Center for Health Insurance Reform, Cardiovascular Outcomes, and Disparities

健康保险改革、心血管结果和差异中心

• 批准号: 8653603
• 负责人: Nancy R. Kressin
• 金额: $ 140.18万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8653603
• 关键词: Admission activity; Ambulatory Care; American; Boston; Cardiac; Cardiovascular system; Caring; Clinical; Complement; Future; Health; Health Insurance; Health Services Accessibility; Hospitals; Improve Access; Inpatients; Insurance Coverage; Massachusetts; Medical center; Methods; Minority Groups; Monitor; Natural experiment; New England; Outcome; Outcomes Research; Outpatients; Patients; Pharmaceutical Services; Policies; Primary Health Care; Procedures; Research; Research Personnel; Seasons; Site; Staging; Statutes and Laws; Thromboembolism; Universities; Venous; cost effectiveness; health related quality of life; improved; medical schools; mortality; patient home care; safety net

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.

描述（由申请人提供）：当今美国的中央政策假设之一是，扩大健康保险范围将改善获得医疗保健的机会，改善健康成果，并使所有美国人更公平。实际上，缺乏健康保险与较少使用心血管（CV）和其他护理，健康状况不佳以及死亡率增加有关。获得护理的机会有限是结果差异最强的贡献者之一。马萨诸塞州（马萨诸塞州）是一项与关键政策相关的自然实验的所在地，最近立法导致该州97％的居民获得了健康保险；因此，它是监测和评估CV健康结果的理想环境以及此类结果的差异。我们建议在新英格兰最大的安全网医院波士顿医学院和波士顿医学中心开发“健康保险改革中心，心血管成果和差异中心”。我们将通过两项研究研究MA健康改革对CV护理和结果的影响以及每种研究的影响。第一个将评估扩大的保险范围是否会与静态护理敏感的简历条件和简历条件的再选中相关的可预防住院入院。该项目还将评估转诊敏感的心脏程序的速度，以及种族/族裔少数民族患者使用安全网医院。第二个项目将检查 对静脉血栓栓塞（VTE）的护理前和改革后，检查是否可以增加获得初级和家庭护理的机会，以及对门诊药房服务的机会，将与更好的临床结果以及改善与健康相关的生活质量，生存和成本效益有关。我们中心的具体目的是：1）进行研究以评估健康改革对MA对CV结果的影响； 2）在简历结果研究中与其他现有中心进行补充和合作。 3）要开发三名早期研究人员，以对经验丰富的研究人员进行经验丰富的研究人员，这些研究人员精通该领域的问题，主题和方法，并且在完成中心活动后，他们将有望为CV成果研究领域做出重大贡献。

项目成果

Effect of Massachusetts healthcare reform on racial and ethnic disparities in admissions to hospital for ambulatory care sensitive conditions: retrospective analysis of hospital episode statistics.

• DOI: 10.1136/bmj.h1480
• 发表时间: 2015-04-01
• 期刊: BMJ (Clinical research ed.)
• 作者: McCormick D;Hanchate AD;Lasser KE;Manze MG;Lin M;Chu C;Kressin NR
• 通讯作者: Kressin NR

A piece of my mind. Mind the outcomes.

我的一点心意。

• DOI: 10.1001/jama.2012.153826
• 发表时间: 2013
• 期刊: JAMA : the journal of the American Medical Association
• 作者: Kressin,NancyR;Atz,JoshuaM
• 通讯作者: Atz,JoshuaM

Training cardiovascular outcomes researchers: A survey of mentees and mentors to identify critical training gaps and needs.

培训心血管结果研究人员：对学员和导师进行调查，以确定关键的培训差距和需求。

• DOI: 10.1016/j.ahj.2017.07.022
• 发表时间: 2018
• 期刊: American heart journal
• 影响因子: 4.8
• 作者: Khazanie,Prateeti;Al-Khatib,SanaM;Wang,TracyY;Crowley,MatthewJ;Kressin,NancyR;Krumholz,HarlanM;Kiefe,CatarinaI;Wells,BarbaraL;O'Brien,SeanM;Peterson,EricD;Sanders,GillianD
• 通讯作者: Sanders,GillianD

Impact of Massachusetts Health Reform on Inpatient Care Use: Was the Safety-Net Experience Different Than in the Non-Safety-Net?

• DOI: 10.1111/1475-6773.12542
• 发表时间: 2017-10-01
• 期刊: HEALTH SERVICES RESEARCH
• 影响因子: 3.4
• 作者: Hanchate, Amresh D.;McCormick, Danny;Kressin, Nancy R.
• 通讯作者: Kressin, Nancy R.

Coverage and Access for Americans with Cardiovascular Disease or Risk Factors After the ACA: a Quasi-experimental Study.

ACA 后患有心血管疾病或危险因素的美国人的承保范围和可及性：一项准实验研究。

• DOI: 10.1007/s11606-019-05108-1
• 发表时间: 2019
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Barghi,Ameen;Torres,H;Kressin,NR;McCormick,D
• 通讯作者: McCormick,D