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Eisinger EC, Chen AT, Ramadan OI, Morgan AU, Delgado MK, Kaufman EJ. Health Care Use Among Patients Retroactively Insured via a Hospital-Based Insurance Linkage Program. J Gen Intern Med 2024; 39:1977-1984. [PMID: 38483779 DOI: 10.1007/s11606-024-08712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE Over 25% of the 27 million uninsured individuals in the United States are eligible for Medicaid. Many hospitals have insurance linkage programs that assist eligible patients with enrollment, but little is known about the impact of these programs on care utilization. This research assessed health care utilization and health outcomes among patients enrolled in Medicaid via a hospital-based insurance linkage program. METHODS This retrospective cohort study included adults aged 18-64 admitted to the hospital from 2016 to 2021. Those who obtained insurance retroactively via insurance linkage (RI) were compared with those who presented with Medicaid (MI) or remained uninsured (UI). The primary outcome was the presence of at least one visit with a primary care provider (PCP) in the 12 months following index admission. Secondary outcomes included having an assigned PCP, ED revisits, and hospital readmissions. For patients with diabetes and hypertension, 12-month hemoglobin A1c (HbA1c) and blood pressure (BP) readings were tracked. RESULTS Of 3882 patients admitted with no insurance, 2905 (74.8%) were enrolled in insurance (RI). In multivariable analysis, RI patients were 14% more likely (OR 1.14, p = 0.020) to have completed at least one PCP visit by 12 months after index admission compared to those with preexisting Medicaid (MI), and uninsured patients were 29% less likely (OR 0.71, p = 0.003). MI and RI patients also had more ED revisits (p < 0.001) and greater 12-month reductions in blood pressure (p < 0.001) compared with uninsured patients. CONCLUSION Hospital-based insurance linkage reached three-quarters of uninsured patients and was associated with increased utilization of acute and outpatient health care services. An acute care encounter represents an opportunity to connect patients to insurance, a key step toward improving their health outcomes.
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Affiliation(s)
- Ella C Eisinger
- The Center for Surgical Health, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Angela T Chen
- The Center for Surgical Health, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Health Care Management Department, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Omar I Ramadan
- The Center for Surgical Health, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna U Morgan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M Kit Delgado
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elinore J Kaufman
- The Center for Surgical Health, University of Pennsylvania, Philadelphia, PA, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Trauma, Surgical Critical Care & Emergency Surgery, Penn Presbyterian Medical Center, Philadelphia, PA, USA.
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Thomas AC, Royan R, Nathens AB, Campbell BT, Reddy S, Spitzer S, Hamad D, Jang A, Stey AM. Patient and Hospital Characteristics Associated with Admission Among Patients With Minor Isolated Extremity Firearm Injuries: A Propensity-Matched Analysis. ANNALS OF SURGERY OPEN 2024; 5:e430. [PMID: 38911659 PMCID: PMC11191909 DOI: 10.1097/as9.0000000000000430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/09/2024] [Indexed: 06/25/2024] Open
Abstract
Objective To quantify the association between insurance and hospital admission following minor isolated extremity firearm injury. Background The association between insurance and injury admission has not been examined. Methods This was an observational retrospective cohort study of minor isolated extremity firearm injury captured in the Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases in 6 states (New York, Arkansas, Wisconsin, Massachusetts, Florida, and Maryland) from 2016 to 2017 among patients aged 16 years or older. The primary exposure was insurance. Admitted patients were propensity score matched to nonadmitted patients on age, extremity Abbreviated Injury Score, and Elixhauser Comorbidity Index with exact matching within hospital to adjust for selection bias. A general estimating equation logistic regression estimated the association between insurance and odds of admission in the matched cohort while controlling for sex, race, injury intent, injury type, hospital profit type, and trauma center designation with observations clustered by propensity score-matched pairs within hospital. Results A total of 8151 patients presented to hospital with a minor isolated extremity firearm injury between 2016 and 2017 in 6 states. Patients were 88.0% male, 56.6% Black, and 71.7% aged 16 to 36 years old, and 22.1% were admitted. A total of 2090 patients were matched on propensity for admission. Privately insured matched patients had 1.70 higher adjusted odds of admission and 95% confidence interval of 1.30 to 2.22, compared with uninsured after adjusting for patient and hospital characteristics. Conclusions Insurance was associated with hospital admission for minor isolated extremity firearm injury.
