The Problem Of The Color Line: Spatial Access To Hospital Services For Minoritized Racial And Ethnic Groups

Eberth, Jan M.; Hung, Peiyin; Benavidez, Gabriel A.; Probst, Janice C.; Zahnd, Whitney E.; McNatt, Mary-Katherine; Toussaint, Ebony; Merrell, Melinda A.; Crouch, Elizabeth; Oyesode, Oyeleye J; Yell, Nicholas

doi:10.1377/hlthaff.2021.01409

Cited by 40 publications

(39 citation statements)

References 38 publications

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“…While rural populations have higher cancer-related mortality rates than urban patients, among rural populations, American Indian/Alaska Native populations have the highest rural-urban disparity in cancer mortality [ 18 , 19 ]. Given the added complexities of the Indian Health Service system and related requirements for tribal affiliation and/or residence on reservation lands, American Indian/Alaska Native residents may be particularly burdened to find culturally competent and low-cost care locally [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

Pre-pandemic geographic access to hospital-based telehealth for cancer care in the United States

et al. 2023

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Importance Little is known about US hospitals’ capacity to ensure equitable provision of cancer care through telehealth. Objective To conduct a national analysis of hospitals’ provision of telehealth and oncologic services prior to the SARS-CoV-2 pandemic, along with geographic and sociodemographic correlates of access. Design, setting, and participants Retrospective cross-sectional analysis with Geographic Information Systems mapping of 1) 2019 American Hospital Association (AHA) Annual Hospital Survey and IT Supplement, 2) 2013 Urban Influence Codes (UIC) from the United States Department of Agriculture, 3) 2018 Area Health Resources Files from the Health Services and Resources Administration (HRSA). Interventions Hospitals were categorized by telehealth and oncology services availability. Counties were classified as low-, moderate-, or high-access based on availability of hospital-based oncology and telehealth within their boundaries. Main outcomes and measures Geospatial mapping of access to hospital-based telehealth for cancer care. Generalized logistic mixed effects models identified associations between sociodemographic factors and county- and hospital-level access to telehealth and oncology care. Results 2,054 out of 4,540 hospitals (45.2%) reported both telehealth and oncology services. 272 hospitals (6.0%) offered oncology without telehealth, 1,369 (30.2%) offered telehealth without oncology, and 845 (18.6%) hospitals offered neither. 1,288 out of 3,152 counties with 26.6 million residents across 41 states had no hospital-based access to either oncology or telehealth. After adjustment, rural hospitals were less likely than urban hospitals to offer telehealth alongside existing oncology care (OR 0.27; 95% CI 0.14–0.55; p < .001). No county-level factors were significantly associated with telehealth availability among hospitals with oncology. Conclusions and relevance Hospital-based cancer care and telehealth are widely available across the US; however, 8.4% of patients are at risk for geographic barriers to cancer care. Advocacy for adoption of telehealth is critical to ensuring equitable access to high-quality cancer care, ultimately reducing place-based outcomes disparities. Detailed, prospective, data collection on telehealth utilization for cancer care is also needed to ensure improvement in geographic access inequities.

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Section: Resultsmentioning

confidence: 99%

Pre-pandemic geographic access to hospital-based telehealth for cancer care in the United States

et al. 2023

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“…Given the disproportionate impact of police violence on minoritized racial and ethnic communities, future work should within-county disparities in access to crisis intervention services, as other work has shown that minoritized and communities tend to be the furthest distance from county health care resources within counties. 27 We that Medicaid may help facilitate funding CIT services, with Medicaid eligibility expansions significantly associated with offering CIT services. State Medicaid have had several opportunities to develop CIT capacity through Section 1115 waivers, especially IMD payment exclusion waivers for serious mental illness, and the CCBHC demonstration and expansion, which specifically requires participating clinics to offer crisis management services that are available 24 hours a day.…”

Section: Discussionmentioning

confidence: 99%

Association of Access to Crisis Intervention Teams With County Sociodemographic Characteristics and State Medicaid Policies and Its Implications for a New Mental Health Crisis Lifeline

2022

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Key Points Question How did county-level access to crisis intervention team (CIT) services change in 2020 compared with 2015, and was CIT access associated with area and state policy characteristics in 2020? Findings In this study of more than 10 000 facilities in 3142 US counties, most US residents lived in counties with access to at least 1 mental health facility offering CIT services; however, fewer than half of US counties had such access. Counties without CIT access tended to have populations that were older and more likely to be uninsured, and they were more likely to be rural. Meaning Encouraging facilities in rural counties to offer CIT may help realize the potential of policies to address behavioral health crises, such as the new mental health crisis lifeline.

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“…This may be exacerbated for Black or Latinx residents, who face additional barriers to access, such as longer travel distances and the higher likelihood of ambulance diversion. 17,18 On the other hand, if hospitals that close tend to provide low-quality care, then closure may improve health outcomes by reallocating patients to higher quality facilities.…”

Section: Access To Care: Hospital and Service Line Closuresmentioning

confidence: 99%

“…On the one hand, hospital closure decreases access to care and increases travel times, raising concerns about adverse health outcomes for patients with time‐sensitive conditions. This may be exacerbated for Black or Latinx residents, who face additional barriers to access, such as longer travel distances and the higher likelihood of ambulance diversion 17,18 . On the other hand, if hospitals that close tend to provide low‐quality care, then closure may improve health outcomes by reallocating patients to higher quality facilities.…”

Section: Access To Care: Hospital and Service Line Closuresmentioning

confidence: 99%

Reimagining and reinvesting in rural hospital markets

Carroll

Planey²,

Kozhimannil

2022

Health Services Research

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The Problem Of The Color Line: Spatial Access To Hospital Services For Minoritized Racial And Ethnic Groups

Cited by 40 publications

References 38 publications

Pre-pandemic geographic access to hospital-based telehealth for cancer care in the United States

Pre-pandemic geographic access to hospital-based telehealth for cancer care in the United States

Association of Access to Crisis Intervention Teams With County Sociodemographic Characteristics and State Medicaid Policies and Its Implications for a New Mental Health Crisis Lifeline

Reimagining and reinvesting in rural hospital markets

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