scholarly journals The effectiveness of providing evidenced-based perinatal practice to low-income populations providing perinatal care: Does patient income influence the delivery of quality care?

2013 ◽  
Vol 2 (4) ◽  
pp. 82 ◽  
Author(s):  
Amy L. Damon ◽  
Carmen D. Parrotta ◽  
Lindsey A. Wallace ◽  
William Riley
Keyword(s):  
Low Income ◽  
Quality Care ◽  
Perinatal Care ◽  
The United States ◽  
Service Area ◽  
Evidence Based ◽  
Hospital Service ◽  
Care Bundles ◽  
Bundle Compliance ◽  
The Relationship

Background: This study examines a national perinatal quality improvement collaborative designed to create high reliability through the use of evidence-based perinatal care bundles. The objective of this study is to determine whether hospitals serving low-income patient populations experienced lower compliance with perinatal care bundles than hospitals serving higher-income patient populations Objective: We investigated the relationship between the rate of perinatal bundle compliance within a hospital and the economic characteristics of the patients and surrounding community. We hypothesized a negative relationship between poverty and care bundle compliance. Methods: Using prospective data from 131,847 births over 34 months within 16 hospitals located in cities across the United States, we examined the relationship between compliance with evidence-based obstetrical care bundles and three measures of the poverty status of the patient population served and the hospital service area: 1) proportion of the obstetrical patients with Medicaid as the primary payer, 2) median income in the hospital service area, and 3) poverty rate in the hospital’s service area. Results: The findings indicate no difference in bundle compliance rates in relation to the economic characteristics of the participating hospitals and their patients. Conclusions: While previous research has indicated that patients of lower socioeconomic status are less likely to receive high quality care, the findings in this study indicate that hospital compliance with evidence-based perinatal care bundles did not differ by economic characteristics of the hospital service area. These results indicate uniformity of care across hospitals irrespective of patient economic characteristics.

scholarly journals Post-acute care use patterns among Hospital Service Areas by older adults in the United States: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Julianna M. Dean ◽  
Kimberly Hreha ◽  
Ickpyo Hong ◽  
Chih-Ying Li ◽  
Daniel Jupiter ◽  
...  
Keyword(s):  
Acute Care ◽  
Care Service ◽  
Inpatient Rehabilitation ◽  
The United States ◽  
Service Area ◽  
Hospital Service ◽  
Medicare Beneficiaries ◽  
Skilled Nursing ◽  
Service Areas ◽  
Post Acute Care

Abstract Background Despite the success of stroke rehabilitation services, differences in service utilization exist. Some patients with stroke may travel across regions to receive necessary care prescribed by their physician. It is unknown how availability and combinations of post-acute care facilities in local healthcare markets influence use patterns. We present the distribution of skilled nursing, inpatient rehabilitation, and long-term care hospital services across Hospital Service Areas among a national stroke cohort, and we describe drivers of post-acute care service use. Methods We extracted data from 2013 to 2014 of a national stroke cohort using Medicare beneficiaries (174,498 total records across 3232 Hospital Service Areas). Patients’ ZIP code of residence was linked to the facility ZIP code where care was received. If the patient did not live in the Hospital Service Area where they received care, they were considered a “traveler”. We performed multivariable logistic regression to regress traveling status on the care combinations available where the patient lived. Results Although 73.4% of all Hospital Service Areas were skilled nursing-only, only 23.5% of all patients received care in skilled nursing-only Hospital Service Areas; 40.8% of all patients received care in Hospital Service Areas with only inpatient rehabilitation and skilled nursing, which represented only 18.2% of all Hospital Service Areas. Thirty-five percent of patients traveled to a different Hospital Service Area from where they lived. Regarding “travelers,” for those living in a skilled nursing-only Hospital Service Area, 49.9% traveled for care to Hospital Service Areas with only inpatient rehabilitation and skilled nursing. Patients living in skilled nursing-only Hospital Service Areas had more than five times higher odds of traveling compared to those living in Hospital Service Areas with all three facilities. Conclusions Geographically, the vast majority of Hospital Service Areas in the United States that provided rehabilitation services for stroke survivors were skilled nursing-only. However, only about one-third lived in skilled nursing-only Hospital Service Areas; over 35% traveled to receive care. Geographic variation exists in post-acute care; this study provides a foundation to better quantify its drivers. This study presents previously undescribed drivers of variation in post-acute care service utilization among Medicare beneficiaries—the “traveler effect”.

