Insurance Instability and Disparities in Chronic Disease Outcomes

保险不稳定和慢性病结果的差异

• 批准号: 8769346
• 负责人: Karen Freund
• 金额: $ 43.38万
• 依托单位: TUFTS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-25 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8769346
• 关键词: Administrator; African American; Asian Americans; Asians; Asthma; Boston; Caring; Chronic; Chronic Disease; Chronic Obstructive Airway Disease; Clinical; Communities; Community Health Centers; Comprehensive Health Insurances; Computerized Medical Record; Congestive Heart Failure; Data; Databases; Diabetes Mellitus; Diagnostic; Disease; Disease Management; Disease Outcome; Documentation; Effectiveness; Ensure; Ethnic Origin; Frequencies; Goals; Guidelines; Health; Health Insurance; Healthcare; Hispanics; Hyperlipidemia; Hypertension; Institution; Insurance; Insurance Coverage; Link; Massachusetts; Mediating; Medical center; Minority; Minority Groups; Monitor; Natural experiment; New England; Outcome; Outpatients; Patients; Pattern; Pharmaceutical Preparations; Population; Process; Qualifying; Race; Services; Socioeconomic Status; Time; Visit; Vulnerable Populations; Work; cancer care; care systems; disorder control; experience; health disparity; improved; innovation; interest; patient population; public health relevance; racial and ethnic; safety net

DESCRIPTION (provided by applicant): Racial and ethnic health disparities in the processes and outcomes of chronic disease care are pervasive, well documented, and consistently linked to health insurance coverage. Insurance instability (the frequency of switches in insurance coverage or gaps without coverage), may contribute to disparities in outcomes of chronic disease care. With the explicit goal of reducing disparities, Massachusetts (MA) Health Insurance Reform has now extended comprehensive health insurance coverage to 98% of the state's residents, with disproportionately greater gains in coverage among racial/ethnic minorities and the poor. To examine if MA insurance reform has lessened health disparities through increased insurance stability, our specific aims are: Aim 1: To examine changes in insurance instability pre- and post-reform, overall and comparing racial/ethnic specific minority populations to whites. We hypothesize that (a) Insurance instability decreased in the post-reform period and (c) Insurance instability decreased more for racial/ethnic minorities. Aim 2: To examine whether patients receiving care post-insurance reform had better processes of chronic disease management and improved health outcomes, compared with patients receiving care pre-insurance reform, and whether such patterns vary by race/ethnicity. We hypothesize that improvements in processes and outcomes of chronic disease management were greater among racial/ethnic minorities who benefited the most from insurance reform, resulting in reduced disparities. Aim 3: To assess whether patients with more favorable insurance stability had better processes of chronic disease care and improved health outcomes compared to patients with less favorable insurance stability, and whether racial/ethnic minority patients experienced disproportionately greater gains. We hypothesize that greater insurance stability will be associated with improved processes and outcomes of chronic disease management, resulting in reduced disparities. We will conduct an innovative study to assess the processes and outcomes of care for six highly prevalent, chronic conditions before and after the implementation of MA Health Insurance Reform. These conditions are diabetes, hypertension, hyperlipidemia, congestive heart failure, asthma, and chronic obstructive pulmonary disease. We will utilize existing electronic medical records on over 110,000 subjects from Boston Medical Center and eight of its affiliated federally qualified Community Health Centers, the largest safety net institution in New England that serves African American and Hispanic communities, and Tufts Medical Center, which serves a large Asian American community in Boston's Chinatown. When the study is completed, we will provide empiric data on the direct impact of insurance reform and insurance instability on health disparities in multiple populations.

描述(由申请人提供)：慢性病护理过程和结果中的种族和民族健康差异是普遍存在的，有很好的记录，并与医疗保险覆盖范围一致。保险不稳定(保险覆盖范围转换的频率或未覆盖的缺口)可能会导致慢性病护理结果的差异。凭借缩小差距的明确目标，马萨诸塞州(MA)医疗保险改革现已将全面医疗保险覆盖范围扩大到该州98%的居民，在种族/少数民族和穷人的覆盖范围内获得了不成比例的更大收益。为了检验MA保险改革是否通过提高保险稳定性缩小了健康差距，我们的具体目标是：目标1：检查改革前后保险不稳定性的变化，总体上并比较特定种族/民族的少数族裔人口和白人。我们假设：(A)保险不稳定程度在改革后时期有所减少；(C)对少数族裔而言，保险不稳定程度下降得更多。目的2：检验接受保险后护理改革的患者是否比保险前接受护理的患者有更好的慢性病管理过程和改善的健康结果，以及这种模式是否因种族/民族而异。我们假设，在从保险改革中受益最大的种族/族裔少数群体中，慢性病管理过程和结果的改善更大，从而缩小了差距。目的3：评估保险稳定性较好的患者是否比保险稳定性较差的患者有更好的慢性病护理过程和改善的健康结果，以及种族/少数民族患者是否获得不成比例的更大收益。我们假设，更大的保险稳定性将与改善慢性病管理的过程和结果相关，从而减少差距。我们将进行一项创新研究，评估MA医疗保险改革实施前后六种高度流行的慢性病的护理过程和结果。这些疾病包括糖尿病、高血压、高脂血症、充血性心力衰竭、哮喘和慢性阻塞性肺病。我们将利用波士顿医疗中心及其八个附属的联邦合格社区健康中心(新英格兰最大的安全网机构，服务于非裔美国人和西班牙裔社区)和塔夫茨医疗中心(服务于波士顿唐人街的一个大型亚裔社区)超过11万名受试者的现有电子医疗记录。研究完成后，我们将提供保险改革和保险不稳定对多个人群健康差距的直接影响的经验数据。