Impact of the Affordable Care Act on Providing Equitable Healthcare Access for IBD in the Kentucky Appalachian Region.
Impact of the Affordable Care Act on Providing Equitable Healthcare Access for IBD in the Kentucky Appalachian Region.
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《平价医疗法案》对肯塔基州阿巴拉契亚地区 IBD 提供公平医疗服务的影响。
DOI：
10.1097/dcr.0000000000002942
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发表时间：
2023
影响因子：
3.9
通讯作者：
Bhakta,AvinashS
中科院分区：
文献类型：
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作者：
Castle,JenniferT;Levy,BrittanyE;Mangino,AnthonyA;McDonald,HannahG;McAtee,ErinE;Patel,JiteshA;Evers,BMark;Bhakta,AvinashS
背景：扩大医疗补助计划提高了慢性病和低收入患者的保险覆盖面。扩大医疗补助对来自高贫困社区的IBD患者的影响尚不清楚。目的：这项研究旨在评估肯塔基州扩大医疗补助对来自历史上贫困的东肯塔基州阿巴拉契亚社区的IBD患者护理的影响。设计：这项研究是一项回顾、描述性和生态学研究。集合：这项研究是使用医院出院和门诊服务数据库在肯塔基州进行的。PATIENTS：纳入2009-2020年东肯塔基州阿巴拉契亚地区患者的所有IBD护理。MAIN结果测量：测量的主要结果是住院和急诊的比例、住院总费用、住院费用和门诊服务结果：共发现扩张期前825例，扩张期后5726例。扩招后，未参保者(9.2%-1.0%；p<；0.001)、住院次数(42.7%-8.1%；p<；0.001)、急诊入院(36.7%-12.3%；p<；0.001)、急诊科入院率(8.0%-0.2%；p<；0.001)、住院总费用中位数(7,080-3,260美元；p<；0.001)、住院总住院时间中位数(4-3天；p<；0.001)、住院总费用中位数(7,080-3,260美元；p<；0.001)、住院总住院天数(4-3天；p<；0.001)、急诊科入院率(8.0%-0.2%；p<；0.001)、住院总费用中位数(7,080-3,260美元；p<；0.001)、住院总住院时间中位数(4-3天；p<；0.001)、急诊科入院率(8.0%-0.2%；p<；0.001)、住院总费用中位数(7,080-3,260美元；p<；0.001)、住院总住院时间中位数(4-3天；p<；0.001)、急诊科住院人数(8.0%-0.2%；p<；0.001)、住院总费用中位数(7,080-3,260美元；p<；0.001)、住院总住院时间中0.001)。同样，扩大后的医疗补助覆盖范围(18.8%-27.7%；p<；0.001)、门诊就诊(57.3%-91.9%；p<；0.001)、选择性入院(46.9%-76.2%；p<；0.001)、诊所入院(78.4%-90.2%；p<；0.001)和出院(43.8%-88.2%；p<；0.001)限制：这项研究受限于回顾和使用部分不确定的数据库所固有的限制。结论：这项研究是第一次展示医疗补助扩大后肯塔基州，特别是阿巴拉契亚肯塔基州IBD患者护理趋势的变化，显示门诊护理利用率显著增加，急诊科就诊次数减少，住院时间减少。
BACKGROUND:Medicaid expansion improved insurance coverage for patients with chronic conditions and low income. The effect of Medicaid expansion on patients with IBD from high-poverty communities is unknown.OBJECTIVE:This study aimed to evaluate the impact of Medicaid expansion in Kentucky on care for patients with IBD from the Eastern Kentucky Appalachian community, a historically impoverished area.DESIGN:This study was a retrospective, descriptive, and ecological study.SETTINGS:This study was conducted in Kentucky using the Hospital Inpatient Discharge and Outpatient Services Database.PATIENTS:All encounters for IBD care for 2009–2020 for patients from the Eastern Kentucky Appalachian region were included.MAIN OUTCOME MEASURES:The primary outcomes measured were proportions of inpatient and emergency encounters, total hospital charge, and hospital length of stay.RESULTS:Eight hundred twenty-five preexpansion and 5726 postexpansion encounters were identified. Postexpansion demonstrated decreases in the uninsured (9.2%–1.0%; p< 0.001), inpatient encounters (42.7%–8.1%; p< 0.001), emergency admissions (36.7%–12.3%; p< 0.001), admissions from the emergency department (8.0%–0.2%; p< 0.001), median total hospital charge ($7080–$3260; p< 0.001), and median total hospital length of stay (4–3 days; p< 0.001). Similarly, postexpansion demonstrated increases in Medicaid coverage (18.8%–27.7%; p< 0.001), outpatient encounters (57.3%–91.9%; p< 0.001), elective admissions (46.9%–76.2%; p< 0.001), admissions from the clinic (78.4%–90.2%; p< 0.001), and discharges to home (43.8%–88.2%; p< 0.001).LIMITATIONS:This study is subject to the limitations inherent in being retrospective and using a partially de-identified database.CONCLUSION:This study is the first to demonstrate the changes in trends in care after Medicaid expansion for patients with IBD in the Commonwealth of Kentucky, especially Appalachian Kentucky, showing significantly increased outpatient care utilization, reduced emergency department encounters, and decreased length of stays.