Trends in Health Care Coverage and Out-Of-Pocket Cost Barriers: A Gender Comparison.

Objective: The presence of disparities in access to health care and insurance coverage can have a tremendous impact on health care outcomes. Programs like the Affordable Care Act were implemented to improve health care access and to address the existing inequities. The objective of this study was to identify any disparities that exist between males and females regarding health care coverage and out-of-pocket cost to health care. Methods: This analysis was a cross-sectional study using the Behavioral Risk Factor Surveillance System survey data collected between 2013 and 2018. The primary predictor was sex assigned at birth (with the binary option of male vs. female). The primary outcome was adequate health coverage. Survey participants who indicated that they had health insurance with no out-of-pocket cost barriers to receiving medical care were considered to have adequate health coverage, while participants who did not meet these criteria were considered to have inadequate health coverage. Covariates measured were age, race/ethnicity, educational level, employment status, and annual household income. SAS survey procedures and weighting methods were used to measure the association between the sex and adequate health coverage, after controlling for covariates. Results: The data spanning 6 years included 2,249,749 adults, of whom 1,898,097 (84.4%) had adequate health coverage. Females made up 55.8% (N = 1,256,243) of the total sample. About 32.6% (N = 733,216) survey participants were aged ≥65 years. Most respondents, 77.6%, were White (Non-Hispanic). Across the 6-year period, females were more likely to have health insurance but with out-of-pocket costs that served as a barrier to their medical care (adjusted odds ratios with 95% CI from 2013 to 2018 were 1.36 [1.29-1.43], 1.38 [1.32-1.46], 1.31 [1.24-1.38], 1.33 [1.26-1.40], and 1.32 [1.25-1.40], respectively). Conclusions: Females were more likely than males to indicate an out-of-pocket cost barrier to medical care despite having health insurance.

Influential Factors in the Recovery Process of Burn Survivors in a Predominately Rural State: A Qualitative Study.

Navigating the recovery journey following a burn injury can be challenging. Survivor stories can help define recovery constructs that can be incorporated into support programs. We undertook this study to determine themes of recovery in a predominately rural state. Eleven purposefully selected burn survivors were interviewed using a semi-structured format. Consensus coding of verbatim transcriptions was used to determine themes of successful recovery. Four support-specific themes were identified. These included: using active coping strategies, expressing altruism through helping others, finding meaning and acceptance, and the active seeking and use of support. These themes could be incorporated into support programming and would help guide future survivors through the recovery period.

"More than Scabs and Stitches": An Interview Study of Burn Survivors' Perspectives on Treatment and Recovery.

Sustaining a burn injury often results in a life-long recovery process. Survivors are impacted by changes in their mobility, appearance, and ability to carry out activities of daily living. In this study, we examined survivors' accounts of their treatment and recovery in order to identify specific factors that have had significant impacts on their well-being. With this knowledge, we may be better equipped to optimize the care of burn patients. We conducted inductive, thematic analysis on transcripts of in-depth, semistructured interviews with 11 burn survivors. Participants were purposefully selected for variability in age, gender, injury size and mechanism, participation in peer support, and rurality. Survivors reported varied perceptions of care quality and provider relationships. Ongoing issues with skin and mobility continued to impact their activities of daily living. Many survivors reported that they did not have a clear understanding or realistic expectations of the recovery process. Wound care was often described as overwhelming and provoked fear for many. Even years later, trauma from burn injury can continue to evolve, creating fears and impediments to daily living for survivors. To help patients understand the realistic course of recovery, providers should focus on communicating the nature of injury and anticipated recovery, developing protocols to better identify survivors facing barriers to care, and referring survivors for further support.

Emergency Medicine Residency Selection Criteria: An Update and Comparison.

OBJECTIVE: The primary objective was to describe emergency medicine (EM) residency selection criteria. METHODS: A survey was sent to the Council of Emergency Medicine Residency Directors listserv. Respondents were asked to rank order the various components of the application on a Likert scale from 1 (minimally important) to 10 (highly important). The mean ranking and standard deviation for each of the components were calculated. The survey sought to determine characteristics associated with offering an applicant an invitation to interview and subsequent ranking. Percentages with defined minimum requirements were calculated. Comparisons across residency length and location were completed with a Pearson chi-square test for categorical variables and Student's t-test for continuous variables. RESULTS: A total of 120 surveys were completed. The highest ranked components included away/visiting institution departmental standardized letter of evaluation (SLOE) (mean ± SD = 8.80 ± 1.25), residency interview (mean ± SD = 8.74 ± 1.28), home institution departmental SLOE (mean ± SD = 8.61 ± 1.18), away/visiting institution EM rotation grade (mean ± SD = 8.29 ± 1.43), and home institution EM rotation grade (mean ± SD = 8.07 ± 1.42). The most consistently ranked items included home institution departmental SLOE (SD = 1.18), away/visiting institution departmental SLOE (1.25), and residency interview (1.28). Characteristics associated with offering an interview to an applicant included only 10% of responses indicating a United States Medical Licensing Examination Step 1 score of 220 was needed. At least one SLOE was required in 80% of responses. Program location was related to the number of SLOEs required (p = 0.03). Length of residency and program location differed significantly in how a residency ranked components when considering an applicant (p < 0.05). CONCLUSION: Emergency medicine programs put high value in departmental SLOEs, the interview, and EM rotation grades when selecting potential residents. Higher value is placed on SLOEs and grades from away/visiting institutions compared with students' home institutions.

The National Incidence and Resource Utilization of Burn Injuries Sustained While Smoking on Home Oxygen Therapy.

Considerable risk of burn injury exists for those patients on home oxygen therapy (HOT) who continue to smoke. In this study, the authors sought to establish the national incidence of burns incurred while smoking on HOT and to determine the resource utilization and sequelae of these injuries. A retrospective review of the American Burn Association's National Burn Repository was conducted to identify patients burned while on HOT during the years 2002 to 2011. Duplicate entries, as well as records of follow-up visits and readmissions, were removed. Univariate analysis was used to compare the differences between patients sustaining burn injuries related to HOT and patients with other mechanisms of injury. Multivariate analysis provided odds ratios for mortality controlling for all significant variables. The frequency of burns sustained on HOT significantly increased during the 10-year period reviewed and were associated with increased comorbidities and certain complications. Compared with non-HOT injuries, HOT injuries had higher incidence of inhalation injury and mortality. Inhalation injury was the strongest predictor of mortality in HOT burn injuries. The likelihood of poor prognosis was even more pronounced in patients who required intubation. Smoking was responsible for 83% of the HOT burn injuries described here. Therefore, smoking cessation counseling and treatment should be mandatory in all patients prescribed HOT.