Changes in Hospitalizations at US Safety-Net Hospitals Following Medicaid Expansion

Lasser, Karen E.; Liu, Zhixiu; Lin, Meng‐Yun; Hanchate, Amresh

doi:10.1001/jamanetworkopen.2021.14343

Cited by 15 publications

(11 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The PTSD prevalence in this sample is much higher than rates found from epidemiological studies [2], but is similar to other populations of youth who receive primary care services in US safety net hospitals or federally qualified health centers [44] which provide healthcare to individuals regardless of their insurance status or ability to pay, and serve a higher proportion of patients who are racial/ethnic minorities, non-English speaking, uninsured, underinsured, undocumented, or lowincome [45][46][47]. Our study sample was more than 60% Black or African-American and more than 21% Hispanic or Latino, which mirrors the overall BMC pediatric primary care clinic population.…”

Section: Discussionsupporting

confidence: 54%

Development and pilot testing of a five item traumatic stress screener for use with adolescents in pediatric primary care

Oblath

Brigham

et al. 2022

Child Adolesc Psychiatry Ment Health

View full text Add to dashboard Cite

Background Almost 80% of adolescents in the US have experienced a traumatic event, and approximately 7% have post-traumatic stress disorder. However, there is a lack of validated and feasible assessments for assessing traumatic stress symptoms in pediatric primary care, and traumatic stress symptoms are routinely unidentified. This study aimed to develop, pilot test, and assess the psychometric properties of the Adolescent Primary Care Traumatic Stress Screen (APCTSS), a five-item yes/no screener for post-traumatic stress symptoms in adolescents designed for use in pediatric primary care. Methods The APCTSS was developed by pediatricians, psychiatrists, psychologists, and social workers who all provide care to trauma-affected adolescent patients. The providers sought to create a developmentally appropriate tool that accurately reflected DSM-5 posttraumatic stress symptoms and that was feasible and acceptable for use in pediatric primary care. To develop the APCTSS, they combined and adapted the UCLA Post-traumatic Stress Disorder (PTSD) Reaction Index for DSM-5 with the adult Primary Care PTSD Screen for DSM-5. Next, 213 adolescent medicine patients were universally approached during routine clinic visits and 178 agreed to participate and were enrolled. The 178 patients were aged 13-22 (M=18.4, SD=2.3), 64.4% female; 62.1% Black or African-American, and 20.7% Hispanic/Latinx. Patients completed APCTSS, Patient Health Questionnaire for Adolescents (PHQ-A), and the Child PTSD Symptom Scale for DSM-5 Interview (CPSS-5-I), and 61 completed the Traumatic Events Screening Inventory for Children (TESI-C). Results 56.7% reported a criterion A trauma, 30.1% met criteria for DSM-5 PTSD, 7.4% met criteria for subsyndromal PTSD symptoms, and 19.0% for post-event impairing symptoms. Validity and reliability testing indicated that the APCTSS was internally consistent, had good concurrent and discriminant validity, and demonstrated good sensitivity and specificity in identifying adolescents at high risk for post-trauma symptoms. Over half of patients (56.0%) who screened positive on the APCTSS (score ≥2) would not have been identified as having a mental health concern using the PHQ-A, including 60.8% of patients who had probable PTSD, subsyndromal PTSD, or post-event impairing symptoms. Conclusions Many youth with trauma-related mental health symptoms are unidentified in pediatric primary care, which is a missed opportunity for early identification and may contribute to a host of poor outcomes. The development of an effective and feasible traumatic stress screening tool for youth primary care may improve early intervention, and the health and well-being of trauma affected youth.

show abstract

Section: Discussionsupporting

confidence: 54%

Development and pilot testing of a five item traumatic stress screener for use with adolescents in pediatric primary care

