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https://www.readbyqxmd.com/read/29452563/code-red-the-essential-yet-neglected-role-of-emergency-care-in-health-law-reform
#1
Shaun Ossei-Owusu
The United States' health care system is mired in uncertainty. Public opinion on the Patient Protection and Affordable Care Act ("ACA") is undeniably mixed and politicized. The individual mandate, tax subsidies, and Medicaid expansion dominate the discussion. This Article argues that the ACA and reform discourse have given short shrift to a more static problem: the law of emergency care. The Emergency Medical Treatment and Active Labor Act of 1986 ("EMTALA") requires most hospitals to screen patients for emergency medical conditions and provide stabilizing treatment regardless of patients' insurance status or ability to pay...
November 2017: American Journal of Law & Medicine
https://www.readbyqxmd.com/read/29447263/insurance-status-and-cancer-treatment-mediate-the-association-between-race-ethnicity-and-cervical-cancer-survival
#2
Sarah C Markt, Tianyu Tang, Angel M Cronin, Ingrid T Katz, Brooke E Howitt, Neil S Horowitz, Larissa J Lee, Alexi A Wright
Cervical cancer outcomes remain poor among disadvantaged populations, including ethnic minorities, low-income, and underinsured women. The aim of this study was to evaluate the mechanisms that underlie the observed association between race/ethnicity and cervical cancer survival. We identified 13,698 women, ages 21 to 64 years, diagnosed with stages I-III primary cervical cancer between 2007-2013 in Surveillance, Epidemiology, and End Results (SEER). Multivariable Cox proportional hazards regression models evaluated associations between race/ethnicity (Non-Hispanic White, Non-Hispanic Black, Hispanic, Other) and cervical cancer-specific mortality...
2018: PloS One
https://www.readbyqxmd.com/read/29435742/information-needs-expressed-during-patient-oriented-oncology-consultations-quantity-variation-and-barriers
#3
Anesa Ahamad, Paul Wallner, Sharon Salenius, Rudi Ross, Eduardo Fernandez
High-quality oncology consultation includes patient-oriented communication tailored to patients' individualized needs. Common methods used in studies to increase question-asking are prompt lists and coaching pre-consultations. However, our patients were encouraged to ask questions by the physician during their visit. We aimed to estimate the quantity, nature, and variation of their questions when they were invited to ask by their oncologist. During radiotherapy consultations from 2012 to 2016, patient's questions were deliberately elicited and physician-transcribed...
February 12, 2018: Journal of Cancer Education: the Official Journal of the American Association for Cancer Education
https://www.readbyqxmd.com/read/29398897/perceptions-of-severe-storms-climate-change-ecological-structures-and-resiliency-three-years-post-hurricane-sandy-in-new-jersey
#4
Joanna Burger, Michael Gochfeld
Global warming is leading to increased frequency and severity of storms that are associated with flooding, increasing the risk to urban, coastal populations. This study examined perceptions of the relationship between severe storms, sea level rise, climate change and ecological barriers by a vulnerable environmental justice population in New Jersey. Patients using New Jersey's Federally Qualified Health Centers were interviewed after Hurricane [Superstorm] Sandy because it is essential to understand the perceptions of uninsured, underinsured, and economically challenged people to better develop a resiliency strategy for the most vulnerable people...
December 2017: Urban Ecosystems
https://www.readbyqxmd.com/read/29397280/the-affordability-of-providing-sexually-transmitted-disease-services-at-a-safety-net-clinic
#5
Lorraine T Dean, Madeline C Montgomery, Julia Raifman, Amy Nunn, Thomas Bertrand, Alexi Almonte, Philip A Chan
INTRODUCTION: Sexually transmitted diseases continue to increase in the U.S. There is a growing need for financially viable models to ensure the longevity of safety-net sexually transmitted disease clinics, which provide testing and treatment to high-risk populations. This micro-costing analysis estimated the number of visits required to balance cost and revenue of a sexually transmitted disease clinic in a Medicaid expansion state. METHODS: In 2017, actual and projected cost and revenues were estimated from the Rhode Island sexually transmitted disease clinic in 2015...
