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

Objectives: To investigate racism in the health care setting experienced by American Indian and Alaska Native people and its influence on health care engagement.

Methods: Data were collected via self-report surveys administered in person at two community powwows in Denver, Colorado in 2021 and 2022.

Results: Approximately one-third (29.8%) of American Indian and/or Alaska Native respondents reported having a health care visit where they felt uncomfortable due to their race. Of those, 51% were less likely to see a doctor in the future because of these experiences. Experiences were categorized as racial microaggressions and overt racism.

Conclusions: American Indian and Alaska Native people experience racial microaggressions and overt racism during health care visits, leading to decreased likelihood of engaging with health care in the future.

Currently, individuals with federally-funded health insurance who desire sterilization are required to sign the Consent for Sterilization form (Title XIX form) at least 30 days before the date of the procedure. The form remains valid for 180 days with the only exceptions being cases in which emergency abdominal surgery or premature delivery is warranted. These tenets were constructed in response to public outcry over sterilization abuses that had occurred during the early 20th century. Although the intention of the Medicaid sterilization consent process lay in protecting the reproductive rights of individuals and preventing forced or coerced sterilization, the restrictions associated with the consent for sterilization currently serve as a barrier to access to care. This commentary is a call to modify the Medicaid sterilization consent form.

We conducted a cross-sectional study to investigate racial disparities among patients hospitalized for COVID-19 using electronic health records from a large community-based health care system between March 2020 and February 2021. The primary outcomes were in-hospital mortality and 30-day readmission. Demographics, clinical characteristics, and socioeconomic factors were analyzed using logistic regression, with adjusted odds ratios (AOR) reported. The study identified 90,490 patients, including Hispanic (29%), White (45.5%), Black (17.3%), Asian (3.1%), and Others (4.1%). The mortality model demonstrated a strong performance with an area under curve (AUC) of 0.88 (95%CI=0.877-0.885) and a Brier score of 0.093 (95%CI=0.092-0.095). For the 30-day readmission model, the AUC was 0.726 (95%CI=0.717-0.734) with a Brier score of 0.091 (95%CI=0.088-0.093). Compared with Whites, Hispanics exhibited a higher risk of mortality (AOR=1.23; 95%CI=1.16-1.31) but a lower likelihood of readmission (AOR=0.89; 95%CI=0.83-0.97). These findings highlight the critical need for targeted health management strategies across different racial and ethnic groups.

The Grady Heart Failure Program (GHFP), based in a safety-net hospital, is an outpatient program that follows heart failure hospitalization. The 2018 GHFP added a community health worker, patient liaison, and mobile integrated health home visits to reduce socioeconomic barriers to treatment. Important outcomes for the GHFP included the program cost and patient follow-up visits within seven days of hospital discharge. We calculated the difference in 30-day related readmission between 2017 and 2018 to assess pre-post program effectiveness. Patient follow-up visits within seven days increased from 63.7% in 2017 to 65.6% in 2018. Related 30-day readmissions declined from 15.5% in 2017 to 13.1% in 2018. Compared with 2017, the incremental program cost per related 30-day hospital readmission averted was $7,955 in 2018. The expanded GHFP is potentially cost-saving from the perspective of the hospital-provider based on the inpatient cost saved from a heart failure readmission averted.

An academic-community partnership developed a bilingual, family-centered type 2 diabetes self-management program for underserved Latinos, emphasizing cultural relevance, stakeholder engagement, and digital equity. This experience provides practical insights for organizations designing digital health interventions to promote healthy lifestyles and disease management among underserved populations.

A collaboration between land trust and health care system organizations in Cleveland, Ohio seeks to enhance community health in historically disinvested neighborhoods by transforming vacant properties into vibrant green spaces. Greening interventions focus on four predominantly Black communities, aiming to bolster cardiovascular wellness and physical activity over time through environmental improvement.

A system of health and social service hubs was recently established by a citywide equity-oriented network in Atlanta. The Office of Minority Health recently funded an expansion of the pilot, which provides an opportunity for the work to mature and yield lessons learned from the network-first model.

An outpatient elective module within a psychiatry residency program was established to train psychiatry trainees on caring for patients who have experienced human trafficking. A description of the year-long elective module and results of the residents' feedback on their experience in the elective are discussed.

Dental care remains an optional benefit for adults with Medicaid, with coverage varying across states. Recent expansions increased periodontal service coverage, but the scope of coverage and the policies that govern that scope remain unknown. This study analyzed coverage policies and fees for four periodontal services across 43 Medicaid programs between January and March 2024. Frequency limitations were the most common coverage policies identified, followed by prior authorization requirements, clinical requirements, and quadrant limitations. Veteran Health Administration fees were roughly three times higher than Medicaid fees across the four dental services. Current coverage policies may not consider the multidimensional and nuanced pathogenesis of periodontitis and the need for individualized treatment plans based on patient risk factors and disease progression. Furthermore, low reimbursement rates and administrative challenges may discourage dentists from participating.

Racial and ethnic disparities persist in cardiovascular disease (CVD) care. Using the Medical Expenditure Panel Survey, we conducted a retrospective cross-sectional study to assess access to care for CVD patients. Unadjusted analysis of 4,686 participants indicated lower consistent access to appointments for Hispanic individuals and lower timely access to care for Black and Hispanic individuals compared with the White cohort. After adjusting for predisposing, enabling, and external factors, differences were no longer significant. Individuals aged 45-64 and those 65 and older had higher odds of consistent access to appointments and timely access to care than younger individuals. Those with only public insurance (OR=0.85, p<.05) and the uninsured (OR=0.34, p<.001) had lower consistent access to appointments than individuals with any private insurance. This study highlights the need for culturally sensitive care and targeted interventions to address socioeconomic barriers in CVD management, ensuring equitable, high-quality care for all racial and ethnic groups.