Showing papers in "Journal of Health Care for the Poor and Underserved in 2001"
TL;DR: This study shows that the high cost of health care and lack of insurance compels the poor and uninsured to seek low-cost health Care and medication in Mexico to meet their most urgent health care needs, despite the burden of cost and travel.
Abstract: A survey was administered to adults attending a health fair in south Los Angeles County, approximately 140 miles from the U.S.-Mexico border. The survey revealed that 14 percent of respondents had crossed the border to seek medical care during the past year. Nearly 80 percent of respondents crossing the border for medical care were uninsured, while 70 percent reported the low cost of medical care obtained across the border as being the most common reason for seeking care there. Twenty-eight percent of respondents reported purchasing medication in Mexico, with antibiotics and pain medication being reported in highest frequency. Ninety percent of these respondents were uninsured. This study shows that the high cost of health care and lack of insurance compels the poor and uninsured to seek low-cost health care and medication in Mexico to meet their most urgent health care needs, despite the burden of cost and travel.
99Â citations
TL;DR: The authors conclude that the renewed national focus on health disparities among underserved populations requires an increased commitment to adequately identify Hispanic subgroups.
Abstract: The limited availability of Hispanic health data has hampered the development of targeted public health policies. Hispanics represent 11.5 percent of the population and are projected to become the largest minority group in the United States by the year 2010. This paper explores current issues in Hispanic health data collection, examines methodological concerns, and presents recommendations for future Hispanic public health data collection. Data are derived from statistical reports of the U.S. Bureau of the Census, National Center for Health Statistics, Bureau of Labor Statistics, and other empirical studies. Recommendations include: collecting both race and ethnic-specific data by Hispanic subgroup, designing appropriate data collection instruments and approaches, and selecting referent groups for comparison purposes. The authors conclude that the renewed national focus on health disparities among underserved populations requires an increased commitment to adequately identify Hispanic subgroups.
77Â citations
TL;DR: It is concluded that homeless persons may be underusing health care services even when they are at high risk of death, because a subset of homeless persons had extensive health care contacts prior to death.
Abstract: This study characterizes health care utilization prior to death in a group of 558 homeless adults in Boston. In the year before death, 27 percent of decedents had no outpatient visits, emergency department visits, or hospitalizations except those during which death occurred. However, 21 percent of homeless decedents had a health care contact within one month of death, and 21 percent had six or more outpatient visits in the year before death. Injection drug users and persons with HIV infection were more likely to have had contact with the health care system. This study concludes that homeless persons may be underusing health care services even when they are at high risk of death. Because a subset of homeless persons had extensive health care contacts prior to death, opportunities to prevent deaths may have been missed, and some deaths may not have been preventable through medical intervention.
68Â citations
TL;DR: The perceptions of control identified in this paper are issues that service providers and policy makers should consider to provide programs that will effectively promote pesticide safety and healthier farmworkers.
Abstract: Farmworkers experience a lack of control over the conditions of their work environment. In trying to reduce the effects of exposure to pesticides, most health care providers give instructions to farmworkers about how to protect themselves. Outreach programs that target farmworkers focus on health education and recommend washing hands, wearing appro- priate clothing, and avoiding direct contact. The research reporta in this paper shows that farmworkers in North Carolina perceive many of these preventive measures to be outside their control. The ability of farmworkers to engage in safe practices depends on their capability to communicate with their employer, have positive work relationships, and the availability of protective equipment. The perceptions of control identified in this paper are issues that service providers and policy makers should consider to pro- vide programs that will effectively promote pesticide safety and healthier farmworkers.
55Â citations
53Â citations
TL;DR: This exploratory study interviewed 130 participants in federal food assistance programs and 51 low-income nonparticipants to assess their behaviors and attitudes toward and awareness of the nutrition label.
Abstract: This exploratory study interviewed 130 participants in federal food assistance programs and 51 low-income nonparticipants to assess their behaviors and attitudes toward and awareness of the nutrition label. Regarding label use, 35.4 percent of participants and 45.1 percent of nonparticipants seldom/never read labels while grocery shopping, 31.5 percent of participants and 19.6 percent of nonparticipants sometimes read them, and 33.1 percent of participants and 35.3 percent of nonparticipants always/frequently read labels in the grocery store. In addition, 38.5 percent of participants and 41.2 percent of nonparticipants seldom/never read labels at home, 33.1 percent of participants and 27.5 percent of nonparticipants sometimes read them, and 28.5 percent of participants and 31.4 percent of nonparticipants always/frequently read labels at home. There were no significant differences between mean scores of participants and nonparticipants on how to use the nutrition label. Findings challenge nutritionists working with low-income individuals to develop more learning opportunities that teach how to use nutrition labels.
