Community Health Center Use After Oregon's Randomized Medicaid Experiment
Community Health Center Use After Oregon's Randomized Medicaid Experiment
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DOI：
10.1370/afm.1812
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发表时间：
2015-07-01
影响因子：
4.4
通讯作者：
Bailey, Steffani R.
中科院分区：
文献类型：
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作者：
DeVoe, Jennifer E.;Marino, Miguel;Bailey, Steffani R.
目的：关于社区卫生中心（CHCs）是否会因《平价医疗法案》（Affordable Care Act）的医疗补助扩张而增加患者的需求，存在争议。为了更好地理解新的医疗补助覆盖对CHC使用的影响，我们研究了俄勒冈州2008年的随机医疗补助扩张（“俄勒冈实验”）。方法我们将参与俄勒冈实验的成年人（19-64岁）的人口统计数据与OCHIN社区卫生信息网络（原俄勒冈社区卫生信息网络）内108个俄勒冈州CHCs的电子健康记录数据进行概率匹配（N = 34,849）。我们使用零膨胀泊松回归模型进行了意向治疗分析，以比较选择申请医疗补助与未选择的36个月（2008-2011）的使用率，并使用工具变量分析来估计获得医疗补助覆盖对使用率的影响。使用结果包括初级保健就诊、行为/心理健康就诊、实验室检查、转诊、免疫接种和影像学检查。结果：意向治疗分析显示，随机选择申请医疗补助的患者与未选择申请医疗补助的患者在行为/心理健康就诊、转诊和影像学方面的比率有统计学显著差异。在工具变量分析中，获得医疗补助覆盖显著增加了初级保健就诊、实验室检查、转诊和成像的比率；比率范围从实验室检查的1.27 （95% CI, 1.05-1.55）到转诊的1.58 （95% CI, 1.10-2.28）。结论：我们的研究结果表明，随着患者通过平价医疗法案的扩展获得医疗补助，许多不同类型的CHC服务的使用将会增加。为了最大限度地获得关键卫生服务，重要的是要确保卫生保健系统能够通过向卫生保健中心和其他初级卫生保健机构提供更多资源来支持日益增长的需求。
PURPOSE There is debate about whether community health centers (CHCs) will experience increased demand from patients gaining coverage through Affordable Care Act Medicaid expansions. To better understand the effect of new Medicaid coverage on CHC use over time, we studied Oregon's 2008 randomized Medicaid expansion (the "Oregon Experiment").METHODS We probabilistically matched demographic data from adults (aged 19-64 years) participating in the Oregon Experiment to electronic health record data from 108 Oregon CHCs within the OCHIN community health information network (originally the Oregon Community Health Information Network) (N = 34,849). We performed intent-to-treat analyses using zero-inflated Poisson regression models to compare 36-month (2008-2011) usage rates among those selected to apply for Medicaid vs not selected, and instrumental variable analyses to estimate the effect of gaining Medicaid coverage on use. Use outcomes included primary care visits, behavioral/mental health visits, laboratory tests, referrals, immunizations, and imaging.RESULTS The intent-to-treat analyses revealed statistically significant differences in rates of behavioral/mental health visits, referrals, and imaging between patients randomly selected to apply for Medicaid vs those not selected. In instrumental variable analyses, gaining Medicaid coverage significantly increased the rate of primary care visits, laboratory tests, referrals, and imaging; rate ratios ranged from 1.27 (95% CI, 1.05-1.55) for laboratory tests to 1.58 (95% CI, 1.10-2.28) for referrals.CONCLUSIONS Our results suggest that use of many different types of CHC services will increase as patients gain Medicaid through Affordable Care Act expansions. To maximize access to critical health services, it will be important to ensure that the health care system can support increasing demands by providing more resources to CHCs and other primary care settings.