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

项目摘要 州和县之间越来越多的政策活动使用非联邦基金提供医疗保健 低收入无保险无证移民。然而，只有有限的证据表明， 无证移民的医疗保健利用的背景下，扩大获得照顾，以支持这些 政策，并指导其实施。这个R21项目将调查一个长期存在的地方计划， 建立证据基础，说明扩大获得护理的机会如何影响无证移民的患者结果 和卫生保健利用率。我们将专注于MyHealth LA（MHLA）招募的患者，这是最古老，最大的 无证移民的当地健康计划，位于洛杉矶县。MHLA提供初级护理 在联邦合格卫生中心（FATHCs）和专业，住院和艾德护理通过县的家 每年为约130，000名患者提供医疗服务。该项目将确定扩大方案的影响， 医疗保健获得无保险，低收入无证移民，并了解这些病人如何 随着时间的推移使用护理。我们项目的目标1将使用一个独特的合并患者记录数据源Medi-Cal 索赔，并从医院遇到登记记录，以确定MHLA患者是否有更好的（1） 艾德和（2）住院病人的结果比匹配的样本无证患者谁没有参加 2016-2022年期间的MHLA（艾德就诊> 140，000，住院就诊> 46，000）。这一目标将提供 通过比较入组和非入组患者， 登记的患者。目标2将在整个入组的MHLA人群中进行研究，以了解随着时间的推移的利用率。 我们将合并2015-2022年的MHLA入组记录与Medi-Cal索赔数据，以构建个人- 水平面板数据（n> 90，000），用于检查（1）艾德，（2）门诊专科，（3）初级保健，（4）住院 住院患者，（5）预防性护理，（6）入组后24个月的处方使用模式。我们将 通过重要的人口统计学特征（例如种族/民族、年龄、语言 慢性疾病）。此信息可用于区分具有高利用率的子组， 标准，并预测随着时间的推移的利用模式。我们还将研究临床特征和 外部事件（即COVID-19大流行）与使用模式相关。这项研究的结果可能是 用于帮助支持制定地方和州一级的政策，扩大获得护理的机会， 无证居民以及帮助政策制定者，临床医生和研究人员预测结果后， 这些政策得到执行。我们将与一个指导委员会， 领导和社区倡导者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.