michigan Farmers' Health Concerns and Experiences: A Focus Group Study. J Prim Care Community Health 2021; 12:21501327211053519. [PMID: 34704487 PMCID: PMC8554574 DOI: 10.1177/21501327211053519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives: Rural residents comprise approximately 15% of the United States population. They face challenges in accessing and using a health care system that is not structured to meet their unique needs. It is important to understand rural residents’ perceptions of health and experiences interacting with the health care system to identify gaps in care. Methods: Our team conducted focus groups with members of the Michigan Farm Bureau during their 2019 Annual Meeting. Topics explored included resources to manage health, barriers to virtual health care services, and desired changes to localized healthcare delivery. Surveys were used to capture demographic and internet access information. Conclusion: Analysis included data from 2 focus groups (n = 14). Participants represented a wide age range and a variety of Michigan counties. The majority were full-time farm owners with most—93% (n = 13)—reporting they had access to the internet in their homes and 86% (n = 12) reporting that their cellphones had internet capabilities. Participants identified challenges and opportunities in 4 categories: formal health care; health and well-being supports; health insurance experiences; and virtual health care. Conclusion: The findings from this study provide a useful framework for developing interventions to address the specific needs of rural farming residents. Despite the expressed challenges in access and use of health care services and resources, participants remained hopeful that innovative approaches, such as virtual health platforms, can address existing gaps in care. The study findings should inform the design and evaluation of interventions to address rural health disparities.
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Matiz LA, Kostacos C, Robbins-Milne L, Chang SJ, Rausch JC, Tariq A. Integrating Nurse Care Managers in the Medical Home of Children with Special Health Care needs to Improve their Care Coordination and Impact Health Care Utilization. J Pediatr Nurs 2021; 59:32-36. [PMID: 33454540 DOI: 10.1016/j.pedn.2020.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE There is a rising number of children with special health care needs (CSHCN) in the pediatric medical home and their care coordination is complicated and challenging. We aimed to integrate nurse care managers to coordinate care for such patients, and then evaluate, if this improved health care utilization. DESIGN AND METHODS This quality improvement project evaluated the impact on CSHCN of the integration of nurse care managers in the pediatric medical home. From October 2015 through February 2019, 673 children received longitudinal care coordination support from a care manager. Health care utilization for primary, subspecialty, emergency department (ED) and inpatient care was reviewed using pre and post design. RESULTS Three medical home-based nurse care managers were integrated into four pediatric hospital affiliated practices in a large, urban center. The number of ED visits and inpatient admissions were statistically significantly decreased post-intervention (p < 0.05).There was also a decrease in the number of subspecialty visits, but it was close to the threshold of significance (p = 0.054). There was no impact noted on primary care visits. CONCLUSION This quality improvement project demonstrates that nurse care managers who are integrated into the medical home of CSHCN can potentially decrease the utilization of ED visits and hospital admissions as well as subspecialty visits. PRACTICE IMPLICATIONS Nurse care managers can play a pivotal role in medical home redesign for the care of CSHCN.
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Affiliation(s)
- Luz Adriana Matiz
- Department of Pediatrics/Division of Child and Adolescent Health, Columbia University Irving Medical Center, NY, United States of America.
| | - Connie Kostacos
- Department of Pediatrics/Division of Child and Adolescent Health, Columbia University Irving Medical Center, NY, United States of America.
| | - Laura Robbins-Milne
- Department of Pediatrics/Division of Child and Adolescent Health, Columbia University Irving Medical Center, NY, United States of America.
| | - Steven J Chang
- Ambulatory Care Network, Division of Community and Population Health, NewYork Presbyterian, NY, United States of America.
| | - John C Rausch
- Department of Pediatrics/Division of Child and Adolescent Health, Columbia University Irving Medical Center, NY, United States of America.
| | - Abdul Tariq
- Ambulatory Care Network, Division of Community and Population Health, NewYork Presbyterian, NY, United States of America.
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Parsons K, Gaudine A, Swab M. Experiences of older adults accessing specialized health care services in rural and remote areas: a qualitative systematic review. JBI Evid Synth 2021; 19:1328-1343. [PMID: 34111043 DOI: 10.11124/jbies-20-00048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this review was to synthesize the literature on the experiences of older adults accessing specialized health care services while living in remote or rural areas. INTRODUCTION Older persons with chronic illnesses often need specialized health care services. Those who live in remote or rural areas may have limited access to these specialized health care services, potentially leading to an increase in morbidity and mortality. Little is known about the experiences of older adults accessing specialized health care services while living in remote or rural areas. INCLUSION CRITERIA This review considered studies of persons 65 years and older who have self-identified as living in remote or rural areas. They will have, on at least one occasion, sought access in person to specialized health care services for a chronic condition such as cardiovascular disease, renal disease, diabetes, cancer, mental illness, or a major health concern beyond the scope of a primary care clinician, such as palliative care. METHODS The search strategy aimed to find both published and unpublished studies in English from 1980 onward. An initial limited search of MEDLINE and CINAHL was undertaken in February 2017, followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe the articles. This informed the development of a search strategy, which was tailored for each information source. The search was first conducted in December 2018 and rerun in November 2019. The databases searched included CINAHL, PubMed, PsycINFO, and AgeLine. The search for unpublished studies included ProQuest Dissertations and Theses, Google Scholar, and MedNar. Papers meeting the inclusion criteria were appraised by two independent reviewers for methodological quality. Data extraction was conducted according to the standardized data extraction tool from JBI. The qualitative research findings were pooled using the JBI method of meta-aggregation. RESULTS Three papers were included in the review yielding a total of five findings and two categories. The categories were aggregated to form one synthesized finding: Distance often results in challenges accessing health care. For almost all older adults, the long distance to drive for specialized services was a barrier, especially for those living far out in the country, and led to delayed care. Lack of health education and peer support was also viewed as an issue. For one older adult, however, the distance was not seen as an issue; rather, it was viewed as an opportunity to enjoy time with family members. Participants noted that they had access to emergency care and, therefore, believed they were not putting their lives at risk by living in a rural area. The overall ConQual score was low. CONCLUSION We believe that the distance to travel to obtain specialized services, as well as living in an area without specialized services, impacted this population's experience of obtaining specialized health care as well as their health. The spectrum of findings for our synthesized finding suggests that this was the case for some people, but not all. We speculate that people who have chosen to live outside an urban area or have lived in a rural area for a prolonged period come to accept their access to health care, including the distance to travel for health care and their potential for this to impact their health. The findings also suggest the older adults have a range of experiences; for some, distance was an issue and for others, it was not an issue. Some participants found living in a rural area impacted their care while others did not.
