Comparing Healthcare Utilization and Diagnoses in Immigrant Versus Nonimmigrant Youth

2021 ◽  
pp. 154041532110369
Author(s):  
Sarah Polk ◽  
Kathryn M. Leifheit ◽  
Amelia J. Brandt ◽  
Lisa Ross DeCamp
Keyword(s):  
Healthcare Utilization ◽  
Low Income ◽  
Propensity Scores ◽  
Care Program ◽  
Matched Sample ◽  
Charity Care ◽  
Pediatric Clinic ◽  
Outpatient Visits ◽  
Reproductive Disease ◽  
Policy Proposals

Introduction: To inform efforts to provide healthcare to uninsurable, immigrant youth, we describe The Access Partnership (TAP) hospital-based charity care program and compare healthcare utilization and diagnoses among TAP and Medicaid patients. Methods: We use propensity scores to match each TAP patient to three Medicaid patients receiving care at a pediatric clinic from October 2010 to June 2015 on demographic characteristics. We use descriptive statistics to compare healthcare visits and diagnoses. Results: TAP ( n = 78) and Medicaid patients ( n = 234) had similar healthcare utilization, though Medicaid patients had more outpatient visits (10.8 vs. 7.7, p = .002), and TAP patients were more likely to have ever received subspecialty care (38.5% vs. 22.2%, p = .005). Diagnoses were similar between groups, with some exceptions: TAP patients more likely to present with genital and reproductive disease (33.3% vs. 19.7%, p = .013); Medicaid patients more likely to present with endocrine, metabolic, and nutritional disease (52.1% vs. 28.2%, p < .001), psychiatric, behavioral disease, and substance abuse (41.0, 26.9%, p = .026). Conclusions: TAP patients had similar healthcare utilization and diagnoses to matched sample of Medicaid patients. Findings indicate policy proposals that extend public health insurance to all children would likely benefit immigrant children and not incur higher costs than those of low-income U.S. citizen children.

scholarly journals Impact of Insulin Initiation and Time to Insulin Initiation on within-Person Change of Healthcare Utilization in Medicaid Enrollees with type 2 Diabetes

2020 ◽  
Author(s):  
Lingshu Xue ◽  
Elsa S. Strotmeyer ◽  
Janice Zgibor ◽  
Tina Costacou ◽  
Robert Boudreau ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Healthcare Utilization ◽  
Low Income ◽  
Propensity Scores ◽  
Sensitivity Analyses ◽  
Insulin Initiation ◽  
First Line ◽  
Initiation Rate ◽  
Subsequent Increase

Abstract Background: Insulin use, time to insulin initiation, and subsequent healthcare utilization in low-income adults with type 2 diabetes (T2DM) are poorly understood.Methods: Our objectives were to examine whether 1) insulin initiation and 2) every 1-year decrease in the time from first-line glucose-lowering agents (GLAs) to insulin initiation reduced healthcare utilization within 12 months after insulin initiation in Pennsylvania (PA) Medicaid enrollees with T2DM. We included a cohort of 12,648 PA Medicaid enrollees (age 47.3±10.3 years) with first-line non-insulin GLAs between 2008 and 2016. Insulin users (N=3,625) were matched with non-insulin users (N=9,023) on dates of 1st GLA prescription and propensity scores calculated based on baseline characteristics to account for potential confounders. Generalized estimating equations models estimated within-person changes in inpatient stays and emergency room (ER) visits 12 months after vs. 12 months before insulin initiation. We performed sensitivity analyses in young (18-45 years) and middle-aged enrollees (>45 to 64 years). Results: The average time from first-line GLAs to insulin initiation was 2.0±1.7 years. Neither insulin initiation (rate ratio [RR]:1.0 [1.0, 1.1]) nor time to insulin initiation (RR: 1.0 [1.0, 1.0]) was associated with within-person change in ER visits. In young T2DM adults, insulin users had a greater subsequent increase in inpatient stays after insulin initiation vs. non-insulin users over the same time period (RR: 1.3 [1.1, 1.5]). Conclusions: In T2DM Medicaid enrollees, no reduction in healthcare utilization was observed after insulin initiation, even in early stages of pharmacotherapy. Studies investigating primary contributors to the increased inpatient use in young insulin users with T2DM are needed.

