Access to Home and Community Health Services for Older Adults With Serious, Life-Limiting Illness: A Study Protocol

Hill, Jacob; Cuthel, Allison; Grudzen, Corita

doi:10.1177/1049909120920230

Cited by 4 publications

(3 citation statements)

References 31 publications

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“…In terms of contextual characteristics, service quality index of the community was the signi cant in uencing factor. As highlighted by other researchers [33,34], the health services of community are becoming increasingly important, and our study suggested that attention should be paid to the relationship between the community and health services utilization, considering the heterogeneity of different dimensions. In terms of individual characteristics, signi cant in uencing factors included educational attainment, income quantiles, self-assessed health, BMI, place of work, self-assessed health and the number of friends.…”

Section: Discussionmentioning

confidence: 59%

Decomposing Differences in Health Service Utilization between Older Rurul-to-Urban Migrant Workers and Older Rural Residents：What is Driving the Differences?

Zhang

2021

Preprint

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Background: In recent years, the widening gap of health service utilization between different groups in mainland China has become an important issue that cannot be avoided. Yet the related study on the health services utilization for older rural-to-urban migrant workers and comparative study on older rural-to-urban migrants in China is still in its infancy. Our study explored the health service utilization of the older rural-to-urban migrant workers based on a sinicization of the latest Andersen model, by comparison with the older rural dwellers. Further, our study revealed the facets and causes by decomposing the differences in the health service utilization into determinants.Methods: The data of China Labor-Force Dynamic Survey in 2016, the data of Urban Statistical Yearbook in 2016, and Statistical Bulletin were used. Our study applied the lasted Andersen Model according to China's currency situation. Before we studied the health service utilization, we used Coarsened Exact Matching to control the confounding factors to enhance the comparability of the two groups. The matched data were used to analyze the influencing factors. Fairlie decomposition method was used to analyze the differences and the sources of health service utilization between older rural-to-urban migrant workers and their rural counterparts.Results: After matching, the probability of two weeks outpatient of older rural-to-urban migrant workers (5.59%) was significantly lower than older rural dwellers (7.57%). The probability of inpatient of older rural migrant workers (5.59%) was significantly lower than older rural dwellers (9.07%). 17.98% of the total difference of two weeks outpatient utilization was due to the observed influence factors. 71.88% of the total difference of inpatient utilization was due to the observed influence factors. Income quantiles (49.57%), self-assessed health (80.91%), and sex ratio in the community (-102.29%) were significant in the differences of inpatient utilization.Conclusions: The findings have important implications for the difference in the health services utilization between older rural-to-urban migrant workers and older rural residents in China, urging the government to take full account of the heterogeneity. The results provide references for the healthcare policy reform in the process of active ageing in China.

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Section: Discussionmentioning

confidence: 59%

Decomposing Differences in Health Service Utilization between Older Rurul-to-Urban Migrant Workers and Older Rural Residents：What is Driving the Differences?

Zhang

2021

Preprint

View full text Add to dashboard Cite

show abstract

“…As highlighted by several researchers [38,39], the health services in a community are becoming increasingly important, and our study suggested that attention should be paid to the relationship between the community and health service utilization, considering the heterogeneity of different dimensions. In terms of individual characteristics, significant influencing factors included educational attainment, income quantiles, self-assessed health, BMI, place of work, SAH, and the number of friends.…”

Section: Discussionmentioning

confidence: 80%

Determinants of Differences in Health Service Utilization between Older Rural-to-Urban Migrant Workers and Older Rural Residents: Evidence from a Decomposition Approach

