Browsing by Subject "utilization"
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Item An Evaluation of the Impact of Continuity of Care on Cost of Services in New and Renewing CHIP Enrollees(2001-01-01) Montague, Brian; Lykens, Kristine; Marshall, Muriel; Singh, KaranObjective. To assess the impact of continuity of care as measured by enrollment history on the cost of services in Colorado’s state insurance program for children in low-income families, the Child Health Plan Plus. Design. A retrospective cohort study using data extracted from the eligibility/enrollment system and the claims payment system for inpatient and specialty services. All children enrolled in the program for at least 90 days and managed under the state managed-care network from its inception to April 1st of 2000 were included in the analysis (n-11841). Enrollees were separated into three enrollment groups: new members, renewing members, and members transition from a prior outpatient services group. The odds by enrollment groups: new members, renewing members, and members transition from a prior outpatient services program. The odds by enrollment group an average monthly claims greater than the 75th percentile amongst those with claims (n-2661) and the odds of presence of any claim in the full data set were compared means of a logistic regression model. In order to permit inferences regarding the total cost of care, all models included age group as a cofactor. Presence of chronic or congenital disease, ethnicity, primary language, urban residence, and the presence of multiple parents or caretakers were tested using univariate chi-square analysis and significant factors (p [less than] 0.1) were included as effects in the models. Results. All cofactors with the exception of ethnicity were significant in both models. Chronic disease status was associated with an increased risk of all claims. (OR=4.961, p [less than] 0.0001) and high claims (OR=9.639, p [less than] 0.0001). Renewal status was associated with a decreased risk of any claim (OR=0.921, p [less than] 0.0936) while rollover status was associated with both an increased risk of any claim (OR=1.157, p=0.0034) and a decreased risk of high claims (OR=0.731, p=0.0033). Residence in rural counties increased the risk of any claim (OR=0.0428, p [less than] 0.0001) and an increased risk of high claims (OR=1.472, p=0.0376). Conclusions. Enrollment history had a modest, though significant, effect on the presence of any claim and the specific presence of high claims. Rollover status was protective increasing utilization of the system overall but reducing the risk of high claims whereas renewal status only reduced the risk of utilization overall. The absence of multiple adults in the household showed a pattern consistent with episodic use of the system. Relative to urban residents, residents of rural counties were more likely to have used any service and less likely to have incurred high claims. This effect may be attributable to the transition of patients to HMO networks in urban counties. Linguistic or cultural barriers as reflected in primary language strongly decreased utilization, suggesting that these may be important barriers to address in outreach and member education.Item Utilization and Access to Healthcare Services Among People Living with Spinal Cord Injuries in the Community(2014-12-01) Noorani, Shayan; Rustin E. ReevesHealthcare for individuals following spinal cord injury (SCI) plays a significant and necessary role in reducing an individual’s risk of managing and preventing associated, secondary, or chronic conditions. Barriers alongside secondary, associated, and chronic issues prevent a viable access to healthcare. Some of these factors include age, income, race, medical insurance type, accessible resources, skill and knowledge of physicians, ER visits, and preventative health measures. This research project will use a cross sectional study design with a survey that utilizes the previously mentioned factors. The purpose of this study is to describe the utilization, accessibility, and satisfaction of primary and preventative health-care services of community-dwelling individuals with SCI. The population sampled was the former inpatient and current outpatient individuals with SCI at a rehabilitation hospital. There were 142 subjects in the study. Of these, 42 were administered the survey by phone and 100 were surveyed in person during a routine follow-up visit. Approximately 99% of individuals in the current sample reported that they had healthcare visits in the past 12 months. Results of the current project also indicated that PCP’s (79%) were the most frequently visited physicians, followed by SCI/Rehab physicians (77%) and urologists (50%). Individuals with SCI also had a high number of ED visits (43% of sample within the past 12-months). The primary reasons for ED visits for the current sample were genital/urological (15%), wounds/skin problems (5%), and pneumonia (4%). Of note, individuals who visited the ER had a lower Geo Unit Quality Score and were less likely to have a post-secondary education. For preventative health services, patients with SCI also reported similar utilization to previous SCI research and data from the general population. Accessibility did not present as a major issue with SCI physicians, and the majority of the study population was satisfied with their physicians. Consequently, further accessibility for individuals with disabilities should be implemented and other barriers should be ameliorated throughout the healthcare industry. Further research and analysis on socio-demographic factors such as transportation, work-related issues, quality of life, needs for better healthcare, and psychological factors can assist in learning more about the needs of individuals with SCI.