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Research Studies is a compilation of published research articles funded by 大象APPor authored by 大象APPresearchers.

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26 to 50 of 455 Research Studies Displayed
Baker L, Munnich EL, Kranz AM
Medicaid managed care and pediatric dental emergency department visits.
The objective of this cohort study was to estimate the association between adoption of managed care for dental services in Florida's Medicaid program and nontraumatic dental emergency department (ED) visits and associated charges. Subjects were Florida-resident patients aged 17 or younger who had a Florida ED visit 2010-2014 for a nontraumatic dental condition which Medicaid paid for. The results indicated that Florida Medicaid's adoption of managed care for pediatric dental services was associated with increased ED visits for children; this could be associated with decreased access to dental care. The researchers found no evidence that the average charge per visit changed.
AHRQ-funded; HS027994.
Citation: Baker L, Munnich EL, Kranz AM . Medicaid managed care and pediatric dental emergency department visits. JAMA Health Forum 2024 Jun 14; 5(6):e241472. doi: 10.1001/jamahealthforum.2024.1472.
Keywords: Children/Adolescents, Medicaid, Dental and Oral Health, Access to Care
Kahn NF, Kidd KM, Hodax JK
Telemedicine-based provision of adolescent gender-affirming medical care to promote equitable access.
This study explored transgender and nonbinary (TNB) young adults' (1) interest in receiving gender-affirming medications through telemedicine before age 18 years and (2) willingness to initiate this care with primary care providers (PCPs). Data was collected from a survey of TNB young adults who had not received gender-affirming medications before age 18 years. Out of 280 respondents, 82.5% indicated interest in telemedicine and 42.0% were willing to initiate medications with their PCP. Black/African American respondents were more likely to indicate interest in telemedicine than White and multiracial respondents, and respondents from rural areas were more likely to indicate willingness to initiate medications with their PCP than those from urban areas.
AHRQ-funded; HS029028.
Citation: Kahn NF, Kidd KM, Hodax JK . Telemedicine-based provision of adolescent gender-affirming medical care to promote equitable access. Telemed J E Health 2024 Jun; 30(7):1896-900. doi: 10.1089/tmj.2023.0575..
Keywords: Telehealth, Children/Adolescents, Health Information Technology (HIT), Disparities, Access to Care
Liaw W, King B, Olaisen H
大象APPAuthor: Olaisen H
How an academic direct primary care clinic served patients from vulnerable communities.
This AHRQ-authored paper鈥檚 purpose was to describe the demographics and appointments of a now closed, academic direct primary care (DPC) clinic and determine whether there are differences in vulnerability between census tracts with and without any clinic patients. The authors linked geocoded data from the DPC's electronic health record with the social vulnerability index (SVI). They described the users鈥 age, sex, language, membership, diagnoses, and appointments. To determine differences in SVI, they calculated a localized SVI percentile within Harris County. They included 322 patients and 772 appointments, with patients seen an average of 2.4 times and predominantly female (58.4%). More than a third spoke Spanish. Census tracts in which DPC patients lived had significantly higher SVI scores (i.e., more vulnerable) than tracts where no DPC clinic patients resided (median, 0.60 vs 0.47).
AHRQ-authored.
Citation: Liaw W, King B, Olaisen H . How an academic direct primary care clinic served patients from vulnerable communities. J Am Board Fam Med 2024 May-Jun; 37(3):455-65. doi: 10.3122/jabfm.2023.230346R1..
Keywords: Primary Care, Vulnerable Populations, Community-Based Practice, Access to Care
Hughes PM, Graaf G, Gigli KH
Pediatric mental health care and scope-of-practice expansions.
This study investigated the relationship between scope-of-practice (SoP) regulations for psychologists and nurse practitioners and access to pediatric mental health services. The researchers analyzed data from the National Survey of Children's Health spanning 2016 to 2020, focusing on a nationally representative sample of children with mental health needs. The study examined two primary outcomes: unmet mental health care needs and receipt of mental health medication. The analysis revealed that children living in states with expanded psychologist SoP had a 5.4 percentage point lower probability of having unmet mental health needs. Additionally, these children had a 2.0 percentage point higher probability of receiving mental health medication. In contrast, nurse practitioner SoP expansion showed no significant association with unmet mental health needs. However, children in states with expanded nurse practitioner SoP had a 1.5 percentage point lower probability of receiving mental health medication. To assess these associations, the researchers employed logistic regression models, adjusting for multiple covariates. The expanded SoP for both psychologists and nurse practitioners was determined based on the child's state of residence and the year of the survey. The study's findings suggest that expanded SoP for psychologists is associated with improved access to pediatric mental health care, both in terms of addressing unmet needs and increasing medication access. However, the impact of expanded SoP for nurse practitioners appears to be less clear, with no significant effect on unmet needs and a slight decrease in medication receipt.
