Health Care Usage Patterns Research Articles

Churn in Supplemental Nutrition Assistance Program: Changes in Medicaid Expenditure and Acute Care Utilization.

The Supplemental Nutrition Assistance Program (SNAP) provides financial assistance to low-income individuals and families to help them purchase food. However, when participants experience short-term disenrollment from the program, known as churn, it can disrupt their health care usage patterns or result in acute health care needs due to the loss of financial benefits and time burden required to reapply for SNAP. The objective of this study was to examine the changes in health care expenditures and acute care utilization during periods of SNAP churn compared with nonchurn periods among those who churn during the study period. Longitudinal analysis of Pennsylvania Medicaid claims data for enrollees participating in SNAP between 2016 and 2018 using individual fixed-effects models. We add to the literature by estimating whether these changes varied based on the amount of SNAP benefit lost, or differed between adults and children. We found that SNAP churn was associated with reductions in pharmacy and primary care spending across all SNAP benefit levels and age groups. Specifically, our findings indicate a reduction of 4%-6% in pharmacy expenditures for adults and 2%-4% for children. Moreover, there was a 3%-4% decrease in primary care expenditures for adults and a 4%-6% decrease for children. Acute care utilization did not significantly change during a SNAP churn period. Our findings of decreases in pharmacy and primary care spending suggest that preventing SNAP churn may help reduce instances where adult and child participants forgo necessary care.

Care Delivery in Cancer Patients With Asymptomatic COVID-19 Infection in a Tertiary, Safety-Net Hospital in Houston, Texas.

Objectives:Current coronavirus disease 2019 (COVID-19) guidelines recommend delaying clinical care for all affected cancer patients, including incidentally diagnosed asymptomatic infections. This retrospective study conducted in a safety-net hospital in Houston examines the care delivery of asymptomatic COVID-19 cancer patients and how their diagnosis affected their care.Methods:A retrospective chart review was conducted on cancer patients with a documented positive SARS-CoV-2 laboratory result in the Harris Health System in Houston, Texas. Patient demographics, treatment delays, and patient outcomes were analyzed.Results:Thirteen percent (n=24) of all patients with cancer and COVID-19 diagnosis (n=181) were asymptomatic and 96% had a solid organ malignancy. Among asymptomatic patients, 44% (n=11) of them experienced a median treatment delay of 33 days and 21% (n=5) transitioned to hospice. No patients had progression of disease at first evaluation after recovering from COVID-19 diagnosis. Asymptomatic patients were more likely to have a worse ECOG performance status, metastatic disease, and charity insurance as compared with symptomatic patients.Conclusions:This study supports the safety of our current isolation guidelines for all COVID-19 asymptomatic cancer patients. While treatment delays occurred, they did not appear to significantly impact overall care. Differences in care delivery and health care usage patterns between symptomatic and asymptomatic patients demonstrate the need for continued studies in vulnerable populations.

Early Life RSV: Can Vaccines Help Fix Societal Ills?

* Abbreviations: LRI — : lower respiratory infection RSV — : respiratory syncytial virus SDOH — : social determinants of health During this pandemic, the impact of health disparities on mortality due to COVID-19 has been high among our concerns about this illness.1–4 Unfortunately, disparities related to respiratory infections are not limited to COVID-19. There are decades of research revealing that morbidity and mortality are strongly influenced by the social determinants of health (SDOH). Respiratory syncytial virus (RSV) is the leading cause of lower respiratory infection (LRI) in infants and a major cause of hospitalization in the first 2 years of life.5–7 In this issue of Pediatrics , Fitzpatrick et al8 report on the impact of sociodemographic and psychosocial factors on the risk for RSV hospitalization in children <3 years of age in Ontario, Canada. The authors used linked sociodemographic and health administrative data sets covering the period from 2012 to 2018 to identify factors associated with hospitalization. Their findings reveal the increased risk of hospitalization associated with maternal characteristics consistent with social vulnerability, including younger age, involvement with the criminal justice system, and mental health problems or addiction. The use of low-income drug benefits, a measure of socioeconomic status, was also associated with RSV hospitalization, as was an area level measure of income showing an increased risk of hospitalization with the lowest two quartiles of income. In their study, Fitzpatrick et al8 reinforce the important, enduring, and widespread influence of SDOH on our youngest patients. These … Address correspondence to Mary T. Caserta, MD, Department of Pediatrics, University of Rochester Medical Center, Golisano Children’s Hospital at Strong, 601 Elmwood Ave, Box 690, Rochester, NY 14642. E-mail: mary_caserta{at}urmc.rochester.edu

