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PubMed2004

A program to improve access to health care among Mexican immigrants in rural Colorado.

CONTEXT: Migration to the United States from Mexico is increasing every year. Mexican immigrants tend to be poor, uninsured, monolingual Spanish speakers without adequate access to appropriate medical care. As a further barrier, many are also undocumented. PURPOSE: This article describes a program developed to improve access to health care among Mexican immigrants in northern Colorado. METHODS: The program was implemented by a migrant/community health center in rural northern Colorado based on findings from an in-depth health needs survey of the target population. The program consists of community outreach services vertically integrated into the main medical clinics, which comprise Salud Family Health Centers. A mobile unit went to nontraditional areas identified by community workers as gathering places for Mexican immigrants. Services provided included preventive health care (screening for diabetes, hypertension, mental health problems, dental problems, and HIV); education; and primary care for acute problems. Patients were referred to a health care home for ongoing care. RESULTS: In the first 6 months, 1,553 Mexican immigrants were seen on the mobile unit. Hypertension and psychosocial problems were the most common problems in this population. Thirty-five percent of patients who received consultation in the mobile unit have visited any of the clinics for follow-up within the following year. CONCLUSIONS: A community-based mobile outreach program targeted toward Mexican immigrants can be effective in uncovering medical and mental illness and in directing patients to a health care home. This is an important first step in eliminating health disparities among this population.

Adolescent↗
PubMed2002

An ABCD program to increase access to dental care for children enrolled in Medicaid in a rural county.

OBJECTIVES: The Access to Baby and Child Dentistry (ABCD) Program addresses the needs of families in obtaining dental care. In this study, the program was evaluated in rural Stevens County, Washington. Aims were to assess utilization of dental services, average dental expenditures per child, and oral health status. METHODS: Medicaid-enrolled children aged 1-4 years were randomly assigned to the ABCD program (n=216) or to regular benefits (n=221). An outreach worker contacted each ABCD family and provided an orientation. Dental care utilization and expenditures were calculated from claims. A posttest-only design was used to evaluate oral health status. RESULTS: An enrollment effect was seen in ABCD, but the difference between groups was not sustained. There was a doubling of utilization between groups for the youngest cohort, while the others showed no differences. In the first year the rate was higher for the entire ABCD group than for the children not in ABCD (34.0% vs 24.7%). Thirty-three percent of ABCD children (70/212) who had visited the dentist had >1 appointment compared to 21.5 percent (47/219) for the children not in ABCD who had visited the dentist. There was no overall difference in expenditures, while expenditures for preventive services were greater for ABCD. ABCD children had fewer teeth with initial caries. The average incremental cost per child per initial lesion prevented was 31.44 dollars. CONCLUSION: ABCD most benefited the youngest cohort of children and improved health.

Child, Preschool↗
PubMed2002

Effect of the North Carolina State Children's Health Insurance Program on Beneficiary Access to Care.

BACKGROUND: In the fall of 1998, North Carolina implemented its State Children Health Insurance Program, North Carolina Health Choice for Children (NCHC). This stand-alone, fee-for-service program quickly enrolled large numbers of children and has been considered one of the State Children Health Insurance Program success stories. OBJECTIVE: To explore the perceptions of parents of children enrolled in NCHC regarding their children's access to health care services before and after enrollment in the NCHC. DESIGN AND SETTING: Qualitative and quantitative data analyses are combined to assess program effectiveness. Two waves of surveys were fielded. A baseline survey asked parents of children newly enrolled in NCHC questions about their child's health experiences before enrollment in NCHC. Parents who responded with baseline data were resurveyed 1 year later to collect information on their child's experiences while insured by NCHC. PARTICIPANTS: Parents of 987 children newly enrolled in NCHC in the summer of 2000, randomly chosen within 3 age group strata. RESULTS: The NCHC has been successful in improving access to health care for low-income children. Parents reported that the program helped make health services financially accessible to their children, enabling them to get needed physician's care, eyeglasses, or prescription drugs. A significantly higher percentage of children received care in the private sector, increasing from 62% to 75% for well-child care visits and 67% to 78% for acute care. The percentage of children with unmet medical needs dropped significantly from 20% to just 2% after enrollment in NCHC. The improvement in access to care is much more striking for the older age groups and for children who were uninsured prior to NCHC enrollment (rather than those who graduated from Medicaid into the program). Despite these gains, there are still substantial numbers of children who are not receiving age-appropriate well-child care. CONCLUSION: The NCHC has successfully improved access to care for its enrollees.

Adolescent↗
PubMed2002

An organized pilot program promoting web access to picture archiving and communications system data: emphasis on offices outside the host institution.