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Affiliation(s)
- Arielle C. Thomas
- From the Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
- American College of Surgeons, Chicago, IL
| | - Regina Royan
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Avery B. Nathens
- American College of Surgeons, Chicago, IL
- Department of Surgery, Sunnybrook Health Sciences Center and the University of Toronto, Toronto, ON, Canada
| | - Brendan T. Campbell
- Department of Pediatric Surgery, Connecticut Children’s Medical Center and University of Connecticut School of Medicine, Hartford, CT
| | - Susheel Reddy
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sarabeth Spitzer
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Doulia Hamad
- Department of Surgery, Sunnybrook Health Sciences Center and the University of Toronto, Toronto, ON, Canada
| | - Angie Jang
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anne M. Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Lee KM, Cheung YB. Estimation and reduction of bias in self-controlled case series with non-rare event dependent outcomes and heterogeneous populations. Stat Med 2024; 43:1955-1972. [PMID: 38438267 DOI: 10.1002/sim.10033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 10/19/2023] [Accepted: 01/23/2024] [Indexed: 03/06/2024]
Abstract
The self-controlled case series (SCCS) is a commonly adopted study design in the assessment of vaccine and drug safety. Recurrent event data collected from SCCS studies are typically analyzed using the conditional Poisson model which assumes event times are independent within-cases. This assumption is violated in the presence of event dependence, where the occurrence of an event influences the probability and timing of subsequent events. When event dependence is suspected in an SCCS study, the standard recommendation is to include only the first event from each case in the analysis. However, first event analysis can still yield biased estimates of the exposure relative incidence if the outcome event is not rare. We first demonstrate that the bias in first event analysis can be even higher than previously assumed when subpopulations with different baseline incidence rates are present and describe an improved method for estimating this bias. Subsequently, we propose a novel partitioned analysis method and demonstrate how it can reduce this bias. We provide a recommendation to guide the number of partitions to use with the partitioned analysis, illustrate this recommendation with an example SCCS study of the association between beta-blockers and acute myocardial infarction, and compare the partitioned analysis against other SCCS analysis methods by simulation.
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Affiliation(s)
| | - Yin Bun Cheung
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
- Signature Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
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Meille G. Interruptions in Insurance Coverage and Prescription Drug Utilization: Evidence from Kentucky. Med Care Res Rev 2024; 81:133-144. [PMID: 38062727 DOI: 10.1177/10775587231213691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
This study examined how interruptions in insurance coverage affect purchases of prescription drugs for young adults. It used data spanning 2014 to 2018 from Kentucky's prescription drug monitoring program, which tracked the universe of federally-regulated (Schedule II-V) prescription drugs dispensed in the state. The study employed a regression discontinuity design based on the age limit at 26 for dependent insurance coverage for children. At age 26, the probability of purchasing a prescription decreased by 5%, with all subcategories of prescriptions affected. The share of generic prescriptions increased for stimulants (the only category observed with substantial branded prescriptions). By age 27, prescription purchases returned to levels observed at 25, but the share purchased with public insurance and the generic share for stimulants remained higher. The findings suggest that interruptions in insurance coverage decrease prescription drug utilization by young adults and that public insurance programs such as Medicaid are important for resuming treatment.