Health-seeking cultural patterns in the use of available healthcare services among refugee groups in south-central Kentucky

Purpose Refugees resettle in the USA every year to escape genocide, famine, civil wars and crises in their countries. The diverse cultural identities of the refugee population in south-central Kentucky make it essential to research into their health-care usage patterns. The purpose of this study is to examine the health-seeking patterns of refugees in relation to their culture and the usage of available health services. Design/methodology/approach This is a descriptive correlational study that culled 110 refugees who completed self-administered or interviewer-administered semi-structured questionnaires. Questionnaires were translated into four different languages. T-tests and ANOVA assessed differences between variables. Findings Findings indicate that a demographic factor such as refugees’ nationality plays a role in both the access and use of health services [F (5, 98) = 4.29, p &lt; 0.001]. Refugees’ beliefs and social factors such as acculturation (t = −2.03, p &lt; 0.04) and having health insurance (t = −3.35, p &lt;0.001) also affect the use of health services. The level of cultural competency of the health-care facility or provider as depicted by the presence of interpreters (t = 1.92, p &lt; 0.05) was associated with increased use of the health services provided. Research limitations/implications The sample of refugees is only representative of the general refugee population in south-central Kentucky; hence, there is inadequate generalization. Originality/value Cultural diversity should be included in the health and policymaking debates that surround the refugee population of south-central Kentucky to ensure their well-being.

Current status and direct medical cost of amyotrophic lateral sclerosis in the region of Catalonia: A population-based analysis.

IntroductionAmyotrophic lateral sclerosis is a neurodegenerative disease that leads to motor weakness. There is no cure, and treatment focuses on slowing down progression, which is achieved by a multidisciplinary approach. Hence, it is vital to understand the population needs for an optimal management of the disease.ObjectivesTo evaluate the current status of amyotrophic lateral sclerosis in the region of Catalonia, how the disease is managed and its direct medical costs.MethodsRecords corresponding to 841 patients diagnosed between the year 2007 and 2017 were analysed in a retrospective population-based study, including data from primary care centres, hospitals (inpatient and outpatient care), extended care facilities and mental health centres.ResultsMean diagnosis age was 66.11 years (SD = 12.61) and 52.79% of admitted patients were males. On average, 14.91 months elapsed between diagnosis and death, and the mean age of death was 72.64 years (SD = 12.00). Patients were admitted 10.70 times per year, mostly into primary care (86.50%), although most expenses were concentrated in hospital inpatient care. The mean cost per patient per year was €1,168. The 83.24% of patients had more than 4 systems affected by chronic conditions.ConclusionsPrimary care is of utmost importance in ALS attention in Catalonia, which may have a direct impact in reducing hospitalisation costs. Nonetheless, the expenses linked to inpatient care represent the biggest portion of total costs. Patients’ healthcare usage patterns and the high proportion of patients with multiple chronic conditions should be taken into account in order to adapt and improve guidelines and healthcare systems.

Health Care Use and Status Among Abused Young People

BackgroundChildhood abuse negatively affects young people's health. Little is known about its effect on health care usage patterns or on perception of health status during a life stage when learning to use care independently is a key developmental task. ObjectivesIn nonclinical study settings, abuse has been found to be associated with disorganized use of care and perceived poorer health. Our objective was to determine whether abused youth receiving health care had similar outcomes. MethodsThis observational study, conducted between December 5, 2005 and April 13, 2007, screened for childhood abuse in 532 young people seeking services at a primary care clinic. The setting was a New York City young people's free health clinic. Participants were aged 12-24 years, recruited during a visit, mostly female (86%), Latino or black (94%), and currently in school or college (79%). Exclusions included not being fluent in English or having difficulty understanding the study/consent process. ResultsHealth care use (routine vs urgent care) in the prior 12 months and perceived health status were measured using the Health Service Utilization Scale. Potential demographic covariates were controlled for, as was depression (using the Beck Depression Inventory for Primary Care—Fast Screen). A total of 54% disclosed abuse. Compared with those who were not abused, those reporting sexual abuse had 1.4 times greater odds of choosing both urgent and routine care over routine care only. Those reporting any type of abuse had lower odds of selecting urgent care only over routine care. No association was found between childhood abuse and perceived health status. ConclusionsIn contrast to studies conducted among youth in nonclinic settings, in this study childhood abuse was not associated with health care usage patterns or with poorer perception of health. Further research is needed regarding the impact receiving health care has on perceived health and health care use in abused youth. Annals of Global Health 2017;0:000-000

