1
|
Bowleg L. The white racial frame of public health discourses about racialized health differences and "disparities": what it reveals about power and how it thwarts health equity. Front Public Health 2023; 11:1187307. [PMID: 37822536 PMCID: PMC10562601 DOI: 10.3389/fpubh.2023.1187307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
Although several public health scholars have advocated for more clarity about concepts such as health disparities and health equity, attention to the framing of public health discourses about racialized health differences and "disparities" in the U.S., and what it reveals about power and the potential for achieving health equity, is surprisingly rare. Sociologist Joe Feagin, in his book, The White Racial Frame: Centuries of Racial Framing and Counter-Framing coined the term white racial frame to describe the predominantly white racialized worldview of majority white and white-oriented decisionmakers in everyday and institutional operations. Informed by insights from critical race theories about the white racial frame, white epistemological ignorance, and colorblind racism; critical perspectives on social class; Black feminist perspectives; framing; and critical discourse analysis, in this perspective I discuss: (1) the power of language and discourses; (2) the white racial frame of three common public health discourses - health disparities, "race," and social determinants of health (SDOH); (3) the costs and consequences of the white racial frame for advancing health equity; and (4) the need for more counter and critical theoretical frames to inform discourses, and in turn research and political advocacy to advance health equity in the U.S.
Collapse
Affiliation(s)
- Lisa Bowleg
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, United States
- The Intersectionality Training Institute, Philadelphia, PA, United States
| |
Collapse
|
2
|
Masood U, Bernshteyn M, Pavelock N, Singh K, Schad LA, Morley CP, Gupta A, Jasti V, Murthy U. Appropriateness of fecal immunochemical testing utilization for colorectal cancer screening at an academic center. Proc AMIA Symp 2022; 36:20-23. [PMID: 36578591 PMCID: PMC9762794 DOI: 10.1080/08998280.2022.2123667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Fecal immunochemical testing (FIT) has become the most utilized test for colorectal cancer (CRC) screening. This retrospective quality assurance report analyzed data for 411 patients from one academic center in Central New York who underwent FIT between September 2015 and September 2016. All 67 positive tests and 344 of 952 negative tests were analyzed. Subjects from the FIT-negative "control group" were chosen at random. The mean age was 67 years and the male/female distribution was 391/20, with differences between the FIT-positive and -negative groups. FIT was inappropriately used in 210 (51%) of the 411 patients. The most common reasons for inappropriate FIT use were a documented refusal of colonoscopy (39.60% of inappropriate use), FIT occurring within the recommended surveillance interval from previous colonoscopy (27.98%), and a Charlson Co-Morbidity Index score ≥5 (22.87%). Other reasons were a history of adenoma (9.25%), family history of CRC/high-risk adenoma <60 years of age (5.84%), active/overt gastrointestinal bleed (4.87%), history of CRC (1.46%), and history of inflammatory bowel disease (1.46%). The results of this study show that FIT is being utilized inappropriately about 50% of the time.
Collapse
Affiliation(s)
- Umair Masood
- Upstate University Hospital, Syracuse, New York,Department of Gastroenterology, Syracuse VA Medical Center, Syracuse, New York,Corresponding author: Umair Masood, MD, 1902 Ridge Rd. #311, West Seneca, NY14224 (e-mail: )
| | - Michelle Bernshteyn
- Department of Medicine, Upstate University Hospital, Syracuse, New York,Department of Medicine, Syracuse VA Medical Center, Syracuse, New York
| | - Natalie Pavelock
- Upstate University Hospital, Syracuse, New York,Department of Gastroenterology, Syracuse VA Medical Center, Syracuse, New York
| | - Kuldip Singh
- Department of Medicine, Upstate University Hospital, Syracuse, New York
| | - Laura A. Schad
- Department of Public Health and Preventive Medicine, Upstate University Hospital, Syracuse, New York
| | - Christopher P. Morley
- Department of Public Health and Preventive Medicine, Upstate University Hospital, Syracuse, New York
| | - Anand Gupta
- Department of Gastroenterology, Syracuse VA Medical Center, Syracuse, New York
| | - Venkata Jasti
- Department of Medicine, Syracuse VA Medical Center, Syracuse, New York
| | - Uma Murthy
- Upstate University Hospital, Syracuse, New York,Department of Gastroenterology, Syracuse VA Medical Center, Syracuse, New York
| |
Collapse
|
3
|
Link E, Baumann E, Kreps GL, Czerwinski F, Rosset M, Suhr R. Expanding the Health Information National Trends Survey Research Program Internationally to Examine Global Health Communication Trends: Comparing Health Information Seeking Behaviors in the U.S. and Germany. J Health Commun 2022; 27:545-554. [PMID: 36250315 DOI: 10.1080/10810730.2022.2134522] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The Health Information National Trends Survey (HINTS) is a well-established U.S.-based research program administered by the National Cancer Institute to track the public access to and use of health information. This paper introduces a German research initiative, part of the International Studies to Investigate Global Health Information Trends (INSIGHTS) research consortium. This adaptation of the HINTS is important for initiating analyses of global health communication practices and comparing health information seeking behaviors (HISB) across nations to pinpoint potentials and challenges of health information provision and contribute to a deeper understanding of socio-contextual determinants of HISB. First cross-country comparisons revealed that the share of residents seeking for health information is high in the U.S. (80%) and Germany (74%), but different primary sources are used. Whereas a clear majority of U.S. residents chose the Internet to gather health information (74.9%), Germans most often turn to health professionals (48.0%). Socio-structural and health(care)-related predictors were found to contribute to the explanation of HISB in both countries, whereas information-related predictors were only relevant in Germany. The results indicate the need to engage in patient-provider communication to initiate HISB and to improve the access to information for residents with lower socio-economic backgrounds.
