PERCEPTION OF PATIENT-PROVIDER COMMUNICATION AND ITS ASSOCIATION WITH HEALTH SERVICES UTILIZATION

The Patient Protection and Affordable Care Act of 2010 has generated an unprecedented emphasis on patient satisfaction and patient-centered care. This dissertation is composed of a series of papers on how patients perceive the quality of care delivered by their healthcare providers and its relationship to their usage of health services. The main hypothesis is that higher perceived quality of care is associated with more effective use of health services. The studies use nationally representative data from the Medical Expenditure Panel Survey (MEPS) with the research grounded in Andersen's Behavioral Model of Health Services Use. In the first study, I explore whether differences in satisfaction between English- and Spanish-speaking Hispanics can be explained by acculturation and concordance with their providers with regard to race, ethnicity, gender, and language. I use the econometric Blinder-Oaxaca decomposition method to quantify the contributions of each measured characteristic for explaining disparities in patient satisfaction. In the second study, I examine whether a lack of patient-centeredness and poor access to a regular provider are associated with greater nonemergent emergency department (ED) utilization. I employ a hurdle model to account for the two-part decision making process of whether to use the ED and how often to use the ED for nonemergent purposes. In the third study, I investigate the relationship between patient-centered care and receipt of six recommended clinical preventive services including screening for breast cancer, cervical cancer, colorectal cancer, high cholesterol, hypertension, and vaccination against influenza. I use multivariate logistic regression models to determine the probability of compliance with national prevention guidelines. The results reveal the importance of how patients perceive interpersonal communication with their healthcare providers. In the first study, acculturation is implicated as a major contributor to differences in patient satisfaction with communication. Furthermore, the results from the second study indicate language concordance between patients and providers is related to less nonemergent ED use. Findings from the third study suggest a pattern of greater compliance with clinical preventive service recommendations when patients perceive receiving patient-centered care from their providers. Implications for policy and practice are presented

Soil Moisture Effects on Entomopathogenic Nematodes

The effect of soil moisture on entomopathogenic nematode virulence was examined in the laboratory. Objectives were to determine the virulence of several species and isolates of entomopathogenic nematodes at various soil moisture contents and temperatures, and after fluctuations in soil moisture. Studies included up to five isolates of entomopathogenic nematodes: Heterorhabditis bacteriophora Poinar (Oswego and Tuscarora strains), Steinernema glaseri (Steiner) (NC1 strain), S. feltiae (Filipjev) (Biosys 369 strain), and S. carpocapsae (Weiser) (NY001 strain). Nematodes were applied to sandy loam soils ranging in soil moisture content from below the permanent wilting point of plants to near saturation. In all experiments, a rainfall or irrigation event was simulated by adding water to rehydrate soils to high moisture levels (near saturation). Nematode virulence was evaluated periodically by measuring insect mortality in Galleria mellonella (L.) larval bioassays, before and after rehydration. Nematode virulence increased with soil moisture content for all species and isolates tested. Our studies demonstrated that the virulence of entomopathogenic nematodes in low moisture conditions could be restored by rehydrating the soil. Insect mortality was generally low in low-moisture, nematode-infested soils before rehydration, but increased to high levels posthydration. Moisture effects were evident from the onset of each experiment, whereas the effect of soil temperature on nematode-induced insect mortality was delayed and nonsignificant until 14 wk after the initiation of the third experimen

Effects of Soil Rehydration on the Virulence of Entomopathogenic Nematodes

The work presented examines the effects of soil moisture on the virulence of selected entomopathogenic nematode isolates in the laboratory and has broad implications for managing soil-dwelling insects in all production systems. Two species of entomopathogenic nematodes, Heterorhabditis bacteriophora (Oswego and Tuscarora strains) and Steinernema glaseri (NC1 strain), were applied to sandy loam soils ranging from below the permanent wilting point of plants to near saturation. Fluctuations in soil moisture were created by simulating a rainfall or irrigation event (i.e., rehydration), or by allowing soil to dry. Nematode virulence was evaluated by measuring insect mortality in Galleria mellonella larvae bioassays. Soils prepared at four moisture contents were inoculated with nematodes and subsequently bioassayed at their original moisture contents and after rehydration, over an 18-mo period. Insect mortality increased with soil moisture content for both H. bacteriophora isolates but was highest in relatively low moisture soils (≈−15 bar) for S. glaseri. Insect mortality was generally low in low-moisture soils before rehydration but rebounded to high levels posthydration. Both isolates of H. bacteriophora nematodes were reactivated to cause high insect mortality (≥ 98%) as long as 18 mo after infective juveniles were inoculated into very low moisture soils (≈−30 bar). The posthydration insect mortality levels in the S. glaseri treatments were significantly lower than in the H. bacteriophora treatments. For all nematode treatments, the cumulative insect mortality of prehydration and posthydration bioassays was higher in lower moisture soils compared with higher moisture soils. In an additional experiment, moisture thresholds for activation of nematodes in dry soil were determine

