Abstract

Objective: To determine characteristics of patients reporting delays in care before hospitalization and the reasons for those delays.

Design: Survey; personal interviews.

Setting: Five hospitals in Massachusetts.

Patients: Subjects were drawn from a consecutive sample of all adult patients (excluding obstetrics or psychiatry patients) hospitalized during the first 6 months of 1987 as part of a larger study of hospital costs. For the current study, if patients were re-admitted, we included in our analysis only data on the first admission during the study period. We obtained usable survey data from 12 068 of 17 231 eligible patients.

Results: Delays in care were reported by 16% of patients. The odds of reporting delays in care among patients who were black, poor, uninsured, or without a regular physician were 40% to 80% greater than those for other patients (P < 0.01). Most patients who reported delays thought that their problem was not serious (64%). Cost was an important factor in delaying care for patients in lower socioeconomic positions; the odds of delaying care because of cost for patients who were both poor and uninsured were 12 times greater than the odds for other patients (P < 0.0¼1). After controllingfor diagnosis-related groups (DRGs) and severity, patients who reported delays had 9% longer hospital stays compared with others (P < 0.001).

Conclusions: Patients generally thought to be disadvantaged are at especially high risk for delaying care for conditions that eventually lead to hospitalization. Because these delays are associated with longer hospital stays and potentially poorer health outcomes, interventions that reduce delays seem especially important.