Improving oral health in low-income pregnant women with a nurse practitioner-directed oral care program

2011 ◽  
Vol 23 (5) ◽  
pp. 249-257 ◽  
Author(s):  
Nancy J. Cibulka ◽  
Sandra Forney ◽  
Kathy Goodwin ◽  
Patricia Lazaroff ◽  
Rebecca Sarabia
Keyword(s):  
Oral Health ◽  
Pregnant Women ◽  
Nurse Practitioner ◽  
Low Income ◽  
Oral Care ◽  
Care Program

The association between an increased reimbursement cap for chronic disease coverage and healthcare utilization in China: an interrupted time series study

2020 ◽  
Vol 35 (8) ◽  
pp. 1029-1038 ◽  
Author(s):  
Menghan Shen ◽  
Wen He ◽  
Eng-Kiong Yeoh ◽  
Yushan Wu
Keyword(s):  
Time Series ◽  
Chronic Disease ◽  
Healthcare Utilization ◽  
Interrupted Time Series ◽  
Claim Data ◽  
Health Events ◽  
Outpatient Visits ◽  
Insurance Claim Data ◽  
Adverse Health Events ◽  
Series Study

Abstract Hypertension and diabetes are highly prevalent in China and pose significant health and economic burdens, but large gaps in care remain for people with such conditions. In this article, drawing on administrative insurance claim data from China’s Urban Employee Basic Medical Insurance (UEBMI), we use an interrupted time series design to examine whether an increase in the monthly reimbursement cap for outpatient visits using chronic disease coverage affects healthcare utilization. The cap was increased by 50 yuan per chronic disease on 1 January 2016, in one of the largest cities in China. Compared with the year before the increase, patients with only hypertension increased their spending using chronic disease coverage by 17.8 yuan (P &lt; 0.001) or 11.6%, and those with only diabetes increased their spending using chronic disease coverage by 19.5 yuan (P &lt; 0.001) or 10.6%, with the differences almost entirely driven by spending on drugs. In addition, these two groups of patients reduced their spending using standard outpatient coverage by 13.9 yuan (P &lt; 0.001) or 5.7% and 14.9 yuan (P = 0.03) or 5.2%, respectively, and thus had no changes in total outpatient spending. Patients with both hypertension and diabetes, meanwhile, increased their spending using chronic disease coverage by 54.8 yuan (P &lt; 0.001) or 18.1% and decreased their spending using standard outpatient coverage by 16.1 yuan (P = 0.002) or 6.1%, with no changes in their probability of hospitalization. Among patients with both hypertension and diabetes who had fewer-than-average outpatient visits in 2015, the hospitalization rate decreased after the 2016 reimbursement cap increase (adjusted odds ratio = 0.702, P = 0.01). These findings suggest that increasing financial protection for patients with hypertension and diabetes may be an important strategy for reducing adverse health events, such as hospitalization, in China.

The Impact of a Community-Based Serious Illness Care Program on Healthcare Utilization and Patient Care Experience

2019 ◽  
Vol 67 (4) ◽  
pp. 825-830 ◽  
Author(s):  
Timothy P. Daaleman ◽  
Natalie C. Ernecoff ◽  
Christine E. Kistler ◽  
Alfred Reid ◽  
David Reed ◽  
...  
Keyword(s):  
Patient Care ◽  
Healthcare Utilization ◽  
Care Program ◽  
Community Based ◽  
Serious Illness ◽  
Care Experience ◽  
The Impact

The Effectiveness of Medical and Surgical Treatment for Children With Refractory Epilepsy

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. E73-E82
Author(s):  
Iwen Pan ◽  
Melissa A LoPresti ◽  
Dave F Clarke ◽  
Sandi Lam
Keyword(s):  
Surgical Treatment ◽  
Healthcare Utilization ◽  
Propensity Scores ◽  
Refractory Epilepsy ◽  
Health Information System ◽  
Treated Group ◽  
Pediatric Epilepsy ◽  
Antiepileptic Medications ◽  
The Impact ◽  
Surgical Group

Abstract BACKGROUND Pediatric refractory epilepsy affects quality of life, clinical disability, and healthcare costs for patients and families. OBJECTIVE To show the impact of surgical treatment for pediatric epilepsy on healthcare utilization compared to medically treated pediatric epilepsy over 5 yr. METHODS The Pediatric Health Information System database was used to conduct a cohort study using 5 published algorithms. Refractory epilepsy patients treated with antiepileptic medications (AEDs) only or AEDs plus epilepsy surgery between 1/1/2008 and 12/31/2014 were included. Healthcare utilization following the index date at 2 and 5 yr including inpatient, emergency department (ED), and all epilepsy-related visits were evaluated. The propensity scores (PS) method was used to match surgically and medically treated patients. PS. SAS® 9.4 and Stata 14.0 were used for data management and statistical analysis. RESULTS A total of 2106 (17.1%) and 10186 (82.9%) were surgically and medically treated. A total of 4050 matched cases, 2025 per each treated group, were included. Compared to medically treated patients, utilization was reduced in the surgical group: at 2 and 5 yr postindex date, there was a reduction of 36% to 37% of inpatient visits and 47% to 50% of ED visits. The total number (inpatient, ED, ambulatory visits) of epilepsy-associated visits were reduced by 39% to 43% in the surgical group compared to the medically treated group. In those who had surgery, the average reduction in AEDs was 16% at 2 and 5 yr after treatment. CONCLUSION Patients with refractory epilepsy treated with surgery had significant reductions in healthcare utilization compared with patients treated only with medications.

