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Omoladun-Tijani TA, Vish NL. Family and Neighborhood Resilience Are Associated with Children's Healthcare Utilization. J Pediatr 2023; 261:113543. [PMID: 37290587 DOI: 10.1016/j.jpeds.2023.113543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the association of external factors of resilience, neighborhood, and family resilience with healthcare use. STUDY DESIGN A cross-sectional, observational study was conducted using data from the 2016-2017 National Survey of Children's Health. Children aged 4-17 years were included. Multiple logistic regression was used to determine aOR and 95% CIs for association between levels of family resilience, neighborhood resilience and outcome measures: presence of medical home, and ≥2 emergency department (ED) visits per year while adjusting for adverse childhood experiences (ACEs), chronic conditions, and sociodemographic factors. RESULTS We included 58 336 children aged 4-17 years, representing a population of 57 688 434. Overall, 8.0%, 13.1%, and 78.9% lived in families with low, moderate, and high resilience, respectively; 56.1% identified their neighborhood as resilient. Of these children, 47.5% had a medical home and 4.2% reported ≥2 ED visits in the past year. A child with high family resilience had 60% increased odds of having a medical home (OR, 1.60; 95% CI, 1.37-1.87), and a child with moderate family resilience or resilient neighborhood had a 30% increase (OR, 1.32 [95% CI, 1.10-1.59] and OR, 1.31 [95% CI, 1.20-1.43], respectively). There was no association between resilience factors and ED use, although children with increased ACEs had increased ED use. CONCLUSIONS Children from resilient families and neighborhoods have an increased odds of receiving care in a medical home after adjusting for the effects of ACEs, chronic conditions, and sociodemographic factors, but no association was seen with ED use.
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Affiliation(s)
| | - Nora L Vish
- Wright State University, Boonshoft School of Medicine, Fairborn; Dayton Children's Hospital, Dayton, OH.
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2
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Shah S. Going Farther by Going Together: Collaboration as a Tool in Advocacy. Pediatr Clin North Am 2023; 70:181-191. [PMID: 36402467 DOI: 10.1016/j.pcl.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
With greater understanding of the impact of social determinants on child health, advocacy has become essential to promoting children's health, particularly at the population level. Successful advocacy requires coalition building. Steps on how to create a productive coalition, including the selection of partner organizations, understanding how these groups enhance your activities, and strict definition of assigned roles is reviewed. Examples of successful coalitions are reviewed. A list of potential partners, who focus on various aspects of child health, is provided.
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Affiliation(s)
- Shetal Shah
- Division of Newborn Medicine C-225A, Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA.
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3
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Association Between Maternal Health Status and Family Resilience: Results from a National Survey. Matern Child Health J 2023; 27:307-317. [PMID: 36662381 DOI: 10.1007/s10995-022-03569-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The relationship between maternal health and health outcome of offspring has been studied extensively. However, measures such as family resilience in the context of maternal health are not well understood. The objective of this study was to determine if overall maternal health status is associated with family resilience. METHODS Using the 2016 National Survey of Children's Health, a nationally representative survey of parents/guardians of children ages 0-17, we evaluated the association of overall maternal health status with measures of family resilience. The analysis was performed using descriptive and multivariable analyses. The study adjusted for current health insurance status, family structure of child's household, income level, highest education of adult in household, child race, primary household language, children with special health care needs, emotional support, neighborhood support, parental aggravation, and adverse childhood experiences. RESULTS Compared to mothers who reported their physical health to be good, mothers who had a very good/excellent physical health status reported significantly higher adjusted rates for family resilience measures [Adjusted Odds Ratio (AOR) 0.741, 95% Confidence Interval (CI) (0.640, 0.859); p < 0.001]. Results suggested also that mothers whose mental health was very good/excellent were more likely to exhibit greater family resilience as compared to those that were good [(AOR) 0.452, 95% (CI) (0.390, 0.525); p < 0.001] or poor/fair [(AOR) 0.283, 95% (CI) (0.223, 0.360); p < 0.001]. CONCLUSION Our findings suggest that maternal mental and physical health may contribute to how families respond to adversity. Our findings highlight the importance of evaluating interventions that target both physical and mental aspects of maternal health status to better the resilience of the family unit. In the healthcare setting, maternal health services should ensure early detection and prevention of chronic conditions beyond obstetric care and detection and treatment of mental health.
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Stolte A, Merli MG, Hurst JH, Liu Y, Wood CT, Goldstein BA. Using Electronic Health Records to understand the population of local children captured in a large health system in Durham County, NC, USA, and implications for population health research. Soc Sci Med 2022; 296:114759. [PMID: 35180593 PMCID: PMC9004253 DOI: 10.1016/j.socscimed.2022.114759] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/05/2022] [Accepted: 01/27/2022] [Indexed: 11/17/2022]
Abstract
Although local policies aimed at reducing childhood health inequities can benefit from local data, sample size constraints in population representative health surveys often prevent rigorous evaluations of child health disparities and health care patterns at local levels. Electronic Health Records (EHRs) offer a possible solution as they contain large amounts of information on pediatric patients within a health system. In this paper, we consider the suitability of using EHRs from a large health system to study local children's health by evaluating the extent to which the EHRs capture the county's child population. First, we compare the demographic characteristics of Duke University Health System pediatric patients who live in Durham County, NC (USA) to the child population estimates in the 2015-2019 American Community Survey. We then examine geographic variation in census tract rates of children captured in the EHR data and estimate negative binomial models to assess how tract characteristics are associated with these rates. We also perform these analyses for the subset of pediatric patients who have a well-child encounter. We find that the demographic characteristics of pediatric patients captured by the EHRs are similar to those of the county's child population. Although the county rate of children captured in the EHRs is high, there is variation across census tracts. On average, census tracts with higher concentrations of non-Hispanic Black residents have lower capture rates and tracts with higher concentrations of poverty have higher capture rates, with the poorest tracts showing the largest racial gap in rates of children captured by EHRs. Our findings suggest that EHRs from a large health system can be used to assess children's population health, but that EHR-based evaluations of children's health disparities and health care patterns should account for differences in who is captured by the EHRs based on census tract characteristics.
