Can Medicaid Managed Care mitigate race/ethnic health disparities in diabetes?

医疗补助管理式医疗能否减轻糖尿病中的种族/民族健康差异？

基本信息

批准号：
10528738
负责人：
Mohammed Kumail Ali
金额：
$ 52.59万
依托单位：
GEORGETOWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-23 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10528738
关键词：
Accident and Emergency department Acute Address Admission activity Adult Affect Age American Americas Amputation Behavior Black race COVID-19 COVID-19 pandemic COVID-19 pandemic effects Caring Characteristics Chronic Disease Communities Contracts Data Data Analyses Data Set Databases Diabetes Mellitus Diagnosis District of Columbia Economic Burden Eligibility Determination Emergency department visit Enrollment Ethnic Origin Expenditure Florida Future Goals Health Care Costs Heterogeneity Hospitalization Hyperglycemia Incentives Indigenous Information Systems Insurance Carriers Interview Investigation Kentucky Latinx Lawyers Link Managed Care Managed Care Programs Medicaid Medicare/Medicaid Methods Minority National Institute on Minority Health and Health Disparities Non-Insulin-Dependent Diabetes Mellitus Obesity Occupations Outcome Patients Penetration Performance Persons Pharmaceutical Preparations Policies Population Poverty Preventive care Primary Health Care Privatization Process Quality of Care Race Research Risk Sampling Selection Bias Services Shock Testing Time Titrations Variant Vulnerable Populations Work base beneficiary black patient burden of illness care outcomes cohort comorbidity coronavirus disease cost data modeling design disenfranchised population disparity reduction ethnic disparity ethnic health disparity ethnic minority evidence base experience family burden foot health disparity high risk improved insight medical specialties member pandemic disease people of color post-COVID-19 programs response service utilization sex socioeconomic disadvantage trend

项目摘要

ABSTRACT This study represents a timely investigation that addresses race/ethnic disparities in type 2 diabetes (T2DM) care over a period that included a major pandemic shock. T2DM is burdensome and disproportionately impacts vulnerable and disenfranchised populations; of note, there are stark race/ethnic disparities in T2DM care goals, emergency department (ED) visits, and hospitalizations. Medicaid covers 25% of Americans with T2DM. More than 80% of Medicaid beneficiaries nationally receive at least some of their care from Medicaid managed care organizations (MMCO). States contract with private (non-profit or for-profit) MMCOs to lower costs, increase quality, and pass on financial risks of covering Medicaid beneficiaries. Heterogeneity across and within state programs can have implications for quality of T2DM care and, specifically, race/ethnic disparities through benefit generosity or by affecting MMCO entry and post-entry behavior. State policymakers also have significant influence over marketplaces in which MMCOs compete, which can have consequences for race/ethnic disparities, given that Medicaid disproportionately covers non-white populations. Little is known about whether and how MMCOs and the state programs they operate in influence disparities in T2DM care and, if or how the COVID-19 pandemic changed the trajectory of health disparities. We propose to answer these unknowns using a convergent mixed-methods study: we will compile a database of MMCO/state program features that could influence care using a health disparities conceptual framework (Aim 1); we will empirically explore race/ethnic disparities among adults with T2DM and whether these vary by MMCO/state features and pre-/post-COVID-19 using comprehensive data from the Transformed Medicaid Statistical Information System over 2016-2025 (Aims 2 and 3); and we will collect and analyze qualitative data from Medicaid stakeholders to triangulate and contextualize the quantitative findings (Aim 4). We focus on non- disabled, non-pregnant 18-64-year-old adults with T2DM who tend to remain stably covered by Medicaid over time. To reduce selection bias, we focus our analyses on 12 states and the District of Columbia that mandate enrollment in comprehensive MMCOs. We will use panel data models to examine race/ethnic and sex-specific receipt of key T2DM services and ED visits and hospitalizations, overall and by MMCO/state features. We will also follow a continuously enrolled cohort over 2020-2025 to assess if and how MMCO/state program features moderate the pandemic’s effects on T2DM disparities. Sensitivity analyses will explore the influence of churn. Further, our preliminary analyses identify Kentucky and Florida as having the lowest and highest disparities in T2DM care, respectively; we will conduct interviews in these states to examine what MMCO/state features and implementation might explain these disparities. This policy-relevant work will provide critical insights into how Medicaid managed care programs can be designed to reduce disparities in chronic disease burdens.

抽象的这项研究代表了及时的调查，该研究涉及2型糖尿病（T2DM）中种族/种族分布在包括大流行休克在内的一段时期里的护理。 T2DM燃烧，影响不成比例易受伤害和被剥夺权利的人群；值得注意的是，T2DM护理目标中存在鲜明的种族/种族差异，紧急部门（ED）访问和住院。医疗补助覆盖了25％的T2DM美国人。更多的全国医疗补助受益人中有80％至少从医疗补助托管护理中获得了一些护理组织（MMCO）。州与私人（非营利或营利性）MMCO合同以降低成本，增加质量，并承担涵盖医疗补助受益人的财务风险。跨州和状态的异质性程序可能会对T2DM护理的质量产生影响，尤其是通过种族/种族差异收益慷慨或通过影响MMCO进入和进入后行为。国家决策者也有对MMCO竞争的市场的重大影响，这可能会对鉴于医疗补助不成比例地涵盖了非白人人群，种族/族裔差异。鲜为人知关于他们在T2DM Care中是否以及如何在影响分布中运行的MMCO和国家计划并且，如果或如何如何改变健康差异的轨迹。我们建议回答这些未知数使用收敛的混合方法研究：我们将编译MMCO/状态的数据库可以使用健康分配概念框架影响护理的程序功能（AIM 1）；我们将经验探索T2DM成年人的种族/种族差异，以及这些差异是否因MMCO/State而异功能和前/循环前19岁，使用转换后的医疗补助统计的综合数据 2016 - 2025年的信息系统（目标2和3）；我们将从医疗补助利益相关者三角测量和背景化定量发现（AIM 4）。我们专注于非残疾人，未怀孕的18-64岁的T2DM的成年人倾向于稳定地被Medicaid覆盖时间。为了减少选择偏见，我们将分析重点放在授权的12个州和哥伦比亚特区综合MMCO的注册。我们将使用面板数据模型来检查种族/种族和性别特定的种族和性别总体和MMCO/州功能的关键T2DM服务以及ED访问和住院。我们将还要遵循2020-2025范围内连续注册的队列，以评估MMCO/State计划的特征以及如何功能调节大流行对T2DM差异的影响。灵敏度分析将探索流失的影响。此外，我们的初步分析确定肯塔基州和佛罗里达州的分布最低和最高 T2DM护理；我们将在这些州进行采访，以检查哪些MMCO/州功能和实施可能解释了这些分布。这项与政策相关的工作将提供有关如何可以设计医疗补助托管护理计划，以减少慢性病伯伦斯的分布。