AHRQ-funded; HS000032.
Citation: Hughes PM, Graaf G, Gigli KH . Pediatric mental health care and scope-of-practice expansions. Adm Policy Ment Health 2024 May; 51(3):384-92. doi: 10.1007/s10488-024-01342-w..
Keywords: Children/Adolescents, Behavioral Health, Access to Care
Amu-Nnadi CN, Ross ES, Garcia NH
Health system integration and cancer center access for rural hospitals.
This study鈥檚 goal was to assess health system integration and cancer center access for rural hospitals. The authors compared health systems with and without cancer centers based on rural hospital presence. They found that 90% of cancer centers are in a health system, and 72% of health systems (434/607) have a cancer center. Larger health systems with more trainees more often have cancer centers but are no more likely to include rural hospitals (11% vs 6%). The minority of cancer centers not in health systems (N = 95) more often serve low complexity patient populations in non-metropolitan areas.
AHRQ-funded; HS013852.
Citation: Amu-Nnadi CN, Ross ES, Garcia NH . Health system integration and cancer center access for rural hospitals. Am Surg 2024 May; 90(5):1023-29. doi: 10.1177/00031348231216497..
Keywords: Health Systems, Cancer, Rural Health, Rural/Inner-City Residents, Access to Care
Adams DR, P茅rez-Flores NJ, Mabrouk F DR, P茅rez-Flores NJ, Mabrouk F
Assessing access to trauma-informed outpatient mental health services for adolescents: a mystery shopper study.
A mystery shopper study examined the accessibility of trauma-informed mental health services for adolescents in Cook County, Illinois safety-net clinics. Posing as mothers of traumatized children, researchers were only able to schedule appointments in 17% of calls to community mental health centers (CMHCs) and federally qualified health centers (FQHCs). Appointment denials were primarily due to capacity constraints at CMHCs (67%) and administrative requirements to switch providers at FQHCs (62%). Notably, non-White callers were less likely to be offered an appointment than White callers, raising concerns about potential racial bias in scheduling practices. Wait times averaged 12 days, with CMHCs offering shorter wait times than FQHCs. Only 38% of schedulers reported offering trauma-informed therapy at their centers. These findings reveal significant disparities and barriers to accessing crucial mental health services for adolescents, particularly those from marginalized backgrounds.
AHRQ-funded; HS000084.
Citation: Adams DR, P茅rez-Flores NJ, Mabrouk F DR, P茅rez-Flores NJ, Mabrouk F . Assessing access to trauma-informed outpatient mental health services for adolescents: a mystery shopper study. Psychiatr Serv 2024 May; 75(5):402-09. doi: 10.1176/appi.ps.20230198..
Keywords: Children/Adolescents, Behavioral Health, Trauma, Access to Care
Nguyen KH, Oronce CIA, Adia AC
Inability to access needed medical care among Asian American, Native Hawaiian, and Pacific Islander Medicaid enrollees.
Researchers examined self-reported inability to access needed medical care and patients鈥 reasons for not accessing medical care among adult Medicaid enrollees, disaggregated across Asian American, Native Hawaiian, and Pacific Islander ethnic groups. Their findings indicated that Chinese, Other Asian, Native Hawaiian enrollees were significantly less likely to report being unable to access needed medical care compared with non-Hispanic White enrollees. The most common reason given was that health plans would not approve, cover, or pay for care. The researchers concluded that different interventions specific to certain ethnic groups may be needed to mitigate inequities.
AHRQ-funded; HS022241.
Citation: Nguyen KH, Oronce CIA, Adia AC . Inability to access needed medical care among Asian American, Native Hawaiian, and Pacific Islander Medicaid enrollees. J Ambul Care Manage 2024 Apr-Jun; 47(2):96-103. doi: 10.1097/jac.0000000000000489..
