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Liang MH, Lew ER, Fraser PA, Flower C, Hennis EH, Bae SC, Hennis A, Tikly M, Roberts WN. Choosing to End African American Health Disparities in Patients With Systemic Lupus Erythematosus. Arthritis Rheumatol 2024; 76:823-835. [PMID: 38229482 DOI: 10.1002/art.42797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/29/2023] [Accepted: 01/11/2024] [Indexed: 01/18/2024]
Abstract
Systemic lupus erythematosus (SLE) is three times more common and its manifestations are more severe in African American women compared to women of other races. It is not clear whether this is due to genetic differences or factors related to the physical or social environments, differences in health care, or a combination of these factors. Health disparities in patients with SLE between African American patients and persons of other races have been reported since the 1960s and are correlated with measures of lower socioeconomic status. Risk factors for these disparities have been demonstrated, but whether their mitigation improves outcomes for African American patients has not been tested except in self-efficacy. In 2002, the first true US population-based study of patients with SLE with death certificate records was conducted, which demonstrated a wide disparity between the number of African American women and White women dying from SLE. Five years ago, another study showed that SLE mortality rates in the United States had improved but that the African American patient mortality disparity persisted. Between 2014 and 2021, one study demonstrated racism's deleterious effects in patients with SLE. Racism may have been the unmeasured confounder, the proverbial "elephant in the room"-unnamed and unstudied. The etymology of "risk factor" has evolved from environmental risk factors to social determinants to now include structural injustice/structural racism. Racism in the United States has a centuries-long existence and is deeply ingrained in US society, making its detection and resolution difficult. However, racism being man made means Man can choose to change the it. Health disparities in patients with SLE should be addressed by viewing health care as a basic human right. We offer a conceptual framework and goals for both individual and national actions.
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Affiliation(s)
- Matthew H Liang
- Veterans Affairs Boston Healthcare System, Brigham and Women's Hospital, and Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | | | - Cindy Flower
- University of the West Indies, Cave Hill campus, Barbados
| | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology Research, and Hanyang Institute of Bioscience and Biotechnology, Seoul, Korea
| | - Anselm Hennis
- University of the West Indies, Cave Hill campus, Barbados
| | - Mohammed Tikly
- The Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, and Life Roseacres Hospital, Primrose, Germiston, South Africa
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Olateju OA, Shen C, Thornton JD. The Affordable Care Act and income-based disparities in health care coverage and spending among nonelderly adults with cancer. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae050. [PMID: 38812986 PMCID: PMC11135644 DOI: 10.1093/haschl/qxae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/12/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024]
Abstract
The Patient Protection and Affordable Care Act (ACA) significantly reduced uninsured individuals and improved financial protection; however, escalating costs of cancer treatment has led to substantial out-of-pocket expenses, causing severe financial and mental health distress for individuals with cancer. Mixed evidence on the ACA's ongoing impact highlights the necessity of assessing health-spending changes across income groups for informed policy interventions. In our nationally representative survey evaluating the early- and long-term effects of the ACA on nonelderly adult patients with cancer, we categorized individuals-based income subgroups defined by the ACA for eligibility. We found that ACA implementation increased insurance coverage, which was particularly evident after 2 years of implementation. Early post-ACA (within two years of implementation), there were declines in out-of-pocket spending for the lowest and low-income groups by 26.52% and 38.31%, respectively, persisting long-term only for the lowest-income group. High-income groups experienced continuously increased out-of-pocket and premium spending by 25.39% and 34.28%, respectively, with a notable 122% increase in the risk of high-burden spending. This study provides robust evidence of income-based disparities in financial burden for cancer care, emphasizing the need for health care policies promoting equitable care and addressing spending disparities across income brackets.