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Affiliation(s)
- Karen Parsons
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada.,Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada
| | - Alice Gaudine
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada.,Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada
| | - Michelle Swab
- Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada.,Health Sciences Library, Memorial University of Newfoundland, St. John's, NL, Canada
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Telemedicine and Outpatient Subspecialty Visits Among Pediatric Medicaid Beneficiaries. Acad Pediatr 2020; 20:642-651. [PMID: 32278078 PMCID: PMC7194998 DOI: 10.1016/j.acap.2020.03.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Live interactive telemedicine is increasingly covered by state Medicaid programs, but whether telemedicine is improving equity in utilization of subspecialty care is not known. We examined patterns of telemedicine use for outpatient pediatric subspecialty care within the state Medicaid programs. METHODS We identified children ≤17 years old in 2014 Medicaid Analysis eXtract data for 12 states. We identified telemedicine-using and telemedicine-nonusing medical and surgical subspecialists. Among children cared for by telemedicine-using subspecialists, we assessed child and subspecialist characteristics associated with any telemedicine visit using logistic regression with subspecialist-level random effects. Among children cared for by telemedicine-using and nonusing subspecialists, we compared visit rates across child characteristics by assessing negative binomial regression interaction terms. RESULTS Of 12,237,770 pediatric Medicaid beneficiaries, 2,051,690 (16.8%) had ≥1 subspecialist visit. Of 42,695 subspecialists identified, 146 (0.3%) had ≥1 telemedicine claim. Among children receiving care from telemedicine-using subspecialists, likelihood of any telemedicine use was increased for rural children (odds ratio [OR] 10.4, 95% confidence interval [CI] 6.3-17.1 compared to large metropolitan referent group) and those >90 miles from the subspecialist (OR 13.4, 95% CI 10.2-17.7 compared to 0-30 mile referent group). Compared to children receiving care from telemedicine-nonusing subspecialists, matched children receiving care from telemedicine-using subspecialists had larger differences in visit rates by distance to care, county rurality, ZIP code median income, and child race/ethnicity (P < .001 for interaction terms). CONCLUSIONS Children in rural communities and at distance to subspecialists had increased likelihood of telemedicine use. Use overall was low, and results indicated that early telemedicine policies and implementation did not close disparities in subspecialty visit rates by child geographic and sociodemographic characteristics.
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Parsons K, Gaudine A, Swab M. Experiences of older adults accessing specialized healthcare services in rural or remote areas. ACTA ACUST UNITED AC 2019; 17:1909-1914. [DOI: 10.11124/jbisrir-2017-003668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Van Horn A, Powell W, Wicker A, Mahairas AD, Creel LM, Bush ML. Outpatient healthcare access and utilization for neonatal abstinence syndrome children: A systematic review. J Clin Transl Sci 2019; 4:389-397. [PMID: 33244427 PMCID: PMC7681131 DOI: 10.1017/cts.2019.407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this study was to systematically assess the literature regarding postnatal healthcare utilization and barriers/facilitators of healthcare in neonatal abstinence syndrome (NAS) children. METHODS A systematic search was performed in PubMed, Cochrane Database of Systematic Reviews, PsychINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science to identify peer-reviewed research. Eligible studies were peer-reviewed articles reporting on broad aspects of primary and specialty healthcare utilization and access in NAS children. Three investigators independently reviewed all articles and extracted data. Study bias was assessed using the Newcastle-Ottawa Assessment Scale and the National Institute of Health Study Quality Assessment Tool. RESULTS This review identified 14 articles that met criteria. NAS children have poorer outpatient appointment adherence and have a higher rate of being lost to follow-up. These children have overall poorer health indicated by a significantly higher risk of ER visits, hospital readmission, and early childhood mortality compared with non-NAS infants. Intensive multidisciplinary support provided through outpatient weaning programs facilitates healthcare utilization and could serve as a model that could be applied to other healthcare fields to improve the health among this population. CONCLUSIONS This review investigated the difficulties in accessing outpatient care as well as the utilization of such care for NAS infants. NAS infants tend to have decreased access to and utilization of outpatient healthcare following hospital birth discharge. Outpatient weaning programs have proven to be effective; however, these programs require intensive resources and care coordination that has yet to be implemented into other healthcare areas for NAS children.
