Evidence map›Paper›PMID 40275640›Full record

Trial reportHealth services research2025

Clinician and Patient Responses to US Health Insurers' Policies: A Qualitative Study of Higher Risk Patients.

Tammy L Eaton, Valerie Danesh, Abigail C Jones, Christine C Kimpel, Carla M Sevin, Han Su, Kelly M Toth, Thomas S Valley, Theodore J Iwashyna, Leanne M Boehm and 1 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03926533 (Telehealth-Enhanced Patient-Oriented Recovery Trajectory After Intensive Care Pilot Feasibility Study), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03926533 nacompletednot on this map

Telehealth-Enhanced Patient-Oriented Recovery Trajectory After Intensive Care Pilot Feasibility Study

TypeinterventionalSponsorVanderbilt UniversityRan2019 to 2023Enrolled91ConditionsCritical Illness, Acute Respiratory Distress Syndrome, Septic ShockArmsTelehealth
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Beyond Survival: Lessons From a Research Journey in Critical Care Recovery Science.American journal of critical care : an official publication, American Association of Critical-Care Nurses · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Tammy L EatonVA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.ORCID https://orcid.org/0000-0002-0348-0527
Valerie DaneshCenter for Applied Health Research, Baylor Scott & White Health, Dallas, Texas, USA.
Abigail C JonesSchool of Nursing, Vanderbilt University, Nashville, Tennessee, USA.
Christine C KimpelSchool of Nursing, Vanderbilt University, Nashville, Tennessee, USA.
Carla M SevinDepartment of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Han SuSchool of Nursing, Vanderbilt University, Nashville, Tennessee, USA.
Kelly M TothCRISMA Center, Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Thomas S ValleyInstitute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
Theodore J IwashynaVA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
Leanne M BoehmSchool of Nursing, Vanderbilt University, Nashville, Tennessee, USA.
Joanne McPeakeThe Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK.

Funding

Telehealth-Enhanced Patient-Oriented Recovery Trajectory After Intensive CareR01AG077644 · NIA · VANDERBILT UNIVERSITY · PI Leanne M Boehm · 2023 to 2026
$3.1M
Vanderbilt Scholars in T4 Translational Research (V-STTaR) ProgramK12HL137943 · NHLBI · VANDERBILT UNIVERSITY MEDICAL CENTER · PI KRIPALANI, SUNIL, ROUMIE, CHRISTIANNE L. · 2017 to 2021
$2.9M
Driving Rehabilitation and Innovation for Evaluating Risk in Post-Intensive Care Unit Survivors (DRIVE-PICS)R21AG080339 · NIA · BAYLOR RESEARCH INSTITUTE · PI DANESH, VALERIE, MCDONALD, ANTHONY D. · 2023 to 2024
$457k
AHRQ HHS T32 HS026122American Association of Critical Care NursesNHLBI NIH HHS K12 HL137943NHLBI NIH HHS K12HL137943-01NIA NIH HHS R01 AG077644NIA NIH HHS R21 AG080339NIA NIH HHS R21AG080339
6 · The paper itself

Abstract

objectiveTo identify specific ways in which US health insurance triggered changes in care and interrupted the encounter between clinicians and patients in post-intensive care unit (ICU) clinics. STUDY SETTING AND

designThis naturalistic qualitative study was nested within a randomized controlled trial that evaluated the feasibility and preliminary efficacy of a telemedicine ICU recovery clinic intervention. Adult participants were referred to a multidisciplinary ICU recovery clinic after septic shock or acute respiratory distress syndrome (ARDS) in a Southeastern US academic medical center. DATA SOURCES AND ANALYTIC SAMPLE: Data were collected from 2019 to 2021. Telemedicine ICU recovery visits within the intervention group were used in this analysis. ICU recovery visits at 3- and 12-week intervals after hospital discharge were recorded and analyzed based upon the constant comparative method. Responses were initially open coded and then consolidated with the Donabedian Model of assessing healthcare quality by two investigators to organize themes and subthemes, with discrepancies in coding resolved by consensus. PRINCIPAL

findingsThirty-three clinic visit transcripts from 19 patients revealed health insurance-related issues commonly elicited by clinicians. One in three patients raised health insurance-related issues during their clinical encounter. Structural barriers to ICU recovery included high out-of-pocket spending, the complexity of interfacing with health insurance companies, and health insurance literacy. Patients initiated modifications to intended care to overcome insurance-related barriers to recovery, including nonadherence to prescribed medications and treatments and crafting unsafe "workarounds" to recommended healthcare, with consequences to their recovery.

conclusionsWe found that health insurance complexity and high out-of-pocket costs compromise the quality of care and recovery experienced by ICU survivors. These findings emphasize the need for solutions at the policy, payor, and healthcare system levels to mitigate barriers to ICU recovery created by health insurance, which can adversely influence affordable, timely, and appropriate critical illness survivor care.

trial registrationNCT03926533.

Indexed as

Insurance CarriersInsurance, HealthIntensive Care UnitsAdultAgedFemaleHumansMaleMiddle AgedQualitative ResearchRespiratory Distress SyndromeTelemedicineUnited Statesaccess to careadverse eventsfinancial hardshiphealth insuranceICU recoverypost‐ICU clinicworkaround

Identifiers

PMID40275640
PMCPMC12120516

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.