Impacts of the Affordable Care Act on Receipt of Women's Preventive Services in Community Health Centers in Medicaid Expansion and Nonexpansion States.
Impacts of the Affordable Care Act on Receipt of Women's Preventive Services in Community Health Centers in Medicaid Expansion and Nonexpansion States.
复制标题
DOI：
10.1016/j.whi.2020.08.011
复制
发表时间：
2021-01
影响因子：
3.2
通讯作者：
Cottrell, Erika
中科院分区：
文献类型：
--
作者：
Hatch, Brigit;Hoopes, Megan;Darney, Blair G.;Marino, Miguel;Templeton, Anna Rose;Schmidt, Teresa;Cottrell, Erika
《平价医疗法案》（ACA）增加了美国各地的医疗保险覆盖面，并改善了某些服务的医疗服务。我们评估ACA的实施和医疗补助的扩大是否遵循了更大的接受建议的预防服务的妇女和女孩在一个大型网络的社区卫生中心。使用来自14个州354个社区健康中心的电子健康记录数据（10个扩展，4个非扩展），我们使用广义估计方程和差分方法比较了六种推荐的预防服务的接受情况（子宫颈癌检查、人类乳头瘤病毒疫苗接种、衣原体检查、流感疫苗接种、人类免疫缺陷病毒检查、和血压筛查）在ACA实施前后以及扩大与不扩大医疗补助的州之间的11至65岁的活跃女性患者（N = 711，121）中进行。除了血压筛查，所有检查预防服务的接收增加后ACA实施在医疗补助扩张和非扩张状态。流感疫苗接种和血压筛查在扩张状态下增加更多（调整后的绝对患病率差异，分别为1.55; 95%置信区间，0.51-2.60;和1.98; 95%置信区间，0.91-3.05）。在非扩张状态下，衣原体筛查增加更多（调整后的绝对患病率差异：-4.21; 95%置信区间，-6.98至-1.45）。宫颈癌筛查、人类免疫缺陷病毒筛查和人乳头瘤病毒疫苗接种的增加在扩张和非扩张状态之间没有显著差异。在社区卫生中心的女性患者中，在医疗补助扩展和非扩展状态下，ACA实施后，推荐的预防性护理的接受情况有所改善，尽管总体比率仍然很低。需要继续提供支持，以克服这一人群在预防保健方面的障碍。
The Affordable Care Act (ACA) increased health insurance coverage throughout the United States and improved care delivery for some services. We assess whether ACA implementation and Medicaid expansion were followed by greater receipt of recommended preventive services among women and girls in a large network of community health centers. Using electronic health record data from 354 community health centers in 14 states (10 expansion, 4 non-expansion), we used generalized estimating equations and difference-in-difference methods to compare receipt of six recommended preventive services (cervical cancer screening, human papilloma virus vaccination, chlamydia screening, influenza vaccination, human immunodeficiency virus screening, and blood pressure screening) among active female patients ages 11 to 65 (N = 711,121) before and after ACA implementation and between states that expanded versus did not expand Medicaid. Except for blood pressure screening, receipt of all examined preventive services increased after ACA implementation in both Medicaid expansion and nonexpansion states. Influenza vaccination and blood pressure screening increased more in expansion states (adjusted absolute prevalence difference-in-difference, 1.55; 95% confidence interval, 0.51–2.60; and 1.98; 95% confidence interval, 0.91–3.05, respectively). Chlamydia screening increased more in nonexpansion states (adjusted absolute prevalence difference-in-difference: −4.21; 95% confidence interval, −6.98 to −1.45). Increases in cervical cancer screening, human immunodeficiency virus screening, and human papilloma virus vaccination did not differ significantly between expansion and nonexpansion states. Among female patients at community health centers, receipt of recommended preventive care improved after ACA implementation in both Medicaid expansion and nonexpansion states, although the overall rates remained low. Continued support is needed to overcome barriers to preventive care in this population.
登录
查看更多内容
影响因子：
12.7
作者：
DeVoe, JE;Fryer, GE;Green, L
通讯作者：
Green, L
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
影响因子：
4.4
作者：
Angier, Heather;Hoopes, Megan;Devoe, Jennifer E.
通讯作者：
Devoe, Jennifer E.
影响因子：
2
作者：
French, Benjamin;Heagerty, Patrick J.
通讯作者：
Heagerty, Patrick J.
DOI：
10.1136/amiajnl-2014-002744
发表时间：
2014-07
期刊：
Journal of the American Medical Informatics Association : JAMIA
影响因子：
--
作者：
DeVoe JE;Gold R;Cottrell E;Bauer V;Brickman A;Puro J;Nelson C;Mayer KH;Sears A;Burdick T;Merrell J;Matthews P;Fields S
通讯作者：
Fields S