Health Care Insurance, Financial Concerns in Accessing Care, and Delays to Hospital Presentation in Acute Myocardial Infarction

Smolderen, Kim G.; Spertus, John A.; Nallamothu, Brahmajee K.; Krumholz, Harlan M.; Tang, Fengming; Ross, Joseph S.; Ting, Henry H.; Alexander, Karen P.; Rathore, Saif S.; Chan, Paul S.

doi:10.1001/jama.2010.409

Cited by 125 publications

(115 citation statements)

References 35 publications

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“…Most women who had a regular source of care depended on public healthcare facilities, access to which may be more difficult than in private settings, [64][65][66] thereby potentially obviating its facilitation of diagnosis. Increased comorbidity had an inverse relationship with delay among women with system-detected abnormalities, similar to the general population, and is likely due to increased exposure to the healthcare system.…”

Section: Discussionmentioning

confidence: 99%

What Influences Diagnostic Delay in Low-Income Women with Breast Cancer?

Maly

Leake

Mojica

et al. 2011

Journal of Women's Health

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Background: Delayed diagnosis of breast cancer (BC) may contribute to adverse outcomes, such as reduced survival. The purpose of this study was to identify correlates of elapsed time between recognition of breast abnormalities and receipt of definitive diagnosis of BC among low-income women. Methods: Data were obtained from a cross-sectional study among a statewide sample of 921 low-income women with a new diagnosis of BC. Patients were grouped by whether their breast abnormalities were self-detected or healthcare system detected. Multivariate logistic regression analyses were used to examine associations between diagnostic delay and patient characteristics, patient communication, and system characteristics. Results: The self-detected group experienced much greater delay than the system-detected group (median intervals 80.5 vs. 31.5 days). African Americans had the longest intervals between symptom detection and diagnostic resolution; median delays in the self-detected and system-detected subgroups were 115 and 70 days, respectively, compared to 64 and 22 days for Caucasians. In multivariate analyses, African Americans had considerably greater odds of > 60-day delay than Caucasians in both the self-detected (odds ratio [OR] 3.51) and system-detected (OR 5.36) groups. Greater perceived self-efficacy in interacting with healthcare providers was significantly associated with shorter delay among the self-detected group (OR 0.86). Conclusions: Disparities in timely BC diagnosis between African Americans and Caucasians were pronounced in this uniformly low-income population of women. Women with self-detected abnormalities had markedly greater delays than those with healthcare system-detected abnormalities. Among this vulnerable group, increasing self-efficacy in interacting with healthcare providers may reduce diagnostic delays.

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Section: Discussionmentioning

confidence: 99%

What Influences Diagnostic Delay in Low-Income Women with Breast Cancer?

Maly

Leake

Mojica

et al. 2011

Journal of Women's Health

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“…EHR databases-such as the one being built and maintained by OCHIN-will be key to the study of how health reform policies implemented under the Patient Protection and Affordable Care Act of 2010 (PPACA) affect the uninsured and underinsured. [41][42][43][44][45][46][47][48][49] Although some states are putting considerable resources toward building all-payer claims databases to better address the PPA-CA's evaluation requirements, 50 such databases will not include uninsured and transiently insured populations. Information from EHR data will be more accurate than administrative claims data; thus, it is imperative to further develop and validate important EHR data resources and to evaluate the extent to which EHR data can be used to supplement (or substitute for) claims data.…”

Section: Research and Policy Implicationsmentioning

confidence: 99%

Electronic Health Records vs Medicaid Claims: Completeness of Diabetes Preventive Care Data in Community Health Centers