An Analysis of the Usage Patterns of Health Services Funded through Capitation and Non-Capitation in Government Owned Primary Healthcare Facilities in The District of Pandeglang

Abstract. The National Health Insurance (JKN) is basically a form of managed care, a technique that integrates health costing and service quality through cost control and quality control. In that concept, the Puskesmas acts as the government’s primary healthcare facility, its vanguard. The aim of this research is to discover and analyze the healthcare usage patterns funded by capitation and non-capitation in government primary healthcare facilities (FKTP). This was an analytical study utilizing a cross-sectional design. 615 patients visiting the government’s FKTP were involved in this research. The results indicated that 47.3% of patients utilizing the government’s FKTP at Pandeglang district were JKN funded, while 52.7% were not funded by the JKN. 66.7% were funded by capitation methods and 33.3% used non-capitation funding. More JKN recipients access non-capitation healthcare than non-recipients. The factors that are related with the type of healthcare accessed are the patient’s health status, JKN status, and ability to pay. Keywords: JKN, utilization, Pandeglang, capitation

The relationship between variations in cesarean delivery and regional health care use in the United States

Cesarean delivery rates vary widely across the United States. Health care usage in many other areas of medicine also varies widely across the United States; it is unknown whether the variation in cesarean delivery rates across US communities is correlated with this broader underlying variation in health care usage patterns. The purpose of this study was to determine whether the variation in cesarean delivery rates across US communities is correlated with other measures of health care usage in that community. We performed a population-based observational study that combined multiple national data sources, which included 2010 birth certificate data and Medicare claims data. Cesarean delivery rates in each US community, as defined by the Hospital Service Area, Medicare total spending per beneficiary, and hospital days in the last 6 months were calculated. Cesarean delivery and Medicare spending were on different patient populations; the Medicare variables were used to characterize the broader health care usage and spending pattern of that community. We examined the relationship between a community's cesarean delivery rates and these measures of health care usage using Pearson correlation coefficients. We also stratified by quartile of Medicare spending and hospital use in the last 6 months of life and calculated the cesarean delivery rates per quartile, adjusting for underlying differences in patient characteristics, demographics, hospital structure, and the malpractice environment using a least-squared means method. We compared the amount of variation in cesarean delivery rates across communities that could be explained by differences in health care usage patterns to the amount of variation that was explained by other factors using the R-squared from multivariable models. Cesarean delivery rates varied from 4-65% across communities in the United States. Cesarean delivery rates were correlated positively with total Medicare spending (r= 0.48; P < .001) and hospital use in the last 6 months of life (r= 0.45; P < .001). Similar variation was seen in nulliparous women with a term fetus in vertex presentation (nulliparous, term, singleton, vertex cesarean deliveries), which is a common subset used for analysis of cesarean delivery rates. Communities in the lowest quartile of Medicare spending had the lowest rates of cesarean delivery (29.1% vs 35.7% in the highest quartile; P < .001 for differences across quartiles), which is a difference that persisted after adjustment (29.5% vs 31.8%; P < .001). Similar results were seen for nulliparous, term, singleton, vertex cesarean deliveries and when data were stratified by hospital days in the last 6 months of life. Overall, 28.6% of the total variation in cesarean delivery rates was explained by differences in health care usage patterns, as compared with 16.6% by differences in obstetric procedures, 7.9% by hospital structure, and 2.3% by variations in the malpractice environment. Of the 56.3% of variation that was unexplained by differences in patient characteristics and area demographics, 8.2% could be accounted for by differences in health careusage patterns, as compared with 4.6% by differences in obstetric procedures, 2.1% by hospital structure, and 1.2% by variation in the malpractice environment. Cesarean delivery rates vary widely across US communities; this variation is correlated broadly with the variation that is seen in other measures of health care usage across US communities.