Collapse
Affiliation(s)
- Elena Link
- Department of Journalism and Communication Research, Hanover University of Music, Drama, and Media, Hannover, Germany
| | - Eva Baumann
- Department of Journalism and Communication Research, Hanover University of Music, Drama, and Media, Hannover, Germany
| | - Gary L Kreps
- Center for Health and Risk Communication, George Mason University, Fairfax, Virginia, USA
| | - Fabian Czerwinski
- Department of Journalism and Communication Research, Hanover University of Music, Drama, and Media, Hannover, Germany
| | - Magdalena Rosset
- Department of Journalism and Communication Research, Hanover University of Music, Drama, and Media, Hannover, Germany
| | - Ralf Suhr
- Stiftung Gesundheitswissen, Berlin, Germany
| |
Collapse
|
4
|
Matus JC. A Comparison of Country's Cultural Dimensions and Health Outcomes. Healthcare (Basel) 2021; 9:healthcare9121654. [PMID: 34946380 PMCID: PMC8701512 DOI: 10.3390/healthcare9121654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022] Open
Abstract
Research comparing health care systems of countries, with a particular emphasis on health care spending and health care outcomes, has found unexplained differences which are often attributed to the countries’ cultures, yet these cultural dimensions are never completely identified or measured. This study examines if culture predicts a country’s population health, measured as life expectancy and health care spending. Using the Hofstede country-level measures (six dimensions) of culture as independent variables, two regression models to predict life expectancy and per capita health care using 2016 World Bank data were developed. The original data set included 112 countries which was reduced to a final total of 60 due to missing or incomplete data. The first regression model, predicting life expectancy, indicated an adjusted R square of 0.45. The second regression model, predicting per capita health care spending, indicated an adjusted R square of 0.63. The study suggests culture is a predictor of both life expectancy and health care spending. However, by creating a composite measure for all six culture measures, we have not found a significant association between culture and life expectancy and healthcare expenditure. The study is limited by small sample size, differences in geography, climate and political systems. Future research should examine more closely the relative influence of individualism on life expectancy and assumptions about models of socialized medicine.
Collapse
Affiliation(s)
- Justin C Matus
- Sidhu School of Business, Wilkes University, Wilkes-Barre, PA 18766, USA
| |
Collapse
|
5
|
Yeung E, Bello AK, Levin A, Lunney M, Osman MA, Ye F, Ashuntantang G, Bellorin-Font E, Benghanem Gharbi M, Davison S, Ghnaimat M, Harden P, Jha V, Kalantar-Zadeh K, Kerr P, Klarenbach S, Kovesdy C, Luyckx V, Neuen B, O'Donoghue D, Ossareh S, Perl J, Ur Rashid H, Rondeau E, See E, Saad S, Sola L, Tchokhonelidze I, Tesar V, Tungsanga K, Turan Kazancioglu R, Wang AYM, Wiebe N, Yang CW, Zemchenkov A, Zhao M, Jager KJ, Caskey F, Perkovic V, Jindal K, Okpechi IG, Tonelli M, Feehally J, Harris DC, Johnson D. Current status of health systems financing and oversight for end-stage kidney disease care: a cross-sectional global survey. BMJ Open 2021; 11:e047245. [PMID: 34244267 PMCID: PMC8273453 DOI: 10.1136/bmjopen-2020-047245] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The Global Kidney Health Atlas (GKHA) is a multinational, cross-sectional survey designed to assess the current capacity for kidney care across all world regions. The 2017 GKHA involved 125 countries and identified significant gaps in oversight, funding and infrastructure to support care for patients with kidney disease, especially in lower-middle-income countries. Here, we report results from the survey for the second iteration of the GKHA conducted in 2018, which included specific questions about health financing and oversight of end-stage kidney disease (ESKD) care worldwide. SETTING A cross-sectional global survey. PARTICIPANTS Key stakeholders from 182 countries were invited to participate. Of those, stakeholders from 160 countries participated and were included. PRIMARY OUTCOMES Primary outcomes included cost of kidney replacement therapy (KRT), funding for dialysis and transplantation, funding for conservative kidney management, extent of universal health coverage, out-of-pocket costs for KRT, within-country variability in ESKD care delivery and oversight systems for ESKD care. Outcomes were determined from a combination of desk research and input from key stakeholders in participating countries. RESULTS 160 countries (covering 98% of the world's population) responded to the survey. Economic factors were identified as the top barrier to optimal ESKD care in 99 countries (64%). Full public funding for KRT was more common than for conservative kidney management (43% vs 28%). Among countries that provided at least some public coverage for KRT, 75% covered all citizens. Within-country variation in ESKD care delivery was reported in 40% of countries. Oversight of ESKD care was present in all high-income countries but was absent in 13% of low-income, 3% of lower-middle-income, and 10% of upper-middle-income countries. CONCLUSION Significant gaps and variability exist in the public funding and oversight of ESKD care in many countries, particularly for those in low-income and lower-middle-income countries.
