Determinants Of Health Care Utilization Research Articles

Predictors of Healthcare Access and Utilization by Syrian Americans in the United States.

There are currently no studies examining healthcare access and utilization by Syrian Americans. A better understanding of the determinants of healthcare utilization among this group could help aid in the design of culturally competent programs. A self-administered survey was distributed at events across Southern California and Jacksonville, Florida from January 2018 to May 2019. Statistical analysis utilized multivariate regressions. Insurance coverage was associated with a preference for speaking Arabic (OR 0.433, p = 0.02) and increased length of residency (OR 1.04, p = 0.02). Routine checkup was associated with female sex (OR 1.97, p = 0.001), age (OR 1.05, p < 0.001), and insurance coverage (OR 6.96, p < 0.001). Colonoscopy compliance rate was 43.3% and positively associated with higher education (OR 2.70, p = 0.002), routine checkup (OR 7.61, p = 0.009) and increased length of residency (OR 1.06, p < 0.001). Syrian Americans may benefit from further health promotion campaigns with regard to insurance coverage, preventative care and cancer screenings.

Predictors of Healthcare Utilization in Newly Diagnosed Myeloma

Introduction The introduction of novel therapies has significantly improved outcomes in myeloma. However, the economic burden of enhanced healthcare utilization is significant and cannot be discounted. This study sought to identify baseline characteristics that may influence outcomes and subsequent healthcare utilization. Patients were also stratified by induction therapy to determine the impact newer combinations have on healthcare utilization. Methods This retrospective single-center study enrolled all newly diagnosed patients with myeloma between 2005 and 2020. Three outcome measures were used to determine healthcare utilization - total inpatient length of stay (LOS), number of admissions, and day ward attendances. Univariate and multivariable analyses were performed to identify significant covariates related to overall survival (OS) and healthcare utilization. Outcomes were subsequently adjusted for duration of follow-up and per patient year. Results There were 113 patients included; 60 (53.1%) female; median age at diagnosis was 67 years (IQR 62, 73 years) and 22.1% were high risk International Staging System (ISS). Further baseline demographics are presented in Table 1. Median duration of follow up was 3.2 years (IQR 1.50, 6.55). Sixty patients (53.1%) died, 91.7% attributable to myeloma or its treatment. Predictors of OS by multivariable analysis were advanced stage [ISS III (p&amp;lt;0.001)] and IgA idiotype [(IgA vs IgG) (p=0.0002)]. Stem cell transplant eligibility was associated with improved OS (p=0.003). The total number of admissions to hospital was 547 (median 4; IQR 2, 7), with 55.4% unplanned. In the multivariable analysis, younger age (p=0.020), higher paraprotein levels (p=0.045), dialysis (p=0.037), and SCT eligibility (p=0.0012) were predictive of greater number of admissions. During the study period, there were 7000 inpatient bed occupancy days (median 46; IQR 26, 80). Only younger age remained significant (p=0.0028) in the multivariable analysis. There were a total of 5987 day care attendances during the study period. Multivariable analysis identified younger age at diagnosis (p&amp;lt;0.0001), WBC (p=0.0072), and light chain (kLC vs lLC) (p=0.0027) as predictive of increased day ward attendance. Healthcare utilization correlated with increased survival, as depicted in figure 1. There was no significant relationship between treatment type and LOS (p=0.055); this remained unchanged when adjusted per patient year (p=0.24). There was significant relationship between treatment type and total number of admissions (p=0.015). Patients receiving anthracycline based therapy (p=0.003), Immunomodulatory (IMiD)/Proteasomal Inhibition (PI)/Steroid (p=0.020), or PI/Steroid (p=0.021) were more likely to have a greater number of admissions. However, when adjusted per patient year, this association was no longer evident (p=0.19). A highly significant relationship between treatment type and day ward attendances was identified (p&amp;lt;0.0001). Alkylator based (pp=0.005), alkylator/PI/Steroid (p=0.006), anthracycline based (p=0.0002), IMiD/PI/Steroid (p=0.0007), or PI/Steroid (0.0002) were more likely to have greater day ward attendance. When adjusted per patient year, this significant association between treatment type and day ward attendance remained (p=0.0002). Conclusion Studies assessing healthcare utilization in patients with myeloma are mostly limited to relapsed refractory setting. In this population, younger age at presentation was a significant predictor for all three measures of healthcare utility. Whilst treatment type did not demonstrate a significant impact of LOS, we did determine that novel triplet therapy combinations were associated with increased number of admissions and day care attendances. We also showed that healthcare utilization increased with survival time. While survival outcomes with novel agents have improved, given current financial and capacity limitations within which the majority of health systems function, resource demand implications must be considered when planning future service provision and novel treatment strategies. Disclosures No relevant conflicts of interest to declare.

