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Suleiman LI, Tucker K, Ihekweazu U, Huddleston JI, Cohen-Rosenblum AR. Caring for Diverse and High-Risk Patients: Surgeon, Health System, and Patient Integration. J Arthroplasty 2022; 37:1421-1425. [PMID: 35158005 DOI: 10.1016/j.arth.2022.02.017] [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: 12/03/2021] [Revised: 01/16/2022] [Accepted: 02/07/2022] [Indexed: 02/02/2023] Open
Abstract
Access and outcome disparities exist in hip and knee arthroplasty care. These disparities are associated with race, ethnicity, and social determinants of health such as income, housing, transportation, education, language, and health literacy. Additionally, medical comorbidities affecting postoperative outcomes are more prevalent in underresourced communities, which are more commonly communities of color. Navigating racial and ethnic differences in treating our patients undergoing hip and knee arthroplasty is necessary to reduce inequitable care. It is important to recognize our implicit biases and lessen their influence on our healthcare decision-making. Social determinants of health need to be addressed on a large scale as the current inequitable system disproportionally impacts communities of color. Patients with lower health literacy have a higher risk of postoperative complications and poor outcomes after hip and knee replacement. Low health literacy can be addressed by improving communication, reducing barriers to care, and supporting patients in their efforts to improve their own health. High-risk patients require more financial, physical, and mental resources to care for them, and hospitals, surgeons, and health insurance companies are often disincentivized to do so. By advocating for alternative payment models that adjust for the increased risk and take into account the increased perioperative work needed to care for these patients, surgeons can help reduce inequities in access to care. We have a responsibility to our patients to recognize and address social determinants of health, improve the diversity of our workforce, and advocate for improved access to care to decrease inequity and outcomes disparities in our field.
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Affiliation(s)
- Linda I Suleiman
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | | | | | - James I Huddleston
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA
| | - Anna R Cohen-Rosenblum
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
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Alang S, Pando C, McClain M, Batts H, Letcher A, Hager J, Person T, Shaw A, Blake K, Matthews-Alvarado K. Survey of the Health of Urban Residents: a Community-Driven Assessment of Conditions Salient to the Health of Historically Excluded Populations in the USA. J Racial Ethn Health Disparities 2021; 8:953-972. [PMID: 32839897 PMCID: PMC7444865 DOI: 10.1007/s40615-020-00852-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Data from the Survey of the Health of Urban Residents (SHUR) identified connections between police brutality and medical mistrust, generating significant media, policy, and research attention. Amidst intersecting crises of COVID-19, racism, and police brutality, this report describes survey development and data collection procedures for the SHUR. BASIC PROCEDURES We conducted focus groups with Black men, Latinxs, and immigrants in Allentown, Pennsylvania. Findings were used to develop and refine measures of conditions salient to the health of urban residents across the country. Quota sampling was employed; oversampling people of color and persons whose usual source of care was not a doctor's office. MAIN FINDINGS Non-Hispanic Whites made up just under two thirds of the sample (63.65%, n = 2793). Black/African American respondents accounted for 14.2% of the sample (n = 623), while 11.62% (n = 510) were Latinx. Only 43.46% of respondents reported a doctor's office as their usual source of care. Novel measures of population-specific stressors include a range of negative encounters with the police, frequency of these encounters, and respondents' assessments of whether the encounters were necessary. SHUR assessed the likelihood of calling the police if there is a problem, worries about incarceration, and cause-specific stressors such as race-related impression management. PRINCIPAL CONCLUSIONS SHUR (n = 4389) is a useful resource for researchers seeking to address the health implications of experiences not frequently measured by national health surveillance surveys. It includes respondents' zip codes, presenting the opportunity to connect these data with zip code-level health system, social and economic characteristics that shape health beyond individual factors.
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Affiliation(s)
- Sirry Alang
- Department of Sociology and Program in Health Medicine and Society, Lehigh University, 31 Williams Drive #280, Bethlehem, PA, USA.
