Healthcare News of Note: 5% of U.S. adults are forgoing healthcare due to transportation barriers

• Having a low income or a disability and lacking household access to a vehicle are the strongest predictors of having unmet healthcare needs because of difficulty finding transportation.
• The proportion of pediatric hospital admissions involving ICU care in the United States “has risen substantially” as general pediatric inpatient admissions have steadily decreased.
• Many nurses are no longer satisfied with their jobs, and more nurses say they will leave their current job.

Over the past few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals.    

1. A low income, having a disability and not having a vehicle are the top reasons people forgo needed healthcare

An April 26 brief by the Robert Wood Johnson Foundation (RWJF) noted the “strongest predictors” of having unmet healthcare needs because of difficulty finding transportation, including:

• A low family income
• Having a disability
• Lacking household access to a vehicle

The information was based on a study sponsored and published by RWJF and conducted by The Urban Institute. The study can be downloaded via the brief.

Key findings

The key findings from the study, which used data from the June 2022 round of the Urban Institute’s Health Reform Monitoring Survey of adults ages 18 to 64, included:

• 5% of all U.S. adults reported forgoing healthcare due to transportation barriers. 
• Black adults (8%), adults with low family incomes (14%) and adults with public health insurance (12%) were all more likely to forgo needed care due to difficulty finding transportation. 
• Adults with a disability (17%) were more than three times as likely to report skipping care due to transportation concerns. 

HFMA resource

Read the February 2023 article “Care coordination networks offer path to addressing problems of health inequity.” It includes a case study of a patient who lacked transportation, was isolated, did not have family support and was unable to take care of herself and her home without assistance.

2. The incidence of children receiving ICU care in the U.S. increased from 2001 to 2019

The prevalence of children receiving ICU care in the United States increased, “as did length of stay, technology use, and associated costs,” during an 18-year period, according to the study  “Epidemiology of Intensive Care Admissions for Children in the US From 2001 to 2019.”

The results from the study, which was published March 27 in JAMA Pediatrics, showed:

• ICU care among hospitalized children increased from 10.6% to 15.5%.
• ICU admissions in children’s hospitals as a share of all pediatric ICU admissions rose from 51.2% to 85.1%.
• Children admitted to an ICU with an underlying comorbidity increased from 46.2% to 57%.

The study used data from the Healthcare Cost and Utilization Project’s state inpatient databases from 21 states in 2001, 2004, 2010, 2016 and 2019.

Conclusions

The authors’ conclusions included:

• The proportion of pediatric hospital admissions involving ICU care in the United States “has risen substantially” as general pediatric inpatient admissions have steadily decreased.
• Children admitted to ICUs increasingly have chronic comorbidities, more commonly develop organ failure and require mechanical ventilation, and have longer hospital stays.
• Pediatric critical care is becoming increasingly regionalized, taking place in dedicated pediatric facilities. But this trend varies by state, and a large number of children continue to receive ICU care in community hospitals.

The authors wrote: “These findings should inform development of a multidisciplinary collaboration across pediatric critical care professionals, epidemiologists, and health services researchers to identify strategies to reduce disparities in pediatric critical illness and better prepare the pediatric critical care community and US health care system for anticipated capacity and resource needs with an increasingly large, diverse, and medically complex patient population.”

3. More nurses ready to leave their jobs in the next year

Two recent reports about the state of nursing in the United States corroborate what healthcare industry leaders already know: Many nurses are no longer satisfied with their jobs, and more say they will leave their current jobs, contributing to the nation’s nursing shortage.

What a recent survey says

Thirty-one percent of nurses are considering “leaving their current direct patient care jobs in the next year,” according to data from McKinsey & Company’s September 2022 survey of 368 frontline nurses in the United States. The survey data is included the May 5 article, Nursing in 2023: How hospitals are confronting shortages.

“Our four frontline nursing surveys over the past two years have enabled us to glean insights into factors contributing to both attrition and retention,” wrote the authors of the McKinsey report. “Frontline nursing respondents have consistently ranked elements of flexibility, meaning, and balance as the most important factors affecting their decision to stay in direct patient care. Recognition, open lines of communication, and embedding breaks into the operating model (for example, during shifts, between shifts, and formal paid time off) have consistently been rated as the top initiatives to support well-being.”

AMN Healthcare survey results

Survey results (download required) from AMN Healthcare are grimmer.

Only 15% of hospital-employed nurses in the 2023 Survey of Registered Nurses “planned to continue working in their current position in the next year,” wrote the study authors. “The other 85% are considering a new place of nursing employment; working as travel nurses, part-time or per diem; taking a job outside of direct patient care; returning to school; or leaving nursing altogether.”

The survey of 18,000 RNs was published May 1 and showed:

• 94% of respondents said there was a severe or moderate shortage of nurses in their area, with half of nurses saying the shortage was severe.
• 80% of nurses expect the shortage to get much worse or somewhat worse in the next five years.
• Career satisfaction dropped 10 percentage points from 2021, to 71%.
• Younger generations are less satisfied with their current jobs, with 71% of baby boomers expressing satisfaction compared with Generation X at 64%, Generation Z at 62% and millennials at 60%.

Cole Edmonson, DNP, RN, chief clinical officer at AMN Healthcare, was quoted in the report: “The [survey] data reveals the depth of the problems faced in nursing today and concludes with solutions that need to be engaged throughout our industry and our society. Collaborative action is now needed by all sectors of the healthcare industry to identify and engage solutions.”

HFMA resources

• Listen to the second installment of a three-part series on the healthcare workforce in a recent Voices in Healthcare podcast episode, with host Erika Grotto. This episode focuses on ways clinical workers need support from their leaders. 
• Read the April hfm cover story: “Meeting healthcare’s workforce challenges requires innovation with a dost of humanity.”
• View HFMA’s on-demand webinar, A fresh approach to staffing challenges, recorded Feb. 28. Learning objectives include how data and analytics can be used to determine staff supply and demand throughout a health system, and how technology helps clinical staff be more efficient.