Sarah B. Laditka

Access to health care and hospitalization for ambulatory care sensitive conditions.

Hospitalization for Ambulatory Care Sensitive Conditions (ACSH) is an accepted indicator of access to health care and avoidable morbidity. Accessible care of reasonable quality should reduce ACSH. Little research has examined the indicator’s external validity. We calculated standardized ACSH rates for 32 areas of Victoria, Australia (population 4.4 million). A representative survey measured access, disease prevalence, propensity to seek care, disease burden, social determinants of health services use, and behavioral risk factors. Regression analyses compared self-rated access with ACSH rates. Independent of prevalence, propensity to seek care, disease burden, and physician supply, better access was associated with lower ACSH rates. Results provide support for the ACSH indicator. When rural residence was considered, the covariate measuring access was not significant. However, rural residence also may contribute importantly to access. Results suggest both the complexity of the meaning of access and the desirability of further research to validate the ACSH indicator.

Effects of residence and race on burden of travel for care: cross sectional analysis of the 2001 US National Household Travel Survey

BackgroundTravel burden is a key element in conceptualizing geographic access to health care. Prior research has shown that both rural and minority populations bear disproportionate travel burdens. However, many studies are limited to specific types of patient or specific locales. The purpose of our study was to quantify geographic and race-based differences in distance traveled and time spent in travel for medical/dental care using representative national data.MethodsData were drawn from 2001 National Household Travel Survey (NHTS), a nationally representative, cross-sectional household survey conducted by the US Department of Transportation. Participants recorded all travel on a designated day; the overall response rate was 41%. Analyses were restricted to households reporting at least one trip for medical and/or dental care; 3,914 trips made by 2,432 households. Dependent variables in the analysis were road miles traveled, minutes spent traveling, and high travel burden, defined as more than 30 miles or 30 minutes per trip. Independent variables of interest were rural residence and race. Characteristics of the individual, the trip, and the community were controlled in multivariate analyses.ResultsThe average trip for care in the US in 2001 entailed 10.2 road miles (16.4 kilometers) and 22.0 minutes of travel. Rural residents traveled further than urban residents in unadjusted analysis (17.5 versus 8.3 miles; 28.2 versus 13.4 km). Rural trips took 31.4% longer than urban trips (27.2 versus 20.7 minutes). Distance traveled did not vary by race. African Americans spent more time in travel than whites (29.1 versus 20.6 minutes); other minorities did not differ. In adjusted analyses, rural residence (odds ratio, OR, 2.67, 95% confidence interval, CI 1.39 5.1.5) was associated with a trip of 30 road miles or more; rural residence (OR, 1.80, CI 1.09 2.99) and African American race/ethnicity (OR 3.04. 95% CI 2.0 4.62) were associated with a trip lasting 30 minutes or longer.ConclusionRural residents and African Americans experience higher travel burdens than urban residents or whites when seeking medical/dental care.

Health care access in rural areas: evidence that hospitalization for ambulatory care-sensitive conditions in the United States may increase with the level of rurality.

UNLABELLED We examined whether levels of rurality are associated with hospitalization for ambulatory care-sensitive conditions (ACSH) in eight states of the United States. ACSH is an indicator of access to reasonably effective primary health care. ACSH for children did not vary systematically with rurality. Compared to the most urban counties, the adjusted rate in the most rural was 90% greater for ages 18-64 and 45% greater for ages 65+ (both p<.001). Adjusted adult rates generally increased with the level of rurality. CONCLUSIONS Increasing levels of rurality may be positively associated with ACSH, suggesting rural disparities in access to primary health care.

