Abstract
Background Safety-net health systems are an important source of healthcare for underserved or vulnerable individuals, but definitions of safety-net institutions are largely based on patient characteristics. Some definitions may not accurately identify such institutions. Therefore, we aimed to describe the characteristics of urban safety-net patients in Texas and compare the distribution of morbidities between safety-net and general population patients. Methods We used hospital claims data from the Dallas-Fort Worth Hospital Council Foundation to create a cross-sectional cohort. Eligible patients were aged ≥18 years and Tarrant County residents in 2018. Patients were divided into two groups for comparison. The first group represented patients with hospital claims from JPS Health Network (i.e. safety-net population). The second group represented all patients with hospital claims in Tarrant County (i.e. general population). We estimated frequencies of patient characteristics. In addition, we estimated overall and payor-stratified standardized morbidity ratios (SMRs) adjusted for age, gender, and race/ethnicity to compare the prevalence of common chronic diseases between safety-net patients and patients in the general population. Results Our study population comprised 459,827 patients, of whom 74,323 (16%) were safety-net patients. Patients aged ≥65 years comprised 23% of the general population and 11% of the safety-net population. Non-Hispanic Whites comprised 52% of the general population and 29% of safety-net patients. A larger proportion of safety-net patients were uninsured compared with general population patients (safety-net: 54%; general population: 25%), but Medicaid distribution was less discrepant (safety-net: 9%; general population: 7%). Medicare was the primary payor for 24% of general population patients and 14% of safety-net patients. Safety-net patients had relative excesses of mental health and chronic conditions ranging between 5% and 230% for all selected conditions except dementia/Alzheimer’s. The patterns for payor-stratified SMRs were consistent with the overall results. Conclusions We observed considerable sociodemographic diversity and a high burden of mental health and chronic conditions among safety-net patients, which may support understanding the healthcare needs of safety-net populations. Our findings raise questions about definitions of safety-net institutions based on Medicaid distribution alone and the transportability of findings from studies in which safety-net populations are unrepresented.
HEALTH LITERACY IN TARRANT COUNTY ADULTS: A SYSTEMS APPROACH TO SERVICE DELIVERY