A formal Pilot Program for Web-based access to a host picture archiving and communication system (PACS) can augment the transition to filmless radiology. Beyond the technical issues of PCs and networks, appropriate legal input and documentation is necessary. While it is important to be in line with overall institutional priorities with regard to online access strategies, it is important to recognize that the Radiology Department has the greatest stake in successfully going filmless, and that it is incumbent upon the Radiology Department itself to take on outreach efforts to the medical community at large. The MMC Web Access Pilot Project has been successful in helping key non-MMC offices overcome the issues associated with preparing for and mastering Web access to PACS images. The benefit has been mutual, and MMC is now able to provide better advice to new offices that are coming online, as well as sharpening its focus on logistical issues that need to be resolved if we are to eliminate film from medical practice.

Humans↗
PubMed1995

9-1-1: rapid identification and treatment of acute myocardial infarction. National Heart Attack Alert Program Coordinating Committee Access to Care Subcommittee.

The sooner a person who is experiencing symptoms and signs of an acute myocardial infarction (AMI) (including out-of-hospital cardiac arrest) receives medical treatment, the greater his or her chances of survival and limitation of infarct size. A universal 9-1-1 emergency telephone system makes it possible for AMI patients or those around them to easily and quickly call for help and for emergency medical services (EMS) personnel to rapidly and accurately locate the patient. This article by the Access to Care Subcommittee of the National Heart Attack Alert Program (NHAAP) Coordinating Committee describes the history of 9-1-1, its key elements, its current implementation status, and existing State legislation and standards. Currently, approximately 78% of the United States population, mainly in urban areas, has access to a 9-1-1 system. Approximately 195 United States cities with a population of greater than 100,000 people have access to enhanced 9-1-1. It is the contention of the NHAAP that 9-1-1 services should be universally available to all Americans to ensure seamless access to EMS and, potentially, early detection, evaluation, and treatment for AMI. This article reports several key recommendations for achieving this goal.

Death, Sudden, Cardiac↗
PubMed1995

Staffing and equipping emergency medical services systems: rapid identification and treatment of acute myocardial infarction. National Heart Attack Alert Program Coordinating Committee Access to Care Subcommittee.

Each year, about 1,250,000 people in the United States experience an acute myocardial infarction (AMI). Emergency medical services (EMS) systems play a key part in the prehospital care and transportation of AMI patients. Rapid, state-of-the-art treatment by EMS personnel is essential for improving AMI survival and outcomes, as dramatized by the patient who is the victim of out-of-hospital cardiac arrest. In order to improve the prehospital care provided to AMI patients, this article by the Access to Care Subcommittee of the National Heart Attack Alert Program Coordinating Committee makes a number of recommendations regarding the staffing and equipping of EMS systems. The recommendations cover the "chain of survival" concept, universal and enhanced 9-1-1, emergency medical dispatching, ground ambulance specifications, automated external defibrillators, advanced life support coverage, medical direction, 12-lead electrocardiograms, and prehospital thrombolysis.

Ambulances↗
PubMed1998

The Ability Program: improving statewide access to assistive technology for adults with disabilities.

In 1995, the Kate B. Reynolds Charitable Trust awarded $2.4 million to support the Ability Program, a statewide initiative to improve awareness of and access to assistive technology for adult North Carolinians with disabilities. This coordinated effort resulted in 11 funded projects, each using a different approach to deliver assistive technology to persons in rural communities. An overall management, technical assistance, and evaluation program ensured coordinated use of the Trust's funds. This paper describes the development and implementation of the Ability Program in North Carolina, accomplishments of program grantees, and results of a comprehensive program evaluation system used to document process and outcome measures. After 2 years of operation, the type and extent of assistive technology services for adults with disabilities in North Carolina increased as a result of the Ability Program.

Activities of Daily Living↗
PubMed1992

Accessibility to primary health care centers: experience and evaluation of an appointment system program.

Appropriate access to health care is one of the components of Primary Health Care (PHC) and it can be a good quality indicator. We present in this paper the results of 1 year of follow-up of an appointment system applied in 29 PHC centers in the Balearic Islands, Spain; the program was set up by the National Institute of Health. Telephonic appointment proportion increased from the first weeks, stabilizing at about 70%. The number of calls that it is necessary to make in order to get an appointment at peak time is now 1.5 and only 1 throughout the rest of the day. To determine changes in the waiting time and visit time, and the user opinion of the system, an enquiry was made to a sample of patients 1 month before, and 1 month, 6 months and 1 year after the program started. The waiting time is now less than 15 min for most of the people interviewed, in contrast with the previous situation when the waiting time was more than 30 min. The visit time is longer now and more than two thirds of the people think that care is better or much better than prior to the start of the program. These results have been verified in the waiting room (11.2 min mean waiting time and 7.2 min mean visit time). We conclude that we have achieved the goals of the appointment system program in all the centers covered by our department.

Appointments and Schedules↗
PubMed2003

Effects of Medicaid managed care programs on health services access and use.