Oblath

Brigham

et al. 2022

Child Adolesc Psychiatry Ment Health

View full text Add to dashboard Cite

show abstract

“…The PTSD prevalence in this sample is much higher than rates found from epidemiological studies (Merikangas et al, 2010), but is similar to other populations of youth who receive primary care services in safety net hospitals or federally qualified health centers (Selwyn et al, 2019) which serve a higher proportion of patients who are racial/ethnic minorities, non-English speaking, uninsured, underinsured, undocumented, or low-income (Gaskin & Hadley, 1999; Lasser et al, 2021; Nath et al, 2016). Our study sample was more than 60% Black or African-American and more than 21% Hispanic or Latino, which mirrors the overall BMC pediatric primary care clinic population.…”

Section: Discussionsupporting

confidence: 53%

Development and Pilot Testing of a Five Item Traumatic Stress Screener for Use with Adolescents in Pediatric Primary Care

Oblath

Brigham

et al. 2022

Preprint

View full text Add to dashboard Cite

ObjectivesTo develop and assess the psychometric properties of the Adolescent Primary Care Traumatic Stress Screen (APCTSS), a five-item yes/no screener for PTSD symptoms in adolescents, and the first developed for pediatric primary care.Study DesignThe APCTSS was developed by combining and adapting the UCLA PTSD Reaction Index for DSM-5 with the adult Primary Care PTSD Screen for DSM-5. Adolescent medicine patients were universally approached during clinic visits. With a response rate of 83.6%, 178 patients aged 13-22 (M=18.4, SD=2.3), 64.4% female; 62.1% Black or African-American and 20.7% Hispanic/Latinx, were enrolled. Patients completed APCTSS, Patient Health Questionnaire for Adolescents (PHQ-A), and Child PTSD Symptom Scale for DSM-5 Interview (CPSS-5-I), and 61 completed the Traumatic Events Screening Inventory for Children (TESI-C).Results56.7% reported a criterion A trauma, 30.1% met criteria for PTSD, 7.4% met criteria for subsyndromal PTSD, and 19.0% for post-event impairing symptoms. Scores ≥ 2 on the APCTSS optimized sensitivity (.79; 95% CI=.66 to .89) and specificity (.68; 95% CI=.55 to .76) for PTSD, with an area under the curve (AUC) of .79. Sensitivity (.86; 95% CI=.65 to .90), specificity (.77; 95% CI=.60 to .90), and AUC (.86) were even stronger when the TESI-C was used to assess criterion A for PTSD diagnosis. Over half (56.0%) of patients who screened positive on the APCTSS were missed by the PHQ-A.ConclusionsThe APCTSS shows promise as an internally consistent, valid, and effective tool for identifying adolescents at high risk of PTSD and traumatic stress.

show abstract

“…This suggests that within-hospital racial disparities may be particularly problematic at facilities that disproportionately serve racial and ethnic minority groups. These wider within-hospital racial disparities at safety net facilities likely represent the multifactorial effects of structural racism—Black and Hispanic pregnant people are at higher risk for obstetric complications, experience barriers to accessing care, and are more likely to give birth at safety net hospitals that have been subjected to decades of disinvestment and segregation . Further research is needed to understand how to close these racial and ethnic disparities at both structural policy and organizational levels.…”

Section: Discussionmentioning

confidence: 99%

“…These wider within-hospital racial disparities at safety net facilities likely represent the multifactorial effects of structural racism—Black and Hispanic pregnant people are at higher risk for obstetric complications, experience barriers to accessing care, 20 and are more likely to give birth at safety net hospitals that have been subjected to decades of disinvestment 21 and segregation. 22 Further research is needed to understand how to close these racial and ethnic disparities at both structural policy and organizational levels. Previously proposed organization-level interventions include strong clinician team communication and teamwork, bias training for leadership and staff, and targeted education around bias resulting in differential treatment in hospital settings.…”