DeVoe

Gold

McIntire

et al. 2011

The Annals of Family Medicine

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PURPOSE Electronic Health Record (EHR) databases in community health centers (CHCs) present new opportunities for quality improvement, comparative effectiveness, and health policy research. We aimed (1) to create individual-level linkages between EHR data from a network of CHCs and Medicaid claims from 2005 through 2007; (2) to examine congruence between these data sources; and (3) to identify sociodemographic characteristics associated with documentation of services in one data set vs the other. METHODSWe studied receipt of preventive services among established diabetic patients in 50 Oregon CHCs who had ever been enrolled in Medicaid (N = 2,103). We determined which services were documented in EHR data vs in Medicaid claims data, and we described the sociodemographic characteristics associated with these documentation patterns. RESULTSIn 2007, the following services were documented in Medicaid claims but not the EHR: 11.6% of total cholesterol screenings received, 7.0% of total infl uenza vaccinations, 10.5% of nephropathy screenings, and 8.8% of tests for glycated hemoglobin (HbA 1c ). In contrast, the following services were documented in the EHR but not in Medicaid claims: 49.3% of cholesterol screenings, 50.4% of infl uenza vaccinations, 50.1% of nephropathy screenings, and 48.4% of HbA 1c tests. Patients who were older, male, Spanish-speaking, above the federal poverty level, or who had discontinuous insurance were more likely to have services documented in the EHR but not in the Medicaid claims data.CONCLUSIONS Networked EHRs provide new opportunities for obtaining more comprehensive data regarding health services received, especially among populations who are discontinuously insured. Relying solely on Medicaid claims data is likely to substantially underestimate the quality of care.

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“…Furthermore, the receipt of cardiac catheterization and specialty care for patients presenting at nonmetropolitan hospitals without these services often requires transfer to centers located in metropolitan areas. Financial barriers,7, 8 intrinsic physician bias,16 and other factors may result in differential receipt of these services based on area median income. Few studies have examined specifically whether location of care modifies the association among area median income and access to cardiac catheterization and outcomes of ACS 9.…”

Section: Introductionmentioning

confidence: 99%

Area Median Income and Metropolitan Versus Nonmetropolitan Location of Care for Acute Coronary Syndromes: A Complex Interaction of Social Determinants

Fabreau

Leung

Southern

et al. 2016

JAHA

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BackgroundMetropolitan versus nonmetropolitan status and area median income may independently affect care for and outcomes of acute coronary syndromes. We sought to determine whether location of care modifies the association among area income, receipt of cardiac catheterization, and mortality following an acute coronary syndrome in a universal health care system.Methods and ResultsWe studied a cohort of 14 012 acute coronary syndrome patients admitted to cardiology services between April 18, 2004, and December 31, 2011, in southern Alberta, Canada. We used multivariable logistic regression to determine the odds of cardiac catheterization within 1 day and 7 days of admission and the odds of 30‐day and 1‐year mortality according to area median household income quintile for patients presenting at metropolitan and nonmetropolitan hospitals. In models adjusting for area income, patients who presented at nonmetropolitan facilities had lower adjusted odds of receiving cardiac catheterization within 1 day of admission (odds ratio 0.22, 95% CI 0.11–0.46, P<0.001). Among nonmetropolitan patients, when examined by socioeconomic status, each incremental decrease in income quintile was associated with 10% lower adjusted odds of receiving cardiac catheterization within 7 days (P<0.001) and 24% higher adjusted odds of 30‐day mortality (P=0.008) but no significant difference for 1‐year mortality (P=0.12). There were no differences in adjusted mortality among metropolitan patients.ConclusionWithin a universal health care system, the association among area income and receipt of cardiac catheterization and 30‐day mortality differed depending on the location of initial medical care for acute coronary syndromes. Care protocols are required to improve access to care and outcomes in patients from low‐income nonmetropolitan communities.

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Health Care Insurance, Financial Concerns in Accessing Care, and Delays to Hospital Presentation in Acute Myocardial Infarction

Cited by 125 publications

References 35 publications

What Influences Diagnostic Delay in Low-Income Women with Breast Cancer?

What Influences Diagnostic Delay in Low-Income Women with Breast Cancer?

Electronic Health Records vs Medicaid Claims: Completeness of Diabetes Preventive Care Data in Community Health Centers

Area Median Income and Metropolitan Versus Nonmetropolitan Location of Care for Acute Coronary Syndromes: A Complex Interaction of Social Determinants

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