Disparities in healthcare services in women with endometriosis with public vs private health insurance

Fourquet, Jessica; Zavala, Diego; Missmer, Stacey A.; Bracero, Nabal; Romaguera, Josefina; Flores, Idhaliz

doi:10.1016/j.ajog.2019.06.020

Cited by 26 publications

(18 citation statements)

References 45 publications

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“…Previous research has reported on disparities in healthcare services and treatment for a number of clinical conditions in the United States, depending on patient insurance type [ 2 , 16 , 17 ]. Fouroquet reported lower use of medical services (e.g., hospital, laboratory, pathology and radiology), laparoscopy, and the emergency room for patients with endometriosis who had public health insurance [ 16 ]. However, Fouroquet did not compare the prognosis of patients with public health insurance to those with private health insurance.…”

Section: Discussionmentioning

confidence: 99%

Outcomes for Patients with Sepsis Following Admission to the Intensive Care Unit Based on Health Insurance Status: A Study from the Medical Information Mart for Intensive Care-III (MIMIC-III) Database

Zhou

Yang²,

Fu³

et al. 2020

Med Sci Monit

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Background Previous research has focused on poor outcomes from a lack of insurance, but the effects of different types of insurance for patients with sepsis in the intensive care unit (ICU) have not been well studied. We aimed to investigate whether private health insurance was better than government-run health insurance in the United States in terms of clinical outcomes of patients with sepsis in the ICU. Material/Methods Patients with sepsis were identified from the Medical information Mart for Intensive Care-III database. Patients were grouped as having private and government-run health insurance. Clinical outcomes were compared in univariate and multivariate analyses. Propensity score match (PSM) and subgroup analysis were used to check the robustness of results. Results Data from 13,957 patients were extracted. After adjustment by multivariate model, the private insurance group had similar rates of ICU mortality (relative risk [RR] [95% confidence interval CI]=1.052 [0.919–1.205], P =.463) and 90-day (RR [95% CI]=.964 [0.885–1.051], P =.406) compared with the group with government-run insurance. The private insurance group had longer ICU stays (strictly standardized mean difference=0.092, P <.001) and better long-term survival (hazard ratio [95% CI]=0.875 [0.825–0.928], P <.001) than the government-run insurance group in the PSM cohorts. Subgroup analysis indicated little variation in results for specific conditions. Conclusions Patients with sepsis who had private insurance had longer ICU stays but similar ICU mortality and 90-day mortality rates than similar patients with government-run insurance; they seemed to have better long-term survival, but more evidence may be required to support this conclusion.

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Section: Discussionmentioning

confidence: 99%

Outcomes for Patients with Sepsis Following Admission to the Intensive Care Unit Based on Health Insurance Status: A Study from the Medical Information Mart for Intensive Care-III (MIMIC-III) Database

Zhou

Yang²,

Fu³

et al. 2020

Med Sci Monit

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“…One such enigmatic condition is endometriosis: a systemic, estrogen-dependent inflammatory condition with a range of debilitating symptoms, 39 comorbidities, 40 and associated with significant impact on daily function and quality of life (QoL). 41 42 Chronic pelvic pain is its most frequent symptom 43 ; others include pain with sexual intercourse (dyspareunia), painful urination (dysuria), and ovulation pain.…”

Section: Background and Significancementioning

confidence: 99%

Augmenting the Clinical Data Sources for Enigmatic Diseases: A Cross-Sectional Study of Self-Tracking Data and Clinical Documentation in Endometriosis

et al. 2020

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Background Self-tracking through mobile health technology can augment the electronic health record (EHR) as an additional data source by providing direct patient input. This can be particularly useful in the context of enigmatic diseases and further promote patient engagement. Objectives This study aimed to investigate the additional information that can be gained through direct patient input on poorly understood diseases, beyond what is already documented in the EHR. Methods This was an observational study including two samples with a clinically confirmed endometriosis diagnosis. We analyzed data from 6,925 women with endometriosis using a research app for tracking endometriosis to assess prevalence of self-reported pain problems, between- and within-person variability in pain over time, endometriosis-affected tasks of daily function, and self-management strategies. We analyzed data from 4,389 patients identified through a large metropolitan hospital EHR to compare pain problems with the self-tracking app and to identify unique data elements that can be contributed via patient self-tracking. Results Pelvic pain was the most prevalent problem in the self-tracking sample (57.3%), followed by gastrointestinal-related (55.9%) and lower back (49.2%) pain. Unique problems that were captured by self-tracking included pain in ovaries (43.7%) and uterus (37.2%). Pain experience was highly variable both across and within participants over time. Within-person variation accounted for 58% of the total variance in pain scores, and was large in magnitude, based on the ratio of within- to between-person variability (0.92) and the intraclass correlation (0.42). Work was the most affected daily function task (49%), and there was significant within- and between-person variability in self-management effectiveness. Prevalence rates in the EHR were significantly lower, with abdominal pain being the most prevalent (36.5%). Conclusion For enigmatic diseases, patient self-tracking as an additional data source complementary to EHR can enable learning from the patient to more accurately and comprehensively evaluate patient health history and status.

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“…Publicly insured or uninsured patients tend to have more locally advanced disease at the time of diagnosis, 9 shorter LOS after a trauma, and fewer diagnostic tests and medical services (hospital, laboratory, pathology, and radiology). 10,11 Race, gender, and marital status are also known to impact LOS after surgery 12,13 ; however, no study has extensively evaluated the impact of these factors on patients undergoing PD. The aim of this study was to assess the influence of social determinants on postoperative LOS after PD.…”

Section: Introductionmentioning

confidence: 99%

Insurance Type and Marital Status Impact Hospital Length of Stay After Pancreatoduodenectomy

Flick

Sublette

Yip-Schneider

et al. 2021

Journal of Surgical Research

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Disparities in healthcare services in women with endometriosis with public vs private health insurance

Cited by 26 publications

References 45 publications

Outcomes for Patients with Sepsis Following Admission to the Intensive Care Unit Based on Health Insurance Status: A Study from the Medical Information Mart for Intensive Care-III (MIMIC-III) Database

Outcomes for Patients with Sepsis Following Admission to the Intensive Care Unit Based on Health Insurance Status: A Study from the Medical Information Mart for Intensive Care-III (MIMIC-III) Database

Augmenting the Clinical Data Sources for Enigmatic Diseases: A Cross-Sectional Study of Self-Tracking Data and Clinical Documentation in Endometriosis

Insurance Type and Marital Status Impact Hospital Length of Stay After Pancreatoduodenectomy

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