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Affiliation(s)
- Allison Stolte
- Department of Sociology, Duke University, Durham, NC, USA; Duke Population Research Institute, Duke University, Durham, NC, USA.
| | - M Giovanna Merli
- Duke Population Research Institute, Duke University, Durham, NC, USA; Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Jillian H Hurst
- Duke Children's Health and Discovery Initiative, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA; Division of Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Yaxing Liu
- Office of Academic Solutions and Information Systems, Duke University School of Medicine, Durham, NC, USA
| | - Charles T Wood
- Division of Primary Care Pediatrics, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Benjamin A Goldstein
- Duke Children's Health and Discovery Initiative, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA
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5
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Chang L, Stewart AM, Monuteaux MC, Fleegler EW. Neighborhood Conditions and Recurrent Emergency Department Utilization by Children in the United States. J Pediatr 2021; 234:115-122.e1. [PMID: 33395566 DOI: 10.1016/j.jpeds.2020.12.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/18/2020] [Accepted: 12/29/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the associations of social and physical neighborhood conditions with recurrent emergency department (ED) utilization by children in the US. STUDY DESIGN This cross-sectional study was conducted with the National Survey of Children's Health from 2016 to 2018 to determine the associations of neighborhood characteristics of cohesion, safety, amenities, and detractors with the proportions of children aged 1-17 years with recurrent ED utilization, defined as 2 or more ED visits during the past 12 months. A multivariable regression model was used to determine the independent association of each neighborhood characteristic with recurrent ED utilization controlling for individual-level characteristics. RESULTS In this study of 98 711 children weighted to a population of 70 million nationally, children had significantly greater rates of recurrent ED utilization if they lived in neighborhoods that were not cohesive, were not safe, or had detractors present (all P < .001). With adjustment for individual-level covariates and the other neighborhood characteristics, only neighborhood detractors were independently associated with recurrent ED utilization (1 detractor: aOR 1.32, 95% CI 1.03-1.68; 2 or 3 detractors: aOR 1.37, 95% CI 1.04-1.81). CONCLUSIONS Among neighborhood characteristics, the presence of physical detractors such as rundown housing and vandalism was most strongly associated with recurrent ED utilization by children. Negative attributes of the built environment may be a potential target for neighborhood-level, place-based interventions to alleviate disparities in child healthcare utilization.
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Affiliation(s)
- Lawrence Chang
- Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Pediatrics, Boston Medical Center, Boston, MA.
| | - Amanda M Stewart
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Michael C Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
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Phillips VL, Hu X. Association of healthy child-rearing practices and children's receipt of care in patient-centered medical homes. J Child Health Care 2021; 25:290-304. [PMID: 32615783 DOI: 10.1177/1367493520933458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Efforts to improve the quality of care for children have focused on the patient-centered medical home (PCMH), defined by the National Committee for Quality Assurance (NCQA). Little research has focused on caregivers' role in choosing physicians for children. This study aims to determine whether healthy caregiving behaviors and specific behaviors are associated with children's receipt of PCMH care. Using data from the 2016-2017 National Survey of Children's Health, which includes information on child-rearing behaviors, we estimated logistic regressions, controlling for children's and caregivers' characteristics, to quantify possible associations. We found that each additional healthy child-rearing practice followed increased a child's chance of receiving PCMH care by 4.5% (p < 0.001). Being breastfed (children aged 0-5 years), sharing ideas with their caregiver (children aged 6-17 years), their caregiver ensuring homework is finished (children aged 6-17 years), and having TV time monitored (all ages), each increased the likelihood of PCMH use. These findings show that caregiving behavior is independently associated with locus of care. Future research is warranted as educating caregivers about healthy child-rearing may lead them to seek higher quality care for their children. Also, evaluating the effect of behaviors on health outcomes associated with PCMH would be valuable.
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Affiliation(s)
- Victoria L Phillips
- Department of Health Policy and Management, Rollins School of Public Health, 25798Emory University, GA, USA
| | - Xin Hu
- Department of Health Policy and Management, Rollins School of Public Health, 25798Emory University, GA, USA
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Amutah C, Greenidge K, Mante A, Munyikwa M, Surya SL, Higginbotham E, Jones DS, Lavizzo-Mourey R, Roberts D, Tsai J, Aysola J. Misrepresenting Race - The Role of Medical Schools in Propagating Physician Bias. N Engl J Med 2021; 384:872-878. [PMID: 33406326 DOI: 10.1056/nejmms2025768] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Christina Amutah
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Kaliya Greenidge
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Adjoa Mante
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Michelle Munyikwa
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Sanjna L Surya
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Eve Higginbotham
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - David S Jones
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Risa Lavizzo-Mourey
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Dorothy Roberts
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Jennifer Tsai
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Jaya Aysola
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
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Bell N, Wilkerson R, Mayfield-Smith K, Lòpez-De Fede A. Community social determinants and health outcomes drive availability of patient-centered medical homes. Health Place 2020; 67:102439. [PMID: 33212394 DOI: 10.1016/j.healthplace.2020.102439] [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] [Received: 02/17/2020] [Revised: 07/11/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
The collaborative design of America's patient-centered medical homes places these practices at the forefront of emerging efforts to address longstanding inequities in the quality of primary care experienced among socially and economically marginalized populations. We assessed the geographic distribution of the country's medical homes and assessed whether they are appearing within communities that face greater burdens of disease and social vulnerability. We assessed overlapping spatial clusters of mental and physical health surveys; health behaviors, including alcohol-impaired driving deaths and drug overdose deaths; as well as premature mortality with clusters of medical home saturation and community socioeconomic characteristics. Overlapping spatial clusters were assessed using odds ratios and marginal effects models, producing four different scenarios of resource need and resource availability. All analyses were conducted using county-level data for the contiguous US states. Counties having lower uninsured rates and lower poverty rates were the most consistent indicators of medical home availability. Overall, the analyses indicated that medical homes are more likely to emerge within communities that have more favorable health and socioeconomic conditions to begin with. These findings suggest that intersecting the spatial footprints of medical homes in relation to health and socioeconomic data can provide crucial information for policy makers and payers invested in narrowing the gaps between clinic availability and the communities that experience the brunt of health and social inequalities.