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Affiliation(s)
- Adam Van Horn
- Department of Otolaryngology – Head and Neck Surgery, University of Kentucky Medical Center, Lexington, KY, USA
| | - Whitney Powell
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - Ashley Wicker
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - Anthony D. Mahairas
- Department of Otolaryngology – Head and Neck Surgery, University of Kentucky Medical Center, Lexington, KY, USA
| | - Liza M. Creel
- Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Matthew L. Bush
- Department of Otolaryngology – Head and Neck Surgery, University of Kentucky Medical Center, Lexington, KY, USA
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Esmonde NO, Garfinkle JS, Chen Y, Lambert WE, Kuang AA. Factors Associated With Adherence to Nasoalveolar Molding (NAM) by Caregivers of Infants Born With Cleft Lip and Palate. Cleft Palate Craniofac J 2017; 55:252-258. [PMID: 29351029 DOI: 10.1177/1055665617718550] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Identify factors associated with adherence to nasoalveolar molding (NAM) therapy. DESIGN Retrospective case-control study. SETTING Tertiary referral center. PATIENTS, PARTICIPANTS Infants with cleft lip, with or without cleft palate, referred for NAM. One hundred thirty-five patients met criteria. MAIN OUTCOME MEASURE(S) Adherence to NAM therapy, defined as continuous use of the appliance and attendance of NAM adjustment visits. RESULTS Female sex (OR = 2.85, 95% CI 1.21-6.74), bilateral cleft (OR = 2.88, 95% CI 1.29-6.46), and travel distance (OR = 1.01, 95% CI 1.00-1.01) were independent predictors of nonadherence. Bilateral clefts (OR = 8.35, 95% CI 2.72-25.64) and public-payer insurance (OR = 3.67, 95% CI 1.13-11.91) for male patients were significantly associated with nonadherence, in our sex-stratified multivariate model. The majority of the families (58%) had public health insurance. Males comprised 77.0% of the cohort. CONCLUSIONS NAM treatment adherence is impaired by bilateral clefts, female sex, increased travel distance, and public insurance. Further studies are warranted to investigate how these factors affect adherence, and to develop interventions to improve adherence in families at risk due to economic or psychosocial barriers.
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Affiliation(s)
- Nick O Esmonde
- 1 Division of Plastic and Reconstructive Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Judah S Garfinkle
- 2 Division of Pediatric Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Yiyi Chen
- 3 Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
| | - William E Lambert
- 3 Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Anna A Kuang
- 4 Division of Plastic & Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
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Henning-Smith C, Prasad S, Casey M, Kozhimannil K, Moscovice I. Rural-Urban Differences in Medicare Quality Scores Persist After Adjusting for Sociodemographic and Environmental Characteristics. J Rural Health 2017; 35:58-67. [DOI: 10.1111/jrh.12261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/21/2017] [Accepted: 07/17/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Carrie Henning-Smith
- Division of Health Policy and Management, Rural Health Research Center; University of Minnesota School of Public Health; Minneapolis Minnesota
| | - Shailendra Prasad
- Department of Family Medicine and Community Health; University of Minnesota School of Medicine; Minneapolis Minnesota
| | - Michelle Casey
- Division of Health Policy and Management, Rural Health Research Center; University of Minnesota School of Public Health; Minneapolis Minnesota
| | - Katy Kozhimannil
- Division of Health Policy and Management, Rural Health Research Center; University of Minnesota School of Public Health; Minneapolis Minnesota
| | - Ira Moscovice
- Division of Health Policy and Management, Rural Health Research Center; University of Minnesota School of Public Health; Minneapolis Minnesota
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Ray KN, Kahn JM, Miller E, Mehrotra A. Use of Adult-Trained Medical Subspecialists by Children Seeking Medical Subspecialty Care. J Pediatr 2016; 176:173-181.e1. [PMID: 27344222 PMCID: PMC5003627 DOI: 10.1016/j.jpeds.2016.05.073] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/28/2016] [Accepted: 05/23/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To quantify the use of adult-trained medical subspecialists by children and to determine the association between geographic access to pediatric subspecialty care and the use of adult-trained subspecialists. Children with limited access to pediatric subspecialty care may seek care from adult-trained subspecialists, but data on this practice are limited. STUDY DESIGN We identified children aged <16 years in 2007-2012 Pennsylvania Medicaid claims. We categorized outpatient visits to 9 selected medical subspecialties as either pediatric or adult-trained subspecialty visits. We used multinomial logistic regression to examine the adjusted association between travel times to pediatric referral centers and use of pediatric vs adult-trained medical subspecialists for children with and without complex chronic conditions (CCCs). RESULTS Among 1.1 million children, 8% visited the examined medical subspecialists, with 10% of these children using adult-trained medical subspecialists. Compared with children with a ≤30-minute travel time to a pediatric referral center, children with a >90-minute travel time were more likely to use adult-trained subspecialists (without CCCs: relative risk ratio [RRR], 1.94, 95% CI, 1.79-2.11; with CCCs: RRR, 2.33; 95% CI, 2.10-2.59) and less likely to use pediatric subspecialists (without CCCs: RRR, 0.66; 95% CI, 0.63-0.68; with CCCs: RRR, 0.76, 95% CI, 0.73-0.79). CONCLUSION Among medical subspecialty fields with pediatric and adult-trained subspecialists, adult-trained subspecialists provided 10% of care to children overall and 18% of care to children living >90 minutes from pediatric referral centers. Future studies should examine consequences of adult-trained medical subspecialist use on pediatric health outcomes and identify strategies to increase access to pediatric subspecialists.
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Affiliation(s)
- Kristin N Ray
- Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA.
| | - Jeremy M Kahn
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Ateev Mehrotra
- Department of Health Care Policy and Medicine, Harvard Medical School, Boston, MA; RAND Corporation, Boston, MA
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Fontanella CA, Guada J, Phillips G, Ranbom L, Fortney JC. Individual and contextual-level factors associated with continuity of care for adults with schizophrenia. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 41:572-87. [PMID: 23689992 DOI: 10.1007/s10488-013-0500-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This retrospective cohort study examined rates of conformance to continuity of care treatment guidelines and factors associated with conformance for persons with schizophrenia. Subjects were 8,621 adult Ohio Medicaid recipients, aged 18-64, treated for schizophrenia in 2004. Information on individual-level (demographic and clinical characteristics) and contextual-level variables (county socio-demographic, economic, and health care resources) were abstracted from Medicaid claim files and the Area Resource File. Outcome measures captured four dimensions of continuity of care: (1) regularity of care; (2) transitions; (3) care coordination, and (4) treatment engagement. Multilevel modeling was used to assess the association between individual and contextual-level variables and the four continuity of care measures. The results indicated that conformance rates for continuity of care for adults with schizophrenia are below recommended guidelines and that variations in continuity of care are associated with both individual and contextual-level factors. Efforts to improve continuity of care should target high risk patient groups (racial/ethnic minorities, the dually diagnosed, and younger adults with early onset psychosis), as well as community-level risk factors (provider supply and geographic barriers of rural counties) that impede access to care.