Patterns of Health Care Usage in the Year Before Suicide: A Population-Based Case-Control Study

ObjectiveTo compare the type and frequency of health care visits in the year before suicide between decedents and controls. Patients and MethodsCases (n=86) were Olmsted County, Minnesota, residents whose death certificates listed “suicide” as the cause of death from January 1, 2000, through December 31, 2009. Each case had 3 age- and sex-matched controls (n=258). Demographic, diagnostic, and health care usage data were abstracted from medical records. Conditional logistic regression was used to analyze differences in the likelihood of having had psychiatric and nonpsychiatric visits in the year before death, as well as in visit types and frequencies 12 months, 6 months, and 4 weeks before death. ResultsCases and controls did not significantly differ in having had any health care exposure (P=.18). Suicide decedents, however, had a significantly higher number of total visits in the 12 months, 6 months, and 4 weeks before death (all P<.001), were more likely to have carried psychiatric diagnoses in the previous year (odds ratio [OR], 8.08; 95% CI, 4.31-15.17; P<.001), and were more likely to have had outpatient and inpatient mental health visits (OR, 1.24; 95% CI, 1.05-1.47; P=.01 and OR 6.76; 95% CI, 1.39-32.96; P=.02, respectively). Only cases had had emergency department mental health visits; no control did. ConclusionGiven that suicide decedents did not differ from controls in having had any health care exposure in the year before death, the fact alone that decedents saw a doctor provides no useful information about risk. Compared with controls, however, decedents had more visits of all types including psychiatric ones. Higher frequencies of health care contacts were associated with elevated suicide risk.

Parental Preferences Regarding Outpatient Management of Children with Congenital Heart Disease.

The objective of this study was to identify patterns of health care usage among children with congenital heart disease (CHD) and determine predictors for contacting cardiologists for routine care. Parents of children with CHD completed surveys, indicating which provider they would contact first for 12 concerns. Predictors for preference for cardiologist evaluation were identified by multivariable logistic regression. Surveys were completed by 307 of 925 (33.2%) parents. Median patient age was 9.4 years [interquartile range (IQR) 5.1-14.4 years] with a median of 1 cardiac surgery (IQR 1-3). Most parents agreed primary care physicians (PCPs) could identify problems related to CHD (70.0%) and when to refer to cardiologists (89.6%). More felt PCPs best understood their values (63.2 vs. 29.6%, P < 0.001) and were more accessible (63.5 vs. 33.6%, P < 0.001) than cardiologists. Parents preferred first evaluation by PCPs for 9 of 12 concerns. Preference for cardiology evaluation was independently associated with the number of cardiac catheterizations [adjusted odds ratio (AOR) for ≥2 catheterizations 2.4, 95% confidence interval (CI) 1.1-4.9], belief the cardiologist better knew the child's medical history (AOR 2.4, 95% CI 1.3-4.6), and provider accessibility (AOR 3.6, 95% CI 1.8-7.4). Parents of CHD patients reported close alignment with PCPs and would contact PCPs first for most routine care. However, some populations continue to contact cardiologists for routine care. Further study is needed to clarify best practices for clinician and parent education.

How can healthcare services for female sex workers be better tailored to meet their health needs?

Governmental sex work strategies call for a holistic approach to specialist services for female sex workers (FSWs), but it is unclear how this will be achieved when the responsibility of...

Healthcare and disability service utilization in the 5-year period following transport-related traumatic brain injury

Primary objective: To describe the type, intensity and direct cost of healthcare and disability services used following transport-related traumatic brain injury (TBI).Methods and procedures: Using the transport accident compensation regulator database, claims records were examined of 423 cases of adult (18–65 years of age) transport-related TBI occurring between 1 January 1995 and 31 December 2004. Claimants were stratified by TBI severity using the Glasgow Coma Scale (GCS) score. Service utilization and costs were examined by TBI severity in the 5-year period post-injury.Main outcomes and results: Claimants accessed a total of 409 740 services. Claimants with severe TBI accessed more medical (median 333 per claimant) and paramedical services (median 436 per claimant) than claimants with mild and moderate TBI. Almost 60% of claimants with severe TBI accessed attendant care services compared to 39% and 45% of claimants with moderate and mild TBI, respectively. Average total costs of services were highest among claimants with severe TBI (AUD $324 515 per claimant).Conclusions: Healthcare service utilization and the economic burden of TBI are substantial. Injury compensation data provides a unique opportunity to explore patterns of healthcare usage post-injury, which is important for the planning and management of resources.