scholarly journals Impact of Socioeconomic Status and Race on Sepsis Epidemiology and Outcomes

2020 ◽  
Author(s):  
Emi Minejima ◽  
Annie Wong-Beringer
Keyword(s):  
Socioeconomic Status ◽  
Low Income ◽  
Formal Education ◽  
Geographic Location ◽  
The United States ◽  
Risk Scores ◽  
Low Ses ◽  
The Relationship ◽  
Poor Health Literacy ◽  
Hispanic White

Abstract Background Socioeconomic status (SES) is a complex variable that is derived primarily from an individual’s education, income, and occupation and has been found to be inversely related to outcomes of health conditions. Sepsis is the sixth most common admitting diagnosis and one of the most costly conditions for in-hospital spending in the United States. The objective of this review is to report on the relationship between SES and sepsis incidence and associated outcomes. Content Sepsis epidemiology varies when explored by race, education, geographic location, income, and insurance status. Sepsis incidence was significantly increased in individuals of Black race compared with non-Hispanic white race; in persons who have less formal education, who lack insurance, and who have low income; and in certain US regions. People with low SES are likely to have onset of sepsis significantly earlier in life and to have poorly controlled comorbidities compared with those with higher SES. Sepsis mortality and hospital readmission is increased in individuals who lack insurance, who reside in low-income or medically underserved areas, who live far from healthcare, and who lack higher level education; however, a person’s race was not consistently found to increase mortality. Summary Interventions to minimize healthcare disparity for individuals with low SES should target sepsis prevention with increasing measures for preventive care for chronic conditions. Significant barriers described for access to care by people with low SES include cost, transportation, poor health literacy, and lack of a social network. Future studies should include polysocial risk scores that are consistently defined to allow for meaningful comparison across studies.

Low-income children’s readiness for group-based learning at age 3 and prekindergarten outcomes at age 5

2020 ◽  
Vol 18 (3) ◽  
pp. 259-274
Author(s):  
Hannah B Mudrick ◽  
JoAnn L Robinson ◽  
Holly E Brophy-Herb
Keyword(s):  
United States ◽  
Low Income ◽  
Social Communication ◽  
Academic Outcomes ◽  
Effortful Control ◽  
The United States ◽  
Classroom Learning ◽  
Classroom Adjustment ◽  
The Relationship ◽  
Early Developmental

Although 3-year-olds in the United States may attend prekindergarten prior to formal school entry in kindergarten, few investigations focus on the socioemotional foundations of classroom learning at age 3 and their relationship to later achievement. This study examined the relationship between age 3 readiness for group-based learning, modeled as the latent constructs, effortful control and social communication, and age 5 classroom adjustment and pre-academic outcomes. Data from the Early Head Start Research and Evaluation Project in the United States ( n = 797) included observations, direct assessment, and examiner and teacher report. Children’s effortful control predicted classroom adjustment and their social communication predicted pre-academic outcomes. Readiness for group-based learning provides a way to describe key constructs of early skill development and a framework to support children’s classroom learning. Implications include promoting parents’ and educators’ capacities to support early developmental foundations for later adjustment and learning by fostering infants’ and toddlers’ effortful control and social communication. Efforts to support these skills simultaneously across diverse experiences in the home and classroom by focusing on children’s individual needs may prove advantageous.

