Center for Health Insurance Reform, Cardiovascular Outcomes, and Disparities

描述(由申请人提供)：当今美国的核心政策假设之一是，扩大医疗保险覆盖范围将改善获得医疗保健的机会，改善健康结果，并使每个人对所有美国人更加公平。事实上，缺乏医疗保险与心血管(CV)和其他护理的使用减少、健康结果不佳和死亡率上升有关。获得护理的机会有限是造成结果差异的最大因素之一。马萨诸塞州(马萨诸塞州)是一项关键的政策相关自然实验的地点，根据最近的立法，该州97%的居民获得了医疗保险；因此，这是监测和评估CV健康结果以及此类结果差异的理想环境。我们建议在波士顿大学医学院和波士顿医疗中心(新英格兰最大的安全网医院)建立“医疗保险改革、心血管结果和差异中心”。我们将通过两项研究来检验MA医疗改革对简历护理和结果的影响，以及两者之间的差异。第一个将评估扩大的保险覆盖范围是否会与可预防的住院病人因门诊护理、敏感的心血管疾病和再次入院的心血管疾病的减少相关。该项目还将评估对转诊敏感的心脏手术的比率，以及种族/少数民族患者使用安全网医院的情况。第二个项目将审查护理和结果 对改革前和改革后的静脉血栓栓塞症(VTE)的护理，检查更多地获得初级和家庭护理以及门诊药房服务是否将与更好的临床结果以及与健康相关的生活质量、存活率和成本效益的提高相关。我们中心的具体目标是：1)开展研究，评估MA医疗改革对心血管结局的影响；2)在心血管结局研究方面与其他现有中心互补和合作。3)将三名早期研究人员培养成经验丰富的简历结果研究人员，他们精通该领域的问题、主题和方法，并且在中心活动完成后，他们将准备好在未来为简历结果研究领域做出实质性贡献。

DESCRIPTION (provided by applicant): One of the central policy assumptions in the U.S. today is that expanding health insurance coverage will improve access to health care, improve health outcomes, and make each more equitable for all Americans. Indeed, lack of health insurance is associated with less use of cardiovascular (CV) and other care, poor health outcomes, and increased mortality. Limited access to care is one of strongest contributors to disparities in outcomes. Massachusetts (MA) is the site of a key policy-relevant natural experiment, whereby recent legislation has resulted in 97% of the state's residents obtaining health insurance; it is thus the ideal setting in which to monitor and evaluate CV health outcomes, and disparities in such outcomes. We propose to develop the "Center for Health Insurance Reform, Cardiovascular Outcomes, and Disparities" at Boston University School of Medicine and Boston Medical Center, New England's largest safety net hospital. We will examine the effects of MA health reform on CV care and outcomes, and in disparities in each, through two studies. The first will evaluate whether expanded insurance coverage will be associated with fewer preventable inpatient admissions for ambulatory care sensitive CV conditions and readmissions for CV conditions. This project will also assess rates of referral-sensitive cardiac procedures, and the use of safety-net hospitals by racial/ethnic minority patients. The second project will examine care and outcomes of care for venous thromboembolism (VTE) both pre- and post-reform, examining whether increased access to primary and home care, and to outpatient pharmacy services, will be associated with better clinical outcomes, as well as improved health related quality of life, survival and cost-effectiveness. The specific aims of our Center are: 1) To conduct research to evaluate the effects of health reform in MA on CV outcomes; 2) To complement and collaborate with other existing centers in CV outcomes research. 3) To develop three Early Stage Investigators into seasoned CV outcomes researchers who are well versed in the issues, topics and methods in the field, and who, upon the completion of the center activities, will be poised to make substantial future contributions to the field of CV outcomes research.