Section: Discussionmentioning

confidence: 99%

Patient Sociodemographics and Comorbidities and Birth Hospital Characteristics Associated With Postpartum Emergency Department Care

et al. 2023

View full text Add to dashboard Cite

ImportancePostpartum emergency department (ED) visits may indicate poor access to care and risk for maternal morbidity.ObjectivesTo identify patient and hospital characteristics associated with postpartum ED visit rates.Design, Setting, and ParticipantsThis retrospective cohort study used data from the 2014 to 2016 New York State Inpatient Database and State Emergency Department Database. All obstetric discharges from acute care hospitals in New York State from January 1, 2014, through November 15, 2016, were included. Obstetric discharges in the inpatient database were linked to subsequent ED visits by the same patient in the ED database. Data were analyzed from February 2020 to August 2022.ExposuresPatient characteristics assessed included age, race, insurance, home zip code income quartile, Charlson Comorbidity Index score, and obstetric risk factors. Hospital characteristics assessed included safety net status, teaching status, and status as a hospital disproportionally serving racial and ethnic minority populations.Main Outcomes and MeasuresThe primary outcome was any ED visit within 42 days of obstetric discharge. Multilevel logistic regression with 2-level nested mixed effects was used to account for patient and hospital characteristics and hospital-level clustering.ResultsOf 608 559 obstetric discharges, 35 299 (5.8%) were associated with an ED visit within 42 days. The median (IQR) birth hospital postpartum ED visit rate was 6.3% (4.6%-8.7%). The mean (SD) age was 28.4 (9.1) years, 53 006 (8.7%) were Asian patients, 90 675 (14.9%) were Black patients, 101 812 (16.7%) were Hispanic patients, and 275 860 (45.3%) were White patients; 292 991 (48%) were insured by Medicaid, and 290 526 (47.7%) had private insurance. Asian patients had the lowest postpartum ED visit rates (2118 ED visits after 53 006 births by Asian patients [3.99%]), and Black patients had the highest postpartum ED visit rates (8306 ED visits after 90 675 births by Black patients [9.15%]). Odds of postpartum ED visits were greater for Black patients (odds ratio [OR], 1.31; 95% CI, 1.26-1.35; P &lt; .001) and Hispanic patients (OR, 1.19; 95% CI, 1.15-1.24; P &lt; .001) relative to White patients; those with Medicare (OR, 1.55; 95% CI, 1.39-1.72; P &lt; .001), Medicaid (OR, 1.37; 95% CI, 1.34-1.41; P &lt; .001), or self-pay insurance (OR, 1.50; 95% CI, 1.41-1.59; P &lt; .001) relative to commercial insurance; births that occurred at safety net hospitals (OR, 1.43; 95% CI, 1.37-1.51; P &lt; .001) and hospitals disproportionately serving racial and ethnic minority populations (OR, 1.14; 95% CI, 1.08-1.20; P &lt; .001); and births that occurred at hospitals with fewer than 500 births per year (OR, 1.25; 95% CI, 1.14-1.39; P &lt; .001) relative to those with more than 2000 annual births. Adjusted odds of postpartum ED visits were lower after birth at teaching hospitals (OR, 0.82; 95% CI, 0.74-0.91; P &lt; .001) and metropolitan hospitals (OR, 0.74; 95% CI, 0.65-0.85; P &lt; .001).Conclusions and RelevanceThis cohort study found that Black and Hispanic patients experienced higher adjusted odds of postpartum ED visits across all hospital types, particularly at safety net hospitals and those disproportionately serving racial and ethnic minority populations . These findings support the urgent need to mitigate structural racism underlying maternal health disparities.

show abstract

Changes in Hospitalizations at US Safety-Net Hospitals Following Medicaid Expansion

Cited by 15 publications

References 6 publications

Development and pilot testing of a five item traumatic stress screener for use with adolescents in pediatric primary care

Development and pilot testing of a five item traumatic stress screener for use with adolescents in pediatric primary care

Development and Pilot Testing of a Five Item Traumatic Stress Screener for Use with Adolescents in Pediatric Primary Care

Patient Sociodemographics and Comorbidities and Birth Hospital Characteristics Associated With Postpartum Emergency Department Care

Contact Info

Product

Resources

About