The Impact of the Affordable Care Act Medicaid Expansion on Acute Diabetes Complications Among Community Health Center Patients.
The Impact of the Affordable Care Act Medicaid Expansion on Acute Diabetes Complications Among Community Health Center Patients.
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DOI：
10.1177/21501319231171437
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发表时间：
2023-01
影响因子：
3.6
通讯作者：
DeVoe, Jennifer E.
中科院分区：
文献类型：
--
作者：
Huguet, Nathalie;Dinh, Dang;Hwang, Jun;Marino, Miguel;Larson, Annie E.;Suchocki, Andrew;DeVoe, Jennifer E.
这项研究评估了在实施《平价医疗法案》（ACA）后，居住在扩张州的患者的急性糖尿病并发症门诊诊断是否比居住在非扩张州的患者增加更多。这项回顾性队列研究使用了来自16个州（11个扩展州和5个非扩展州）的347个社区卫生中心（CHC）的10，665名年龄在19至64岁之间的非妊娠患者的电子健康记录（EHR），这些患者在2012年或2013年被诊断为糖尿病。纳入的患者在以下每个时期均接受了≥1次门诊访视：ACA前：2012年至2013年，ACA后：2014年至2016年，ACA后：2017年至2019年。使用国际疾病分类（ICD-9-CM和ICD-10-CM）代码分类确定急性糖尿病相关并发症，这些并发症可能发生在糖尿病诊断时或之后。我们使用广义估计方程进行了差异中的差异（DID）分析，以比较急性糖尿病并发症发生率的变化。2015年后，生活在医疗补助扩展州的患者中与血糖异常相关的访视增加幅度大于非扩展州（2017 DID = 0.041，95% CI = 0.027-0.056）。虽然由于任何急性糖尿病并发症和感染相关的糖尿病并发症的就诊率在生活在医疗补助扩展状态的患者中较高，但扩展和非扩展状态之间的趋势随时间推移没有差异。我们发现，从2015年开始，接受扩张状态护理的患者的血糖异常就诊率显著高于非扩张状态的CHC患者。这些诊所的额外资源，例如提供血糖监测设备或邮寄/递送药物的能力，可以使糖尿病患者受益匪浅。
This study evaluates whether patients residing in expansion states have a greater increase in outpatient diagnoses of acute diabetes complications than those living in non-expansion states following the implementation of the Affordable Care Act (ACA). This retrospective cohort study uses electronic health records (EHR) from 10,665 non-pregnant patients, aged 19 to 64 years old who were diagnosed with diabetes in 2012 or 2013 from 347 community health centers (CHCs) across 16 states (11 expansion and 5 non-expansion states). Patients included had ≥1 outpatient ambulatory visit in each of these periods: pre-ACA: 2012 to 2013, post-ACA: 2014 to 2016, and post-ACA: 2017 to 2019. Acute diabetes-related complications were identified using International Classification Diseases (ICD-9-CM and ICD-10-CM) codes classification and could occur on or after diagnosis of diabetes. We performed difference-in-differences (DID) analysis using a generalized estimating equation to compare the change in rates of acute diabetes complications by year and by Medicaid expansion status. There was a greater increase after year 2015 in visits related to abnormal blood glucose among patient living in Medicaid expansion states than in non-expansion states (2017 DID = 0.041, 95% CI = 0.027-0.056). Although both visits due to any acute diabetes complications and infection-related diabetes complications were higher among patients living in Medicaid expansion states, there was no difference in the trend overtime between expansion and non-expansion states. We found a significantly greater rate of visits for abnormal blood glucose in patients receiving care in expansion states relative to patients in CHCs in non-expansion states starting in 2015. Additional resources for these clinics, such as the ability to provide blood glucose monitoring devices or mailed/delivered medications, could substantially benefit patients with diabetes.
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新的高血压和糖尿病诊断后，可负担得起的医疗补助法扩展。
影响因子：
6.1
作者：
Angier H;Huguet N;Ezekiel-Herrera D;Marino M;Schmidt T;Green BB;DeVoe JE
通讯作者：
DeVoe JE
影响因子：
3
作者：
Monnette, Alisha;Stoecker, Charles;Shi, Lizheng
通讯作者：
Shi, Lizheng
DOI：
10.3122/jabfm.2019.06.190087
发表时间：
2019-11-01
影响因子：
2.9
作者：
Huguet, Nathalie;Angier, Heather;DeVoe, Jennifer E.
通讯作者：
DeVoe, Jennifer E.
影响因子：
3.4
作者：
Shi, Leiyu;Lebrun, Lydie A.;Ngo-Metzger, Quyen
通讯作者：
Ngo-Metzger, Quyen
影响因子：
5.7
作者：
Tilhou, Alyssa Shell;Huguet, Nathalie;Angier, Heather
通讯作者：
Angier, Heather