Publications by authors named "Jiexin Jason Liu"

4 Publications

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Bypass of local primary care in rural counties: effect of patient and community characteristics.

Ann Fam Med 2008 Mar-Apr;6(2):124-30

Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.

Purpose: This national study sought information from rural patients (1) to assess the prevalence of bypass, a pattern of seeking health care outside the local community; (2) to examine the impact of locally available primary care physicians (PCPs) and hospital size on the odds of bypass; and (3) to identify patient demographic and geographic factors associated with bypass. This study also ascertained the reasons patients give for bypass and their suggestions for how hospitals can retain patients locally.

Methods: We analyzed data from a 2005 telephone survey of 1,264 adults, aged 18 years or older, who lived within 20 miles of 25 randomly selected Critical Access Hospitals and were linked with a Health Professional Shortage Area and 2004 census data. Respondents were asked about demographic characteristics, travel time and distance to local hospitals, and insurance status, as well as for suggestions of what local hospitals could do to retain patients.

Results: Overall, 32% of respondents bypassed local primary care; the rate ranged from 9% to 66% across the Critical Access Hospital service areas. Factors associated with bypass included age, education, marital status, satisfaction with the local hospital, admission to a hospital in the past 12 months, hospital size, and local density of PCPs. Compared with residents in areas with a higher density of PCPs (=3,500 residents per PCP), residents in areas with a low density (>4,500 residents per PCP) were more likely to bypass local care (odds ratio, 1.58; 95% confidence interval, 1.02-2.46). Lack of specialty care and limited services were most frequently mentioned as reasons why patients bypassed local hospitals.

Conclusions: The sizable variation in bypass rates among this sample of Critical Access Hospital service areas suggests that strategies to reduce bypass behavior should be directed at the local community or facility level. Changing rural residents' perception of their local care, helping them gain a better understanding of the function of primary care, and increasing the number of PCPs might help hospitals retain patients and rural communities stay healthy.
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April 2008

Health professional shortage and health status and health care access.

Jiexin Jason Liu

J Health Care Poor Underserved 2007 Aug;18(3):590-8

Department of Family and Community Medicine, University of Maryland School of Medicine, 29 S. Paca St., LL, Baltimore, MD 21201, USA.

Although areas designated as Health Professional Shortage Areas (HPSAs) have fewer primary care physicians than non-HPSAs, few studies have tested whether HPSA designation is related to health status and medical service access. This study examined whether residents living in HPSAs were more likely to report worse health status and to be more likely to have difficulty in getting access medical services than residents living in non-HPSAs, with survey data of 10,940 adult West Virginians. Multiple regression results indicate that HPSA is associated with worse general health status and poor physical health, and less access to medical services (measured by had usual place for medical care, experienced not getting needed health care and had outpatient care) but not to inpatient care. These findings indicate that the current HPSA designation system does capture the significant differences between residents of HPSAs and residents of non-HPSAs in health status and medical services access.
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August 2007

Patient bypass behavior and critical access hospitals: implications for patient retention.

J Rural Health 2007 ;23(1):17-24

West Virginia University Institute for Health Policy Research, Charleston, WVA, USA.

Purpose: To assess the extent of bypass for inpatient care among patients living in Critical Access Hospital (CAH) service areas, and to determine factors associated with bypass, the reasons for bypass, and what CAHs can do to retain patients locally.

Methods: Six hundred and forty-seven subjects, aged 18 years and older, who had been admitted to a hospital for inpatient care in the past 12 months and lived within 15-20 miles of 25 randomly selected CAHs were surveyed by phone during the period from early February through late July 2005. Survey questions included demographic characteristics, general health status, travel time/distance to health care, questions on satisfaction with local health services, bypass behavior, and solicited suggestions on how local hospitals could retain patients locally.

Findings: About 60% of surveyed patients bypassed their local CAHs for inpatient care including 16% who were referred to another facility by the local CAH/health care providers and would use the local hospital if needed services were available. Bypass rates ranged from 16% to 70% across the sampled CAHs. Factors associated with bypass included age, income, satisfaction with the local hospital, and traveling distance/time. Lack of specialty care, limited services, and the quality/reputation of local services/doctors were most frequently mentioned as reasons why patients bypass local CAHs.

Conclusions: The bypass rate for sampled CAHs is considerably higher than the 20%-50% bypass rates documented in the literature for all hospitals in general using discharge/administrative data. The sizeable variation in bypass rates across CAHs suggests that the appropriate response/fix should come from the facility/community levels.
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April 2007

Using resident reports of quality of life to distinguish among nursing homes.

Gerontologist 2004 Oct;44(5):624-32

Division of Health Services Research and Policy, University of Minnesota School of Public Health, Minneapolis 55455, USA.

Purpose: We used measures created to assess the quality of life (QOL) of nursing home residents to distinguish among nursing facilities.

Design And Methods: We statistically adjusted scores for 10 QOL domains derived from standardized interviews with nursing home residents for age, gender, activities of daily living functioning, cognitive functioning, and length of stay, and then we aggregated them to the facility level. We compared the patterns across a sample of 40 facilities. We correlated facility characteristics with QOL scores.

Results: The pattern of QOL scores for each of the 10 domains was generally consistent within a given facility. Although resident characteristics played a major role in explaining variance, there were significant effects of facilities as well. Some modest relationships were found between facility characteristics such as ownership, percentage of private rooms, and rural-urban location and facility QOL scores. No effect of facility size was detected.

Implications: This article shows that it is possible to differentiate among facilities on the basis of resident self-reported QOL. On the basis of our analysis, we find that a sample of 28 residents per facility is sufficient to generate a reliable QOL score for each of the domains studied.
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October 2004