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Affiliation(s)
- Olajumoke A Olateju
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX 77204-5000, United States
| | - Chan Shen
- Departments of Surgery and Public Health Sciences, Penn State Cancer Institute, Hershey, PA 17033, United States
| | - James Douglas Thornton
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX 77204-5000, United States
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Brady SS, Arguedas A, Huling JD, Hellemann G, Lewis CE, Fok CS, Van Den Eeden SK, Markland AD. Financial strain across 25 years and women's bladder health: a life course perspective. Am J Obstet Gynecol 2024; 230:77.e1-77.e12. [PMID: 37778676 PMCID: PMC10842084 DOI: 10.1016/j.ajog.2023.09.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND A small number of cross-sectional studies have found that financial insecurity-a social determinant of health-is associated with lower urinary tract symptoms. OBJECTIVE This study aimed to examine (1) whether women in the Coronary Artery Risk Development in Young Adult Study with higher levels of financial strain, assessed at 7 time points across 25 years beginning in 1985-1986, were more likely to report lower urinary tract symptoms and impact after the 2010-2011 financial strain assessment and (2) whether healthcare access and comorbidities mediated potential associations. STUDY DESIGN This prospective cohort study recruited Black and White participants aged 18 to 30 years at baseline (1985-1986) from the populations of 4 US cities. The analytical sample was composed of women with complete data for analyses involving financial strain trajectories across 7 assessments (n=841) and mediation tests of data collected at 4 assessments (n=886). The outcome variable was previously developed through a cluster analysis of urinary incontinence severity, urinary incontinence impact, other lower urinary tract symptoms severity, and their impact in 2012-2013, which yielded 4 lower urinary tract symptoms and impact cluster categories: women with no symptom or very mild symptoms and no impact vs women with mild, moderate, or severe symptoms and impact. Financial strain was defined as finding it "very hard," "hard," or "somewhat hard" (vs "not very hard") to pay for the very basics, such as food, heating, and medical care. Using proportional odds logistic regression, cluster categories were regressed on the financial strain trajectory group, adjusting for age, race, education, and parity. For mediation analyses, separate financial strain variables (difficulty paying for the very basics, such as food and heating, and difficulty paying for medical care) were created by combining 1995-1996 and 2000-2001 values. Two healthcare access variables (difficulty receiving care and underutilization of care) and a single comorbidity index (smoking, physical inactivity, body mass index, hypertension, diabetes mellitus, and depressive symptoms) were created by combining 2005-2006 and 2010-2011 values. Regression analyses and structural equation modeling were used to test whether healthcare access and comorbidities mediated associations between financial strain and lower urinary tract symptoms and impact cluster categories. RESULTS In comparison to women who were consistently not financially strained, women who were consistently strained (odds ratio, 2.10; 95% confidence interval, 1.13-3.91), shifted into being strained (odds ratio, 2.00; 95% confidence interval, 1.29-3.10), or experienced >1 shift in strain (odds ratio, 1.99; 95% confidence interval, 1.46-2.71) had roughly twice the odds of reporting greater lower urinary tract symptoms and impact. Underutilization of healthcare and comorbidities mediated the association between difficulty paying for medical care and lower urinary tract symptoms and impact. In the structural equation model, difficulty paying for medical care and underutilization of care were associated (β=.31; P<.01), as was underutilization of care and greater lower urinary tract symptoms and impact (β=.09; P<.01). Moreover, difficulty paying for medical care and the comorbidity index were associated (β=.34; P<.01), as was the comorbidity index and greater lower urinary tract symptoms and impact (β=.24; P<.01). Collectively, these mediation pathways eliminated a direct association between difficulty paying for medical care and lower urinary tract symptoms and impact. CONCLUSION Underutilization of healthcare and comorbidities explained an association between financial strain (difficulty paying for medical care) and lower urinary tract symptoms and impact. Research is needed to confirm the findings and examine other mechanisms that may further explain the association. Accumulated evidence may inform future policies and practices.
