Association of Health Insurance with Access to Cardiovascular Care

健康保险与心血管护理协会

• 批准号: 10039560
• 负责人: Sameed Ahmed Mustafa Khatana
• 金额: $ 19.64万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10039560
• 关键词: Acute; Acute myocardial infarction; Adherence; Advisory Committees; Affect; Affordable Care Act; Ambulatory Care; Behavior; Cardiology; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Chronic; Chronic Care; Cohort Studies; Data; Data Set; Databases; Eligibility Determination; Event; Face; Federal Government; Funding; Future; General Population; Goals; Health; Health Insurance; Health Personnel; Health Policy; Health Services Accessibility; Health Status; Hospitalization; Improve Access; Individual; Inpatients; Insurance; Insurance Coverage; Interview; Lead; Low Income Population; Low income; Medicaid; Medicaid eligibility; Medical; Medicine; Mentorship; Methodology; Morbidity - disease rate; Not Hispanic or Latino; Outcome; Outcomes Research; Outpatients; Patient-Focused Outcomes; Patients; Policy Maker; Policy Research; Primary Prevention; Public Health; Publishing; Qualitative Methods; Qualitative Research; Quality of life; Race; Research; Research Methodology; Research Personnel; Risk Factors; Secondary Prevention; Site; Stroke; Structure; Supervision; Techniques; Time; Training; Uninsured; United States; Work; administrative database; adverse outcome; behavior influence; behavioral adherence; cardiovascular disorder prevention; cardiovascular health; cardiovascular risk factor; care outcomes; career; court; econometrics; experience; health care availability; health care disparity; health difference; health seeking behavior; hospital readmission; hospitalization rates; improved; inpatient service; mortality; prospective; racial disparity; racial minority

PROJECT SUMMARY/ABSTRACT Cardiovascular morbidity and mortality disproportionately impact lower income individuals and racial minorities. These groups are also significantly less likely to have health insurance coverage in the United States. There is growing evidence that expansion of health insurance coverage in low-income populations can lead to improvements in health outcomes. In a recently published analysis by Dr. Khatana and colleagues, that serves as the preliminary analysis for the proposed research, expansion of insurance coverage through Medicaid was associated with fewer deaths from cardiovascular disease. A possible mechanism by which this occurred is improved access to cardiovascular care, however, this has not been previously studied. This proposed research plan aims to understand whether expansion of insurance coverage impacts access to inpatient and outpatient care for cardiovascular disease, and whether it narrows disparities in care access for racial minorities. Aim 1 seeks to examine whether expansion of insurance coverage through Medicaid under the Affordable Care Act led to an increase in access to inpatient care in the setting of acute myocardial infarction or stroke, and whether this varied between non-Hispanic Black and non-Hispanic White individuals. Aim 2 will investigate whether access to outpatient care for chronic cardiovascular disease is associated with changes in insurance coverage and whether insurance expansion narrows racial disparities in outpatient access. These two aims will utilize different large administrative claims databases. Aim 3 will augment these analyses by employing qualitative research methods to interview low-income patients discharged after a cardiovascular hospitalization. Patients in the post-discharge period are especially vulnerable to adverse outcomes such as readmission or death. Therefore, uninsured and insured patients will be interviewed to understand whether insurance status is associated with differences in health seeking behaviors, adherence to medical advice and therapies, health status and outcomes. These aims will lead to a future multi-site cohort study of low-income individuals with cardiovascular disease, which will be used to prospectively investigate how changes in health insurance coverage impact cardiovascular outcomes. Dr. Khatana, an early career investigator and a fellow in cardiovascular medicine, has a long-term goal of becoming an independently funded cardiovascular health policy and outcomes researcher with a focus on how health policies impact the cardiovascular health of low- income individuals using both large administrative databases as well as qualitative methods at the individual level. These research aims are part of a comprehensive training plan and will be supervised by a mentorship and advisory team consisting of national leaders in health outcomes and policy research, and advanced statistical and qualitative methodologies, and will guide his transition to an independently funded research career.

项目摘要/摘要 心血管发病率和死亡率不成比例地影响低收入的个人和种族少数群体。 这些团体在美国拥有健康保险范围的可能性也很小。有 越来越多的证据表明，低收入人群中健康保险的扩大可能导致 改善健康结果。在Khatana博士及其同事最近发表的分析中， 作为拟议研究的初步分析，通过医疗补助的保险扩大是 与心血管疾病的死亡人数更少有关。发生这种情况的可能机制是 但是，改善了获得心血管护理的机会，但以前尚未对此进行研究。这提出了 研究计划旨在了解保险覆盖范围的扩展是否会影响进入住院和 心血管疾病的门诊护理，以及它是否会缩小种族的护理差异 少数民族。 AIM 1试图检查是否通过Medicaid扩大保险范围 在急性心肌梗塞的情况下，负担得起的护理法案导致了获得住院治疗的机会 或中风，以及非西班牙裔黑人和非西班牙裔白人之间是否有所不同。 AIM 2意志 调查是否获得慢性心血管疾病的门诊护理是否与变化有关 保险范围以及保险扩展是否会缩小门诊通道中的种族差异。这些 两个目标将利用不同的大型行政索赔数据库。 AIM 3将通过 采用定性研究方法采访心血管后出院的低收入患者 住院。入院后期的患者特别容易受到不良结果的影响 再入院或死亡。因此，将对未保险和保险的患者进行采访，以了解是否 保险状况与寻求健康行为的差异有关，遵守医疗建议和 疗法，健康状况和结果。这些目标将导致未来的低收入多站点队列研究 患有心血管疾病的人，该疾病将用于前瞻性地研究健康的变化 保险范围影响心血管结果。 Khatana博士，早期的职业调查员，同伴 心血管医学的长期目标是成为独立资助的心血管健康 政策和结果研究人员的重点是健康政策如何影响低 - 收入个人使用大型行政数据库以及个人的定性方法 等级。这些研究目的是一项全面培训计划的一部分，将由指导监督 以及由健康成果和政策研究领域的国家领导人组成的咨询团队，并高级 统计和定性方法论，将指导他向独立资助的研究过渡 职业。