Collapse
Affiliation(s)
| | - A K Bello
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Feng Ye
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Gloria Ashuntantang
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I Faculty of Medicine and Biomedical Sciences, Yaounde, Cameroon
| | | | - Mohammed Benghanem Gharbi
- Urinary Tract Diseases Department, University of Hassan II Casablanca Faculty of Science Ain Chock, Casablanca, Morocco
| | - Sara Davison
- Division of Nephrology and Immunology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Mohammad Ghnaimat
- Department of Internal Medicine, The Specialty Hospital, Amman, Jordan
| | - Paul Harden
- Oxford Kidney Unit, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California, USA
| | - Peter Kerr
- Department of Nephrology, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | | | - Csaba Kovesdy
- Nephrology, Memphis VA Medical Center, Memphis, Tennessee, USA
| | - Valerie Luyckx
- Institute of Biomedical Ethics and the History of Medicine, University of Zurich Institute of Biomedical Ethics History of Medicine, Zurich, Switzerland
| | - Brendon Neuen
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Donal O'Donoghue
- Salford Royal Hospitals NHS Trust, Salford, UK
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Shahrzad Ossareh
- Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jeffrey Perl
- Department of Nephrology, St Michael's Hospital, Toronto, Ontario, Canada
- Division of Nephrology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Harun Ur Rashid
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Eric Rondeau
- Intensive Care Nephrology and Transplantation Department, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Emily See
- Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
| | - Syed Saad
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Laura Sola
- Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
| | - Irma Tchokhonelidze
- Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia
| | - Vladimir Tesar
- Department of Nephrology, Charles University, Praha, Czech Republic
| | - Kriang Tungsanga
- Department of Medicine, King Chulalong Memorial Hospital, Bangkok, Thailand
- Bhumirajanagarindra Kidney Institute, Bangkok, Thailand
| | | | | | - Natasha Wiebe
- Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Chih-Wei Yang
- Kidney Research Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Alexander Zemchenkov
- Department of Internal Disease and Nephrology, North-Western State Medical University named after I I Mechnikov, Sankt-Peterburg, Russia
| | - Minhui Zhao
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Kitty J Jager
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Fergus Caskey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Vlado Perkovic
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Kailash Jindal
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John Feehally
- Department of Infection, Inflammation and Immunity, University of Leicester, Leicester, UK
| | - David Ch Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - David Johnson
- Centre for Kidney Disease Research, The University of Queensland, Saint Lucia, Queensland, Australia
- Metro South Integrated Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| |
Collapse
|
6
|
Hilts KE, Yeager VA, Gibson PJ, Halverson PK, Blackburn J, Menachemi N. Hospital Partnerships for Population Health: A Systematic Review of the Literature. J Healthc Manag 2021; 66:170-98. [PMID: 33960964 DOI: 10.1097/JHM-D-20-00172] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
EXECUTIVE SUMMARY The U.S. healthcare system continues to experience high costs and suboptimal health outcomes that are largely influenced by social determinants of health. National policies such as the Affordable Care Act and value-based payment reforms incentivize healthcare systems to engage in strategies to improve population health. Healthcare systems are increasingly expanding or developing new partnerships with community-based organizations to support these efforts. We conducted a systematic review of peer-reviewed literature in the United States to identify examples of hospital-community partnerships; the main purposes or goals of partnerships; study designs used to assess partnerships; and potential outcomes (e.g., process- or health-related) associated with partnerships. Using robust keyword searches and a thorough reference review, we identified 37 articles published between January 2008 and December 2019 for inclusion. Most studies employed descriptive study designs (n = 21); health needs assessments were the most common partnership focus (n = 15); and community/social service (n = 21) and public health organizations (n = 15) were the most common partner types. Qualitative findings suggest hospital-community partnerships hold promise for breaking down silos, improving communication across sectors, and ensuring appropriate interventions for specific populations. Few studies in this review reported quantitative findings. In those that did, results were mixed, with the strongest support for improvements in measures of hospitalizations. This review provides an initial synthesis of hospital partnerships to address population health and presents valuable insights to hospital administrators, particularly those leading population health efforts.
