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.

"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


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/


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.

Mixed Studies Review of Factors Influencing Receipt of Pain Treatment by Injured Black Patients

Sep. 30, 2019

Shoshana V. Aronowitz, Catherine C. McDonald, Robin C. Stevens, Therese S. Richmond

Abstract [from journal]

Aim: To explore the factors that influence provider pain treatment decision making and the receipt of pain management by injured Black patients in the United States.

Design: We completed a systematic mixed studies review using a results-based convergent synthesis design.

Data source: PubMed, SCOPUS, and CINAHL were searched for articles published between 2007-2017 using the search terms "African American", "Black American", "race", "pain treatment", "pain management", and "analgesia".


Nonadherence Labeling in Primary Care: Bias by Race and Insurance Type for Adults With Type 2 Diabetes

Peter Cronholm, MD, MSCE
Sep. 24, 2019

Sourik Beltrán, Lanair A.Lett, Peter F.Cronholm

Abstract [from journal] 

Introduction: Little is known about how provider bias can influence nonadherence labeling. Therefore, a retrospective cohort analysis was conducted to assess the risk of patients with Type 2 diabetes being labeled nonadherent by sociodemographic factors.

Methods: Patients with Type 2 diabetes were identified from 4 primary care sites of the University of Pennsylvania Health System. Demographics, HbA1c, and ICD-10 codes for Type 2 diabetes and nonadherence were extracted from the electronic health


Fast-tracking Behavioral Health Care

Sep. 17, 2019

Imagine struggling with a behavioral health issue, searching for a local psychiatrist, and finding out the provider you’ve chosen doesn’t accept insurance. You wouldn’t be alone: most psychiatrists in the United States don’t. But let’s say your plan has some out-of-network benefits, which means you pay the full cost up front and request an itemized receipt for every appointment.

Associations Between Neighborhood Recreation Environments and Adolescent Physical Activity

Karen Glanz, PhD, MPH
Sep. 10, 2019

Kavita A. Gavand, Kelli L. Cain, Terry L. Conway, Brian E. Saelens, Lawrence D. Frank, Jacqueline Kerr, Karen Glanz, James F. Sallis

Abstract [from journal]

Background: To examine relations between parents' perceived neighborhood recreation environments and multiple measures of adolescent physical activity (PA).

Methods: Participants (N = 928; age 14.1 [1.4] y, 50.4% girls, and 33.4% nonwhite/Hispanic) and their parents were recruited. Teen moderate to vigorous PA (MVPA) was assessed with 7-day accelerometry. Self-reported total PA, PA near home, and PA at recreation locations were also assessed. Proximity of home to 8 types of recreation facilities was reported by


When Crises Converge: Hospital Visits Before And After Shelter Use Among Homeless New Yorkers

Sep. 3, 2019

Dan Treglia, Eileen L. Johns, Maryanne Schretzman, Jacob Berman, Dennis P. Culhane, David C. Lee, and Kelly M. Doran

Abstract [from journal]

People who are homeless use more hospital-based care than average, yet little is known about how hospital and shelter use are interrelated. We examined the timing of emergency department (ED) visits and hospitalizations relative to entry into and exit from New York City homeless shelters, using an analysis of linked health care and shelter administrative databases


Assessing the Relationship Between Housing and Health Among Medically Complex, Chronically Homeless Individuals Experiencing Frequent Hospital Use in the United States

Judy A. Shea, PhD
Sep. 2, 2019

Manik Chhabra, Emily Spector, Sophia Demuynck, Dawn Wiest, Laura Buckley, Judy A. Shea

Abstract [from journal]

In the United States and abroad, health systems have begun to address housing insecurity through programs that adhere to the Housing First model. The model provides permanent supportive housing without disqualification due to current mental health problems or substance use, along with optional case management services. This study used qualitative methods to explore how housing stability affected chronic disease management and social and community relationships among individuals with complex health and social needs and patterns of high hospital


Effect of Prices, Distribution Strategies, and Marketing on Demand for HIV Self-testing in Zimbabwe: A Randomized Clinical Trial

Aug. 28, 2019

Wei Chang, Primrose Matambanadzo, Albert Takaruza, Karin Hatzold, Frances M. Cowan, Euphemia Sibanda, Harsha Thirumurthy

Abstract [from journal]

Importance: HIV self-testing is a promising approach for increasing awareness of HIV status in sub-Saharan Africa, particularly in Zimbabwe, where HIV prevalence is 13%. Evidence is lacking, however, on the optimal pricing policies and delivery strategies for maximizing the effect of HIV self-testing.

Objective: To assess demand for HIV self-testing among adults and priority-population subgroups under alternative pricing and distribution strategies.

Design, Setting, and Participants:...