Association Between Adolescent Preventive Care and the Role of the Affordable Care Act
Association Between Adolescent Preventive Care and the Role of the Affordable Care Act
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DOI：
10.1001/jamapediatrics.2017.3140
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发表时间：
2018-01-01
期刊：
影响因子：
26.1
通讯作者：
Irwin, Charles E., Jr.
中科院分区：
文献类型：
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作者：
Adams, Sally H.;Park, Jane;Irwin, Charles E., Jr.
尽管几十年来青少年预防性就诊和服务促进(青少年预防服务和光明未来指南)很重要，但比率低于推荐水平，而且对患者保护和平价医疗法案(ACA)实施对这些照顾率的影响知之甚少。目的使用医疗支出小组调查数据来确定(1)青少年良好就诊率是否从ACA前增加到ACA后，以及(2)在进行过任何过去一年卫生保健访问的青少年中，照顾者对过去一年预防性服务交付的报告是否从ACA前增加到ACA后。设计、设置、和参与者对2007-2009年(ACA实施前)和2012-2014(ACA实施后)医疗支出小组调查数据进行二次数据分析，了解探井和预防服务的差异。数据是通过计算机辅助的个人访谈收集的，该样本是美国非制度化人口(n=25,89510-17岁)的全国代表性样本的照顾者。主要结果和测量目标1，ACA前后在过去一年探井的差异：(1)确定亚组比率差异的分层双变量Logistic回归和(2)控制人口因素的多变量分析。对于目标2，ACA前和ACA后照顾者接受预防性服务报告的差异，包括与临床医生单独相处的时间：(1)双变量(年份差异)和(2)控制人口统计学变量的多变量Logistic回归。结果ACA前和ACA后数据中，共有6279名(50.9%)和6730名(50.8%)参与调查的青少年为男性。在目标1下，我们发现ACA实施后的好访率从41%增加到48%(优势比1.3；95%CI，1.2-1.5)；少数族裔和低收入组的增长最大，在目标2下，我们发现在过去一年的任何一次访问中，大多数预防服务率(8/9)增加了ACA实施后(范围，2%-9%，绝对)，当控制人口变量时，变化很小或没有变化。与临床医生独处的时间增加了1%，只有在控制协变量时才有意义(调整后的优势比，1.2；95%可信区间。结论和相关性尽管青少年预防保健率有小幅到中等的增长，但服务不足的青少年的预防保健率仍然很低，这突出表明需要加大努力，使青少年得到良好的护理，并在其实践中改善临床医生提供的预防保健品。
IMPORTANCE Despite decades of adolescent preventive well visit and services promotion (Guidelines for Adolescent Preventive Services and Bright Futures), rates are below recommended levels and little is known of the effect of the Patient Protection and Affordable Care Act (ACA) implementation on these care rates.OBJECTIVES To use Medical Expenditure Panel Survey data to determine (1) whether adolescent well visit rates increased from the pre-ACA period to post-ACA period, and (2) whether caregivers' reports of past-year preventive services delivery increased from the pre-to post-ACA period among adolescents with any past-year health care visit.DESIGN, SETTING, AND PARTICIPANTS Secondary data analysis of 2007-2009 (before ACA implementation) and 2012-2014 (after ACA implementation) Medical Expenditure Panel Survey data on the differences in well visits and preventive services. Data were collected through computer-assisted personal interviews of caregivers of a nationally representative sample of a noninstitutionalized US population (n = 25 89510-to 17-year-old adolescents).MAIN OUTCOMES AND MEASURES For objective 1, pre-to post-ACA period differences in past-year well visits: (1) stratified bivariable logistic regressions identifying subgroup rate differences and (2) multivariable analyses controlling for demographic factors. For objective 2, pre-to post-ACA period differences in caregiver reports of preventive services receipt, including time alone with clinician: (1) bivariable (year differences) and (2) multivariable logistic regressions controlling for demographic variables.RESULTS A total of 6279 (50.9%) and 6730 (50.8%) participating adolescents in the pre-and post-ACA period data were male, respectively. Under objective 1, we found that well-visit rates increased from 41% to 48% post-ACA implementation (odds ratio, 1.3; 95% CI, 1.2-1.5); minority and low-income groups had the greatest increases, Under objective 2, we found that among those with any past-year visit, most preventive services rates (8 of 9) increased post-ACA implementation (range, 2%-9%, absolute), with little or no change when control ling for demographic variables. Time alone with clinicians increased 1%, significant only when covariates were controlled (adjusted odds ratio, 1.2; 95% CI. 1.0-1.3).CONCLUSIONS AND RELEVANCE Despite modest to moderate increases, with greatest gains for underserved youth, adolescent preventive care rates remain low, highlighting the need for increased efforts to bring adolescents into well care and improve clinician delivery of preventive care within their practices.