Prevalence of Informal Caregiving in States Participating in the US Patient Protection and Affordable Care Act Balancing Incentive Program, 2011-2018.
Prevalence of Informal Caregiving in States Participating in the US Patient Protection and Affordable Care Act Balancing Incentive Program, 2011-2018.
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2011-2018 年参与美国患者保护和平价医疗法案平衡激励计划的各州非正式护理的流行情况。
DOI：
10.1001/jamanetworkopen.2020.25833
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发表时间：
2020-12-01
影响因子：
13.8
通讯作者：
Chatterjee P
中科院分区：
文献类型：
--
作者：
Anastos-Wallen R;Werner RM;Chatterjee P
这项队列研究评估了美国患者保护和平价医疗法案（ACA）平衡激励计划与2011年至2018年美国非正式医疗的患病率和频率之间的关联。根据美国《患者保护和平价医疗法案》设计的平衡激励计划，旨在将长期护理从机构转移到家庭，与2011年至2018年非正式护理的流行率和频率的变化或护理人员福祉的变化相关吗？在这项对38343名参与者进行的队列研究中，平衡激励计划与增加每日工作量和改善护理人员睡眠有关，这是幸福的标志。这些福利主要提供给社会经济地位较高的照顾者。这些研究结果与平衡激励计划的目标是一致的，但建议照顾者的社会经济地位的压力的差异。根据2010年《患者保护和平价医疗法》建立的平衡激励计划（BIP）为各州提供了联邦资金，以将长期护理从机构环境转移到家庭。然而，其实施与非正式的协商之间的联系尚不清楚。评估BIP参与率与非正式分娩的患病率和频率以及照顾者之间的社会经济差异之间的关联。这项队列研究包括2011-2018年美国时间使用调查的受访者，他们来自采用BIP的州和非采用BIP的州。在计划实施后，居住在实施BIP的州（2012年4月至2018年4月）。所有受访者中睡眠的患病率，睡眠的频率和每天睡眠的分钟数，这是幸福的标志。差异中的差异（DID）回归分析被用来比较这些结果之间的BIP采用状态和非BIP采用状态。该研究包括采用BIP的州的38343名受访者（中位年龄，47岁[四分位距（IQR），31-61岁]; 51.9%为女性），其中7，428人为照顾者（中位年龄，51岁[IQR，37-61岁]; 55.6%为女性），26437名非BIP采用州的受访者（中位年龄，48岁[IQR，32-62岁]; 52.7%为女性），其中5527人为护理人员（中位年龄，52岁[IQR，38-62岁]; 57.9%为女性）。在项目实施后，采用BIP和不采用BIP的州之间的患病率没有变化（DID，0.00%; 95%CI，-0.01%至0.01%）。与非BIP采用状态的护理人员相比，采用BIP状态的护理人员在实施后更有可能提供日常护理（DID，3.2%; 95%CI，0.3%-6.0%; P = .03），并报告睡眠时间增加（DID，15.6分钟; 95%CI，4.9-26.2分钟; P = .005）。与具有相同教育和收入水平的非BIP采用州的照顾者相比，这种关联在受教育程度较高（DID，25.1分钟; 95% CI，6.5-43.8分钟; P = .01）和家庭年收入较高（DID，16.9分钟; 95% CI，5.9-27.9分钟; P = .004）的照顾者中更为明显。在这项队列研究中，BIP与增加的日常生活和改善护理人员的幸福感相关。然而，它可能不成比例地使社会经济地位较高的照顾者受益，可能加剧照顾者压力的差异。未来的政策应旨在减轻这一意外后果。
This cohort study assessed the association of the US Patient Protection and Affordable Care Act (ACA) Balancing Incentives Program with the prevalence and frequency of informal caregiving in the US from 2011 to 2018. Was the Balancing Incentives Program, designed under the US Patient Protection and Affordable Care Act to shift long-term care out of institutions and into the home, associated with changes in the prevalence and frequency of informal caregiving or changes in caregiver well-being from 2011 to 2018? In this cohort study of 38 343 participants, the Balancing Incentives Program was associated with increased daily caregiving and improvements in caregiver sleep, a marker of well-being. These benefits accrued mainly to caregivers of higher socioeconomic status. These findings were consistent with the goals of the Balancing Incentives Program but suggest disparities in caregiver stress by socioeconomic status. The Balancing Incentives Program (BIP), established under the 2010 Patient Protection and Affordable Care Act provided federal funding for states to shift long-term care out of institutional settings and into the home. However, the association of its implementation with informal caregiving is not known. To evaluate the association between BIP participation and the prevalence and frequency of informal caregiving and socioeconomic disparities among caregivers. The cohort study included respondents to the 2011-2018 American Time Use Survey in BIP-adopting states and non–BIP-adopting states. Living in a state that had implemented the BIP after program implementation had begun (April 2012 to April 2018). Prevalence of caregiving among all respondents, frequency of caregiving, and minutes of daily sleep, a marker of well-being. Differences-in-differences (DID) regression analysis was used to compare these outcomes between BIP-adopting states and non–BIP-adopting states. The study included 38 343 respondents in BIP-adopting states (median age, 47 years [interquartile range (IQR), 31-61 years]; 51.9% women), of whom 7428 were caregivers (median age, 51 years [IQR, 37-61 years]; 55.6% women), and 26 437 respondents in non–BIP-adopting states (median age, 48 years [IQR, 32-62 years]; 52.7% women), of whom 5527 were caregivers (median age, 52 years [IQR, 38-62 years]; 57.9% women). There was no change in the prevalence of caregiving between BIP-adopting and non–BIP-adopting states after program implementation (DID, 0.00%; 95% CI, −0.01% to 0.01%). Caregivers in BIP-adopting states were more likely to provide daily care after implementation (DID, 3.2%; 95% CI, 0.3%-6.0%; P = .03) and report increased time sleeping (DID, 15.6 minutes; 95% CI, 4.9-26.2 minutes; P = .005) compared with caregivers in non–BIP-adopting states. This association was more pronounced among caregivers with more education (DID, 25.1 minutes; 95% CI, 6.5-43.8 minutes; P = .01) and higher annual family income (DID, 16.9 minutes; 95% CI, 5.9-27.9 minutes; P = .004) compared with caregivers in non–BIP-adopting states who had the same education and income levels, respectively. In this cohort study, the BIP was associated with increased daily caregiving and improved caregiver well-being. However, it may have disproportionately benefited caregivers of higher socioeconomic status, potentially exacerbating disparities in caregiver stress. Future policies should aim to mitigate this unintended consequence.
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影响因子：
39.2
作者：
von Elm, Erik;Altman, Douglas G.;Vandenbroucke, Jan P.
通讯作者：
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影响因子：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
2.1
作者：
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通讯作者：
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