Evaluation of Medicaid Expansion Under the Affordable Care Act and Contraceptive Care in US Community Health Centers
Evaluation of Medicaid Expansion Under the Affordable Care Act and Contraceptive Care in US Community Health Centers
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DOI：
10.1001/jamanetworkopen.2020.6874
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发表时间：
2020-06-04
影响因子：
13.8
通讯作者：
Cottrell, Erika K.
中科院分区：
文献类型：
--
作者：
Darney, Blair G.;Jacob, R. Lorie;Cottrell, Erika K.
根据《平价医疗法案》扩大医疗补助是否与美国医疗安全网中避孕药具使用质量指标的改善有关？在这项包括50多万名妇女的横断面研究中，医疗保险的扩大与最有效避孕方法的使用增加有关在扩大医疗补助的州，与未扩大的州相比，控制其他支付避孕保健（如标题X和1115豁免计划）。MeaningAffordable Care Act赞助的Medicaid expansion is independently associated with a small but meaningful increase in access to the most effective methods of controlling.This cross-sectional study evaluates the association of Medicaid expansion under the Affordable Care Act with changes in use of controlling among patients at the risk of pregnancy receiving care at US community health centers.ImportanceUse of effective contraceptions reduces unintended pregnancy.目前尚不清楚根据《平价医疗法案》扩大医疗补助是否增加了在美国医疗保健安全网中服务不足的妇女的避孕药具使用。目的评估根据《平价医疗法案》扩大医疗补助与美国社区卫生中心有妊娠风险的患者使用避孕方法的变化之间的关联，假设医疗补助的扩大与最有效的避孕方法（长效可逆避孕）的使用增加有关。设计，设置和避孕这是一项参与者水平的回顾性横断面研究，比较了医疗补助扩展之前（2013年）与之后（2014年）和之后（2016年）更长时间内接受避孕的情况。包括来自24个州的社区卫生中心临床研究网络的电子健康记录数据。样本包括所有年龄在15至44岁之间有怀孕风险的女性患者，在研究期间在参与社区卫生中心进行了门诊护理访问（315个诊所在扩展状态和165个诊所在非扩展状态）。ExposureMedicaid扩展状态（按州）。主要结果和措施两个国家质量论坛认可的避孕质量指标，每年计算：有怀孕风险的妇女接受（1）中等有效或最有效的方法（激素和长效可逆避孕）方法和（2）最有效的方法（长效可逆避孕）的比例。结果样本包括310132名妇女从扩张状态和235408名妇女从nonexpansion状态。与2014年的非扩张状态相比，扩张状态的女性使用长效可逆避孕方法的绝对调整后增加了0.58（95%CI，0.13-1.05）个百分点，2016年增加了1.19（95%CI，0.41-1.96）个百分点。在青少年中，这种关联更大，特别是在长期内（2014年与2013年：绝对差异，0.80 [95%CI，0.30-1.30]个百分点; 2016年与2013年：绝对差异，1.79 [95%CI，0.88-2.70]个百分点）。与非标题X诊所和非扩展州相比，在标题X诊所接受护理的扩展州妇女接受最有效避孕方法的比例最高。结论和相关性在这项研究中，医疗补助的扩大与在美国安全网系统中寻求护理的有怀孕风险的妇女中使用长效可逆避孕方法的增加有关，并且在青少年中获益最大。
Key PointsQuestionWas Medicaid expansion under the Affordable Care Act associated with improvements in contraceptive use quality metrics in the US health care safety net? FindingsIn this cross-sectional study including more than 500 000 women, Medicare expansion was associated with an increase in use of the most effective contraceptive methods (long-acting reversible contraception) by 1.2 percentage points among women at risk of pregnancy in states that expanded Medicaid compared with nonexpansion states, controlling for other payers for contraceptive care (such as Title X and 1115 waiver programs). MeaningAffordable Care Act-sponsored Medicaid expansion was independently associated with a small but meaningful increase in access to the most effective methods of contraception.This cross-sectional study evaluates the association of Medicaid expansion under the Affordable Care Act with changes in use of contraception among patients at risk of pregnancy receiving care at US community health centers.ImportanceUse of effective contraception decreases unintended pregnancy. It is not known whether Medicaid expansion under the Affordable Care Act increased use of contraception for women who are underserved in the US health care safety net. ObjectiveTo evaluate the association of Medicaid expansion under the Affordable Care Act with changes in use of contraception among patients at risk of pregnancy at US community health centers, with the hypothesis that Medicaid expansion would be associated with increases in use of the most effective contraceptive methods (long-acting reversible contraception). Design, Setting, and ParticipantsThis was a participant-level retrospective cross-sectional study comparing receipt of contraception before (2013) vs immediately after (2014) and a longer time after (2016) Medicaid expansion. Electronic health record data from a clinical research network of community health centers across 24 states were included. The sample included all female patients ages 15 to 44 years at risk for pregnancy, with an ambulatory care visit at a participating community health center during the study period (315 clinics in expansion states and 165 clinics in nonexpansion states). ExposuresMedicaid expansion status (by state). Main Outcomes and MeasuresTwo National Quality Forum-endorsed contraception quality metrics, calculated annually: the proportion of women at risk of pregnancy who received (1) either a moderately effective or most effective method (hormonal and long-acting reversible contraception) methods and (2) the most effective method (long-acting reversible contraception). ResultsThe sample included 310132 women from expansion states and 235408 women from nonexpansion states. The absolute adjusted increase in use of long-acting reversible contraceptive methods was 0.58 (95% CI, 0.13-1.05) percentage points greater among women in expansion states compared with nonexpansion states in 2014 and 1.19 (95% CI, 0.41-1.96) percentage points larger in 2016. Among adolescents, the association was larger, particularly in the longer term (2014 vs 2013: absolute difference-in-difference, 0.80 [95% CI, 0.30-1.30] percentage points; 2016 vs 2013: absolute difference, 1.79 [95% CI, 0.88-2.70] percentage points). Women from expansion states who received care at a Title X clinic had the highest percentage of women receiving most effective contraceptive methods compared with non-Title X clinics and nonexpansion states. Conclusions and RelevanceIn this study, Medicaid expansion was associated with an increase in use of long-acting reversible contraceptive methods among women at risk of pregnancy seeking care in the US safety net system, and gains were greatest among adolescents.