Access to Appointments Based on Insurance Status in Washington, D.C.

Blanchard, Janice; Ogle, Kathleen; Thomas, Oluwatoyin; Lung, Derrick; Asplin, Brent R.; Lurie, Nicole

doi:10.1353/hpu.0.0036

Cited by 39 publications

(35 citation statements)

References 17 publications

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“…The high rate of ER visits and hospitalizations among Medicaid-dependent patients might be attributed in part to their relatively poor access to preventive and follow-up care. 2,3 Considered in the context of previous findings, the utilization data from this study, which demonstrate poor access to care among Medicaid patients, highlight the need to improve care across the continuum of preventive, acute, and follow-up care. COPD, chronic obstructive pulmonary disease; ER, emergency room; HF, heart failure.…”

Section: Discussionmentioning

confidence: 55%

“…1 Recent research suggests that these goals are not being met for many publicly insured Americans. [2][3][4][5][6] Medicaid coverage, compared with other insurance types such as commercial or self-pay insurance, has shown an association with poorer access to preventive, acute, and follow-up care. 2,3 The reasons for these discrepancies in care and outcomes based on insurance type are likely multifactorial and could include insufficient funding, sicker patients, and subpar health care providers and organizations.…”

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confidence: 99%

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Quality of Care Associated with Common Chronic Diseases in a 9-State Medicaid Population Utilizing Claims Data: An Evaluation of Medication and Health Care Use and Costs

Priest

Cantrell

Fincham

et al. 2011

Population Health Management

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The objective of this cross-sectional, retrospective study was to utilize claims data to establish a quality-of-care benchmark in a large multistate Medicaid population overall and by race. Quality of care and medication adherence (persistence and compliance) per national treatment guidelines, and health care costs/utilization were assessed across common chronic conditions in a large, 9-state Medicaid population. Overall, quality of care was suboptimal across conditions. Over 15% of asthma patients had 1 asthma-related emergency room/hospital event and 12% of chronic obstructive pulmonary disease patients had a Level II or III exacerbation. Only 36% of depression patients filled any antidepressant medication within 90 days of new episode. Only 45% of diabetes patients received 2 A1c tests. Patients who filled a prescription for any acceptable pharmacotherapy ranged from 35% (depression) to 83% (heart failure [HF]). Persistence for those filling any acceptable medication ranged from 16% (asthma) to 68% (HF). Compliance for patients filling 2 prescriptions ranged from 27% (asthma) to 75% (HF). Blacks had the lowest medication compliance and persistence for all conditions except hyperlipidemia. The results highlight the need to assess and improve quality across the spectrum of care, both overall and by race. (Population Health Management 2011;14:43-54)

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Section: Discussionmentioning

confidence: 55%

mentioning

confidence: 99%

Quality of Care Associated with Common Chronic Diseases in a 9-State Medicaid Population Utilizing Claims Data: An Evaluation of Medication and Health Care Use and Costs

Priest

Cantrell

Fincham

et al. 2011

Population Health Management

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“…Studies have shown that being uninsured or having government-sponsored insurance decreases one’s ability to obtain ambulatory appointments. 33,34 Thus, one possible explanation for our results is that insurance status and low income are related to an inability to access appropriate follow-up care in an outpatient clinic, which leads to a reliance on the ED for nonurgent issues. Although the host institution does have a trauma clinic, during the study period, patients would have to call and make an appointment to schedule follow-up, typically in 1 to 2 weeks after discharge, depending on whether follow-up was indicated.…”

Section: Discussionmentioning

confidence: 88%

Factors Affecting the Likelihood of Presentation to the Emergency Department of Trauma Patients After Discharge

Ladha

Young

et al. 2011

Annals of Emergency Medicine

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Study objective We determine the rate at which trauma patients re-present to the emergency department (ED) after discharge from the hospital and determine whether re-presentation is related to race, insurance, and socioeconomic factors such as neighborhood income level. Methods Trauma patients admitted to a Level I trauma center between January 1, 1997, and December 31, 2007, were identified with the hospital’s trauma registry. These patients were linked to administrative data to obtain information about re-presentation to the hospital. Neighborhood income was obtained with census block data; multiple imputation was implemented to account for missing income data. Logistic regression analysis was used to determine the predictors of re-presentation. Results There were 6,675 patients who were included in the study. A total of 886 patients (13.3%) returned to the ED within 30 days of discharge from the hospital. Uninsured patients (odds ratio [OR]=1.64; 95% confidence interval [CI] 1.30 to 2.06) and publicly insured patients (OR=1.60; 95% CI 1.20 to 2.14) were more likely to re-present to the ED than those with commercial insurance. Residing in a neighborhood with a median household income less than $20,000 was associated with a higher odds of re-presentation (OR=1.77; 95% CI 1.37 to 2.29). Only 13.2% of patients who came to the ED were readmitted to the hospital. Conclusion A substantial number of trauma patients return to the ED within 30 days of being discharged, but only a small proportion of these patients required readmission. Re-presentation is associated with being uninsured or underinsured and with lower neighborhood income level.

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“…One of the reasons for patients with health coverage to use the ED for less-urgent visits may be the need to use after-hour services as well as the inability to get timely appointments at the clinic [24,25]. In this study, we controlled for visits over the weekend when the clinics were closed, but could not control for evening visits during the week.…”

Section: Discussionmentioning

confidence: 99%

Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program

Chiou

Campbell

Horswell

et al. 2009

BMC Health Serv Res

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BackgroundThis study analyzed the likelihood of less-urgent emergency department (ED) visits among type 2 diabetic patients receiving care under a diabetes disease management (DM) program offered by the Louisiana State University Health Care Services Division (LSU HCSD).MethodsAll ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM) Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables.ResultsPatients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c) levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI), gender, prior hospitalization, and the admitting facility showed no effect.ConclusionPatients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further research to understand inappropriate ED use among insured patients is needed. We suggest providing visit reminders, a call centre, or case managers to reduce the likelihood of less-urgent ED visit use among DM patients. By reducing the likelihood of unnecessary ED visits, successful DM programs can improve patient care.

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Access to Appointments Based on Insurance Status in Washington, D.C.

Cited by 39 publications

References 17 publications

Quality of Care Associated with Common Chronic Diseases in a 9-State Medicaid Population Utilizing Claims Data: An Evaluation of Medication and Health Care Use and Costs

Quality of Care Associated with Common Chronic Diseases in a 9-State Medicaid Population Utilizing Claims Data: An Evaluation of Medication and Health Care Use and Costs

Factors Affecting the Likelihood of Presentation to the Emergency Department of Trauma Patients After Discharge

Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program

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