改善低收入美国人财务和医疗结果的医疗-金融伙伴关系:系统回顾。

IF 4 Q1 SOCIAL SCIENCES, INTERDISCIPLINARY Campbell Systematic Reviews Pub Date : 2024-12-06 DOI:10.1002/cl2.70008
Julie Birkenmaier, Brandy R. Maynard, Harly M. Blumhagen, Hannah Shanks
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引用次数: 0

摘要

背景:贫穷被认为是健康(即影响健康和福祉的一系列社会和环境条件)的社会决定因素之一,因为它与重大健康问题有关。近年来,卫生保健环境已成为具有直接健康影响的贫困干预措施的协调中心。医疗机构越来越多地实施财务伙伴关系,以提供旨在改善患者财务状况的干预措施,实现提高预约出勤率和减轻患者经济负担的双重目标。虽然医疗-金融伙伴关系(mfp)似乎越来越受欢迎,但尚不清楚这些干预措施是否对财务和/或健康结果产生积极影响。目的:本审查的目的是通过分析和综合与产妇健康和财务结果有关的经验证据,为产妇的相关政策和做法提供信息。本综述的主要目的是回答以下研究问题:(1)MFP干预研究的范围和质量是什么?(2)医疗环境中嵌入的金融服务对财务结果的影响是什么?(3)医疗环境中嵌入的金融服务对健康相关结果的影响是什么?检索方法:我们对2023年9月至12月的已发表文献和灰色文献进行了综合检索。我们检索并检索了谷歌、谷歌Scholar和10个电子数据库中发表的研究。我们还检索了5个相关网站和2个已注册研究的试验注册中心。我们从纳入研究的参考文献列表中获取数据,并使用谷歌Scholar进行前向引文检索。最后,我们联系了四项纳入研究的第一作者,并询问了未发表的研究、正在进行的研究和在其他搜索活动中可能遗漏的已发表研究的信息。入选标准:入选本综述的研究符合以下标准。首先,研究必须使用前瞻性随机对照试验或准实验(QED)研究设计与平行队列。其次,研究必须涉及在医疗保健环境中提供现场金融服务的干预措施。第三,这些研究必须衡量财务结果。第四,为了满足现场金融服务的标准,干预措施必须至少包括以下一项:(1)金融教育、咨询或指导,(2)信用咨询,或(3)提供帮助患者获得金融产品或服务的服务,如免费报税服务,或(4)增加收入的服务,如筛选公共福利和协助申请流程,以及就业服务(如协助撰写简历和工作面试技巧)。提取和分析了与健康相关的结果,但不是入选的必要条件。数据收集和分析:检索结果保存在文献管理软件EndNote2中,删除重复并上传到Rayyan。四名审稿人随后完成了对Rayyan中66807个条目的标题和摘要筛选。三名审稿人独立审查了26篇被提交全文筛选的文章。第四名审稿人审查差异,并做出最终决定,包括或排除。四项符合纳入标准的研究被保留下来,使用标准化的提取表格进行数据提取。由于纳入的研究没有测量和报告足够的数据来计算类似结果的效应量,因此不可能进行定量综合。在可能的情况下计算效应量,并描述研究结果。主要结果:本综述纳入的4项独特研究中,2项为随机对照试验,2项为qed。四项研究中有三项是在儿科环境中进行的。其中两项研究仅将税务准备作为其财务干预措施,均在医疗保健诊所设置现场提供VITA税务诊所。一项研究以财务指导为特色,包括一对一的案例管理、预算和目标设定等一系列服务,第四项研究提供了两次远程授课的财务咨询。所有四项研究都报告了至少一项财务结果,两项研究报告了至少一项健康相关结果。由于纳入的研究数量少,且缺乏作者报告计算效应量的数据,因此关于mfp对健康和财务影响的证据有限。结果表明,mfp对报告的财务结果的影响很小且不显著,而一些作者报告的对参加预约和遵守疫苗接种计划的积极统计显着影响。 偏倚评估的风险表明纳入研究的重要方法学弱点。作者的结论是:尽管mfp正变得越来越流行,并且有可能改善财务和健康状况,但总体上缺乏关于mfp是否达到其目标的证据。很少有研究符合纳入标准,而那些符合标准的研究通常质量较低,因此,我们无法得出有关干预效果的任何结论。考虑到这项研究的新生性质,对MFPS的高度热情似乎超过了它们对重要结果的有效性的证据。我们主张医疗保健机构首先投资于试点mfp的严格研究,并广泛传播其研究结果,然后再决定将其推广到实践中,并/或将其纳入医疗保健政策。
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Medical-financial partnerships for improving financial and medical outcomes for lower-income Americans: A systematic review

Background

Poverty is considered one of the social determinants of health (i.e., a range of social and environmental conditions that affect health and well-being) because of its association with significant health problems. In recent years, healthcare settings have emerged as focal points for poverty interventions with direct health implications. Medical institutions are increasingly implementing financial partnerships to provide interventions targeted at improving the financial well-being of patients with the dual objective of boosting appointment attendance rates and alleviating financial burdens on patients. While medical-financial partnerships (MFPs) appear to be growing in popularity, it is unclear if these interventions positively impact financial and/or health outcomes.