Keywords: Access to Care, Racial and Ethnic Minorities, Medicaid
Adler JT, Kuk AE, Cron DC
Insurance transitions from employer-based insurance to Medicare and waitlisting for kidney transplantation: placing Marietta v. DaVita in context.
In a retrospective cohort study of incident dialysis patients aged 18-62 with employer-sponsored group health plans (EGHPs), researchers found that 36% switched to Medicare before the end of the 30-month coordination period. Patients residing in counties with higher social vulnerability and those with non-commercial dialysis modalities were more likely to switch early. Early switchers were less likely to be waitlisted for kidney transplantation, even after adjusting for various confounders. This association persisted even among patients who maintained their EGHP for at least one month after starting dialysis. These findings highlight the potential impact of recent legal changes allowing EGHPs to decrease dialysis reimbursements, which may increase early switching to Medicare and consequently affect transplant access.
AHRQ-funded; HS028476.
Citation: Adler JT, Kuk AE, Cron DC . Insurance transitions from employer-based insurance to Medicare and waitlisting for kidney transplantation: placing Marietta v. DaVita in context. J Am Soc Nephrol 2024 Apr; 35(4):495-98. doi: 10.1681/asn.0000000000000298..
Keywords: Transplantation, Kidney Disease and Health, Health Insurance, Access to Care, Medicare
Meille G, Koch T, Wendling B
大象APPAuthor: Meille G, Zuvekas S
The consequences of firm scope and scale on patient access to healthcare.
The objective of this study was to quantify changes in the market structure of primary care physicians and to examine its relationship with access to care. Researchers created measures of market structure from a 5% sample of Medicare fee-for-service claims and examined access to care using MEPS data. The findings showed that respondents in highly concentrated ZIP codes were less likely to report having access to immediate care than respondents in unconcentrated ZIP codes; the association was largest among Medicaid beneficiaries. No association between HHI and indicators for having a usual source of care and annual checkups were found. Multispecialty market share was negatively associated with checkups, but not other measures of access.
AHRQ-authored.
Citation: Meille G, Koch T, Wendling B . The consequences of firm scope and scale on patient access to healthcare. Health Serv Res 2024 Apr; 59(2):e14228. doi: 10.1111/1475-6773.14228..
Keywords: Medical Expenditure Panel Survey (MEPS), Access to Care, Healthcare Delivery, Medicare
Daw JR, MacCallum-Bridges CL, Kozhimannil KB
Continuous Medicaid eligibility during the COVID-19 pandemic and postpartum coverage, health care, and outcomes.
This study鈥檚 objective was to evaluate the association of continuous Medicaid eligibility due to the Families First Coronavirus Response Act (FFCRA) during the COVID-19 public health emergency (PHE) with postpartum health insurance, health care use, breastfeeding, and depressive symptoms. This cohort study included 47,716 respondents from the Pregnancy Risk Assessment Monitoring System (PRAMS) comparing 21 states with continuous prepolicy (2017-2019) and postpolicy (2020-2021) participation. Based on adjusted estimates, a 100% federal poverty level (FPL) increase in postpartum Medicaid eligibility was associated with a 5.1 percentage point (pp) increase in reported postpartum Medicaid enrollment, no change in commercial coverage, and a 6.6 pp decline in uninsurance, which represents a 40% reduction in postpartum uninsurance after a Medicaid-paid birth compared with the prepolicy baseline of 16.7%. Continuous Medicaid eligibility during the COVID-19 PHE was associated with significantly reduced postpartum uninsurance for people with Medicaid-paid births, but was not associated with postpartum visit attendance, contraception use, breastfeeding, or depressive symptoms at approximately 4 months postpartum. Uninsurance reductions were observed only among White and Black non-Hispanic individuals and Hispanic individuals had no change with no policy-associated changes in other outcomes.
AHRQ-funded; HS029159.
Citation: Daw JR, MacCallum-Bridges CL, Kozhimannil KB . Continuous Medicaid eligibility during the COVID-19 pandemic and postpartum coverage, health care, and outcomes. JAMA Health Forum 2024 Mar; 5(3):e240004. doi: 10.1001/jamahealthforum.2024.0004..
Keywords: COVID-19, Medicaid, Maternal Health, Women, Access to Care
Feinberg E, Eilenberg JS
Role of community health workers in promoting health equity in pediatrics.