46Â citations
TL;DR: Pregnancy, drug dependence, more episodes of homelessness, and general physical health symptoms were positively associated with a number of gynecological symptoms, and health insurance coverage and an interruption in the cycle of homelessness also appear vital to women's health.
Abstract: Information is lacking on homeless women's gynecological symptoms and use of medical care for symptoms. This paper documents and explains gynecological symptoms and conditions and use of medical care in a probability sample of 974 reproductive-age (15-44) homeless women. Two-thirds of women reported symptoms during the previous year; 71 percent of those received medical care for their gynecological symptoms. Pregnancy, drug dependence, more episodes of homelessness, and general physical health symptoms were positively associated with a number of gynecological symptoms. Gynecological symptoms, younger age, better perceived health, and insurance coverage were positively associated with medical care; women reporting recent drug use and rape received less care. These findings support the importance of medical care and other treatment and support services for homeless women, including expanded care during pregnancy and substance abuse treatment. Health insurance coverage and an interruption in the cycle of homelessness also appear vital to women's health.
42Â citations
TL;DR: Compared to the elderly, working-age adults have greater problems paying their medical bills and gaining access to care and are less satisfied with their health insurance coverage.
Abstract: This paper examines health coverage and access to care among working-age adults using the Kaiser/Commonwealth 1997 National Survey of Health Insurance. One in three (52 million) working-age adults were either uninsured at the time of the survey or had a recent gap in their health coverage in the past two years. Having even a temporary gap in health coverage made a significant difference in access to care. Compared to the elderly, who are continuously covered by Medicare, working-age adults have greater problems paying their medical bills and gaining access to care and are less satisfied with their health insurance coverage.
37Â citations
TL;DR: Explicating explanatory models in health care interactions can provide an effective device for identifying the sources of clinical miscommunications and misrecognitions and is cautioned that they are easily misapplied.
Abstract: Health care concerns, health issues, and illness are defined within a social, cultural, political, and economic context.1 When health care practitioners and patients share a common culture, it is not always necessary to negotiate an understanding of the health problem. The distinctive ways that health problems are discussed and treated are often taken for granted when cultures are shared.2 Immigrants to North America may bring a set of beliefs and expectations to health care interactions that differ from those held by Western health care providers trained in biomedicine. Differences in explanatory models between professionals and their patients have the potential to create mismatches that can lead to problems, including misunderstandings and unmet expectations and needs. Explicating explanatory models in health care interactions can provide an effective device for identifying the sources of clinical miscommunications and misrecognitions.3 The concept of explanatory models is based on a distinction between illness (the patient's perceptions of symptoms and disability) and disease (the biomedical practitioner's perspective). While authors such as Kleinman have extensively explored the nature of these explanatory models, Kleinman has cautioned that they are easily misapplied when a patient's perceptions and beliefs are treated as distinct entities to be identified and recorded.4
36Â citations
TL;DR: Cardiac risk factor identification and intervention programs may help to reduce the health care costs for these patients and help to understand the health status of this population of Russian immigrants.
Abstract: Immigration from the former Soviet Union has been increasing. In 1990, there were 454,000 Russian immigrants living in the United States. Lifestyle habits prevalent in Russia, including smoking, alcoholism, and little preventive health, are compelling medical and economic reasons to understand the health status of this population. This study identified a cohort of Russian-born subjects living in Denver to characterize their cardiovascular risk profile. Using a risk assessment questionnaire, 204 Russian immigrants were screened. Seventy-one percent had Medicaid insurance; 14 percent were medically indigent. Those aged 55 to 64 years had a higher prevalence of hyperlipidemia (p < 0.04) and hypertension (p < 0.03) than U.S. counterparts; those age 20 to 34 and 65 to 74 years had a higher prevalence of hypertension (p < 0.00001). Almost half of the participants had two or more cardiac risk factors. Cardiac risk factor identification and intervention programs may help to reduce the health care costs for these patients.
35Â citations
TL;DR: Although there was some differences by race, the strongest determinant of anesthesia remained insurance type, which was approximately twice as likely to receive general anesthesia as those with traditional private coverage.
