Association Between Medicaid Expansion and Diagnosis and Management of Colon Cancer.
Association Between Medicaid Expansion and Diagnosis and Management of Colon Cancer.
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DOI：
10.1016/j.jamcollsurg.2020.10.021
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发表时间：
2021-03
影响因子：
5.2
通讯作者：
Tohme ST
中科院分区：
文献类型：
--
作者：
Hoehn RS;Rieser CJ;Phelos H;Sabik LM;Nassour I;Paniccia A;Zureikat AH;Tohme ST
《平价医疗法案》（Affordable Care Act）为扩大医疗补助覆盖范围的州改善了保险覆盖面，但对癌症预后的影响尚不清楚。这项研究比较了参与和未参与医疗补助扩大的州在结肠癌诊断和管理方面的变化。使用准实验差分法（DID），我们分析了国家癌症数据库中两个时间段的医疗补助和未参保患者：扩张前（2011-12）和扩张后（2015-16）。将未扩展状态的患者与2014年1月扩展状态的患者在患者和设施特征、癌症分期、治疗决策和手术结果方面的变化进行比较。随着医疗补助覆盖率的增加（DID=20.27, p<0.001），扩展州的患者在I期诊断（DID=2.97, p=0.035），旅行距离（英里，DID=6.67, p=0.005）和综合网络计划治疗（DID=2.67, p=0.045）方面有所增加。早期患者在30天内接受治疗较多（DID=7.24, p=0.035）， IV期患者接受姑息治疗较多（DID=5.01, p=0.048）。在外科患者中，医疗补助扩大与急诊病例减少（<7天，DID= - 5.88, p=0.008）和微创手术增多（DID=5.00, p=0.022）相关。在术后结果或辅助化疗方面没有观察到差异。扩大医疗补助与结肠癌患者早期诊断、增加就诊机会和改善手术护理相关。这些发现突出了改善健康保险覆盖面的重要性，并可能有助于指导未来的政策努力。这项对国家癌症数据库的准实验分析发现，扩大医疗补助与早期诊断和改善结肠癌患者的治疗有关。
The Affordable Care Act facilitated improved insurance coverage for states that expanded Medicaid coverage, but the impact on cancer outcomes is unclear. This study compared changes in the diagnosis and management of colon cancer in states that did and did not participate in Medicaid expansion. Using a quasi-experimental difference-in-differences (DID) approach, we analyzed Medicaid and uninsured patients in the National Cancer Data Base during two time periods: pre- (2011–12) and post-expansion (2015–16). Patients in non-expansion states were compared to those in January 2014 expansion states with regard to changes in patient and facility characteristics, cancer staging, treatment decisions, and surgical outcomes. Along with increased Medicaid coverage (DID=20.27, p<0.001), patients in expansion states had an increase in Stage I diagnoses (DID=2.97, p=0.035), distance travelled (miles, DID=6.67, p=0.005), and treatment at integrated network programs (DID=2.67, p=0.045). More early stage patients were treated within 30 days (DID=7.24, p=0.035) and more Stage IV patients received palliative care (DID=5.01, p=0.048). Among surgical patients, Medicaid expansion correlated with fewer urgent cases (<7 days, DID=−5.88, p=0.008) and more minimally invasive surgery (DID=5.00, p=0.022). There were no observed differences in postoperative outcomes or adjuvant chemotherapy. Medicaid expansion correlated with earlier diagnosis, enhanced access, and improved surgical care for colon cancer patients. These findings highlight the importance of improving health insurance coverage and may help guide future policy efforts. This quasi-experimental analysis of the National Cancer Data Base found that Medicaid Expansion correlated with earlier diagnosis, and improved treatment for patients with colon cancer.
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影响因子：
16.9
作者：
Bailey CE;Hu CY;You YN;Bednarski BK;Rodriguez-Bigas MA;Skibber JM;Cantor SB;Chang GJ
通讯作者：
Chang GJ
影响因子：
13.8
作者：
Takvorian, Samuel U.;Oganisian, Arman;Werner, Rachel M.
通讯作者：
Werner, Rachel M.
影响因子：
12.7
作者：
Soni, Aparna;Simon, Kosali;Sabik, Lindsay
通讯作者：
Sabik, Lindsay
DOI：
10.1016/j.jamcollsurg.2017.09.012
发表时间：
2018-01-01
影响因子：
5.2
作者：
Xiao, David;Zheng, Chaoyi;Al-Refaie, Waddah B.
通讯作者：
Al-Refaie, Waddah B.
影响因子：
--
作者：
Loehrer, Andrew P.;Chang, David C.;Chang, George J.
通讯作者：
Chang, George J.