scholarly journals Factors Driving High-Need High-Risk Vulnerable Veterans Use of Outpatient Healthcare

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1012-1013
Author(s):  
Ali Vaeli Zadeh ◽  
Fei Tang ◽  
Carlos Gomez ◽  
Luci Leykum ◽  
Orna Intrator ◽  
...  
Keyword(s):  
High Risk ◽  
Behavioral Model ◽  
Area Deprivation ◽  
Enabling Factors ◽  
Time Service ◽  
Care Access ◽  
Healthcare Needs ◽  
Driving Time ◽  
Extended Care ◽  
The Individual

Abstract Using predictive analytic modeling, the Veterans Affairs (VA) Geriatrics and Extended Care Data Analysis Center (GECDAC) identified vulnerable “High-Need High-Risk” (HNHR) Veterans, as requiring more support and services. We sought to identify variables linked with utilization of our outpatient HNHR C4 clinic offering Comprehensive Geriatric Assessment, Care Planning, Care Coordination, and Co-management". Of 724 HNHR Veterans contacted, 531 were reached and invited to participate; 193 were not reached, 326 were reached but declined the C4 clinic, 205 attended the clinic. We compared these groups. Independent variables were organized using Anderson’s behavioral model into predisposing (age, gender, race, ethnicity), enabling (drive time, service eligibility, Area Deprivation Index, marital status), and need factors (mental health cognitive condition, ambulatory care sensitive conditions, NOSOS, JFI, CAN, etc.). C4 enrollment acceptance was the outcome. Results showed that compared to patients who declined, HNHR veterans who attended C4 clinic had more chronic health conditions(p<0.01), more service eligibility(p=0.01), more driving time to the closest VA clinic(p=0.01), and more were married (p=0.01). Patients who declined C4 clinic might have greater barriers to care access. Accessing needed healthcare among HNHR older adults maybe impacted more by enabling factors that allow the individual to seek care if needed and are the resources that may facilitate access to services, rather than need factors, which include individuals' perceptions of their health and functional state, and healthcare needs assessed by professionals. More social and intermediary determinants of health should be incorporated as enabling factors into models striving to understand drivers of healthcare use.

scholarly journals Factors Influencing Variations in Hospitalization for Diabetes with Hypoglycemia

2018 ◽  
Vol 7 (10) ◽  
pp. 367 ◽  
Author(s):  
Waleed Kattan ◽  
Thomas Wan
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Economic Status ◽  
Geographical Location ◽  
Behavioral Model ◽  
Care Utilization ◽  
Personal Factors ◽  
Enabling Factors ◽  
Practical Applications ◽  
Total Charges

Many studies have explored risk factors associated with Hypoglycemia (HG) and examined the variation in healthcare utilization among HG patients. However, most of these studies failed to integrate a comprehensive list of personal risk factors in their investigations. This empirical study employed the Behavioral Model (BM) of health care utilization as a framework to investigate diabetes’ hospitalizations with HG. The national inpatient sample with all non-pregnant adult patients admitted to hospitals’ emergency departments and diagnosed with HG from 2012 to 2014 was used. Personal factors were grouped as predictors of the length of stay and the total charges incurred for hospitalization. High-risk profiles of hospitalized HG patients were identified. The analysis shows the need for care factors are the most influential predictors for lengthy hospitalization. The predisposing factors have a limited influence, while enabling factors influence the variation in hospital total charges. The presence of renal disease and diabetes mellitus (DM) complications played a key role in predicting hospital utilization. Furthermore, age, socio-economic status (SES), and the geographical location of the patients were also found to be vital factors in determining the variability in utilization among HG patients. Findings provide practical applications for targeting the high-risk HG patients for interventions.