Objectives

The purpose of this review is to inform policy and practice relevant to MFPs by analyzing and synthesizing empirical evidence related to their health and financial outcomes. The primary objectives of this review is to answer the following research questions: (1) What is the extent and quality of MFP intervention research? (2) What are the effects on financial outcomes of financial services embedded within healthcare settings? (3) What are the effects on health-related outcomes of financial services embedded within healthcare settings?

Search Methods

We conducted a comprehensive search for published and gray literature from September to December 2023. We searched for and retrieved published studies from Google, Google Scholar, and 10 Electronic databases. We also searched five relevant websites and two trial registries for registered studies. We harvested from the reference lists of included studies and conducted forward citation searching using Google Scholar. Lastly, we contacted the first authors of the four included studies and requested information about unpublished studies, studies in progress, and published studies potentially missed in the other search activities.

Selection Criteria

Studies eligible for this review met the following criteria. First, studies must have used a prospective randomized controlled trial or quasi-experimental (QED) research design with parallel cohorts. Second, studies must have involved an intervention that provides financial services on-site within a healthcare setting. Third, the studies must have measured a financial outcome. Fourth, to meet the criteria for on-site financial services, interventions must have included at least one of the following: (1) financial education, counseling or coaching, (2) credit counseling, or (3) the provision of services that assist patients to access financial products or services, such as free tax preparation services, or (4) services to increase income, such as screening for public benefits and assistance with the application process, as well as employment services (e.g., assistance with resume writing and job interviewing skills). Health-related outcomes were extracted and analyzed, but were not required for eligibility.

Data Collection and Analysis

Searches were saved in the reference management software EndNote2, and duplicates were removed and uploaded to Rayyan. Four reviewers then completed title and abstract screening on 66,807 entries in Rayyan. Three reviewers independently reviewed the 26 articles that were moved forward for full-text screening. A fourth reviewer reviewed discrepancies and made the final decision to include or exclude. Four studies that satisfied the inclusion criteria were retained for data extraction using a standardized extraction form. Because the included studies did not measure and report sufficient data to calculate effect sizes for similar outcomes, quantitative synthesis was not possible. Effect sizes were calculated when possible, and study outcomes were described.

Main Results

Of the four unique studies included in this review, two were randomized control trials and two were QEDs. Three of the four studies were conducted in pediatric settings. Two of the studies focused on tax preparation only as their financial intervention, both offering a VITA tax clinic on-site in the healthcare clinic setting. One study featured financial coaching, which included a bundle of services such as one-on-one case management, budgeting and goal setting, and the fourth study provided financial counseling over two sessions delivered remotely. All four studies reported at least one financial outcome, and two studies reported at least one health-related outcome. The evidence on the health and financial impacts of MFPs is limited due to the small number of included studies and lack of authors reporting data to calculate effect sizes. Results indicate small and nonsignificant effects of MFPs on financial outcomes reported, and some author-reported positive statistically significant effects on attending appointments and adhering to vaccination schedules. The risk of bias assessment indicated important methodological weaknesses across included studies.

Authors' Conclusions

Although MFPs are becoming popular and have the potential to improve financial and health outcomes, there is an overall lack of evidence about whether MFPs are meeting their goals. Very few studies met inclusion criteria, and those that did were generally low quality, and therefore, we were unable to draw any conclusions regarding the intervention effects. Given the nascent nature of the research, the high level of enthusiasm for MFPS seems to be outpacing the evidence about their effectiveness on important outcomes. We advocate that healthcare settings invest first in rigorous research on pilot MFPs and disseminate their findings widely before making a determination about taking them to scale in practice and/or move ahead to integrate them into healthcare policy.

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来源期刊
Campbell Systematic Reviews
Campbell Systematic Reviews Social Sciences-Social Sciences (all)
CiteScore
5.50
自引率
21.90%
发文量
80
审稿时长
6 weeks
期刊最新文献
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