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Affiliation(s)
- Sonya S Brady
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN.
| | - Andrés Arguedas
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Jared D Huling
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Gerhard Hellemann
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Cynthia S Fok
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN
| | - Stephen K Van Den Eeden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Birmingham VA Medical Center, Birmingham, AL
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Alvear-Vega S, Vargas-Garrido H. Social determinants of the non-use of the explicit health guarantees plan (the GES plan). BMC Health Serv Res 2023; 23:1129. [PMID: 37858166 PMCID: PMC10588241 DOI: 10.1186/s12913-023-10149-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/15/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION The public policy called Explicit health guarantees (GES) could serve as a basis for the future implementation of universal health coverage in Chile. An improvement in the quality of health of the Chilean population has been observed since the launching of the GES, which has a high adherence (84% of the beneficiary population uses this health program). This work seeks the social determinants related to a portion of the remaining 16% of people who do not use the GES. METHODS This secondary analysis study used a sample of GES recipients (n = 164,786) from the National Socioeconomic Characterization Survey (CASEN) 2020. The GES recipients included in the study responded that they had been under medical treatment for 20 of the 85 pathologies included in the GES, and they had not had access to such policy due to "trust in physician/facility," "decided not to wait," or "lack of information." The CASEN survey chose the 20 pathologies. The Average Marginal Effects of social determinants of the non-use of the GES health plan were predicted using multivariable and panel multinomial probit regression analyses, where the outcome variable assumed three possible values (the three reasons for not accessing) while taking those variables reported in previous studies as independent variables. RESULTS A higher probability of non-access due to distrust in the physician/facility among adults with higher economic income was found. Among those who prefer not to wait are vulnerable groups of people: women, people with a lower-middle income, those who belong to groups with longer waiting times, and ethnic groups. The people who least access the GES due to lack of information correspond to part of the migrant population and those belonging to the lowest income group. CONCLUSIONS The GES policy must necessarily improve the timeliness and quality of the services to make them attractive to groups that currently do not have access to them, managing waiting times rather than referrals and using patient-centered evaluations, especially in those most vulnerable groups that do not access GES because they choose not to wait or lack the necessary information, thereby improving their health literacy.
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Scott AJ, Correa AB, Bisby MA, Dear BF. Depression and Anxiety Trajectories in Chronic Disease: A Systematic Review and Meta-Analysis. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:227-242. [PMID: 37607505 DOI: 10.1159/000533263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION People living with chronic diseases are at an increased risk of anxiety and depression, which are associated with poorer medical and psychosocial outcomes. Many studies have examined the trajectories of depression and anxiety in people with specific diseases, including the predictors of these trajectories. This is valuable for understanding the process of adjustment to diseases and informing treatment planning. However, no review has yet synthesised this information across chronic diseases. METHODS Electronic databases were searched for studies reporting trajectories of depression or anxiety in chronic disease samples. Data extracted included sample characteristics, results from trajectory analyses, and predictors of trajectories. Meta-analysis of the overall pooled prevalence of depression and anxiety trajectories was conducted, and qualitative synthesis of disease severity predictors was undertaken. RESULTS Following search and screening, 67 studies were included (N = 61,201 participants). Most participants followed a stable nonclinical trajectory for depression (69.0% [95% CI: 65.6, 72.2]) and anxiety (73.4% [95% CI: 66.3, 79.5]). Smaller but meaningful subsamples followed a trajectory of depression and anxiety symptoms consistently in the clinical range (11.8% [95% CI: 9.2, 14.8] and 13.7% [95% CI: 9.3, 19.7], respectively). Several clinical and methodological moderators emerged, and qualitative synthesis suggested that few aspects of disease severity were associated with participants' trajectories. CONCLUSION Most people with chronic disease follow a trajectory of distress that is low and stable, suggesting that most people psychologically adjust to living with chronic disease. Evidence also suggests that the nature and severity of the disease are not meaningful predictors of psychological distress.