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Affiliation(s)
- Nathaniel Bell
- College of Nursing, University of South Carolina, United States
| | - Rebecca Wilkerson
- Institute for Families in Society, University of South Carolina, United States
| | | | - Ana Lòpez-De Fede
- Institute for Families in Society, University of South Carolina, United States.
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Leung LB, Steers WN, Hoggatt KJ, Washington DL. Explaining racial-ethnic differences in hypertension and diabetes control among veterans before and after patient-centered medical home implementation. PLoS One 2020; 15:e0240306. [PMID: 33044984 PMCID: PMC7549758 DOI: 10.1371/journal.pone.0240306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 09/23/2020] [Indexed: 11/18/2022] Open
Abstract
Patient-centered medical homes (PCMH) are primary care delivery models that improve care access and population-level health outcomes, yet they have not been observed to narrow racial-ethnic disparities in the Veteran Health Administration (VHA) or other health systems. We aimed to identify and compare underlying drivers of persistent hypertension and diabetes control differences between non-Hispanic Black (Black) and Hispanic versus non-Hispanic White (White) patients before and after PCMH implementation in the VHA. Among Black and Hispanic versus White VHA primary care patients in 2009 (nhypertension = 26,906; ndiabetes = 21,141) and 2014 (nhypertension = 83,809; ndiabetes = 38,887), we retrospectively examined hypertension control (blood pressure<140/90) and diabetes control (hemoglobin A1c <9) obtained through random chart abstraction of patient health records nationally via VHA's quality monitoring program. We fit linear probability regression models, adjusting for age, gender, comorbidity, and socioeconomic status (SES). Blinder-Oaxaca and Smith-Welch decomposition methods were used to parse out explained and unexplained contributors to health disparity between racial-ethnic groups pre- and post-PCMH implementation. Compared to White patients, hypertension and diabetes control remained significantly lower for Black (-6.2%[0.4%] and -3.1%[0.6%], respectively; p's<0.001) and Hispanic (-1.4%[0.8%] and -4.0%[1.0%], respectively; p's<0.001) patients following VHA PCMH implementation. Most racial-ethnic differences (55.7-92.3%; all p<0.05) were not attributed to age, gender, comorbidity, and SES. The contribution of explained versus unexplained factors did not significantly change over time. While many explanations for persistent racial-ethnic disparities in disease control among veterans exist, our study did not find that it was due to an influx of "sick" or "socioeconomically vulnerable" patients into the VHA following PCMH implementation. Instead, unexplained differences may be due to differential healthcare and community experiences (e.g., discrimination). Understanding underlying pathways leading to health disparities will better inform policy and clinical interventions to improve PCMH care delivery to racial-ethnic minority patients in health systems.
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Affiliation(s)
- Lucinda B. Leung
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy (Health Equity-QUERI National Partnered Evaluation Center), VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, United States of America
| | - W. Neil Steers
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy (Health Equity-QUERI National Partnered Evaluation Center), VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, United States of America
| | - Katherine J. Hoggatt
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Donna L. Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy (Health Equity-QUERI National Partnered Evaluation Center), VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, United States of America
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10
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Ceasar JN, Ayers C, Andrews MR, Claudel SE, Tamura K, Das S, de Lemos J, Neeland IJ, Powell-Wiley TM. Unfavorable perceived neighborhood environment associates with less routine healthcare utilization: Data from the Dallas Heart Study. PLoS One 2020; 15:e0230041. [PMID: 32163470 PMCID: PMC7067436 DOI: 10.1371/journal.pone.0230041] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/20/2020] [Indexed: 11/18/2022] Open
Abstract
Neighborhood environment perception (NEP) has been associated with health outcomes. However, little is known about how NEP relates to routine healthcare utilization. This study investigated the relationship between NEP and independent subfactors with healthcare utilization behavior, as measured by self-reported (1) usual source of healthcare and (2) time since last routine healthcare check-up. We used cross-sectional data from the Dallas Heart Study, which features a diverse, probability-based sample of Dallas County residents ages 18 to 65. We used logistic regression modeling to examine the association of self-reported NEP and routine healthcare utilization. NEP was assessed via a questionnaire exploring residents' neighborhood perceptions, including violence, the physical environment, and social cohesion. Routine healthcare utilization was assessed via self-reported responses regarding usual source of care and time since last routine healthcare check-up. The analytic sample (N = 1706) was 58% black, 27% white, 15% Hispanic, 42% male, and had a mean age of 51 (SD = 10.3). Analysis of NEP by tertile demonstrated that younger age, lower income, and lower education were associated with unfavorable overall NEP (p trend <0.05 for each). After adjustment for potential confounders, including neighborhood deprivation, health insurance, disease burden and psychosocial factors, we found that individuals with more unfavorable perception of their physical environment were more likely to report lack of a usual source of care (p = 0.013). Individuals with more unfavorable perception of the neighborhood physical environment or greater neighborhood violence reported longer time periods since last routine visit (p = 0.001, p = 0.034 respectively). There was no relationship between perceived social cohesion and healthcare utilization. Using a multi-ethnic cohort, we found that NEP significantly associates with report of a usual source of care and time since last routine check-up. Our findings suggest that public health professionals should prioritize improving NEP since it may act as barrier to routine preventive healthcare and ideal health outcomes.