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Affiliation(s)
- Giacomo Meille
- Agency for Healthcare Research and Quality, Rockville, MD, USA
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Qin X, Huckfeldt P, Abraham J, Yee D, Virnig BA. Was Unstable Medicaid Coverage Among Older Medicare Beneficiaries Associated With Worse Clinical Outcomes? Evidence From the Delivery of Breast Cancer Care. Med Care 2023; 61:611-618. [PMID: 37440716 DOI: 10.1097/mlr.0000000000001885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND Medicare and Medicaid dually eligible beneficiaries (duals) could experience Medicaid coverage changes without losing Medicaid. It is unknown whether health care use and clinical outcomes among elderly duals with coverage changes would be like those among duals without coverage changes or duals ever lost Medicaid and whether various types of unstable coverage due to income/asset changes are associated with worse clinical outcomes. OBJECTIVES Examine the associations of unstable Medicaid coverage with clinical outcomes among older Medicare beneficiaries. RESEARCH DESIGN Population-based cohort study. SUBJECTS A total of 131,202 women newly diagnosed with breast cancer at 65 years and older between 2007 and 2015 were identified from the Surveillance, Epidemiology, and End Results-Medicare linked database. MEASURES We examined 2 types of unstable Medicaid coverage: (1) those who had changes in the types of Medicaid support they received and (2) those who ever lost Medicaid. We examined outcomes that predict better cancer survival and involve the use of inpatient and outpatient services and prescription drugs: early diagnosis, receiving surgery, receiving radiation, hormonal therapy adherence, and discontinuation. We used logistic regressions to estimate the predicted probabilities of outcomes for dual groups. RESULTS Duals had poorer outcomes than those who were "never dual." Women with the 2 types of unstable Medicaid coverage had similarly worse outcomes than those with stable coverage. Those with stable coverage had similar outcomes regardless of the generosity of Medicaid support. CONCLUSIONS These patterns are concerning and, in the context of well-defined clinical guidelines for beneficial treatments that extend survival, point to the importance of stable insurance coverage and income.
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Affiliation(s)
- Xuanzi Qin
- Department of Health Policy and Management, University of Maryland School of Public Health, MD
- Division of Health Policy and Management, University of Minnesota School of Public Health
| | - Peter Huckfeldt
- Division of Health Policy and Management, University of Minnesota School of Public Health
| | - Jean Abraham
- Division of Health Policy and Management, University of Minnesota School of Public Health
| | - Douglas Yee
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Beth A Virnig
- Division of Health Policy and Management, University of Minnesota School of Public Health
- University of Florida College of Public Health and Health Professions, Gainesville, FL
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Wang Y, Cao P, Liu F, Chen Y, Xie J, Bai B, Liu Q, Ma H, Geng Q. Gender Differences in Unhealthy Lifestyle Behaviors among Adults with Diabetes in the United States between 1999 and 2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16412. [PMID: 36554290 PMCID: PMC9778889 DOI: 10.3390/ijerph192416412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Lifestyle management is important to patients with diabetes, but whether gender differences exist in lifestyle management is unclear. Data from the US National Health and Nutrition Examination Survey (NHANES 1999 to 2018) was used for this research. Gender differences were evaluated descriptively and using an odds ratio (OR) with a 95% confidence interval (CI). A total of 8412 participants (48% women) were finally included. Across these surveys, the incidences of poor diet (OR: 1.26 (95% CI, 1.12, 1.43)), smoking (1.58 (1.35, 1.84)), alcohol consumption (1.94 (1.68, 2.25)) and sedentary behavior (1.20 (1.04, 1.39)) were more common in men, while depression (0.47 (0.37, 0.59)), obesity (0.69 (0.61, 0.78)) and insufficient physical activity (0.56 (0.49, 0.65)) were more common in women. Reductions in poor diet were greater in men between 1999 and 2000 and 2017 and 2018 (p = 0.037), while the mean body mass index (BMI) levels (p = 0.019) increased more among women. Furthermore, several gender differences were found to be related to age, race/ethnicity and marital/insurance/employment statuses. Our research found gender differences in diabetes-related unhealthy lifestyle behaviors and provides reference data for implementing measures to reduce the gender differences. Further work to reduce gender-specific barriers to a healthy lifestyle is warranted in order to further improve diabetes management.