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Affiliation(s)
- Cynthia A Fontanella
- Department of Psychiatry, The Ohio State University, 1670 Upham Drive, Columbus, OH, 43210, USA,
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McManus BM, Lindrooth R, Richardson Z, Rapport MJ. Urban/Rural Differences in Therapy Service Use Among Medicaid Children Aged 0-3 With Developmental Conditions in Colorado. Acad Pediatr 2016; 16:358-65. [PMID: 26546856 DOI: 10.1016/j.acap.2015.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 10/27/2015] [Accepted: 10/30/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe urban/rural differences in physical (PT) and occupational therapy (OT) service utilization and spending among a sample of young Medicaid-enrolled children with developmental conditions. METHODS We analyzed Colorado Children's Medicaid administrative claims from 2006 to 2008. The sample included children who were younger than 36 months of age, had a select developmental condition, and were continuously eligible for each study year up to their third birthday. The study outcomes were number of PT/OT claims, type of PT/OT service, and Medicaid PT/OT spending. Multivariable analyses examined urban/rural differences in PT/OT utilization and spending, adjusting for child, family, and health service characteristics. RESULTS The sample included 20,959 children. In adjusted analyses, urban children had 2-fold higher odds (odds ratio 2.18, 95% confidence interval 1.89, 2.51) of receiving PT/OT compared to their rural peers. Median annual per-child Medicaid PT/OT spending was $99 higher ($98.79 [$3.23, $194.35]) for urban children versus rural children. When place of PT/OT service and PT/OT procedures was included, this spending difference was drastically reduced. CONCLUSIONS Even accounting for child, family, and health service characteristics, Medicaid PT/OT spending is lower for rural children compared to their urban peers. The difference in spending is largely attributable to utilization of services that are less specialized than urban peers, thus suggesting disparities in access to appropriate PT/OT services.
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Affiliation(s)
- Beth M McManus
- Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, Colo.
| | - Richard Lindrooth
- Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, Colo
| | - Zachary Richardson
- Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, Colo
| | - Mary Jane Rapport
- Physical Therapy Program, School of Medicine, University of Colorado, Aurora, Colo
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Magnusson D, Palta M, McManus B, Benedict RE, Durkin MS. Capturing Unmet Therapy Need Among Young Children With Developmental Delay Using National Survey Data. Acad Pediatr 2016; 16:145-53. [PMID: 26183004 DOI: 10.1016/j.acap.2015.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Estimates of unmet therapy need based on parent report overlook the unmet needs of children with developmental delay (DD) whose parents do not first recognize a need for therapy. Using national survey, data we: 1) identified children with DD who likely need physical, occupational, or speech therapy services; 2) estimated the prevalence of overall unmet therapy need; and 3) examined factors associated with unrecognized therapy need and parent-reported unmet therapy need. METHODS Criteria for DD were applied to children aged 0 to 4 years using the 2009-2010 National Survey of Children With Special Health Care Needs (NS-CSHCN). Multivariate logistic regression was used to identify factors associated with unrecognized or parent-reported unmet therapy need. RESULTS Among 5349 children with special health care needs aged 0 to 4 years, 50.2% met our inclusion criteria for DD, 21.6% had overall unmet therapy need, 15.4% had unrecognized therapy needs, and 6.2% had parent-reported unmet therapy need. The adjusted odds of unrecognized therapy need were higher among black and Hispanic children, and children from other racial or ethnic groups than among white children (adjusted odds ratio 1.78 [95% confidence interval 1.23-2.57]). The odds of parent-reported unmet therapy need were higher for children lacking special education services. CONCLUSIONS Relying on parent-reported unmet therapy need, without considering children with DD whose therapy needs go unrecognized, likely underestimates overall unmet therapy need among children with DD. Exploring the mechanisms underlying racial, ethnic, and socioeconomic disparities in overall unmet therapy need should facilitate the development of effective interventions aimed at improving therapy access for children with DD.
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Affiliation(s)
- Dawn Magnusson
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wis.
| | - Mari Palta
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wis; Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wis
| | - Beth McManus
- Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, Colo
| | - Ruth E Benedict
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wis; Department of Kinesiology, Occupational Therapy Program, School of Education, University of Wisconsin-Madison, Madison, Wis
| | - Maureen S Durkin
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wis; Department of Pediatrics, University of Wisconsin-Madison, Madison, Wis; School of Medicine and Public Health, Waisman Center, University of Wisconsin-Madison, Madison, Wis
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Richards MR, Saloner B, Kenney GM, Rhodes KV, Polsky D. Availability of New Medicaid Patient Appointments and the Role of Rural Health Clinics. Health Serv Res 2015; 51:570-91. [PMID: 26119695 DOI: 10.1111/1475-6773.12334] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the willingness to accept new Medicaid patients among certified rural health clinics (RHCs) and other nonsafety net rural providers. DATA SOURCES Experimental (audit) data from a 10-state study of primary care practices, county-level information from the Area Health Resource File, and RHC information from the Center for Medicare and Medicaid Services. STUDY DESIGN We generate appointment rates for rural and nonrural areas by patient-payer type (private, Medicaid, self-pay) to then motivate our focus on within-rural variation by clinic type (RHC vs. non-RHC). Multivariate linear models test for statistical differences and assess the estimates' sensitivity to the inclusion of control variables. DATA COLLECTION The primary data are from a large field study. PRINCIPAL FINDINGS Approximately 80 percent of Medicaid callers receive an appointment in rural areas-a rate more than 20 percentage points greater than nonrural areas. Importantly, within rural areas, RHCs offer appointments to prospective Medicaid patients nearly 95 percent of the time, while the rural (nonsafety net) non-RHC Medicaid rate is less than 75 percent. Measured differences are robust to covariate adjustment. CONCLUSIONS Our study suggests that RHC status, with its alternative payment model, is strongly associated with new Medicaid patient acceptance. Altering RHC financial incentives may have consequences for rural Medicaid enrollees.