Differentiation of endemic areas by incidence rates of tick-borne infectious diseases as the basis for choosing prevention strategy and tactics

2019 ◽  
pp. 56-61
Author(s):  
N.V. Rudakov ◽  
N.A. Penyevskaya ◽  
D.A. Saveliev ◽  
S.A. Rudakova ◽  
C.V. Shtrek ◽  
...  
Keyword(s):  
High Risk ◽  
Infectious Diseases ◽  
Population Based ◽  
Preventive Therapy ◽  
Incidence Rates ◽  
Prevention Strategy ◽  
Individual Risk ◽  
The Individual ◽  
Integral Assessment ◽  
Very High

Research objective. Differentiation of natural focal areas of Western Siberia by integral incidence rates of tick-borne infectious diseases for determination of the strategy and tactics of their comprehensive prevention. Materials and methods. A retrospective analysis of official statistics for the period 2002-2018 for eight sub-federal units in the context of administrative territories was carried out. The criteria of differentiation were determined by means of three evaluation scales, including long-term mean rates of tick-borne encephalitis, tick-borne borreliosis, and Siberian tick-borne typhus. As a scale gradation tool, we used the number of sample elements between the confidence boundaries of the median. The integral assessment was carried out by the sum of points corresponding to the incidence rates for each of the analyzed infections. Results. The areas of low, medium, above average, high and very high risk of tick-borne infectious diseases were determined. Recommendations on the choice of prevention strategy and tactics were given. In areas of very high and high incidence rates, a combination of population-based and individual prevention strategies is preferable while in other areas a combination of high-risk and individual strategies is recommended. Discussion. Epidemiologic zoning should be the basis of a risk-based approach to determining optimal volumes and directions of preventive measures against natural focal infections. It is necessary to improve the means and methods of determining the individual risk of getting infected and developing tick-borne infectious diseases in case of bites, in view of mixed infection of vectors, as well as methods of post-exposure disease prevention (preventive therapy).

scholarly journals Examining Dementia Family Caregivers’ Forgone Care for General Practitioners and Medical Specialists during a COVID-19 Lockdown

2021 ◽  
Vol 18 (7) ◽  
pp. 3688
Author(s):  
Perla Werner ◽  
Aviad Tur-Sinai ◽  
Hanan AboJabel
Keyword(s):  
Family Caregivers ◽  
Emotional Support ◽  
Online Survey ◽  
Behavioral Model ◽  
Cross Sectional Study ◽  
Enabling Factors ◽  
Dementia Caregivers ◽  
Predisposing Factor ◽  
Cross Sectional ◽  
Medical Specialists

The present study aimed to assess dementia caregivers’ reports of the prevalence and correlates of forgone care regarding visits to a general practitioner (GP) and to a specialist during the COVID-19 lockdown in Israel, using Andersen’s Behavioral Model of Healthcare Utilization. A cross-sectional study using an online survey was conducted with 73 Israeli family caregivers of persons with dementia residing in the community (81% Jews, 86% female, mean age = 54). Overall, one out of two participants reported having to delay seeking needed help from a GP or a specialist for themselves, as well as for their relatives with dementia, during the COVID-19 lockdown period. Among the predisposing factor, education was associated with caregivers’ reports regarding forgone care for themselves as well as for their loved ones. Living with the care-receiver and income level were the enabling factors associated with forgone care for caregivers. Finally, feelings of burden were associated with caregivers’ forgone care and feelings of loneliness and perceptions of the care-receiver’s cognitive functioning were associated with care-receivers’ forgone care. Our findings show that it is essential that this population receive appropriate practical and emotional support at times of distress and crisis to enable them to continue with their caregiving role.

Workplace Location and ICTs Substituting Travel

2010 ◽  
pp. 205-225 ◽  
Author(s):  
Greger Henriksson ◽  
Minna Räsänen
Keyword(s):  
Case Studies ◽  
Environmental Sustainability ◽  
Relevant Literature ◽  
Social Practices ◽  
Time Service ◽  
Individual Level ◽  
The Difference ◽  
The Individual ◽  
Relations Of Power ◽  
Shed Light

This chapter is based on the assumption that keeping the number and length of business and commuting trips at reasonable levels could contribute to reaching targets of environmental sustainability. The authors highlight a couple of options for reducing or avoiding business trips and commuting through workplace location or improved use of communications. They present case studies concerning travel and communications, carried out by using diaries and interviews. They also present relevant literature on social practices and sustainability goals in relation to use of ICT. The aim is to shed light on variation in the use of travel and communications on an individual level in work life. The case studies illustrate that such variation is mainly due to the concrete practices involved in execution of professional duties and roles. Duties that involve a clearly defined end result or product being delivered regularly by the member of staff are correlated to clearly defined needs for communications. Less clearly defined end results of the work duties seem to make it harder for the individual to plan and perform communication and travel in a more energy saving way. The difference in professional duties can thus be expressed in terms of clarity and maturity. Another factor that affect who can replace travel with ICTs is relations of power, e.g., when a purchaser dictates the terms for a subcontractor concerning how and where to “deliver” his working time, service or product. The importance of clarity, maturity and power aspects means that professional practices need to be studied at a detailed level to find out who could substitute ICTs for travel and how this could be done.