Abstract: This study measures the association between health insurance and the likelihood of receiving different obstetrical anesthesia protocols among 121,351 singleton live births in upstate New York during 1992. Mothers receiving a cesarean under Medicaid were approximately twice as likely to receive general anesthesia as those with traditional private coverage. Those receiving a cesarean under an HMO were least likely to receive general anesthesia with adjusted odds of 0.73 (confidence interval [CI] = 0.68-0.79), compared to those with traditional private insurance. Those delivering vaginally under Medicaid, HMO, or no coverage had adjusted odds of receiving an epidural of 0.45 (CI = 0.43-0.48), 0.68 (CI = 0.64-0.71), and 0.44 (CI = 0.38-0.52), respectively, compared to those under traditional private insurance. Although there was some differences by race, the strongest determinant of anesthesia remained insurance type. Insurance-mediated disparities in obstetrical anesthesia care are evident in upstate New York and warrant further study nationally.
TL;DR: Minority and lower socioeconomic status community health center users who used timely screening services were more likely to obtain them at community health centers, which appear to facilitate the use of timely screenings services for minority and low socioeconomic status users.
Abstract: This study measures associations between minority and low socioeconomic status and the use of screening services for secondary prevention among adult community health center users. Among those who obtained timely screening services, the study also measures associations between minority and low socioeconomic status and obtaining these preventive services at a community health center. The data include 1,175 individuals ages 18 and older from a 1995 survey of community health center users. Minority and lower socioeconomic status adult community health center users were not less likely to obtain timely screening services than other adult community health center users. This differs from the trend in the general population. Minority and lower socioeconomic status community health center users who used timely screening services were more likely to obtain them at community health centers, which appear to facilitate the use of timely screening services for minority and low socioeconomic status users.
TL;DR: There was no significant difference in appointment adherence rates among the three groups, and individuals not attending their scheduled appointments were interviewed by telephone to determine reason for nonadherence.
Abstract: The aim of this study was to determine the impact of reminder systems on appointment nonadherence rates in an low-income inner-city clinic population. A total of 2,304 consenting patients were randomly assigned to one of three groups: (1) automated telephone reminder, (2) postcard reminder, or (3) no reminder. In contrast with research on other populations, the results of this study demonstrated no significant difference in appointment adherence rates among the three groups. To aid in the development of more effective interventions in the future, individuals not attending their scheduled appointments were interviewed by telephone to determine reason for nonadherence.
TL;DR: It is concluded that hospitals serving Medicaid children, at least in these three states, are providing asthma inpatient care of fairly comparable quality to that of privately insured children, however, there remain significant problems surrounding outpatient medication regimens and follow-up care.
Abstract: Asthma is an important condition to study in the Medicaid population because it is the most frequent reason for hospital admission of Medicaid children, with rates substantially higher than those of non-Medicaid children. This study addressed how the quality of hospital care provided to children with asthma on Medicaid compares with that provided to privately insured children. Children inpatient records were studied in California, Georgia, and Michigan, comparing the care that was provided to standards created by a national panel of physician experts. Process-of-care analysis showed that Medicaid children in each state were more likely than privately insured children to be discharged on suboptimal medication regimens. This study concluded that hospitals serving Medicaid children, at least in these three states, are providing asthma inpatient care of fairly comparable quality to that of privately insured children. However, there remain significant problems surrounding outpatient medication regimens and follow-up care.
TL;DR: Risk of death was elevated for patients living in census tracts in the highest quintile for poverty rate, independent of comorbidity (as recorded in a hospital discharge database), age, and stage at diagnosis.
Abstract: Studies have reported reduced survival rates for colorectal cancer patients in lower socioeconomic status categories, but this finding could be due (at least in part) to higher comorbidity. This study involved 1,219 patients diagnosed with invasive colorectal cancer in 1992 who were reported to the population-based Connecticut Tumor Registry and followed to their death or through the end of 1997. Risk of death was elevated for patients living in census tracts in the highest quintile for poverty rate, independent of comorbidity (as recorded in a hospital discharge database), age, and stage at diagnosis. Patients living in census tracts with a poverty rate of 20 percent or higher had the highest risk of death. The explanation for these findings requires further study, in order to reduce socioeconomic status disparities in survival rates.