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Affiliation(s)
- Michael R Richards
- Leonard Davis Institute of Health Economics, Colonial Penn Center, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Karin V Rhodes
- Perelman School of Medicine, Center for Emergency Care Policy & Research, University of Pennsylvania, Philadelphia, PA
| | - Daniel Polsky
- Wharton School and Perelman School of Medicine, Leonard Davis Institute of Health Economics, Colonial Penn Center, University of Pennsylvania, Philadelphia, PA
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Choi JW, Kim JH, Park EC. The Relief Effect of Copayment Decreasing Policy on Unmet Needs in Targeted Diseases. HEALTH POLICY AND MANAGEMENT 2014. [DOI: 10.4332/kjhpa.2014.24.1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Wu CF, Wang MS, Eamon MK. Employment hardships and single mothers' self-rated health: evidence from the panel study of income dynamics. SOCIAL WORK IN HEALTH CARE 2014; 53:478-502. [PMID: 24835091 DOI: 10.1080/00981389.2014.896846] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Using a national sample of single mothers from the 2007 and 2009 waves of the Panel Study of Income Dynamics, this study examined the effects of multiple employment statuses on the selfrated health of single mothers during the recent economic recession. Unlike other studies, the current study minimized selection bias by controlling for prior self-rated health, in addition to other predisposing factors, enabling factors, and need factors. We found that underemployment, but not unemployment, is associated with lower levels of self-rated health of single mothers. Results further indicate that the 25-39 age range (compared to the 18-24 age range), lower family income, prior lower self-rated health, more chronic diseases, and binge drinking place single mothers at an increased risk of lower levels of self-rated health. In contrast, strength-building physical activity is significantly associated with higher levels of self-rated health. Implications for health care policy and social work practice are drawn from the results.
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Affiliation(s)
- Chi-Fang Wu
- a School of Social Work , University of Illinois at Urbana-Champaign , Urbana , Illinois , USA
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18
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Bennett AC, Rankin KM, Rosenberg D. Does a medical home mediate racial disparities in unmet healthcare needs among children with special healthcare needs? Matern Child Health J 2012; 16 Suppl 2:330-8. [PMID: 22976880 DOI: 10.1007/s10995-012-1131-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study extends mediation analysis techniques to explore whether and to what extent differential access to a medical home explains the black/white disparity in unmet healthcare needs among children with special healthcare needs (CSHCN). Data were obtained from the 2007 National Survey of Children's Health, with analyses limited to non-Hispanic white and black CSHCN (n = 14,677). The counterfactual approach to mediation analysis was used to estimate odds ratios for the natural direct and indirect effects of race on unmet healthcare needs. Overall, 43.0 % of white CSHCN and 60.4 % of black CSHCN did not have a medical home. Additionally, 8.8 % of white CSHCN and 15.3 % of black CSHCN had unmet healthcare needs. The natural indirect effect indicates that the odds of unmet needs among black CSHCN are elevated by approximately 20 % as a result of their current level of access to the medical home rather than access at a level equal to white CSHCN (OR(NIE) = 1.2, 95 % CI = 1.1, 1.3). The natural direct effect indicates that even if black CSHCN had the same level of access to a medical home as white CSHCN, blacks would still have 60 % higher odds of unmet healthcare needs than whites (OR(NDE) = 1.6, 95 % CI = 1.1, 2.4). The racial disparity in unmet healthcare needs among CSHCN is only partially explained by disparities in having a medical home. Ensuring all CSHCN have equal access to a medical home may reduce the racial disparity in unmet needs, but will not completely eliminate it.
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Affiliation(s)
- Amanda C Bennett
- Division of Epidemiology/Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 W Taylor St, Chicago, IL 60612, USA.
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Jackson KE, Krishnaswami S, McPheeters M. Unmet health care needs in children with cerebral palsy: a cross-sectional study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:2714-2723. [PMID: 21705193 DOI: 10.1016/j.ridd.2011.05.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 05/27/2011] [Accepted: 05/30/2011] [Indexed: 05/31/2023]
Abstract
Children with potentially severe health conditions such as cerebral palsy (CP) are at risk for unmet health care needs. We sought to determine whether children with CP had significantly greater unmet health care needs than children with other special health care needs (SHCN), and whether conditions associated with CP increased the odds of unmet health care needs. We analyzed data from the National Survey of Children with Special Health Care Needs, 2005-2006, using multivariate logistic regression to calculate the adjusted odds of children with CP having one or more unmet health care needs compared to children with other SHCN. We also determined the association of CP-related conditions with unmet health care needs in children with CP. After weighting to national averages, our sample represented 178,536 children with CP (1.9%), and 9,236,794 with children with other SHCN (98.1%). Although having CP increased the odds that children had unmet health care needs (OR = 1.46, 95% CI [1.07-1.99]), the presence of a "severe" health condition weakened the association. Gastrointestinal problems and emotional problems increased the odds that children with CP would have unmet health care needs above that of children without the associated conditions (p ≤ .01). Children with CP are similar to children with other SHCN and may benefit from collaborative programs targeting severe chronic conditions. However, children with CP and associated conditions have increased odds of unmet health care needs in comparison to children without those problems.