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Affiliation(s)
- Yu Wang
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Peihua Cao
- Clinical Research Center, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Fengyao Liu
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Yilin Chen
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Jingyu Xie
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Bingqing Bai
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Quanjun Liu
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Huan Ma
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Qingshan Geng
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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Kirby JB, Nogueira L, Zhao J, Yabroff KR. Do Disruptions in Health Insurance Continue to Affect Access to Care Even After Coverage Is Regained? J Gen Intern Med 2022; 37:2579-2581. [PMID: 34993858 PMCID: PMC9360292 DOI: 10.1007/s11606-021-07187-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- James B Kirby
- The Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Rockville, MD, USA.
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Association Between High Deductible Health Plans and Cost-Related Non-adherence to Medications Among Americans with Diabetes: an Observational Study. J Gen Intern Med 2022; 37:1910-1916. [PMID: 34324130 PMCID: PMC9198142 DOI: 10.1007/s11606-021-06937-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND For people with diabetes, adherence to prescribed medications is essential. However, the rising prevalence of high-deductible health plans (HDHPs), and prices of diabetes medications such as insulin, could deter adherence. OBJECTIVE To assess the impact of HDHP on cost-related medication non-adherence (CRN) among non-elderly adults with diabetes in the US. DESIGN Repeated cross-sectional survey. SETTING National Health Interview Survey, 2011-2018. PARTICIPANTS A total of 7469 privately insured adults ages 18-64 with diabetes who were prescribed medications and enrolled in a HDHP or a traditional commercial health plan (TCP). MAIN MEASURES Self-reported measures of CRN were compared between enrollees in HDHPs and TCPs overall and among the subset using insulin. Analyses were adjusted for demographic and clinical characteristics using multivariable linear regression models. KEY RESULTS HDHP enrollees were more likely than TCP enrollees to not fill a prescription (13.4% vs 9.9%; adjusted percentage point difference (AD) 3.4 [95% CI 1.5 to 5.4]); skip medication doses (11.4% vs 8.5%; AD 2.8 [CI 1.0 to 4.7]); take less medication (11.1% vs 8.8%; AD 2.3 [CI 0.5 to 4.0]); delay filling a prescription to save money (14.4% vs 10.8%; AD 3.0 [CI 1.1 to 4.9]); and to have any form of CRN (20.4% vs 15.5%; AD 4.4 [CI 2.2 to 6.7]). Among those taking insulin, HDHP enrollees were more likely to have any CRN (25.1% vs 18.9%; AD 5.9 [CI 1.1 to 10.8]). CONCLUSION HDHPs are associated with greater CRN among people with diabetes, particularly those prescribed insulin. For people with diabetes, enrollment in non-HDHPs might reduce CRN to prescribed medications.
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Mizokami-Stout K, Bailey R, Ang L, Aleppo G, Levy CJ, Rickels MR, Shah VN, Polsky S, Nelson B, Carlson AL, Vendrame F, Pop-Busui R. Symptomatic diabetic autonomic neuropathy in type 1 diabetes (T1D): Findings from the T1D exchange. J Diabetes Complications 2022; 36:108148. [PMID: 35279403 DOI: 10.1016/j.jdiacomp.2022.108148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
AIMS We aimed to evaluate the contemporary prevalence of and risk factors for symptomatic diabetic autonomic neuropathy (DAN) in participants with type 1 diabetes (T1D) enrolled in the T1D Exchange Clinic Registry. METHODS DAN symptoms and severity were assessed with the Survey of Autonomic Symptoms (SAS) in adults with ≥5 years of T1D participating in the T1D Exchange from years 2010-2017. Associations of demographic, clinical, and laboratory factors with symptomatic DAN were assessed. RESULTS Of the 4919 eligible T1D participants, 965 (20%) individuals completed the SAS questionnaire [mean age 40 ± 17 years, median diabetes duration 20 years (IQR: 13,34), 64% female, 90% non-Hispanic White, and 82% with private insurance]. DAN symptoms were present in 166 (17%) of responders with 72% experiencing moderate severity symptoms or worse. Symptomatic DAN participants had higher hemoglobin A1c (p = 0.03), longer duration (p = 0.004), were more likely to be female (p = 0.03), and more likely to have lower income (p = 0.03) versus no DAN symptoms. Symptomatic DAN was associated with diabetic peripheral neuropathy (p < 0.0001), smoking (p = 0.002), cardiovascular disease (p = 0.02), depression (p < 0.001), and opioid use (p = 0.004). CONCLUSIONS DAN symptoms are common in T1D. Socioeconomic factors and psychological comorbidities may contribute to DAN symptoms and should be explored further.
