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

Introduction: The objective of this study was to examine liver-related mortality trends in a large cohort of homeless-experienced adults.

Methods: We linked a cohort of 60,092 adults who received care at Boston Health Care for the Homeless Program (BHCHP) from 2003-2017 to death occurrence files. We evaluated temporal trends in age-standardized liver-related mortality and identified leading causes of liver-related death compared with the Massachusetts population, reporting standardized mortality rate ratios (SRRs).

Results: Of the 7,130 deaths in the cohort, 652 (9.1%) were liver-related. Liver-related mortality decreased on average 3.5% annually, though remained significantly higher than the Massachusetts population. Leading causes of liver-related death were cirrhosis (n=157, SRR 3.2), liver cancer (n=148, SRR 2.4), alcohol-related liver disease (n=140, SRR 4.4), and viral hepatitis (n=99, SRR 7.2).

Conclusion: Efforts to address alcohol use disorder and viral hepatitis in this population may reduce the substantial disparity seen in liver-related mortality in this population.

There is a growing population of adults under 65 with disabilities needing to access long-term care (LTC). Rural areas are seeing this population rise while also experiencing growing nursing home closures. Medicaid, the largest payer of LTC, already pays for more LTC in rural areas than in urban areas. Therefore, state Medicaid expansion may increase insurance coverage for newly eligible individuals needing to use rural nursing homes. Using LTC Focus from 2011-2019, this paper conducts a Callaway Sant'Anna Difference-in-Differences analysis to understand the impacts of Medicaid expansion on rural nursing home admission demographics. Results indicated no significant effect of expansion on the percentage of Medicaid-dependent admissions and the percentage of under-65 admissions. Expansion was associated with a decrease in the percentage of admissions accounted for by Black individuals (-0.97** CI: -1.62, -0.33) in the included counties. More research must be conducted to study why the percent of Black admissions declined.

Objective: To identify recommendations from sex workers for the design of a hospital-based ambulatory clinic.

Methods: We used community-partnered purposive recruitment to identify sex workers in our county. We used nominal group process, and participants of two focus groups generated recommendations for health care delivered in a clinic for sex workers, reviewed relevant research identified by narrative review, and ranked a final list of recommendations.

Results: In the first focus group (n=6), sex workers recommended the clinic have access to housing, food, and insurance resources, along with non-judgmental, anti-racist providers who are approved by sex workers as appropriate caregivers. In the second group (n=5), participants considered five relevant research articles and added recommendations on substance use treatment services and funding for free care.

Conclusion: Recommendations made by sex workers during this nominal group process created a guide for an ambulatory clinic that may improve health care for sex workers in [our region].

People experiencing unsheltered homelessness (PEUH) have an increased risk of frostbite injury, which can be a dangerous and debilitating condition. Our study aims to determine the prevalence, incidence, and impact of frostbite in the unsheltered population in Chicago and nearby suburbs. We administered a survey at a Chicago Transit Authority metro station in suburban Cook County to assess the frequency of frostbite injury and the circumstances surrounding frostbite in this community. Our results demonstrated that frostbite is both common (incidence rate (IR) =1271.67 cases of frostbite per 100,000 life-years (LY)) and highly morbid (IR=46.24 amputations per 100,000 LY) in PEUH in Chicago. We hope to include more street medicine partners to raise awareness about the impact of frostbite injury in the unsheltered population and advocate for improved emergency preparedness plans during the cold winter season.

We examined whether undocumented patients enrolled in a health care coverage program in Los Angeles have fewer avoidable emergency department (ED) visits than other foreign-born patients. We analyzed 2016-2020 ED encounters from all safety-net hospitals in Los Angeles County. We estimated the odds that an ED encounter was for an ambulatory care sensitive condition from mixed effects models among 1) undocumented patients in the program, My Health LA (MHLA), 2) non-MHLA undocumented patients, and 3) foreign-born documented patients (n=567,671). My Health LA patients had a lower likelihood of avoidable visits from acute conditions and non-diabetes chronic diseases than the foreign-born documented patients and non-MHLA patients. However, they had greater likelihood of visits related to type 2 diabetes (T2D). Having access to regular primary care improves some acute and chronic disease-related utilization but undocumented patients with T2D may select into the program and face ongoing challenges managing the disease.

This report describes a practice evaluation initiative aimed at improving access to tertiary referral care for American Indian and Alaska Native patients. It outlines challenges related to insurance coverage, electronic systems, and related logistical issues. Conversations with local tribal health leaders yielded future education and service collaboration opportunities.

Families living in poverty with young children are particularly vulnerable to poor health outcomes. This study used a randomized controlled trial to analyze the impact of Early Bird (EB), a novel health system-integrated program that provided financial incentives to low-income mothers for achieving healthy milestones. Participants randomized to the EB condition received contributions in a tax-advantaged children's savings account (CSA) for attending a maternal six-week postpartum check-up ($25), a pediatric dental visit by age 12 months ($75), six well-check visits by age 15 months ($75), two financial coaching sessions ($30), and enrolling in the EB program and opening a CSA ($250). We found that Early Bird increased the likelihood that mothers attended a financial coaching session. We found no evidence of an increase in the likelihood of completing any of the medical milestones. Future work should examine whether larger contributions to CSAs might incentivize mothers to achieve the medical milestones.