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Rosamilia MB, Williams J, Bair CA, Mulder H, Chiswell KE, D'Ottavio AA, Hartman RJ, Sang CJ, Welke KF, Walsh MJ, Hoffman TM, Landstrom AP, Li JS, Sarno LA. Risk Factors and Outcomes Associated with Gaps in Care in Children with Congenital Heart Disease. Pediatr Cardiol 2024; 45:976-985. [PMID: 38485760 PMCID: PMC11056317 DOI: 10.1007/s00246-024-03414-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/09/2024] [Indexed: 04/29/2024]
Abstract
Adults with congenital heart disease (CHD) benefit from cardiology follow-up at recommended intervals of ≤ 2 years. However, benefit for children is less clear given limited studies and unclear current guidelines. We hypothesize there are identifiable risks for gaps in cardiology follow-up in children with CHD and that gaps in follow-up are associated with differences in healthcare utilization. Our cohort included children < 10 years old with CHD and a healthcare encounter from 2008 to 2013 at one of four North Carolina (NC) hospitals. We assessed associations between cardiology follow-up and demographics, lesion severity, healthcare access, and educational isolation (EI). We compared healthcare utilization based on follow-up. Overall, 60.4% of 6,969 children received cardiology follow-up within 2 years of initial encounter, including 53.1%, 58.1%, and 79.0% of those with valve, shunt, and severe lesions, respectively. Factors associated with gaps in care included increased drive time to a cardiology clinic (Hazard Ratio (HR) 0.92/15-min increase), EI (HR 0.94/0.2-unit increase), lesion severity (HR 0.48 for shunt/valve vs severe), and older age (HR 0.95/month if < 1 year old and 0.94/year if > 1 year old; p < 0.05). Children with a care gap subsequently had more emergency department (ED) visits (Rate Ratio (RR) 1.59) and fewer inpatient encounters and procedures (RR 0.51, 0.35; p < 0.05). We found novel factors associated with gaps in care for cardiology follow-up in children with CHD and altered health care utilization with a gap. Our findings demonstrate a need to mitigate healthcare barriers and generate clear cardiology follow-up guidelines for children with CHD.
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Affiliation(s)
| | - Jason Williams
- Department of Pediatrics, Division of Pediatric Cardiology, Duke School of Medicine, Durham, NC, USA
| | | | - Hillary Mulder
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Karen E Chiswell
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Alfred A D'Ottavio
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Robert J Hartman
- Department of Pediatrics, Division of Pediatric Cardiology, University of North Carolina at Chapel Hill Medical Center, Chapel Hill, NC, USA
| | - Charlie J Sang
- Department of Pediatrics, Division of Pediatric Cardiology, East Carolina University, Greenville, NC, USA
| | - Karl F Welke
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Atrium Health Levine Children's Hospital, Charlotte, NC, USA
| | - Michael J Walsh
- Department of Pediatrics, Division of Pediatric Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Timothy M Hoffman
- Department of Pediatrics, Division of Pediatric Cardiology, University of North Carolina at Chapel Hill Medical Center, Chapel Hill, NC, USA
| | - Andrew P Landstrom
- Department of Pediatrics, Division of Pediatric Cardiology, Duke School of Medicine, Durham, NC, USA
- Department of Cell Biology, Duke School of Medicine, Durham, NC, USA
| | - Jennifer S Li
- Department of Pediatrics, Division of Pediatric Cardiology, Duke School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Lauren A Sarno
- Department of Pediatrics, Division of Pediatric Cardiology, East Carolina University, Greenville, NC, USA.
- Brody School of Medicine, East Carolina University, 115 Heart Drive, Greenville, NC, 27834, USA.
