Access to Care

The extent to which someone can gain access to the health care system, and the financial, social, and organizational factors that affect a person’s ability to get needed care in a timely way.

Medicaid Expansion’s Effects on Patients with Newly Diagnosed, Common Screenable Cancers

Feb. 24, 2020

In our study of nearly a million patients with newly diagnosed breast, colon, or lung cancer, the Affordable Care Act’s Medicaid expansion was associated with a decreased rate of uninsurance and a shift toward earlier-stage cancer diagnosis. Despite concerns that coverage expansions would result in longer wait times for treatment, my colleagues and I found no evidence that Medicaid expansion worsened access to timely cancer-directed therapies.

Health Inequity in the United States: A Primer

Issue Brief
Jan. 6, 2020

By any measure, the United States has a level of health inequity rarely seen among developed nations. The roots of this inequity are deep and complex, and are a function of differences in income, education, race and segregation, and place. In this primer, we provide an overview of these distinctly American problems, and discuss programs and policies that might promote greater health equity in the population. 

 

Live Discharge From Hospice Due to Acute Hospitalization: The Role of Neighborhood Socioeconomic Characteristics and Race/Ethnicity

Dec. 24, 2019

David Russell, Elizabeth Luth, Miriam Ryvicker, Kathryn Bowles, Holly Prigerson

Abstract [from journal]

Background: Acute hospitalization is a frequent reason for live discharge from hospice. Although risk factors for live discharge among hospice patients have been well documented, prior research has not examined the role of neighborhood socioeconomic characteristics, or how these characteristics relate to racial/ethnic disparities in hospice outcomes.

Objective: To examine associations between neighborhood socioeconomic characteristics and risk for live discharge from hospice because of acute hospitalization. The...

Public Libraries as Partners in Confronting the Overdose Crisis: A Qualitative Analysis

Dec. 18, 2019

Margaret Lowenstein, Rachel Feuersteun-Simon, Risha Sheni, Roxanne Dupuis, Eliza Whiteman Kinsey, Xochitl Luna Marti, Carolyn Cannuscio

Abstract [from journal]

Background: The overdose crisis is affecting public libraries. In a 2017 survey of public librarians, half reported providing patrons support regarding substance use and mental health in the previous month, and 12% reported on-site drug overdose at their library in the previous year. Given the magnitude of the overdose crisis and the fact that public libraries host 1.4 billion visits annually, our aim was to understand how libraries currently assist with substance use and overdose and how they can further address these

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Annual Report on Children's Healthcare: Healthcare Access and Utilization by Obesity Status in the United States

James Guevara, MD, MPH
Dec. 13, 2019

Terceira Berdahl, Adam Biener, Marie C. McCormick, James P. Guevara, Lisa Simpson

Abstract

Research Objective: To examine access to care and utilization patterns across a set of healthcare measures by obesity status and socio-demographic characteristics among children.

Study Design/Population Studied: Nationally representative data from the Medical Expenditure Panel Survey (2010-2015) provides data on obesity status, well-child visits, access to a usual source of care provider, preventive dental visits and prescription medication fills in the past year.

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Feasibility of Diabetes Self-Management Telehealth Education for Older Adults During Transitions in Care

Dec. 12, 2019

Christina R. Whitehouse, Judith A. Long, Lori McLeer Maloney, Kimberly Daniels, David A. Horowitz, Kathryn H. Bowles

Abstract [from journal]

The current study investigated the feasibility of telehealth-delivered diabetes self-management education and support (DSMES) for older adults with type 2 diabetes mellitus following hospital discharge. The intervention included one in-person home visit and follow-up weekly virtual DSMES for 4 additional weeks. Diabetes knowledge was measured at baseline and completion of the program. The Telehealth Usability Questionnaire was completed following the final session. Hemoglobin A1C (A1C) level was abstracted from the electronic health record at baseline

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"I Wouldn't Know Where to Start": Perspectives from Clinicians, Agency Leaders, and Autistic Adults on Improving Community Mental Health Services for Autistic Adults

Nov. 1, 2019

Brenna Maddox, Samantha Crabbe, Rinad Beidas, Lauren Brookman-Frazee, Carolyn Cannuscio, Judith Miller, Christina Nicolaidis, David Mandell
 

Abstract [from journal]

Most autistic adults struggle with mental health problems, and traditional mental health services generally do not meet their needs. This study used qualitative methods to identify ways to improve community mental health services for autistic adults for treatment of their co-occurring psychiatric conditions. We conducted semistructured, open-ended interviews with 22 autistic adults with mental healthcare experience, 44 community mental health clinicians, and 11 community mental health agency leaders in the United States. The participants identified

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Patient Portal Usage and Outcomes Among Adult Patients with Uncontrolled Asthma

Andrea Apter, MD, MA, MSc
Oct. 23, 2019

Andrea J. Apter, Tyra Bryant-Stephens, Luzmercy Perez, Knashawn H. Morales, John T. Howell, Alyssa N. Mullen, Xiaoyan Han, Maryori Canales, Marisa Rogers, Heather Klusaritz, A. Russell Localio 

ABSTRACT [from journal]

Background: Patient-clinician communication, essential for favorable asthma outcomes, increasingly relies on information technology including the electronic heath record-based patient portal. For patients with chronic disease living in low-income neighborhoods, the benefits of portal communication remain unclear.

Objective: To describe portal activities and association with 12-month outcomes among low-income asthma patients formally trained in portal use.

Methods: In a...

Healthcare Utilization for Children in Foster Care

Oct. 14, 2019

Colleen E.Bennett, Joanne N.Wood, Philip V.Scribano

Abstract [from journal]

Objective: To utilize hospital EMR data for children placed in foster care (FC) and a matched control group to compare: 1) healthcare utilization rates for primary care, subspecialty care, emergency department (ED) visits, and hospitalizations; 2) overall charges per patient-year; and, 3) prevalence of complex chronic conditions (CCC) and their effect on utilization.

Methods: Children ≤18 years old with a designation of FC placement and controls matched on age, race/

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Screening Instruments for Developmental and Behavioral Concerns in Pediatric Hispanic Populations in the United States: A Systematic Literature Review

Oct. 9, 2019

Stacey Bevan, Jianghong Liu, Kate Wallis, Jennifer Pinto-Martin

Abstract [from journal]

Background: Racial and ethnic disparities in the identification of developmental and behavioral concerns in children are public health problems in the United States. Early identification of developmental delay using validated screening instruments provides a pathway to prevention and intervention in pediatric health care settings. However, the validity of Spanish-language screening instruments, used in clinical settings in the...

Health Care Safety-Net Programs After The Affordable Care Act

Issue Brief
Oct. 1, 2019

Prior to the Affordable Care Act (ACA), health care safety-net programs were the primary source of care for over 44 million uninsured people. While the ACA cut the number of uninsured substantially, about 30 million people remain uninsured, and many millions more are vulnerable to out-of-pocket costs beyond their resources. The need for the safety net remains, even as the distribution and types of need have shifted. This brief reviews the effects of the ACA on the funding and operation of safety-net institutions. It highlights the challenges and opportunities that health care reform presents to safety-net programs, and how they have adapted and evolved to continue to serve our most vulnerable residents.

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