Association of Affordable Care Act Implementation With Ambulance Utilization for Asthma Emergencies in New York City, 2008-2018.
Association of Affordable Care Act Implementation With Ambulance Utilization for Asthma Emergencies in New York City, 2008-2018.
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DOI：
10.1001/jamanetworkopen.2020.25586
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发表时间：
2020-11-02
影响因子：
13.8
通讯作者：
Camargo CA Jr
中科院分区：
文献类型：
--
作者：
Peters GA;Ordoobadi AJ;Cash RE;Wong ML;Avillach P;Camargo CA Jr
对于像哮喘这样的非卧床护理敏感性疾病，保险扩张和紧急医疗服务（EMS）派遣之间有什么联系？在这项队列研究中，包括纽约市217303例哮喘急诊EMS调度，患者保护和平价医疗法案的实施与哮喘急诊呼叫的减少有关。在调整后的模型中，未投保率的较大下降与哮喘EMS派遣率的较大下降相关。这项研究的结果表明，保险的扩大可能会导致改善门诊管理的门诊护理敏感的条件，如哮喘，导致减少使用EMS。这项准实验性队列研究通过检查2008年至2018年纽约市哮喘急诊救护车派遣率的变化，评估了平价医疗法案实施与哮喘治疗之间的关联。紧急医疗服务（EMS）是医疗保健系统的重要组成部分，但保险扩张对EMS呼叫量的影响仍不清楚。这项研究调查了健康保险的扩大和EMS派遣哮喘之间的关系，哮喘是一种对门诊护理敏感的疾病。我们假设，根据《患者保护和平价医疗法案》（ACA）扩大保险范围与哮喘紧急情况的EMS派遣减少有关。这项队列研究检查了2008年至2018年纽约市内发出的14 865 267次救护车呼叫，包括217 303次哮喘相关紧急呼叫，并使用中断时间序列分析研究了ACA实施后哮喘紧急EMS派遣的年发生率变化。多变量线性回归分析了未投保率与哮喘相关调度发生率之间的关系，控制了人口统计学特征和空气质量指数。ACA于2014年1月1日生效。根据911接警员分类，每年每100 000人哮喘紧急情况的EMS派遣发生率（即哮喘EMS派遣率）。在这项研究中，217303例哮喘相关紧急情况的EMS派遣率在实施ACA后有所下降，从干预前的平均（SD）每10万人每年261（24）次派遣到干预后的211（47）次派遣（P = 0.047）。ACA实施后哮喘EMS派遣率的下降在中断时间序列分析中具有显著性。在2014年之前，哮喘EMS年派遣率每年每10万人增加11.8次呼叫（95% CI，6.1 - 17.4）。ACA实施后，哮喘EMS派遣率每年每10万人下降28.5次（95%CI，-37.6至19.3），与干预前相比，斜率有显著变化（P <0.001）。多变量线性回归，控制18岁以下的个人百分比，种族/民族多样性程度，家庭收入中位数和空气质量指数，发现全市未保险率下降1%与每年每10万人口减少98.9例哮喘派遣相关（95%CI，5.72-192.10; P = 0.04）。ACA下纽约市内的保险扩张与哮喘EMS派遣率的显著降低相关。保险扩展可能是一个可行的方法，以减少EMS的使用门诊护理敏感的条件，如哮喘。
What is the association between insurance expansion and emergency medical services (EMS) dispatches for an ambulatory care–sensitive condition like asthma? In this cohort study including 217 303 EMS dispatches for asthma emergencies in New York City, implementation of the Patient Protection and Affordable Care Act was associated with a decrease in calls for asthma emergencies. In adjusted models, larger decreases in the uninsured rate were associated with larger decreases in the asthma EMS dispatch rate. The findings of this study suggest that insurance expansion may lead to improved outpatient management of ambulatory care–sensitive conditions like asthma, resulting in decreased utilization of EMS. This quasi-experimental cohort study assesses the association between Affordable Care Act implementation and asthma treatment by examining changes in ambulance dispatch rates for asthma emergencies in New York City between 2008 and 2018. Emergency medical services (EMS) are an essential component of the health care system, but the effect of insurance expansion on EMS call volume remains unclear. This study investigated the association between health insurance expansion and EMS dispatches for asthma, an ambulatory care–sensitive condition. We hypothesized that insurance expansion under the Patient Protection and Affordable Care Act (ACA) would be associated with decreased EMS dispatches for asthma emergencies. This cohort study examined 14 865 267 ambulance calls dispatched within New York City from 2008 to 2018, including 217 303 calls for asthma-related emergencies, and used interrupted time series analysis to study the change in the annual incidence of EMS dispatches for asthma emergencies after implementation of the ACA. Multivariable linear regression examined the association between the uninsured rate and the incidence of asthma-related dispatches, controlling for population demographic characteristics and air quality index. Implementation of ACA on January 1, 2014. Incidence of EMS dispatches for asthma emergencies per 100 000 population per year (ie, asthma EMS dispatch rate) as classified by the 911 call–taker. In this study of 217 303 EMS dispatches for asthma-related emergencies, there was a decrease in the asthma EMS dispatch rate after implementation of the ACA, from a mean (SD) of 261 (24) dispatches per 100 000 population per year preintervention to 211 (47) postintervention (P = .047). This decrease in asthma EMS dispatch rate after ACA implementation was significant on interrupted time series analysis. Prior to 2014, the annual asthma EMS dispatch rate was increasing by 11.8 calls per 100 000 population per year (95% CI, 6.1 to 17.4). After ACA implementation, the asthma EMS dispatch rate decreased annually by 28.5 calls per 100 000 population per year (95% CI, −37.6 to −19.3), a significant change in slope from the preintervention period (P < .001). Multivariable linear regression, controlling for percentage of individuals younger than age 18 years, degree of racial/ethnic diversity, median household income, and air quality index, found that a 1% decrease in the citywide uninsured rate was associated with a decrease of 98.9 asthma dispatches per 100 000 population per year (95% CI, 5.72-192.10; P = .04). Insurance expansion within New York City under the ACA was associated with a significant reduction in the asthma EMS dispatch rate. Insurance expansion may be a viable method to reduce EMS utilization for ambulatory care–sensitive conditions such as asthma.
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影响因子：
2.3
作者：
Al-Muhsen S;Horanieh N;Dulgom S;Aseri ZA;Vazquez-Tello A;Halwani R;Al-Jahdali H
通讯作者：
Al-Jahdali H
影响因子：
5.8
作者：
Eisner MD;Katz PP;Yelin EH;Shiboski SC;Blanc PD
通讯作者：
Blanc PD
影响因子：
1.9
作者：
Guilbert, Theresa W.;Garris, Cindy;Schatz, Michael
通讯作者：
Schatz, Michael
影响因子：
5.1
作者：
Cloutier, MM;Hall, CB;Bailit, H
通讯作者：
Bailit, H
影响因子：
13.8
作者：
Courtemanche, Charles;Friedson, Andrew I.;Rees, Daniel I.
通讯作者：
Rees, Daniel I.