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Affiliation(s)
- Joniqua N. Ceasar
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Colby Ayers
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Marcus R. Andrews
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sophie E. Claudel
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Kosuke Tamura
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sandeep Das
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - James de Lemos
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Ian J. Neeland
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Tiffany M. Powell-Wiley
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
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Martone CM, Gjelsvik A, Brown JD, Rogers ML, Vivier PM. Adolescent Access to Patient-Centered Medical Homes. J Pediatr 2019; 213:171-179. [PMID: 31399246 DOI: 10.1016/j.jpeds.2019.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To analyze the distribution of patient-centered medical homes (PCMHs) among US adolescents, and to examine whether disparities exist among subgroups. STUDY DESIGN Data on adolescents ages 12-17 years (n = 34 601) from the 2011-2012 National Survey of Children's Health were used in this cross-sectional study to determine what proportion had access to a PCMH. Multivariable logistic regression was used to calculate the odds of having a PCMH, adjusting for sociodemographic characteristics and special health care needs. Comparisons were made to distribution of PCMH in 2007. RESULTS Although most US adolescents had a usual source of care (91%), only about one-half (51%) had access to a PCMH. Disparities in the prevalence of PCMHs were seen by race/ethnicity, poverty, and having special health care needs. There were lower adjusted odds in having a PCMH for Hispanic (aOR, 0.56; 95% CI, 0.45-0.68) and black adolescents (aOR, 0.55; 95% CI, 0.46-0.66) compared with white adolescents. Those living below 4 times the poverty level had lower adjusted odds of PCMH access. Adolescents with 3-5 special health care needs had lower adjusted odds (aOR, 0.43; 95% CI, 0.35-0.52) of having a PCMH compared with adolescents without any special health care needs. Other than receiving family centered care, every component of PCMH was slightly lower in 2011-2012 compared with 2007. CONCLUSIONS PCMH access was lower among minorities, those living in poverty, and those with multiple special health care needs. These disparities in PCMH access among these typically underserved groups call for further study and interventions that would make PCMHs more accessible to all adolescents.
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Affiliation(s)
| | - Annie Gjelsvik
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI; Department of Epidemiology, Brown University, Providence, RI; Department of Pediatrics, Alpert Medical School, Brown University, Providence, RI
| | - Joanna D Brown
- Department of Family Medicine, Alpert Medical School, Brown University, Providence, RI
| | - Michelle L Rogers
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI
| | - Patrick M Vivier
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI; Department of Pediatrics, Alpert Medical School, Brown University, Providence, RI; Department of Health Services, Policy, and Practice, Brown University, Providence, RI
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12
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McKenzie C, Silverberg JI. Associations of unsafe, unsupportive, and underdeveloped neighborhoods with atopic dermatitis in US children. Ann Allergy Asthma Immunol 2018; 122:198-203.e3. [PMID: 30712577 DOI: 10.1016/j.anai.2018.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/12/2018] [Accepted: 10/21/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is influenced by multiple emotional and environmental factors. Yet, little is known about the impact of neighborhood environment characteristics on AD. OBJECTIVE To determine the association of neighborhood characteristics with AD prevalence and severity in US children. METHODS We analyzed data from the 2007-2008 National Survey of Children's Health, including a representative sample of 79,667 children and adolescents (age 0-17 years) in the United States. Multivariable weighted logistic regression models that adjusted for sociodemographics were constructed to determine the associations of neighborhood characteristics with AD prevalence and severity. RESULTS Atopic dermatitis prevalence or severity were significantly increased in children residing in neighborhoods where people reportedly definitely do not help each other out (adjusted odds ratio [95% confidence interval]: 1.32 [1.15-1.52]), watch out for each other's children (1.26 [1.10-1.45] and 1.66 [1.14-2.41], respectively), have people to count on (1.28 [1.13-1.45]), and trusted adults to help the child (1.16 [1.01-1.32] and 1.54 [1.05-2.27], respectively). Children also had increased odds of AD if their caregiver felt that the child was never (1.52 [1.27-1.82]) or sometimes (1.23 [1.12-1.36]) safe in his/her neighborhood. Severe AD was less common in children residing in a neighborhood with a bookmobile or library (0.68 [0.52-0.90]). CONCLUSION US children residing in unsafe, unsupportive, or underdeveloped neighborhoods have higher prevalence and severity of AD.
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Affiliation(s)
- Costner McKenzie
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois.
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13
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Yingling ME, Bell BA. Racial-ethnic and neighborhood inequities in age of treatment receipt among a national sample of children with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:963-970. [PMID: 30112915 DOI: 10.1177/1362361318791816] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The aim of this study is to examine the impact of child race-ethnicity and neighborhood characteristics on age of treatment receipt among children with autism spectrum disorder. Here, we included 1309 children diagnosed with autism spectrum disorder in the National Survey of Children's Health, 2011-2012. Controlling for key covariates, we used a weighted generalized logit model to analyze differences in age of treatment receipt (<2 years, 2 years, 3 years, and ⩾4 years). Compared to non-Hispanic White children, the relative probability (odds) of entering treatment at 3 years and ⩾4 years rather than <2 years was 326% and 367% higher, respectively, for non-Hispanic Black children. Compared to children whose parents perceived their neighborhood to be cohesive, the relative probability of entering treatment at 2 years and 3 years rather than <2 years was 59% and 61% lower, respectively, for children whose parents did not. Significant racial-ethnic and neighborhood inequities exist in age of treatment receipt, suggesting a need for research that explores the underlying causal mechanisms of inequities.
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Gregg A, Chen LW, Kim J, Tak HJ, Tibbits M. Patient-Centered Medical Home Measurement in School-Based Health Centers. J Sch Nurs 2017; 35:189-202. [PMID: 29237335 DOI: 10.1177/1059840517746728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
School-based health centers (SBHCs) have been suggested as potential medical homes, yet minimal attention has been paid to measuring their patient-centered medical home (PCMH) implementation. The purposes of this article were to (1) develop an index to measure PCMH attributes in SBHCs, (2) use the SBHC PCMH Index to compare PCMH capacity between PCMH certified and non-PCMH SBHCs, and (3) examine differences in index scores between SBHCs based in schools with and without adolescents. A total of six PCMH dimensions in the SBHC PCMH Index were identified through factor analysis. These dimensions were collapsed into two domains: care quality and comprehensive care. SBHCs recognized as PCMHs had higher scores on the index, both domains, and four dimensions. SBHCs based in schools with just young children and those with adolescents scored similarly on the overall index, but analysis of individual index items shows their strengths and weaknesses in PCMH implementation.