January 31, 2018: American Journal of Preventive Medicine
https://www.readbyqxmd.com/read/29395026/association-of-shared-decision-making-on-patient-reported-health-outcomes-and-healthcare-utilization
#6
Tasha M Hughes, Katiuscha Merath, Qinyu Chen, Steven Sun, Elizabeth Palmer, Jay J Idrees, Victor Okunrintemi, Malcolm Squires, Eliza W Beal, Timothy M Pawlik
BACKGROUND: Shared decision-making (SDM) is a process that respects the rights of patients to be fully involved in decisions about their care. By evaluating all available healthcare options and weighing patients' personal values and preferences against available unbiased evidence, patients and healthcare professionals can make health-related decisions together, as partners. We sought to evaluate the impact of perceived SDM on patient-reported outcomes, healthcare quality, and healthcare utilization...
January 31, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/29360645/breast-cancer-stage-at-diagnosis-in-a-new-jersey-cancer-education-and-early-detection-site
#7
Bonnie Jerome-D'Emilia, Debashis Kushary, Sherry A Burrell, Patricia D Suplee, Katherine Hansen
OBJECTIVES: The National Breast and Cervical Cancer Early Detection Program provides free or low-cost screening to uninsured or underinsured women and has had positive results; however, only a few state programs have been evaluated. This study will provide a first snapshot of the effectiveness of the New Jersey program, by comparing stage at diagnosis for enrollees as compared with nonenrollees who received definitive treatment for breast cancer at the same academic medical center. MATERIALS AND METHODS: A retrospective analysis of 5 years of breast cancer data abstracted from the Cancer Registry of a large urban hospital in the Northeast United States...
January 22, 2018: American Journal of Clinical Oncology
https://www.readbyqxmd.com/read/29284026/a-monte-carlo-simulation-approach-for-estimating-the-health-and-economic-impact-of-interventions-provided-at-a-student-run-clinic
#8
Daniel J Arenas, Lanair A Lett, Heather Klusaritz, Anne M Teitelman
BACKGROUND: Student Run Clinics (SRCs) are a common aspect of medical education, present at more than half of US medical schools, and noted for providing care to communities that might otherwise lack access, including the uninsured and underinsured. To date, few studies have rigorously quantified the health and economic benefits of SRCs, and the present study remedies that. METHODS AND FINDINGS: We used Monte Carlo simulations to estimate the health impact of common preventive health interventions applied to individuals in quality-adjusted life-years (QALYs)...
2017: PloS One
https://www.readbyqxmd.com/read/29176511/payer-policy-behavior-towards-opioid-pharmacotherapy-treatment-in-ohio
#9
Todd Molfenter, Carol Sherbeck, Sandy Starr, Jee-Seon Kim, Mark Zehner, Andrew Quanbeck, Nora Jacobson, Dennis McCarty
OBJECTIVE: Few studies examine how payers address the need for improved access to pharmacotherapy for opioid use disorders and the influence of environmental variables on access to opioid agonist and antagonist medications. METHOD: The 52 Ohio Addiction Drug Abuse and Mental Health Services (ADAMHS) Boards that disburse funds for treatment services for the uninsured and underinsured were surveyed to assess coverage for opioid agonist and antagonist treatment medications...
November 15, 2017: Journal of Addiction Medicine
https://www.readbyqxmd.com/read/29155612/health-reform-and-utilization-of-high-volume-hospitals-for-complex-cancer-operations
#10
Andrew P Loehrer, David C Chang, Zirui Song, George J Chang
PURPOSE: Underinsured patients are less likely to receive complex cancer operations at hospitals with high surgical volumes (high-volume hospitals, or HVHs), which contributes to disparities in care. To date, the impact of insurance coverage expansion on site of complex cancer surgery remains unknown. METHODS: Using the 2006 Massachusetts coverage expansion as a natural experiment, we searched the Hospital Cost and Utilization Project state inpatient databases for Massachusetts and control states (New York, New Jersey, and Florida) between 2001 and 2011 to evaluate changes in the utilization of HVHs for resections of bladder, esophageal, stomach, pancreatic, rectal, or lung cancer after the expansion of insurance coverage...