Race, Ethnicity and Hospitalization for Six Chronic Ambulatory Care Sensitive Conditions in the USA

Objectives. Hospitalization for ambulatory care sensitive conditions, also called preventable hospitalization, has been widely accepted as an indicator of access to primary health care, and of the overall success of the primary health care system. Our objective is to examine associations between preventable hospitalization and race and ethnicity in the USA, separately for six major chronic diseases: angina, asthma, chronic obstructive pulmonary disease, congestive heart failure, diabetes and hypertension. Design. We used the 1997 Nationwide Inpatient Sample, 1997 Current Population Survey and 1997 National Health Interview Survey, to calculate rates of preventable hospitalization, and the prevalence of ambulatory care sensitive conditions, for African Americans, Hispanics and non-Hispanic whites. Rates were calculated for ages 19–64, and 65 and over. Preventable hospitalization rates that accounted for underlying hospitalization patterns were also estimated. A final set of estimations adjusted the preventable hospitalization rates for disease prevalence. Results. Preventable hospitalization rates were notably higher for African Americans and Hispanics than for non-Hispanic whites for almost all of the conditions, both for women and men and for both age groups. Rates adjusted for underlying hospitalization patterns showed a similar pattern. Adjusted for disease prevalence, rate differences remained notably large for both women and men, and for both age groups. Particularly great, for both African Americans and Hispanics of both sexes, are the risks of preventable hospitalization for asthma, diabetes and hypertension. Conclusion. African Americans and Hispanics have high preventable hospitalization rates for major chronic conditions, even after disease prevalence and underlying hospital utilization patterns are considered. These rates are particularly high for asthma, diabetes and hypertension, which are amenable to prevention and management interventions. Our results suggest a need to improve access to quality primary health care for African Americans and Hispanics in the USA, and for enhanced support of targeted prevention efforts.

Association between community health center and rural health clinic presence and county-level hospitalization rates for ambulatory care sensitive conditions: an analysis across eight US states

BackgroundFederally qualified community health centers (CHCs) and rural health clinics (RHCs) are intended to provide access to care for vulnerable populations. While some research has explored the effects of CHCs on population health, little information exists regarding RHC effects. We sought to clarify the contribution that CHCs and RHCs may make to the accessibility of primary health care, as measured by county-level rates of hospitalization for ambulatory care sensitive (ACS) conditions.MethodsWe conducted an ecologic analysis of the relationship between facility presence and county-level hospitalization rates, using 2002 discharge data from eight states within the US (579 counties). Counties were categorized by facility availability: CHC(s) only, RHC(s) only, both (CHC and RHC), and neither. US Agency for Healthcare Research and Quality definitions were used to identify ACS diagnoses. Discharge rates were based on the individuals county of residence and were obtained by dividing ACS hospitalizations by the relevant county population. We calculated ACS rates separately for children, working age adults, and older individuals, and for uninsured children and working age adults. To ensure stable rates, we excluded counties having fewer than 1,000 residents in the child or working age adult categories, or 500 residents among those 65 and older. Multivariate Poisson analysis was used to calculate adjusted rate ratios.ResultsAmong working age adults, rate ratio (RR) comparing ACS hospitalization rates for CHC-only counties to those of counties with neither facility was 0.86 (95% Confidence Interval, CI, 0.78–0.95). Among older adults, the rate ratio for CHC-only counties compared to counties with neither facility was 0.84 (CI 0.81–0.87); for counties with both CHC and RHC present, the RR was 0.88 (CI 0.84–0.92). No CHC/RHC effects were found for children. No effects were found on estimated hospitalization rates among uninsured populations.ConclusionOur results suggest that CHCs and RHCs may play a useful role in providing access to primary health care. Their presence in a county may help to limit the countys rate of hospitalization for ACS diagnoses, particularly among older people.

Adult Children Helping Older Parents: Variations in Likelihood and Hours by Gender, Race, and Family Role

Using the 1993 Panel Study of Income Dynamics, the authors examine help given to older parents in typical American families. Daughters and sons not in couples were more likely to help than those in couples, and gave substantially more hours. In couples, daughters were less likely to help than sons, but they helped for considerably more hours. Black daughters helped at least as commonly as White daughters, and did so for substantially more hours than either White daughters or sons of either race. Results suggest that Black sons may help less commonly than White sons. Black sons who help, however, do so for at least as many hours as White sons. Findings suggest that changes in the Black American family have not produced the notable intergenerational relations breakdown anticipated by some researchers. Results also illuminate the important role of sons in family help and suggest that changing marriage patterns may not reduce help to older parents.