| | - Cynthia Pando
- Department of Sociology and Program in Health Medicine and Society, Lehigh University, 31 Williams Drive #280, Bethlehem, PA, USA
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Malcolm McClain
- Department of Sociology and Program in Health Medicine and Society, Lehigh University, 31 Williams Drive #280, Bethlehem, PA, USA
- Greater Newark Conservancy, Newark, NJ, USA
| | - Hasshan Batts
- Department of Sociology and Program in Health Medicine and Society, Lehigh University, 31 Williams Drive #280, Bethlehem, PA, USA
- Promise Neighborhoods of the Lehigh Valley, Allentown, PA, USA
| | - Abby Letcher
- Lehigh Valley Health Network, Allentown, PA, USA
- Neighborhood Health Centers of the Lehigh Valley, Allentown, PA, USA
| | - Janelle Hager
- Neighborhood Health Centers of the Lehigh Valley, Allentown, PA, USA
| | - Taylor Person
- Promise Neighborhoods of the Lehigh Valley, Allentown, PA, USA
| | - Adama Shaw
- Department of Sociology and Program in Health Medicine and Society, Lehigh University, 31 Williams Drive #280, Bethlehem, PA, USA
- Digestive Care, Inc., Bethlehem, PA, USA
| | - Kwamaine Blake
- Promise Neighborhoods of the Lehigh Valley, Allentown, PA, USA
| | - Kevelis Matthews-Alvarado
- Department of Sociology and Program in Health Medicine and Society, Lehigh University, 31 Williams Drive #280, Bethlehem, PA, USA
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Worth G, Martin T, Christian R, Palokas M. Free clinic oversight and outcomes in the United States: a scoping review protocol. JBI Evid Synth 2020; 18:1522-1527. [PMID: 32813391 DOI: 10.11124/jbisrir-d-19-00176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to explore existing literature related to free clinic oversight, and patient and health outcomes reported with the use of free clinics in the United States, to examine and conceptually map the evidence, and to identify any gaps. INTRODUCTION Free clinics serve a unique role in American health care; however, little is known about clinic oversight and the outcomes seen in uninsured and under-insured patients who are treated at free health clinics. INCLUSION CRITERIA The review will consider studies that include hospital or privately owned and operated community free clinics, and adults and children who utilize free clinics in the United States. In addition to information about clinic oversight, patient outcomes to be considered include disease course management metrics and patient satisfaction. Health outcomes to be considered include hospitalization rates and emergency room visit rates. METHODS This scoping review will consider both experimental and quasi-experimental study designs in addition to analytical observational studies. Qualitative studies, systematic reviews that meet the inclusion criteria, and text and opinion papers will also be included. The search will be limited to those studies published in English since 1967, the year the first free clinic opened in the United States. The proposed review will be conducted in accordance with the JBI methodology for scoping reviews. Data will be extracted from papers by two independent reviewers using an extraction tool developed by the reviewers.
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Affiliation(s)
- Grace Worth
- 1School of Nursing, University of Mississippi Medical Center, Jackson, USA 2Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence
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Erickson KF, Shen JI, Zhao B, Winkelmayer WC, Chertow GM, Ho V, Bhattacharya J. Safety-Net Care for Maintenance Dialysis in the United States. J Am Soc Nephrol 2020; 31:424-433. [PMID: 31857351 PMCID: PMC7003304 DOI: 10.1681/asn.2019040417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/18/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Although most American patients with ESKD become eligible for Medicare by their fourth month of dialysis, some never do. Information about where patients with limited health insurance receive maintenance dialysis has been lacking. METHODS We identified patients initiating maintenance dialysis (2008-2015) from the US Renal Data System, defining patients as "safety-net reliant" if they were uninsured or had only Medicaid coverage at dialysis onset and had not qualified for Medicare by the fourth dialysis month. We examined four dialysis facility ownership categories according to for-profit/nonprofit status and ownership (chain versus independent). We assessed whether patients who were safety-net reliant were more likely to initiate dialysis at certain facility types. We also examined hospital-based affiliation. RESULTS The proportion of patients <65 years initiating dialysis who were safety-net reliant increased significantly over time, from 11% to 14%; 73% of such patients started dialysis at for-profit/chain-owned facilities compared to 76% of all patients starting dialysis. Patients who were safety-net reliant had a 30% higher relative risk of initiating dialysis at nonprofit/independently owned versus for-profit/independently owned facilities (odds ratio, 1.30; 95% CI, 1.24 to 1.36); they had slightly lower relative risks of initiating dialysis at for-profit and non-profit chain-owned facilities, and were more likely to receive dialysis at hospital-based facilities. These findings primarily reflect increased likelihood of dialysis among patients without insurance at certain facility types. CONCLUSIONS Although most patients who were safety-net reliant received care at for-profit/chain-owned facilities, they were disproportionately cared for at nonprofit/independently owned and hospital-based facilities. Ongoing loss of market share of nonprofit/independently owned outpatient dialysis facilities may affect safety net-reliant populations.
