Association of Health Insurance with Access to Cardiovascular Care

健康保险与心血管护理协会

• 批准号: 10039560
• 负责人: Sameed Ahmed Mustafa Khatana
• 金额: $ 19.64万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10039560
• 关键词: Acute; Acute myocardial infarction; Adherence; Advisory Committees; Affect; Affordable Care Act; Ambulatory Care; Behavior; Cardiology; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Chronic; Chronic Care; Cohort Studies; Data; Data Set; Databases; Eligibility Determination; Event; Face; Federal Government; Funding; Future; General Population; Goals; Health; Health Insurance; Health Personnel; Health Policy; Health Services Accessibility; Health Status; Hospitalization; Improve Access; Individual; Inpatients; Insurance; Insurance Coverage; Interview; Lead; Low Income Population; Low income; Medicaid; Medicaid eligibility; Medical; Medicine; Mentorship; Methodology; Morbidity - disease rate; Not Hispanic or Latino; Outcome; Outcomes Research; Outpatients; Patient-Focused Outcomes; Patients; Policy Maker; Policy Research; Primary Prevention; Public Health; Publishing; Qualitative Methods; Qualitative Research; Quality of life; Race; Research; Research Methodology; Research Personnel; Risk Factors; Secondary Prevention; Site; Stroke; Structure; Supervision; Techniques; Time; Training; Uninsured; United States; Work; administrative database; adverse outcome; behavior influence; behavioral adherence; cardiovascular disorder prevention; cardiovascular health; cardiovascular risk factor; care outcomes; career; court; econometrics; experience; health care availability; health care disparity; health difference; health seeking behavior; hospital readmission; hospitalization rates; improved; inpatient service; mortality; prospective; racial disparity; racial minority

PROJECT SUMMARY/ABSTRACT Cardiovascular morbidity and mortality disproportionately impact lower income individuals and racial minorities. These groups are also significantly less likely to have health insurance coverage in the United States. There is growing evidence that expansion of health insurance coverage in low-income populations can lead to improvements in health outcomes. In a recently published analysis by Dr. Khatana and colleagues, that serves as the preliminary analysis for the proposed research, expansion of insurance coverage through Medicaid was associated with fewer deaths from cardiovascular disease. A possible mechanism by which this occurred is improved access to cardiovascular care, however, this has not been previously studied. This proposed research plan aims to understand whether expansion of insurance coverage impacts access to inpatient and outpatient care for cardiovascular disease, and whether it narrows disparities in care access for racial minorities. Aim 1 seeks to examine whether expansion of insurance coverage through Medicaid under the Affordable Care Act led to an increase in access to inpatient care in the setting of acute myocardial infarction or stroke, and whether this varied between non-Hispanic Black and non-Hispanic White individuals. Aim 2 will investigate whether access to outpatient care for chronic cardiovascular disease is associated with changes in insurance coverage and whether insurance expansion narrows racial disparities in outpatient access. These two aims will utilize different large administrative claims databases. Aim 3 will augment these analyses by employing qualitative research methods to interview low-income patients discharged after a cardiovascular hospitalization. Patients in the post-discharge period are especially vulnerable to adverse outcomes such as readmission or death. Therefore, uninsured and insured patients will be interviewed to understand whether insurance status is associated with differences in health seeking behaviors, adherence to medical advice and therapies, health status and outcomes. These aims will lead to a future multi-site cohort study of low-income individuals with cardiovascular disease, which will be used to prospectively investigate how changes in health insurance coverage impact cardiovascular outcomes. Dr. Khatana, an early career investigator and a fellow in cardiovascular medicine, has a long-term goal of becoming an independently funded cardiovascular health policy and outcomes researcher with a focus on how health policies impact the cardiovascular health of low- income individuals using both large administrative databases as well as qualitative methods at the individual level. These research aims are part of a comprehensive training plan and will be supervised by a mentorship and advisory team consisting of national leaders in health outcomes and policy research, and advanced statistical and qualitative methodologies, and will guide his transition to an independently funded research career.

项目概要/摘要 心血管发病率和死亡率对低收入个人和少数族裔的影响尤为严重。 这些群体在美国拥有医疗保险的可能性也明显较低。有 越来越多的证据表明，扩大低收入人群的医疗保险覆盖范围可以导致 健康结果的改善。 Khatana 博士及其同事最近发表的一项分析表明， 作为拟议研究的初步分析，通过医疗补助扩大保险范围是 与心血管疾病死亡人数减少有关。发生这种情况的可能机制是 改善心血管护理的可及性，然而，此前尚未对此进行过研究。这个提议 研究计划旨在了解保险覆盖范围的扩大是否会影响住院和医疗服务的获取 心血管疾病的门诊护理，以及它是否缩小了种族间护理机会的差距 少数民族。目标 1 旨在审查是否可以根据《医疗补助计划》扩大保险范围 《平价医疗法案》增加了急性心肌梗死患者获得住院治疗的机会 或中风，以及这在非西班牙裔黑人和非西班牙裔白人之间是否有所不同。目标2将 调查慢性心血管疾病的门诊治疗是否与患者的变化相关 保险覆盖范围以及保险扩张是否缩小了门诊就诊的种族差异。这些 两个目标将利用不同的大型行政索赔数据库。目标 3 将通过以下方式增强这些分析： 采用定性研究方法采访因心血管疾病出院的低收入患者 住院治疗。出院后的患者特别容易受到不良后果的影响，例如 重新入院或死亡。因此，将采访未参保和参保的患者，以了解是否有参保 保险状况与求医行为、遵守医疗建议和 治疗、健康状况和结果。这些目标将导致未来对低收入人群进行多地点队列研究 患有心血管疾病的个体，将用于前瞻性研究健康变化如何 保险范围影响心血管结果。 Khatana 博士，早期职业研究员和研究员 心血管医学，长期目标是成为独立资助的心血管健康 政策和结果研究人员，重点研究卫生政策如何影响低收入人群的心血管健康 收入个人使用大型管理数据库以及个人定性方法 等级。这些研究目标是综合培训计划的一部分，并将由导师监督 由国家卫生成果和政策研究领域的领导者以及先进的专家组成的咨询团队 统计和定性方法，并将指导他过渡到独立资助的研究 职业。