Disparities In Health Service Use Research Articles

Identifying Longer-Term Health Events and Outcomes and Health Service Use of Low Birthweight CALD Infants in Australia

IntroductionApproximately one-third of all births in Australia each year are by culturally and linguistically diverse (CALD) women. CALD women are at an increased risk of adverse pregnancy and birth outcomes including prematurity and low birthweight. Infants born weighing less than 2500 g are susceptible to increased risk of ill health and morbidities such as cognitive defects including cerebral palsy, and neuro-motor functioning.MethodsAn existing linked administrative dataset, Maternity 1000 was utilized for this study which has identified all children born in Queensland (QLD), Australia, between 1st July 2012 to 30th June 2018 from the QLD Perinatal Data Collection. This has then been linked to the QLD Hospital Admitted Patient Data Collection, QLD Hospital Non-Admitted Patient Data Collection, QLD Emergency Department Data Collection, and Medicare Benefits Schedule and Pharmaceutical Benefits Scheme Claims Records between 1 and 2012 to 30th June 2019.ResultsCulturally and linguistically diverse infants born with low birthweight had higher mean and standard deviation of all health events and outcomes; potentially preventable hospitalisations, hospital re-admissions, ED presentations without admissions, and development of chronic diseases compared to non-CALD infants born with low birthweight.DiscussionResults from this study highlight the disparities in health service use and health events and outcomes associated with low birthweight infants, between both CALD and Australian born women. This study has responded to the knowledge gap of low birthweight on the Australian economy by identifying that there are significant inequalities in access to health services for CALD women in Australia, as well as increased health events and poor birth outcomes for these infants when compared to those of mothers born in Australia.

Nursing leadership and influence in practice domains at a Veterans Affairs Health Care System

BackgroundStudies in Veteran populations have examined disparities in health service use, care quality, outcomes and increased demands for behavioral health. PurposeThe purpose is to describe the development of nursing leadership roles that influenced practice improvements and demonstrated outcomes related to health disparities in a Veterans Affairs (VA) population over a 12-year period. MethodsThe Sundean and colleagues' concept analysis of nurse leadership influence was applied to frame the initiative process and impacts. DiscussionAntecedents and processes that facilitated leadership development included mentorship, disparities expertise, partnerships, consultation, scholarship, dissemination, advocacy, education, and strong coauthor collaboration. Improvements and outcomes included access to services, improved health indicators, tools, workforce, funding, innovations, and nurse investigator studies, consistent with VA priorities and policy related to disparities and equity. Limitations and barriers were addressed. ConclusionThis initiative models’ strategies to increase nurse leadership in health equity and care transformation in health systems and community practices.

Differences in the pattern and cost of hospital care between Indigenous and non-Indigenous Australians with cirrhosis: an exploratory study.

Liver diseases are important contributors to the mortality gap between Indigenous and non-Indigenous Australians. This cohort study examined factors associated with hospital admissions and healthcare outcomes among Indigenous Australians with cirrhosis. Patient-reported outcomes were obtained by face-to-face interview (Chronic Liver Disease Questionnaire and Short Form 36 (SF-36)). Clinical data were extracted from medical records and through data linkage for 534 patients (25 indigenous). Cumulative overall survival (Kaplan-Meier), rates of hospital admissions and emergency presentations, and costs were assessed by indigenous status. Incidence rate ratios (IRR; Poisson regression) were reported. Indigenous Australians admitted to hospital with cirrhosis had lower educational status compared with non-indigenous patients (79.2% vs 43.4%; P< 0.001). The two groups had, in general, similar clinical characteristics including disease severity (P= 0.78), presence of cirrhosis complications (P= 0.67), comorbidities (P= 0.62), rates of cirrhosis-related admissions (P= 0.86) and 5-year survival (P= 0.30). However, indigenous patients had a lower score in the SF-36 domain related to bodily pain (P= 0.037), more cirrhosis admissions via the emergency department (IRR=1.42, 95% confidence interval (CI) 1.10-1.83) and fewer planned cirrhosis admissions (IRR=0.32, 95% CI 0.14-0.72). The total cost for cirrhosis-related hospital admissions for 534 patients over 6 years (July 2012 to June 2018) was A$13.7 million. The cost of cirrhosis-related hospital admissions was double for indigenous patients (cost ratio=2.04, 95% CI 2.04-2.05). Our data highlight the disparities in health service use and patient-reported outcomes, despite having similar clinical profiles. Integration between primary care, Aboriginal Community Controlled Health Organisations and liver specialists is critical for appropriate health service delivery and effective use of resources. Chronic liver disease costs the community dearly.

Ethnic, socio-economic and geographic inequities in maternal health service coverage in Australia.