Subject-specific and task-specific characteristics of metalinguistic awareness in bilingual children

1988 ◽  
Vol 9 (2) ◽  
pp. 141-162 ◽  
Author(s):  
Sylvia Joseph Galambos ◽  
Kenji Hakuta
Keyword(s):  
Language Proficiency ◽  
Low Income ◽  
The United States ◽  
Metalinguistic Awareness ◽  
Puerto Rican Spanish ◽  
Transitional Bilingual ◽  
Subject Specific ◽  
Native Language Proficiency ◽  
The Relationship ◽  
And Task

AbstractThe relationship between bilingualism and metalinguistic awareness was explored in Puerto Rican Spanish- and English-speaking children. All subjects were from low-income backgrounds and were enrolled in a transitional bilingual education program in the United States. Two longitudinal studies were conducted. The first study examined the abilities to note and correct ungrammatical sentences in Spanish. Subjects were 104 children in first and second grade at the beginning of the study. They were followed over a period of 2 years. The second study looked at the ability to detect ambiguity in sentences, and to paraphrase the different meanings. There were 107 subjects who were in fourth and fifth grades, and were also followed over a 2-year period. The results from both studies indicated that native language proficiency as well as the degree of bilingualism affected metalinguistic awareness. The results also indicated that these effects interacted with the types of items in the metalinguistic tasks. This suggests that both subject-specific and task-specific factors are important in understanding the relationship between bilingualism and metalinguistic awareness.

scholarly journals Article processing charges, the geographic diversity of author communities, and barriers to publication for authors in the Global South

2020 ◽  
Author(s):  
Audrey Culver Smith ◽  
Leandra Merz ◽  
Jesse B. Borden ◽  
Chris Gulick ◽  
Akhil Ravindra Kshirsagar ◽  
...  
Keyword(s):  
Low Income ◽  
United States Of America ◽  
The United States ◽  
Global South ◽  
Low Income Countries ◽  
Editorial Boards ◽  
Geographic Diversity ◽  
The Usa ◽  
Article Processing Charges ◽  
The Relationship

Many OA journals require authors pay an article processing charge (APC), which researchers in the Global South often cite as an insurmountable financial barrier. This has led to speculation that there will be lower representation of these authors in OA journals charging APCs. We used “mirror journals” – APC-charging OA versions of paywalled (PW) titles with whom they share editorial boards and standards for acceptance – to investigate the relationship between APCs and the geographic diversity of authors. Most of the >41,000 articles we reviewed were published in PW journals. Although lead authors were based in >140 countries, ~45% were based in either the United States of America (USA) or China. After correcting for differences in sample size, we found no difference between OA and PW journals in the number of countries in which lead authors were based. After correcting for the dominance of China and the USA, we found that author diversity in OA journals was significantly lower than in PW journals. Most OA articles were written by authors in high-income countries; no articles in OA journals had first authors from low-income countries. Our results suggest APCs are a barrier to OA publication for scientists from the Global South.

scholarly journals Food Instability and Academic Achievement: A Quasi-Experiment Using SNAP Benefit Timing

2018 ◽  
Vol 55 (5) ◽  
pp. 897-927 ◽  
Author(s):  
Anna Gassman-Pines ◽  
Laura Bellows
Keyword(s):  
Academic Achievement ◽  
Low Income ◽  
Test Scores ◽  
The United States ◽  
Benefit Transfer ◽  
Assistance Program ◽  
Low Income Families ◽  
Nutrition Assistance ◽  
End Of Grade ◽  
The Relationship

Although social policies aimed at low-income families are thought to promote children’s educational success, little research has examined how these policies are related to children’s academic achievement. This article focuses on the Supplemental Nutrition Assistance Program (SNAP), the United States’ largest food assistance program. Using administrative data on over 148,000 SNAP-receiving public school children, we analyze the recency of SNAP benefit transfer and children’s end-of-grade math and reading achievement test scores. Results indicate differences in students’ math and reading performance based on the recency of SNAP benefit transfer. Although the relationship is stronger for reading than for math, the relationship between students’ test scores and SNAP transfer is roughly curvilinear. Test scores peak in the third week following benefit transfer.

scholarly journals Addressing opioid use disorder among rural pregnant and postpartum women: a study protocol

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
M. Aryana Bryan ◽  
Marcela C. Smid ◽  
Melissa Cheng ◽  
Katherine T. Fortenberry ◽  
Amy Kenney ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Study Protocol ◽  
Repeated Measures ◽  
Perinatal Care ◽  
The United States ◽  
Opioid Use Disorder ◽  
Rural Setting ◽  
Evidence Based ◽  
Provider Education ◽  
Opioid Use