Analyzing the predictors of health care utilization in the agricultural worker population using decision tree analysis: Does language matter?

To analyze the predictors of health care utilization among respondents to the National Agricultural Worker Survey. Specifically, we hypothesized that English proficiency would predict utilization of health care services within the last 2years. Using the 2015-2016 National Agricultural Worker Survey, we performed a secondary data analysis to analyze the predictors of health care utilization within the last 2years in the United States' agricultural worker population. Data were cleaned and analyzed using decision tree analysis, which produced a classification tree model that was trained on 90% of the data and validated on 10%. Exposure to English was not a predictor of health care utilization in our classification tree. The first major partition that predicted utilization was insurance status. Additional partitions were on age, gender, hypertension diagnosis, and public aid. By partitioning on insurance status and use of public aid, the decision tree provided evidence that systemic factors are key determinants of health care utilization in the agricultural worker community. This highlights the importance of agencies that connect agricultural workers with resources that provide insurance and improve access to health care. This is especially important given that agricultural workers are one of the highest risk groups for occupational injury or death in the United States.

Healthcare utilization and cost in patients with atrial fibrillation and heart failure undergoing catheter ablation.

BackgroundCatheter ablation is an effective treatment for patients with atrial fibrillation (AF) and heart failure (HF). However, little is known about how healthcare utilization and cost change after ablation in this population. We sought to determine healthcare utilization and cost patterns among patients with AF and HF undergoing ablation.MethodsUsing a large United States administrative database, we identified (n = 1568) treated with ablation with a primary and secondary diagnosis of AF and HF, respectively, were evaluated 1‐year pre‐ and postablation for outcomes including inpatient admissions (AF or HF), emergency department (ED) visits, cardioversions, length of stay (LOS), and cost. A secondary analysis was extended to 3‐years postablation.ResultsReductions were observed in AF‐related admissions (64%), LOS (65%), cardioversions (52%), ED visits (51%, all values, p < .0001), and HF‐related admissions (22%, p = .01). There was a 40% reduction in inpatient admission cost ($4165 preablation to $2510 postablation, p < .0001). In a sensitivity analysis excluding repeat‐ablation patients, a greater reduction in overall AF management cost was observed compared to the full cohort (−43% vs. −2%). Comparing 1‐year pre‐ to 3‐years postablation, both total mean AF‐management cost ($850 per‐patient per‐month 1‐year pre‐ to $546 3‐years postablation, p < .0001) and AF‐related healthcare utilization was reduced.ConclusionsCatheter ablation in patients with AF and HF resulted in significant reductions in healthcare utilization and cost through 3‐years of follow‐up. This reduction was observed regardless of whether repeat ablation was performed, reflecting the positive impact of ablation on longer term cost reduction.

Determinants of Health Care Utilization among Retirees in Rural Akwa Ibom State, Nigeria

The rising population of the elderlyis one of the most important demographic phenomena in recent times globally. In Nigeria, the estimated population of older persons is about 6 million, and this group of people are confronted with various health challenges and a reduction in earnings, which exacerbates their poor health and healthcare utilization. Studies have shown that healthcare is a fundamental requirement for living a socially and economically productive life; however, in many developing countries including Nigeria, healthcare services utilization among older persons and particularly retirees has received less attention. The main objective of this study was to examine the determinants of healthcare services use among retired primary school teachers in Etinan Local Government in Akwa Ibom State. We utilized Andersen’s healthcare model to explain the factors associated with retirees’ healthcare utilization.Data were collected throughnon-participant observation and semi-structured interviews, conducted with 217 respondents.Data on socio-demographic characteristics of respondents were analyzed using descriptive statistics, while qualitative narratives were analyzed thematically and presented verbatim. Findings from the study revealed that the majority of respondents attributed difficulties in the utilization of health care services to inadequate health facilities, lack of trained healthcare personnel, high cost of health services, distance to health facilities, and late payment of pension, among other factors. Study findings suggest the need for the provision of quality healthcare infrastructure for the retired adults and timely payment of pensions as a panacea for poor healthcare accessibility and utilization.