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Affiliation(s)
| | - Ryan Bailey
- Jaeb Center for Health Research, Tampa, FL, United States of America
| | - Lynn Ang
- University of Michigan, Ann Arbor, MI, United States of America
| | - Grazia Aleppo
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Carol J Levy
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Michael R Rickels
- Rodebaugh Diabetes Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Bryce Nelson
- Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Anders L Carlson
- International Diabetes Center, Minneapolis, MN, United States of America
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Bensken WP, Ciesielski TH, Williams SM, Stange KC, Sajatovic M, Koroukian SM. Inconsistent Medicaid Coverage is Associated with Negative Health Events for People with Epilepsy. J Health Care Poor Underserved 2022; 33:1036-1053. [PMID: 35574892 PMCID: PMC9147776 DOI: 10.1353/hpu.2022.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Examine the association between gaps in Medicaid coverage and negative health events (NHEs) for people with epilepsy (PWE). METHODS Using five years of Medicaid claims for PWE, we identified gaps in Medicaid coverage. We used logistic regression to evaluate the association between a gap in coverage and being in the top quartile of NHEs and factors associated with having a gap. These models adjusted for: demographics, residence, medication adherence, disease severity, and comorbidities. RESULTS Of 186,616 PWE, 21.7% had a gap in coverage. The odds of being in the top quartile of NHEs per year were 66% higher among those with a gap (OR: 1.66; 95% CI: 1.61, 1.70). Being female, younger, and having psychiatric comorbidities increased the odds of having a gap. CONCLUSIONS Gaps in Medicaid coverage are associated with being a high utilizer during covered periods. Specific groups could be targeted with interventions to reduce churning.
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Affiliation(s)
- Wyatt P. Bensken
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Timothy H. Ciesielski
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Scott M. Williams
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Kurt C. Stange
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Center for Community Health Integration, Departments of Family Medicine & Community Health and Sociology, Case Western Reserve University, Cleveland, OH
| | - Martha Sajatovic
- Departments of Neurology and Psychiatry, University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Siran M. Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio
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Nip ASY, Lodish M. Trend of Diabetes-Related Hospital Admissions During the Transition Period From Adolescence to Adulthood in the State of California. Diabetes Care 2021; 44:2723-2728. [PMID: 34675057 DOI: 10.2337/dc21-0555] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/25/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study examined the incidence of diabetes-related hospital admissions and described the characteristics among youth and emerging adults with type 1 (T1D) and type 2 diabetes (T2D) in California. RESEARCH DESIGN AND METHODS A retrospective study was conducted using the statewide inpatient database during the years 2014-2018. Individuals aged 13-24 years hospitalized with diabetic ketoacidosis (DKA) or severe hypoglycemia (SH) were recorded. Demographic characteristics and health measures among youth (ages 13-18) and young adults (ages 19-24) were compared. RESULTS A total of 34,749 admission encounters for T1D and 3,304 for T2D were analyzed. Hospitalization rates significantly increased with age during the transition to adulthood, from 70/100,000 California population at age 17 to 132/100,000 at age 19 in T1D. Higher hospitalization rates were demonstrated in young adults than in youth in T1D, and the rate was significantly higher in Black young adults (23.9%) than in youth (12.0%) among the age-adjusted population with diabetes (P < 0.0001). More young adults admitted were on public insurance, and approximately half were from the lowest income quartile. No difference was observed in hospital length of stay; however, hospital charges were higher among young adults. Young adults were three times more likely to be admitted for severe conditions. CONCLUSIONS We demonstrated a significant rise in hospital admission during the transition period in individuals with T1D. There were significantly more Black young adults who were on public insurance and had lower socioeconomic status. Our findings suggest that the health care system fails many emerging adults with diabetes, particularly for people of color, and that improving medical transition is crucial.
