Effect of Massachusetts healthcare reform on racial and ethnic disparities in admissions to hospital for ambulatory care sensitive conditions: retrospective analysis of hospital episode statistics.
Effect of Massachusetts healthcare reform on racial and ethnic disparities in admissions to hospital for ambulatory care sensitive conditions: retrospective analysis of hospital episode statistics.
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DOI：
10.1136/bmj.h1480
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发表时间：
2015-04-01
期刊：
影响因子：
--
通讯作者：
Kressin NR
中科院分区：
文献类型：
--
作者：
McCormick D;Hanchate AD;Lasser KE;Manze MG;Lin M;Chu C;Kressin NR
目的利用马萨诸塞州和3个对照州完整的出院数据(住院事件统计数据)，研究马萨诸塞州医疗改革对门诊敏感疾病(ACSC)入院率变化的影响，以及种族和民族差异。在差异分析中设计差异以确定变化，总体上并根据种族/民族进行调整，以适应与改革无关的长期变化。背景：美国马萨诸塞州、纽约、新泽西州和宾夕法尼亚州的医院。参与者18岁的成年人-(最有可能受到改革影响的人)在改革实施前后的21个月内(2006年7月至2007年12月)，接受了12家ACSC中的任何一家。主要结果衡量所有12个急性和慢性急性脑脊髓瘤患者的入院率，以及急性和慢性急性脑脊髓炎患者的亚组入院率。结果在调整了年龄、种族、性别、县级收入、失业率和医生供给等潜在混杂因素后，我们没有发现综合ACSC的入院率(1.2%，95%可信区间−为1.6%~4.1%)或急性和慢性ACSC的亚组综合入院率的变化。我们也没有发现改革前马萨诸塞州存在的黑人和白人(−1.9%，−8.5%至5.1%)或白人和西班牙裔(2.0%，−7.5%至12.4%)之间的录取率差异。在仅限于马萨诸塞州的分析中，我们发现没有证据表明在基线未参保率较高和较低的县之间，总体综合ACSC的入院率发生变化(1.4%，−2.3%至5.3%)。结论：马萨诸塞州的改革与ACSCs入院率的总体或种族和民族差异并不显著相关。在美国，尤其是马萨诸塞州，可能需要做出更多努力，以改善获得门诊护理的机会，并减少可预防的入院人数。
Objectives To examine the impact of Massachusetts healthcare reform on changes in rates of admission to hospital for ambulatory care sensitive conditions (ACSCs), which are potentially preventable with good access to outpatient medical care, and racial and ethnic disparities in such rates, using complete inpatient discharge data (hospital episode statistics) from Massachusetts and three control states. Design Difference in differences analysis to identify the change, overall and according to race/ethnicity, adjusted for secular changes unrelated to reform. Setting Hospitals in Massachusetts, New York, New Jersey, and Pennsylvania, United States. Participants Adults aged 18-64 (those most likely to have been affected by the reform) admitted for any of 12 ACSCs in the 21 months before and after the period during which reform was implemented (July 2006 to December 2007). Main outcome measures Admission rates for a composite of all 12 ACSCs, and subgroup composites of acute and chronic ACSCs. Results After adjustment for potential confounders, including age, race and ethnicity, sex, and county income, unemployment rate and physician supply, we found no evidence of a change in the admission rate for overall composite ACSC (1.2%, 95% confidence interval −1.6% to 4.1%) or for subgroup composites of acute and chronic ACSCs. Nor did we find a change in disparities in admission rates between black and white people (−1.9%, −8.5% to 5.1%) or white and Hispanic people (2.0%, −7.5% to 12.4%) for overall composite ACSC that existed in Massachusetts before reform. In analyses limited to Massachusetts only, we found no evidence of a change in admission rate for overall composite ACSC between counties with higher and lower rates of uninsurance at baseline (1.4%, −2.3% to 5.3%). Conclusions Massachusetts reform was not associated with significantly lower overall or racial and ethnic disparities in rates of admission to hospital for ACSCs. In the US, and Massachusetts in particular, additional efforts might be needed to improve access to outpatient care and reduce preventable admissions.
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影响因子：
37.8
作者：
Albert MA;Ayanian JZ;Silbaugh TS;Lovett A;Resnic F;Jacobs A;Normand SL
通讯作者：
Normand SL
影响因子：
2.5
作者：
Chang, Cyril F.;Mirvis, David M.;Waters, Teresa M.
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影响因子：
3.4
作者：
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通讯作者：
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影响因子：
3.5
作者：
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通讯作者：
RELLES, DA
影响因子：
9.7
作者：
Joynt, Karen E.;Chan, David;Jha, Ashish K.
通讯作者：
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