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Affiliation(s)
- Katie E Jackson
- Vanderbilt University School of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Ste 600, Nashville, TN 37203-1738, United States.
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Goodridge D, Hutchinson S, Wilson D, Ross C. Living in a rural area with advanced chronic respiratory illness: a qualitative study. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2011; 20:54-8. [PMID: 20871944 DOI: 10.4104/pcrj.2010.00062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIM To explore the impact of living with advanced chronic respiratory illness in a rural area METHODS Using an interpretive descriptive approach, semi-structured interviews were conducted with seven people living with advanced chronic respiratory illness in a rural area of Western Canada. RESULTS Themes that characterised the experience of living in a rural setting with a chronic obstructive respiratory illness included: a) distance as a barrier to accessing health care; b) relationships with family practice physicians; c) supportive local community; and d) lack of respiratory education and peer support. CONCLUSIONS Whilst living with advanced respiratory illness in a rural area posed some significant challenges, experiences of "place", conceptualised as a web of relationships embedded within a local context, are an important factor in rural residents' decisions to remain in situations where distance may present significant challenges to accessing health care.
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Affiliation(s)
- Donna Goodridge
- University of Saskatchewan, College of Nursing, Saskatoon, Saskatchewan, Canada.
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Bono JD, Crawford SY. Impact of Medicare Part D on independent and chain community pharmacies in rural Illinois—A qualitative study. Res Social Adm Pharm 2010; 6:110-20. [DOI: 10.1016/j.sapharm.2009.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 11/20/2009] [Accepted: 11/25/2009] [Indexed: 10/19/2022]
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Rose RA, Parish SL, Yoo J, Grady MD, Powell SE, Hicks-Sangster TK. Suppression of racial disparities for children with special health care needs among families receiving Medicaid. Soc Sci Med 2010; 70:1263-70. [PMID: 20185219 DOI: 10.1016/j.socscimed.2009.12.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 09/24/2009] [Accepted: 12/14/2009] [Indexed: 10/19/2022]
Abstract
This study examines whether the US public health insurance program Medicaid suppresses racial disparities in parental identification of service needs of their children with special health care needs (CSHCN). We analyze data from the 2001 US National Survey of CSHCN (n = 14,167 children). We examine three outcomes which were parental identification of (a) the child's need for professional care coordination, (b) the child's need for mental health services, and (c) the family's need for mental health services. A suppression analysis, which is a form of mediation analysis, was conducted. Our results show a disparity, reflected in a negative direct effect of race for all three outcomes: Black parents of CSHCN are less likely to report a need for services than White parents of CSHCN and Medicaid coverage was associated with reduced racial disparities in reporting the need for services. These analyses suggest receipt of Medicaid is associated with a suppression of racial disparities in reported need for services.
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Affiliation(s)
- Roderick A Rose
- University of North Carolina, School of Social Work, 325 Pittsboro Street, CB 3550, Chapel Hill, NC 27599-3550, United States
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Abstract
OBJECTIVE Low dental care service utilization among Medicaid-enrolled children has often been attributed to low Medicaid reimbursement levels. The purpose of this study was to provide estimates of preventive dental care utilization by Medicaid-enrolled children with special health care needs (CSHCN) and investigate the association of Medicaid preventive dental care reimbursement levels with the receipt of preventive dental care. METHODS We analyzed data for 40256 CSHCN (1-17 years of age). Unadjusted estimates of not needing, needing and receiving, and needing but not receiving preventive dental care are presented. Multilevel logistic regression models were fitted to examine associations between state Medicaid dental-procedure reimbursement and receipt of preventive dental care. RESULTS Some significant associations were found between state-level Medicaid dental-procedure reimbursements and receipt of preventive dental care. The strongest individual-level factor associated with not receiving needed preventive dental care was not receiving needed preventive medical care. Parents of Medicaid-enrolled CSHCN were less likely to report receiving needed preventive dental care and more likely to report not needing or not receiving preventive dental care than non-Medicaid-enrolled CSHCN. CONCLUSIONS Medicaid-enrolled CSHCN received less needed preventive dental care than non-Medicaid-enrolled CSHCN. An important link to receiving appropriate dental care may be the primary care provider. Raising the level of preventive dental care reimbursement along with other policy changes should increase the frequency of CSHCN receiving preventive dental services. State Medicaid agencies must develop models of medical-dental care management for CSHCN in their programs to ensure the most appropriate care.
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Affiliation(s)
- Mary Kay Kenney
- US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, Room 18-41, Rockville, MD 20857, USA.
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Wiltshire JC, Person SD, Kiefe CI, Allison JJ. Disentangling the influence of socioeconomic status on differences between African American and white women in unmet medical needs. Am J Public Health 2009; 99:1659-65. [PMID: 19608942 PMCID: PMC2724438 DOI: 10.2105/ajph.2008.154088] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2008] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to disentangle the relationships between race/ethnicity, socioeconomic status (SES), and unmet medical care needs. METHODS Data from the 2003-2004 Community Tracking Study Household Survey were used to examine associations between unmet medical needs and SES among African American and White women. RESULTS No significant racial/ethnic differences in unmet medical needs (24.8% of Whites, 25.9% of African Americans; P = .59) were detected in bivariate analyses. However, among women with 12 years of education or less, African Americans were less likely than were Whites to report unmet needs (odds ratio [OR] = 0.57; 95% confidence interval [CI] = 0.42, 0.79). Relative to African American women with 12 years of education or less, the odds of unmet needs were 1.69 (95% CI = 1.24, 2.31) and 2.18 (95% CI = 1.25, 3.82) among African American women with 13 to 15 years of education and 16 years of education or more, respectively. In contrast, the relationship between educational level and unmet needs was nonsignificant among White women. CONCLUSIONS Among African American women, the failure to recognize unmet medical needs is related to educational attainment and may be an important driver of health disparities, representing a fruitful area for future interventions.
