An expanding framework for rural patients who travel for health care
AuthorSweeney Fee, Sharon K.
KeywordsHealth Sciences, Nursing.
Health Sciences, Public Health.
Health Sciences, Health Care Management.
MetadataShow full item record
PublisherThe University of Arizona.
RightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
AbstractThis exploratory study utilized Donabedian's Quality model to develop a framework to study patients who must migrate for health care. One year of the Arizona Department of Health Services Discharge Database was used to analyze patient characteristics that influenced discharge travel and the impact of distance on risk adjusted patient outcomes. Geographic Interface software was used to identify rural patients, defined as those with zip codes farther than thirty miles from hospitals. Zip Code analysis was used to create distance variables between 31 and over 300 miles. The key findings for patients who traveled greater distances included larger hospitals, emergency admission type, private insurance, critical care services, and Neuro/Ortho/Trauma diagnosis group. Patients which traveled shorter distances included smaller hospitals, referral or transfer admit source, AHCCCS insurance (or Medicaid) and Women's Health diagnosis group. Outcomes were risk adjusted using age and distance was significant for both number of procedures and length of stay. Patients who traveled farther received fewer procedures and had a greater length of stay. A preliminary cost analysis of the length of stay outliers identified approximately four million dollars in potentially non-reimbursable charges.
Degree ProgramGraduate College
Degree GrantorUniversity of Arizona
Showing items related by title, author, creator and subject.
Modeling the cost-effectiveness of a regional poison control center using decision analysisDraugalis, JoLaine R.; Harrison, Donald Lee, 1956- (The University of Arizona., 1996)Using decision analysis techniques, the cost-effectiveness of two alternatives for treating human poison exposures were modeled. The alternatives were the treatment of poisonings with the services of a regional poison control center versus without access to any poison control center. The relative cost-effectiveness was modeled based on two outcomes (morbidity and mortality) for each of four typical poison exposures: acetaminophen overdose, tricyclic antidepressant overdose, cleaning substance exposure in children, and cough/cold preparation overdose in children. Additionally, analyses were conducted to test the sensitivity of the cost-effectiveness ratio to outcome probability, average inpatient and emergency room charges, and proportion of poison exposures managed on site by the regional poison control center. This research was conducted from society's point of view.
Development of the Diabetes Resource Consumption Index and profiling quality of diabetes care in the Veterans Health AdministrationMalone, Daniel C.; Joish, Vijay (The University of Arizona., 2003)The purpose of this study was to develop and validate a risk-adjustment index for one year healthcare resource use specific to diabetic patients, based on severity of illness measures; and to profile quality of diabetes care between outpatient clinics. The data for this study was collected from four outpatient clinics within the Southern Arizona Veterans Affairs Healthcare System, Tucson, AZ. The DRCI was developed using a sample size of 367 diabetic subjects that had complete information on diabetes-specific variables. Individual DRCI weights, based on the magnitude of one year healthcare resource use and socio-demographic characteristics, ranged from -471.5 to 3,081.2 for total healthcare costs, from -304.3 to 1,582.1 for outpatient costs, and -0.19 to 0.93 for risk of hospitalization. The DRCI was better than or equivalent to the Chronic Disease Score in predicting health care costs. Diabetics in the second cohort were predominantly elderly (mean = 66yrs ± 11.1), married (61%), white (73%), males (96%), had a high BMI (31 ± 6.3 kg/m²), and mean comorbidity score of 4.2 ± 1.8 conditions. Screening for HbA1c and microalbuminuria was frequently performed in all clinics. Overall, 61% and 36% of study patients did not have evidence of foot or eye examinations during the entire study period, respectively. Approximately, 27% (n = 408), 41% (n = 643), and 26% (n = 515) of the study patients had poor glycemic, renal function, and lipid control, respectively. Significant differences (p < .05) in HbA1c and creatinine clearance rates between the clinics were observed after adjusting for patient case-mix. However, differences between the clinics in cardiovascular outcome were not observed after adjusting for patient case-mix. This study demonstrated an association between diabetes severity with healthcare resource and costs. The DRCI, using laboratory data, is a diabetes-specific severity measure for prediction of one year healthcare resource use. Future studies are needed to validate this index in other settings. Finally, the results from this study emphasize the need to adjust for case-mix variable when comparing quality of diabetic care outcomes between outpatient clinics.
Emergency transportation interventions for reducing adverse pregnancy outcomes in low- and middle-income countries: a systematic review protocolEhiri, John; Alaofè, Halimatou; Asaolu, Ibitola; Chebet, Joy; Esu, Ekpereonne; Meremikwu, Martin; Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona (BioMed Central, 2018-04-25)Transportation interventions seek to decrease delay in reaching a health facility for emergency obstetric care and are, thus, believed to contribute to reductions in such adverse pregnancy and childbirth outcomes as maternal deaths, stillbirths, and neonatal mortality in low- and middle-income countries (LMICs). However, there is limited empirical evidence to support this hypothesis. The objective of the proposed review is to summarize and critically appraise evidence regarding the effect of emergency transportation interventions on outcomes of labor and delivery in LMICs. The following databases will be searched from inception to March 31, 2018: MEDLINE/PubMed, EMBASE, Web of Science, EBSCO (PsycINFO and CINAHL), the Cochrane Pregnancy and Child Birth Group's Specialized Register, and the Cochrane Central Register of Controlled Trials. We will search for studies in the grey literature through Google and Google Scholar. We will solicit unpublished reports from such relevant agencies as United Nations Fund for Population Activities (UNFPA), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United States Agency for International Development (USAID), and the United Kingdom Department for International Development (DfID) among others. Data generated from the search will be managed using Endnote Version 7. We will perform quantitative data synthesis if studies are homogenous in characteristics and provide adequate outcome data for meta-analysis. Otherwise, data will be synthesized, using the narrative synthesis approach. Among the many barriers that women in LMICs face in accessing life-saving interventions during labor and delivery, lack of access to emergency transportation is particularly important. This review will provide a critical summary of evidence regarding the impact of transportation interventions on outcomes of pregnancy and childbirth in LMICs. PROSPERO CRD42017080092.