This progress report describes 2 pilot RCTs that examined the feasibility and acceptability of using a community health worker (CHW) implemented intervention as a strategy to improve timely completion of autism diagnostic evaluations among young children from historically marginalized communities. The authors describe the research that has been published on the topic since they submitted their original study report on November 17, 2019. Their team conducted a subsequent large multisite RCT (鈥淧roject EARLY鈥) as part of National Institute of Mental Health鈥檚 Autism Spectrum Disorder Pediatric Early Detection, Engagement and Services Network, whose aim was to develop and test interventions that coordinate early autism screening, evaluation, and engagement in services. Their findings confirmed the efficacy of family navigation to reduce time to autism diagnostic resolution while also uncovering family navigation鈥檚 differential impact by ethnicity. Positive effects of using a CHW were significantly greater for Hispanic families compared to non-Hispanic families, suggesting that the intervention may be an effective strategy to reduce disparities by minoritized subgroups. The authors also discussed recent funding through grants, and the fact that Medicaid reimburses CHWs for patient education and health care navigation in 29 US states. They also discuss future directions for investigating the impact of CHWs on autism outcomes specifically, and child well-being more generally.
AHRQ-funded; HS022155.
Citation: Feinberg E, Eilenberg JS . Role of community health workers in promoting health equity in pediatrics. Acad Pediatr 2024 Mar; 24(2):199-200. doi: 10.1016/j.acap.2023.09.005..
Keywords: Children/Adolescents, Disparities, Access to Care
Mullens Hernandez, JA JA, Murthy J
Understanding the impacts of rural hospital closures: a scoping review.
Researchers conducted a scoping literature review to understand the impact of rural hospital closure in order to inform ongoing federal policy debates and research. Key categories of adverse impacts that emerged included: emergency medical service transport; availability of emergency care, hospital services, and outpatient services; changes in quality of care: effects on workforce and community members and the local economy. The researchers concluded that a synthesis of their findings will permit policymakers and researchers to understand, and mitigate, the harms of rural hospital closure. They also recommended a tailored approach and discussed crucial knowledge gaps in the evidence base.
AHRQ-funded; HS028672; HS027788; HS028606; HS028963.
Citation: Mullens Hernandez, JA JA, Murthy J . Understanding the impacts of rural hospital closures: a scoping review. J Rural Health 2024 Mar; 40(2):227-37. doi: 10.1111/jrh.12801..
Keywords: Rural Health, Rural/Inner-City Residents, Hospitals, Access to Care
King CA, Beetham T, Smith N
Adolescent residential addiction treatment in the US: uneven access, waitlists, and high costs.
This study examined adolescent residential addiction treatment facilities in the United States, and their accessibility and cost. The authors used the Substance Abuse and Mental Health Services Administration's treatment locator and search engine advertising data to identify 160 residential addiction treatment facilities that treated adolescents with opioid use disorder as of December 2022. They called facilities while role-playing as the aunt or uncle of a sixteen-year-old child with a recent nonfatal overdose to inquire about policies and costs. A little over half (54.5%) had a bed immediately available. The mean wait time for a bed was 28.4 days among sites with a waitlist. Of the facilities that provided cost information, the mean cost of treatment per day was $878, with daily costs among for-profit facilities triple of nonprofit facilities. Half of facilities required up-front payments by noninsured patients, with a mean up-front cost of $28,731. They were unable to identify any facilities for adolescents in ten states or Washington, D.C.
AHRQ-funded; HS017589.
Citation: King CA, Beetham T, Smith N . Adolescent residential addiction treatment in the US: uneven access, waitlists, and high costs. Health Aff 2024 Jan; 43(1):64-71. doi: 10.1377/hlthaff.2023.00777..
Keywords: Children/Adolescents, Substance Abuse, Healthcare Costs, Access to Care
Adams DR
Availability and accessibility of mental health services for youth: a descriptive survey of safety-net health centers during the COVID-19 pandemic.
The goal of this study was to assess the availability of outpatient mental health services for children and adolescents at safety-net health centers in a large metropolitan county. A comprehensive sample of Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) received a 5-minute survey approximately one year after the beginning of the COVID-19 pandemic. The response indicated that 10% of health centers had closed and 20% reported that they were not offering outpatient mental health services. Reported wait times were longer at CMHCs than FQHCs. The author concluded that these findings suggested that online directories such as the SAMHSA Treatment Locator are often inaccurate or out-of-date.
AHRQ-funded; HS000084.