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Affiliation(s)
- Jacqueline C Wiltshire
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A & M University, Tallahassee, FL 32301, USA.
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DeVoe JE, Krois L, Stenger R. Do children in rural areas still have different access to health care? Results from a statewide survey of Oregon's food stamp population. J Rural Health 2009; 25:1-7. [PMID: 19166555 DOI: 10.1111/j.1748-0361.2009.00192.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine if rural residence is independently associated with different access to health care services for children eligible for public health insurance. METHODS We conducted a mail-return survey of 10,175 families randomly selected from Oregon's food stamp population (46% rural and 54% urban). With a response rate of 31%, we used a raking ratio estimation process to weight results back to the overall food stamp population. We examined associations between rural residence and access to health care (adjusting for child's age, child's race/ethnicity, household income, parental employment, and parental and child's insurance type). A second logistic regression model controlled for child's special health care needs. FINDINGS Compared with urban children (reference = 1.00), rural children were more likely to have unmet medical care needs (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.07-2.04), problems getting dental care (OR 1.36, 95% CI 1.03-1.79), and at least one emergency department visit in the past year (OR 1.42, 95% CI 1.10-1.81). After adjusting for special health care needs (more prevalent among rural children), there was no rural-urban difference in unmet medical needs, but physician visits were more likely among rural children. There were no statistically significant differences in unmet prescription needs, delayed urgent care, or having a usual source of care. CONCLUSIONS These findings suggest that access disparities between rural and urban low-income children persist, even after adjusting for health insurance. Coupled with continued expansions in children's health insurance coverage, targeted policy interventions are needed to ensure the availability of health care services for children in rural areas, especially those with special needs.
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Affiliation(s)
- Jennifer E DeVoe
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon 97239, USA.
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Financial and employment problems in families of children with special health care needs: implications for research and practice. J Pediatr Health Care 2009; 23:117-25. [PMID: 19232928 DOI: 10.1016/j.pedhc.2008.03.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2007] [Revised: 02/23/2008] [Accepted: 03/07/2008] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The purpose of this study was to identify factors related to financial burden among families of children with special needs and to identify specific provider-level activities associated with decreased risk for such burden. METHOD Data for secondary analysis are from the National Survey of Children with Special Health Care Needs (CSHCN). Logistic regression analysis of state-level data was conducted to identify significant predictors of financial and employment problems among families of children with SHCN in Minnesota. RESULTS Children with more severe conditions and whose family members provided health care at home were more likely to have parents report financial and employment problems due to the child's condition. On the other hand, families whose health care providers communicated well with other service providers and who helped them feel like partners in their child's care were significantly less likely to report financial and employment problems. DISCUSSION Pediatric nurses and nurse practitioners can use these findings as they work with families for optimal family outcomes. Advocacy and policy implications at state and federal levels also are discussed.
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Cuffe SP, Moore CG, McKeown R. ADHD and health services utilization in the national health interview survey. J Atten Disord 2009; 12:330-40. [PMID: 19095891 DOI: 10.1177/1087054708323248] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Describe the general health, comorbidities and health service use among U.S. children with ADHD. METHOD The 2001 National Health Interview Survey (NHIS) contained the Strengths and Difficulties Questionnaire (SDQ; used to determine probable ADHD), data on medical problems, overall health, and health care utilization. RESULTS Asthma was two and headaches were three times more prevalent, and overall health was significantly lower, among children with SDQ ADHD. Of children with SDQ ADHD, 45% saw a mental health professional in the past year and over half were not taking medication regularly. Urban residence, age (9-13), higher family education, having health insurance, and having comorbid emotional problems were associated with mental health care utilization in children with SDQ AD/HD, while race, gender and family income were not associated. CONCLUSIONS Children with SDQ AD/HD had more medical problems and were more likely to visit the emergency room. Treatment data suggest a problem with under-treatment of ADHD in the United States. Interventions should be targeted in rural areas, and among families with low education and without health insurance.
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Affiliation(s)
- Steven P Cuffe
- Department of Psychiatry, University of Florida College of Medicine, Jacksonville, FL 32209, USA.
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Skinner AC, Mayer ML. Effects of insurance status on children's access to specialty care: a systematic review of the literature. BMC Health Serv Res 2007; 7:194. [PMID: 18045482 PMCID: PMC2222624 DOI: 10.1186/1472-6963-7-194] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 11/28/2007] [Indexed: 11/23/2022] Open
Abstract
Background The current climate of rising health care costs has led many health insurance programs to limit benefits, which may be problematic for children needing specialty care. Findings from pediatric primary care may not transfer to pediatric specialty care because pediatric specialists are often located in academic medical centers where institutional rules determine accepted insurance. Furthermore, coverage for pediatric specialty care may vary more widely due to systematic differences in inclusion on preferred provider lists, lack of availability in staff model HMOs, and requirements for referral. Our objective was to review the literature on the effects of insurance status on children's access to specialty care. Methods We conducted a systematic review of original research published between January 1, 1992 and July 31, 2006. Searches were performed using Pubmed. Results Of 30 articles identified, the majority use number of specialty visits or referrals to measure access. Uninsured children have poorer access to specialty care than insured children. Children with public coverage have better access to specialty care than uninsured children, but poorer access compared to privately insured children. Findings on the effects of managed care are mixed. Conclusion Insurance coverage is clearly an important factor in children's access to specialty care. However, we cannot determine the structure of insurance that leads to the best use of appropriate, quality care by children. Research about specific characteristics of health plans and effects on health outcomes is needed to determine a structure of insurance coverage that provides optimal access to specialty care for children.