TL;DR: Patients reporting more serious traumatic experiences, such as incarceration, witnessing violence, or carrying a weapon, had the highest risk of violent assault, and may help primary care physicians identify young men at risk for violence and foster better interventions.
Abstract: Correlates of violent assault (defined here as having been shot, stabbed, shot at, or beaten) were identified among young male primary care patients. Data were analyzed from a cohort of young men ages 17 to 29 during their initial visits to an urban primary care facility. Each underwent a clinical assessment, including a self-report health inventory and provider history. In multivariable analysis, history of incarceration (odds ratio [OR] = 6.29, 95 percent confidence interval [CI], 2.34-16.89), having children (OR = 3.06, 95 percent CI, 1.30-7.17), and a high school education or less (OR = 0.69, 95 percent CI, 0.50-0.96) were significantly associated with increased likelihood of violent assault. Patients reporting more serious traumatic experiences, such as incarceration, witnessing violence, or carrying a weapon, had the highest risk (OR = 9.91, 95 percent CI, 4.0-24.57). These findings may help primary care physicians identify young men at risk for violence and foster better interventions.
TL;DR: The presence of health insurance was significantly associated with health care use in the past year, both for a checkup and a visit for any reason and for a regular source of care.
Abstract: The objective of this study was to determine if health care access is equitable and effective for Mexican Americans at the U.S.-Mexico border. The design was a cross-sectional telephone and door-to-door survey using the Behavioral Risk Factor Surveillance System, and the subjects were 1,409 El Paso County residents, ages 18 to 64 years. After controlling for other predisposing, enabling, and need characteristics, the presence of health insurance was significantly associated with health care use in the past year, both for a checkup (odds ratio [OR] = 2.48; 95 percent confidence interval [CI] = 1.83, 3.38) and a visit for any reason (OR = 2.20; 95 percent CI = 1.60, 3.04). Findings were similar for a regular source of care. Those who reported a checkup in the past year were significantly more likely to receive clinical preventive services. The lack of health insurance and a regular source of care for Mexican Americans on the U.S.-Mexico border creates significant inequalities in access to care.
TL;DR: Black women's experiences with Medicaid enrollment and application procedures were associated with less than adequate prenatal care and programmatic efforts and policies should emphasize further improvement in the systems of health care access and delivery to disadvantaged women.
Abstract: Most studies have concluded that good prenatal care plays an essential role in improving birth outcomes, and numerous reports have documented barriers to adequate prenatal care. The relationship between health care insurance eligibility and enrollment procedures and adequacy of prenatal care, however, has not been suitably investigated. This study used data from a statewide representative sample of recently delivered women in South Carolina to assess (1) patterns of health care insurance source and (2) the independent effects of Medicaid enrollment and application procedures on receipt of prenatal care. Health insurance during pregnancy varied by sociodemographic characteristics. Black women's experiences with Medicaid enrollment and application procedures were associated with less than adequate prenatal care. Programmatic efforts and policies should emphasize further improvement in the systems of health care access and delivery to disadvantaged women.
TL;DR: It was found that Hispanic physicians spent more hours per week in direct patient care, were more likely to have a primary care specialty, and were less often specialty board certified than white, non-Hispanic doctors.
Abstract: The purpose of the study was to extend the scope of earlier research on minority physicians attending to the needs of the poor and their own ethnicity by contrasting practice characteristics of Hispanic doctors in Colorado with those of their white, non-Hispanic counterparts. It was found that Hispanic physicians spent more hours per week in direct patient care, were more likely to have a primary care specialty, and were less often specialty board certified than white, non-Hispanic doctors. Hispanic generalists established practices in areas in which the percentages of the population that were (1) below poverty level, (2) Hispanic, (3) Hispanic and below poverty level, and (4) white, non-Hispanic, and below poverty level were greater than in areas in which white, non-Hispanic primary care physicians practiced. These findings argue for special provision to admit ethnic minorities to undergraduate and graduate medical education programs.
TL;DR: MFW tuberculosis cases were more likely to be male, foreign-born, or Hispanic and to have a history of alcohol abuse and homelessness than were non-MFWs, and HIV status was poorly reported.