“We Need to Stand Together”

2017 ◽  
Author(s):  
Natalie M. Fousekis
Keyword(s):  
Child Care ◽  
Women Leaders ◽  
Single Mothers ◽  
Low Income ◽  
Nursery School ◽  
Care Program ◽  
Publicly Funded ◽  
Child Care Program ◽  
Working Families ◽  
Female Networks

This chapter focuses on two women leaders, Theresa Mahler and Mary Young, and describes how they helped the coalition navigate female networks, create alliances with men inside and outside the legislature, and finally secure a permanent public child care program, even if only for California's low-income working mothers. As legislative chair for the Northern California Association for Nursery Education (NCANE), Mahler served as the key spokeswoman for nursery school educators and child care supervisors throughout the postwar struggles to secure permanent, publicly funded child care. A soft-spoken, unassuming woman who became president and later legislative chairman of the California Parents' Association for Child Care (CPACC), Young spoke on behalf of California's low-income working families, particularly single mothers.

scholarly journals Impact of Gaps in Care during Adult Care Transfer in Sickle Cell Disease

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2992-2992
Author(s):  
Kristen E Howell ◽  
Mariam Kayle ◽  
Matthew P Smeltzer ◽  
Vikki Nolan ◽  
James G Gurney ◽  
...  
Keyword(s):  
Health Care ◽  
Young Adults ◽  
Healthcare Utilization ◽  
Sickle Cell ◽  
Healthcare Resource Utilization ◽  
Adult Health ◽  
Adult Care ◽  
Outpatient Visits ◽  
Acute Healthcare ◽  
Transfer Interval

Abstract The transition from pediatric to adult health care is critical to the care of young adults with sickle cell disease (SCD). Young adults with SCD, compared with children with SCD, are at risk for a marked increase in disease severity, frequency of acute complications, healthcare utilization, and mortality. 1-4 Professional societies and healthcare experts recommend that young adults with chronic health conditions should transfer to adult-centered healthcare within 6 months of their last pediatric visit. 5-8 However, the effect of a 6-month transfer interval on healthcare utilization in SCD has not been studied. Given the complex health care needs of young adults with SCD, 9-15 it remains unclear whether the recommended 6-month transfer interval 5 is optimal. We hypothesized that longer gaps between pediatric and adult care would be associated with greater healthcare utilization in the first 2 to 6 years of adult care. This study included patients with SCD who were followed by a pediatric sickle cell program in the mid-southern US, participated in a transition to adult care program, 16 and fulfilled an initial adult visit to a partner adult SCD facility during the years 2011-2017. Participants were retrospectively followed from their first adult visit through December 31, 2017. Transfer gap was defined as the time (in months) between the last pediatric and the first adult sickle cell clinic visit. We estimated the association between varying transfer gaps from pediatric to adult care and the rate of healthcare utilization (inpatient, emergency department, and outpatient visits) in the first 2 to 6 years of adult care using negative binomial regression. Transfer gaps were evaluated at &lt;2, ≥2 to &lt;6, ≥6 to &lt;9, and ≥9 months to evaluate whether adult health care utilization increased as the gap in SCD-specific care increased. Transfer gaps were also dichotomized at 6 months (&gt;6 vs ≤6) to evaluate the current recommendation to complete transfer of patients to adult care within 6 months. 6,7 Healthcare resource utilization was analyzed for the complete follow-up (up to 6 years) and for the first 2 years of adult care to assess the immediate effects of delayed transfer. In total, 172 young adults with SCD (52% male, 63% HbSS/HbSβ 0-thalassemia) transferred to adult care at a median age of 18 years during the years 2011-2017 (Table 1). Approximately 83% of the included participants transferred to adult care within the recommended 6 months. young adults with transfer gaps ≥9 months had 2.86 (95%CI: 1.32, 6.20) times the rate of acute healthcare visits (inpatient and emergency department combined) compared to those with &lt;2 months transfer gap (Table 2). The incidence rate ratio increased (IRR: 4.06; 95%CI: 1.65, 9.94) when evaluating the first 2 years of adult care. When evaluating the recommended transfer gap (6 months) as a dichotomous variable, those with gaps &gt;6 months had 2.27 (95%CI: 1.18, 4.40) times the rate of acute care visits compared to those with ≤6 months transfer gap (Table 3). The incidence rate ratio increased slightly (IRR: 2.37; 95%CI: 1.29, 4.37) when evaluating the first 2 years of adult care only. There were no apparent associations between transfer gap duration and outpatient visits during the first 6 years in adult care; however, when restricted to the first 2 years of adult care, those with gaps &gt;6 months had 1.32 (95%CI: 1.01, 1.72) times the rate of outpatient visits compared to those with gaps ≤6 months. Consistent with current guidelines, transfer gaps between pediatric and adult-centered care of greater than 6 months were found to be associated with increased acute healthcare resource utilization. Therefore, SCD transition programs would be well-served to consider policies for young adults that initiate adult care within 6 months of leaving pediatric care. Future studies should continue to investigate duration of transfer gaps from pediatric to adult care for their long-term clinical effects and explore interventions to reduce the transfer gap in the SCD population. Figure 1 Figure 1. Disclosures Shah: Novartis: Consultancy, Research Funding, Speakers Bureau; GBT: Research Funding, Speakers Bureau; Alexion: Speakers Bureau; Guidepoint Global: Consultancy; GLG: Consultancy; Emmaus: Consultancy. Hankins: Bluebird Bio: Consultancy; UpToDate: Consultancy; Vindico Medical Education: Consultancy; Global Blood Therapeutics: Consultancy.