Citation: Adams DR . Availability and accessibility of mental health services for youth: a descriptive survey of safety-net health centers during the COVID-19 pandemic. Community Ment Health J 2024 Jan; 60(1):88-97. doi: 10.1007/s10597-023-01127-9..
Keywords: Children/Adolescents, Behavioral Health, Access to Care, COVID-19, Public Health
Eliason EL, Agostino J, Vivier P
Infant health care disruptions by race and ethnicity, income, and insurance during the COVID-19 pandemic.
This cross-sectional study examined the impact that the COVID-19 pandemic had on infant health care, and broke it down by race and ethnicity, income, and insurance type. This study used the Pregnancy Risk Assessment Monitoring System COVID-19 supplement with data from 29 jurisdictions to examine infant health care disruptions due to the pandemic: 1) well visits/checkups canceled or delayed, 2) well visits/checkups changed to virtual appointments, and 3) postponed immunizations. The authors found that among 12,053 parental respondents with infants born from April to December 2020, 7.25% reported cancelations or delays in infant well visits/checkups, 5.49% reported changes to virtual infant care appointments, and 5.33% reported postponing immunizations, with significant differences by race and ethnicity, income, and insurance type. They found higher odds of canceling/delaying visits and postponing immunizations among non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid-paid deliveries. The odds of switching to virtual appointments was also significantly higher among Hispanic infants and infants whose parents had Medicaid-paid deliveries.
AHRQ-funded; HS000011.
Citation: Eliason EL, Agostino J, Vivier P . Infant health care disruptions by race and ethnicity, income, and insurance during the COVID-19 pandemic. Acad Pediatr 2024 Jan-Feb; 24(1):105-10. doi: 10.1016/j.acap.2023.07.005..
Keywords: Newborns/Infants, Racial and Ethnic Minorities, COVID-19, Access to Care, Uninsured, Health Insurance, Healthcare Delivery
Cron DC, Braun HJ, Ascher NL
Sex-based disparities in access to liver transplantation for waitlisted patients with model for end-stage liver disease score of 40.
The objective of this study was to determine association of sex with access to liver transplantation among candidates with the highest possible model for end-stage liver disease score (MELD 40). Using national transplant registry data, researchers compared liver offer acceptance and waitlist outcomes by sex for waitlisted liver transplant candidates who reached MELD 40. Results showed that even among candidates with high disease severity and equally high MELD scores, women have reduced access to liver transplantation and worse outcomes compared with men. The researchers concluded that policies addressing this disparity should consider factors beyond MELD score adjustments.
AHRQ-funded; HS028476.
Citation: Cron DC, Braun HJ, Ascher NL . Sex-based disparities in access to liver transplantation for waitlisted patients with model for end-stage liver disease score of 40. Ann Surg 2024 Jan; 279(1):112-18. doi: 10.1097/sla.0000000000005933..
Keywords: Disparities, Access to Care, Sex Factors, Transplantation
Mitchell JM, Kranz AM, Steiner ED
Barriers and strategies used to continue school-based health services during the COVID-19 pandemic.
This study examined perceived barriers and strategies adopted to continue the delivery of school-based health services when schools reopened in Fall of 2021 during the COVID-19 pandemic and to assess whether these barriers and strategies varied by locality. The authors developed and subsequently conducted an online survey of school nurses who worked at the 1178 public elementary schools in Virginia in May 2021 to describe the impact of the COVID-19 pandemic on the delivery of school-based health services. They compared perceived barriers, strategies adopted and the effectiveness of strategies to continue the delivery of school-based health services by geographic locality (city vs. rural; suburban vs. rural and city vs. suburban). More than half of urban schools expected nine of ten potential barriers to affect the delivery of school-based health services during Fall 2021. More than half of responding schools located in urban, suburban, and rural areas indicated that external barriers outside of their control, including insufficient funding and families not able to bring students to school, were likely to be barriers to delivering care. There was no variation in strategies identified as 鈥渧ery effective鈥 by locality.
AHRQ-funded; HS025430.
Citation: Mitchell JM, Kranz AM, Steiner ED . Barriers and strategies used to continue school-based health services during the COVID-19 pandemic. Matern Child Health J 2024 Jan; 28(1):155-64. doi: 10.1007/s10995-023-03824-z.
Keywords: COVID-19, Children/Adolescents, Access to Care
Burns A, Vest JR, Menachemi N
Market factors associated with comprehensive behavioral health crisis care availability: a resource dependence theory study.