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Affiliation(s)
- Kevin F Erickson
- Selzman Institute for Kidney Health, Section of Nephrology, and
- Center for Innovations in Quality, Effectiveness, and Safety, Baylor College of Medicine, Houston, Texas
- Baker Institute for Public Policy, Rice University, Houston, Texas
| | - Jenny I Shen
- Los Angeles Biomedical Research Institute at Harbor-University of California, Los Angeles Medical Center, Torrance, California
| | - Bo Zhao
- Selzman Institute for Kidney Health, Section of Nephrology, and
| | | | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
| | - Vivian Ho
- Baker Institute for Public Policy, Rice University, Houston, Texas
| | - Jay Bhattacharya
- Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
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Molina Y, San Miguel C, Sanz S, San Miguel L, Rankin K, Handler A. Adapting to a Shifting Health Care Landscape: Illinois Breast and Cervical Cancer Program Lead Agencies' Perspectives. Health Promot Pract 2018; 20:600-607. [PMID: 29759013 DOI: 10.1177/1524839918776012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Understanding how safety net programs adapt to systemic health care changes is pivotal for creating feasible recommendations for policy implementation. This study characterizes perspectives of Lead Agency (LA) coordinators of the Illinois Breast and Cervical Cancer Program (IBCCP) in response to sociopolitical changes at state and national levels. Our cross-sectional study included 29 semistructured telephone interviews between December 2015 and January 2016. Respondents indicated some changes in the priority population served, changes in referrals and clinical services, and, a continued commitment to IBCCP. Our findings suggest that IBCCP and other safety net programs will need to be flexible to meet the ongoing needs of historically vulnerable populations in a complex, shifting environment. Implications for public health practice and policy include the need to ensure that program personnel are aware of evidence-based strategies to reach different priority populations and are kept abreast of organizational and system changes that may affect referral patterns as well as the need to educate health care providers working with safety net programs about changes in the delivery and coordination of services.
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Affiliation(s)
- Yamile Molina
- 1 University of Illinois at Chicago, Chicago, IL, USA
| | | | - Stephanie Sanz
- 2 California Department of Public Health, San Diego, CA, USA
| | | | | | - Arden Handler
- 1 University of Illinois at Chicago, Chicago, IL, USA
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Jean-Baptiste E, Alitz P, Birriel PC, Davis S, Ramakrishnan R, Olson L, Marshall J. Immigrant Health through the Lens of Home Visitors, Supervisors, and Administrators: The Florida Maternal, Infant, and Early Childhood Home Visiting Program. Public Health Nurs 2017; 34:531-540. [DOI: 10.1111/phn.12315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Esther Jean-Baptiste
- Department of Community and Family Health; College of Public Health; University of South Florida; Tampa Florida
- Department of Epidemiology and Biostatistics; College of Public Health; University of South Florida; Tampa Florida
| | - Paige Alitz
- Department of Community and Family Health; College of Public Health; University of South Florida; Tampa Florida
| | - Pamela C. Birriel
- Department of Community and Family Health; College of Public Health; University of South Florida; Tampa Florida
| | - Siobhan Davis
- Department of Community and Family Health; College of Public Health; University of South Florida; Tampa Florida
| | - Rema Ramakrishnan
- Department of Community and Family Health; College of Public Health; University of South Florida; Tampa Florida
- Department of Epidemiology and Biostatistics; College of Public Health; University of South Florida; Tampa Florida
| | - Leandra Olson
- Department of Community and Family Health; College of Public Health; University of South Florida; Tampa Florida
| | - Jennifer Marshall
- Department of Community and Family Health; College of Public Health; University of South Florida; Tampa Florida
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Goldstein E, Athale N, Sciolla AF, Catz SL. Patient Preferences for Discussing Childhood Trauma in Primary Care. Perm J 2017; 21:16-055. [PMID: 28333604 DOI: 10.7812/tpp/16-055] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Exposure to traumatic events is common in primary care patients, yet health care professionals may be hesitant to assess and address the impact of childhood trauma in their patients. OBJECTIVE To assess patient preferences for discussing traumatic experiences and posttraumatic stress disorder (PTSD) with clinicians in underserved, predominantly Latino primary care patients. DESIGN Cross-sectional study. MAIN OUTCOME MEASURE We evaluated patients with a questionnaire assessing comfort to discuss trauma exposure and symptoms using the Adverse Childhood Experiences (ACE) Study questionnaire and the Primary Care-PTSD screen. The questionnaire also assessed patients' confidence in their clinicians' ability to help with trauma-related issues. Surveys were collected at an integrated medical and behavioral health care clinic. RESULTS Of 178 adult patients asked, 152 (83%) agreed to participate. Among participants, 37% screened positive for PTSD, 42% reported 4 or more ACEs, and 26% had elevated scores on both measures. Primary Care-PTSD and ACE scores were strongly positively correlated (r = 0.57, p < 0.001). Most patients agreed they were comfortable being asked about trauma directly or through screening questionnaires and did not oppose the inclusion of trauma-related information in their medical record. In addition, most patients perceived their clinician as comfortable asking questions about childhood trauma and able to address trauma-related problems. CONCLUSION Screening is acceptable to most primary care patients regardless of trauma exposure or positive PTSD screening. Findings may aid primary care clinicians to consider screening regularly for ACEs and PTSD to better serve the health care needs of trauma-exposed patients.