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Affiliation(s)
- Abbey Gregg
- 1 Department of Community Medicine and Population Health, Institute for Rural Health Research, University of Alabama, Tuscaloosa, AL, USA
| | - Li-Wu Chen
- 2 Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jungyoon Kim
- 2 Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Hyo Jung Tak
- 2 Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Melissa Tibbits
- 3 Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, NE, USA
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Tarraf W, Jensen G, González HM. Patient Centered Medical Home Care Among Near-Old and Older Race/Ethnic Minorities in the US: Findings from the Medical Expenditures Panel Survey. J Immigr Minor Health 2017; 19:1271-1280. [PMID: 27655628 PMCID: PMC5714276 DOI: 10.1007/s10903-016-0491-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Access to Patient Centered Medical Home (PCMH) care has not been explored among older racial/ethnic minorities. We used data on adults 55-years and older from the Medical Expenditure Panel Survey (2008-2013). We account for five features of PCMH experiences and focus on respondents self-identifying as Non-Latino White, Black, and Latino. We used regression models to examine associations between PCMH care and its domains and race/ethnicity and decomposition techniques to assess contribution to differences by predisposing, enabling and health need factors. We found low overall access and significant racial/ethnic variations in experiences of PCMH. Our results indicated strong deficiencies in access to a personal primary care physician provided healthcare. Factors contributing to differences in reported PCMH experiences relative to Whites differed by racial/ethnic grouping. Policy initiatives aimed at addressing accessibility to personal physician directed healthcare could potentially reduce racial/ethnic differences while increasing national access to PCMH care.
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Affiliation(s)
- Wassim Tarraf
- Institute of Gerontology, Wayne State University, 87 East Ferry Street, Detroit, MI, 48202, USA.
- Department of Healthcare Sciences, Eugene Appelbaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, USA.
| | - Gail Jensen
- Institute of Gerontology, Wayne State University, 87 East Ferry Street, Detroit, MI, 48202, USA
- Department of Economics, Wayne State University, Detroit, USA
| | - Hector M González
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, USA
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Liang H, Zhu J, Kong X, Beydoun MA, Wenzel JA, Shi L. The Patient-Centered Care and Receipt of Preventive Services Among Older Adults With Chronic Diseases: A Nationwide Cross-sectional Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2017; 54:46958017724003. [PMID: 28814174 PMCID: PMC5798736 DOI: 10.1177/0046958017724003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article investigates the associations between the patient-centered care (PCC) and receipt of preventive services among older adults with chronic diseases. Data were derived from the nationally representative Medical Expenditure Panel Survey. The full-year consolidated data files from 2009 to 2013 were pooled to yield a final analytic sample (N = 16 654). Study outcomes included the receipt of 7 types of preventive screenings and 2 types of health education services. Patients’ PCC groups were categorized as PCC, partial PCC, and non-PCC, based on 9 questions classified under the 3 distinctive attributes of PCC—whole-person care, patient engagement, and enhanced access to care. Prevalence rates for each outcome variable were calculated. We estimated odds ratios from multiple logistic regressions, comparing the likelihood of outcome variables across 3 groups of patients. Adjusting for covariates, the PCC group was more likely than the non-PCC group to receive 8 types of preventive services. The partial PCC group had a greater likelihood than the non-PCC group of receiving 7 types of preventive services. Our study reveals significant associations between PCC and receipt of preventive services. PCC has demonstrated the potential to improve preventive care for older adults with chronic diseases.
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Affiliation(s)
| | - Junya Zhu
- 1 Johns Hopkins University, Baltimore, MD, USA
| | | | - May A Beydoun
- 2 National Institute on Aging, Intramural Research Program, NIH, Baltimore, MD, USA
| | | | - Leiyu Shi
- 1 Johns Hopkins University, Baltimore, MD, USA
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Hu X, Phillips VL, Gaydos LM, Joski P. Association of Healthy Home Environments and Use of Patient-Centered Medical Homes by Children of Low-Income Families. J Pediatr Health Care 2017; 31:203-214. [PMID: 27692504 DOI: 10.1016/j.pedhc.2016.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/28/2016] [Accepted: 08/12/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Medicaid agencies have been promoting the patient-centered medical home (PCMH) model. Most caregivers choose physician practices for their children, and we hypothesized that those following healthier childrearing practices are more likely to seek care in a PCMH. METHOD We selected children with public insurance plans (n = 20,801) from the 2011-2012 National Survey of Children's Health. We used generalized ordinal logistic regression with state fixed effects to assess the association between home environments and children's use of PCMHs. RESULTS Children living in the healthiest homes were 1.33 times (p = .001) more likely to receive care from the highest level of PCMH. In states with early PCMH implementation, the odds increased to 2.11 times (p = .001). DISCUSSION Our results show a significant, sizeable relationship between healthier home environments and the use of PCMH by children from low-income families. They provide implications for assessing the effect of PCMH use on health outcomes and use patterns.
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18
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Characteristics Associated with Patient-Centered Medical Home Capability in Health Centers: A Cross-Sectional Analysis. J Gen Intern Med 2016; 31:1041-51. [PMID: 27216480 PMCID: PMC4978681 DOI: 10.1007/s11606-016-3729-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/18/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The patient-centered medical home (PCMH) model is being implemented in health centers (HCs) that provide comprehensive primary care to vulnerable populations. OBJECTIVE To identify characteristics associated with HCs' PCMH capability. DESIGN Cross-sectional analysis of a national dataset of Federally Qualified Health Centers (FQHCs) in 2009. Data for PCMH capability, HC, patient, neighborhood, and regional characteristics were combined from multiple sources. PARTICIPANTS A total of 706 (70 %) of 1014 FQHCs from the Health Resources and Services Administration Community Health Center Program, representing all 50 states and the District of Columbia. MAIN MEASURES PCMH capability was scored via the Commonwealth Fund National Survey of FQHCs through the Safety Net Medical Home Scale (0 [worst] to 100 [best]). HC, patient, neighborhood, and regional characteristics (all analyzed at the HC level) were measured from the Commonwealth survey, Uniform Data System, American Community Survey, American Medical Association physician data, and National Academy for State Health Policy data. KEY RESULTS Independent correlates of high PCMH capability included having an electronic health record (EHR) (11.7-point [95 % confidence interval, CI 10.2-13.3]), more types of financial performance incentives (0.7-point [95 % CI 0.2-1.1] higher total score per one additional type, maximum possible = 10), more types of hospital-HC affiliations (1.6-point [95 % CI 1.1-2.1] higher total score per one additional type, maximum possible = 6), and location in certain US census divisions. Among HCs with an EHR, location in a state with state-supported PCMH initiatives and PCMH payments was associated with high PCMH capability (2.8-point, 95 % CI 0.2-5.5). Other characteristics had small effect size based on the measure unit (e.g. 0.04-point [95 % CI 0-0.08] lower total score per one percentage point more minority patients), but the effects could be practically large at the extremes. CONCLUSIONS EHR adoption likely played a role in HCs' improvement in PCMH capability. Factors that appear to hold promise for supporting PCMH capability include a greater number of types of financial performance incentives, more types of hospital-HC affiliations, and state-level support and payment for PCMH activities.
