The Impact of Massachusetts Health Insurance Reform on Critical Care Resource Uti

描述（由申请人提供）：以前的研究表明，保险状况可能会在危重病患者的利用和结局中发挥作用。然而，这种影响的机制尚不清楚，医疗保险扩张对重症监护利用的影响尚不清楚（1-5）。马萨诸塞州于2006年启动了全州范围的保险改革，目标是实现近乎全民的保险覆盖，在三年内将未投保的州居民比例从约7.5%降至3%以下（6）。这项立法成为美国国会2010年3月通过的《患者保护和平价医疗法》的范本。在美国，几乎全民的医疗保险覆盖率是前所未有的，了解医疗保险改革对重症监护服务利用率的影响至关重要。该提案概述了一项计划，利用马萨诸塞州改革的自然实验来检查和帮助预测国民健康保险改革对重症护理提供的影响。在目标一中，我将确定马萨诸塞州保险改革和重症监护病房入院率之间的关系。在目标二中，我将确定马萨诸塞州保险改革与危重病患者总住院时间之间的关系。这两个目标都将使用医疗保健研究和质量机构的医疗保健成本和利用项目提供的州出院数据，使用差异中的差异方法比较马萨诸塞州与几个对照州随时间推移的住院情况。除了解决这些研究目标，在这个奖学金的过程中，我将从事教学课程工作和密切的研究指导由高级卫生服务研究人员，卫生经济学家，临床流行病学家和生物统计学家严格的培训计划。在整个研究和培训计划的实施过程中，我将获得技能，使我能够成为一名成熟的研究者，并竞争K系列职业发展奖。最终，这个NRSA奖学金的机会将使我能够通过深入了解医疗保险改革对重症监护利用的影响，为医疗服务研究和重症监护医学领域做出重大贡献。这项研究将有助于预测资源分配需求，并更好地为医疗保健改革的讨论提供信息。 公共卫生相关性：在美国，危重病的临床和经济负担是巨大的，每年有超过500万美国人住进重症监护室，费用接近国内生产总值的1%。本计画将产生新的见解，医疗保险改革对重症照护利用的作用，并提供一个机会，为主要研究者发展成为一个独立的研究人员，在该领域的重症照护卫生服务研究。

DESCRIPTION (provided by applicant): Previous studies suggest that insurance status may play a role in utilization and outcomes for patients with critical illness. However, the mechanism for this effect is unclear, and the impact of health insurance expansion on critical care utilization is unknown (1-5). Massachusetts initiated statewide insurance reform in 2006 with the goal of near-universal insurance coverage, decreasing the rate of uninsured state residents from approximately 7.5% to less than 3% within three years (6). This legislation served as a model for the Patient Protection and Affordable Care Act passed by the United States Congress in March 2010. Near-universal health insurance coverage is unprecedented in the United States and it is critical to understand the impact of health insurance reform on critical care service utilization. This proposal outlines a plan to utilize the natural experiment of reform in Massachusetts to examine and help anticipate the impact of national health insurance reform on critical care delivery. In Aim One I will determine the relationship between Massachusetts insurance reform and intensive care unit admission rates. In Aim Two I will determine the relationship between Massachusetts insurance reform and total hospital length of stay in patients with critical illness. Both aims will use state discharge data available from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project, comparing hospital admissions over time in Massachusetts to several control states using a difference-in-differences approach. In addition to addressing these research aims, over the course of this fellowship I will engage in a rigorous training program of didactic course work and close research mentoring by senior health services researchers, health economists, clinical epidemiologists and biostatisticians. Throughout the conduct of this study and training plan, I will gain skills that will allow me to mature as an investigator and compete for a K series career development award. Ultimately, this NRSA fellowship opportunity will enable me to make significant contributions to the fields of health services research and critical care medicine through insights into the impact of health insurance reform on critical care utilization. This research will facilitate the anticipation of resource allocation needs, and better inform discussions of health care reform. PUBLIC HEALTH RELEVANCE: The clinical and economic burden of critical illness in the United States is enormous-over 5 million Americans are admitted to an intensive care unit each year, with costs approaching 1% of the gross domestic product. This project will generate novel insights into the role of health insurance reform on critical care utilization and provide an opportunity for the primary investigator to develop into an independent researcher in the field of critical care health services research.