Researchers examined market factors associated with comprehensive behavioral health crisis care (BHCC) availability. 2022 county-level data on mental health treatment facilities from the Substance Abuse and Mental Health Services Administration was used. The researchers found that counties with more mental health providers and metropolitan counties had higher odds of having comprehensive BHCC facilities. They concluded that their findings highlight the importance of developing the mental health workforce to increase BHCC availability and addressing disparities in rural counties.
AHRQ-funded; HS029654.
Citation: Burns A, Vest JR, Menachemi N . Market factors associated with comprehensive behavioral health crisis care availability: a resource dependence theory study. Inquiry 2024 Jan-Dec; 61:469580241256822. doi: 10.1177/00469580241256822.
Keywords: Behavioral Health, Access to Care
Jindal M, Chaiyachati KH, Fung V
Eliminating health care inequities through strengthening access to care.
The objective of this study was to provide a research agenda and recommendations to address inequities in access to health care based on findings from AHRQ's 2022 Health Equity Summit and subsequent meetings of access and equity experts from academia, industry, and the government. The authors noted that addressing access inequities cannot be done without considering the roles of racism and intersectionality. Their recommendations included funding research that measures racism within health care as well as tests burgeoning anti-racist practices, synthesizing best practices to mitigate racism, and forging a path forward for research on equity and access. They concluded that 大象APPis well-positioned to develop and fund an action plan and convene stakeholders across the health care spectrum to employ these recommendations.
AHRQ-funded.
Citation: Jindal M, Chaiyachati KH, Fung V . Eliminating health care inequities through strengthening access to care. Health Serv Res 2023 Dec; 58(suppl 3):300-10. doi: 10.1111/1475-6773.14202..
Keywords: Disparities, Access to Care, Healthcare Delivery
Grove LR, Berkowitz SA, Cuddeback G
Permanent supportive housing receipt and health care use among adults with disabilities.
This study鈥檚 objective was to assess whether permanent supportive housing (PSH) participation is associated with health service use among a population of adults with disabilities, including people transitioning into PSH from community and institutional settings. Primary data sources used were 2014 to 2018 secondary data from a PSH program in North Carolina linked to Medicaid claims. The authors used propensity score weighting to estimate the average treatment effect on the treated of PSH participation. Using weighted analysis, they found that among individuals who were institutionalized prior to PSH, PSH participation was associated with greater hospitalizations and emergency department (ED) visits and fewer primary care visits during the follow-up period, compared with similar individuals who largely remained institutionalized. There was no significantly different health service use from similar comparison group members for individuals who entered PSH from community settings during the 12-month follow-up period.
AHRQ-funded; HS000032.
Citation: Grove LR, Berkowitz SA, Cuddeback G . Permanent supportive housing receipt and health care use among adults with disabilities. Med Care Res Rev 2023 Dec; 80(6):596-607. doi: 10.1177/10775587231183192..
Keywords: Disabilities, Vulnerable Populations, Access to Care
Frank M, Loh R, Everhart R
No health without access: using a retrospective cohort to model a care continuum for people released from prison at an urban, safety net health system.
This retrospective cohort study of persons released from correctional facilities examined healthcare utilization by merging records from Denver Health (DH), an urban safety-net healthcare system, and the Colorado Department of Corrections (CDOC), for people released from January 1 to June 30, 2021. The study population was either 1) released to the Denver metro area (Denver and its five neighboring counties); or (2 assigned to the DH Regional Accountable Entity; or (3 assigned to the DH medical home based on Colorado Department of Healthcare Policy and Financing attribution methods. From January to June 2021 3242 people were released from CDOC and 2848 were included in the data exchange. 905 individuals of the total 2848 were released to the Denver metro area or attributed to DH. In the study population over three-fourths (78.1%) had a chronic medical or psychological condition. Within the first 6 months of release, 31.1% utilized any health service, 24.5% utilized at least one outpatient service, and 17.1% utilized outpatient services two or more times. Within the first 30 days of release 10.1% utilized outpatient services.
AHRQ-funded; HS027389.
Citation: Frank M, Loh R, Everhart R . No health without access: using a retrospective cohort to model a care continuum for people released from prison at an urban, safety net health system. Health Justice 2023 Nov 18; 11(1):49. doi: 10.1186/s40352-023-00248-3..