Collapse
|
7
|
Pang HYM, Chalmers K, Landon B, Elshaug AG, Matelski J, Ling V, Krzyzanowska MK, Kulkarni G, Erickson BA, Cram P. Utilization Rates of Pancreatectomy, Radical Prostatectomy, and Nephrectomy in New York, Ontario, and New South Wales, 2011 to 2018. JAMA Netw Open 2021; 4:e215477. [PMID: 33871618 PMCID: PMC8056282 DOI: 10.1001/jamanetworkopen.2021.5477] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/20/2021] [Indexed: 12/13/2022] Open
Abstract
Importance Few studies have compared surgical utilization between countries or how rates may differ according to patients' socioeconomic status. Objective To compare population-level utilization of 3 common nonemergent surgical procedures in New York State (US), Ontario (Canada), and New South Wales (Australia) and how utilization differs for residents of lower- and higher-income neighborhoods. Design, Setting, and Participants This cohort study included all adults aged 18 years and older who were hospitalized for pancreatectomy, radical prostatectomy, or nephrectomy between 2011 and 2016 in New York, between 2011 and 2018 in Ontario, and between 2013 and 2018 in New South Wales. Each patient's address of residence was linked to 2016 census data to ascertain neighborhood income. Data were analyzed from August 2019 to November 2020. Main Outcomes and Measures Primary outcomes were (1) each jurisdiction's per capita age- and sex-standardized utilization rates (procedures per 100 000 residents per year) for each surgery and (2) utilization rates among residents of lower- and higher-income neighborhoods. Results This study included 115 428 surgical patients (25 780 [22.3%] women); 5717, 21 752, and 24 617 patients in New York were hospitalized for pancreatectomy, radical prostatectomy, and nephrectomy, respectively; 4929, 19 125, and 16 916 patients in Ontario, respectively; and 2069, 13 499, and 6804 patients in New South Wales, respectively. Patients in New South Wales were older for all procedures (eg, radical prostatectomy, mean [SD] age in New South Wales, 64.8 [7.3] years; in New York, 62.7 [8.4] years; in Ontario, 62.8 [6.7] years; P < .001); patients in New York were more likely than those in other locations to be women for pancreatectomy (New York: 2926 [51.2%]; Ontario: 2372 [48.1%]; New South Wales, 1003 [48.5%]; P = .004) and nephrectomy (New York: 10 645 [43.2%]; Ontario: 6529 [38.6%]; 2605 [38.3%]; P < .001). With the exception of nephrectomy in Ontario, there was a higher annual utilization rate for all procedures in all jurisdictions among patients residing in affluent neighborhoods (quintile 5) compared with poorer neighborhoods (quintile 1). This difference was largest in New South Wales for pancreatectomy (4.65 additional procedures per 100 000 residents [SE, 0.28]; P < .001) and radical prostatectomy (73.46 additional procedures per 100 000 residents [SE, 1.20]; P < .001); largest in New York for nephrectomy (8.43 additional procedures per 100 000 residents [SE, 0.85]; P < .001) and smallest in New York for radical prostatectomy (19.70 additional procedures per 100 000 residents [SE, 2.63]; P < .001); and smallest in Ontario for pancreatectomy (1.15 additional procedures per 100 000 residents [SE, 0.28]; P < .001) and nephrectomy (-1.10 additional procedures per 100 000 residents [SE, 0.52]; P < .001). New York had the highest utilization of nephrectomy (28.93 procedures per 100 000 residents per year [SE, 0.18]) and New South Wales for had the highest utilization of pancreatectomy and radical prostatectomy (6.94 procedures per 100 000 residents per year [SE, 0.15] and 94.37 procedures per 100 000 residents per year [SE, 0.81], respectively; all P < .001). Utilization was lowest in Ontario for all procedures (pancreatectomy, 6.18 procedures per 100 000 residents per year [SE, 0.09]; radical prostatectomy, 49.24 procedures per 100 000 residents per year [SE, 0.36]; nephrectomy, 21.40 procedures per 100 000 residents per year [SE, 0.16]; all P < .001). Conclusions and Relevance In this study, New York and New South Wales had higher per capita surgical utilization and larger neighborhood income-utilization gradients than Ontario. These findings suggest that income-based disparities are larger in the United States and Australia and smaller in Canada and highlight trade-offs inherent in the health care systems of different countries.
Collapse
Affiliation(s)
- Hilary Y. M. Pang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kelsey Chalmers
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Lown Institute, Brookline, Massachusetts
| | - Bruce Landon
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Adam G. Elshaug
- Centre for Health Policy, Melbourne School of Population and Global Health and the Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- USC–Brookings Schaeffer Initiative for Health Policy, The Brookings Institution, Washington, DC
| | - John Matelski
- Biostatistics Research Unit, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Monika K. Krzyzanowska
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Girish Kulkarni
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES Sciences, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Peter Cram
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES Sciences, Toronto, Ontario, Canada
- Department of General Internal Medicine, University Health Network and Sinai Health Systems, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Carmody JB, Green LM, Kiger PG, Baxter JD, Cassese T, Fancher TL, George P, Griffin EJ, Haywood YC, Henderson D, Hueppchen NA, Karras DJ, Leep Hunderfund AN, Lindsley JE, McGuire PG, Meholli M, Miller CS, Monrad SU, Nelson KL, Olson KA, Pahwa AK, Starr SR, Tunkel AR, Van Eck RN, Youm JH, Ziring DJ, Rajasekaran SK. Medical Student Attitudes toward USMLE Step 1 and Health Systems Science - A Multi-Institutional Survey. Teach Learn Med 2021; 33:139-153. [PMID: 33289589 DOI: 10.1080/10401334.2020.1825962] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Phenomenon: Because of its importance in residency selection, the United States Medical Licensing Examination Step 1 occupies a critical position in medical education, stimulating national debate about appropriate score use, equitable selection criteria, and the goals of undergraduate medical education. Yet, student perspectives on these issues and their implications for engagement with health systems science-related curricular content are relatively underexplored. Approach: We conducted an online survey of medical students at 19 American allopathic medical schools from March-July, 2019. Survey items were designed to elicit student opinions on the Step 1 examination and the impact of the examination on their engagement with new, non-test curricular content related to health systems science. Findings: A total of 2856 students participated in the survey, representing 23.5% of those invited. While 87% of students agreed that doing well on the Step 1 exam was their top priority, 56% disagreed that studying for Step 1 had a positive impact on engagement in the medical school curriculum. Eighty-two percent of students disagreed that Step 1 scores should be the top item residency programs use to offer interviews. When asked whether Step 1 results should be reported pass/fail with no numeric score, 55% of students agreed, while 33% disagreed. The majority of medical students agreed that health systems science topics were important but disagreed that studying for Step 1 helped learn this content. Students reported being more motivated to study a topic if it was on the exam, part of a course grade, prioritized by residency program directors, or if it would make them a better physician in the future. Insights: These results confirm the primacy of the United States Medical Licensing Examination Step 1 exam in preclinical medical education and demonstrate the need to balance the objectives of medical licensure and residency selection with the goals of the broader medical profession. The survey responses suggest several potential solutions to increase student engagement in health systems science curricula which may be especially important after Step 1 examination results are reported as pass/fail.
