Barriers to Healthcare Access and Patient Outcomes After a Hospitalization for an Acute Coronary Syndrome and Other Acute Conditions
Authors
Erskine, Nathaniel A. K.Faculty Advisor
Catarina Kiefe PhD MDAcademic Program
Clinical and Population Health ResearchUMass Chan Affiliations
Quantitative Health SciencesDocument Type
Doctoral DissertationPublication Date
2017-11-29Keywords
Health StatusAcute Coronary Syndrome
Myocardial Ischemia
Health Services Accessibility
Mortality
Patient Discharge
Transportation
Cardiovascular Diseases
Clinical Epidemiology
Epidemiology
Health Services Administration
Metadata
Show full item recordAbstract
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/M2310DPermanent Link to this Item
http://hdl.handle.net/20.500.14038/32313Rights
Copyright is held by the author, with all rights reserved.ae974a485f413a2113503eed53cd6c53
10.13028/M2310D