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Affiliation(s)
- Ellen Goldstein
- Doctoral Graduate from the Betty Irene Moore School of Nursing at the University of California, Davis.
| | - Ninad Athale
- Family Physician at OLE Health, an Associate Medical Director of County Campus, the Medical Director of Napa County Alcohol and Drug Services, and a Volunteer Clinical Instructor at the University of California, Davis School of Medicine.
| | - Andrés F Sciolla
- Associate Professor at the Department of Psychiatry and Behavioral Sciences at the University of California, Davis.
| | - Sheryl L Catz
- Professor of Nursing Science from the Betty Irene Moore School of Nursing at the University of California, Davis.
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Hussein M, Diez Roux AV, Field RI. Neighborhood Socioeconomic Status and Primary Health Care: Usual Points of Access and Temporal Trends in a Major US Urban Area. J Urban Health 2016; 93:1027-1045. [PMID: 27718048 PMCID: PMC5126022 DOI: 10.1007/s11524-016-0085-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Neighborhood socioeconomic status (SES), an overall marker of neighborhood conditions, may determine residents' access to health care, independently of their own individual characteristics. It remains unclear, however, how the distinct settings where individuals seek care vary by neighborhood SES, particularly in US urban areas. With existing literature being relatively old, revealing how these associations might have changed in recent years is also timely in this US health care reform era. Using data on the Philadelphia region from 2002 to 2012, we performed multilevel analysis to examine the associations of neighborhood SES (measured as census tract median household income) with access to usual sources of primary care (physician offices, community health centers, and hospital outpatient clinics). We found no evidence that residence in a low-income (versus high-income) neighborhood was associated with poorer overall access. However, low-income neighborhood residence was associated with less reliance on physician offices [-4.40 percentage points; 95 % confidence intervals (CI) -5.80, -3.00] and greater reliance on the safety net provided by health centers [2.08; 95 % CI 1.42, 2.75] and outpatient clinics [1.61; 95 % CI 0.97, 2.26]. These patterns largely persisted over the 10 years investigated. These findings suggest that safety-net providers have continued to play an important role in ensuring access to primary care in urban, low-income communities, further underscoring the importance of supporting a strong safety net to ensure equitable access to care regardless of place of residence.
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Affiliation(s)
- Mustafa Hussein
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Ana V Diez Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Robert I Field
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Maeda JLK, Bradley JJ, Eissler SR, Lobrano M, Rubin MR, Gay M, Horberg MA, Loftus BC. Expanding Access to Care and Improving Quality in the Mid-Atlantic States Safety-Net Clinics: Kaiser Permanente's Community Ambassador Program. Perm J 2015; 19:22-7. [PMID: 25785638 DOI: 10.7812/tpp/14-109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Community Ambassador Program (CAP) in the Mid-Atlantic States Region places Kaiser Permanente-employed nurse practitioners, midwives, and physician assistants to work in the safety-net clinics and share best practices through a long-term community collaboration. The authors conducted an evaluation of 18 safety-net clinics that participated in the CAP in 2012. The Community Ambassadors provided an estimated 32,249 encounters to 11,988 patients. Performance was at or near 90% for 2 adult quality measures (weight screening and tobacco use assessment). For breast cancer screenings, however, performance among the Community Ambassadors was much lower (48%). The program expanded access and improved quality of care.