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Abstract
BACKGROUND Recent efforts to revitalize primary care have centered on the patient-centered medical home (PCMH). Although enhanced access is an integral component of the PCMH model, the effect of PCMHs on access to primary care services is understudied. OBJECTIVE To determine whether PCMH practices are associated with better access to new appointments for nonelderly adults by direct measurement. RESEARCH DESIGN We estimated the relationship between practice PCMH status and access to care in multivariate regression models, adjusting for a robust set of patient, practice, and geographic characteristics; using data on 11,347 simulated patient calls to 7266 primary care practices across 10 US states merged with data on PCMH practices. PARTICIPANTS Trained field staff posing as patients (age younger than 65 y) seeking a new primary care appointment with varying insurance status (private, Medicaid, or self-pay). MEASURES Our primary predictor was practice PCMH status and our primary outcome was the ability of simulated patients to schedule a new appointment. Secondary outcomes included the number of days to that appointment; availability of after-hour appointments; and an appointment with an ongoing primary care provider. RESULTS Of the 7266 practices contacted for an appointment, 397 (5.5%) were National Committee for Quality Assurance-recognized PCMHs. In adjusted analyses, callers to PCMH practices compared with non-PCMH practices were more likely to schedule a new appointment (adjusted odds ratio=1.26 (95% CI, 1.01-1.58); P=0.04] and be offered after-hour appointments [adjusted odds ratio=1.36 (95% CI, 1.04-1.75); P=0.02]. DISCUSSION PCMH practices maybe associated with better access to new primary care appointments for nonelderly adults, those most likely to gain insurance under the Affordable Care Act.
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20
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Relationship Between Adolescent Report of Patient-Centered Care and of Quality of Primary Care. Acad Pediatr 2016; 16:770-776. [PMID: 26802684 PMCID: PMC4958046 DOI: 10.1016/j.acap.2016.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Few studies have examined adolescent self-report of patient-centered care (PCC). We investigated whether adolescent self-report of PCC varied by patient characteristics and whether receipt of PCC is associated with measures of adolescent primary care quality. METHODS We analyzed cross-sectional data from Healthy Passages, a population-based survey of 4105 10th graders and their parents. Adolescent report of PCC was derived from 4 items. Adolescent primary care quality was assessed by measuring access to confidential care, screening for important adolescent health topics, unmet need, and overall rating of health care. We conducted weighted bivariate analyses and multivariate logistic regression models of the association of PCC with adolescent characteristics and primary care quality. RESULTS Forty-seven percent of adolescents reported that they received PCC. Report of receiving PCC was associated with high quality for other measures, such as having a private conversation with a clinician (adjusted odds ratio [aOR] 2.2; 95% confidence interval [CI] [1.9, 2.6]) and having talked about health behaviors (aOR 1.6; 95% CI 1.4, 1.8); it was also associated with lower likelihood for self-reported unmet need for care (aOR 0.8; 95% CI 0.7, 0.9) and having a serious untreated health problem (aOR 0.4; 95% CI 0.3, 0.5). CONCLUSIONS Many adolescents do not report receiving PCC. Adolescent-reported PCC positively correlates with measures of high-quality adolescent primary care. Our study provides support for using adolescent-report of PCC as a measure of adolescent primary care quality.
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Platonova EA, Saunders WB, Warren-Findlow J, Hutchison JA. Patient Perceptions of Patient-Centered Medical Home Characteristics and Satisfaction with Free Clinic Services. Popul Health Manag 2015; 19:324-31. [PMID: 26674255 DOI: 10.1089/pop.2015.0100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The patient-centered medical home (PCMH) is a model of health care delivery designed to improve patient health outcomes by increasing the effectiveness of primary care. The effectiveness of PCMH on vulnerable populations is still largely unknown. The purpose of this study was to examine the relationship between patient perceptions of PCMH characteristics and patient satisfaction among Spanish-speaking and non-Spanish-speaking patients receiving health care at free clinics. A self-administered survey was used to collect data in 2 free clinics in the United States in 2013. Patients were primarily young and female; 44% were Spanish speaking. Patient perceptions of PCMH characteristics were assessed using multi-item Consumer Assessment of Healthcare Providers and Systems scales developed by the Agency for Healthcare Research and Quality. Patient satisfaction was assessed as satisfaction with care received at the clinic and willingness to recommend the provider. Multivariate logistic regression modeled the association between PCMH components and these 2 patient satisfaction measures. In adjusted analyses among Spanish speakers, satisfaction with clinic care was associated with staff helpfulness (OR = 6.03, 95% CI = 1.87-19.46) and no perceived discrimination (OR = 2.55, 95% CI = 1.22-5.33). For non-Spanish speakers, provider communication and politeness significantly increased odds of satisfaction with clinic services. Provider communication was strongly associated with patients' intention to recommend the provider to others for both Spanish speakers and non-Spanish speakers (OR = 4.83, 95% CI = 1.35-17.24; OR = 5.42, 95% CI = 1.54-19.09, respectively). Findings suggest that interpersonal characteristics of providers and clinic staff are critical to patient satisfaction among vulnerable populations served by free clinics. Future studies should examine PCMH components and clinical outcomes among this population.
