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: 10533828
• 负责人: Xu Ji
• 金额: $ 8.39万
• 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 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10533828
• 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; Functional disorder; Funding Opportunities; Future; General Population; 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; Recommendation; Research; Risk; Second Primary Cancers; Siblings; Survival Rate; Survivors; US State; Uninsured; Visit; aged; cancer prevention; cancer therapy; 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/摘要 儿童癌症幸存者患慢性病的风险增加，与晚期癌症相关的死亡率增加。 癌症治疗的影响，特别是在他们的成年人。虽然终身后续护理，特别是 对危及生命的晚期效应的监测至关重要，许多儿童癌症幸存者从未接受过 后续护理。缺乏健康保险是获得所需医疗保健服务的一个主要障碍， 儿童癌症的成年幸存者，低收入的成年幸存者特别容易被 未投保或保险不足。《平价医疗法案》（ACA）为各州扩大医疗补助提供了一种选择。 从2014年开始，覆盖所有收入不超过联邦贫困线138%的成年人。到目前为止，没有任何研究 研究了ACA医疗补助计划扩大对增加保险覆盖面的影响， 推荐的生存护理，或儿童晚期死亡率的相关下游变化 癌症幸存者我们将研究一组大约20，000名儿童癌症成年幸存者， 儿童癌症幸存者研究（CCSS），1970年至2010年期间，21岁或以下被诊断患有癌症的儿童 1999年，以及他们的4,000名兄弟姐妹，在美国所有州和哥伦比亚特区。 严格的准实验方法，以确定ACA医疗补助扩展对医疗补助的净影响 覆盖率、卫生服务利用率和晚期死亡率。哥斯达黎加社会保险局的队列将与国家 行政医疗补助数据文件，跨越四年之前（2010-2013）和之后（2014-2017） 实施医疗补助扩展，跟踪医疗补助参与率和医疗补助覆盖范围的稳定性。 数据连接还将使人们能够全面掌握筛查服务的利用情况， 晚期死亡率，反映了与生存指南一致的医疗保健获得改善，以及使用 急诊科（艾德）和住院服务的数量，这是非艾德门诊护理有限的标志。 CCSS所有参与者与国家死亡指数的现有联系将使我们能够追踪死亡率和原因 截至2017年12月31日，该人群的死亡率。这项研究将为癌症的政策干预提供信息 控制以减少儿童癌症幸存者的晚期效应相关的发病率和死亡率。