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Affiliation(s)
- Jared Lane K Maeda
- Former Research Scientist at the Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group in Rockville, MD.
| | - Jacqueline J Bradley
- Community Ambassador at the Kaiser Foundation Health Plan of the Mid-Atlantic States in Rockville, MD.
| | - Sarah R Eissler
- Director of Community Outreach Operations at the Kaiser Foundation Health Plan of the Mid-Atlantic States in Rockville, MD.
| | - Marcia Lobrano
- Former Emergency Physician at the Mid-Atlantic Permanente Medical Group in Rockville, MD.
| | - Mindy R Rubin
- Director of Safety Net Partnerships at the Kaiser Foundation Health Plan of the Mid-Atlantic States in Rockville, MD.
| | - Maritha Gay
- Senior Director of External Affairs at the Kaiser Foundation Health Plan of the Mid-Atlantic States in Rockville, MD.
| | - Michael A Horberg
- Executive Director of Research and Community Benefit at the Mid-Atlantic Permanente Research Institute and Mid-Atlantic Permanente Medical Group in Rockville, MD.
| | - Bernadette C Loftus
- Executive Director of the Mid-Atlantic Permanente Medical Group in Rockville, MD, and an Associate Executive Director of The Permanente Medical Group in Oakland, CA.
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Kibicho J, Pinkerton SD. Multiple drug cost containment policies in Michigan's Medicaid program saved money overall, although some increased costs. Health Aff (Millwood) 2012; 31:816-26. [PMID: 22492899 DOI: 10.1377/hlthaff.2011.0246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Michigan's Medicaid program implemented four cost containment policies--preferred drug lists, joint and multistate purchasing arrangements, and maximum allowable cost--during 2002-04. The goal was to control growth of drug spending for beneficiaries who were enrolled in both Medicaid and Medicare and taking antihypertensive or antihyperlipidemic prescription drugs. We analyzed the impact of each policy while holding the effect of all other policies constant. Preferred drug lists increased both preferred and generic drugs' market share and reduced daily cost--the cost per day for each prescription provided to a beneficiary. In contrast, the maximum allowable cost policy increased daily cost and was the only policy that did not generate cost savings. The joint and multistate arrangements did not affect daily cost. Despite these policy trade-offs, the cumulative effect was a 10 percent decrease in daily cost and a total cost savings of $46,195 per year. Our findings suggest that policy makers need to evaluate the impact of multiple policies aimed at restraining drug spending, and further evaluate the policy trade-offs, to ensure that scarce public dollars achieve the greatest return for money spent.
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Affiliation(s)
- Jennifer Kibicho
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, USA.
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Mulvaney-Day N, Alegría M, Nillni A, Gonzalez S. Implementation of Massachusetts health insurance reform with vulnerable populations in a safety-net setting. J Health Care Poor Underserved 2012; 23:884-902. [PMID: 22643631 DOI: 10.1353/hpu.2012.0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This qualitative study examines the experience of racial and ethnic minorities receiving behavioral health care in a safety net setting during the early process of health insurance reform in Massachusetts. Three rounds of interviews were conducted between August 2007 and May 2009, collecting information from patients (n=65) on the experience of health reform and delivery of mental health care. Four categories of enrollees transitioning into health reform emerged over the course of the study that grouped into a typology of experiences with reform: early enrollees, middle enrollees, late enrollees, and multiple switchers. With support, a majority of the sample transitioned smoothly to the new health insurance mechanisms. However, some experienced administrative confusion and disruption in mental health care during the transition. Administrative policies providing special accommodations for individuals with mental health disorders and other vulnerable populations may be important to consider during the transition to health insurance reform.
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Affiliation(s)
- Norah Mulvaney-Day
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, MA 02143, USA.
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MacKenzie TD, Kukolja T, House R, Loehr AA, Hirsh JM, Boyle KA, Sabel AI, Mehler PS. A Discharge Panel At Denver Health, Focused On Complex Patients, May Have Influenced Decline In Length-Of-Stay. Health Aff (Millwood) 2012; 31:1786-95. [DOI: 10.1377/hlthaff.2012.0515] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Thomas D. MacKenzie
- Thomas D. MacKenzie ( ) is chief quality officer at Denver Health, in Colorado
| | - Teresa Kukolja
- Teresa Kukolja is director of utilization management at Denver Health Medical Center
| | - Robert House
- Robert House is director of behavioral health at Denver Health
| | - Amanda A. Loehr
- Amanda A. Loehr is clinical social work supervisor at Denver Health
| | - Joel M. Hirsh
- Joel M. Hirsh is chief of the Rheumatology Division and director of the medicine subspecialty clinics at Denver Health
| | - Kathy A. Boyle
- Kathy A. Boyle is chief nursing officer at Denver Health
| | - Allison I. Sabel
- Allison I. Sabel is director of biostatistics and clinical data warehousing at Denver Health Medical Center
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Collar RM, Shuman AG, Feiner S, McGonegal AK, Heidel N, Duck M, McLean SA, Billi JE, Healy DW, Bradford CR. Lean Management in Academic Surgery. J Am Coll Surg 2012; 214:928-36. [DOI: 10.1016/j.jamcollsurg.2012.03.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 03/02/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
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Taylor IL, Clinchy RM. Impact of health care reform on academic medical centers. Gastrointest Endosc Clin N Am 2012; 22:29-37. [PMID: 22099710 DOI: 10.1016/j.giec.2011.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The impact of health care reform on academic medical centers will be just as great as it is on community practices. The economics of academic medical centers and training programs has been challenging, and will become even more so as funding is cut and the demand for regional integrated systems mounts. This article is one of the first to articulate these challenges and is written by authors well positioned to understand this arena.