Determinants of healthcare utilisation by migrant workers in the State of Qatar

BackgroundLabour migration enables populations to adjust to changing economic and social conditions, yet often precipitates increased health risks. Few previous studies examined healthcare utilisation by migrant workers. This study aimed to examine the healthcare utilisation by migrant workers in Qatar. MethodsIn 2011, Qatar launched National Health Strategy 2011–2016, phasing in Universal Health Care accessible to both Qataris and non-Qataris. Qatar’s high proportion of foreign migrant workers to Qatari citizens is unique, estimated at 5:1. Multivariate analysis on Household Utilization and Expenditure Survey (HUES) 2014 data yielded determinant factors for healthcare utilisation by migrant workers in Qatar. ResultsIn nationally-representative sampling, the proportion of migrant labourers accessing outpatient care was only half of expatriates and Qataris, with inpatient care utilisation even less. Results suggest all forms of health insurance coverage had protective effects for expatriate and labourer healthcare utilisation. Specifically, such protective impact on all migrant groups’ inpatient care use was much greater than outpatient. ConclusionsThis study highlights differences in the pattern of care-seeking and total health expenditure across migrant worker groups in Qatar. Improving health insurance coverage to migrant worker groups can promote higher utilisation of care, and thereby reduce health disparities of migrant workers to better protect their health and productivity.

Domestic Violence and Healthcare Utilization in Turkey

ABSTRACT This study aims to analyze the prevalence of domestic violence, the level, and determinants of healthcare utilization of women exposed to violence and the satisfaction from the behaviors of health personnel. The data source of this study is the 2014 Research on Domestic Violence against Women in Turkey which was carried out with Hacettepe University Institute of Population Studies and Ministry of Family and Social Policies in Turkey. The research has a nationally representative sample of 7462 women aged 15–59. Logistic regression analysis was performed to determine the effect of the basic characteristics of women on receiving healthcare due to violence. In this study, the rate of women receiving healthcare was 63%. Women who were unemployed have no health insurance, live in low wealth level, in rural areas, and the Eastern region had used healthcare services at a lower level.

Abstract WP242: Using Systems Redesign in the Development, Implementation, and Evaluation of a Care Transitions and Hypertension (catch) Management Program for Veterans With Ischemic Stroke

Introduction: Systems Redesign approaches have the potential to be used to develop, implement, and evaluate the implementation of post-ischemic stroke hypertension quality improvement initiatives. Methods: The CAre Transitions and Hypertension (CATcH) management program is a bundled, multi-faceted, provider- and healthcare-systems level pilot-intervention designed to enhance care coordination using infrastructure routinely available within a Veterans Health Administration (VHA) medical center delivering suboptimal post-stroke hypertension care. A rapid process improvement workshop with local personnel from internal medicine, neurology, clinical pharmacy, and facility leadership. The team process mapped out the current state of post-stroke blood pressure (BP) control from the hospitalization period to outpatient follow-up, and conceptualized a future state where there was enhanced care coordination between inpatient and outpatient providers, generalists and specialists, and increased engagement of underutilized talent within clinical pharmacy and telehealth. The CATcH bundle also included a Transition in Care note to improve communication between providers. The team decided to meet weekly to determine newly identified and ongoing needs for patients. Chart review was conducted to determine healthcare utilization. Results: In the six-months prior to the implementation of CATcH, facility-level pass rate for BP control (i.e., obtaining BP &lt; 140/90 mmHg) was 50% (18/36). Stroke survivors were neither discharged with telehealth for BP monitoring nor received clinical pharmacy appointments. In the six-months after CATcH implementation, facility-level pass rate for BP control was 69% (22/32). Nineteen percent were enrolled in telehealth whereas all patients received and attended at least two clinical pharmacy appointments post-discharge. All patients discharged during the intervention period were recipients of the CATcH program. Conclusions: A Systems Redesign approach could be used to eliminate waste and minimize variability in the process of post-stroke hypertension management while using readily available hospital infrastructure to improve hypertension care for stroke survivors.