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Affiliation(s)
- Amelia J Scott
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Ashleigh B Correa
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Madelyne A Bisby
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Blake F Dear
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
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Alanazi A, Alanazi M, Aldosari B. Personal Health Record (PHR) Experience and Recommendations for a Transformation in Saudi Arabia. J Pers Med 2023; 13:1275. [PMID: 37623525 PMCID: PMC10455360 DOI: 10.3390/jpm13081275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
A Personal Health Record (PHR) is a patient-managed platform for health data. Most hospitals provide a PHR as an extension of the Electronic Medical Record (EMR). However, there are unresolved issues around the adoption rate, functionalities, barriers and, more importantly, the impact of the PHR on patients' health. A cross-sectional, survey-based descriptive study was conducted in which patients from four main tertiary hospitals in Saudi Arabia were targeted from September 2022 to February 2023. The survey was tested and validated to address the objectives of the study. The survey covered components related to intention to use the PHR, required functions, obstacles and expected outcomes. This study involved 396 participants from the top four hospitals. It was discovered that the majority of them had intentions to use the PHR (93%) and believed it to be useful (94%) and easy to use (94%). It was widely agreed that accessing medical records (77%), scheduling appointments (88%), renewing medication (90%), tracking patient data (70%) and receiving personalized education (78%) were essential aspects of the PHR. Furthermore, the survey revealed that 54% of respondents saw a positive effect on their health status. A significant number of participants, around 54%, expressed concerns about the privacy of their PHR, and 46% reported concerns about the accuracy of their information. The study found that demographic factors and the type of hospital did not have a statistically significant association with the intention to use the PHR. Our findings showed that there were no significant barriers to adopting the PHR. Additionally, we found that less than half of the participants believed that their current PHR helped them to improve their health. This highlights the need for healthcare organizations to focus on improving the PHR's functionality and overall purpose. Instead of simply providing basic features, the PHR should allow patients to manage their health information comprehensively, including compiling information from hospitals and patient-generated data. Having a PHR is crucial in improving an individual's overall health. As technology advances, more data are being generated that should be included in the PHR to ensure an accurate and comprehensive view of the patient's health. Expanding the scope of the PHR to include capabilities beyond merely hospital data is important. Achieving this requires an open and honest discussion about the role of the PHR, potential obstacles and how to coordinate efforts among different stakeholders.
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Affiliation(s)
- Abdullah Alanazi
- Health Informatics Department, King Saud Ibn Abdulaziz University for Health Sciences, P.O. Box 3660, Riyadh 11481, Saudi Arabia (B.A.)
- King Abdullah International Medical Research Center, P.O. Box 3660, Riyadh 11481, Saudi Arabia
| | - Mohammed Alanazi
- Health Informatics Department, King Saud Ibn Abdulaziz University for Health Sciences, P.O. Box 3660, Riyadh 11481, Saudi Arabia (B.A.)
- King Abdullah International Medical Research Center, P.O. Box 3660, Riyadh 11481, Saudi Arabia
| | - Bakheet Aldosari
- Health Informatics Department, King Saud Ibn Abdulaziz University for Health Sciences, P.O. Box 3660, Riyadh 11481, Saudi Arabia (B.A.)
- King Abdullah International Medical Research Center, P.O. Box 3660, Riyadh 11481, Saudi Arabia
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Greenhill RG, Khalil M. Sustainable Healthcare Depends on Good Governance Practices. Front Health Serv Manage 2023; 39:5-11. [PMID: 36811480 DOI: 10.1097/hap.0000000000000163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Effective leadership and governance are at the heart of creating and maintaining resilient health systems. COVID-19 exposed a plethora of issues in its wake, most notably the need to plan for resilience. Facing threats that swirl around climate, fiscal solvency, and emerging infectious diseases, healthcare leaders are challenged to think broadly on issues that affect operational viability. The global healthcare community has offered numerous approaches, frameworks, and criteria to assist leaders in creating strategies for better health governance, security, and resilience. As the world exits the worst of the pandemic, now is the time to plan for the sustainability of those strategies. Based on guidance developed by the World Health Organization, good governance is one key to sustainability. Healthcare leaders who develop measures to assess and monitor progress toward strengthening resilience can achieve sustainable development goals.