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Affiliation(s)
- Ian L Taylor
- SUNY Downstate Medical Center, Dean's Office, School of Medicine, Brooklyn, NY 11203, USA.
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Notaro SJ, Khan M, Bryan N, Kim C, Osunero T, Senseng MG, Eiten M, Desai K, Nasaruddin M. Analysis of the Demographic Characteristics and Medical Conditions of the Uninsured Utilizing a Free Clinic. J Community Health 2011; 37:501-6. [DOI: 10.1007/s10900-011-9470-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jessop EG. America's Uninsured Crisis. J Public Health (Oxf) 2011. [DOI: 10.1093/pubmed/fdr059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hall MA. The mission of safety net organizations following national insurance reform. J Gen Intern Med 2011; 26:802-5. [PMID: 21442337 PMCID: PMC3138599 DOI: 10.1007/s11606-011-1654-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 01/19/2011] [Accepted: 01/26/2011] [Indexed: 11/28/2022]
Abstract
National health insurance reform will pose considerable challenges to the core missions of safety net organizations that serve the uninsured. Those who currently donate money or time will, rightly or wrongly, view uninsured recipients as less deserving on the whole. Nevertheless, safety net organizations can serve several critical functions that continue to justify their existence and support.One important mission is to maintain access for low-income uninsured until all elements of insurance reform are fully in place. Second, once the reform is implemented, people will need a great deal of assistance and encouragement to determine what they are supposed to do and where they are supposed to sign up. Third, substantial portions of the remaining uninsured will continue to lack affordable insurance options, and large numbers of people eligible for coverage will unavoidably undergo temporary gaps in coverage as their family and financial circumstances change. Finally, not all people with insurance will have affordable access to all needed care. Market conditions will continue pushing higher levels of patient cost-sharing through deductibles and co-payments.To serve these multiple needs, safety net organizations should consider adapting their missions and business models so that they accept both insured and uninsured patients under a sliding fee scale that varies charges according to ability to pay.
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Affiliation(s)
- Mark A Hall
- Center for Bioethics, Health & Society, Wake Forest University, Winston-Salem, NC 27157-1063, USA.
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Health care systems of developed non-U.S. nations: strengths, weaknesses, and recommendations for the United States--observations from internationally recognized imaging specialists. AJR Am J Roentgenol 2011; 196:W30-6. [PMID: 21178028 DOI: 10.2214/ajr.10.5321] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The purpose of this article is to survey imaging experts from developed nations on their impression of their own health care system and recommendations for the U.S. health care system as it seeks to enact health care reform. MATERIALS AND METHODS A survey was sent to individual imaging experts from developed nations requesting information on their health care systems (type of system, strengths, and weaknesses) and their recommendations for the United States. RESULTS Eighteen respondents from 17 developed nations completed the survey. All respondents reported universal health care coverage: four with government-operated health care, one with mixed government and private insurance-operated health care, 10 with predominantly government run with private insurance supplementation health care, and one with predominantly private insurance with government-operated supplementation health care. The most commonly cited strength was universal health care coverage for all citizens. The most commonly cited weakness was prolonged wait times. Notably absent was concern by the respondent physicians about malpractice litigation. The most commonly cited recommendation was the implementation of a universal health care coverage program. CONCLUSION In our survey of 18 imaging experts from 17 nations outside the United States, most respondents thought that their nations offered adequate universal health care coverage for their citizens, with the primary drawback of long wait times.
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Affiliation(s)
- Mark A Hall
- Wake Forest University School of Law, Winston-Salem, NC, USA
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