{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T03:37:01Z","timestamp":1783136221498,"version":"3.54.6"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T00:00:00Z","timestamp":1745452800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["T32 HS026122"],"award-info":[{"award-number":["T32 HS026122"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R21AG080339"],"award-info":[{"award-number":["R21AG080339"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K12HL137943\u201001"],"award-info":[{"award-number":["K12HL137943\u201001"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009320","name":"American Association of Critical-Care Nurses","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009320","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To identify specific ways in which US health insurance triggered changes in care and interrupted the encounter between clinicians and patients in post\u2010intensive care unit (ICU) clinics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Setting and Design<\/jats:title><jats:p>This 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources and Analytic Sample<\/jats:title><jats:p>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\u2010 and 12\u2010week 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>Thirty\u2010three clinic visit transcripts from 19 patients revealed health insurance\u2010related issues commonly elicited by clinicians. One in three patients raised health insurance\u2010related issues during their clinical encounter. Structural barriers to ICU recovery included high out\u2010of\u2010pocket spending, the complexity of interfacing with health insurance companies, and health insurance literacy. Patients initiated modifications to intended care to overcome insurance\u2010related barriers to recovery, including nonadherence to prescribed medications and treatments and crafting unsafe \u201cworkarounds\u201d to recommended healthcare, with consequences to their recovery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found that health insurance complexity and high out\u2010of\u2010pocket 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.<\/jats:p><jats:p>\n<jats:bold>Trial Registration:<\/jats:bold> NCT03926533<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.14615","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T02:09:09Z","timestamp":1745546949000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinician and Patient Responses to <scp>US<\/scp> Health Insurers' Policies: A Qualitative Study of Higher Risk Patients"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0348-0527","authenticated-orcid":false,"given":"Tammy L.","family":"Eaton","sequence":"first","affiliation":[{"name":"VA Center for Clinical Management Research, VA Ann Arbor Healthcare System  Ann Arbor Michigan USA"},{"name":"Department of Internal Medicine, Division of Hospital Medicine Michigan Medicine  Ann Arbor Michigan USA"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Danesh","sequence":"additional","affiliation":[{"name":"Center for Applied Health Research Baylor Scott &amp; White Health  Dallas Texas USA"},{"name":"Department of Medicine Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail C.","family":"Jones","sequence":"additional","affiliation":[{"name":"School of Nursing Vanderbilt University  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine C.","family":"Kimpel","sequence":"additional","affiliation":[{"name":"School of Nursing Vanderbilt University  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla M.","family":"Sevin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Su","sequence":"additional","affiliation":[{"name":"School of Nursing Vanderbilt University  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly M.","family":"Toth","sequence":"additional","affiliation":[{"name":"CRISMA Center, Critical Care Medicine University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas S.","family":"Valley","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Policy and Innovation, University of Michigan  Ann Arbor Michigan USA"},{"name":"Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine University of Michigan  Ann Arbor Michigan USA"},{"name":"VA Center for Clinical Management Research  Ann Arbor Michigan USA"},{"name":"Center for Bioethics and Social Sciences in Medicine University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore J.","family":"Iwashyna","sequence":"additional","affiliation":[{"name":"VA Center for Clinical Management Research, VA Ann Arbor Healthcare System  Ann Arbor Michigan USA"},{"name":"Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine University of Michigan  Ann Arbor Michigan USA"},{"name":"Division of Pulmonary &amp; 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