scholarly journals Waste Disposal Practices in Low-Income Settlements of South Africa

2021 ◽  
Vol 18 (15) ◽  
pp. 8176
Author(s):  
Lorren Kirsty Haywood ◽  
Thandi Kapwata ◽  
Suzan Oelofse ◽  
Gregory Breetzke ◽  
Caradee Yael Wright
Keyword(s):  
Solid Waste ◽  
South African ◽  
Waste Disposal ◽  
Low Income ◽  
Care Program ◽  
Potential Health ◽  
Piped Water ◽  
Primary Care Program ◽  
Poor Access ◽  
Domestic Solid Waste

Domestic solid waste is rapidly increasing due to accelerated population growth and urbanization. Improper waste disposal poses potential health risks and environmental concerns. Here, we investigated waste disposal practices in relation to household/dwelling characteristics in South African low-income communities. Data for 2014 to 2019 from a community-orientated primary care program were analyzed using logistic regression. Families who reported living in a shack were more likely to dump waste in the street. Households who reported using non-electric sources of fuel for heating/cooking, those who lacked proper sanitation, and those who did not have access to piped water inside the dwelling were more likely to dispose of waste by dumping it in the street/in the yard or burying it. Families living in low-income settlements are at risk of solid waste exposure and this situation is exacerbated by poor access to piped water, proper sanitation, and electricity.

scholarly journals Modeling Count Data for Healthcare Utilization: an Empirical Study of Outpatient Visits Among Vietnamese Older People

2020 ◽  
Author(s):  
Dung Duc Le ◽  
Roberto Leon-Gonzalez ◽  
Joseph Upile Matola
Keyword(s):  
Model Selection ◽  
Older People ◽  
Healthcare Utilization ◽  
Count Data ◽  
Aging Process ◽  
Cross Validation ◽  
Outpatient Visits ◽  
Best Fitting ◽  
Fold Cross Validation ◽  
Fitting Model

Abstract Background Vietnam is undergoing an unprecedented pace of aging process and is expected to experience the fastest aging process in region. Association between increasing age and health deterioration has been well-documented across settings. Consequently, demand for healthcare utilization is rising among older people. However, healthcare utilization, here measured as count data, creates challenges for modeling because such data typically has distributions that are skewed with a large mass at zero. This study compares empirical econometric strategies for the modeling of healthcare utilization (measured as the number of outpatient visits in the last 12 months), and identifies the determinants of healthcare utilization among Vietnamese older people based on the best-fitting model identified. Methods Using the Vietnam Household Living Standard Survey in 2006 (N=2426), nine econometric regression models for count data were examined to identify the best-fitting one. We used model selection criteria; statistical tests; and goodness-of-fit for in-sample model selection. In addition, we conducted 10-fold cross-validation checks to examine reliability of in-sample model selection. Finally, we utilized marginal effects to identify the factors associated with number of outpatient visits among Vietnamese older people based on the best-fitting model identified. Results We found strong evidence in favor of hurdle negative binomial model 2 (HNB2) for both in-sample selection and 10-fold cross-validation checks. The marginal effect results of the HNB2 showed that predisposing, enabling, need, and lifestyle factors were significantly associated with number of outpatient visits. The predicted probabilities for each count event showed the distinct trends of healthcare utilization among specific groups: at low count events, women and people in younger age group used more healthcare utilization than did men and their counterparts in older age groups, but a reversed trend was found at higher count events. Conclusions The findings here suggest that the HNB2 model should be considered for use in modeling counts of healthcare use. This study’s findings lay the groundwork for future research on the modeling of healthcare utilization in developing countries and those findings could be used to forecast on healthcare demand and making provisions for healthcare costs.

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