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Affiliation(s)
- Richard G Greenhill
- Richard G. Greenhill, DHA, FACHE, is director of the bachelor of science in healthcare management program at Texas Tech University Health Sciences Center in Lubbock, Texas
- Merette Khalil is a consultant (hospital resilience) at the World Health Organization Eastern Mediterranean Regional Office in Cairo, Egypt
| | - Merette Khalil
- Richard G. Greenhill, DHA, FACHE, is director of the bachelor of science in healthcare management program at Texas Tech University Health Sciences Center in Lubbock, Texas
- Merette Khalil is a consultant (hospital resilience) at the World Health Organization Eastern Mediterranean Regional Office in Cairo, Egypt
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Debray TPA, Collins GS, Riley RD, Snell KIE, Van Calster B, Reitsma JB, Moons KGM. Transparent reporting of multivariable prediction models developed or validated using clustered data (TRIPOD-Cluster): explanation and elaboration. BMJ 2023; 380:e071058. [PMID: 36750236 PMCID: PMC9903176 DOI: 10.1136/bmj-2022-071058] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 02/09/2023]
Affiliation(s)
- Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
- National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Richard D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - Kym I E Snell
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- EPI-centre, KU Leuven, Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Suntai Z, Noh H, Jeong H. Racial and ethnic differences in retrospective end-of-Life outcomes: A systematic review. DEATH STUDIES 2022:1-19. [PMID: 36533421 DOI: 10.1080/07481187.2022.2155888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The purpose of this systematic review was to provide a comprehensive account of racial and ethnic differences in retrospective end-of-life outcomes. Studies were searched from the following databases: Abstracts in Social Gerontology, Academic Search Premier, CINAHL Plus with Full Text, ERIC, MEDLINE, PsycINFO, PubMED, and SocIndex. Studies were included if they were published in English, included people from groups who have been minoritized, included adults aged 18 and older, used retrospective data, and examined end-of-life outcomes. Results from most of the 29 included studies showed that people from groups who have been minoritized had more aggressive/intensive care, had less hospice care, were more likely to die in a hospital, less likely to engage in advance care planning, less likely to have good quality of care, and experienced more financial burden at the end of life. Implications for practice (timely referrals), policy (health insurance access), and research (intervention studies) are provided.
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Affiliation(s)
- Zainab Suntai
- Diana R. Garland School of Social Work, Baylor University, Waco, Texas, USA
| | - Hyunjin Noh
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
| | - Haelim Jeong
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
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Assessment of Healthcare Delivery Systems in Orthopaedic Surgery: A Large Retrospective Cohort Evaluation. J Am Acad Orthop Surg 2022; 30:e1526-e1539. [PMID: 36037275 DOI: 10.5435/jaaos-d-22-00290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/03/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The purpose of this study was to assess how quality and volume of common orthopaedic care varies across private, municipal, and federal healthcare delivery systems (HDSs). METHODS Hip and knee arthroplasty, knee and shoulder arthroscopy, and hip fracture repair were audited over a two-year period. Electronic medical records were reviewed for demographics, diagnosis, lengths of stay (LoSs), surgical wait times, inpatient complication, readmission, and revision surgery rates. Multivariate regression controlled for differences in age, sex, diagnosis, and Charlson Comorbidity Index to determine how HDS correlated with surgical wait time, length of stay, complication rates, readmission, and revision surgery. RESULTS The 5,696 included patients comprise 87.4% private, 8.6% municipal, and 4.0% federal HDSs. Compared with private HDS for arthroplasty, federal surgical wait times were 18 days shorter (95% CI = 9 to 26 days, P < 0.001); federal LoS was 4 days longer (95% CI = 3.6 to 4.3 days, P < 0.001); municipal LoS was 1 day longer (95% CI = 0.8 to 1.4, P < 0.001); municipal 1-year revision surgery odds were increased (odds ratio [OR] = 2.8, 95% CI = 1.3 to 