The Impact of Massachusetts Health Insurance Reform on Critical Care Resource Uti

描述（由申请人提供）：以往的研究表明，保险状况可能在危重疾病患者的使用和结果中发挥作用。然而，这种效应的机制尚不清楚，健康保险扩大对重症监护利用的影响尚不清楚（1-5）。马萨诸塞州于2006年启动了全州范围的保险改革，目标是实现几乎全民保险覆盖，在三年内将未参保的州居民比例从大约7.5%降低到不到3%(6)。这项立法是2010年3月美国国会通过的《患者保护和平价医疗法案》的样板。在美国，近乎全面的医疗保险覆盖是前所未有的，了解医疗保险改革对重症护理服务利用的影响至关重要。本提案概述了一项计划，利用马萨诸塞州改革的自然实验来检查和帮助预测国家医疗保险改革对重症护理服务的影响。在第一个目标中，我将确定马萨诸塞州保险改革与重症监护病房入院率之间的关系。在第二项目标中，我将确定马萨诸塞州保险改革与危重病患者住院总时间之间的关系。这两个目标都将使用医疗保健研究和质量机构的医疗保健成本和利用项目提供的各州出院数据，使用差异中的差异方法将马萨诸塞州的住院情况与几个对照州的住院情况进行比较。除了实现这些研究目标之外，在这个奖学金的过程中，我将参与一个严格的培训计划，包括教学课程工作和高级卫生服务研究人员、卫生经济学家、临床流行病学家和生物统计学家的密切研究指导。通过这项研究和培训计划的实施，我将获得技能，使我成为一名成熟的调查员，并竞争K系列职业发展奖。最终，这个NRSA奖学金的机会将使我能够通过洞察医疗保险改革对重症监护利用的影响，为卫生服务研究和重症监护医学领域做出重大贡献。这项研究将促进对资源分配需求的预测，并更好地为医疗改革的讨论提供信息。

DESCRIPTION (provided by applicant): Previous studies suggest that insurance status may play a role in utilization and outcomes for patients with critical illness. However, the mechanism for this effect is unclear, and the impact of health insurance expansion on critical care utilization is unknown (1-5). Massachusetts initiated statewide insurance reform in 2006 with the goal of near-universal insurance coverage, decreasing the rate of uninsured state residents from approximately 7.5% to less than 3% within three years (6). This legislation served as a model for the Patient Protection and Affordable Care Act passed by the United States Congress in March 2010. Near-universal health insurance coverage is unprecedented in the United States and it is critical to understand the impact of health insurance reform on critical care service utilization. This proposal outlines a plan to utilize the natural experiment of reform in Massachusetts to examine and help anticipate the impact of national health insurance reform on critical care delivery. In Aim One I will determine the relationship between Massachusetts insurance reform and intensive care unit admission rates. In Aim Two I will determine the relationship between Massachusetts insurance reform and total hospital length of stay in patients with critical illness. Both aims will use state discharge data available from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project, comparing hospital admissions over time in Massachusetts to several control states using a difference-in-differences approach. In addition to addressing these research aims, over the course of this fellowship I will engage in a rigorous training program of didactic course work and close research mentoring by senior health services researchers, health economists, clinical epidemiologists and biostatisticians. Throughout the conduct of this study and training plan, I will gain skills that will allow me to mature as an investigator and compete for a K series career development award. Ultimately, this NRSA fellowship opportunity will enable me to make significant contributions to the fields of health services research and critical care medicine through insights into the impact of health insurance reform on critical care utilization. This research will facilitate the anticipation of resource allocation needs, and better inform discussions of health care reform. PUBLIC HEALTH RELEVANCE: The clinical and economic burden of critical illness in the United States is enormous-over 5 million Americans are admitted to an intensive care unit each year, with costs approaching 1% of the gross domestic product. This project will generate novel insights into the role of health insurance reform on critical care utilization and provide an opportunity for the primary investigator to develop into an independent researcher in the field of critical care health services research.