Browsing by Author "Parekh, Tarang"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Cost and non-cost factors associated with delays in receiving medical care in adults with atherosclerotic cardiovascular disease
    (Journal of the Royal College of Physicians of Edinburgh, 2024-05-28) Mszar, Reed; Hagan, Kobina; Lahan, Shubham; Parekh, Tarang
    Introduction: The study aims to compare cost and non-cost factors associated with delays in receiving medical care in adults with atherosclerotic cardiovascular disease (ASCVD). Methods: Using 2014–2018 data from the Centers for Disease Control and Prevention (CDC) Behaviour Risk Factor Surveillance System (BRFSS) survey (N = 508,203), multivariate logistic regression models were developed to compute the adjusted odds ratio of reasons for delays in medical care in adults with ASCVD. Results: Our study population of 61,227 adults with ASCVD (9.1%) had higher odds of any medical care delay (aOR 1.50, 95% CI 1.43–1.57), delay due to cost (aOR 1.55, 95% CI 1.45–1.65), long clinic wait times (aOR 1.21, 95% CI 1.04–1.39) and lack of transportation (aOR 1.64, 95% CI 1.47–1.84) than those without ASCVD. Conclusion: Novel public health and health policy approaches are urgently needed to reduce the cost- and non-cost-related barriers that adults with ASCVD encounter when accessing healthcare services.
  • Thumbnail Image
    Item
    From Policy to Practice: Assessing the State Innovation Models Initiative’s Early Success in Incorporating Social Determinants of Health in ASCVD Hospitalizations in the United States
    (American Journal of Epidemiology, 2024-08-27) Parekh, Tarang; Xue, Hong; Wadhera, Rishi K.; Cheskin, Lawrence J.; Cuellar, Alison E.
    The study examines effects of the CMS State Innovation Models(SIM) on capturing social risk factors in adults hospitalized with Atherosclerotic Cardiovascular Disease (ASCVD). Using a difference-in-differences(DID) approach with propensity score weights, the study compared documentation of secondary diagnosis of SDOH/social factors using ICD-9 V codes (“SDOH codes”) in adults hospitalized with ASCVD as a primary diagnosis (N= 1,485,354). Data were gathered from January 1, 2010, to September 30, 2015, covering the period before and after the SIM implementation in October 2013. From January 2010 to September 2015, SDOH codes were infrequently utilized among adults with ASCVD(0.55%, 95% CI: 0.43%-0.67%). SDOH codes with ASCVD increased from pre- to post-period in SIM states(0.56% to 0.93%) and comparison states (0.46% to 0.56%). SIM implementation was associated with greater improvement in SDOH codes utilization (adjusted OR 1.30, 95%CI: 1.18-1.43) during ASCVD hospitalizations. The odds of SDOH codes utilization were 86% higher in ED admissions(AOR 1.86, 95%CI: 1.76-1.97) than in routine admissions with ASCVD. Findings were similar when limiting population to older adults(>=65 years) enrolled in Medicare(AOR 1.50, 95%CI 1.31-1.71), whereas not significant for Medicaid beneficiaries. The study points to challenges for healthcare providers in documenting SDOH in adults with ASCVD.