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Affiliation(s)
- Elena A Platonova
- 1 Department of Public Health Sciences, University of North Carolina at Charlotte , Charlotte, North Carolina
| | - William B Saunders
- 1 Department of Public Health Sciences, University of North Carolina at Charlotte , Charlotte, North Carolina
| | - Jan Warren-Findlow
- 1 Department of Public Health Sciences, University of North Carolina at Charlotte , Charlotte, North Carolina
| | - Jenny A Hutchison
- 1 Department of Public Health Sciences, University of North Carolina at Charlotte , Charlotte, North Carolina
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Asking the Patient About Patient-Centered Medical Homes: A Qualitative Analysis. J Gen Intern Med 2015; 30:1461-7. [PMID: 25876739 PMCID: PMC4579220 DOI: 10.1007/s11606-015-3312-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/06/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND What patients perceive and experience within a patient-centered medical home (PCMH) is an understudied area, and to date, the patient perspective has not been an integral component of existing PCMH measurement standards. However, upcoming guidelines necessitate the use of patient-reported experiences and satisfaction in evaluations of practice and provider performance. OBJECTIVE To characterize patients' experiences with care after PCMH adoption and their understanding and perceptions of the PCMH model and its key components, and to compare responses by degree of practice-level PCMH adoption and patient race/ethnicity. DESIGN Qualitative study. PARTICIPANTS Adult patients with diabetes and/or hypertension (n = 48). APPROACH We surveyed and ranked all PCMH adult primary care practices affiliated with one academic medical center with at least three providers (n = 23), using an instrument quantifying the degree of PCMH adoption. We purposively sampled minority and non-minority patients from the four highest-ranked and four lowest-ranked PCMH-adopting practices to determine whether responses varied by degree of PCMH adoption or patient race/ethnicity. We conducted semi-structured telephone interviews with patients about their experiences with care and their perceptions and understanding of key PCMH domains. Interviews were recorded, transcribed, and imported into NVivo 10 for coding and analysis, using a modified grounded theory approach. KEY RESULTS We found that patients uniformly lacked awareness of the PCMH concept, and the vast majority perceived no PCMH-related structural changes, regardless of the degree of practice-reported PCMH adoption or the patient's race/ethnicity. Despite this lack of awareness, patients overwhelmingly reported positive relationships with their provider and positive overall experiences. CONCLUSIONS As we continue to redesign primary care delivery with an emphasis on patient experience measures as performance metrics, we need to better understand what, if any, aspects of practice structure relate to patient experience and satisfaction with care.
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Jones C, Finison K, McGraves-Lloyd K, Tremblay T, Mohlman MK, Tanzman B, Hazard M, Maier S, Samuelson J. Vermont's Community-Oriented All-Payer Medical Home Model Reduces Expenditures and Utilization While Delivering High-Quality Care. Popul Health Manag 2015; 19:196-205. [PMID: 26348492 PMCID: PMC4913508 DOI: 10.1089/pop.2015.0055] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Patient-centered medical home programs using different design and implementation strategies are being tested across the United States, and the impact of these programs on outcomes for a general population remains unclear. Vermont has pursued a statewide all-payer program wherein medical home practices are supported with additional staffing from a locally organized shared resource, the community health team. Using a 6-year, sequential, cross-sectional methodology, this study reviewed annual cost, utilization, and quality outcomes for patients attributed to 123 practices participating in the program as of December 2013 versus a comparison population from each year attributed to nonparticipating practices. Populations are grouped based on their practices' stage of participation in a calendar year (Pre-Year, Implementation Year, Scoring Year, Post-Year 1, Post-Year 2). Annual risk-adjusted total expenditures per capita at Pre-Year for the participant group and comparison group were not significantly different. The difference-in-differences change from Pre-Year to Post-Year 2 indicated that the participant group's expenditures were reduced by −$482 relative to the comparison (95% CI, −$573 to −$391; P < .001). The lower costs were driven primarily by inpatient (−$218; P < .001) and outpatient hospital expenditures (−$154; P < .001), with associated changes in inpatient and outpatient hospital utilization. Medicaid participants also had a relative increase in expenditures for dental, social, and community-based support services ($57; P < .001). Participants maintained higher rates on 9 of 11 effective and preventive care measures. These results suggest that Vermont's community-oriented medical home model is associated with improved outcomes for a general population at lower expenditures and utilization. (Population Health Management 2016;19:196–205)
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Affiliation(s)
- Craig Jones
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | | | | | - Timothy Tremblay
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | - Mary Kate Mohlman
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | - Beth Tanzman
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | - Miki Hazard
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | - Steven Maier
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | - Jenney Samuelson
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
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King CJ, Chen J, Dagher RK, Holt CL, Thomas SB. Decomposing differences in medical care access among cancer survivors by race and ethnicity. Am J Med Qual 2014; 30:459-69. [PMID: 24904178 DOI: 10.1177/1062860614537676] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
More research is needed to identify factors that explain why minority cancer survivors ages 18 to 64 are more likely to delay or forgo care when compared with whites. Data were merged from the 2000-2011 National Health Interview Survey to identify 12 125 adult survivors who delayed medical care. The Fairlie decomposition technique was applied to explore contributing factors that explain the differences. Compared with whites, Hispanics were more likely to delay care because of organizational barriers (odds ratio = 1.38; P < .05), and African Americans were more likely to delay medical care or treatment because of transportation barriers (odds ratio = 1.54; P < .001). The predicted probability of not receiving timely care because of each barrier was lowest among minorities. Age, insurance, perceived health, comorbidity, nativity, and year were significant factors that contributed to the disparities. Although expanded insurance coverage through the Affordable Care Act is expected to increase access, organizational factors and transportation play a major role.
