Patterns of perceived barriers to medical care in older adults: a latent class analysis

Thorpe, Joshua M.; Thorpe, Carolyn T.; Kennelty, Korey A.; Pandhi, Nancy

doi:10.1186/1472-6963-11-181

Cited by 76 publications

(81 citation statements)

References 40 publications

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“…Similar reasons for nonresponse among the elderly have been documented in other studies 10 and in fact may well represent the physical and psychological barriers to care found in the elderly in the general population. [41][42][43][44] A consequence of nonparticipation in the examination is that the prevalence of undiagnosed glaucoma among nonparticipating elderly, the uninsured, or those below the poverty line is difficult to estimate. Overall prevalence rates of undiagnosed glaucoma may possibly be lower in the elderly population because they were also more likely to self-report glaucoma.…”

Section: We Found That Approximately 24 Million People Inmentioning

confidence: 99%

“…This is indicated by the similarity between reasons given for nonparticipation in this study's examination and prior research findings of nonparticipation in actual clinical examinations and also in other study settings. 10,[41][42][43][44] Our study uses the most recent data available for a nationally representative assessment of glaucoma status of the US population. Since the study data were released in 2008 and 2010 for the 2005-2006 and 2007-2008 iterations, respectively, significant change has happened in the US healthcare system, including the introduction of the Patient Protection and Affordable Care Act, enacted by the 111th US Congress, with its increased incentives for preventive care.…”

Section: We Found That Approximately 24 Million People Inmentioning

confidence: 99%

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Burden of Undetected and Untreated Glaucoma in the United States

Shaikh

Coleman

2014

American Journal of Ophthalmology

131

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Section: We Found That Approximately 24 Million People Inmentioning

confidence: 99%

Section: We Found That Approximately 24 Million People Inmentioning

confidence: 99%

Burden of Undetected and Untreated Glaucoma in the United States

Shaikh

Coleman

2014

American Journal of Ophthalmology

131

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“…Clustering Veterans in this manner also enables policies and interventions to be tailored to the specific needs of different subgroups. 39 The goal of LCA in this study was to identify the smallest number of classes necessary to account for patterns of diabetes care utilization received by Veterans in the VA and/or Medicare.…”

Section: Methodsmentioning

confidence: 99%

VA and Medicare Utilization Among Dually Enrolled Veterans with Type 2 Diabetes: A Latent Class Analysis

et al. 2016

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Background Many Veterans treated within the VA Healthcare System (VA) are also enrolled in fee-for-service (FFS) Medicare and receive treatment outside the VA. Prior research has not accounted for the multiple ways that Veterans receive services across healthcare systems. Objective To establish a typology of VA and Medicare utilization among dually-enrolled Veterans with type 2 diabetes. Design Retrospective cohort. Participants 316,775 community-dwelling Veterans age ≥65 with type 2 diabetes who were dually-enrolled in the VA and FFS Medicare in 2008–2009. Methods Using latent class analysis, we identified classes of Veterans based upon their probability of using VA and Medicare diabetes care services, including patient visits, laboratory tests, glucose test strips, and medications. We compared amount of healthcare use between classes and identified factors associated with class membership using multinomial regression. Key Results We identified 4 distinct latent classes: class 1 (53.9%) had high probabilities of VA use and low probabilities of Medicare use; classes 2 (17.2%), 3 (21.8%), and 4 (7.0%) had high probabilities of VA and Medicare use, but differed in their Medicare services used. For example, Veterans in class 3 received test strips exclusively through Medicare, while Veterans in class 4 were reliant on Medicare for medications. Living ≥40 miles from a VA predicted membership in classes 3 (OR 1.1, CI 1.06–1.15) and 4 (OR 1.11, CI 1.04–1.18), while Medicaid eligibility predicted membership in class 4 (OR 4.30, CI 4.10–4.51). Conclusions Veterans with diabetes can be grouped into 4 distinct classes of dual health system use, representing a novel way to characterize how patients use multiple services across healthcare systems. This classification has applications for identifying patients facing differential risk from care fragmentation.

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“…Because we were interested in developing a predictive model to assess validity, rather than describing how classes differed on characteristics of interest, we conducted multiple logistic regression analyses using STATA 9.2, appropriately accounting for survey weights, rather than using Latent Gold 4.5 (Thorpe, Thorpe, Kennelty, & Pandhi, 2011)…”

Section: Methodsmentioning

confidence: 99%

Jurisdiction Over Nursing Care Systems in Nursing Homes

et al. 2012

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Background In the context of declining registered nurse (RN) staffing levels in nursing homes, professional nursing jurisdiction over nursing care systems may erode. Objectives The purpose of this study is to develop a typology of professional nursing jurisdiction in nursing homes in relation to characteristics of RN staffing, drawing upon Abbott's (1988) tasks and jurisdictions framework. Method The study was a cross-sectional, observational study using the 2004 National Nursing Home Survey (N=1,120 nursing homes). Latent class analysis tested whether RN staffing indicators differentiated facilities in a typology of RN jurisdiction, and compared classes on key organizational environment characteristics. Multiple logistic regression analysis related the emergent classes to presence or absence of specialty care programs in 8 clinical areas. Results Three classes of capacity for jurisdiction were identified, including ‘low capacity’ (41% of homes) with low probabilities of having any indicators of RN jurisdiction, ‘mixed capacity’ (26% of homes) with moderate to high probabilities of having higher RN education and staffing levels, and ‘high capacity’ (32% of homes) with moderate to high probabilities of having almost all indicators of RN jurisdiction. ‘High capacity’ homes were more likely to have specialty care programs relative to ‘low capacity’ homes; such homes were less likely to be chain-owned, and more likely to be larger, provide higher technical levels of patient care, have unionized nursing assistants, have a lower ratio of LPNs to RNs, and a higher education level of the administrator. Discussion Findings provide preliminary support for the theoretical framework as a starting point to move beyond extensive reliance on staffing levels and mix as indicators of quality. Further, findings indicate the importance of RN specialty certification.

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Patterns of perceived barriers to medical care in older adults: a latent class analysis

Cited by 76 publications

References 40 publications

Burden of Undetected and Untreated Glaucoma in the United States

Burden of Undetected and Untreated Glaucoma in the United States

VA and Medicare Utilization Among Dually Enrolled Veterans with Type 2 Diabetes: A Latent Class Analysis

Jurisdiction Over Nursing Care Systems in Nursing Homes

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