The development and validation of a measurement instrument to investigate determinants of health care utilisation for low back pain in Ethiopia.

Introduction and objectivesLow back pain (LBP) is a highly prevalent and disabling public health problem globally. However, little is known about factors affecting health care utilisation for optimal management of the pain, and there is no validated instrument to derive epidemiological data for a better understanding of these factors. The aim of this study was to develop and validate an instrument used to measure determinants of health care utilisation for LBP in Ethiopia.MethodsThe relevant domains of potential determinants of health care utilisation for LBP were identified following a comprehensive review of the literature. Items relating to each domain were then generated by considering the context of Ethiopia, and where necessary, existing items were adapted. The instrument was then translated, and an expert panel reviewed the instrument for content validity, clarity and any other suggestions. Using the data collected from 1303 adults with LBP, factorial validity was assessed by conducting principal component and parallel analyses. Internal consistency reliability was also assessed using Cronbach’s alpha. Intraclass correlation coefficient (ICC) and Cohen Kappa statistic were calculated to evaluate temporal stability of the instrument.ResultsParallel analysis showed that there were six components with Eigenvalues (obtained from principal component analysis) exceeding the corresponding criterion values for a randomly generated data matrix of the same size. Cronbach’s alpha for the internal consistency reliability ranged from 0.65 to 0.82. In assessing temporal stability, ICC ranged from 0.60, 95% CI: 0.23–0.98 to 0.95, 95% CI: 0.81–1.00 while Cohen Kappa ranged from 0.72, 95% CI: 0.49–0.94 to 0.93, 95% CI: 0.85–1.00.ConclusionsThis study demonstrated that the newly developed instrument has an overall good level of content and factorial validity, internal consistency reliability, and temporal stability. In this way, this instrument is appropriate for measuring determinants of health care utilisation among people with LBP in Ethiopia.

Body Appreciation and Health Care Avoidance: A Brief Report.

Research suggests that body image is related to health behaviors and health care use, but possible mechanisms for this relationship remain unclear. The current study examined the presence of a relationship between body appreciation and avoiding the doctor to avoid being weighed, using a diverse sample of women (N = 499). Controlling for body size and determinants of health care utilization, logistic regression results suggested that women with higher body appreciation were less likely to avoid health care to avoid being weighed (odds ratio = 0.38, p < .001). In addition, differences in avoiding the doctor to avoid being weighed were found for the covariates (that is, age, race, body mass index, and socioeconomic status). These results inform knowledge regarding barriers to health care use and the relationship between body image and health care use. The article concludes with a discussion of the implications for future research, social work interventions, and social work education to promote women's health and well-being.

Frequency and determinants of health care utilization for symptomatic reproductive tract infections in rural Indian women: A cross-sectional study.

IntroductionThe public health burden of reproductive tract infections (RTIs) among women in rural areas of low-income countries is poorly addressed because health care seeking for treatment of RTIs is inadequate. There are gaps in knowledge about whether low care seeking behavior stems from challenges in accessing health care versus women's recognition of and response to RTI-specific disease symptoms. We aim to identify determinants of care seeking behavior and analyze the difference in utilization of health care resources in response to symptoms of an RTI versus non-RTI disease symptoms in rural India. This will aid in the design of interventions that promote RTI care seeking behavior.MethodsOur analysis uses data from a cross-sectional, population-based surveillance survey among rural, non-pregnant women in Odisha, India, from 2013–2014 (n = 3,600). We utilized bivariate logistic regression to determine the degree that certain determinants are associated with a woman’s likelihood to seek RTI treatment, and chi-Squared tests to assess for differences in health care resources used for non-RTI versus RTI symptoms.ResultsMarried women were significantly more likely to seek health care for RTI symptoms (Odds Ratio (OR) = 1.9, 95% Confidence Interval (CI): 1.2–3.0) while unmarried adolescents were less likely to seek treatment (OR = 0.4, CI: 0.2–0.6). There was no association between RTI health care seeking with education level, belief about whether symptoms can be treated, or poverty. The majority (73.8%) of women who did not seek treatment for RTI symptoms reported not seeking treatment because they did not know treatment was needed. Women utilized formal health care providers at a higher rate in response to RTI symptoms than in response to their most recent symptoms of any kind (p = 0.003).ConclusionsCommunity-based reproductive health education interventions are needed to increase health care seeking behavior for RTIs in rural Indian women. Interventions should target unmarried women and focus on both sexual health education and access to care.