New approaches to spatially analyse primary health care usage patterns in rural South Africa.

To develop indices to quantitatively assess and understand the spatial usage patterns of health facilities in the Hlabisa district of South Africa. We mapped and interviewed more than 23 000 homesteads (approximately 200 000 people) in Hlabisa district, South Africa and spatially analysed their modal primary health usage patterns using a geographical information system. We generated contour maps of health service use and quantified the relationship between clinic catchments and distance-defined catchments using inclusion and exclusion error. We propose the distance usage index (DUI) as an overall spatial measure of clinic usage. This index is the sum of the distances from clinic to all client homesteads divided by the sum of the distances from clinic to all homesteads within its distance-defined catchment. The index encompasses inclusion, exclusion, and strength of patient attraction for each clinic. Eighty-seven per cent of homesteads use the nearest clinic. Residents of homesteads travel an average Euclidean distance of 4.72 km to attend clinics. There is a significant logarithmic relationship between distance from clinic and their use by homesteads (r(2)=0.774, P < 0.0001). The DUI values range between 31 and 198% (mean=110%, SD=43.7) for 12 clinics and highlight clinic usage patterns across the district. The DUI is a powerful and informative composite measure of clinic usage. The results of the study have important implications for health care provision in developing countries.

Declining incidence of episodes of asthma: a study of trends in new episodes presenting to general practitioners in the period 1989–98

BACKGROUNDA study was undertaken to determine trends in the incidence of new episodes of asthma presented to general practitioners participating in the Weekly Returns Service of the Royal College of...

Demographic characteristics and primary health care utilization patterns of strictly orthodox Jewish and non-Jewish patients

The importance of providing health care services that are acceptable to different cultural groups is widely acknowledged. Strictly orthodox Jewish communities have particular health care needs that reflect their religious teaching and beliefs. To describe the demographic characteristics and health care usage patterns of the strictly orthodox Jewish population of Gateshead. Registration and claims data were used in combination with encounter data from computerized and manual practice records. Jewish patients were identified and comparisons made between Jewish and non-Jewish populations registered at the same practices. The orthodox Jewish population was predominantly young (69% aged under 20). The birth rate in orthodox Jewish women aged 20-44 was much higher (294 per 1000) than non-Jewish women. Rates of uptake of cervical screening and childhood immunizations were significantly lower in the orthodox Jewish population. Uptake of breast screening and attendance at diabetic clinics did not differ significantly. The average number of consultations and home visits per annum was higher in Jewish than in non-Jewish patients. The demographic and health care utilization patterns of orthodox Jewish and non-Jewish patients in Gateshead are different. There are implications for the provision of primary care services, particularly with regard to preventative health care.

AIDS deaths shift from hospital to home. AIDS Mortality Project Group.

This study monitors trends in place of death among persons with acquired immunodeficiency syndrome (AIDS) as a measure of health care usage patterns and terminal health care among persons infected with human immunodeficiency virus (HIV). Sixteen health departments collected death certificates for 55,186 persons with AIDS whose deaths occurred through 1991. Place of death was categorized as hospital, residence, hospice or nursing home, and other. The percentage of AIDS deaths at hospital facilities decreased from 92% in 1983 to 57% in 1991. In 1988, 23% of deaths occurred at home or in hospices and nursing homes. This trend was more evident among men, Whites, and men who had sex with men; less so among persons with other modes of exposure; and not at all among injecting drug users and children with perinatally acquired AIDS. Place of death varied by geographic location, with the greatest percentage of hospital deaths in the Northeast (91%) and the greatest percentage of at-home deaths in the West (27%). The percentage of AIDS deaths at home or in hospices and nursing homes has increased since 1983. These trends may reflect changes in hospital use for end-stage HIV infection. Decreasing hospitalization and increasing outpatient services and home care will decrease costs and may allow HIV-infected persons improved social support.