Center for Health Insurance Reform, Cardiovascular Outcomes, and Disparities

描述（由申请人提供）：当今美国的核心政策假设之一是，扩大医疗保险覆盖范围将改善获得医疗保健的机会，改善健康结果，并使所有美国人更加公平。事实上，缺乏健康保险与较少使用心血管（CV）和其他护理、不良健康结果和死亡率增加有关。获得医疗服务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）是一项与政策相关的关键自然实验的所在地，最近的立法使该州97%的居民获得了医疗保险；因此，它是监测和评估心血管健康结果以及这些结果差异的理想环境。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、心血管结果和差异中心”。我们将通过两项研究来检验MA医疗改革对CV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覆盖范围是否与可预防的门诊敏感心血管疾病住院人数减少和心血管疾病再入院人数减少有关。该项目还将评估对转诊敏感的心脏手术的比率，以及少数种族/族裔患者使用安全网医院的比率。第二个项目将检查护理和结果

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.