November 20, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/29151365/effectiveness-of-direct-acting-antiviral-therapy-for-hepatitis-c-in-difficult-to-treat-patients-in-a-safety-net-health-system-a-retrospective-cohort-study
#11
Christina Yek, Carolina de la Flor, John Marshall, Cindy Zoellner, Grace Thompson, Lisa Quirk, Christian Mayorga, Barbara J Turner, Amit G Singal, Mamta K Jain
BACKGROUND: Direct-acting antivirals (DAAs) have revolutionized chronic hepatitis C (HCV) treatment, but real-world effectiveness among vulnerable populations, including uninsured patients, is lacking. This study was conducted to characterize the effectiveness of DAAs in a socioeconomically disadvantaged and underinsured patient cohort. METHODS: This retrospective observational study included all patients undergoing HCV treatment with DAA-based therapy between April 2014 and June 2016 at a large urban safety-net health system (Parkland Health and Hospital System, Dallas, TX, USA)...
November 20, 2017: BMC Medicine
https://www.readbyqxmd.com/read/29150748/an-evaluation-of-a-rural-community-based-breast-education-and-navigation-program-highlights-and-lessons-learned
#12
Essie Torres, Alice R Richman, Ann M Schreier, Nasreen Vohra, Kathryn Verbanac
Cancer has become the leading cause of death in North Carolina (NC) (North Carolina DHHS, State Center for Health Statistics 2015) and the eastern region of North Carolina (ENC) has experienced greater cancer mortality than the remainder of the state. The Pitt County Breast Wellness Initiative-Education (PCBWI-E) provides culturally tailored breast cancer education and navigation to screening services for uninsured/underinsured women in Pitt and Edgecombe Counties in ENC. PCBWI-E created a network of 23 lay breast health educators, and has educated 735 women on breast health and breast cancer screening guidelines...
November 17, 2017: Journal of Cancer Education: the Official Journal of the American Association for Cancer Education
https://www.readbyqxmd.com/read/29102459/health-insurance-status-and-clinical-cancer-screenings-among-u-s-adults
#13
Guixiang Zhao, Catherine A Okoro, Jun Li, Machell Town
INTRODUCTION: Health insurance coverage is linked to clinical preventive service use. This study examined cancer screenings among U.S. adults by health insurance status. METHODS: The Behavioral Risk Factor Surveillance System collected data on healthcare access and cancer screenings from 42 states and the District of Columbia in 2014. Data analyses were conducted in 2016. Participants' health insurance status during the preceding 12 months was categorized as adequately insured, underinsured, or never insured...
November 1, 2017: American Journal of Preventive Medicine
https://www.readbyqxmd.com/read/28886800/temporal-image-comparison-serial-imaging-in-assessing-pigmented-lesions
#14
REVIEW
Rhett J Drugge, Elizabeth D Drugge
The large-scale deployment of low-cost, noninvasive mechanisms of early detection are needed to reduce the melanoma burden. A serial 2-step system could power mass screening efforts serving the uninsured and underinsured as well as the rural and remote US counties where melanoma mortality is doubled for lack of access to dermatologists. Furthermore, serial melanoma screening strategies, serial total body photography and serial digital dermatoscopy imaging may be performed as a telehealth service, and thus would be available in any location that can support activity compliant with the Health Insurance Portability and Accountability Act and has appropriate bandwidth...
October 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28881902/frequency-of-endoscopic-surveillance-for-barrett-s-esophagus-is-influenced-by-health-insurance-status-results-from-a-population-based-analysis
#15
A Faqih, K K Broman, L-C Huang, S E Phillips, M D Holzman, R A Pierce, B K Poulose, P S Yachimski
Factors that influence the frequency of surveillance endoscopy for nondysplastic Barrett's esophagus are not well understood. The objective of this study is to assess factors which influence the frequency of endoscopic surveillance for Barrett's esophagus, including health insurance/third-party payer status. Cases of nondysplastic Barrett's esophagus undergoing esophagogastroduodenoscopy with biopsy were identified using longitudinal data from the Healthcare Utilization Project database in 2005-2006 and followed through 2011...