Disparities in health service use exist in many sectors of Australia's health system, particularly affecting the most vulnerable people in the population, who are typically those with the greatest healthcare needs. Understanding patterns of health service coverage is critical for acknowledging the underlying, systemic drivers including racialised practices that inhibit the uptake of health services for certain population groups. This study aims to determine whether there are disparities in health service utilisation between socioeconomic, geographic and ethnic groups of mothers who experience hypertension, diabetes and mental health conditions. This study utilised a linked administrative healthcare dataset containing data of all mothers who gave birth in Queensland, Australia, between 2012 and 2015 (n=186,789), plus their resultant babies (n=189,909). The study compared health service utilisation for mothers with maternal health conditions between population groups. The results of this study showed a broad trend of inequitable health service utilisation, with mothers who experienced the greatest healthcare needs-First Nations, rural and remote and socio-economically disadvantaged mothers-being less likely to access health services and in some cases when care was accessed, fewer services being utilised during the perinatal period. Access to health care during the perinatal period is a reflection of Australia's general health system strengths and weaknesses, in particular a failure of the government to translate national and state policy intent into acceptable and accessible care in rural and remote areas, for First Nations women and for mothers experiencing socio-economic disadvantage.

Inequity in healthcare needs, health service use and financial burden of medical expenditures in China: results from a consecutive household monitoring study in Jiangsu Province

BackgroundAlthough public medical insurance covers over 95% of the population in China, disparities in health service use and out-of-pocket (OOP) health expenditure across income groups are still widely observed. This study aims to investigate the socio-economic disparities in perceived healthcare needs, informal care, formal care and payment for healthcare and explore their equity implication.MethodsWe assessed healthcare needs, service use and payment in 400 households in rural and urban areas in Jiangsu, China, and included only the adult sample (N = 925). One baseline survey and 10 follow-up surveys were conducted during the 7-month monitoring period, and the Affordability Ladder Program (ALP) framework was adopted for data analysis. Negative binomial/zero-inflated negative binomial and logit regression models were used to explore factors associated with perceived needs of care and with the use of self-treatment, outpatient and inpatient care respectively. Two-part model and logit regression modeling were conducted to explore factors associated with OOP health expenditure and with the likelihood of incurring catastrophic health expenditure (CHE).ResultsAfter adjusting for covariates, rural residence was significantly associated with more perceived healthcare needs, more self-treatment, higher probability of using outpatient and inpatient service, more OOP health expenditure and higher likelihood of incurring catastrophic expenditure (P < 0.05). Compared to the Urban Employee Basic Medical Insurance (UEBMI), enrollment in the New Rural Cooperative Medical Scheme (NRCMS) or in the Urban Resident Basic Medical Insurance (URBMI) was correlated with lower probability of ever using outpatient services, but with more outpatient visits when people were at risk of using outpatient service (P < 0.05). NRCMS/URBMI enrollment was also associated with higher likelihood of incurring CHE compared to UEBMI enrollment (OR = 2.02, P < 0.05); in stratified analysis of the rural and urban sample this effect was only significant for the rural population.ConclusionsThe rural population in Jiangsu perceived more healthcare needs, had a higher probability of using both informal and formal healthcare services, and had more OOP health expenditure and a higher likelihood of incurring CHE. The inequity mainly exists in health care financing, and may be partially addressed through improving the benefit packages of NRCMS/URBMI.

Neighborhood Poverty and Pediatric Intensive Care Use.

Disparities in health service use have been described across a range of sociodemographic factors. Patterns of PICU use have not been thoroughly assessed. This was a population-level, retrospective analysis of admissions to the Cincinnati Children's Hospital Medical Center PICU between 2011 and 2016. Residential addresses of patients were geocoded and spatially joined to census tracts. Pediatric patients were eligible for inclusion if they resided within Hamilton County, Ohio. PICU admission and bed-day rates were calculated by using numerators of admissions and bed days, respectively, over a denominator of tract child population. Relationships between tract-level PICU use and child poverty were assessed by using Spearman's ρ and analysis of variance. Analyses were event based; children admitted multiple times were counted as discrete admissions. There were 4071 included admissions involving 3129 unique children contributing a total of 12 297 PICU bed days. Child poverty was positively associated with PICU admission rates (r = 0.59; P < .001) and bed-day rates (r = 0.47; P < .001). When tracts were grouped into quintiles based on child poverty rates, the PICU bed-day rate ranged from 23.4 days per 1000 children in the lowest poverty quintile to 81.9 days in the highest poverty quintile (P < .001). The association between poverty and poor health outcomes includes pediatric intensive care use. This association exists for children who grow up in poverty and around poverty. Future efforts should characterize the interplay between patient- and neighborhood-level risk factors and explore neighborhood-level interventions to improve child health.

Integrated Case Management: Does It Reduce Health Service Disparities Across African American and White Medicaid Beneficiaries?

Evidence of persistent racial and ethnic disparities in health service use is substantial. Even among Medicaid beneficiaries, minority individuals may have lower use of specific health services relative to Whites due to varying degrees of trust in the health system, beliefs about the usefulness of medical treatment, provider stereotyping, or geographic service availability. Prior research demonstrated that a Florida Medicaid disease management program led to reductions in service disparities between Whites and African Americans. We study a Medicaid Integrated Case Management program implemented in Virginia, which shares disease management program objectives but can be applied to a broader range of patients. Two versions of the program are assessed, the latter of which incorporated more patient-focused and targeted approaches in identifying client needs and structuring patient interaction. Both versions of the program were associated with reductions in disparities, especially for physician services and when more targeted, patient-centered approaches were adopted.