title: Understanding why patients of low socioeconomic status prefer hospitals over ambulatory care.
abstract: Patients with low socioeconomic status (SES) use more acute hospital care and less primary care than patients with high socioeconomic status. This low-value pattern of care use is harmful to these patients' health and costly to the health care system. Many current policy initiatives, such as the creation of accountable care organizations, aim to improve both health outcomes and the cost-effectiveness of health services. Achieving those goals requires understanding what drives low-value health care use. We conducted qualitative interviews with forty urban low-SES patients to explore why they prefer to use hospital care. They perceive it as less expensive, more accessible, and of higher quality than ambulatory care. Efforts that focus solely on improving the quality of hospital care to reduce readmissions could, paradoxically, increase hospital use. Two different profile types emerged from our research. Patients in Profile A (five or more acute care episodes in six months) reported social dysfunction and disability. Those in Profile B (fewer than five acute care episodes in six months) reported social stability but found accessing ambulatory care to be difficult. Interventions to improve outcomes and values need to take these differences into account.
authors.affiliation: Department of Medicine, Philadelphia Veterans Affairs Medical Center, PA, USA. kangovi@upenn.edu
authors.forename: Shreya
authors.initials: S
authors.lastname: Kangovi
authors.forename: Frances K
authors.initials: FK
authors.lastname: Barg
authors.forename: Tamala
authors.initials: T
authors.lastname: Carter
authors.forename: Judith A
authors.initials: JA
authors.lastname: Long
authors.forename: Richard
authors.initials: R
authors.lastname: Shannon
authors.forename: David
authors.initials: D
authors.lastname: Grande
mesh_terms: D000553:Ambulatory Care / Q000191:economics; D003363:Cost Control / Q000191:economics; D004185:Disability Evaluation; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006300:Health Services Misuse / Q000191:economics; D006760:Hospitalization; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics; D017057:Medically Uninsured; D017063:Outcome Assessment, Health Care; D057240:Patient Preference / Q000191:economics; D010359:Patient Readmission / Q000191:economics; D011203:Poverty / Q000191:economics; D036301:Qualitative Research; D011787:Quality of Health Care / Q000191:economics; D012917:Social Adjustment; D014481:United States
keywords: Access To Care; Cost Of Health Care; Disparities; Organization And Delivery Of Care; Quality Of Care