THE CORRELATION BETWEEN DEMAND FACTORS AND HEALTH CARE SERVICE UTILIZATION BY CONTRIBUTION BENEFICIARY PATIENTS

Background: National Health Insurance is the government's effort to increase public access to health care services. As the implementer of the National Health Insurance, the Outpatient Unit of Haji General Hospital, Surabaya has undergone the decrease of contribution beneficiaries’ visits from 2010-2013. This condition indicates a decrease in health care utilization by the low-income community.Aim: This study aims to identify the correlation between health care demands and health care utilization by the contribution beneficiary patients.Method: The study was an observational analytic using a cross-sectional design. A systematic random sampling technique was used to determine the sample of the study. The respondents were 74 contribution beneficiary patients who possessed a district government free care scheme and had ever utilized the health care services at the Outpatient Unit of Haji General Hospital, Surabaya, and at least 13 years old. The data were collected through questionnaires and analyzed with Spearman and Chi-Square tests (α =0.05).Results: Health status, insurance needs, additional costs, gender, ethnicity, education, and income did not have a significant correlation with the health care service utilization by the contribution beneficiary patients at the Outpatient Unit of Haji General Hospital. It was identified that the older the people are, the higher the frequency of health care utilization is. Besides, service time was proven to be the determinants of health care utilization (p = 0.006).Conclusion: The most influential factors in utilizing the health care services by contribution beneficiary patients are service time and age. Based on those factors, the Haji General Hospital requires to improve its services and service timeliness for the elderly contribution beneficiary patients.Keywords: demand, contribution beneficiary patients, utilization.

Frailty, hospital use and mortality in the older population: findings from the Newcastle 85+ study.

Frailty is a significant determinant of health care utilisation and associated costs, both of which also increase with proximity to death. What is not known is how the relationships between frailty, proximity to death, hospital use and costs develop in a population aged 85years and over. This study used data from a prospective observational cohort, the Newcastle 85+ Study, linked with hospital episode statistics and death registrations. Using the Rockwood frailty index (cut off <0.25), we analysed the relationship between frailty and mortality, proximity to death, hospital use and hospital costs over 2, 5 and 7 years using descriptive statistics, Kaplan-Meier survival curves, Cox's proportional hazards and negative binomial regression models. Baseline frailty was associated with a more than two-fold increased risk of mortality after 7 years, compared to people who were non-frail. Participants classified as frail spent more time in hospital over 7 years than the non-frail, but this difference declined over time. Baseline frailty was not associated with increased time spent in hospital during the last 90days of life. Evidence continues to accrue on the impact of frailty on emergency health care use. Hospital and community services need to adapt to meet the challenge of introducing new proactive and preventative approaches, designed to achieve benefits in clinical and/or cost effectiveness of frailty management.

Determinants of Health Care Utilization among the Elderly Population in Jimma Town, Oromia Region, Southwest Ethiopia

Determinants of Health Care Utilization among the Elderly Population in Jimma Town, Oromia Region, Southwest Ethiopia

Frequent Emergency Department Use by Children.

Frequent use of the emergency department (ED) is often targeted as a quality improvement metric. The objective of this study was to assess ED visit frequency by the demographic and health characteristics of children who visit the ED to better understand risk factors for high ED utilization. The majority of pediatric ED services in Rhode Island are provided by a hospital network that includes the state's only children's hospital. Using 10 years of data (2005-2014) from this statewide hospital network, we examined ED use in this network for all children aged 0 to 17 years. Patients' home addresses were geocoded to assess their neighborhood characteristics. Between 2005 and 2014, 17,844 children visited 1 or more of the network EDs at least once. In their year of maximum use, 67.8% had only 1 ED visit, 20.1% had 2 visits, 6.9% had 3 visits, and 5.2% had 4 or more visits. In the adjusted multinomial logistic regression model, age, race/ethnicity, language, insurance coverage, medical complexity, neighborhood risk, and distance to the ED were found to be significantly associated with increased visit frequency. Risk factors for frequent ED use by children include age, race/ethnicity, language, insurance coverage, medical complexity, neighborhood risk, and distance to the hospital. To decrease frequent pediatric ED use, improved medical management of complex medical problems is needed, but it is also essential to address modifiable social determinants of health care utilization in this population.