Collapse
Affiliation(s)
- J Bryan Carmody
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Lauren M Green
- EVMS-Sentara Healthcare Analytics and Delivery Science Institute, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Patti G Kiger
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Jared D Baxter
- Office of Undergraduate and Graduate Medical Education, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Todd Cassese
- Department of Medicine, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tonya L Fancher
- Department of Internal Medicine, University of California Davis, Sacramento, California, USA
| | - Paul George
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Erin J Griffin
- Office of Medical Education, University of California Davis, Sacramento, California, USA
| | - Yolanda C Haywood
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - David Henderson
- Department of Family Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Nancy A Hueppchen
- Gynecology and Obstetrics, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - David J Karras
- Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | | | - Janet E Lindsley
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Paul G McGuire
- Department of Cell Biology and Physiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Mimoza Meholli
- Department of Medicine, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA
| | - Chad S Miller
- School of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Seetha U Monrad
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kari L Nelson
- Office of Undergraduate and Graduate Medical Education, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kristin A Olson
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California, USA
| | - Amit K Pahwa
- Department of Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephanie R Starr
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Allan R Tunkel
- Section of Medical Education, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Richard N Van Eck
- Department of Medical Education, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
| | - Julie H Youm
- Office of Medical Education, University of California, Irvine, Irvine, California, USA
| | - Deborah J Ziring
- Academic Affairs, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Senthil K Rajasekaran
- Medical Academic and School Programs, Wayne State University School of Medicine, Detroit, Michigan, USA
| |
Collapse
|
9
|
McCullough JM, Speer M, Magnan S, Fielding JE, Kindig D, Teutsch SM. Reduction in US Health Care Spending Required to Meet the Institute of Medicine's 2030 Target. Am J Public Health 2020; 110:1735-1740. [PMID: 33058710 PMCID: PMC7661993 DOI: 10.2105/ajph.2020.305793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 12/19/2022]
Abstract
Objectives. To quantify changes in US health care spending required to reach parity with high-resource nations by 2030 or 2040 and identify historical precedents for these changes.Methods. We analyzed multiple sources of historical and projected spending from 1970 through 2040. Parity was defined as the Organisation for Economic Co-operation and Development (OECD) median or 90th percentile for per capita health care spending.Results. Sustained annual declines of 7.0% and 3.3% would be required to reach the median of other high-resource nations by 2030 and 2040, respectively (3.2% and 1.3% to reach the 90th percentile). Such declines do not have historical precedent among US states or OECD nations.Conclusions. Traditional approaches to reducing health care spending will not enable the United States to achieve parity with high-resource nations; strategies to eliminate waste and reduce the demand for health care are essential.Public Health Implications. Excess spending reduces the ability of the United States to meet critical public health needs and affects the country's economic competitiveness. Rising health care spending has been identified as a threat to the nation's health. Public health can add voices, leadership, and expertise for reversing this course.
Collapse
Affiliation(s)
- J Mac McCullough
- J. Mac McCullough and Matthew Speer are with the College of Health Solutions, Arizona State University, Phoenix. Sanne Magnan is with the Health Partners Institute, Minneapolis, MN, and the Department of Medicine, University of Minnesota, Minneapolis. Jonathan E. Fielding and Steven M. Teutsch are with the Center for Health Advancement, Fielding School of Public Health, University of California, Los Angeles. David Kindig is with the Population Health Institute, University of Wisconsin School of Medicine and Public Health, Madison
| | - Matthew Speer
- J. Mac McCullough and Matthew Speer are with the College of Health Solutions, Arizona State University, Phoenix. Sanne Magnan is with the Health Partners Institute, Minneapolis, MN, and the Department of Medicine, University of Minnesota, Minneapolis. Jonathan E. Fielding and Steven M. Teutsch are with the Center for Health Advancement, Fielding School of Public Health, University of California, Los Angeles. David Kindig is with the Population Health Institute, University of Wisconsin School of Medicine and Public Health, Madison
| | - Sanne Magnan
- J. Mac McCullough and Matthew Speer are with the College of Health Solutions, Arizona State University, Phoenix. Sanne Magnan is with the Health Partners Institute, Minneapolis, MN, and the Department of Medicine, University of Minnesota, Minneapolis. Jonathan E. Fielding and Steven M. Teutsch are with the Center for Health Advancement, Fielding School of Public Health, University of California, Los Angeles. David Kindig is with the Population Health Institute, University of Wisconsin School of Medicine and Public Health, Madison
| | - Jonathan E Fielding
- J. Mac McCullough and Matthew Speer are with the College of Health Solutions, Arizona State University, Phoenix. Sanne Magnan is with the Health Partners Institute, Minneapolis, MN, and the Department of Medicine, University of Minnesota, Minneapolis. Jonathan E. Fielding and Steven M. Teutsch are with the Center for Health Advancement, Fielding School of Public Health, University of California, Los Angeles. David Kindig is with the Population Health Institute, University of Wisconsin School of Medicine and Public Health, Madison
| | - David Kindig
- J. Mac McCullough and Matthew Speer are with the College of Health Solutions, Arizona State University, Phoenix. Sanne Magnan is with the Health Partners Institute, Minneapolis, MN, and the Department of Medicine, University of Minnesota, Minneapolis. Jonathan E. Fielding and Steven M. Teutsch are with the Center for Health Advancement, Fielding School of Public Health, University of California, Los Angeles. David Kindig is with the Population Health Institute, University of Wisconsin School of Medicine and Public Health, Madison
| | - Steven M Teutsch
- J. Mac McCullough and Matthew Speer are with the College of Health Solutions, Arizona State University, Phoenix. Sanne Magnan is with the Health Partners Institute, Minneapolis, MN, and the Department of Medicine, University of Minnesota, Minneapolis. Jonathan E. Fielding and Steven M. Teutsch are with the Center for Health Advancement, Fielding School of Public Health, University of California, Los Angeles. David Kindig is with the Population Health Institute, University of Wisconsin School of Medicine and Public Health, Madison
| |
Collapse
|
10
|
Abstract
Policy Points Changes in US state policies since the 1970s, particularly after 2010, have played an important role in the stagnation and recent decline in US life expectancy. Some US state policies appear to be key levers for improving life expectancy, such as policies on tobacco, labor, immigration, civil rights, and the environment. US life expectancy is estimated to be 2.8 years longer among women and 2.1 years longer among men if all US states enjoyed the health advantages of states with more liberal policies, which would put US life expectancy on par with other high‐income countries.
