Date of Award

1-1-2011

Document Type

Campus Access Dissertation

Department

Health Services and Policy Management

First Advisor

Janice C Probst

Abstract

Congestive Heart Failure Hospital Admissions among Non-Elderly Medicaid and Uninsured Patients in South Carolina, 2008.

Background: Despite significant advances in the quality of care in some areas, hospital admissions for heart failure (HF) continue to rise . Data for this study examined hospital discharge data for South Carolina, 2008.

Purpose: The purpose of this analysis was to examine the likelihood of admission with a diagnosis of HF versus other diagnoses is higher for African Americans than white individuals. Also to determine the likelihood of admission with a diagnosis of HF versus other diagnoses is higher among 20 to 64 year olds who are uninsured or are Medicaid recipients than those that have private insurance.

Methods: Patient sociodemographic characteristics in relation to their income status, geographical location, payer status (Medicaid or uninsured) and age groups to privately insured patients of similar characteristics were compared using bivariate statistical analysis. Patients with HF between the ages of 20-64 were used as the study population. Logistic modeling was used to determine the differences with respect to insurance type, racial distribution, physician type and geographical location.

Results: Among the demographic characteristics in persons among 20-64, the likelihood of admission with a diagnosis of heart failure versus other diagnoses was found to be higher for African Americans than white individuals with the exception of geographical location. Those individuals that were discharged with the diagnosis of HF were less likely to have a cardiologist as a discharge physician than those who had a higher median income. Additionally, males were more likely to have higher HF admissions than non-HF admissions for the age group of 45-64 and also higher admissions for HF than females. Those patients with private insurance (53.2%) were found to be more likely to be discharged by a cardiologist than those that were Medicaid (20.0%), uninsured (8.5%)or for those that receive Medicare (18.2%).

Conclusion: Many barriers to care can lead to increased hospitalization for HF. The need for transitional care and better utilization of resources to manage chronic diseases at its earlier stage can prove valuable for both patient and state level resources.

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