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    Barriers to Healthcare Access and Patient Outcomes After a Hospitalization for an Acute Coronary Syndrome and Other Acute Conditions

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    Authors
    Erskine, Nathaniel A. K.
    Faculty Advisor
    Catarina Kiefe PhD MD
    Academic Program
    Clinical and Population Health Research
    UMass Chan Affiliations
    Quantitative Health Sciences
    Document Type
    Doctoral Dissertation
    Publication Date
    2017-11-29
    Keywords
    Health Status
    Acute Coronary Syndrome
    Myocardial Ischemia
    Health Services Accessibility
    Mortality
    Patient Discharge
    Transportation
    Cardiovascular Diseases
    Clinical Epidemiology
    Epidemiology
    Health Services Administration
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    Abstract
    Background: Guideline-concordant therapies for survivors of an acute coronary syndrome (ACS) hospitalization require healthcare access, something that millions of Americans lack. Methods and Results: Using data from a prospective cohort study of over 2,000 survivors of a hospitalization for an ACS in central Massachusetts and Georgia from 2011 to 2013, the first two aims of this thesis sought to identify the post-discharge consequences for survival and health status of having: 1) financial barriers to healthcare, 2) no usual source of care, and 3) transportation barriers. We found that patients lacking a usual source of care and having a transportation barrier were more likely to have died within two years following hospital discharge compared to those without such barriers. Also, patients with financial barriers to healthcare were more likely to experience clinically meaningful declines in physical and mental health-related quality of life over the six months after hospital discharge. The third aim sought to better understand factors influencing the success of care transitions home after an unplanned hospitalization through a qualitative study of 22 patients. Participants described how adequate healthcare access, particularly having insurance and transportation to clinical appointments, facilitated the receipt of follow-up care and adherence to treatments. Conclusions: Limitations in healthcare access may contribute to poorer survival, health-related quality of life, and survival. Additional research is needed to identify interventions to improve healthcare access and test whether improved access leads to better patient outcomes.
    DOI
    10.13028/M2310D
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/32313
    Rights
    Copyright is held by the author, with all rights reserved.
    ae974a485f413a2113503eed53cd6c53
    10.13028/M2310D
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