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Kang Y, Kang S, Gibson D, Rodriguez AM, Prochaska J, Kaul S. Disparities in utilization of preventive health services among Asian young adults in the United States. Prev Med 2023; 175:107670. [PMID: 37586609 DOI: 10.1016/j.ypmed.2023.107670] [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] [Received: 02/27/2023] [Revised: 07/07/2023] [Accepted: 08/13/2023] [Indexed: 08/18/2023]
Abstract
Despite the favorable health impacts of preventive services use, young adults remain at a higher risk of not using these services compared with older adults. This study seeks to identify barriers to receiving recommended preventive services among Asian young adults compared to other racial/ethnic young adults. Using 2016-2018 National Health Interview Survey data, this study examined barriers to recommended preventive services among non-Hispanic (NH) Asian young adults aged 18-39 years compared with other racial/ethnic groups in the United States (Total = 25,430; NH Asians = 6.3%). General prevention included fasting blood sugar, cholesterol, blood pressure, and Human Immunodeficiency Virus checkups. We documented information on vaccinations for influenza, pneumonia, tetanus, hepatitis A/B, and female-specific preventive care measures. NH Asian young adults reported blood pressure checkups less often than NH Whites (72.88% vs. 79.92%, p < 0.001). NH Asian young adults were also less likely to report HIV testing than all other racial/ethnic groups (p < 0.001). After controlling for covariates, NH Whites (odds ratio [OR] = 2.00, 95% confidence interval [CI] = 1.60, 2.50), NH Blacks (OR = 1.55, 95% CI = 1.18, 2.02), and other races (OR = 2.40, 95% CI = 1.60, 3.58) were more likely to receive any preventive services than NH Asians. Among those receiving any preventive services, there were no differences between NH Asians and all other racial/ethnic groups in whether they reported receiving relatively more preventive services. Our findings demonstrate that the rates of certain recommended preventive services use were lower among NH Asian young adults. Targeted public health strategies are needed to increase the use of preventive healthcare for racial/ethnic minority young adults.
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Affiliation(s)
- Yejin Kang
- School of Public and Population Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
| | - SuJin Kang
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Building 221, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Derrick Gibson
- School of Public and Population Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
| | - Ana M Rodriguez
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Blvd Fl 3., Galveston, TX 77555, USA.
| | - John Prochaska
- School of Public and Population Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
| | - Sapna Kaul
- School of Public and Population Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
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Costs and Trends of Emergency Department Utilization Pre-ACA and Post-ACA: Evidence From a Rural Georgia Hospital. Med Care 2019; 57:407-409. [PMID: 30994524 DOI: 10.1097/mlr.0000000000001114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A high volume of emergency department (ED) visits in the rural United States may be the result of barriers to accessing primary care. The Affordable Care Act (ACA) increased the number of insured, which may improve patient access to primary care and therefore reduce ED utilization. The objective of this study is to estimate the trends and cost of ED utilization pre-ACA and post-ACA implementation in a rural United States. DATA AND METHODS We use 2009-2013 ED utilization data from a rural Georgia hospital to estimate trends and costs by demographic characteristics, referring source, and payor information. T tests and log-linear regression models are used to assess the sociodemographic factors impacting ED inflation-adjusted costs before (2009-2010) and after ACA (2011-2013) implementation. RESULTS During 2009-2013, 39,970 ED encounters were recorded with an average cost (AC) of $2002 per visit. Results indicate that during pre-ACA, on average, 8702 encounters were recorded per year with an AC of $1759. During post-ACA, there were 7521 annual visits, with an annual AC of $2241. Regression model results indicate that AC were significantly higher for men, older adults, nonblack patients, those with private insurance, and during the post-ACA period. CONCLUSIONS Results suggest that post-ACA, declining ED visits may be due to more patients with insurance accessing primary care instead of ED. We further hypothesize that increased AC during this period may be due to ED visits being of an emergent nature, which require more resources to treat. Further comprehensive investigation is warranted to study the impact of ACA on ED utilization for nonemergency purposes among rural and nonrural hospitals.