Keywords: Access to Care, Vulnerable Populations, Urban Health, Rural/Inner-City Residents
Bernard DM, Selden TM, Fang Z
大象APPAuthor: Bernard
The joint distribution of high out-of-pocket burdens, medical debt, and financial barriers to needed care.
This AHRQ-authored paper examined the joint distribution of three financial problems related to healthcare: high out-of-pocket burdens, medical debt, and financial barriers to needed care. The authors applied relatively strict definitions of financial problems to data from the 2018-2019 MEPS and found that 27% of nonsenior adults lived in families with at least one of the three financial strains assessed. The percentage of participants who faced more broadly defined financial problems was 45.5%. This prevalence varied across sociodemographic characteristics, families' health care needs, insurance coverage, and financial resources.
AHRQ-authored.
Citation: Bernard DM, Selden TM, Fang Z . The joint distribution of high out-of-pocket burdens, medical debt, and financial barriers to needed care. Health Aff 2023 Nov; 42(11):1517-26. doi: 10.1377/hlthaff.2023.00604..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Access to Care, Health Insurance
Zachrison KS, Hsia RY, Schwamm LH
Insurance-based disparities in stroke center access in california: a network science approach.
The purpose of this study was to examine whether there is a relationship between ischemic stroke patient insurance and probability of transfer to a stroke center overall as well as whether hospital cluster modified the relationship between insurance and likelihood of stroke center transfer. The study included 332,995 total ischemic stroke encounters, with 3.5% transferred from the initial ED. The study found that of 52,316 participants presenting to a non-stroke center, 7.1% were transferred. Compared to privately insured patients, there were lower odds of transfer and of transfer to a stroke center among all groups. Within the 14 identified hospital clusters, there was variation in insurance-based disparities in transfer. The largest hospital was also the lowest performing cluster which fully explained the insurance-based disparity in odds of stroke center transfer. The study concluded that uninsured patients had lower stroke center access through transfer than patients with insurance, with the variation primarily explained by patterns in 1 specific hospital cluster.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Hsia RY, Schwamm LH . Insurance-based disparities in stroke center access in california: a network science approach. Circ Cardiovasc Qual Outcomes 2023 Oct; 16(10):e009868. doi: 10.1161/circoutcomes.122.009868..
Keywords: Access to Care, Stroke, Cardiovascular Conditions, Disparities, Health Insurance, Uninsured
Vear KR, Esbrook E, Padley E
"Time and money and support": adolescents and young adults' perceived social and logistical support needs for safe abortion care.
This study鈥檚 objective was to understand what support adolescents and young adults need to access abortion amidst the changing legal landscape. A diverse nationwide sample of individuals aged 14-24 responded to a text message survey in July 2022 about the social and logistical support they would need for safe abortion access. Out of the sample of 638, there was a 78% response rate. Primary sources of social support from parents and friends were named by the respondents for potential abortion decisions. The respondents frequently cited money and transportation as logistical support needs for out-of-state abortion care.
AHRQ-funded; HS026369.
Citation: Vear KR, Esbrook E, Padley E . "Time and money and support": adolescents and young adults' perceived social and logistical support needs for safe abortion care. Contraception 2023 Oct; 126:110128. doi: 10.1016/j.contraception.2023.110128..
Keywords: Children/Adolescents, Young Adults, Maternal Health, Patient Safety, Access to Care
Ramadan OI, Kelz RR, Sharpe JE
Impact of Medicaid expansion on outcomes after abdominal aortic aneurysm repair.
Researchers sought to assess the association between Medicaid expansion and outcomes after abdominal aortic aneurysm repair using HCUP State Inpatient Databases data from 14 states. They examined data on 8995 adult patients under age 65 from both non-expansion states and Medicaid expansion states. The results indicated that Medicaid expansion was associated with decreased in-hospital mortality after abdominal aortic aneurysm repair among all patients, particularly among patients who were either on Medicaid or were uninsured. The researchers concluded that these results provided support for improved access to care for patients undergoing abdominal aortic aneurysm repair through Medicaid expansion.
AHRQ-funded; HS026116.
Citation: Ramadan OI, Kelz RR, Sharpe JE . Impact of Medicaid expansion on outcomes after abdominal aortic aneurysm repair. J Vasc Surg 2023 Sep; 78(3):648-56.e6. doi: 10.1016/j.jvs.2023.04.029..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Outcomes, Access to Care

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