New hypertension and diabetes diagnoses following the Affordable Care Act Medicaid expansion.
New hypertension and diabetes diagnoses following the Affordable Care Act Medicaid expansion.
复制标题
新的高血压和糖尿病诊断后，可负担得起的医疗补助法扩展。
DOI：
10.1136/fmch-2020-000607
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发表时间：
2020-12
影响因子：
6.1
通讯作者：
DeVoe JE
中科院分区：
文献类型：
--
作者：
Angier H;Huguet N;Ezekiel-Herrera D;Marino M;Schmidt T;Green BB;DeVoe JE
评估平价医疗法案（ACA）医疗补助扩展对社区卫生中心（CHC）新的高血压和糖尿病诊断的影响。新的高血压和糖尿病诊断率使用广义估计方程泊松模型计算，我们测试了ACA前与ACA后的差异（DID），与那些没有扩大医疗补助的州相比。我们使用了来自全国社区卫生中心网络临床数据网络的加速数据价值的电子健康记录数据（ACA前：2012年1月1日至2013年12月31日-ACA后：2014年1月1日至2016年12月31日）。我们纳入了每个研究年有≥50例患者构成风险患者时间的诊所。纳入了研究期间≥1次门诊访视的19-64岁患者。然后，我们排除了研究期间怀孕的患者（N=127 530）。对于高血压结局，我们排除了在研究开始前诊断为高血压的个体、在首次就诊时或3年未就诊后首次就诊时诊断为高血压的个体以及在末次就诊后3年以上诊断为高血压的个体（ACA前非扩增N=130 973;扩增N=193 198; ACA后非扩增N=186 341;扩增N=251 015）。对于糖尿病分析，我们排除了在研究开始前、首次访视或非活动患者状态后首次访视时诊断为糖尿病的患者，以及诊断为非活动患者的患者（ACA非扩展前N=145 435;扩展N=198 558; ACA非扩展后N=215 039;扩展N=264 644）。在非扩张状态下，调整后的高血压诊断率相对下降6%，而在扩张状态下，调整后的高血压诊断率相对增加7%（DID 1.14，95% CI 1.11 - 1.18）。对于糖尿病诊断，非扩张状态下的校正率显著相对增加28%，扩张状态下的校正率相对增加25%;然而，与扩张和非扩张状态相比，ACA前后的这些差异并不显著（DID 0.98，95% CI 0.91至1.05）。医疗补助扩大对高血压和糖尿病诊断的影响不同。在ACA后由CHC服务的所有患者中，糖尿病诊断率适度增加（在扩展和非扩展状态下）。这些增加表明，与ACA相关的获得医疗保险的机会（如市场和医疗补助计划的扩大）可能有助于这一人群获得诊断测试。该研究发现，从ACA前到ACA后，高血压诊断率略有变化（非扩张状态减少，扩张状态增加）。尽管扩张和非扩张状态之间存在显着差异，但ACA前到ACA后的微小变化表明，无论健康保险是否可用，患者的高血压诊断都可能被记录在案。未来的研究需要了解ACA对高血压和糖尿病治疗和控制的影响。
To assess the Affordable Care Act (ACA) Medicaid expansion’s impact on new hypertension and diabetes diagnoses in community health centres (CHCs). Rates of new hypertension and diabetes diagnoses were computed using generalised estimating equation Poisson models and we tested the difference-in-difference (DID) pre-ACA versus post-ACA in states that expanded Medicaid compared with those that did not. We used electronic health record data (pre-ACA: 1 January 2012–31 December 2013—post-ACA: 1 January 2014–31 December 2016) from the Accelerating Data Value Across a National Community Health Center Network clinical data network. We included clinics with ≥50 patients contributing to person-time-at risk in each study year. Patients aged 19–64 with ≥1 ambulatory visit in the study period were included. We then excluded patients who were pregnant during the study period (N=127 530). For the hypertension outcome, we excluded individuals with a diagnosis of hypertension prior to the start of the study period, those who had a hypertension diagnosis on their first visit to a clinic or their first visit after 3 years without a visit, and those who had a diagnosis more than 3 years after their last visit (pre-ACA non-expansion N=130 973; expansion N=193 198; post-ACA non-expansion N=186 341; expansion N=251 015). For the diabetes analysis, we excluded patients with a diabetes diagnosis prior to study start, on their first visit or first visit after inactive patient status, and diagnosis while not an active patient (pre-ACA non-expansion N=145 435; expansion N=198 558; post-ACA non-expansion N=215 039; expansion N=264 644). In non-expansion states, adjusted hypertension diagnosis rates saw a relative decrease of 6%, while in expansion states, the adjusted rates saw a relative increase of 7% (DID 1.14, 95% CI 1.11 to 1.18). For diabetes diagnosis, adjusted rates in non-expansion states experienced a significant relative increase of 28% and in expansion states the relative increase was 25%; yet these differences were not significant pre-ACA to post-ACA comparing expansion and non-expansion states (DID 0.98, 95% CI 0.91 to 1.05). There was a differential impact of Medicaid expansion for hypertension and diabetes diagnoses. Moderate increases were found in diabetes diagnosis rates among all patients served by CHCs post-ACA (both in expansion and non-expansion states). These increases suggest that ACA-related opportunities to gain health insurance (such as marketplaces and the Medicaid expansion) may have facilitated access to diagnostic tests for this population. The study found a small change in hypertension diagnosis rates from pre-ACA to post-ACA (a decrease in non-expansion and an increase in expansion states). Despite the significant difference between expansion and non-expansion states, the small change from pre-ACA to post-ACA suggests that the diagnosis of hypertension is likely documented for patients, regardless of health insurance availability. Future studies are needed to understand the impact of the ACA on hypertension and diabetes treatment and control.
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影响因子：
37.8
作者：
Muntner P;Carey RM;Gidding S;Jones DW;Taler SJ;Wright JT Jr;Whelton PK
通讯作者：
Whelton PK
影响因子：
3.6
作者：
Huguet N;Hoopes MJ;Angier H;Marino M;Holderness H;DeVoe JE
通讯作者：
DeVoe JE
DOI：
10.3122/jabfm.2019.06.190087
发表时间：
2019-11-01
影响因子：
2.9
作者：
Huguet, Nathalie;Angier, Heather;DeVoe, Jennifer E.
通讯作者：
DeVoe, Jennifer E.
影响因子：
3.4
作者：
Shi, Leiyu;Lebrun, Lydie A.;Ngo-Metzger, Quyen
通讯作者：
Ngo-Metzger, Quyen
影响因子：
5.7
作者：
Tilhou, Alyssa Shell;Huguet, Nathalie;Angier, Heather
通讯作者：
Angier, Heather