Utilization profile of emergency department by irregular migrants and hospitalization rates: lessons from a large urban medical center in Tel Aviv, Israel

Shachaf, Sara; Davidovitch, Nadav; Halpern, Pinchas; Mor, Zohar

doi:10.1186/s12939-020-1152-6

Cited by 4 publications

(7 citation statements)

References 22 publications

(24 reference statements)

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“…Patients seek ED care for urgent, life threatening issues, but at the same time, the ED is a routine source of primary care for many, and especially unserved patients. 38,39 Additionally, evidence shows that small percentages of patients accounts for the majority of ED visits. 40 Such variance requires risk stratification in order to find interventions to prevent revisits and to facilitate transitions to other care settings.…”

Section: Discussionmentioning

confidence: 99%

Return visits to the emergency department: An analysis using group based curve models

Ben‐Assuli

Vest

2022

Health Informatics J

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Stratification modeling in health services is useful to identify differential patient risk groups, or latent classes. Given the frequency and costs, repeated emergency department (ED) may be an appropriate candidate for risk stratification modeling. We applied a method called group-based trajectory modeling (GBTM) to a sample of 37,416 patients who visited an urban, safety-net ED between 2006 and 2016. Patients had up to 10 ED visits during the study period. Data sources included the hospital’s electronic health record (EHR), the state-wide health information exchange system, and area-level social determinants of health factors. Results revealed three distinct trajectory groups. Trajectories with a higher risk of revisit were marked by more patients with behavioral diagnoses, injuries, alcohol & substance abuse, stroke, diabetes, and other factors. The application of advanced computational techniques, like GBTM, provides opportunities for health care organizations to better understand the underlying risks of their large patient populations. Identifying those patients who are likely to be members of high-risk trajectories allows healthcare organizations to stratify patients by level of risk and develop early targeted interventions.

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Section: Discussionmentioning

confidence: 99%

Return visits to the emergency department: An analysis using group based curve models

Ben‐Assuli

Vest

2022

Health Informatics J

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“…Referring to demographic characteristics, general factors, including gender, age, marital status, and education level, were found to be associated with health knowledge and attitude and thus affected migrants' HSU. Gender was found to be associated with both immigrants' (64,71,(87)(88)(89)(90)(91) and IMs' (12,13,17,50,55,(92)(93)(94) HSU; however, the association was mixed. Age also had a mixed effect on immigrants' (64,90) and IMs' (12-14, 38, 92, 95, 96) HSU.…”

Section: Predisposing Factorsmentioning

confidence: 92%

“…Gender was found to be associated with both immigrants' (64,71,(87)(88)(89)(90)(91) and IMs' (12,13,17,50,55,(92)(93)(94) HSU; however, the association was mixed. Age also had a mixed effect on immigrants' (64,90) and IMs' (12-14, 38, 92, 95, 96) HSU. Marital status was more frequently regarded as a protective factor for immigrants' (81, 89,97) and IMs' (13,14,17,50,55) HSU, while some articles reported that marital status had no influence on HSU by IMs (12,38).…”

Section: Predisposing Factorsmentioning

confidence: 92%

“…The former two factors would affect both immigrants' and IMs' (78) HSU. First, time pressures (79), including lack of leave for illness (63), scheduling conflicts (59,69,90), and time flexibility (97), are associated with immigrants' HSU. Long working hours are associated with immigrants' (45) and IMs' (72) HSU.…”

Section: Enabling Resourcesmentioning

confidence: 99%

“…The immigrants had a higher utilization rate of emergency services during off-peak hours (3,90,148,149) and underuse of primary healthcare services (3,147) and preventive services (147). As a result, immigrants had a higher risk of avoidable hospitalization (150).…”

Section: Choice Of Types/sitesmentioning

confidence: 99%

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Health service behaviors of migrants: A conceptual framework

Peng

2023

Front. Public Health

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Universal health coverage is vital to the World Health Organization’s (WHO’s) efforts to ensure access to health as a human right. However, it has been reported that migrants, including both international immigrants and internal migrants, underuse health services. Establishing a conceptual framework to facilitate research on the health service behaviors (HSB) of migrants is particularly important. Many theoretical frameworks explaining the general population’s HSB have been published; however, most theoretical frameworks on migrants’ HSB only focus on international immigrants without the inclusion of internal migrants. Of note, internal migrants are much more abundant than immigrants, and this group faces similar barriers to HSB as immigrants do. Based on theoretical frameworks of immigrants’ HSB and Anderson’s behavior model, the author proposes a new conceptual framework of migrants’ HSB that includes both immigrants and internal migrants. The new conceptual framework divides the determinants into macro-structural or contextual factors, health delivery system characteristics, and characteristics of the population at risk and describes subgroup-specific factors. The author added some variables and reclassified variables in some dimensions, including characteristics of health delivery systems and access to healthcare. The characteristics of health delivery systems comprise the volume, organization, quality, and cost of the health delivery system, while the characteristics of access to healthcare include time accessibility, geographic accessibility, and information accessibility. The outcomes of HSB have been expanded, and relationships between them have been reported. The mediating effects of some variables have also been described. This conceptual framework can facilitate a deep and comprehensive understanding of the HSB determination process for migrants, including internal migrants.

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Neutrality, conflict, and structural determinants of health in a Jerusalem emergency department

Orr

Jackson

Alpert

et al. 2022

Int J Equity Health

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Background Medical neutrality is a normative arrangement that differentiates a zone of medical treatment disconnected from the field of politics. While medical neutrality aims to ensure impartial healthcare for all and to shield the healthcare personnel from political demands, it can also divert attention away from conflicts and their effects on health inequity. This article analyzes how healthcare professionals understand and negotiate the depoliticized space of the emergency department (ED) through their views on neutrality. It also examines how medical staff use depoliticized concepts of culture to account for differences in the health status of patients from disadvantaged groups. These questions are examined in the context of the Israeli-Palestinian conflict. Methods Twenty-four in-depth, semi-structured interviews were conducted with healthcare personnel in a Jerusalem hospital’s ED. All but one of the participants were Jewish. The interviews were analyzed using qualitative content analysis and Grounded Theory. Results The ED staff endorsed the perspective of medical neutrality as a nondiscriminatory approach to care. At the same time, some medical staff recognized the limits of medical neutrality in the context of the Israeli-Palestinian conflict and negotiated and challenged this concept. While participants identified unique health risks for Arab patients, they usually did not associate these risks with the effects of conflict and instead explained them in depoliticized terms of cultural and behavioral differences. Culture served as a non-controversial way of acknowledging and managing problems that have their roots in politics. Conclusions The normative demand for neutrality works to exclude discussion of the conflict from clinical spaces. The normative exclusion of politics is a vital but under-appreciated aspect of how political conflict operates as a structural determinant of health. Healthcare personnel, especially in the ED, should be trained in structural competency. This training may challenge the neglect of issues that need to be solved at the political level and enhance health equity, social justice, and solidarity.

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Utilization profile of emergency department by irregular migrants and hospitalization rates: lessons from a large urban medical center in Tel Aviv, Israel

Cited by 4 publications

References 22 publications

Return visits to the emergency department: An analysis using group based curve models

Return visits to the emergency department: An analysis using group based curve models

Health service behaviors of migrants: A conceptual framework

Neutrality, conflict, and structural determinants of health in a Jerusalem emergency department

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