Self-Reported Lower Respiratory Symptoms and Exhaled Nitric Oxide in a WTC-Exposed Cohort

Abstract

S (ACE) AEP Vol. 20, No. 9 September 2010: 691–724 710 RESULTS: Population prevalences were estimated from 7,137 interviews (54% response rate). Most (91%) farm operators had health insurance. In the previous 12 months, Latino operators were less likely to have health insurance or receive prescribed medications compared with white-nonLatino operators. In addition, Latino men had more difficulty obtaining medical care, and had fewer emergency room visits than white-non-Latino men. African American and Alaska Native men and women were less likely to have health insurance, and a greater number of Alaska Native men reported difficulty obtaining medical care compared with white operators of the same gender. Asian American men were less likely to have emergency room visits and fewer Asian American men and women reported hospital stays during the last 12 months. Prevalence for reporting worse general health compared to a year ago were similar across ethnic and racial groups. CONCLUSIONS: Health care access and utilization for ethnic and racial groups of farm operators vary. Studies that combine these social categories may overor underestimate access to care and healthcare use in the entire farm operator population. P54 THE COST-EFFECTIVENESS OF BASELINE MRI VERSUS CT IN PATIENTS WITH CLINICAL SYMPTOMS STRONGLY SUGGESTIVE OF STROKEdA DECISION ANALYSIS KR Burton, Department of Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada PURPOSE: All patients with stroke symptoms should undergo a “baseline” magnetic resonance imaging (MRI) or computed tomography (CT) study; however, it remains unclear whether immediate CT or MRI scanning yields a difference in long-term outcomes or costs. METHODS: A Markov decision analysis model was used with a population of any patient eligible to receive thrombolytic therapy who presents on any time of day and any day of the week to a healthcare facility, with stroke symptoms. The interventions studied were CT or MRI scan at baseline. The outcomes measured were costs (adjusted to 2008 dollars), qualityadjusted life years (QALYs), and incremental costeffectiveness. RESULTS: Compared with CT, the MRI strategy has an incremental costeffectiveness ratio (ICER) of $4,765 per QALY gained. The MRI strategy gains more QALYs than the CT strategy and incurs lower incremental costs; therefore, the MRI strategy dominates the CT strategy. Over a wide range of variables, the ICERs of the MRI imaging strategy were less than $50,000 per QALY gained, except for the cost associated with strokerelated life-years lost. Varying the prevalence of acute ischemic stroke, the costs of MRI and CT scans and the sensitivity and specificity of CT and MRI had no effects on outcomes. CONCLUSION: The most cost-effective strategy for baseline imaging of stroke patients is MR imaging. Clinically significant benefits accrue from imaging patients with MRI at baseline. P55 BARRIERS TO HEALTH CARE AMONG PARENTS USING CHILDREN’S HEALTH INSURANCE PROGRAM P Valencia-Castro, A Stachnik, D Fuentes, G Gaitan, W Yang, J Smith-Gagen, School of Community Health Sciences, University of Nevada, Reno, NV PURPOSE: We evaluated parents’ perceived barriers to health care, when using the Nevada’s State Children’s Health Insurance Plan (Nevada CheckUp) in seeking health care for their children. METHODS: Using the Andersen-Newman Behavioral Model of Health Service Use, we identified barriers to health care from self-administered questionnaires, collected among a group of newly enrolled Nevada CheckUp beneficiaries, between November, 2008 and May, 2009. RESULTS: A 39-item questionnaire measuring parents’ barriers to obtaining health care for their children was completed by 356 Nevadan parents. Among them, 56.5% (n Z 201) had one child and 43.5% (n Z 155) had two or more children. The most common predisposing factors affecting a parent’ propensity to use health care were communication with physician (69.0%, nZ 238) and knowledge of the health care systems (54.6%, nZ 191), at the contextual and individual level respectively. Similarly, almost half of the respondents reported having frequent problems with meeting the needs of other family members (44.6%, nZ 153). In contrast, most respondents reported no problems with doctor visit transportation (79.9%, nZ 282) or with contacting the doctor’s office by phone (68.2%, nZ 240). CONCLUSION: Contextual and individual characteristics that could predispose insured individuals to not use health services are a common problem. These findings should guide future policy and public health interventions.