Unwinding pandemic-era social programs: Effects on healthcare outcomes and disparities

放松大流行时代的社会计划：对医疗保健结果和差异的影响

• 批准号: 10835335
• 负责人: Rajan Anthony Sonik
• 金额: $ 233.2万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10835335
• 关键词: Affect; COVID-19; Caring; Clinical; Complement; Coronavirus; Data; Disabled Persons; Disease Management; Disparity; Economic Conditions; Economics; Eligibility Determination; Ethnic Origin; Event; Expenditure; Family; Food; Goals; Growth; Health Insurance; Health Services Accessibility; Health system; Health trends; Healthcare; Healthcare Systems; Housing; Individual; Institute of Medicine (U.S.); Intervention; Knowledge; Learning; Link; Machine Learning; Massachusetts; Measures; Medicaid; Medical; Methods; Modeling; Natural experiment; Outcome; Pattern; Policies; Politics; Population; Preventive; Primary Care; Public Health; Race; Records; Reduce health disparities; Registries; Research; Social Policies; Social Welfare; Speed; Strategic Planning; Techniques; United States National Institutes of Health; Variant; Vulnerable Populations; Work; care outcomes; cooking; disability; disorder prevention; ethnic minority; experience; expiration; flexibility; food insecurity; health care disparity; health determinants; health disparity; health disparity populations; insight; minority health; minority health disparity; nutrition; pandemic disease; programs; racial minority; response; secondary analysis; social

Project Summary/Abstract This project will study the effects of the expiration of Families First Coronavirus Response Act (FFCRA) increases to Supplemental Nutrition Assistance Program (SNAP) benefit levels on healthcare outcomes and disparities by disability, race, and ethnicity. These groups experience disparities in disease prevention and management, unfavorable clinical events, and care expenditures, each of which are associated with food insecurity. Existing studies have found SNAP to reduce food insecurity and suggest SNAP may reduce unfavorable healthcare outcomes, especially for vulnerable groups, but these studies suffered key causal inference limitations and have focused on SNAP changes substantially different from the FFCRA unwinding. Meanwhile, state-level variation in approaches to unwinding the FFCRA SNAP increases (e.g., timing ranging from April 2021 to March 2023), individual-level variation in the size of benefit losses (ranging from $95 per month to over $1,000 per month), and a Massachusetts (MA) policy that broke the state’s SNAP rollbacks into two uneven steps all create natural experiments we can use to identify the causal impacts of SNAP. Further, we will use robust policy tracking to identify and adjust for non-SNAP policy unwinding patterns, and we will leverage both national T-MSIS Medicaid data and uniquely detailed linked data from MA. Ultimately, the MA and US analyses will complement each other and provide high internal and external validity. Specifically, we will create a registry of policies related to the unwinding of food, housing, and Medicaid access and then develop parsimonious sets of policy unwinding patterns to identify adjusters for later analyses (we will similarly attend to other healthcare, public health, and economic conditions) (Aim 1). We will then estimate the effects of SNAP unwinding on Medicaid event rates (preventive use, unfavorable event rates, and expenditures; Aim 2), and we will finally estimate the effects of SNAP unwinding on disparities in these event rates by disability, race, and ethnicity (Aim 3). For Aims 2 and 3 (2020-2026), we will measure differences in the levels and trends of healthcare outcomes and disparities before and after unwinding-related changes using a multilevel approach to growth curve modeling that is flexible and robust to many validity threats (while also utilizing eligible non-participants with past SNAP applications as a comparator with no unwinding exposure). Current policy proposals would reduce SNAP access, but there is little data to shed light on how such reductions may affect healthcare outcomes and disparities. Our study will reduce this critical knowledge gap. Studying the ongoing SNAP unwinding will extend past work that has focused on SNAP increases and/or changes uniform in their size and timing, and learnings from this project will also advance the NIH Minority Health and Health Disparities Strategic Plan’s Goal 3 to assess “interventions to reduce health disparities.”

项目摘要/摘要 该项目将研究家庭第一冠状病毒反应法(FFCRA)到期的影响。 提高补充营养援助计划(SNAP)的医疗保健成果和福利水平 残疾、种族和民族方面的差异。这些群体在疾病预防和治疗方面存在差异 管理、不良临床事件和护理支出，每一项都与食物有关 不安全感。现有研究发现，SNAP可以减少粮食不安全，并表明SNAP可能会减少 不利的医疗结果，特别是对弱势群体，但这些研究遭受了关键原因 推理的局限性，并专注于SNAP的变化，与FFCRA的平仓有很大不同。 同时，解开FFCRA SNAP的方法中的状态级变化增加(例如，定时 2021年4月至2023年3月)，个人一级福利损失数额的差异(从95美元不等 每月超过1,000美元)，以及马萨诸塞州(MA)的政策，打破了该州的SNAP回滚 分成两个不同的步骤，所有这些都创建了自然实验，我们可以用来确定SNAP的因果影响。 此外，我们将使用强大的策略跟踪来识别和调整非SNAP策略展开模式，以及 我们将利用全国T-MSIS医疗补助数据和MA提供的唯一详细链接数据。归根结底， 马和美国的分析将相辅相成，并提供高度的内部和外部有效性。 具体地说，我们将创建一个与取消食品、住房和医疗补助相关的政策登记 访问并随后开发简明的政策解除模式集，以确定调整器以供以后分析 (我们将同样关注其他医疗保健、公共卫生和经济状况)(目标1)。到时候我们会的 评估SNAP解除对医疗补助事件发生率(预防性使用、不良事件发生率和 支出；目标2)，我们将最终评估SNAP解除对这些事件差异的影响 按残疾、种族和族裔分列的比率(目标3)。对于目标2和目标3(2020-2026)，我们将衡量 医疗保健结果的水平和趋势以及取消相关变化前后的差距 增长曲线建模的多层次方法，对许多有效性威胁是灵活和健壮的(同时 利用过去有SNAP申请的合格非参与者作为比较对象，没有平仓风险)。 目前的政策建议将减少SNAP的访问，但几乎没有数据说明这是如何实现的 削减可能会影响医疗保健结果和差距。我们的研究将缩小这一关键的知识差距。 研究正在进行的SNAP解除将扩展过去专注于SNAP增加和/或 在大小和时机上一致的变化，从这个项目中吸取的教训也将推动NIH少数民族 健康和健康差距战略计划的目标3，评估“减少健康差距的干预措施”。