Understanding the impact of the Affordable Care Act on healthcare coverage, utilization, and outcomes for childhood cancer survivors

了解《平价医疗法案》对儿童癌症幸存者的医疗保健覆盖范围、利用和结果的影响

• 批准号: 10359441
• 负责人: Xu Ji
• 金额: $ 8.6万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-12-03 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10359441
• 关键词: 21 year old; Accident and Emergency department; Adherence; Adult; Affect; Affordable Care Act; Ambulatory Care; Cancer Control; Cancer Intervention; Cardiovascular Diseases; Caring; Cause of Death; Cessation of life; Childhood Cancer Survivor Study; Chronic; Cohort Studies; Complex; Data; Data Files; Data Linkages; Diagnosis; Early Diagnosis; Emergency Situation; Emergency department visit; Enrollment; Funding Opportunities; Future; General Population; Geographic state; Guidelines; Health; Health Insurance; Health Services Accessibility; Healthcare; Hospitalization; Improve Access; Income; Inpatients; Insurance Coverage; Intervention; Late Effects; Lead; Life; Link; Low income; Lung; Lung diseases; Malignant Childhood Neoplasm; Malignant Neoplasms; Medicaid; Morbidity - disease rate; Outcome; Participant; Policies; Population; Population Research; Public Health; Quasi-experiment; Research; Risk; Second Primary Cancers; Siblings; Survival Rate; Survivors; Uninsured; Visit; aged; cancer prevention; cancer therapy; care outcomes; childhood cancer mortality; childhood cancer survivor; cohort; federal poverty level; follow-up; health care availability; health care service; health care service utilization; health service use; high risk population; improved; indexing; inpatient service; mortality; screening guidelines; screening services; secondary analysis; survivorship

PROJECT SUMMARY/ABSTRACT Childhood cancer survivors have increased risks for chronic conditions and mortality associated with late effects of cancer treatment, particularly in their adult years. While lifetime follow-up care, specifically surveillance for life-threatening late effects, is vitally important, many childhood cancer survivors never receive follow-up care. Lack of health insurance coverage is a key barrier to accessing needed healthcare services for adult-aged survivors of childhood cancer, with low-income adult survivors particularly vulnerable to being uninsured or underinsurance. The Affordable Care Act (ACA) provided an option for states to expand Medicaid coverage starting in 2014 to all adults with income ≤138% of the federal poverty level. To date, no studies have examined the impact of the ACA Medicaid expansion on increasing insurance coverage, improving access to recommended survivorship care, or the associated downstream changes in late mortality among childhood cancer survivors. We will study a cohort of approximately 20,000 adult survivors of childhood cancer from the Childhood Cancer Survivor Study (CCSS) who were diagnosed with cancer at age 21 or younger during 1970- 1999, as well as 4,000 of their siblings, across all US states and D.C. The nationwide CCSS cohort will allow a rigorous quasi-experimental approach to determine the net effect of the ACA Medicaid expansion on Medicaid coverage, health service utilization, and late mortality. The CCSS cohort will be linked to the national administrative Medicaid data files, spanning four years before (2010-2013) and after (2014-2017) the implementation of Medicaid expansion, to trace Medicaid participation rates and stability of Medicaid coverage. The data linkage will also allow the comprehensive capture of utilization of screening services for key drivers of late mortality, reflecting improved access to healthcare concordant with survivorship guidelines, as well as use of emergency department (ED) and inpatient services, a marker for limited access to non-ED ambulatory care. The existing link of all CCSS participants to the National Death Index will allow us to trace mortality and cause of death in this population through December 31, 2017. This research will inform policy interventions for cancer control toward reducing late effects related morbidity and mortality for childhood cancer survivors.

项目总结/文摘