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Affiliation(s)
- Asheley Cockrell Skinner
- Department of Health Policy and Administration, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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Abstract
CONTEXT Rural deficits in dental care and oral health are well documented and are typically attributed to the low number of dentists practicing in rural areas, but the relationships between rural residence, dental supply, and access to care have not been firmly established, impeding the development of effective public policy. PURPOSE The purpose of this study is to develop a conceptual framework for observed variations in dental supply, oral health, and access to dental care in rural versus nonrural areas, and to test key empirical implications of this framework (eg, whether lower levels of utilization are associated with the lack of dentists and/or other aspects of residence in a rural area). METHODS This study employs descriptive statistics, bivariate analyses, and multiple logistic regression to describe the relationship between oral health, access to care, and the supply of dentists in rural versus nonrural populations. Data analyzed includes Kansas' dental licensure records and the 2002 Behavioral Risk Factor Surveillance System. FINDINGS Bivariate results confirm that dental supply, access to care, and oral health are lower for populations living in rural areas. Multivariate models indicate that dentist supply has a positive and independent association with utilization, but that rurality is not associated with utilization and oral health after controlling for demographics and dentist supply. CONCLUSIONS Findings are consistent with a conceptual framework linking the geography of rural residence, individual preferences for services such as dental care, and the financial disincentives for dentists to locate in rural areas.
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Skinner AC, Slifkin RT. Rural/urban differences in barriers to and burden of care for children with special health care needs. J Rural Health 2007; 23:150-7. [PMID: 17397371 DOI: 10.1111/j.1748-0361.2007.00082.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To examine the barriers and difficulties experienced by rural families of children with special health care needs (CSHCN) in caring for their children. METHODS The National Survey of Children with Special Health Care Needs was used to examine rural-urban differences in types of providers used, reasons CSHCN had unmet health care needs, insurance and financial difficulties encountered, and the family burden of providing the child's medical care. We present both unadjusted and adjusted results to allow consideration of the causes of rural-urban differences. FINDINGS Rural CSHCN are less likely to be seen by a pediatrician than urban children. They are more likely to have unmet health care needs due to transportation difficulties or because care was not available in the area; there were minimal other differences in barriers to care. Families of rural CSHCN are more likely to report financial difficulties associated with their children's medical needs and more likely to provide care at home for their children. CONCLUSIONS Examining results from both unadjusted and adjusted odds ratios shows that the burden of care for families of rural CSHCN stems both from socioeconomic differences and health system differences. Policies aimed at achieving equity for rural children will require focusing on both individual factors and the health care infrastructure, including increasing insurance coverage to lessen financial difficulties and addressing the availability of providers in rural areas.
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Affiliation(s)
- Asheley Cockrell Skinner
- North Carolina Rural Health Research and Policy Analysis Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590, USA.
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Hodgson N, Landsberg L, Lehning A, Kleban M. Palliative care services in Pennsylvania nursing homes. J Palliat Med 2007; 9:1054-8. [PMID: 17040142 DOI: 10.1089/jpm.2006.9.1054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Palliative care is an interdisciplinary model that focuses on the comprehensive management of physical, psychological, social, and spiritual needs of individuals with lifelimiting illness. Although palliative care is increasingly common in acute care settings, regulatory, financial, and educational barriers often bar nursing home residents from access to palliative care services. OBJECTIVE The purpose of the Palliative Care Services in Pennsylvania Nursing Homes Survey was to describe existing palliative care services within nursing homes in Pennsylvania, and to classify these services by level of care delivery. METHODS Ninety-one nursing home administrators throughout the state of Pennsylvania participated in the mailed survey. Multiple logistic regression analysis was used to investigate the association between various organizational characteristics and provision of palliative care services. RESULTS Results reveal that urban facilities were more likely to provide palliative care services than rural facilities. Urban facilities cited the need for bereavement training most frequently, whereas rural clinical cited the need for training in pain management. Larger facility size was associated with an increased likelihood of pain management practices, even after adjusting for regional differences. CONCLUSIONS These pilot findings are consistent with and extend previous findings suggesting that palliative care practice in nursing homes is strongly influenced by nonclinical factors and invites further investigation.
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Affiliation(s)
- Nancy Hodgson
- Polisher Research Institute, North Wales, Pennsylvania 19454, USA.
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Skinner AC, Slifkin RT, Mayer ML. The Effect of Rural Residence on Dental Unmet Need for Children With Special Health Care Needs. J Rural Health 2006; 22:36-42. [PMID: 16441334 DOI: 10.1111/j.1748-0361.2006.00008.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Unmet need for dental care is the most prevalent unmet health care need among children with special health care needs (CSHCN), even though these children are at a greater risk for dental problems. The combination of rural residence and special health care needs may leave rural CSHCN particularly vulnerable to high levels of unmet dental needs. OBJECTIVE To examine the effects of rural residence on unmet dental need for CSHCN. METHODS We use the nationally representative National Survey of CSHCN Needs. We performed logistic regression to estimate the independent effects of rural residence on the likelihood of having an unmet dental need, using a measure of unmet need based on professional society recommendations and a measure based on parental report. RESULTS Using either of the measures, a substantial percentage of CSHCN do not receive all needed dental care. Rural CSHCN are more likely to forgo needed dental care than their urban counterparts. Our results suggest that rural CSHCN have unmet needs for dental care due to both difficulty accessing care and because their parents do not recognize a need. CONCLUSION Traditional access barriers for rural children, such as inadequate provider supply and lack of insurance, may increase unmet needs both directly and indirectly, through their effects on parents' perceptions of need. Reducing unmet needs for dental care in rural children with special needs will require addressing both access issues and parents' understanding of dental care need.
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Affiliation(s)
- Asheley Cockrell Skinner
- Department of Health Policy and Administration, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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