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Affiliation(s)
- Angel Siu Ying Nip
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Maya Lodish
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA.,Division of Pediatric Endocrinology, University of California, San Francisco, San Francisco, CA
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He C, Hinds D, Pezalla E, Cheng D, Chen E, Sammon J, Solari PG, Recht M. Health insurance coverage and switching among people with hemophilia A in the United States. J Manag Care Spec Pharm 2021; 28:232-243. [PMID: 34780299 DOI: 10.18553/jmcp.2021.21311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Hemophilia A (HA) is marked by substantial economic burden, including costs of ongoing treatment, increased monitoring, bleed events, and other health care utilization associated with managing the disease and comorbidities related to the disease. Gene therapies and other anticipated breakthrough treatments hold potential to substantially offset long-term traditional factor VIII (FVIII) prophylaxis in specific populations. Fragmentation of the US insurance system, however, may impact payers' approaches to coverage of new treatments, given concerns about patients "switching" insurance and the payer's ability to offset costs over time. OBJECTIVE: To assess insurance coverage and switching across payers among people with severe HA (SHA) using real-world data. METHODS: Adult men with SHA (FVIII measuring < 1%) in the American Thrombosis and Hemostasis Network dataset between January 2013 and September 2019 were identified. Patients' primary insurance category (ie, commercial, Medicaid, Medicare) and insurance switching over time were described. Outcomes included distribution of current primary insurance coverage by category and mean years of coverage per payer for commercially insured patients, including those with 2 or more commercial payers, and for those who switched insurance categories (eg, coverage by a commercial payer and government payer). RESULTS: Among the cohort of patients with SHA (N = 3,677), 51.9% had commercial primary insurance and 29.0% had coverage by Medicaid (including state-funded programs). The mean duration of follow-up in the database was 6.3 years for patients with at least 1 year of follow-up. Among patients who had ever been commercially insured, 74.9% had the same commercial payer for the entire follow-up period. The mean time covered by the same commercial insurance was 4.8 years. Only 7.5% of patients switched insurance categories (eg, from commercial to Medicaid). Among those who switched categories, patients averaged 3.9 years of commercial coverage, 4.0 years of Medicaid coverage, and 4.8 years of Medicare coverage during the follow-up period. CONCLUSIONS: Both commercially and government-insured patients with SHA typically maintain continuous coverage for extended periods, with limited switching between payers and insurance categories over time. These findings suggest that should breakthrough treatments be approved, payers would likely be able to realize substantial cost savings associated with avoiding long-term prophylactic therapies during the several years after treatment. DISCLOSURES: This study was funded by BioMarin Pharmaceutical Inc. Hinds, Chen, and Sammon are employees of BioMarin Pharmaceutical Inc. and own stock/stock options. Solari was an employee of BioMarin Pharmaceutical Inc. at the time of the study. Pezalla is CEO of Enlightenment Bioconsult, LLC. He, Cheng, and Recht are, or were at the time of this study, employees of American Thrombosis and Hemostasis Network (ATHN), which has received ATHNdataset licensing and other fees from BioMarin Pharmaceutical Inc. Research funding to Recht's employers has come from Bayer, BioMarin Pharmaceutical Inc., CSL Behring, Genentech, Grifols, Hema Biologics, LFB, Novo Nordisk, Octapharma, Pfizer, Sanofi, Spark, Takeda, and uniQure. Recht has also worked as a consultant for Catalyst Biosciences, CSL Behring, Genentech, Hema Biologics, Kedrion, Novo Nordisk, Pfizer, Sanofi, Takeda, and uniQure; sits on the board of directors of the Foundation for Women and Girls with Blood Disorders and of Partners in Bleeding Disorders; and is an employee of the Oregon Health & Science University. Data from this study were presented as a poster at AMCP Nexus 2021; October 18-21, 2021; Denver, CO.