Cardiovascular risk estimation at the individual level

ESC CardioMed ◽  
2018 ◽  
pp. 846-863
Author(s):  
Yvo M. Smulders ◽  
Marie-Therese Cooney ◽  
Ian Graham
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Estimation ◽  
Pharmacological Therapy ◽  
Cardiovascular Risks ◽  
Individual Level ◽  
The Individual ◽  
Very High ◽  
Cardiovascular Risk Estimation

The absolute benefit of any measure to prevent cardiovascular disease, be it lifestyle improvement or pharmacological therapy, depends on the baseline cardiovascular risk. This risk cannot be assessed exactly, but only be estimated because many known risk determinants cannot be accounted for in existing risk scoring systems, and because the application to an individual of risk estimates derived from populations is imprecise. Several cardiovascular risk estimation methods are available, and the European Society of Cardiology has favoured the European-based Systematic COronary Risk Evaluation (SCORE) system as a basis for their cardiovascular disease prevention guidelines. SCORE estimates absolute 10-year cardiovascular mortality risk. In specific circumstances, estimation of relative risk, risk age, or lifetime risk may be considered. High- and very-high-risk population are defined by SCORE risks greater than 5% and greater than 10%, respectively, or by clinical conditions conferring (very) high risk, such as existing cardiovascular disease or chronic kidney disease. The role of additional risk information on top of the information entered in SCORE is generally limited. In particular, markers of early cardiovascular damage should be collected and interpreted with caution. Absolute cardiovascular risks in young and elderly individuals are almost always low or very high, respectively, and the options for appropriate interpretation and management of these risks are discussed.

scholarly journals Analyzing Factors of Breast Cancer Screening Adherence among Korean American Women Using Andersen’s Behavioral Model of Healthcare Services Utilization

2019 ◽  
Vol 29 (Supp2) ◽  
pp. 427-434
Author(s):  
Seok Won Jin ◽  
Hee Yun Lee ◽  
Jongwook Lee
Keyword(s):  
Breast Cancer ◽  
Behavioral Model ◽  
Healthcare Services ◽  
Decisional Balance ◽  
Korean American ◽  
Self Report ◽  
Enabling Factors ◽  
Cross Sectional ◽  
Services Utilization ◽  
Andersen’S Behavioral Model

Objectives: Regular uptake of mammogra­phy screening reduces the risk of advanced stage diagnosis of breast cancer (BC). How­ever, BC screening rates remain suboptimal among Korean American (KA) women. Using the Andersen’s Behavioral Model of Healthcare Services Utilization, this study examined factors associated with mammog­raphy screening among KA women aged 50 to 80 years in the state of Georgia, USA.Methods: We used purposive sampling to recruit study participants in the Atlanta met­ropolitan area from May 2015 to February 2016. A total of 303 KA women completed a cross-sectional, self-report survey about their sociodemographics, health care access information, knowledge, self-efficacy, deci­sional balance, and mammography history.Results: Descriptive analyses confirmed low rates of mammography screening in the participants. Multiple logistic regression analyses showed that having a mammogram within the past year was associated with greater BC knowledge, higher scores of decisional balance and fewer annual health check-ups among KA women without any cancer history.Conclusions: The findings offer implica­tions for health policy aimed at increas­ing BC screening by leveraging enabling factors among medically underserved KA women at both structural and cultural levels.Ethn Dis.2019;29(Suppl 2):427-434; doi:10.18865/ed.29.S2.427

Health Literacy in Korean Adults and Korean American Immigrants: Implications for Achieving Health Equity

2020 ◽  
pp. 0272684X2097351
Author(s):  
Soondool Chung ◽  
Hee Yun Lee ◽  
Miwoo Lee ◽  
Semi Chung
Keyword(s):  
Health Literacy ◽  
Age Groups ◽  
Behavioral Model ◽  
The United States ◽  
Korean American ◽  
Cross Sectional Survey ◽  
Enabling Factors ◽  
Cross Sectional ◽  
Korean Adults ◽  
Quota Sampling

