scholarly journals Reasons Why Patients Remain Uninsured after Massachusetts’ Health Care Reform: A Survey of Patients at a Safety-Net Hospital

2011 ◽  
Vol 27 (2) ◽  
pp. 250-256 ◽  
Author(s):  
Rachel Nardin ◽  
Assaad Sayah ◽  
Hermione Lokko ◽  
Steffie Woolhandler ◽  
Danny McCormick
Keyword(s):  
Health Care ◽  
Health Care Reform ◽  
Safety Net ◽  
Safety Net Hospital

scholarly journals Access to Care After Massachusetts’ Health Care Reform: A Safety Net Hospital Patient Survey

2012 ◽  
Vol 27 (11) ◽  
pp. 1548-1554 ◽  
Author(s):  
Danny McCormick ◽  
Assaad Sayah ◽  
Hermione Lokko ◽  
Steffie Woolhandler ◽  
Rachel Nardin
Keyword(s):  
Health Care ◽  
Access To Care ◽  
Health Care Reform ◽  
Safety Net ◽  
Patient Survey ◽  
Hospital Patient ◽  
Safety Net Hospital

Behavioral Health Patient Engagement in Video-based Visits through a Patient Portal at an Urban Safety-Net Hospital During COVID-19: Direct Patient Outreach and Case-Control Study (Preprint)

2021 ◽  
Author(s):  
Han Yue ◽  
Victoria Mail ◽  
Maura DiSalvo ◽  
Christina Borba ◽  
Joanna Piechniczek-Buczek ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Behavioral Health ◽  
Patient Engagement ◽  
Safety Net ◽  
Patient Portal ◽  
Patient Portals ◽  
Safety Net Hospital ◽  
Urban Safety

BACKGROUND Patient portals are a safe and secure way for patients to connect with providers for video-based telepsychiatry and help to overcome the financial and logistical barriers associated with face-to-face mental health care. Due to the coronavirus disease 2019 (COVID-19) pandemic, telepsychiatry has become increasingly important to obtaining mental health care. However, financial, and technological barriers, termed the “digital divide,” prevent some patients from accessing the technology needed to utilize telepsychiatry services. OBJECTIVE As part of an outreach project during COVID-19 to improve patient engagement with video-based visits through the hospital’s patient portal among adult behavioral health patients at an urban safety net hospital, we aimed to assess patient preference for patient portal-based video visits or telephone-only visits, and to identify the demographic variables associated with their preference. METHODS Patients in an outpatient psychiatry clinic were contacted by phone and preference for telepsychiatry by phone or video through a patient portal, as well as device preference for video-based visits, were documented. Patient demographic characteristics were collected from the electronic medical record. RESULTS One hundred and twenty-eight patients were reached by phone. Seventy-nine patients (61.7%) chose video-based visits and 69.6% of these patients preferred to access the patient portal through a smartphone. Older patients were significantly less likely to agree to video-based visits. CONCLUSIONS Among behavioral health patients at a safety-net hospital, there was a relatively low engagement with video-based visits through the hospital’s patient portal, particularly among older adults.

Health care reform and the safety net

1996 ◽  
Vol 27 (2) ◽  
pp. 234-236 ◽  
Author(s):  
Robert K.Knopp
Keyword(s):  
Health Care ◽  
Health Care Reform ◽  
Safety Net

Breast cancer diagnosis and treatment in a safety net setting: Differences between insured and uninsured patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6566-6566
Author(s):  
N. J. Farrell ◽  
C. J. Bradley ◽  
L. M. Schickle
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Health Insurance ◽  
Adjuvant Chemotherapy ◽  
Breast Cancer Diagnosis ◽  
Safety Net ◽  
Cancer Center ◽  
Hospital System ◽  
Safety Net Hospital ◽  
Chemotherapy Initiation

6566 Background: Despite the safety net system and many other means of providing free or low cost care to women with breast cancer, disparities in health outcomes between uninsured and insured women with breast cancer exist. In this study, we evaluate the role of health insurance on breast cancer treatments at a large safety net hospital system. Methods: From the patient population at the Massey Cancer Center at Virginia Commonwealth University Health Care System (a large regional safety net provider), we selected women ages 21 to 64 diagnosed with breast cancer between January 1999 and March 2006 (n=1,381). We used billing records to identify health insurance status of these patients. First, we compared the stage of disease and tumor size at diagnosis for women with and without insurance. Next, we compared the number of days between diagnosis and surgery and the number of days between surgery and chemotherapy initiation. Finally, we estimated the number of days it took these groups of women to complete a common adjuvant chemotherapy regimen of doxorubicin plus cyclophosphamide (AC) or doxorubicin plus cyclophosphamide followed by paclitaxel (ACT). Results: Our analysis shows that women without insurance were more likely to have more advanced cancers and correspondingly larger tumors. Uninsured women experienced considerable delays from the date of diagnosis to surgery and from surgery to chemotherapy initiation compared with insured women (21.5 and 22 days longer, respectively). Uninsured women also took significantly longer to complete adjuvant chemotherapy regimens relative to insured women (4 and 26 days for AC and ACT, respectively). Conclusions: To understand the disparities that exist in breast cancer outcomes among women with and without health insurance, we must understand the different experiences these groups of women have with treatment. In this study, uninsured women had more advanced cancers, and experienced considerable delays receiving and completing treatment relative to insured women. Our study demonstrates the value of health insurance in the timely provision of health care even in a safety net setting where care is guaranteed. No significant financial relationships to disclose.