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Berg GM, Searight M, Sorell R, Lee FA, Hervey AM, Harrison P. Payer Source Associated with Disparities in Procedural, but Not Surgical, Care in a Trauma Population. Am Surg 2018. [DOI: 10.1177/000313481808400856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Trauma centers are legally bound by Emergency Medical Treatment and Active Labor Act to provide equal treatment to trauma patients, regardless of payer source. However, evidence has suggested that disparities in trauma care exist. This study investigated the relationships between payer source and procedures (total, diagnostic, and surgical) and the number of medical consults in an adult trauma population. This is a 10-year retrospective trauma registry study at a Level I trauma facility. Payer source of adult trauma patients was identified, demographics and variables associated with trauma outcomes were abstracted, and multivariate logistic regression tests were used to determine statistical differences in the number of procedures and medical consults. Of the 12,870 records analyzed, 69.1 per cent of patients were commercially insured, 21.2 per cent were uninsured, and 9.6 per cent had Medicaid. After controlling for patient- and injury-related variables, the commercially insured received more total procedures (4.30) than the uninsured (3.35) or those with Medicaid (3.34), and more diagnostic (2.59) procedures than the uninsured (2.03) or those with Medicaid (2.04). There was not a difference in the number of surgical procedures or medical consults among payer sources. This study noted that disparities (measured by the number of procedures received) compared by payer source existed in the care of trauma patients. However, for medical consults and definitive care (measured by surgical procedures), disparities were not observed. Future research should focus on secondary factors that influence levels of care such as patient-level factors (health literacy) and trauma program policies.
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Affiliation(s)
- Gina M. Berg
- Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, Kansas
- Department of Trauma Services, Wesley Healthcare, Wichita, Kansas
| | - Maggie Searight
- Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, Kansas
| | - Ryan Sorell
- Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, Kansas
| | - Felecia A. Lee
- Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, Kansas
| | - Ashley M. Hervey
- Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, Kansas
| | - Paul Harrison
- Department of Trauma Services, Wesley Healthcare, Wichita, Kansas
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Concepts, antecedents and consequences of ambulance ramping in the emergency department: A scoping review. ACTA ACUST UNITED AC 2017; 20:153-160. [PMID: 29054574 DOI: 10.1016/j.aenj.2017.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/17/2017] [Accepted: 07/30/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Patients arriving at the Emergency Department (ED) via ambulance can experience a delay in receiving definitive care. In Australia, this phenomenon is referred to as 'Ambulance Ramping', 'Patient Off Stretcher Time Delay' or 'Offload Delay'. As a direct consequence of crowding, and in the context of a worldwide increase in ED and ambulance usage, hospital and ambulance service function is hampered. The aim of this review was to synthesize the literature with respect to the conceptualisation, meaning, antecedents and consequences of Ambulance Ramping. METHODS This was a scoping review and synthesis of the literature. Six search terms were employed: emergency medical technician; paramedic; ambulance; hospital emergency services; delay; and ambulance ramping. Journal articles that discussed Ambulance Ramping (or similar terms), and were published in English between 1983 and March 2015 were included. PubMed and CINAHL Plus databases were searched, with secondary searches of reference lists and grey literature also undertaken. RESULTS Thirteen papers were selected and inform this review. Several terms are used internationally to describe phenomena similar to Ambulance Ramping, where there is a delay in patient handover from paramedics to ED clinicians. Antecedents of Ambulance Ramping included reduction/limitation of ambulance diversion, patient acuity, the time of day, the day of the week, insufficient ED staff, insufficient ED beds, and high ED workload. Consequences of Ambulance Ramping include: further delays in patients' ability to receive definitive care and workforce stressors such as missed meal breaks, sick leave and staff attrition. CONCLUSION While the existing research literature indicates that Ambulance Ramping is problematic, little is known about the patient's experience of Ambulance Ramping; this is required so that an enhanced understanding of its implications, including those for emergency nurses, can be identified.
