Journal of Health Care for the Poor and Underserved最新文献

Limited English proficient patients are prone to adverse health care effects compared to English proficient patients, including decreased access to care, lower health literacy, and worse clinical outcomes. This report describes a multi-modal medical interpreter program at a safety-net health system designed for the emerging Afghan population in San Antonio, Texas.

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services is a Medicaid benefit for children that addresses their health problems before they become advanced, debilitating, and expensive. We conducted a retrospective cross-sectional analysis of pediatric beneficiaries (newborn to younger than 21 years) enrolled in a Medicaid managed care organization to examine the factors associated with EPSDT screening services completion. We obtained 2018 administrative claims data for beneficiaries continuously enrolled for a minimum of 90 days (n=156,108). Completion of EPSDT screening services among our Medicaid managed care beneficiaries was low. Those having more emergency department visits and hospitalizations, having family medicine practitioners as primary care physicians, belonging to the racial/ethnic group Asian/Pacific Islander/Hawaiian/Alaskan Native/Native American, and 18 to younger than 21 years age group were less likely than others to complete EPSDT services. Our results provide information on segments of pediatric beneficiaries that can be targeted to increase EPSDT screening services completion.

This study analyzed electronic health record (EHR) data from 2016 through 2019 from a federally qualified health center (FQHC) serving predominantly low-income Latine immigrants in the Washington, D.C. metropolitan area to examine how changes in health insurance coverage relate to changes in health care use. Federally qualified health center clients were insured for an average of 59% to 63% of their annual visits, but about one-third had no coverage throughout the year. Findings from descriptive regression and within-client fixed effects models indicate that in years with higher proportions of insured visits, clients averaged more medical visits and interpreter services but fewer mental health and care coordination visits. Latine immigrant clients in D.C., a city with a universal health insurance option, had health insurance coverage for 89% of their visits, and averaged more medical and fewer coordination visits relative to those in a neighboring county in a state without a universal insurance option.

This study explores the association between health system changes over the last decade and women's preventive care utilization in Illinois. A cross-sectional analysis using Illinois Behavioral Risk Factor Surveillance System (BRFSS) data from 2012-2020 among women aged 21-75 (n=21,258) examined well-woman visit (WWV) receipt and breast and cervical cancer screening overall and over several time periods. There was an increase in the prevalence of receiving a WWV for Illinois women overall from 2012-2020. However, the overall adjusted prevalence difference was only significant for the 2020 versus 2015-2019 comparison and not for 2015-2019 versus 2012-2014. The COVID-19 pandemic was not associated with a decrease in the prevalence of mammogram use but was manifest for cervical cancer screening, particularly for Black women. Finally, those reporting having a WWV in the past year had a significantly higher prevalence of being up to date with screening compared with those not reporting a WWV.

Inpatient food insecurity (FI), or caregiver inability to obtain adequate food for themselves during child hospitalization, negatively affects caregiver participation in care. Using mixed methods, we assessed inpatient FI prevalence, factors associated with inpatient FI, and perspectives on an inpatient FI intervention among immigrant caregivers (ICs) at a children's hospital from 2021-2022. We performed a sub-analysis of data from a larger FI intervention study, which provided meal trays and food bank public benefit navigator referrals for caregivers screening positive for household or inpatient FI. Logistic regression assessed factors associated with inpatient FI among ICs. We interviewed ICs enrolled in the intervention and identified themes. Of 369 ICs, 56% reported inpatient FI. Low income, poor caregiver health, and household FI were associated with inpatient FI in regression analysis. Nine qualitative interviews revealed positive reception to the intervention. Immigrant caregivers noted that it facilitated participation in care and alleviated financial burden.