Abstract: Migrant farm workers (MFWs) are considered a high-risk group for tuberculosis. MFW tuberculosis cases reported to the Centers for Disease Control and Prevention represented 1 percent of all reported tuberculosis cases from 1993 to 1997. Most of these cases (70 percent) were reported from Florida, Texas, and California. MFW tuberculosis cases were more likely to be male, foreign-born, or Hispanic and to have a history of alcohol abuse and homelessness than were non-MFWs. Most (79 percent) foreign-born MFWs were from Mexico. HIV status was poorly reported, with results available for only 28 percent of MFW and 33 percent of non-MFW cases. Of the MFWs tested, 28 percent were HIV infected, whereas 34 percent of non-MFWs were HIV infected. Twenty percent of MFWs move or are lost to follow-up before completing therapy; these cases pose a management challenge for the nation's tuberculosis control efforts.
TL;DR: The authors found significant lack of awareness of the magnitude of HIV/AIDS and syphilis in African American communities and lack of knowledge about the etiology and transmission of syphilis.
Abstract: Infectious syphilis disproportionately affects African Ameri- cans living in poverty in metropolitan areas in the southeastern United States. In this population, where syphilis persists, the rates of HTV and AIDS are also persistently high. In an effort to facilitate the design of more effective prevention programs, the present investigation employed focus groups to obtain information from low-income African Americans con- cerning the determinants of high rates of syphilis and HTV/AIDS in their communities. The subjects were 36 African American men and women ages 18 to 56 residing in metropolitan Memphis and surrounding Shelby County, Tennessee. Overall, the authors found significant lack of aware- ness of the magnitude of HTV/AIDS and syphilis in African American communities and lack of knowledge about the etiology and transmission of syphilis. The investigation points to the important role of women and partnerships of community organizations in preventing the spread of HIV, syphilis, and other sexually transmitted diseases in this population.
TL;DR: The historic role of consumer involvement in health policy decision making, an overview of major barriers that consumers have encountered, and strategies for overcoming these barriers so that consumer empowerment can be enhanced when they serve on health policy panels are discussed.
Abstract: Many consumers in today's society have increased access to information about health and medical care through books, videotapes, audiotapes, the Internet, and television programming However, consumers often are excluded from involvement in health policy decision making because it is believed that they do not have the necessary expertise In this paper, the following will be discussed: (1) the historic role of consumer involvement in health policy decision making, (2) an overview of major barriers that consumers have encountered in health policy decision making, and (3) strategies for overcoming these barriers so that consumer empowerment can be enhanced when they serve on health policy panels
TL;DR: While some variation in the quality of mammography services was found, there were no significant differences between the two race categories in the mean scores for each of three quality indices, and variation in quality of screening mammographic services does not appear to be race linked.
Abstract: The purpose of this investigation was to (1) determine whether there was variability in the quality of services offered in mammography facilities across Connecticut and (2) determine whether African American women were more likely than white women to receive mammograms in facilities that offered substandard services. Since most facilities do not routinely record information on race, this investigation represents a unique opportunity to address the question of race-linked variation in the quality of screening mammography. Information on equipment, personnel, and record keeping in mammography facilities was used to construct indices that represented separate domains of quality: technical attributes, educational practices, and tracking of clients. While some variation in the quality of mammography services was found, there were no significant differences between the two race categories in the mean scores for each of three quality indices. Thus, variation in quality of screening mammographic services does not appear to be race linked.
TL;DR: In the multivariate model, high school education or greater, age of 30 or more, participation in risk behaviors, and knowing an HIV-positive person were significantly associated with perceived susceptibility.
Abstract: Recent reports indicate that AIDS is increasing among Asian and Pacific Islander populations. Data from 249 women sampled from nine Asian and Pacific Islander communities in San Diego County from 1993 to 1995 were examined to determine what factors contributed to perceived susceptibility to HIV infection and having had an HIV test. Thirteen percent of women sampled were classified as high risk for HTV infection, while half of the women reported perceived susceptibility to HIV. Years in the United States and ethnicity appeared to be effect modifi- ers of the relationship between risk behaviors and perceived susceptibility. In the multivariate model, high school education or greater, age of 30 or more, participation in risk behaviors, and knowing an HIV-positive per- son were significantly associated with perceived susceptibility. Reliability of self-reported sexual behavior was somewhat low, while the reliability of data relating to injection drug use and needle sharing was high.
TL;DR: It was found that patients referred through the CIP were significantly more likely to receive follow-up care through a primary care provider than those referred through a routine care medical clinic or special primary care intervention program.