Determinants of healthcare utilization and costs in COPD patients: first longitudinal results from the German COPD cohort COSYCONET.

BackgroundIn light of overall increasing healthcare expenditures, it is mandatory to study determinants of future costs in chronic diseases. This study reports the first longitudinal results on healthcare utilization and associated costs from the German chronic obstructive pulmonary disease (COPD) cohort COSYCONET.Material and methodsBased on self-reported data of 1904 patients with COPD who attended the baseline and 18-month follow-up visits, direct costs were calculated for the 12 months preceding both examinations. Direct costs at follow-up were regressed on baseline disease severity and other co-variables to identify determinants of future costs. Change score models were developed to identify predictors of cost increases over 18 months. As possible predictors, models included GOLD grade, age, sex, education, smoking status, body mass index, comorbidity, years since COPD diagnosis, presence of symptoms, and exacerbation history.ResultsInflation-adjusted mean annual direct costs increased by 5% (n.s., €6,739 to €7,091) between the two visits. Annual future costs were significantly higher in baseline GOLD grades 2, 3, and 4 (factors 1.24, 95%-confidence interval [1.07–1.43], 1.27 [1.09–1.48], 1.57 [1.27–1.93]). A history of moderate or severe exacerbations within 12 months, a comorbidity count >3, and the presence of dyspnea and underweight were significant predictors of cost increase (estimates ranging between + €887 and + €3,679, all p<0.05).ConclusionsHigher GOLD grade, comorbidity burden, dyspnea and moderate or severe exacerbations were determinants of elevated future costs and cost increases in COPD. In addition we identified underweight as independent risk factor for an increase in direct healthcare costs over time.

Trends in site of death and health care utilization at the end of life: a population-based cohort study.

High rates of health care utilization at the end of life may be a marker of care that does not align with patient-stated preferences. We sought to describe trends in end-of-life care and factors associated with dying in hospital. We conducted a population-level retrospective cohort study of adult decedents in Ontario between Apr. 1, 2004, and Mar. 31, 2015, using linked administrative data sets, including the Office of the Registrar General for Deaths database, the hospital Discharge Abstract Database, the National Ambulatory Care Reporting System and physicians' billing claims (Ontario Health Insurance Plan). The primary outcome was place of death. To determine health care utilization and health care costs during the 6 months before death, we also identified admissions to hospital and to the intensive care unit, emergency department visits, and receipt of mechanical ventilation and palliative care. In the last 6 months of life, 77.3% of 962 462 decedents presented to an emergency department, 68.4% were admitted to hospital, 19.4% were admitted to an intensive care unit, and 13.9% received mechanical ventilation. Forty-five percent of all deaths occurred in hospital, a proportion that declined marginally over time, whereas receipt of palliative care increased during terminal hospital admissions (from 14.0% in fiscal year 2004/05 to 29.3% in 2014/15, p < 0.001) and in the last 6 months of life (from 28.1% in 2004/05 to 57.7% in 2014/15, p < 0.001). The proportion of decedents who presented to the emergency department, were admitted to hospital or were admitted to the intensive care unit in the last 6 months of life did not change over 11 years. The mean total health care costs in the last 6 months of life were highest among those dying in hospital, with most costs attributable to inpatient medical care. Health care utilization in the last 6 months of life was substantial and did not decrease over time. It is possible that increased capacity for palliative, hospice and home care at the end of life may help to better align health system resources with the preferences of most patients, a topic that should be explored in future studies.