Context Life expectancy in the United States has increased little in previous decades, declined in recent years, and become more unequal across US states. Those trends were accompanied by substantial changes in the US policy environment, particularly at the state level. State policies affect nearly every aspect of people's lives, including economic well‐being, social relationships, education, housing, lifestyles, and access to medical care. This study examines the extent to which the state policy environment may have contributed to the troubling trends in US life expectancy. Methods We merged annual data on life expectancy for US states from 1970 to 2014 with annual data on 18 state‐level policy domains such as tobacco, environment, tax, and labor. Using the 45 years of data and controlling for differences in the characteristics of states and their populations, we modeled the association between state policies and life expectancy, and assessed how changes in those policies may have contributed to trends in US life expectancy from 1970 through 2014. Findings Results show that changes in life expectancy during 1970‐2014 were associated with changes in state policies on a conservative‐liberal continuum, where more liberal policies expand economic regulations and protect marginalized groups. States that implemented more conservative policies were more likely to experience a reduction in life expectancy. We estimated that the shallow upward trend in US life expectancy from 2010 to 2014 would have been 25% steeper for women and 13% steeper for men had state policies not changed as they did. We also estimated that US life expectancy would be 2.8 years longer among women and 2.1 years longer among men if all states enjoyed the health advantages of states with more liberal policies. Conclusions Understanding and reversing the troubling trends and growing inequalities in US life expectancy requires attention to US state policy contexts, their dynamic changes in recent decades, and the forces behind those changes. Changes in US political and policy contexts since the 1970s may undergird the deterioration of Americans’ health and longevity.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Anna Zajacova
- University of Western Ontario.,Coauthors listed alphabetically
| |
Collapse
|
11
|
Cram P, Girotra S, Matelski J, Koh M, Landon BE, Han L, Lee DS, Ko DT. Utilization of Advanced Cardiovascular Therapies in the United States and Canada: An Observational Study of New York and Ontario Administrative Data. Circ Cardiovasc Qual Outcomes 2020; 13:e006037. [PMID: 31957474 DOI: 10.1161/circoutcomes.119.006037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Endovascular aortic aneurysm repair (EVAR), left ventricular assist device (LVAD), and transcatheter aortic valve replacement (TAVR) are expensive cardiovascular technologies with potential to benefit large numbers of patients. There are few population-based studies comparing utilization between countries. Our objective was to compare patient characteristics and utilization patterns of EVAR, LVAD, and TAVR in Ontario, Canada, and New York State, United States. METHODS AND RESULTS We performed a retrospective cohort study using administrative data to identify all adults who received EVAR, LVAD, or TAVR in Ontario and New York between 2012 and 2015. We compared socio-demographics of EVAR, LVAD, and TAVR recipients in Ontario and New York. We compared standardized utilization rates between jurisdictions for each procedure. We identified 3295 EVAR recipients from Ontario and 6236 from New York (mean age 74.6 versus 74.5 years; P=0.61): 136 LVAD recipients from Ontario and 686 from New York (age, 57.4 versus 57.7 years; P=0.80): 1708 TAVR recipients from Ontario and 4838 from New York (age, 83.1 versus 83.1; P=1.0). A significantly smaller percentage of EVAR and TAVR recipients in Ontario were female compared to New York (EVAR, 15.8% versus 22.1% female; P<0.001; TAVR, 45.9% versus 51.8%; P<0.001), but for LVAD the percentage female was similar (21.3% versus 20.8%; P=0.99). Utilization was significantly higher in New York for all procedures: EVAR (12.8 procedures per-100 000 adults per-year in Ontario, 20.2 in New York; P<0.001); LVAD (0.3 in Ontario versus 1.3 in New York; P<0.001); and TAVR (6.6 in Ontario, 14.3 in New York; P<0.001). Higher utilization of EVAR and TAVR in New York relative to Ontario increased substantially with increasing age. CONCLUSIONS We observed significantly higher utilization of EVAR, LVAD, and TAVR in New York compared to Ontario. Our results highlight important differences in how 2 different countries are using advanced cardiovascular therapies.
