Unwinding pandemic-era social programs: Effects on healthcare outcomes and disparities

放松大流行时代的社会计划：对医疗保健结果和差异的影响

• 批准号: 10835335
• 负责人: Rajan Anthony Sonik
• 金额: $ 233.2万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10835335
• 关键词: Affect; COVID-19; Caring; Clinical; Complement; Coronavirus; Data; Disabled Persons; Disease Management; Disparity; Economic Conditions; Economics; Eligibility Determination; Ethnic Origin; Event; Expenditure; Family; Food; Goals; Growth; Health Insurance; Health Services Accessibility; Health system; Health trends; Healthcare; Healthcare Systems; Housing; Individual; Institute of Medicine (U.S.); Intervention; Knowledge; Learning; Link; Machine Learning; Massachusetts; Measures; Medicaid; Medical; Methods; Modeling; Natural experiment; Outcome; Pattern; Policies; Politics; Population; Preventive; Primary Care; Public Health; Race; Records; Reduce health disparities; Registries; Research; Social Policies; Social Welfare; Speed; Strategic Planning; Techniques; United States National Institutes of Health; Variant; Vulnerable Populations; Work; care outcomes; cooking; disability; disorder prevention; ethnic minority; experience; expiration; flexibility; food insecurity; health care disparity; health determinants; health disparity; health disparity populations; insight; minority health; minority health disparity; nutrition; pandemic disease; programs; racial minority; response; secondary analysis; social

Project Summary/Abstract This project will study the effects of the expiration of Families First Coronavirus Response Act (FFCRA) increases to Supplemental Nutrition Assistance Program (SNAP) benefit levels on healthcare outcomes and disparities by disability, race, and ethnicity. These groups experience disparities in disease prevention and management, unfavorable clinical events, and care expenditures, each of which are associated with food insecurity. Existing studies have found SNAP to reduce food insecurity and suggest SNAP may reduce unfavorable healthcare outcomes, especially for vulnerable groups, but these studies suffered key causal inference limitations and have focused on SNAP changes substantially different from the FFCRA unwinding. Meanwhile, state-level variation in approaches to unwinding the FFCRA SNAP increases (e.g., timing ranging from April 2021 to March 2023), individual-level variation in the size of benefit losses (ranging from $95 per month to over $1,000 per month), and a Massachusetts (MA) policy that broke the state’s SNAP rollbacks into two uneven steps all create natural experiments we can use to identify the causal impacts of SNAP. Further, we will use robust policy tracking to identify and adjust for non-SNAP policy unwinding patterns, and we will leverage both national T-MSIS Medicaid data and uniquely detailed linked data from MA. Ultimately, the MA and US analyses will complement each other and provide high internal and external validity. Specifically, we will create a registry of policies related to the unwinding of food, housing, and Medicaid access and then develop parsimonious sets of policy unwinding patterns to identify adjusters for later analyses (we will similarly attend to other healthcare, public health, and economic conditions) (Aim 1). We will then estimate the effects of SNAP unwinding on Medicaid event rates (preventive use, unfavorable event rates, and expenditures; Aim 2), and we will finally estimate the effects of SNAP unwinding on disparities in these event rates by disability, race, and ethnicity (Aim 3). For Aims 2 and 3 (2020-2026), we will measure differences in the levels and trends of healthcare outcomes and disparities before and after unwinding-related changes using a multilevel approach to growth curve modeling that is flexible and robust to many validity threats (while also utilizing eligible non-participants with past SNAP applications as a comparator with no unwinding exposure). Current policy proposals would reduce SNAP access, but there is little data to shed light on how such reductions may affect healthcare outcomes and disparities. Our study will reduce this critical knowledge gap. Studying the ongoing SNAP unwinding will extend past work that has focused on SNAP increases and/or changes uniform in their size and timing, and learnings from this project will also advance the NIH Minority Health and Health Disparities Strategic Plan’s Goal 3 to assess “interventions to reduce health disparities.”

项目概要/摘要 该项目将研究《家庭优先冠状病毒应对法案》（FFCRA）到期的影响 提高补充营养援助计划 (SNAP) 对医疗保健结果和 这些群体在疾病预防和治疗方面存在差异。 管理、不良临床事件和护理支出，每一项都与食物相关 现有研究发现 SNAP 可以减少粮食不安全，并表明 SNAP 可能会减少粮食不安全。 不利的医疗保健结果，特别是对于弱势群体而言，但这些研究遭受了关键的因果关系 推理局限性，并重点关注与 FFCRA 展开有本质不同的 SNAP 变化。 与此同时，各州解除 FFCRA SNAP 方法的差异也在增加（例如，时间安排） 范围从 2021 年 4 月到 2023 年 3 月），福利损失规模的个人层面差异（范围从 95 美元 每月超过 1,000 美元），以及马萨诸塞州 (MA) 的政策打破了该州的 SNAP 回滚 分为两个不均匀的步骤，所有步骤都创建了自然实验，我们可以用它来确定 SNAP 的因果影响。 此外，我们将使用强大的政策跟踪来识别和调整非 SNAP 政策解除模式，以及 我们将利用国家 T-MSIS 医疗补助数据和 MA 最终的独特详细链接数据。 MA 和 US 分析将相辅相成，并提供较高的内部和外部有效性。 具体来说，我们将创建一个与取消食品、住房和医疗补助相关的政策登记册 访问并开发一套简约的政策放松模式，以确定调整者以供后续分析 （我们将同样关注其他医疗保健、公共卫生和经济状况）（目标 1）。 估计 SNAP 解除对医疗补助事件发生率的影响（预防性使用、不利事件发生率和 支出；目标 2)，我们最终将估计 SNAP 解除对这些事件中差异的影响 按残疾、种族和民族划分的比率（目标 3），对于目标 2 和 3（2020-2026 年），我们将衡量以下方面的差异。 使用与放松相关的变化前后的医疗保健结果和差异的水平和趋势 一种多层次的增长曲线建模方法，对于许多有效性威胁来说是灵活且稳健的（同时也 过去 SNAP 申请的合格非参与者作为比较对象，没有平仓风险）。 当前的政策建议将减少 SNAP 的获取，但几乎没有数据可以说明如何减少 SNAP 的获取 减少可能会影响医疗保健结果和差异。我们的研究将缩小这一关键的知识差距。 研究正在进行的 SNAP 解除将延续过去专注于 SNAP 增加和/或 改变其规模和时间的统一，从该项目中获得的经验也将推动 NIH 少数派的发展 健康与健康差异战略计划的目标 3 是评估“减少健康差异的干预措施”。