Access to medical care and health care utilization among low-income immigrants

项目摘要 在各州和县之间，使用非联邦资金提供医疗保健的政策活动越来越多 覆盖低收入、无保险的无证移民。然而，只有有限的证据表明 无证移民在扩大保健机会的背景下的保健利用情况 政策并指导其执行。该R21项目将调查一个长期存在的本地计划，以 建立证据基础，了解扩大获得护理的机会如何影响非法移民的患者结局 和卫生保健利用率。我们将重点关注MyHealth LA(MHLA)登记的患者，这是历史最悠久、规模最大的 为非法移民提供的当地医疗计划，位于洛杉矶县。MHLA提供初级保健 联邦合格健康中心(FQHC)的家，以及县内的专科、住院和急诊护理 卫生系统每年为约130,000名患者提供服务。该项目将确定扩展计划的影响 向无保险、低收入无证移民提供医疗服务，并了解这些患者如何 随着时间的推移，利用护理。我们项目的目标1将使用合并患者记录的唯一数据源Medi-Cal 来自医院的索赔和登记记录，以确定MHLA患者是否有更好的(1) ED和(2)住院结果比没有登记的匹配样本的无证患者 2016-2022年间，MHLA(ED遇到140,000例，住院患者遇到46,000例)。这一目标将提供 通过比较登记和非登记的患者，证明扩大获得护理的机会对患者结局的影响 登记的病人。目标2将研究整个登记的MHLA人口，以了解随着时间的推移的利用率。 我们将把2015-2022年的MHLA登记记录与Medi-Cal索赔数据合并，以构建个人- 水平面板数据(n&gt；90,000)以检查(1)急诊、(2)门诊专科、(3)初级保健、(4)住院 住院患者，(5)预防性护理，和(6)登记后24个月的处方利用模式。我们会 按重要的人口统计特征(如种族/民族、年龄、语言、 慢性疾病)。这些信息可以用来区分利用率高的子组，设定程序 标准，并预测随时间推移的使用模式。我们还将研究临床特征和 外部事件(如新冠肺炎大流行)与使用模式相关。这项研究的结果可以是 用于帮助支持制定地方和州一级的政策，扩大护理的机会 以及帮助政策制定者、临床医生和研究人员预测 这些政策都得到了落实。我们将与FQHC领导层指导委员会合作，MHLA 领导层和社区倡导者来解释和传播我们的调查结果。

Project Summary There is growing policy activity among states and counties to use non-federal funds to offer health care coverage to low-income, uninsured undocumented immigrants. However, there is only limited evidence on undocumented immigrants’ health care utilization in the context of expanded access to care to support these policies and guide their implementation. This R21 project will investigate one long-standing local program to build the evidence base on how expanded access to care affects undocumented immigrants’ patient outcomes and health care utilization. We will focus on patients enrolled in MyHealth LA (MHLA), the oldest and largest local health plan for undocumented immigrants, located in Los Angeles County. MHLA provides a primary care home at Federally Qualified Health Centers (FQHCs) and specialty, inpatient, and ED care through the county health system for ~130,000 patients annually. This project will determine the impact of programs that expand health care access to uninsured, low-income undocumented immigrants and understand how these patients utilize care over time. Aim 1 of our project will use a unique data source of merged patient records, Medi-Cal claims, and enrollment records from hospital encounters to determine whether MHLA patients have better (1) ED and (2) inpatient outcomes than a matched sample of undocumented patients who are not enrolled in MHLA (ED encounters>140,000 , inpatient encounters>46,000) between 2016-2022. This aim will provide evidence on the impact of expanded access to care on patient outcomes by comparing enrolled and non- enrolled patients. Aim 2 will look within the entire enrolled MHLA population to understand utilization over time. We will merge MHLA enrollment records with Medi-Cal claims data from 2015-2022 to construct individual- level panel data (n>90,000) to examine (1) ED, (2) outpatient specialty, (3) primary care, (4) hospitalized inpatient, (5) preventive care, and (6) prescription utilization patterns 24 months after enrollment. We will identify differences in utilization by important demographic characteristics (e.g race/ethnicity, age, language, chronic conditions). This information can be used to distinguish subgroups with high utilization, set program standards, and anticipate utilization patterns over time. We will also examine whether clinic characteristics and external events (ie, COVID-19 pandemic) correlate with utilization patterns. The result of this study can be used to help support the development of local and state-level policies that expand access to care for undocumented residents as well as help policy makers, clinicians, and researchers anticipate outcomes after these policies are implemented. We will work with a Steering Committee of FQHC leadership, MHLA leadership, and community advocates to interpret and disseminate our findings.