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Bell N, Repáraz L, Fry WR, Smith RS, Luis A. Variation in type and frequency of diagnostic imaging during trauma care across multiple time points by patient insurance type. BMC Med Imaging 2016; 16:61. [PMID: 27809859 PMCID: PMC5094090 DOI: 10.1186/s12880-016-0146-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 06/13/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Research has shown that uninsured patients receive fewer radiographic studies during trauma care, but less is known as to whether differences in care are present among other insurance groups or across different time points during hospitalization. Our objective was to examine the number of radiographic studies administered to a cohort of trauma patients over the entire hospital stay as well as during the first 24-hours of care. METHODS Patient data were obtained from an American College of Surgeons (ACS) verified Level I Trauma Center between January 1, 2011 and December 31, 2012. We used negative binomial regression to construct relative risk (RR) ratios for type and frequency of radiographic imaging received among persons with Medicare, Medicaid, no insurance, or government insurance plans in reference to those with commercial indemnity plans. The analysis was adjusted for patient age, sex, race/ethnicity, injury severity score, injury mechanism, comorbidities, complications, hospital length of stay, and Intensive Care Unit (ICU) admission. RESULTS A total of 3621 records from surviving patients age > =18 years were assessed. After adjustment for potential confounders, the expected number of radiographic studies decreased by 15 % among Medicare recipients (RR 0.85, 95 % CI 0.78-0.93), 11 % among Medicaid recipients (0.89, 0.81-0.99), 10 % among the uninsured (0.90, 0.85-0.96) and 19 % among government insurance groups (0.81, 0.72-0.90), compared with the reference group. This disparity was observed during the first 24-hours of care among patients with Medicare (0.78, 0.71-0.86) and government insurance plans (0.83, 0.74-0.94). Overall, there were no differences in the number of radiographic studies among the uninsured or among Medicaid patients during the first 24-hours of care compared with the reference group, but differences were observed among the uninsured in a sub-analysis of severely injured patients (ISS > 15). CONCLUSIONS Both uninsured and insured patients treated at a not-for-profit verified Level I Trauma Center receive fewer radiographic studies than patients with commercial indemnity plans, even after adjusting for clinical and demographic confounders. There is less disparity in care during the first 24-hours, which suggests that patient pathology is the determining factor for radiographic evaluation during the acute care phase. Results from this study offer initial evidence of disparity in diagnostic imaging across multiple insurance groups over different periods of trauma care.
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Affiliation(s)
- Nathaniel Bell
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC 29208 USA
| | - Laura Repáraz
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC 29208 USA
| | - William R. Fry
- Department of Surgery, Good Samaritan Medical Center, Lafayette, CO USA
| | - R. Stephen Smith
- Professor of Surgery, Trauma Medical Director, University of Florida, Gainesville, FL USA
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Emergency nursing workload and patient dependency in the ambulance bay: A prospective study. ACTA ACUST UNITED AC 2016; 19:210-216. [DOI: 10.1016/j.aenj.2016.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/16/2016] [Accepted: 09/17/2016] [Indexed: 11/23/2022]
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Patient Insurance Profiles: A Tertiary Care Compared to Three Freestanding Emergency Departments. J Emerg Med 2016; 51:466-470. [DOI: 10.1016/j.jemermed.2016.05.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/28/2016] [Accepted: 05/06/2016] [Indexed: 11/16/2022]
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Kingswell C, Shaban RZ, Crilly J. The lived experiences of patients and ambulance ramping in a regional Australian emergency department: An interpretive phenomenology study. ACTA ACUST UNITED AC 2015; 18:182-9. [PMID: 26603895 DOI: 10.1016/j.aenj.2015.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/26/2015] [Accepted: 08/10/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Internationally, the workload of emergency departments (ED) has increased, resulting in overcrowding and frequent delays in the offloading of patients arriving via ambulance--referred to in Australia as 'ambulance ramping'. METHODS Using interpretive phenomenology, this study sought to understand the experience of ambulance ramping from the perspective of patients. Semi-structured interviews were undertaken with seven patients who presented to a regional Queensland ED via ambulance, and experienced an ambulance offload delay of >30 min. RESULTS Ambulance ramping in the ED was described as 'Being a patient, patient', and three major themes emerged: Understanding the emergency healthcare system; Making do within the emergency healthcare system; and Being 'in the dark' during ambulance ramping. Most participants did not understand the antecedents to ambulance ramping, but understood some of the consequences. Most were happy to wait with paramedics for a bed and, although without privacy, felt safe. However, most participants felt 'in the dark' during ambulance ramping, due to communication difficulties regarding bed availability, and this led to frustration. CONCLUSIONS In light of the Australian Charter of Healthcare Rights, service improvement opportunities exist for patients arriving to the ED by ambulance to ensure delays are minimised and quality care is delivered.
