Access to and Utilization of Health Services by RuralDwelling Ohio Children: Are There Unique Challe

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Access to and Utilization of Health Services by
Rural-Dwelling Ohio Children Are There Unique
Challenges for those in the Appalachia Region?

• Laureen H. Smith, PhD, RN
• Principal Investigator
• The Ohio State University
• June 1, 2009

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Research Team

• Pamela Salsberry, PhD, RN
• Co Investigator
• Jodi Nearns, PhD, RN
• Co Investigator
• Christopher Holloman, PhD
• Statistician

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Introduction and Background

• Children living in Rural Ohio
• Children living in Rural Appalachia
• Appalachia Ohio
• Counties that Border the Ohio River
• Comparisons to Date
• Urban and Rural

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Purpose of Study

• Examine if there are differences in access to and
  utilization of health care services between
  children living in rural areas and children
  living in Appalachian areas of Ohio
• Describe the underlying health of these children

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Specific Aims

• Are there differences in the health?
• Are there differences in health care access?
• Are there differences in health care utilization?
• What is the relationship between health, health
  care access and health care utilization?
• How do Appalachian children living in
  river-bordering counties compare to the other
  children?

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Geographic Regions of Interest
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Guiding Framework
Smiths Adaptation of Adays Framework
for Understanding Access and Utilization (Aday et
al, 1999)2
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Methods

• Data from 2008 OFHS
• Child Questionnaire and Parent Health Status Data
• Children someone under the age of 18 years
• Parent mother or father of said child

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Sample

• Un-weighted sample
• Rural Children N 2750
• Appalachia Children N 2954
• Weighted values were applied to all model
  variables using Weight_C

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Note N137 (regular place for care) was recoded
in such as way that it is the same as the created
variable usual_c found in the final OFHS dataset
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Other Key Controls

• Parent Health
• Perception of general health D30
• BMI Category BMI_A_CAT

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Analysis Plan

• Descriptive Analyses
• Chi-Square Tests
• Correlations
• Bi-variate and Logistic Regression
• Bayesian Hierarchical Modeling

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Bayesian Hierarchical Modeling

• Cross-sectional data with reasonable latent
  factors
• Not assuming a linear relationship with all
  variables
• Not constrained to assume linear relationships
• Not constrained to assume normal distribution
• Models for missing data
• Directly test the interactions between groups

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Diagram of Hypothesized Model
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Descriptive Chi Square Results
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Health Key Findings

• No difference between Appalachian and Rural
  Children
• Children who are underweight, overweight or obese
  had poorer general health
• Male children had poorer health
• Black and Hispanic children had poorer health
• Parent health was related to child health
• Black and Hispanic parents has poorer health

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Correlations Health
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Correlations Access to Care
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Correlations Care Utilization
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Regression Analysis

• Noteworthy findings Children who had a
  regular place for care were
• 3 ½ times more likely to have had a well
  
• baby/child check up
• Children who had a regular provider were 1 ½
  times more likely to have had a well baby/child
  check up
• Children in poorer health were less likely to
  have had a well baby/child check up
• Children with a regular provider were 1 ½ times
  more likely to have receive preventive dental
  care
• Children with a regular place for care were 2 ½
  times more likely to receive preventive dental
  care

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Modeling Results for Rural Children
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Modeling Results for Appalachian Children
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Rural and Appalachian Model Comparisons

• Appalachian Children have less access to care
• Appalachian Children in poorer health had less
  access to care
• Having a regular care provider improved access to
  care for both groups

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Rural and Appalachian Model Comparisons

• Children with private insurance had better access
  and care utilization (compared to uninsured)
• Insurance coverage had a larger impact on access
  to care for Appalachian children
• Government insurance improved access for
  Appalachian children
• Rural children with government insurance did not
  differ from uninsured in accessing care

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Rural and Appalachian Model Comparions

• More wellness and sickness care utilization in
  Appalachia
• Regardless of access, health or insurance status
• Private insurance most important for
• wellness care in rural region
• Government insurance larger impact on wellness
  care in Appalachia
• In rural region, children in poorer health had
  less wellness care utilization

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Rural and Appalachian Model Comparisons

• In rural region, children with government
  insurance had more sickness care utilization
  (compared to uninsured)
• Appalachian children with government insurance
  did not differ from uninsured in sickness care
  utilization
• Having insurance coverage was more important for
  Appalachian children in sickness are utilization,
  compared to rural region

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Modeling Results for Non-River Appalachian
Children
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Modeling Results for River-Bordering Appalachian
Children
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3 Group Comparions

• Less overall access to care in River-bordering
  Appalachian counties
• Having private insurance was most important to
  accessing care in River-bordering Appalachia
• In non-River Appalachia, children in poorer
  health had less access to care (compared to other
  Appalachia and rural)

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3 Group Comparisons

• Wellness care most prevalent in River-bordering
  Appalachia
• Wellness care least prevalent in Rural region
• Sickness care most prevalent in non-River
  Appalachia
• Importance of insurance coverage on sickness care
  greatest in Rural region
• In non-River Appalachia, children with private
  insurance had less sickness care

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Discussion

• Health Professional Shortage Areas
• Unique Characteristics of Appalachia
• Insurance Status and Access to Care
• Insurance Status and Health Care Utilization
• Prevalence of Childhood Overweight and Obesity

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Limitations

• Used 2008 OHFS data only
• Measures of child and parent health
• Locations of care not included
• Under-insured

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Policy Implications

• Wrap-around services
• Expansion of services
• Pediatric health care providers
• Reduction of missed opportunities
• Safety net of providers- rural region
• Recognizing rural region as vulnerable
• Alternative health care delivery methods
• BMI Screening Surveillance
• Social Marketing Education