Abstract: Lack of follow-up care for hypertension adversely affects health in urban communities. The authors designed this study to (1) evaluate the effectiveness of a specialized intervention program for hypertension follow-up and (2) evaluate the associations with loss to follow-up. They evaluated factors related to loss to follow-up to either a routine care medical clinic or a special primary care intervention program (the Competitive Initiative Program [CIP]). They also conducted interviews to provide in-depth information on the barriers to this program. They found that patients referred through the CIP were significantly more likely to receive follow-up care through a primary care provider. Cost of care, long waiting times, lack of physician continuity, and more pressing priorities explained the lack of follow-up care. Despite a program to provide health care at no cost to patients, lack of insurance and worries about cost are described as barriers to adequate follow-up for hypertension treatment.
TL;DR: Overall, elderly with Medicaid coverage were more likely to make long-term stays in nursing homes, and African American elderly were significantly less likely to have recovery stays than were white elderly.
Abstract: This study examined the type of nursing home stay of white and minority elderly and investigated whether minority differences in nursing home admissions were extended to the type of stay, and if so, what accounted for those differences. African American/white and Latino/ white elderly were compared with respect to stays of(l) longer than three months, (2) shorter than three months and discharged alive (recovery), and (3) shorter than three months and deceased (terminal). African Amer- ican elderly in nursing homes were significantly less likely to have recov- ery stays than were white elderly. Multivariate analysis revealed that this difference was due to Medicaid coverage. Overall, elderly with Medicaid coverage were more likely to make long-term stays in nursing homes. The findings highlight the importance of Medicaid coverage for short-term recovery nursing home stays. Reductions of benefits or restrictions in eli- gibility would negatively and disproportionately affect the nursing home stays of elderly African Americans.
TL;DR: This study explores whether poverty areas of Chicago have fewer nursing home beds and unique staffing patterns and whether economic segregation may work together with Medicaid's policy of serving the poorest to increase the supply of beds to those who might otherwise remain unserved.
Abstract: This study explores whether poverty areas of Chicago have fewer nursing home beds and unique staffing patterns. Using 1990 census data and Illinois's 1994 Long-Term Care Facility Survey, census tracts were compared by need for long-term care, bed supply, and nursing home characteristics. While facilities cluster on the north side, and the number of beds follow the elderly, the supply of beds per elderly is actually greater in tracts with high proportions of poverty, disability, and African American residents due, in part, to the predominance of larger facilities. Ironically, economic segregation may work together with Medicaid's policy of serving the poorest to increase the supply of beds to those who might otherwise remain unserved. Nursing homes in the poorest communities have high percentages of Medicaid residents, are larger, and employ fewer staff per resident; homes with a high Medicaid population are more likely to employ LPNs, which may reflect labor supply differences.
TL;DR: Examining 93,074 diagnoses given to 20,331 homeless patients seen in a seven-year period in a primary care mobile and fixed clinic system in Texas may be useful to clinical site managers and health care planners contemplating an outreach program for the homeless.
Abstract: Responding to the medical needs of the homeless population across the United States exact large costs on the health care system. To provide effectively for such vulnerable populations, health care systems require creative and efficient strategies of service organization tailored to the specific needs of the homeless. However, such needs often vary by geographic region due to the inherent diversity of the population. Currently, no published medical evaluation of the urban homeless in Texas exists. Therefore, this study examines 93,074 diagnoses given to 20,331 homeless patients seen in a seven-year period in a primary care mobile and fixed clinic system. The most frequent disease conditions evaluated in this cohort of patients are reported. These findings may be useful to clinical site managers and health care planners contemplating an outreach program for the homeless.
TL;DR: Subsidized personal response system may be an appropriate third-party government-supported secondary intervention for home-based low-income and at-risk elders to prevent premature emergency room use, hospitalizations, and institutional placements.
Abstract: In 1994, the American Red Cross initiated a subsidized personal response system program for low-income elders in the Detroit area to help these elders maintain their independence at home. Data were collected on 379 low-income, at-risk elderly clients from Detroit and surrounding Wayne County, Michigan. More than 80 percent of the sample were African American ( n = 313), and the remainder were white ( n = 66) elders. Statistically significant changes in number of emergency room visits only occurred among white subscribers, increasing on average by 1.4 annual visits. One year after the installation of the personal response system, white users were twice as likely as the African Americans to make an emergency room visit or to stay overnight in the hospital. Subsidized personal response system may be an appropriate third-party government-supported secondary intervention for home-based low-income and at-risk elders to prevent premature emergency room use, hospitalizations, and institutional placements.