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10. Rural-urban disparities in health care costs and health service utilization following pediatric mild traumatic brain injury

Author

Graves, Janessa M., Mackelprang, Jessica L., Moore, Megan, Abshire, Demetrius A., Rivara, Frederick P., Jimenez, Nathalia, Fuentes, Molly, and Vavilala, Monica S.

Subjects
Medical care discrimination -- Comparative analysis -- Research, Brain injuries -- Comparative analysis -- Research, Health care disparities, Medical economics, Medical care utilization, Pediatrics, Health care industry, Speech therapy, Health care costs, Rural areas, Business, Health care industry
Abstract

Objectives: To compare health care costs and service utilization associated with mild traumatic brain injury (mTBI) in rural and urban commercially insured children. Data Source: MarketScan Commercial Claims and Encounters Data, 2007-2011. Study Design: We compared health care costs and outpatient encounters for physical/occupational therapy, speech therapy, and psychiatry/psychology encounters 180 days after mTBI among rural versus urban children ( Principal Findings: A total of 387 846 children had mTBI, with 13 percent residing in rural areas. Adjusted mean total health care costs in the 180 days after mTBI were $2778 (95% CI: 2660-2897) among rural children, compared to $2499 (95% CI: 2471-2528) among urban children (adjusted cost ratio 1.11, 95% CI 1.06-1.16). Rural-urban differences in utilization for specific services were also found. Conclusions: Total health care costs were higher for rural compared to urban children despite lower utilization of certain services. Differences in health service utilization may exacerbate geographic disparities in adverse outcomes associated with mTBI. KEYWORDS health care costs, health service utilization, pediatrics, rehabilitation, rural health, 1 | INTRODUCTION Traumatic brain injury (TBI) is the leading cause of death and disability among children and adolescents in the United States. (1) Adverse outcomes associated with TBI include [...]

Published
2019
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22. PLATFORM ABSTRACTS 1- 25: 2021 ASCIP Hybrid Educational Conference & Expo.

Author

Trbovich, Michelle, Romo, Terry, Kelly, Che, Stowe, Sharon, Kellogg, Dean, Li, Chao, Cao, Yue, Krause, James S., Newman, Susan D., Toatley, Sherwood L., Rodgers, Marka D., Qanungo, Suparna, Mueller, Martina, Denny, Brian, Rodriguez, Angela, Barnett, Heather, Fuentes, Molly, Bunnell, Aaron, Farkas, Gary J., and Berg, Arthur S.

Published
2021
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23. Research on Injury Disparities: A Scoping Review

Author

Moore, Megan, primary, Conrick, Kelsey M., additional, Fuentes, Molly, additional, Rowhani-Rahbar, Ali, additional, Graves, Janessa M., additional, Patil, Divya, additional, Herrenkohl, Madeline, additional, Mills, Brianna, additional, Rivara, Frederick P., additional, Ebel, Beth, additional, and Vavilala, Monica S., additional

Published
2019
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30. Unmet Rehabilitation Needs After Hospitalization for Traumatic Brain Injury

Author

Fuentes, Molly M., primary, Wang, Jin, additional, Haarbauer-Krupa, Juliet, additional, Yeates, Keith Owen, additional, Durbin, Dennis, additional, Zonfrillo, Mark R., additional, Jaffe, Kenneth M., additional, Temkin, Nancy, additional, Tulsky, David, additional, Bertisch, Hilary, additional, and Rivara, Frederick P., additional

Published
2018
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36. Disparities in Functional Outcomes during Inpatient Rehabilitation between American Indian/ Alaska Native and White Children.

Author

Fuentes, Molly M., Bjornson, Kristie, Christensen, Ana, Harmon, Rachel, and Apkon, Susan D.

Abstract

American Indian/Alaska Native (AI/AN) children have a high risk for poor health outcomes. Race/ethnicity and functional impairments are linked with health care disparities. While data exist for other race/ethnicity groups, little is known about outcomes for AI/AN children with functional impairments. In this study the Functional Independence Measure for Children (WeeFIM®) was used to determine differences in outcomes between AI/AN and White children receiving inpatient rehabilitation for functional impairments at one pediatric rehabilitation facility. American Indian/Alaska Native and White children had similar impairment types and functional levels at admission to inpatient rehabilitation. Both groups experienced functional improvement during rehabilitation. At discharge, AI/AN children had lower total functional scores and had less improvement in mobility scores compared with White children, with more impairment in physical mobility at discharge. This is one of the first studies to show a disparity in functional outcomes for AI/AN children compared with White children during inpatient rehabilitation. [ABSTRACT FROM AUTHOR]

Published
2016
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37. Identifying Common Data Elements to Achieve Injury-related Health Equity Across the Lifespan: A Consensus-Driven Approach.

Author

Conrick KM, Mills B, Fuentes M, Graves JM, St Vil C, Vavilala MS, Bulger EM, Arbabi S, Rowhani-Rahbar A, and Moore M

Abstract

Background: Limited availability and poor quality of data in medical records and trauma registries impede progress to achieve injury-related health equity across the lifespan., Methods: We used a Nominal Group Technique (NGT) in-person workgroup and a national web-based Delphi process to identify common data elements (CDE) that should be collected., Results: The 12 participants in the NGT workgroup and 23 participants in the national Delphi process identified 10 equity-related CDE and guiding lessons for research on collection of these data., Conclusions: These high-priority CDE define a detailed, equity-oriented approach to guide research to achieve injury-related health equity across the lifespan., Competing Interests: No competing financial interests exist., (© Kelsey M. Conrick et al., 2024; Published by Mary Ann Liebert, Inc.)

Published
2024
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38. The association among neighborhood socioeconomic status, race and chronic pain in black and white older adults.

Author

Fuentes M, Hart-Johnson T, and Green CR

Subjects
Aged, Chronic Disease, Female, Humans, Male, Michigan epidemiology, Middle Aged, Retrospective Studies, Health Status Disparities, Pain economics, Pain ethnology, Racial Groups ethnology, Residence Characteristics statistics & numerical data, Social Class
Abstract

The association among race, neighborhood socioeconomic status (SES), and chronic pain has not been well examined in older people. Clinical data was obtained from older adults (>50 years old) presenting to a tertiary care pain center. The relative roles of race and neighborhood SES on the chronic pain experienced in older black and white adults were assessed. Older blacks experienced more affective pain, pain-related disability and mood disorder symptoms than older whites. Confirmatory factor analysis confirmed previously hypothesized factors for the McGill Pain Questionnaire pain dimensions and the Pain Disability Index. Exploratory and confirmatory factor analyses also identified factors in the Brief Symptom Inventory and neighborhood SES. Structural equation modeling showed black race was associated with lower neighborhood SES and also with increased affective pain, obligatory disability and mood disorders mediationally through neighborhood SES. It was indirectly associated with increased sensory and miscellaneous pain, and voluntary disability through low neighborhood SES. Racial interaction examination showed that neighborhood SES had the same relationship to outcomes by race. We found increasing neighborhood SES is associated with decreasing negative chronic pain outcomes for older blacks and whites. Our data provide evidence that both race and neighborhood SES are important factors to consider when examining the chronic pain experience among older Americans.

Published
2007

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