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Affiliation(s)
- Chris Kingswell
- Emergency Department, Hervey Bay Hospital, Nissen Street, Urraween, Qld 4655, Australia
| | - Ramon Z Shaban
- Menzies Heath Institute, School of Nursing and Midwifery, Griffith University, Parklands Drive, Southport, Qld 4111, Australia; Infection Control Department, Gold Coast University Hospital, Gold Coast Hospital and Heath Service, 1 Hospital Boulevard, Southport, Qld 4215, Australia.
| | - Julia Crilly
- Menzies Heath Institute, School of Nursing and Midwifery, Griffith University, Parklands Drive, Southport, Qld 4111, Australia; Emergency Department, Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Southport, Qld 4215, Australia
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The CARE 2 Committee: improving efficient use of the ED through a review of high-use patients. Am J Emerg Med 2015; 33:465-7. [DOI: 10.1016/j.ajem.2014.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 12/01/2014] [Accepted: 12/10/2014] [Indexed: 11/19/2022] Open
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Read JG, Varughese S, Cameron PA. Determinants of non-urgent Emergency Department attendance among females in Qatar. Qatar Med J 2014; 2014:98-105. [PMID: 25745599 PMCID: PMC4344983 DOI: 10.5339/qmj.2014.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/10/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The use of emergency department (ED) services for non-urgent conditions is well-studied in many Western countries but much less so in the Middle East and Gulf region. While the consequences are universal-a drain on ED resources and poor patient outcomes-the causes and solutions are likely to be region and country specific. Unique social and economic circumstances also create gender-specific motivations for patient attendance. Alleviating demand on ED services requires understanding these circumstances, as past studies have shown. We undertook this study to understand why female patients with low-acuity conditions choose the emergency department in Qatar over other healthcare options. SETTING AND DESIGN Prospective study at Hamad General Hospital's (HGH) emergency department female "see-and-treat" unit that treats low-acuity cases. One hundred female patients were purposively recruited to participate in the study. Three trained physicians conducted semi-structured interviews with patients over a three-month period after they had been treated and given informed consent. RESULTS The study found that motivations for ED attendance were systematically influenced by employment status as an expatriate worker. Forty percent of the sample had been directed to the ED by their employers, and the vast majority (89%) of this group cited employer preference as the primary reason for choosing the ED. The interviews revealed that a major obstacle to workers using alternative facilities was the lack of a government-issued health card, which is available to all citizens and residents at a nominal rate. CONCLUSION Reducing the number of low-acuity cases in the emergency department at HGH will require interventions aimed at encouraging patients with non-urgent conditions to use alternative healthcare facilities. Potential interventions include policy changes that require employers to either provide workers with a health card or compel employees to acquire one for themselves.
