HLTH 4205 Week 11 Short Research Report Example

Having a Usual Source of Care Half a Year Into Medicaid: Adults Enrolled at a Community Clinic: A Short Research Report

Student Name

Walden University

HLTH 4205: Introduction to Research Methods and Analysis

Instructor Name

Month Day, Year

Having a Usual Source of Care Half a Year Into Medicaid: Adults Enrolled at a Community Clinic: A Short Research Report

Introduction and Question

Gaining health coverage is expected to help people establish a regular place to get care. A randomized study in Oregon found that Medicaid coverage increased the share of low-income adults reporting a usual place of care within the first year (Finkelstein et al., 2012), but local evidence on how quickly newly insured adults establish care, and who is left behind, is limited. This study asked: among working-age adults (19 through 64) who signed up for Medicaid at a community clinic, what share named a usual source of care at the six-month survey, and how did that compare with the proportion at enrollment? All figures here come from an invented teaching dataset.

Methods

Design. Prospective cohort with surveys at enrollment and six months later.

Participants. Working-age adults (19 through 64) signing up for Medicaid at the clinic over seven months and consented to the study. Recruitment was done by a research assistant after the application was submitted, separate from enrollment staff.

Measures. The primary outcome was a usual source of care, recorded yes when a participant could name one particular clinic or clinician as their first stop for an illness. The item was worded the same way at both surveys. Secondary items asked about time to the next available appointment at that place and whether transportation or cost had prevented a visit, added because a single item captures only part of access (Penchansky & Thomas, 1981).

Analysis. The proportion with a usual source of care at each time point was compared among participants who answered the item at both. The paired difference was reported with a 95% confidence interval, and McNemar's test, which uses only the participants whose answer changed, was used to compare paired proportions. Descriptive statistics follow reporting guidelines, with medians and interquartile ranges for skewed variables and counts shown with their bases (Lang & Altman, 2015).

Results

Of 212 participants surveyed at enrollment, 174 (82.1%) completed the six-month survey, and 172 answered the usual source of care item at both times. Participants lost to follow-up were younger on average and had more emergency department visits at baseline than those who completed both surveys.

At enrollment, 70 of 172 (40.7%) reported a usual source of care; at six months, 118 of 172 (68.6%) did. Fifty-four participants moved from no to yes, and six moved from yes to no. The paired difference was 27.9 percentage points (95% confidence interval 20.1 to 35.7; McNemar's test, p < .001).

Among the 118 with a usual source of care at six months, the median reported wait for the next available appointment was 9 days (interquartile range 4 to 16). Of the 174 who completed the follow-up survey, 31 (17.8%) said a lack of transportation or money had stopped them from attending care since enrollment.

Results Table

Table 1 summarizes the primary and secondary results.

Table 1

Usual Source of Care and Related Access Measures at Enrollment and Six Months (Composite Data)

Discussion

Among adults who enrolled in Medicaid through this clinic and completed follow-up, the share reporting a usual source of care rose from about two in five to about two in three over six months. The direction is consistent with the Oregon findings, though the two studies differ in design and setting.

The design does not allow this increase to be attributed to coverage. Without a comparison group of similar adults who did not gain coverage, other explanations remain possible: some participants enrolled during an illness and may have sought a regular clinic regardless, and the clinic's own enrollment staff may have referred people to its services. Loss to follow-up also matters. Those who did not complete the six-month survey were younger and heavier users of emergency care, groups that may be less likely to establish a usual source, so the true proportion among all enrollees may be lower than 68.6%. The outcome is a single self-reported item, and the secondary measures suggest that having a usual place does not remove every barrier: nearly one in five participants reported that transportation or cost had prevented a visit.

Limitations

The study had no comparison group, so it describes change rather than its cause. It followed participants for six months only. The sample came from one clinic's enrollment office and included only those who consented. The primary measure captures one dimension of access, and self-reports may overstate it if participants named a clinic they had not yet visited. The data in this report are composite values built for a methods course.

Conclusion

Six months after enrolling in Medicaid through this clinic, about two-thirds of participants who completed follow-up reported a usual source of care, up from about two-fifths at enrollment. This study cannot say how much of that change was caused by coverage. It does suggest that a substantial minority of newly insured adults still lacked a usual source of care at six months, and that cost and transportation remained barriers for some who had one. Those findings point to questions for a study with a comparison group, such as the navigator trial proposed earlier in this course, rather than to conclusions about the effect of coverage itself.

For the clinic, the practical use of these results is modest but real. They describe the people it enrolls and show that a third of them still lack a usual source of care six months later, which is enough to justify testing an intervention aimed at that group. They do not justify telling funders that enrollment alone connects people to care, and the report should not be cited that way.

References

Finkelstein, A., Taubman, S., Wright, B., Bernstein, M., Gruber, J., Newhouse, J. P., Allen, H., Baicker, K., & Oregon Health Study Group. (2012). The Oregon Health Insurance Experiment: Evidence from the first year. The Quarterly Journal of Economics, 127(3), 1057-1106. https://doi.org/10.1093/qje/qjs020

Lang, T. A., & Altman, D. G. (2015). Basic statistical reporting for articles published in biomedical journals: The "Statistical Analyses and Methods in the Published Literature" or the SAMPL guidelines. International Journal of Nursing Studies, 52(1), 5-9. https://doi.org/10.1016/j.ijnurstu.2014.09.006

Penchansky, R., & Thomas, J. W. (1981). The concept of access: Definition and relationship to consumer satisfaction. Medical Care, 19(2), 127-140. https://doi.org/10.1097/00005650-198102000-00001