Yang

Zhai

et al. 2022

IJERPH

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Background: The widening gap in health service utilization between different groups in mainland China has become an important issue that cannot be avoided. Our study explored the existence of differences and the causes of the differences in the health service utilization of older rural-to-urban migrant workers in comparison to older rural dwellers. Further, our study explored socioeconomic differences in health service utilization. Methods: The data from the China Labor-Force Dynamic Survey in 2016, the data from the Urban Statistical Yearbook in 2016, and the Statistical Bulletin were used. Our study applied the latest Andersen Model according to China’s current situation. Before we studied health service utilization, we used Coarsened Exact Matching to control the confounding factors. After matching, 2314 respondents were successfully matched (859 older rural-to-urban migrant workers and 1455 older rural dwellers). The Fairlie decomposition method was used to analyze the differences and the sources of health service utilization between older rural-to-urban migrant workers and their rural counterparts. Results: After matching, the probability two-weeks outpatient for older rural-to-urban migrant workers (5.59%) was significantly lower than older rural dwellers (7.57%). The probability of inpatient for older rural-to-urban migrant workers (5.59%) was significantly lower than older rural dwellers (9.07%). Overall, 17.98% of the total difference for two-week outpatient utilization was due to the observed influence factors. Moreover, 71.88% of total difference in inpatient utilization was due to the observed influence factors. Income quantiles (49.57%), health self-assessments (80.91%), and the sex ratio in the community (−102.29%) were significant in the differences in inpatient utilization. Conclusions: The findings provide important insights into the socioeconomic differences in health service utilization among older rural-to-urban migrant workers and older rural residents in China. These insights urge the government to take full account of the heterogeneity in designing health security system reform and public health interventions targeting vulnerable groups.

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“…We collected information on 1) familiarity with local HCS, 2) helpful and desired HCS services, 3) provideridentified barriers and facilitators to HCS, and 4) procedures involved when referring to HCS. This study is a sub-project of a national multi-site, pragmatic, cluster-randomized steppedwedge trial titled Primary Palliative Care for Emergency Medicine (PRIM-ER) [15,16].…”

Section: Introductionmentioning

confidence: 99%

Emergency provider perspectives on facilitators and barriers to home and community services for older adults with serious life limiting illness: A qualitative study

et al. 2022

Self Cite

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Background Older adults account for a large proportion of emergency department visits, but those with serious life-limiting illness may benefit most from referral to home and community services instead of hospitalization. We aim to document emergency provider perspectives on facilitators and barriers to accessing home and community services for older adults with serious life-limiting illness. Methods We conducted interviewer-administered semi-structured interviews with emergency providers from health systems across the United States to obtain provider perspectives on facilitators and barriers to accessing home and community services. We completed qualitative thematic analysis using an iterative process to develop themes and subthemes to summarize provider responses. Results We interviewed 8 emergency nurses and 10 emergency physicians across 11 health systems. Emergency providers were familiar with local home and community services. Facilitators to accessing these services include care management and social workers. Barriers include services that are not accessible full-time to receive referrals, insurance/payment, and the busy nature of the emergency department. The most helpful reported services were hospice, physical therapy, occupational therapy, and visiting nursing services. Home-based palliative care and full-time emergency department-based care management and social work were the services most desired by providers. Providers expressed support for improving access to home and community services in the hopes of decreasing unnecessary emergency visits and inpatient admissions, and to provide patients with greater options for supportive care. Conclusion Obtaining the perspective of emergency providers highlights important considerations to accessing HCS for older-adults with serious life-limiting illness from the emergency department. This study provides foundational information for futures studies and initiatives for improving access to home and community services directly from the emergency department.

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Access to Home and Community Health Services for Older Adults With Serious, Life-Limiting Illness: A Study Protocol

Cited by 4 publications

References 31 publications

Decomposing Differences in Health Service Utilization between Older Rurul-to-Urban Migrant Workers and Older Rural Residents：What is Driving the Differences?

Decomposing Differences in Health Service Utilization between Older Rurul-to-Urban Migrant Workers and Older Rural Residents：What is Driving the Differences?

Determinants of Differences in Health Service Utilization between Older Rural-to-Urban Migrant Workers and Older Rural Residents: Evidence from a Decomposition Approach

Emergency provider perspectives on facilitators and barriers to home and community services for older adults with serious life limiting illness: A qualitative study

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