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Affiliation(s)
| | - Jie Chen
- University of Maryland, College Park, MD
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Miller NA, Kirk A, Kaiser M, Glos L. Miller et al. respond. Am J Public Health 2014; 104:e3-4. [PMID: 24625151 PMCID: PMC3987577 DOI: 10.2105/ajph.2014.301891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2014] [Indexed: 05/06/2024]
Affiliation(s)
- Nancy A Miller
- Nancy A. Miller, Adele Kirk, and Lukas Glos are with the Department of Public Policy, University of Maryland, Baltimore County, Baltimore. Michael J. Kaiser is with Econometrica Inc, Rockville, MD
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Sills MR, Kwan BM, Yawn BP, Sauer BC, Fairclough DL, Federico MJ, Juarez-Colunga E, Schilling LM. Medical home characteristics and asthma control: a prospective, observational cohort study protocol. EGEMS 2013; 1:1032. [PMID: 25848577 PMCID: PMC4371502 DOI: 10.13063/2327-9214.1032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background: This paper describes the methods for an observational comparative effectiveness research study designed to test the association between practice-level medical home characteristics and asthma control in children and adults receiving care in safety-net primary care practices. Methods: This is a prospective, longitudinal cohort study, utilizing survey methodologies and secondary analysis of existing structured clinical, administrative, and claims data. The Scalable Architecture for Federated Translational Inquiries Network (SAFTINet) is a safety net-oriented, primary care practice-based research network, with federated databases containing electronic health record (EHR) and Medicaid claims data. Data from approximately 20,000 patients from 50 practices in four healthcare organizations will be included. Practice-level medical home characteristics will be correlated with patient-level asthma outcomes, controlling for potential confounding variables, using a clustered design. Linear and non-linear mixed models will be used for analysis. Study inception was July 1, 2012. A causal graph theory approach was used to guide covariate selection to control for bias and confounding. Discussion: Strengths of this design include a priori specification of hypotheses and methods, a large sample of patients with asthma cared for in safety-net practices, the study of real-world variations in the implementation of the medical home concept, and the innovative use of a combination of claims data, patient-reported data, clinical data from EHRs, and practice-level surveys. We address limitations in causal inference using theory, design and analysis.
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Viola D, Arno PS, Byrnes JG, Doran EA. The Postpediatrician Transition. JOURNAL OF DISABILITY POLICY STUDIES 2013. [DOI: 10.1177/1044207313503684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A variety of factors impacts the transition from childhood to adulthood for persons with special health care needs or disabilities. Among these are the barriers in care coordination associated with our bifurcated health care delivery system in which pediatric medicine does not smoothly link up with the medical care received by adults. After reviewing the literature, we discuss the strong case to be made for reconceptualizing the medical home model, introducing a life span perspective to resolve the postpediatrician transition. Rather than a “hand off” from pediatrician to adult provider, this approach provides a pathway to fully integrating this patient population into our evolving health care system.
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Affiliation(s)
| | - Peter S. Arno
- Political Economy Research Institute, Amherst, MA, USA
- City University of New York, Lehman College, Bronx, NY, USA
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Colvin JD, Zaniletti I, Fieldston ES, Gottlieb LM, Raphael JL, Hall M, Cowden JD, Shah SS. Socioeconomic status and in-hospital pediatric mortality. Pediatrics 2013; 131:e182-90. [PMID: 23248226 DOI: 10.1542/peds.2012-1215] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Socioeconomic status (SES) is inversely related to pediatric mortality in the community. However, it is unknown if this association exists for in-hospital pediatric mortality. Our objective was to determine the association of SES with in-hospital pediatric mortality among children's hospitals and to compare observed mortality with expected mortality generated from national all-hospital inpatient data. METHODS This is a retrospective cohort study from 2009 to 2010 of all 1,053,101 hospitalizations at 42 tertiary care, freestanding children's hospitals. The main exposure was SES, determined by the median annual household income for the patient's ZIP code. The main outcome measure was death during the admission. Primary outcomes of interest were stratified by income and diagnosis-based service lines. Observed-to-expected mortality ratios were created, and trends across quartiles of SES were examined. RESULTS Death occurred in 8950 (0.84%) of the hospitalizations. Overall, mortality rates were associated with SES (P < .0001) and followed an inverse linear association (P < .0001). Similarly, observed-to-expected mortality was associated with SES in an inverse association (P = .014). However, mortality overall was less than expected for all income quartiles (P < .05). The association of SES and mortality varied by service line; only 3 service lines (cardiac, gastrointestinal, and neonatal) demonstrated an inverse association between SES and observed-to-expected mortality. CONCLUSIONS Within children's hospitals, SES is inversely associated with in-hospital mortality, but is lower than expected for even the lowest SES quartile. The association between SES and mortality varies by service line. Multifaceted interventions initiated in the inpatient setting could potentially ameliorate SES disparities in in-hospital pediatric mortality.
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Affiliation(s)
- Jeffrey D Colvin
- Sections of Pediatric Hospital Medicine, Children’s Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri 64108, USA.
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Harrington DW, Wilson K, Bell S, Muhajarine N, Ruthart J. Realizing neighbourhood potential? The role of the availability of health care services on contact with a primary care physician. Health Place 2012; 18:814-23. [PMID: 22503325 DOI: 10.1016/j.healthplace.2012.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 03/02/2012] [Accepted: 03/26/2012] [Indexed: 11/16/2022]
Abstract
Access to health services research has traditionally focused on demographic, socioeconomic, and need-based factors, resulting in a relative lack of knowledge regarding place-based determinants. Further, much of what we know comes from international, national, and regional study. This study analyzes survey data (n=1635) to explore the relationship between neighbourhood-level potential access (i.e., availability) and realized access (i.e., use) in two Canadian cities. Controlling for predisposing, enabling and need factors, living in a well-served neighbourhood was a significant predictor of realized access, particularly in Saskatoon. This suggests that the relationship between potential and realized access may be modified by place-based factors.
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Affiliation(s)
- Daniel W Harrington
- Department of Geography, University of Toronto Mississauga, 3359 Mississauga Rd N, WG Davis Bldg, Mississauga, Ontario, Canada L5L 1C6.
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