Dual Barriers: Examining Digital Access and Travel Burdens to Hospital Maternity Care Access in the United States, 2020.

IF 4.8 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Milbank Quarterly Pub Date : 2023-12-01 Epub Date: 2023-08-23 DOI:10.1111/1468-0009.12668
Peiyin Hung, Marion Granger, Nansi Boghossian, Jiani Yu, Sayward Harrison, Jihong Liu, Berry A Campbell, B O Cai, Chen Liang, Xiaoming Li
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引用次数: 0

Abstract

Policy Points The White House Blueprint for Addressing the Maternal Health Crisis report released in June 2022 highlighted the need to enhance equitable access to maternity care. Nationwide hospital maternity unit closures have worsened the maternal health crisis in underserved communities, leaving many birthing people with few options and with long travel times to reach essential care. Ensuring equitable access to maternity care requires addressing travel burdens to care and inadequate digital access. Our findings reveal socioeconomically disadvantaged communities in the United States face dual barriers to maternity care access, as communities located farthest away from care facilities had the least digital access.

Context: With the increases in nationwide hospital maternity unit closures, there is a greater need for telehealth services for the supervision, evaluation, and management of prenatal and postpartum care. However, challenges in digital access persist. We examined associations between driving time to hospital maternity units and digital access to understand whether augmenting digital access and telehealth services might help mitigate travel burdens to maternity care.

Methods: This cross-sectional study used 2020 American Hospital Association Annual Survey data for hospital maternity unit locations and 2020 American Community Survey five-year ZIP Code Tabulation Area (ZCTA)-level estimates of household digital access to telecommunication technology and broadband. We calculated driving times of the fastest route from population-weighted ZCTA centroids to the nearest hospital maternity unit. Rural-urban stratified generalized median regression models were conducted to examine differences in ZCTA-level proportions of household lacking digital access equipment (any digital device, smartphones, tablet), and lacking broadband subscriptions by spatial accessibility to maternity units.

Findings: In 2020, 2,905 (16.6%) urban and 3,394 (39.5%) rural ZCTAs in the United States were located >30 minutes from the nearest hospital maternity units. Regardless of rurality, these communities farther away from a maternity unit had disproportionally lower broadband and device accessibility. Although urban communities have greater digital access to technology and broadband subscriptions compared to rural communities, disparities in the percentage of households with access to digital devices were more pronounced within urban areas, particularly between those with and without close proximity to a hospital maternity unit. Communities where nearest hospital maternity units were >30 minutes away had higher poverty and uninsurance rates than those with <15-minute access.

Conclusions: Socioeconomically disadvantaged communities face significant barriers to maternity care access, both with substantial travel burdens and inadequate digital access. To optimize maternity care access, ongoing efforts (e.g., Affordable Connectivity Program introduced in the 2021 Infrastructure Act), should bridge the gaps in digital access and target communities with substantial travel burdens to care and limited digital access.

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双重障碍:2020 年美国医院孕产妇护理的数字访问和旅行负担研究》(Examining Digital Access and Travel Burdens to Hospital Maternity Care Access in the United States,2020 年)。
政策要点 2022 年 6 月发布的《白宫应对孕产妇健康危机蓝图》报告强调了加强公平获得孕产妇护理的必要性。全国范围内医院产科的关闭加剧了服务不足社区的孕产妇健康危机,使许多分娩者几乎没有选择余地,而且需要长途跋涉才能获得必要的护理。要确保公平地获得孕产妇保健服务,就必须解决前往医疗机构的旅行负担和数字访问不足的问题。我们的研究结果表明,美国社会经济条件较差的社区在获得孕产妇保健服务方面面临双重障碍,因为距离保健设施最远的社区的数字接入最少:背景:随着全国范围内医院产科关闭数量的增加,产前和产后护理的监督、评估和管理对远程医疗服务的需求越来越大。然而,数字接入方面的挑战依然存在。我们研究了前往医院产科的行车时间与数字化访问之间的关联,以了解增强数字化访问和远程医疗服务是否有助于减轻产科护理的旅行负担:这项横断面研究使用了 2020 年美国医院协会关于医院产科地点的年度调查数据和 2020 年美国社区调查五年邮政编码制表区 (ZCTA) 级别的家庭数字接入电信技术和宽带估计值。我们计算了从人口加权 ZCTA 中心点到最近医院产科的最快路线的驾驶时间。我们建立了农村-城市分层广义中值回归模型,以研究ZCTA层面缺乏数字接入设备(任何数字设备、智能手机、平板电脑)和缺乏宽带用户的家庭比例在与产科医院空间可达性方面的差异:2020 年,美国有 2905 个城市地区(16.6%)和 3394 个农村地区(39.5%)距离最近的医院产科超过 30 分钟车程。无论是否属于农村,这些距离产科病房较远的社区的宽带和设备可及性都低得不成比例。虽然与农村社区相比,城市社区拥有更多的数字技术和宽带用户,但在城市地区,特别是在那些靠近和不靠近医院产科的社区,拥有数字设备的家庭比例差距更为明显。与有结论的社区相比,距离最近的医院产科超过 30 分钟路程的社区的贫困率和无保险率更高:社会经济条件较差的社区在获得产科护理方面面临着巨大的障碍,既要承受巨大的旅行负担,又要面对不充分的数字访问。为了优化孕产妇保健服务,目前正在进行的努力(如《2021 年基础设施法案》中提出的 "负担得起的连接计划")应弥合在数字访问方面的差距,并将目标锁定在有大量旅行负担和数字访问受限的社区。
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来源期刊
Milbank Quarterly
Milbank Quarterly 医学-卫生保健
CiteScore
9.60
自引率
3.00%
发文量
37
审稿时长
>12 weeks
期刊介绍: The Milbank Quarterly is devoted to scholarly analysis of significant issues in health and health care policy. It presents original research, policy analysis, and commentary from academics, clinicians, and policymakers. The in-depth, multidisciplinary approach of the journal permits contributors to explore fully the social origins of health in our society and to examine in detail the implications of different health policies. Topics addressed in The Milbank Quarterly include the impact of social factors on health, prevention, allocation of health care resources, legal and ethical issues in health policy, health and health care administration, and the organization and financing of health care.
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