Center for Health Insurance Reform, Cardiovascular Outcomes, and Disparities

描述（由申请人提供）：在美国的一个中心政策假设今天是，扩大医疗保险覆盖范围将改善获得医疗保健，改善健康结果，并使每一个更公平的所有美国人。事实上，缺乏健康保险与心血管（CV）和其他护理的使用减少，健康状况不佳和死亡率增加有关。获得保健的机会有限是造成结果差异的最主要因素之一。马萨诸塞州（MA）是一个关键的政策相关的自然实验的网站，最近的立法已导致97%的国家的居民获得医疗保险;因此，它是理想的设置，以监测和评估心血管疾病的健康结果，并在这种结果的差异。我们建议在波士顿大学医学院和波士顿医学中心（新英格兰最大的安全网医院）建立“健康保险改革、心血管结局和差异中心”。我们将通过两项研究来检查MA卫生改革对心血管护理和结果的影响，以及两者之间的差异。第一项研究将评估扩大保险范围是否会减少门诊护理敏感性CV疾病的可预防住院和CV疾病的再入院。该项目还将评估种族敏感心脏手术的比率，以及少数种族/族裔患者使用安全网医院的情况。第二个项目将审查护理和成果， 静脉血栓栓塞症（VTE）的护理改革前后，检查是否增加获得初级和家庭护理，门诊药房服务，将与更好的临床结果，以及改善健康相关的生活质量，生存和成本效益。我们中心的具体目标是：1）开展研究，以评估MA的卫生改革对CV结局的影响; 2）与其他现有中心在CV结局研究方面进行补充和合作。3)将三名早期研究者培养成经验丰富的CV结局研究者，他们精通该领域的问题、主题和方法，并且在中心活动完成后，将准备为CV结局研究领域做出实质性的未来贡献。

DESCRIPTION (provided by applicant): One of the central policy assumptions in the U.S. today is that expanding health insurance coverage will improve access to health care, improve health outcomes, and make each more equitable for all Americans. Indeed, lack of health insurance is associated with less use of cardiovascular (CV) and other care, poor health outcomes, and increased mortality. Limited access to care is one of strongest contributors to disparities in outcomes. Massachusetts (MA) is the site of a key policy-relevant natural experiment, whereby recent legislation has resulted in 97% of the state's residents obtaining health insurance; it is thus the ideal setting in which to monitor and evaluate CV health outcomes, and disparities in such outcomes. We propose to develop the "Center for Health Insurance Reform, Cardiovascular Outcomes, and Disparities" at Boston University School of Medicine and Boston Medical Center, New England's largest safety net hospital. We will examine the effects of MA health reform on CV care and outcomes, and in disparities in each, through two studies. The first will evaluate whether expanded insurance coverage will be associated with fewer preventable inpatient admissions for ambulatory care sensitive CV conditions and readmissions for CV conditions. This project will also assess rates of referral-sensitive cardiac procedures, and the use of safety-net hospitals by racial/ethnic minority patients. The second project will examine care and outcomes of care for venous thromboembolism (VTE) both pre- and post-reform, examining whether increased access to primary and home care, and to outpatient pharmacy services, will be associated with better clinical outcomes, as well as improved health related quality of life, survival and cost-effectiveness. The specific aims of our Center are: 1) To conduct research to evaluate the effects of health reform in MA on CV outcomes; 2) To complement and collaborate with other existing centers in CV outcomes research. 3) To develop three Early Stage Investigators into seasoned CV outcomes researchers who are well versed in the issues, topics and methods in the field, and who, upon the completion of the center activities, will be poised to make substantial future contributions to the field of CV outcomes research.