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Taylor J, Uchino K, Hussain MS, Carlson JN. Factors associated with delayed evaluation of patients with potential stroke in US EDs. Am J Emerg Med 2014; 32:1373-7. [DOI: 10.1016/j.ajem.2014.08.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/18/2014] [Accepted: 08/19/2014] [Indexed: 11/24/2022] Open
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Ondler C, Hegde G, Carlson JN. Resource utilization and health care charges associated with the most frequent ED users. Am J Emerg Med 2014; 32:1215-9. [DOI: 10.1016/j.ajem.2014.07.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 07/21/2014] [Indexed: 10/25/2022] Open
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Increased Use of the Emergency Department After Health Care Reform in Massachusetts. Ann Emerg Med 2014; 64:107-15, 115.e1-3. [DOI: 10.1016/j.annemergmed.2014.02.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 01/29/2014] [Accepted: 02/07/2014] [Indexed: 12/29/2022]
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Fields BE, Bell JF, Moyce S, Bigbee JL. The impact of insurance instability on health service utilization: does non-metropolitan residence make a difference? J Rural Health 2014; 31:27-34. [PMID: 25040420 DOI: 10.1111/jrh.12077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Discontinuous and no health insurance are major barriers to health care utilization. This paper examines if nonmetropolitan versus metropolitan residence is associated with differences in health care utilization in the face of insurance instability. METHODS A cross-sectional analysis of adults aged 18-64 years was conducted using the 2006-2010 Medical Expenditure Panel Survey data set (N = 61,039). Negative binomial regression was used to model measures of health service utilization (emergency room [ER] visits, inpatient discharges, office-based visits, dental care visits, prescriptions filled, home health visits) as functions of insurance continuity, adjusted for sociodemographic and health-related covariates. Models were stratified by metropolitan versus nonmetropolitan residence. FINDINGS Health insurance continuity was significantly associated with several measures of health service utilization, including more ER visits for individuals with gaps in health insurance (IRR [incident risk ratio] = 1.29; 95% CI: 1.16-1.42) and fewer inpatient discharges for individuals without insurance (IRR = 0.50; 95% CI: 0.43-0.57) when compared with individuals with continuous insurance. Individuals who were discontinuously insured or uninsured had significantly fewer office-based visits. They also had significantly fewer dental visits, prescription fills, and home health visits; moreover, the magnitudes of these associations were generally significantly greater for residents of nonmetropolitan areas. CONCLUSIONS Insurance instability is associated with higher use of emergency services and reduced use of nonhospital health care services. Residents of nonmetropolitan areas with unstable or no insurance coverage may be at particular risk for reduced access and use of some health services relative to their counterparts living in metropolitan areas.
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Affiliation(s)
- Bronwyn E Fields
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California
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Primary care in the emergency department -- an untapped resource for public health research and innovation. W INDIAN MED J 2014; 63:234-7. [PMID: 25314280 DOI: 10.7727/wimj.2013.332] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 01/13/2014] [Indexed: 11/18/2022]
Abstract
With rising patient volumes and increasingly complex cases, the specialty of emergency medicine faces a growing array of challenges. Efforts have been made to improve patient throughput, yet little attention has been directed to the increasing amount of primary care delivered in emergency departments (EDs) for chronic disease states such as hypertension and diabetes. Management of chronic medical conditions is traditionally seen as beyond the purview of the ED and emergency physicians tend to defer critical aspects of related patient care to other components of the healthcare continuum. As a result, vulnerable patients are often forced to navigate exceedingly complex and fragmented systems of care with little guidance, which often leads to inadequate treatment and exposure to increased risk for development of potentially avoidable complications. As evidenced by our experience with hypertension in an under resourced community, there is a crucial need for emergency physicians to espouse their role as providers of healthcare across the acuity spectrum and lead the way in defining regionally relevant solutions to better manage patients with chronic medical problems.
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Antiemetic use in US EDs. Am J Emerg Med 2013; 32:89-92. [PMID: 24184010 DOI: 10.1016/j.ajem.2013.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 09/25/2013] [Accepted: 10/01/2013] [Indexed: 11/21/2022] Open
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The impact of the patient protection and affordable care act on the national safety net. J Emerg Nurs 2013; 39:360-1. [PMID: 23829987 DOI: 10.1016/j.jen.2013.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Davis H. WITHDRAWN: The Impact of the Patient Protection and Affordable Care Act on the National Safety Net. J Emerg Nurs 2013:S0099-1767(13)00112-8. [PMID: 23642844 DOI: 10.1016/j.jen.2013.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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