Emergency Department and Ambulatory Care Visits in the First Twelve Months of Coverage Under Medicaid Expansion: A Group-Based Trajectory Analysis.
Emergency Department and Ambulatory Care Visits in the First Twelve Months of Coverage Under Medicaid Expansion: A Group-Based Trajectory Analysis.
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DOI：
10.1016/j.annemergmed.2021.01.015
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发表时间：
2021-07
影响因子：
6.2
通讯作者：
Donohue JM
中科院分区：
文献类型：
--
作者：
Hollander MAG;Cole ES;Sabik LM;Kahn JM;Chang CH;Jarlenski MP;Donohue JM
超过1700万人通过《平价医疗法案》（ACA）的医疗补助计划扩展获得了医疗保险覆盖。很少有研究对医疗补助计划扩展受益人群内部的异质性进行考察。
我们采用基于群体的多轨迹建模方法，对2015 - 2017年宾夕法尼亚州医疗补助计划扩展受益人群在参保头12个月内的门诊医疗和急诊使用情况的轨迹进行联合估算。
在601877名扩展受益人群中，我们根据急诊和门诊医疗使用的联合轨迹确定了六个不同的群体。各群体在第一个月每100名参保者的急诊平均使用次数在3.4次到48.7次之间，在第12个月每100名参保者的急诊平均使用次数在2.8次到44.0次之间。第一个月每100名参保者的门诊平均就诊次数在0次到179次之间，第12个月在0次到274次之间。在研究期间，急诊就诊率并未随时间变化，但有四个群体的门诊就诊率至少增长了50%。各群体在慢性病诊断方面存在差异，包括心理健康和物质使用障碍，以及与门诊就诊相关的诊断。
我们发现，在根据实证定义的医疗补助计划扩展受益人群子群体中，急诊和门诊医疗的使用率存在显著差异。我们还确定了与这些就诊相关的诊断之间的异质性。这种基于数据的方法可用于有针对性地分配资源，以鼓励高效使用急诊服务，并支持与门诊医疗服务提供者的互动。
More than 17 million people have gained health insurance coverage through the Affordable Care Act’s (ACA) Medicaid expansion. Few studies have examined heterogeneity within the Medicaid expansion population. We used group-based multi-trajectory modeling to jointly estimate trajectories of ambulatory care and ED utilization in the first 12 months of enrollment among Pennsylvania Medicaid expansion enrollees from 2015–2017. Among 601,877 expansion enrollees, we identified six distinct groups based on joint trajectories of ED and ambulatory care use. Mean ED use varied across groups from 3.4 to 48.7 visits per 100 enrollees in the first month and between 2.8 and 44.0 visits per 100 enrollees in month 12. Mean ambulatory visits rates varied from 0.0 to 179 visits per 100 enrollees in the first month and from 0.0 to 274 visits in month 12. Rates of ED visits did not change over time, but rates of ambulatory care visits increased by at least 50% among four groups during the study period. Groups varied on chronic condition diagnoses, including mental health and substance use disorders, as well as diagnoses associated with ambulatory care visits. We find substantial variation in rates of ED and ambulatory care use across empirically defined subgroups of Medicaid expansion enrollees. We also identified heterogeneity among the diagnoses associated with these visits. This data-driven approach may be used to target resources to encourage efficient use of ED services and support engagement with ambulatory care providers.
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