Collapse
Affiliation(s)
- Peter Cram
- Department of Medicine (P.C., D.S.L., D.T.K.), University of Toronto, ON.,North American Observatory on Health Systems and Policies (P.C.), University of Toronto, ON.,Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, ON (P.C., J.M.).,ICES, Toronto, ON (P.C., M.K., L.H., D.S.L., D.T.K.)
| | - Saket Girotra
- Department of Medicine, University of Iowa (S.G.).,Comprehensive Access Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.)
| | - John Matelski
- Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, ON (P.C., J.M.)
| | - Maria Koh
- ICES, Toronto, ON (P.C., M.K., L.H., D.S.L., D.T.K.)
| | - Bruce E Landon
- Division of General Medicine, Department of Health Care Policy, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA (B.L.)
| | - Lu Han
- ICES, Toronto, ON (P.C., M.K., L.H., D.S.L., D.T.K.)
| | - Douglas S Lee
- Department of Medicine (P.C., D.S.L., D.T.K.), University of Toronto, ON.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health (D.S.L.), University of Toronto, ON.,ICES, Toronto, ON (P.C., M.K., L.H., D.S.L., D.T.K.).,Peter Munk Cardiac Centre and Joint Department of Medical Imaging, University Health Network, Toronto, ON (D.S.L.)
| | - Dennis T Ko
- Department of Medicine (P.C., D.S.L., D.T.K.), University of Toronto, ON.,ICES, Toronto, ON (P.C., M.K., L.H., D.S.L., D.T.K.).,Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON (D.T.K.)
| |
Collapse
|
12
|
Martin G, Clarke J, Liew F, Arora S, King D, Aylin P, Darzi A. Evaluating the impact of organisational digital maturity on clinical outcomes in secondary care in England. NPJ Digit Med 2019; 2:41. [PMID: 31304387 PMCID: PMC6550220 DOI: 10.1038/s41746-019-0118-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 04/18/2019] [Indexed: 12/24/2022] Open
Abstract
All healthcare systems are increasingly reliant on health information technology to support the delivery of high-quality, efficient and safe care. Data on its effectiveness are however limited. We therefore sought to examine the impact of organisational digital maturity on clinical outcomes in secondary care within the English National Health Service. We conducted a retrospective analysis of routinely collected administrative data for 13,105,996 admissions across 136 hospitals in England from 2015 to 2016. Data from the 2016 NHS Clinical Digital Maturity Index were used to characterise organisational digital maturity. A multivariable regression model including 12 institutional covariates was utilised to examine the relationship between one measure of organisational digital maturity and five key clinical outcome measures. There was no significant relationship between organisational digital maturity and risk-adjusted 30-day mortality, 28-day readmission rates or complications of care. In multivariable analysis risk-adjusted long length of stay and harm-free care were significantly related to aspects of organisational digital maturity; digitally mature hospitals may not only deliver more harm-free care episodes but also may have a significantly increased risk of patients experiencing a long length of stay. Organisational digital maturity is to some extent related to selected clinical outcomes in secondary care in England. Digital maturity is, however, also strongly linked to other institutional factors that likely play a greater role in influencing clinical outcomes. There is a need to better understand how health IT impacts care delivery and supports other drivers of hospital quality.
Collapse
Affiliation(s)
- Guy Martin
- 1Department of Surgery & Cancer, Imperial College London, London, UK
| | - Jonathan Clarke
- 1Department of Surgery & Cancer, Imperial College London, London, UK
| | - Felicity Liew
- 2School of Public Health, Imperial College London, London, UK
| | - Sonal Arora
- 1Department of Surgery & Cancer, Imperial College London, London, UK
| | - Dominic King
- 1Department of Surgery & Cancer, Imperial College London, London, UK.,3DeepMind, London, UK
| | - Paul Aylin
- 2School of Public Health, Imperial College London, London, UK
| | - Ara Darzi
- 1Department of Surgery & Cancer, Imperial College London, London, UK
| |
Collapse
|
13
|
Teoh D, Hultman G, DeKam M, Isaksson Vogel R, Downs LS Jr, Geller MA, Le C, Melton G, Kulasingam S. Excess Cost of Cervical Cancer Screening Beyond Recommended Screening Ages or After Hysterectomy in a Single Institution. J Low Genit Tract Dis 2018; 22:184-8. [PMID: 29733302 DOI: 10.1097/LGT.0000000000000400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to estimate the excess cost of guideline nonadherent cervical cancer screening in women beyond the recommended screening ages or posthysterectomy in a single healthcare system. MATERIALS AND METHODS All Pap tests performed between September 1, 2012, and August 31, 2014, in women younger than 21 years, older than 65 years, or after hysterectomy, were coded as guideline adherent or nonadherent per the 2012 America Society of Colposcopy and Clinical Pathology guidelines. We assumed management of abnormal results per the 2013 America Society of Colposcopy and Clinical Pathology management guidelines. Costs were obtained from a literature review and Center for Medicare and Medicaid Services data and applied to nonadherent screening and subsequent diagnostic tests. RESULTS During this period, 1,398 guideline nonadherent Pap tests were performed (257 in women <21 years, 536 in women >65 years, and 605 after hysterectomy), with 88 abnormal results: 35 (13.5%) in women younger than 21 years, 14 (2.6%) in women older than 65 years, and 39 (6.5%) in women after hysterectomy. The excess cost for initial screening, diagnostic tests, and follow-up was US $35,337 for 2 years in women younger than 21 years, US $54,378 for 5 years in women older than 65 years, and US $77,340 for 5 years in women after hysterectomy, resulting in a total excess cost of US $166,100 for 5 years. Of the 1,398 women who underwent guideline nonadherent screening, there were only 2 (0.1%) diagnoses of high-grade dysplasia (VaIN3). CONCLUSIONS Guideline nonadherent cervical cancer screening in women beyond the recommended screening ages and posthysterectomy resulted in costs exceeding US $160,000 for screening, diagnostic tests, and follow-up with minimal improvement in detection of high-grade dysplasia.
