Understanding Why Patients Of Low Socioeconomic Status Prefer Hospitals Over (original) (raw)
Related papers
Addressing Social Determinants to Improve HealthCare Quality and Reduce Cost
Journal for Healthcare Quality, 2012
Most healthcare quality improvement and cost reduction efforts currently focus on care processes, or transitions-for example, the hospital discharge process. While identification and adoption of best practices to address these aspects of healthcare are essential, more is needed for systems that serve vulnerable populations: to account for social factors that often inhibit patients' ability to take full advantage of available healthcare. Our urban safety net healthcare system developed and implemented an innovative quality improvement approach. The programs, Guided Chronic Care TM , and Passport to Wellness, use Assertive Care and provide social support for patients between medical encounters, enabling patients to make better use of the healthcare system and empowering them to better manage their conditions. Results: The majority of patients reported problems with mobility and nearly half reported anxiety or depression. Early indications show improved quality of care and significant reduction in costs. Challenges encountered and lessons learned in implementing the programs are described, to assist others developing similar interventions.
The Effects of Socioeconomic Status on the Quality and Accessibility of Healthcare Services
2021
As the wealth gap continues to increase in the United States of America, disparities in healthcare, exacerbated by the COVID-19 pandemic, continue to grow. Healthcare patients of lower socioeconomic status (SES) are affected by such disparities through lesser quality and accessibility of healthcare services. SES is defined by the American Psychological Association as the social standing or class of an individual or group, often measured through the intersection of education, income, and occupation. However, the measurement of SES is not limited to these criteria. In order to explore areas of healthcare services where quality and accessibility vary due to the effects of SES, this study gauged SES by examining race, and income to determine an individual or household's SES. A questionnaire distributed online collected data that helped determine the healthcare quality and accessibility of households in New York City and Los Angeles County neighborhoods, in which the services, experi...
Challenges Faced by Patients with Low Socioeconomic Status During the Post-Hospital Transition
Journal of General Internal Medicine, 2013
BACKGROUND: Patients with low socioeconomic status (low-SES) are at risk for poor outcomes during the posthospital transition. Few prior studies explore perceived reasons for poor outcomes from the perspectives of these high-risk patients. OBJECTIVE: We explored low-SES patients' perceptions of hospitalization, discharge and post-hospital transition in order to generate hypotheses and identify common experiences during this transition. DESIGN: We conducted a qualitative study using indepth semi-structured interviewing. PARTICIPANTS: We interviewed 65 patients who were: 1) uninsured, insured by Medicaid or dually eligible for Medicaid and Medicare; 2) residents of five low-income ZIP codes; 3) had capacity or a caregiver who could be interviewed as a proxy; and 4) hospitalized on the general medicine or cardiology services of two academically affiliated urban hospitals. APPROACH: Our interview guide investigated patients' perceptions of hospitalization, discharge and the posthospital transition, and their performance of recommended post-hospital health behaviors related to: 1) experience of hospitalization and discharge; 2) external constraints on patients' ability to execute discharge instructions; 3) salience of health behaviors; and 4) self-efficacy to execute discharge instructions. We used a modified grounded theory approach to analysis. KEY RESULTS: We identified six themes that low-SES patients shared in their narratives of hospitalization, discharge and post-hospital transition. These were: 1) powerlessness during hospitalization due to illness and socioeconomic factors; 2) misalignment of patient and care team goals; 3) lack of saliency of health behaviors due to competing issues; 4) socioeconomic constraints on patients' ability to perform recommended behaviors; 5) abandonment after discharge; and 6) loss of self-efficacy resulting from failure to perform recommended behaviors. CONCLUSIONS: Low-SES patients describe discharge goals that are confusing, unrealistic in the face of significant socioeconomic constraints, and in conflict with their own immediate goals. We hypothesize that this goal misalignment leads to a cycle of low achievement and loss of self-efficacy that may underlie poor post-hospital outcomes among low-SES patients.
Population Health Management, 2019
Understanding how unmet basic needs impact health care in patients with complex conditions is vital to improve health outcomes and reduce health care costs. The purpose of this observational study was to explore the association between health care and socioeconomic needs and health care utilization and disease management among patients with chronic conditions at an intensive, patient-centered, office-based program. The study used a cross-sectional design and a convenience sampling approach. Data were collected through a patient questionnaire and medical records. Analysis included descriptive and inferential statistics. Data from 48 established patients were analyzed. Financial and lack of transportation were the 2 most frequently reported unmet needs. More than 65% of participants had their chronic condition(s) under control. Sex and ethnicity were the only 2 demographic variables that yielded significant differences (P £ 0.01) on visits to the emergency room and having chronic condition(s) under control. Those who reported having unmet transportation needs were more likely to have a condition uncontrolled and to have lost medical appointments compared to those who had this social need met (P £ 0.05). Statistically significant differences in terms of missing medical appointments also were found between those whose overall financial and housing needs were unmet and those who had those needs met (P £ 0.05). Results indicate that participating patients generally had good control of their conditions. The study adds evidence in support of the call for health care to address patients' socioeconomic needs, and the health care benefits of intensive case management programs. The model may be considered for adoption throughout New Mexico, and nationally.