Palliative care and end-of-life health care utilization of pancreatic cancer patients at an urban safety-net hospital.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 489-489
Author(s):  
Nizar Bhulani ◽  
M. Elizabeth Paulk ◽  
Arjun Gupta ◽  
Kiauna Donnell ◽  
Valorie Harvey ◽  
...  
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Palliative Care ◽  
Intensive Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Cancer Patients ◽  
Safety Net ◽  
Care Utilization ◽  
Safety Net Hospital

489 Background: There has been an increase in Palliative care utilization in cancer patients. We examined trends of palliative care and intensive care utilization in pancreatic cancer patients in an urban setting safety net hospital. Methods: This is a retrospective analysis of pancreatic cancer patients seen at the Parkland Health and Hospital System between January 1999 and September 2016. Cancer cases and receipt of palliative care were identified from prospectively maintained registries. Health care utilization including intensive care unit (ICU) was reviewed. All statistical analysis was done using IBM SPSS version 24. Results: We identified 455 new diagnoses of pancreatic cancer, mean age 61 years, 227 (50%) female and 228 (50%) white. Of these, 277 (61%) received palliative care ever. Patient who received palliative care were more likely to be younger (mean age, 59.3+-12 vs 62.8 +- 12 years) and have stage 4 disease vs stage 1-3 disease (p 0.006, and p 0.003 respectively). There was no statistically significant difference in palliative care utilization between gender and ethnicity groups. 140 patients had a DNR order and 29 required ICU admission at any point. A first contact with palliative care consult was obtained < = 7 days before death for 29 (10%) patients, < = 30 days before death for 86 (31%) patients, 30-60 days before death for 50 (18%) and more than 60 days before death for 141 (51%) patients. Patients receiving palliative care were more likely to have a DNR status (p < 0.001) but had no difference in ICU use within the last 30 days of life (p 0.285). Conclusions: The rate of palliative care in patients with pancreatic cancer in this cohort from a safety net hospital is higher than nationally reported studies. Most patients received palliative care > 30 days before death. While patients received early palliative care, it did not result in reduced ICU care. Factors influencing ICU care utilization near the end of life need further study.

Public Dental Safety Net in Iowa: Capacity and Readiness for Health Care Reform

2016 ◽  
Vol 27 (2) ◽  
pp. 450-464 ◽  
Author(s):  
Julie C. Reynolds ◽  
Susan C. McKernan ◽  
Raymond A. Kuthy ◽  
Nancy B. Adrianse ◽  
Simi Mani ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Reform ◽  
Safety Net

scholarly journals Ordering Patterns and Costs of Specialized Laboratory Testing by Hospitalists and House Staff in Hospitalized Patients With HIV at a County Hospital: An Opportunity for Diagnostic Stewardship

2019 ◽  
Vol 6 (6) ◽  
Author(s):  
Kathryn Bolles ◽  
Laila Woc-Colburn ◽  
Richard J Hamill ◽  
Vagish Hemmige
Keyword(s):  
Health Care ◽  
Laboratory Testing ◽  
Laboratory Tests ◽  
Tertiary Care ◽  
Safety Net ◽  
Hiv Care ◽  
Hiv Positive ◽  
Safety Net Hospital ◽  
Study Laboratory ◽  
Health Care Waste

Abstract Background Inpatient HIV care often requires specialized laboratory testing with which practitioners may not be familiar. In addition, computerized physician order entry allows for ordering tests without understanding test indications, but it can also provide a venue for education and diagnostic stewardship. Methods All charts of HIV-positive patients hospitalized at a tertiary care public safety net hospital in Houston, Texas, between January 1, 2014, and June 30, 2014, were reviewed for a set list of laboratory tests. Appropriateness of test ordering was assessed by 2 providers. Cost estimates for each test were obtained from Medicaid and a national nonprofit health care charge database. Results A total of 274 HIV-positive patients were admitted 429 times in the 6-month study period. During the study period, 45% of the study laboratory tests ordered were not indicated. A total of 532 hepatitis serologies were ordered, only 52% of which were indicated. Overall, 71 serum qualitative cytomegalovirus (CMV) polymerase chain reactions (PCRs) and eight CMV quantitative PCRs were ordered, with most (85%) qualitative PCRs ordered for nonspecific signs of infection (eg, fever). Other tests ordered without clear indications included Aspergillus IgE (7), serum Epstein-Barr virus (EBV) PCR (5), parvovirus serology (7), and Toxoplasma IgM (18). Overall, the estimated laboratory cost of inappropriate testing over the study period was between $14 000 and $92 000, depending on which cost database was used. Conclusions Many tests ordered in HIV-positive inpatients do not have indications, representing a substantial source of health care waste and cost and potentially leading to inappropriate treatment. Opportunities exist to decrease waste through education of trainees and hospitalists and through implementation of diagnostic stewardship via the electronic medical record.

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