November 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/28869210/the-affordable-care-act-s-dependent-care-coverage-expansion-and-behavioral-health-care
#16
Chandler B McClellan
BACKGROUND: In September 2010, the Affordable Care Act (ACA) extended dependent care coverage to individuals under the age of 26, allowing young adults to remain on their parent's private insurance. AIMS OF THE STUDY: This policy offers a natural experiment to examine the impact of expanded insurance coverage on mental health and substance use treatment utilization and payment composition. METHODS: Using National Survey on Drug Use and Health (NSDUH) and Medical Expenditure Panel Survey (MEPS) data between 2005 and 2014, this study employs a difference-in-differences approach with 23-25 year olds as the treatment group and 27-30 year olds as the control group to examine the impact of the expansion on insurance coverage, behavioral health treatment utilization, and treatment payment source...
September 1, 2017: Journal of Mental Health Policy and Economics
https://www.readbyqxmd.com/read/28861676/machete-injuries-to-the-upper-extremity
#17
Chester J Donnally, William Hannay, Derek A Rapp, Nikola Lekic, Seth D Dodds
PURPOSE: We intend to describe and analyze the spectrum of upper extremity injuries that arises from both accidental and intentional machete injuries with a focus on associated complications and comorbidities. This review is the first from a United States institution, and the only from a designated level 1 trauma center. METHODS: A retrospective review of machete related upper extremity injuries admitted to a level 1 trauma center from 2008 to 2016. The following data was collected on admitted patients: demographics, mechanism of injury, surgical management, and complications...
August 31, 2017: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/28831638/health-insurance-status-and-eligibility-among-patients-who-seek-healthcare-at-a-free-clinic-in-the-affordable-care-act-era
#18
Kristen Sessions, Amal Hassan, Thomas G McLeod, Mark L Wieland
Free clinics provide care to over 1.8 million people in the United States every year and are a valuable safety net for uninsured and underinsured patients. The Affordable Care Act has resulted in millions of newly insured Americans, yet there is continued demand for healthcare at free clinics. In this study, we assessed health insurance status and eligibility among 489 patients who visited a free clinic in 2016. Eighty-seven percent of patients seen were uninsured, 53.1% of whom were eligible for health insurance (Medicaid or subsidized insurance premiums)...
August 22, 2017: Journal of Community Health
https://www.readbyqxmd.com/read/28817791/using-practice-facilitation-to-increase-rates-of-colorectal-cancer-screening-in-community-health-centers-north-carolina-2012-2013-feasibility-facilitators-and-barriers
#19
Bryan J Weiner, Catherine L Rohweder, Jennifer E Scott, Randall Teal, Alecia Slade, Allison M Deal, Naima Jihad, Marti Wolf
INTRODUCTION: Practice facilitation involves trained individuals working with practice staff to conduct quality improvement activities and support delivery of evidence-based clinical services. We examined the feasibility of using practice facilitation to assist federally qualified health centers (FQHCs) to increase colorectal cancer screening rates in North Carolina. METHODS: The intervention consisted of 12 months of facilitation in 3 FQHCs. We conducted chart audits to obtain data on changes in documented recommendation for colorectal cancer screening and completed screening...
August 17, 2017: Preventing Chronic Disease
https://www.readbyqxmd.com/read/28797422/in-hospital-outcomes-of-percutaneous%C3%A2-coronary-intervention-in%C3%A2-america-s-safety%C3%A2-net-insights-from-the-ncdr-cath-pci-registry
#20
Tushar Acharya, Adam C Salisbury, John A Spertus, Kevin F Kennedy, Amarbir Bhullar, H Kiran K Reddy, Bipin K Joshi, John A Ambrose
OBJECTIVES: This study compared risk-adjusted percutaneous coronary intervention (PCI) outcomes of safety-net hospitals (SNHs) and non-SNHs. BACKGROUND: Although risk adjustment is used to compare hospitals, SNHs treat a disproportionate share of uninsured and underinsured patients, who may have unmeasured risk factors, limited health care access, and poorer outcomes than patients treated at non-SNHs. METHODS: Using the National Cardiovascular Data Registry CathPCI Registry from 2009 to 2015, we analyzed 3,746,961 patients who underwent PCI at 282 SNHs (hospitals where ≥10% of PCI patients were uninsured) and 1,134 non-SNHs...
August 14, 2017: JACC. Cardiovascular Interventions
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