5.4, P = 0.045); and complication odds increased for municipal (OR = 12.2, 95% CI = 5.2 to 27.4, P < 0.001) and federal (OR = 12.0, 95% CI = 4.5 to 30.8, P < 0.001) HDSs. Compared with private HDS for arthroscopy, municipal wait times were 57 days longer (95% CI = 48 to 66 days, P < 0.001) and federal wait times were 34 days longer (95% CI = 21 to 47 days, P < 0.001). Compared with private HDS for fracture repair, municipal wait times were 0.6 days longer (95% CI = 0.2 to 1.0, P = 0.02); federal LoS was 7 days longer (95% CI = 3.6 to 9.4 days, P < 0.001); and municipal LoS was 4 days longer (95% CI = 2.4 to 4.8, P < 0.001). Only private HDS fracture repair patients received bone health consultations. DISCUSSION The private HDS provided care for a markedly larger volume of patients seeking orthopaedic care. In addition, private HDS patients experienced reduced surgical wait times, LoSs, and complication odds for inpatient elective cases, with better referral patterns for nonsurgical orthopaedic care after hip fractures within the private HDS. These results may guide improvements for federal and municipal HDSs.
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Kingsbury S, Khvalabov N, Stirn J, Held C, Fleckenstein SM, Hendrickson K, Walker EA. Barriers to Equity in Pediatric Hearing Health Care: A Review of the Evidence. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2022; 7:1060-1071. [PMID: 36275486 PMCID: PMC9585532 DOI: 10.1044/2021_persp-21-00188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE We review the evidence regarding barriers to hearing health care for children who are deaf or hard of hearing. BACKGROUND There are considerable data to suggest that hearing health care disparities constitute a major factor in loss to follow-up or documentation for children going through the Early Hearing Detection and Intervention process. Families are affected by a combination of factors underlying these disparities, resulting in delayed care and suboptimal developmental outcomes for children who are deaf or hard of hearing. CONCLUSIONS To address the socioeconomic, cultural, and linguistic inequities seen in the diagnosis and management of childhood hearing loss, pediatric audiologists and speech-language pathologists have a responsibility to provide culturally responsive practice to their individual clients and their families, as well as advocate for substantive changes at the policy level that impact their clients' daily lives.
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Affiliation(s)
- Sarah Kingsbury
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Nicole Khvalabov
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Jonathan Stirn
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Cara Held
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | | | - Kristi Hendrickson
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Elizabeth A. Walker
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
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Zhao X, Jiang L, Zhao K. 3D Differential Equation Model for Patients' Choice of Hospital in China. Front Public Health 2022; 10:760143. [PMID: 35558543 PMCID: PMC9087185 DOI: 10.3389/fpubh.2022.760143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
The number of patients in a hospital is a direct indicator of patients' choice of hospital, which is a complex process affected by many factors. Based on the national medical system and patients' preference for high-grade hospitals in China, this study establishes a three-dimensional differential equation model for calculating the time variation of the number of visits to three grades of hospitals. We performed a qualitative analysis of the system. We carried out a subsequent numerical simulation to analyze the impact on the system when the rate of leapfrog treatment and the maximum capacity of doctors and treatments changed. The results show that the sustainability of China's three levels of hospitals mainly depends on the level of hospital development. The strength of comprehensive health improvement at specific levels is the key to increasing the service efficiency of medical resources.
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Affiliation(s)
- Xiaoxia Zhao
- Faculty of Management and Economics, Kunming University of Science and Technology, Kunming, China
| | - Lihong Jiang
- First People's Hospital of Yunnan Province, Kunming, China
| | - Kaihong Zhao
- Department of Applied Mathematics, Kunming University of Science and Technology, Kunming, China
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