Providing Shelter to Nursing Home Evacuees in Disasters: Lessons From Hurricane Katrina

OBJECTIVES We examined nursing home preparedness needs by studying the experiences of nursing homes that sheltered evacuees from Hurricane Katrina. METHODS Five weeks after Hurricane Katrina, and again 15 weeks later, we conducted interviews with administrators of 14 nursing homes that sheltered 458 evacuees in 4 states. Nine weeks after Katrina, we conducted site visits to 4 nursing homes and interviewed 4 administrators and 38 staff members. We used grounded theory analysis to identify major themes and thematic analysis to organize content. RESULTS Although most sheltering facilities were well prepared for emergency triage and treatment, we identified some major preparedness shortcomings. Nursing homes were not included in community planning or recognized as community health care resources. Supplies and medications were inadequate, and there was insufficient communication and information about evacuees provided by evacuating nursing homes to sheltering nursing homes. Residents and staff had notable mental health-related needs after 5 months, and maintaining adequate staffing was a challenge. CONCLUSIONS Nursing homes should develop and practice procedures to shelter and provide long-term access to mental health services following a disaster. Nursing homes should be integrated into community disaster planning and be classified in an emergency priority category similar to hospitals.

Care Transitions by Older Adults From Nursing Homes to Hospitals: Implications for Long-Term Care Practice, Geriatrics Education, and Research

Older adults residing in nursing homes are among the most vulnerable members of our society. A large percentage of nursing home residents are at risk of experiencing a care transition to a hospital. This review examines care transitions from nursing homes to hospitals, focusing on resident safely, effectiveness and timeliness of these transitions, and ways to enhance resident-centered care. Recommendations to improve care include promoting clear communication, managing medications, encouraging appropriate use of formal advance directives, providing timely access to care to reduce the risk of potentially avoidable hospitalization, and promoting an interdisciplinary resident-centered approach in geriatrics education. Studies examining nursing homes that have adopted models of care that emphasize resident autonomy as well as qualitative research focusing on in-depth ethnographic approaches can provide new perspectives of care transition experiences, and help to identify additional ways to improve care.

ATTITUDES ABOUT AGING AND GENDER AMONG YOUNG, MIDDLE AGE, AND OLDER COLLEGE-BASED STUDENTS

Using an updated version of the Aging Semantic Differential, 534 younger, middle age, and older participants from a college community rated female and male targets categorized as ages 21–34 and 75–85. Participants also provided views about their own aging. Repeated measures of analysis of variance examined attitudinal differences by age and gender of targets, and by participant age and gender. Female targets were viewed more positively than males by most rater groups. Older targets were viewed more positively by older participants than by other age groups. Older participants had more positive views about their own aging than did participants of younger or middle ages.

The Relationship Between Workplace Environment and Job Satisfaction Among Nursing Assistants: Findings From a National Survey

OBJECTIVES To identify supervisory factors related to job satisfaction among certified nursing assistants (CNAs). Although this topic has been studied at the facility and state levels, it has not previously been addressed in a nationally representative sample. DESIGN Cross-sectional analysis of data from the 2004 National Nursing Assistant Survey, conducted by the National Center for Health Statistics. SETTING Nationally representative sample of nursing homes (n = 790). PARTICIPANTS Eight randomly selected CNAs from each nursing home, 4 who had been at that job for less than 1 year and 4 at the job for a year or more (n = 3011). Analysis was limited to 2897 individuals working at the same facility when interviewed. MEASURES Job satisfaction was measured by a 6-item score addressing workplace morale, challenging work, benefits, salary or wages, learning new skills, and overall satisfaction. Characteristics of the work environment included supervisor behavior, time pressures, organizational climate, perception that the CNAs work was valued, and whether the CNA principally cared for the same residents. RESULTS In adjusted analysis, organizational climate, supervisor behavior, sufficient time for tasks, and being valued were positively associated with job satisfaction, as were hourly earnings. CONCLUSIONS Clear communication from supervisors and evidence that the CNA function is valued were associated with job satisfaction. Specific strategies, such as merit raises and job design, may increase job satisfaction.