Abstract Background Opioid use disorder (OUD) among women delivering at a hospital has increased 400% from 1999–2014 in the United States. From the years 2007 to 2016, opioid-related mortality during pregnancy increased over 200%, and drug-overdose deaths made up nearly 10% of all pregnancy-associated mortality in 2016 in the US. Disproportionately higher rates of neonatal opioid withdrawal syndrome (NOWS) have been reported in rural areas of the country, suggesting that perinatal OUD is a pressing issue among these communities. There is an urgent need for comprehensive, evidence-based treatment services for pregnant women experiencing OUD. The purpose of this article is to describe a study protocol aimed at developing and evaluating a perinatal OUD curriculum, enhancing evidence-based perinatal OUD treatment in a rural setting, and evaluating the implementation of such collaborative care for perinatal OUD. Methods This two-year study employed a one group, repeated measures, hybrid type-1 effectiveness-implementation design. This study delivered interventions at 2 levels, both targeting improvement of care for pregnant women with OUD. The first area of focus was at the community healthcare provider-level, which aimed to evaluate the acceptability and feasibility of perinatal OUD education across time and to improve provider education by increasing knowledge specific to: MOUD provision; screening, brief intervention, and referral to treatment (SBIRT) utilization; and NOWS treatment. The second area of intervention focus was at the patient-level, which assessed the preliminary effect of perinatal OUD provider education in promoting illicit opioid abstinence and treatment engagement among pregnant women with OUD. We adopted constructs from the Consolidated Framework for Implementation Research (CFIR) to assess contextual factors that may influence implementation, and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model to comprehensively evaluate implementation outcomes. Discussion This article presents the protocol of an implementation study that is employing the CFIR and RE-AIM frameworks to implement and evaluate a perinatal OUD education and service coordination program in two rural counties. This protocol could serve as a model for clinicians and researchers seeking to implement improvements in perinatal care for women with OUD in other rural communities. Trial registration NCT04448015 clinicaltrials.gov.

scholarly journals The Role of Child Support Insurance in Antipoverty Policy

1985 ◽  
Vol 479 (1) ◽  
pp. 119-131 ◽  
Author(s):  
IRWIN GARFINKEL
Keyword(s):  
Low Income ◽  
Child Support ◽  
Current System ◽  
The United States ◽  
Single Parent ◽  
Single Parent Families ◽  
Welfare Dependence ◽  
Relationship Of ◽  
The Relationship

This article describes existing child support practice in the United States, giving attention to the establishment and enforcement of parental child support obligations as well as to publicly provided child support benefits. Effects of the current system on alleviating poverty are assessed. The article addresses several questions. Should low-income absent parents be excused from the obligation to support their children? Can child support provide more generous benefits to single-parent families while minimizing incentives for the formation of single-parent families? Should children in single-parent families be aided by a welfare program? What are the problems with the current child support system? Finally, a proposal for a new child support insurance system is described, along with estimates of the costs of the system and its effects on poverty and welfare dependence. The relationship of estimated benefits to costs is promising enough to warrant trying out the new system in selected jurisdictions.

scholarly journals Digging Deeper into Dialogic Feedback: Evaluating How Science Teachers Manage Uncertainty as a Predictor of Students’ Ability to Construct an Epistemically Sound Argument

2020 ◽  
Vol 7 (1) ◽  
pp. p36
Author(s):  
Mason Kuhn ◽  
Marine Pepanyan
Keyword(s):  
Student Achievement ◽  
Critical Thinking ◽  
Science Teachers ◽  
Low Income ◽  
Educational Practice ◽  
School Science ◽  
Middle School Science ◽  
Evidence Based ◽  
The Relationship ◽  
Scientific Arguments

In this study, we examined the relationship between the use of two teachers’ dialogue feedback as an educational practice to promote evidence-based argumentation in middle school science lessons and the students’ ability to create scientific arguments in a standardized critical thinking exam. The teachers had an equal amount of training on Argument-Based Inquiry (ABI) and taught in a federally-identified low-income school. When the patterns of talk were analyzed, divergent themes emerged and feedback that promoted critique correlated with student achievement on the critical thinking exam.

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