Vietnamese Americans experience significant health disparities compared with other groups, but their health care utilization is suboptimal. Boat People SOS (BPSOS), a nationwide Vietnamese-serving community-based organization, implemented a community health worker and community-clinical linkage electronic referral system to improve health care utilization. Three sites (in Alabama, California, and Virginia) received the intervention; Mississippi was the comparison site. The intervention included bridging between communities and health systems, culturally appropriate health education, informal counseling and social support, advocating for individual and community needs, direct services, and building individual and community capacity through partnerships with service providers. Compared with the comparison site, clients at the intervention sites reported better overall perceived health after the intervention. Past-year medical checkups declined in both groups during the COVID-19 pandemic but declined less in the treatment group. The intervention did not reduce emergency room visits. Findings suggest that this intervention can improve health care utilization and health status among Vietnamese Americans.

Home Together (HT) is a multi-level multi-component health promotion program, co-led by academic and non-profit partners in Arkansas that sought (1) to improve access to and family acceptance of social services and health care among women experiencing homelessness who have a diagnosed mental health condition and a child younger than six years and (2) to increase service provider capacity to engage with this population. A socioecological perspective was used to detail program components and lessons learned. Home Together enrolled 345 women representing unduplicated families. Of these, 214 completed six-month reassessments and 111 completed discharge assessments. Representative of the area and population served, most self-identified as belonging to racial minorities (87.0%), being younger than 35 years (80.1%), experiencing violence (76%), and being heterosexual (82%). Pre-post testing indicated positive changes for HT families, including improvements in mental health, health care access, and housing. Yet, even the most coordinated comprehensive programs are no substitute for policy-level changes that help families reach stability.

In 2014, the Affordable Care Act (ACA) expanded the role of Medicaid by encouraging states to increase eligibility for lower-income adults. As of 2024, 10 states had not adopted the expanded eligibility provisions of the ACA, possibly due to concerns about the state's share of spending. Using the Medical Expenditure Panel Survey (MEPS), we documented how health care utilization, expenditures, and the overall health status of newly eligible enrollees compare with enrollees who would have been eligible under their states' rules before the ACA. Our estimates suggest that, during 2014-16, newly eligible Medicaid enrollees had worse health and greater utilization and expenditures than previously eligible enrollees. However, during 2017-19, newly and previously eligible enrollees had comparable per capita health expenditures across six types of health spending. We find some evidence that changes in Medicaid enrollment composition muted observed differences between eligibility groups.

Objectives: To characterize the proportion of Medicaid-eligible infants experiencing gaps in Medicaid coverage during early infancy and to determine whether infants without Medicaid coverage were covered by other plans or not at all.

Study design: Infants with Medicaid-financed births from three states participating in the 2016-2020 Pregnancy Risk Assessment Monitoring System (PRAMS) were included (N=3,658). Infant insurance coverage (Medicaid, non-Medicaid, none) was assessed at the time of the PRAMS survey, typically around four months of age.

Results: Fifteen percent of infants had non-Medicaid insurance coverage, two percent were uninsured, and 83% had Medicaid coverage after Medicaid-financed birth. The strongest predictor of infant uninsurance was maternal uninsurance or non-Medicaid coverage before pregnancy.

Conclusion: Some presumably eligible infants are not enrolled in Medicaid or experience lapses in Medicaid coverage. Informing families about infants' coverage eligibility and supporting families during the enrollment process would especially benefit families with no pre-pregnancy experience with Medicaid.

Abortion clients who experience economic hardship face barriers paying for abortion care. Between September 2020 and June 2021, we conducted a facility-based survey with 211 abortion clients who obtained care in Mississippi, and 25 respondents completed in-depth interviews. We computed the frequency with which survey respondents used social network-based, agency-based, and individual strategies to pay for care and we employed thematic analysis to explore in-depth interviewees' decision-making and experiences with these strategies. Overall, 93% used at least one strategy to pay for their abortion: 62% sought help from social networks; 61% received assistance from abortion funds (non-profit organizations that help people pay for abortion care); and 47% relied on individual strategies, such as postponing routine expenses. Interviewees often noted it was difficult to use these strategies and doing so adversely affected their economic stability. These findings support the need for insurance coverage and expanded financial assistance for abortion seekers, particularly those now forced to travel following abortion bans.