Collapse
|
14
|
Affiliation(s)
- Derek S Wheeler
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Erika L Stalets
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
15
|
Watkins J, Wulaningsih W, Da Zhou C, Marshall DC, Sylianteng GDC, Dela Rosa PG, Miguel VA, Raine R, King LP, Maruthappu M. Effects of health and social care spending constraints on mortality in England: a time trend analysis. BMJ Open 2017; 7:e017722. [PMID: 29141897 PMCID: PMC5719267 DOI: 10.1136/bmjopen-2017-017722] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/10/2017] [Accepted: 08/24/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Since 2010, England has experienced relative constraints in public expenditure on healthcare (PEH) and social care (PES). We sought to determine whether these constraints have affected mortality rates. METHODS We collected data on health and social care resources and finances for England from 2001 to 2014. Time trend analyses were conducted to compare the actual mortality rates in 2011-2014 with the counterfactual rates expected based on trends before spending constraints. Fixed-effects regression analyses were conducted using annual data on PES and PEH with mortality as the outcome, with further adjustments for macroeconomic factors and resources. Analyses were stratified by age group, place of death and lower-tier local authority (n=325). Mortality rates to 2020 were projected based on recent trends. RESULTS Spending constraints between 2010 and 2014 were associated with an estimated 45 368 (95% CI 34 530 to 56 206) higher than expected number of deaths compared with pre-2010 trends. Deaths in those aged ≥60 and in care homes accounted for the majority. PES was more strongly linked with care home and home mortality than PEH, with each £10 per capita decline in real PES associated with an increase of 5.10 (3.65-6.54) (p<0.001) care home deaths per 100 000. These associations persisted in lag analyses and after adjustment for macroeconomic factors. Furthermore, we found that changes in real PES per capita may be linked to mortality mostly via changes in nurse numbers. Projections to 2020 based on 2009-2014 trend was cumulatively linked to an estimated 152 141 (95% CI 134 597 and 169 685) additional deaths. CONCLUSIONS Spending constraints, especially PES, are associated with a substantial mortality gap. We suggest that spending should be targeted on improving care delivered in care homes and at home; and maintaining or increasing nurse numbers.
Collapse
Affiliation(s)
- Johnathan Watkins
- Institute for Mathematical and Molecular Biomedicine, King’s College London, London, UK
- PILAR Research and Education, Cambridge, UK
| | - Wahyu Wulaningsih
- PILAR Research and Education, Cambridge, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | | | - Dominic C Marshall
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
| | - Guia D C Sylianteng
- PILAR Research and Education, Cambridge, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Phyllis G Dela Rosa
- PILAR Research and Education, Cambridge, UK
- University of the Philippines Manila, Manila, Philippines
| | - Viveka A Miguel
- PILAR Research and Education, Cambridge, UK
- University of the Philippines Diliman, Quezon City, Philippines
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Lawrence P King
- Department of Sociology, University of Cambridge, Cambridge, UK
| | - Mahiben Maruthappu
- Department of Applied Health Research, University College London, London, UK
| |
Collapse
|
16
|
Mier N, Ory MG, Towne SD, Smith ML. Relative Association of Multi-Level Supportive Environments on Poor Health among Older Adults. Int J Environ Res Public Health 2017; 14:ijerph14040387. [PMID: 28383513 PMCID: PMC5409588 DOI: 10.3390/ijerph14040387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/31/2017] [Accepted: 04/02/2017] [Indexed: 12/14/2022]
Abstract
Background: The aging of the United States population poses significant challenges to American healthcare and informal caregiving systems. Additional research is needed to understand how health promotion programs and policies based on a socio-ecological perspective impact the health and well-being of older persons. The purpose of this study was to investigate personal characteristics and supportive environments associated with poor health among older individuals aged 65 and over. Methods: This study used a cross-sectional design and was guided by a conceptual framework developed by the authors to depict the relationship between personal characteristics and environments associated with poor health status. Environment types included in this study were family, home, financial, neighborhood, and healthcare. The sample was comprised of 1319 adults aged 65 years and older residing in Central Texas. From a random selection of households, participants were administered a mail-based survey created by a community collaborative effort. Descriptive statistics and three binary logistic regression models were fitted to examine associations with poor health status (i.e., physical, mental, and combined physical/mental). Results: Two personal characteristics (number of chronic conditions and educational level) were consistently related (p < 0.05) to health outcomes. Supportive family, home, financial, neighborhood, and health care environmental factors were shown to be related (p < 0.05) to various aspects of physical or mental health outcomes. Conclusions: Multidimensional factors including personal characteristics and protective environments are related to health status among older individuals. The unique roles of each environment can help inform public health interventions to create and enhance support for older adults to engage in healthful activities and improve their physical and mental health.
Collapse
Affiliation(s)
- Nelda Mier
- Department of Public Health Studies, Texas A&M School of Public Health, McAllen Campus, McAllen, TX 78503, USA.
| | - Marcia G Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX 77843, USA.
| | - Samuel D Towne
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX 77843, USA.
| | - Matthew Lee Smith
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX 77843, USA.
- Institute of Gerontology, Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA 30602, USA.
| |
Collapse
|