References

  • 1. Cooper RSimmons BCastaner APrasad RFanklin C, and Ferlinz J. Survival rates and prehospital delay during myocardial infarction among black persons. Am J Cardiol. 1986;57:208-11. CrossrefMedlineGoogle Scholar
  • 2. Hackett TCassem N, and Raker J. Patient delay in cancer. N Engl J Med. 1973;289:14-20. CrossrefMedlineGoogle Scholar
  • 3. Neale ATilley B, and Vernon S. Marital status, delay in seeking treatment and survival from breast cancer. Soc Sci Med. 1986;23:305-12. CrossrefMedlineGoogle Scholar
  • 4. Burr W and Schultz K. Delayed abortion in an area of easy accessibility. JAMA. 1980;244:44-8. CrossrefMedlineGoogle Scholar
  • 5. Duffy J and Owens R. Factors affecting promptness of reporting in breast cancer patients. Hygie. 1984;3:29-32. MedlineGoogle Scholar
  • 6. Temoshok LDiClemente RSweet DBlois M, and Sagebiel R. Factors related to patient delay in seeking medical attention for cutaneous malignant melanoma. Cancer. 1984;54:3048-3. CrossrefMedlineGoogle Scholar
  • 7. Safer MTharps QJackson T, and Leventhal H. Determinants of three stages of delay in seeking care at a medical clinic. Med Care. 1979, 17:11. CrossrefMedlineGoogle Scholar
  • 8. Epstein AStern R, and Weissman J. Do the poor cost more? A multihospital study of patients' socioeconomic status and use of hospital resources. N Engl J Med. 1990;322:1122-8. CrossrefMedlineGoogle Scholar
  • 9. Bonham G. Procedures and questionnaires of the National Medical Care Utilization and Expenditure Survey. National Medical Care Utilization and Expenditure Survey. Series A, Methodological Report #1. DHS publication no. 83-20001. Washington, D.C.: U.S. Government Printing Office; 1983. Google Scholar
  • 10. Christoffersson JConklin J, and Gonnella J. The impact of severity of illness on hospital costs. DRG Monitor. 1988;6:1-8. MedlineGoogle Scholar
  • 11. Gonnella JHornbrook M, and Louis D. Staging of disease: a case mix measurement. JAMA. 1984;251:637. CrossrefMedlineGoogle Scholar
  • 12. Roos NWennberg J, and McPherson K. Using diagnosis-related groups for studying variations in hospital admissions. Health Care Financing Review. 1988;9:53. MedlineGoogle Scholar
  • 13. . Fed Register. 1986;51:31561-74. Google Scholar
  • 14. Cleary P and Angel R. The analysis of relationships involving dichotomous dependent variables. J Health Soc Behav. 1984;25:334-48. CrossrefMedlineGoogle Scholar
  • 15. Kleinbaum DKupper L, and Muller K. Applied Regression Analysisand Other Multivariable Methods. Second edition. Boston, Massachusetts: PWS-Kent; 1988. Google Scholar
  • 16. Dowd BJohnson A, and Madson R. Inpatient length of stay in Twin Cities health plans. Med Care. 1986;24:694. CrossrefMedlineGoogle Scholar
  • 17. Weissman J and Epstein A. Case mix and resource utilization by uninsured hospital patients in the Boston metropolitan area. JAMA. 1989;261:3572-6. CrossrefMedlineGoogle Scholar
  • 18. Epstein AStern R, and Tognetti J. The association of patients' socioeconomic characteristics with the length of hospital stay and hospital charges within diagnosis-related groups. N Engl J Med. 1988;318:1579-88. CrossrefMedlineGoogle Scholar
  • 19. Rushing W. Status resources, societal reactions, and type of mental hospital admission. Am Sociol Rev. 1978;43:521-33. CrossrefMedlineGoogle Scholar
  • 20. Green L. Manual for scoring socioeconomic status for research on health behavior. Public Health Rep. 1970;85:815-27. CrossrefMedlineGoogle Scholar
  • 21. Halvorsen R and Palmquist R. The interpretation of dummy variables in semilogarithmic equations. American Economics Review. 1980;70:474-5. Google Scholar
  • 22. Wenneker M and Epstein A. Racial inequalities in the use of cardiac procedures for patients with ischemic heart disease in Massachusetts. JAMA. 1989;261:253-7. CrossrefMedlineGoogle Scholar
  • 23. Yelin EKramer J, and Epstein W. Is health care use equivalent across social groups? A diagnosis-based study. Am J Public Health. 1983;73:563-71. CrossrefMedlineGoogle Scholar
  • 24. Berg JRoss R, and Latourette H. Economic status and survival of cancer patients. Cancer. 1977;39:467-77. CrossrefMedlineGoogle Scholar
  • 25. Farley T and Flannery J. Late-stage diagnosis of breast cancer in women of lower socio-economic status: public health implications. Am J Public Health. 1989;79:1508-12. CrossrefMedlineGoogle Scholar
  • 26. Cockerham WKunz GLeuschen G, and Spaeth J. Symptoms, social stratification and self-responsibility for health in the United States and West Germany. Soc Sci Med. 1986;22:1263-71. CrossrefMedlineGoogle Scholar
  • 27. Roos N and Roos L Surgical rate variations: do they reflect the health or socioeconomic characteristics of the population? Med Care. 1982;20:945-58. CrossrefMedlineGoogle Scholar
  • 28. Siemiatycki JRichardson L, and Pless I. Equality in medical care under national health insurance in Montreal. N Engl J Med. 1980;303:10-5. CrossrefMedlineGoogle Scholar
  • 29. LeGrand J. The distribution of public expenditure: The case of health care. Economica. 1978;45:125-42. CrossrefGoogle Scholar
  • 30. McKinlay J. Some approaches and problems in the study of the use of services: an overview. J Health Soc Behav. 1972;13:115-52. CrossrefMedlineGoogle Scholar
  • 31. Piper JRay W, and Griffin M. Effects of Medicaid eligibility expansion on prenatal care and pregnancy outcome in Tennessee. JAMA. 1990;264:2219-23. CrossrefMedlineGoogle Scholar
  • 32. Dutton D. Explaining the low use of health services by the poor: costs, attitudes or delivery systems. Am Sociol Rev. 1978;43:348-68. CrossrefMedlineGoogle Scholar
  • 33. Mechanic D. Socioeconomic status and health: an examination of underlying processes. In: Bunker JP, Gomby DS, Kehrer BH, eds. Pathways to Health: The Role of Social Factors. Menlo Park, California: Henry J. Kaiser Foundation; 1989:9-26. Google Scholar
  • 34. Bullough B. Poverty, ethnic identity and preventive health care. J Health Soc Behav. 1972;13:347-59. CrossrefMedlineGoogle Scholar
  • 35. Curbow B. Health care and the poor: psychological implications of restrictive policies. Health Psychol. 1986;5:375-91. CrossrefMedlineGoogle Scholar
  • 36. Reissman C. The use of health services by the poor. Social Policy. 1974;5:41-9. Google Scholar

This content is PDF only. To continue reading please click on the PDF icon.