Hospital Readmission From the Perspective of Medicaid and Uninsured Patients
Journal for healthcare quality : official publication of the National Association for Healthcare Quality, 2017
Patients with little or no health insurance are frequently readmitted to the hospital, yet few previous studies have listened to patients' explanations of why they returned to the hospital after discharge. Enhanced understanding of patient perspectives may facilitate targeted services and improve care. We enrolled 18 patients with Medicaid or no insurance during a hospital readmission within 30 days in a major metropolitan area, and conducted semi-structured qualitative interviews to explore the impact of patients' experiences around readmission using a grounded theory approach. We identified five themes contributing to readmission: (1) therapeutic misalignment; (2) accountability; (3) social fragility; (4) access failures; and (5) disease behavior. Medical conditions were complicated by social influences and insufficiently addressed by our health system. Patients understood the need to manage their own health but were unable to effectively execute care plans because of comp...
Impact of socioeconomic status on hospital use in New York City
Health Affairs, 1993
This DataWatch examines the potential impact of socioeconomic differences on rates of hospitalization, based on patterns of hospital use in New York City in 1988. The research suggests that lack of timely and effective outpatient care may lead to higher hospitalization rates in low-income areas. For certain conditions identified as ambulatory care sensitive, hospitalization rates were higher in low-income areas than they were in higher-income areas where appropriate outpatient care was more readily available. Further study is needed to determine the relative impact of various economic, structural, and cultural factors that affect access to care.
Research Directs in health sciences, 2022
Introduction: Ambulatory care sensitive conditions (ACSCs) have been linked to higher emergency room and hospitalization rates. Research suggests social determinants of health (SDOH) may play a role; however, there is a limited understanding of the relationship between ACSCs and SDOH. This study's objective was to examine the relationship between structural and intermediary SDOH and chronic ACSC status among United States adults (U.S.). Methods: Data were drawn from the 2017 Behavioral Risk Surveillance System for 12 states and U.S. territories that completed the SDOH module (N= 111,828). Descriptive statistics and binary logistic regression analysis identified SDOH associated with a chronic ACSC status. Results: More than 45% of participants had a chronic ACSC. Individuals with ACSCs had higher odds of reporting their neighborhood as unsafe (AOR=1.25; 95%CI=1.05-1.49) than those who reported their neighborhood as extremely safe. Similarly, participants with ACSCs were significantly more likely to report challenges paying their utilities/rent/mortgage (AOR=1.18; 95%CI=1.03-1.36) than to report not experiencing challenges. Conclusions: To address chronic ACSCs, intersectoral public policies are warranted to diminish educational inequalities and racial disparities. This population would also benefit from community-based interventions that connect them to local resources that reduce stress and improve their financial stability and neighborhood safety level.
Use of ambulatory health services by the near poor
American Journal of Public Health, 1978
Individuals in the gray area between Medicaid eligibility and sufficient income to meet the costs of health care, the near poor, utilize health services less than other groups. As part of a study of health care behavior in an inner-city area based on a household survey of three distinct populations (HMO) members, public housing project residents, and a defined geographical area), we examined this question more thoroughly. Survey results show that the near poor had lower levels of use than Medicaid recipients when other factors were controlled. Particularly among those classified as in poor health, the near poor were more likely to be non-users and less likely to make multiple visits. However, differences in use between the near poor and the Medicaid recipients are substantially and consistently smaller for the HMO users (whose costs were covered by a special contract) than for users of a hospital outpatient department. The patterns persist for regular care received for a chronic con...
Inquiry, 2004
This study examines the effects of community-level and individual-level factors on access to ambulatory care for lower-income adults in 54 urban metropolitan statistical areas in the United States. Drawing on a conceptual behavioral and structural framework of access, the authors developed multivariate models for insured and uninsured lower-income adults to assess the adjusted effects of community-and individual-level factors on two indicators of access: having a usual source of care, and having at least one physician visit in the past year. Several community factors influenced access, but they did so differently for insured and uninsured adults and for the two measures of access used. The findings of this study confirm that public policies and community environment have measurable and substantial impacts on access to care, and that expanded public resources, such as Medicaid payments and safety-net clinics, can lead to measurable improvements in access for vulnerable populations residing in large urban areas.