Neighborhood characteristics as determinants of healthcare utilization \u2013 a theoretical model

BackgroundWe propose using neighborhood characteristics as demand-related morbidity adjusters to improve prediction models such as the risk equalization model.ResultsSince the neighborhood has no explicit ‘place’ in healthcare demand models, we have developed the “Neighborhood and healthcare utilization model” to show how neighborhoods matter in healthcare utilization. Neighborhood may affect healthcare utilization via (1) the supply-side, (2) need, and (3) demand for healthcare – irrespective of need. Three pathways are examined in detail to explain how neighborhood characteristics influence healthcare utilization via need: the physiological, psychological and behavioral pathways. We underpin this theoretical model with literature on all relevant neighborhood characteristics relating to health and healthcare utilization.ConclusionPotential neighborhood characteristics for the risk equalization model include the degree of urbanization, public and open space, resources and facilities, green and blue space, environmental noise, air pollution, social capital, crime and violence, socioeconomic status, stability, and ethnic composition. Air pollution has already been successfully tested as an important predictive variable in a healthcare risk equalization model, and it might be opportune to add more neighborhood characteristics.

The Patient Protection and Affordable Care Act and Utilization of Preventive Health Care Services Among Asian Americans in Michigan during Pre- and Post-Affordable Care Act Implementation.

Since the implementation of the Patient Protection and Affordable Care Act (ACA), significant increases in the percent of insured United States residents has steadily increased. Studies have shown that there is an increase in preventative services usage and a decrease in chronic disease burden with increased access to insurance. However, very little has been studied about how the implementation of ACA has impacted utilization of health services and health status among Asian Americans. In this study, we recruited 427 Asian Americans who attended health fairs and examined (1) changes in health care coverage and utilization of preventive health services before and after ACA, (2) health status on chronic disease risk factors, (3) comparing health services utilization by insurance status and types of insurance, and (4) identifying relationships between health care utilization and demographic factors. Study results indicate that even though the percentage of insured Asian Americans in Michigan increased significantly over study periods, health care utilization and chronic disease burden did not change significantly. The insured tended to utilize preventive health services more than the uninsured, but the types of insurance did not affect health care utilization. Gender and having a primary care physician were significant predictors in determining health care utilization. There is a need in this population for language-appropriate and culturally-sensitive education about the importance and availability of preventive services, which could improve adherence to preventive health services, thereby reducing health disparities.

Healthcare Utilization and Cost Associated with Cytomegalovirus Infection Among Pediatric Allogeneic Hematopoietic Cell Transplant Recipients.

Understanding the cost and healthcare utilization associated with cytomegalovirus (CMV) treatment is particularly important as new alternative agents for CMV prevention and treatment such as letermovir and anti-CMV cytotoxic T lymphocytes become available. Literature on the impact of CMV-related hospitalization in allogeneic hematopoietic cell transplant (alloHCT) pediatric patients is limited. We hypothesized that CMV infections post-alloHCT will result in increased length of stay (LOS) in hospital and higher healthcare costs. The aim of this study was to determine healthcare utilization and outcomes of CMV-related hospitalization in alloHCT patients using a single-center clinical database. This was a retrospective study of 240 children ages 3 months to 21 years old who were transplanted between 2005 and 2016. Impact of CMV-related length of stay and total healthcare costs were quantified. Factors associated with prolonged CMV viremia (>25 days) were also examined. The median age of patients was 9.5 years old. In at risk CMV patients, the incidence of CMV viremia was 38%, the median time to onset was 33 days (range 0-292 days), and the median time to resolution was 25 days (range 3-148 days). The median LOS in the first year post-alloHCT for patients with viremia was higher compared to those without viremia (101 days [range 25-319 days] vs 72 days [range 26-354 days], p In the regression analyses, the unadjusted association between CMV infection and LOS was 27.4 days (p=0.003). In multivariable analysis, patients with CMV infection had an average of 23.3 days (p=0.004) longer LOS compared to patients without infection [Table] and added hospital costs of US$45,443 (p=0.162) compared to patients without CMV infection. In multivariable analysis, alemtuzumab was associated with CMV viremia >25 days (p=0.027). In conclusion, CMV viremia is associated with prolonged LOS and higher healthcare costs and indicates a need for improved and cost-effective CMV prevention strategies. Further study into patient outcomes and costs in alloHCT pediatric populations is needed.