Moisture Effects on Entomopathogenic Nematodes

NYS IPM Type: Project ReportEntomopathogenic nematodes are well adapted to infect larval insect pests living in soil and have the potential to be important biological control agents in a variety of ornamental and crop production systems. In the mid 1980’s, several species of entomopathogenic nematodes become commercially available to insect pest management. Initially, small-scale production and limited marketing resulted in these products being used mainly for home gardens, lawns and landscapes

Impact of Soil Moisture on the Reactivation Capacity of Entomopathogenic Nematodes

NYS IPM Type: Project ReportEntomopathogenic nematodes are well adapted to infect larval insect pests living in soil and have the potential to be important biological control agents in a variety of ornamental and crop production systems. In the mid 1980’s, several species of entomopathogenic nematodes become commercially available to insect pest management. Initially, small-scale production and limited marketing resulted in these products being used mainly for home gardens, lawns and landscapes

Nonemergent emergency department use among patients with a usual source of care

Emergency department (ED) use for nonemergent conditions is associated with discontinuity of care at a greater cost. The objective of this study was to determine whether the quality of patient-provider communication and access to one's usual source of care (USC) were associated with greater nonemergent ED use. A hurdle model was employed using data from the 2007 to 2009 Medical Expenditure Panel Survey. First, a multivariate logistic regression model was used to identify factors associated with the likelihood of a nonemergent ED visit. Given that one occurrence exists, a second negative binomial model was used to establish whether patient-provider communication or access are related to the frequency of nonemergent ED use. One element of communication, patient-provider language concordance, is associated with fewer nonemergent ED visits (P < .05). Several aspects of access are related to reduced ED use for nonemergent purposes. Patients whose USC is available after hours and those who travel less than an hour to get to their USC use the ED less for nonemergent care (P ≤ .05). Enhancing primary care by expanding interpreter services and access to care after hours may reduce the demand for nonemergent ED services

Decomposing the Gap in Satisfaction with Provider Communication Between English- and Spanish-Speaking Hispanic Patients

Disparities in patient-provider communication exist among racial/ethnic groups. Hispanics report the lowest satisfaction with provider communication compared to whites and blacks; these differences may be due to level of acculturation or patient-provider concordance according to their ability to speak English. Using data from the 2007–2009 Medical Expenditure Panel Survey, this study identifies and quantifies the components that constitute the gap in satisfaction with provider communication between English- and Spanish-speaking Hispanics. English-speaking Hispanics are 7.3 percentage points more likely to be satisfied with the amount of time their providers spent with them compared to Spanish-speaking Hispanics. Differences in acculturation between the two groups account for 77 % of this gap. Satisfaction with provider listening is 6.8 percentage points higher for English-speaking Hispanics. Hispanics who speak English are more satisfied with provider communication. The gap in satisfaction is largely attributable to differences in health insurance, acculturation, and education

Health Care and Health Insurance in Retirement

This chapter discusses the current states of health care and health insurance practice for retirees. The retired population has important public policy significance for the health care sector. Retirees over age 65 are less healthy than the younger population, use more health care services, have higher health expenditures, and are a powerful voting and lobbying force in politics. This chapter details the health insurance options available to retirees and use of health care services in retirement, and offers future directions for research. Medicare is the primary insurer for virtually all retirees over age 65, so the benefits, financing, eligibility, enrollment, quality, access, and utilization of health care services covered by Medicare are described in detail. Retirees will be affected in many ways by the Patient Protection and Affordable Care Act (PPACA) of 2010. The changes will be highlighted throughout the chapter and discussed in depth in the Future Directions section