OBJECTIVE: To estimate the effects of Medicaid managed care (MMC) programs on Medicaid enrollees' access to and use of health care services at the national level. DATA SOURCES/STUDY SETTING: 1991-1995 National Health Interview Surveys (NHIS) and a 1998 Urban Institute survey on state Medicaid managed care programs. STUDY DESIGN: Using multivariate regression models, we estimated the effect of living in a county with an MMC program on several access and use measures for nonelderly women who receive Medicaid through AFDC and child Medicaid recipients. We focus on mandatory programs and estimate separate effects for primary care case management (PCCM) programs, health maintenance organization (HMO) programs, and mixed PCCM/HMO programs, relative to fee-for-service (FFS) Medicaid. We control for individual and county characteristics, and state and year effects. DATA COLLECTION/EXTRACTION METHOD: This study uses pooled individual-level data from up to five years of the NHIS (1991-1995), linked to information on Medicaid managed care characteristics at the county level from the 1998 MMC survey. PRINCIPAL FINDINGS: We find virtually no effects of mandatory PCCM programs. For women, mandatory HMO programs reduce some types of non-emergency room (ER) use, and increase reported unmet need for medical care. The PCCM/HMO programs increase access, but had no effects on use. For children, mandatory HMO programs reduce ER visits, and increase the use of specialists. The PCCM/HMO programs reduce ER visits, while increasing other types of use and access. CONCLUSIONS: Mandatory PCCM/HMO programs improved access and utilization relative to traditional FFS Medicaid, primarily for children. Mandatory HMO programs caused some access problems for women.

Adult↗
PubMed1995

Emergency medical dispatching: rapid identification and treatment of acute myocardial infarction. National Heart Attack Alert Program Coordinating Committee Access to Care Subcommittee.

Emergency medical telephone calls (ie, those made to 9-1-1 or 7-digit emergency numbers) are directed to emergency medical dispatchers (EMDs) who are responsible for quickly obtaining critical pieces of information from the caller, then activating an appropriate level of emergency medical services (EMS) response and providing the caller with patient care instructions until medical help arrives. The impact of well-trained, medically managed EMDs on the early care of potential acute myocardial infarction (AMI) patients is believed to be beneficial. However, standards for emergency medical dispatching vary widely across the nation. To improve emergency medical dispatching for AMI patients in the United States, this article by the Access to Care Subcommittee on behalf of the National Heart Attack Alert Program makes a number of recommendations regarding the use of medical dispatch protocols, provision of dispatch life support, EMD training, EMD certification, and emergency medical dispatch quality control and improvement processes.

Certification↗
PubMedDate not supplied

Needle exchange programs. Delivery and access issues.

OBJECTIVE: Examine the challenges of four service delivery models (i.e., fixed, mobile, satellite and home visits) and how service delivery may impact on NEP HIV prevention efforts. METHODS: Using a modified ethnographic approach, semi-structured interviews concerning policies and procedures were conducted with staff (n = 59) of NEPs (n = 15) in Ontario. An iterative, inductive analytic process was used. RESULTS: According to workers and managers, effectiveness of NEP prevention efforts depend on client development and retention and service design. Fixed and satellite sites, home visits and mobile services provide varied levels of temporal and spatial accessibility. Combining modes of delivery can offset the disadvantages of individual modes. DISCUSSION: NEP evaluations that do not consider service and resource factors run the risk of concluding that NEPs are ineffective when it may be that the program works for a small proportion of IDUs whom the NEP has the resources to serve.

Attitude of Health Personnel↗
PubMed2005

National estimates of the effects of mandatory Medicaid managed care programs on health care access and use, 1997-1999.

OBJECTIVE: We sought to explore how mandatory Medicaid managed care programs affect access to care and use among full-year Medicaid beneficiaries not receiving SSI or Medicare. RESEARCH DESIGN: We used data from the 1997 and 1999 National Survey of America's Families. To establish what Medicaid beneficiaries' access and use would have been in the absence of Medicaid managed care (MMC) and to control for unobserved county differences, we estimated difference-in-difference models using a comparison group of privately insured individuals who we would not expect to be affected by MMC. RESULTS: We found weaker effects of MMC programs for children than adults. The strongest result is that mandatory HMO programs lower the probability of Medicaid adults using emergency rooms, when implemented alone or in combination with Primary Care Case Management (PCCM) programs. PCCM programs reduced the number of visits among adults but had little effect on other measures of access and use. There was less preventive care in mandatory HMO counties for women, suggesting that the federally required external quality review may be appropriate. CONCLUSION: The effects of Medicaid managed care vary with the type of program, and policy makers should not expect programs that rely on PCCMs to have the same effects as those that incorporate mandatory HMO enrollment. Moreover, none of the program models had strong and consistent effects across the indicators of access and use that we considered.

Adult↗