Health literacy is necessary to understand health information and make appropriate decisions regarding one’s health. This study aims to investigate (1) the health literacy level of Korean citizens and Korean American (KA) immigrants in the United States and (2) factors that influence health literacy across three age groups. A quota sampling method was used to collect cross-sectional survey data from 404 Korean participants and 404 KA immigrants. Andersen’s behavioral model was used as the theoretical framework for this study. Overall, Korean participants had a higher mean score on health literacy than did the KA immigrants. Only one of predisposing and enabling factors were significant variables influencing health literacy in KA immigrants, while several predisposing, enabling and need factors were significantly associated with health literacy in Korean adults. Our findings indicate that both countries need to have a community-based health literacy educational program that is tailored to each age group.

scholarly journals Impact of fees on access to dental care: evidence from France

2020 ◽  
Vol 30 (6) ◽  
pp. 1066-1071
Author(s):  
Anne-Charlotte Bas ◽  
Paul Dourgnon ◽  
Sylvie Azogui-Levy ◽  
Jérôme Wittwer
Keyword(s):  
Health Insurance ◽  
Dental Care ◽  
P Value ◽  
Care Needs ◽  
Enabling Factors ◽  
Healthcare Needs ◽  
Out Of Pocket Payments ◽  
Access To Dental Care ◽  
The Impact ◽  
Dental Prosthetics

Abstract Background For financial reasons, dental prosthetics is one of the major unmet dental healthcare needs [Financial-SUN (F-SUN)]. Private fees for dental prosthetics result in significant out-of-pocket payments for users. This study analyzes the impact of geo-variations in protheses fees on dental F-SUN. Methods Using a nationwide French declarative survey and French National Health Insurance administrative data, we empirically tested the impact of prosthetic fees on dental F-SUN, taking into account several other enabling factors. Our empirical strategy was built on the homogeneous quality of the dental prosthesis selected and used to compute our price index. Results Unmet dental care needs due to financial issues concern not only the poorest but also people with middle incomes. The major finding is the positive association between dental fees and difficulty in gaining access to dental care when other enabling factors are taken into account (median fee in the highest quintile: OR = 1.35; P value = 0.024; 95% CI 1.04–1.76). People with dental F-SUN are those who have to make a greater financial effort due to a low/middle income or a lack of complementary health insurance. For identical financial reasons, the tendency to give up on healthcare increases as health deteriorates. Conclusions The results underscore the need for fee regulation regarding dental prosthetics. This is in line with the current French government dental care reform.

Implication of Burn Disaster Planning and Management: Coverage and Accessibility of Burn Centers in Belgium

2019 ◽  
pp. 1-11 ◽  
Author(s):  
Mustafa Al-Shamsi ◽  
Serge Jennes
Keyword(s):  
Disaster Preparedness ◽  
Time Window ◽  
Secondary Analysis ◽  
Access Time ◽  
Cross Sectional ◽  
Industrial Countries ◽  
Burn Centers ◽  
Driving Time ◽  
Disaster Scenario ◽  
The Individual

AbstractIntroduction:Burn disasters represent a real challenge to burn centers worldwide. Several burn disasters with a considerable number of casualties happened in Belgium in the past. The positioning of burn centers is a significant issue to account for in a burn disaster preparedness and response. The objectives of this study are to identify the geographic coverage and accessibility of the burn centers in Belgium in the realm of a burn disaster scenario.Method:Cross-sectional secondary analysis was performed using data from the Belgian Burn Association and Belgian Department of the Statistic. Data were analyzed using ArcGIS, a geographic information system tool to identify the coverage of burn centers within half an hour driving time, and access time of both populations in the districts and the disaster-prone areas to the individual burn centers.Results:Around 7.3 million (65%) people are covered by a half an hour driving time window from the burn centers. However, the accessibility to the individual burn centers is varied across different regions and provinces.Conclusion:There is a slightly over-supply of burn centers in the mid part of the country, contrasted by an under-supply and poor accessibility for the population living near the borders, particularly in the south part of the country. This study would provide a benchmark for stakeholders in Belgium and other industrial countries to consider the coverage and accessibility of the burn centers as part of preparation and planning for burn disasters in the future.

Sign in / Sign up

Export Citation Format

Share Document