ongenital heart disease (CHD) affects nearly 1% of US children and is associated with significant health care costs. Recurrent hospitalizations, surgical p ro c e d u re s , a n d o u t p at i e nt s e r v i c e s c re ate l a rge expenditures for families of children with CHD, even for those who have insurance, 1 and children with CHD frequently have additional comorbidities that contribute to out-of-pocket costs. 2 Indirect costs from lost wages and caregiver responsibilities further compound the financial burden associated with direct medical care.Recent data estimate that approximately 90% of families of children with CHD experience financial hardship. 3 However, little is known about how financial hardship affects families' ability to meet essential n e e d s o r o b t a i n m e d i c a l c a r e . S t u d i e s o n a d u l t s with atherosclerotic disease, c ancer survivors, and f a m i l i e s o f c h i l d r e n w i t h m e d i c a l c o m p l e x i t i e s suggest that competing financial priorities may result in cost shifting away from patients' medical care, which can negatively impact patient outcomes. [3][4][5][6][7] We used data from the National Health Inter view Sur vey to assess the national prevalence of financial hardship because of medical bills among families of children with CHD and the association of such hardship with food insecurity, delayed care because of cost, and cost-related medication nonadherence. IMPORTANCE Congenital heart disease (CHD) carries significant health care costs and out-of-pocket expenses for families. Little is known about how financial hardship because of medical bills affects families' access to essential needs or medical care. OBJECTIVE To assess the national prevalence of financial hardship because of medical bills among families of children with CHD in the US and the association of financial hardship with adverse outcomes. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey study used data on children 17 years and younger with self-reported CHD from the National Health Interview Survey of US households between 2011 and 2017. Data were analyzed from March 2019 to April 2020.EXPOSURES Financial hardship because of medical bills was classified into 3 categories: no financial hardship, financial hardship but able to pay medical bills, and unable to pay medical bills.MAIN OUTCOMES AND MEASURES Food insecurity, delayed care because of cost, and cost-related medication nonadherence.
RESULTSOf 188 families of children with CHD (weighted sample of 151 537 families), 48.9% reported some financial hardship because of medical bills, with 17.0% being unable to pay their medical bills at all. Compared with those who denied financial hardships because of medical bills, families who were unable to pay their medical bills reported significantly higher rates of food insecurity (61.8% [SE, 11.0] vs 13.6% [SE, 4.0]; P < .001) and delays in care because of cost (26.2% [SE, 10.4] vs 4.8% [SE, 2.5]; P = .002). Reported medication adherence did not differ across financial har...
Context:
The COVID-19 pandemic has disproportionately impacted vulnerable populations, including those who are non–English-speaking and those with lower socioeconomic status; yet, participation of these groups in contact tracing was initially low. Distrust of government agencies, anticipated COVID-19–related stigma, and language and cultural barriers between contact tracers and communities are common challenges.
Program:
The Community Outreach Specialist (COS) program was established within the Connecticut Department of Public Health (DPH) COVID-19 contact tracing program to encourage participation in contact tracing and address a need for culturally competent care and social and material support among socially vulnerable and non–English-speaking populations in 11 high-burden jurisdictions in Connecticut.
Implementation:
In partnership with state and local health departments, we recruited 25 COS workers with relevant language skills from target communities and trained them to deliver contact tracing services to vulnerable and non–English speaking populations.
Evaluation:
We conducted a cross-sectional analysis using data from ContaCT, DPH's enterprise contact tracing system. Overall, the COS program enrolled 1938 cases and 492 contacts. The proportion of residents reached (ie, called and interviewed) in the COS program was higher than that in the regular contact tracing program for both cases (70% vs 57%, P < .001) and contacts (84% vs 64%, P < .001). After adjusting for client age, sex, race and ethnicity, language, and jurisdiction, we found that the COS program was associated with increased reach for contacts (odds ratio [OR] = 1.52; 95% confidence interval [95% CI], 1.17-1.99) but not for cases (OR = 0.78; 95% CI, 0.70-0.88). Rapid qualitative analysis of programmatic field notes and meeting reports provided evidence that the COS program was feasible and acceptable to clients and contributed to COVID-19 education and communication efforts.
Conclusion:
A COS program employing a client-centered, community-engaged strategy for reaching vulnerable and non–English-speaking populations was feasible and more effective at reaching contacts than standard COVID-19 contact tracing.
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