Lack Of Access To Specialists Associated With Mortality And Preventable Hospitalizations Of Rural Medicare Beneficiaries

Johnston, Kenton J.; Wen, Hefei; Maddox, Karen E. Joynt

doi:10.1377/hlthaff.2019.00838

Cited by 120 publications

(124 citation statements)

References 31 publications

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“…General dentists may not routinely provide all dental services, and dental specialists are more likely to practice in higher population density areas that require lengthy travel time for rural residents to access 28,30,31 . This finding that has been replicated among physician specialists, and is associated with worse health outcomes 32 . This is consistent with the lower rate of procedures provided more commonly by dental specialists among rural residents in our sample.…”

Section: Discussionsupporting

confidence: 79%

Variation in dental services by rurality among privately insured adults in the United States

Simon

Ahern

Fox

et al. 2020

J Public Health Dent

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Objectives: Rurality is associated with reduced dental access and worse oral health outcomes. It is unknown whether there is variation in dental services received by rural adults who visit a dentist. Methods: This was a retrospective analysis of claims data from a large private insurer. All individuals who had at least one dental visit in 2018 were included. Patient demographics, whether or not a patient's ZIP code was rural as defined by the Federal Office of Rural Health Policy, as well as ZIP code demographics were collected. Differences in the frequency of dental services received were evaluated using χ 2 tests. Multilevel logistic regressions were used to evaluate the individual and ZIP code-level correlates of receiving a preventive dental procedure, a tooth extraction, or a denture-related dental procedure. Results: Rates of preventive, oral and maxillofacial surgery, and denture-related procedures were higher among rural adults. Accounting for individual age and gender, and ZIP code average income and dentist density, rural dwellers were more likely to receive a preventive procedure [odds ratio (OR) 1.15, P < 0.0001] or tooth extraction (OR 1.08, P < 0.0001), and less likely to have a denturerelated procedure (OR 0.94, P = 0.015) compared to nonrural dwellers. Female gender was the strongest predictor of receiving a preventive procedure (OR 1.30, P < 0.0001). Conclusions: Even among privately insured individuals with known access to dental care, rurality was associated with significant differences in the frequency of various dental procedures. Rural dental patients may have higher needs for oral surgical procedures, even when they have access to preventive care.

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Section: Discussionsupporting

confidence: 79%

Variation in dental services by rurality among privately insured adults in the United States

Simon

Ahern

Fox

et al. 2020

J Public Health Dent

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“…There also appear to be racial disparities in access to specialists. Multiple studies find that regular medical care by specialists in the ambulatory setting is associated with better quality of care, fewer hospitalizations, and lower mortality for individuals with chronic conditions . This does not detract from the value of primary care, but it does indicate reason for concern about a lack of specialist access among socially at‐risk Medicare beneficiaries, many of whom have chronic conditions.…”

Section: Discussionmentioning

confidence: 99%

Patient social risk factors and continuity of care for Medicare beneficiaries

Johnston

Mittler

Hockenberry

2020

Health Services Research

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Objective To identify patient social risk factors associated with Continuity of Care (COC) index. Data Sources/Study Setting Medicare Current Beneficiary Survey (MCBS), the Dartmouth Institute, and Area Resource File for 2006‐2013. Study Design We use regression methods to assess the effect of patient social risk factors on COC after adjusting for medical complexity. In secondary analyses, we assess the effect of social risk factors on annual utilization of physicians and specialists for evaluation and management (E&M). Data Collection/Extraction Methods We retrospectively identified 59 499 patient years for Medicare beneficiaries with one year of enrollment and three or more E&M visits. Principal Findings After adjustment for medical complexity, individual‐level social risk factors such as lack of education, low income, and living alone are all associated with better patient COC (P < .05). Similarly, area‐level social risk factors such as living in areas that are nonurban or high poverty, as well as in areas with low specialist or high primary care physician supply, are all associated with better patient COC (P < .05). We found the opposite pattern of associations between these same risk factors and annual patient utilization of physicians and specialists (P < .05). Conclusions Medicare patients with multiple social risk factors have consistently better COC; these same social risk factors are associated with reduced patient‐realized access to specialist physician care.

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“…Прогностическая значимость визита к специалисту убедительно продемонстрирована для пациентов с хроническими заболеваниями (СН, ИБС, хронической обструктивной болезнью легких или бронхиальной астмой), живущих в сельских районах. Посещение специалиста, по сравнению с одним или несколькими визитами к врачу первичной медицинской помощи, было ассоциировано со снижением частоты потенциально предотвратимых госпитализаций на 15,9% и смерти на 16,6% [33].…”

Section: обеспеченность населения кардиологами и смертность от бскunclassified

Association of medical staffing and outcomes in cardiovascular diseases

et al. 2021

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Raised life expectancy of patients with cardiovascular diseases (CVD), due to continuous progress in drug treatment options and widespread use of innovate technologies, increase the burden of CVD on healthcare system. The development of human resources by highly qualified specialists is of fundamental importance. For the rational use of human resources to achieve the targets of federal project on the prevention of cardiovascular diseases, it is necessary not only to analyze the actual situation with medical staffing, but also the potential effects of staff shortages and imbalances on mortality. The review presents evidence of associations between staffing and quality of care and CVD outcomes.

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Lack Of Access To Specialists Associated With Mortality And Preventable Hospitalizations Of Rural Medicare Beneficiaries

Cited by 120 publications

References 31 publications

Variation in dental services by rurality among privately insured adults in the United States

Variation in dental services by rurality among privately insured adults in the United States

Patient social risk factors and continuity of care for Medicare beneficiaries

Association of medical staffing and outcomes in cardiovascular diseases

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