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Affiliation(s)
- Chunla He
- American Thrombosis and Hemostasis Network, Rochester, NY
| | - David Hinds
- BioMarin Pharmaceutical Inc., San Rafael, CA
| | | | - Dunlei Cheng
- American Thrombosis and Hemostasis Network, Rochester, NY
| | - Er Chen
- BioMarin Pharmaceutical Inc., San Rafael, CA
| | | | | | - Michael Recht
- American Thrombosis and Hemostasis Network, Rochester, NY
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13
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Garcia JF, Fogel J, Reid M, Bisno DI, Raymond JK. Telehealth for Young Adults With Diabetes: Addressing Social Determinants of Health. Diabetes Spectr 2021; 34:357-362. [PMID: 34866868 PMCID: PMC8603121 DOI: 10.2337/dsi21-0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Type 1 diabetes is a challenging chronic condition and can lead to diabetes-related distress and disengagement. Historically disadvantaged, racially and ethnically diverse young adults (YAs) with type 1 diabetes experience higher blood glucose levels and encounter more barriers to care than their White counterparts. Current research shows that telehealth may provide a route for improving psychosocial issues and diabetes care among YAs.
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Affiliation(s)
- Jaquelin Flores Garcia
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
- Corresponding author: Jaquelin Flores Garcia,
| | - Jennifer Fogel
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | - Mark Reid
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | - Daniel I. Bisno
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jennifer K. Raymond
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
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14
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Yan C. WITHDRAWN: The effect of commercial health insurance and health policy incentives on health risk assessment of residents. Work 2021:WOR210251. [PMID: 34308893 DOI: 10.3233/wor-210251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ahead of Print article withdrawn by publisher.
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15
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Ng BP, Laxy M, Shrestha SS, Soler RE, Cannon MJ, Smith BD, Zhang P. Prevalence and medical expenditures of diabetes-related complications among adult Medicaid enrollees with diabetes in eight U.S. states. J Diabetes Complications 2021; 35:107814. [PMID: 33419632 DOI: 10.1016/j.jdiacomp.2020.107814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
AIMS To estimate the prevalence and medical expenditures of diabetes-related complications (DRCs) among adult Medicaid enrollees with diabetes. METHODS We estimated the prevalence and medical expenditures for 12 diabetes-related complications by Medicaid eligibility category (disability-based vs. non-disability-based) in eight states. We used generalized linear models with log link and gamma distribution to estimate the total per-person annual medical expenditures for DRCs, controlling for demographics, and other comorbidities. RESULTS Among non-disability-based enrollees (NDBEs), 40.1% (in California) to 47.5% (in Oklahoma) had one or more DRCs, compared to 53.6% (in Alabama) to 64.8% (in Florida) among disability-based enrollees (DBEs). The most prevalent complication was neuropathy (16.1%-27.1% for NDBEs; 20.2%-30.4% for DBEs). Lower extremity amputation (<1% for both eligibilities) was the least prevalent complication. The costliest per-person complication was dialysis (per-person excess annual expenditure of $22,481-$41,298 for NDBEs; $23,569-$51,470 for DBEs in 2012 USD). Combining prevalence and per-person excess expenditures, the three costliest complications were nephropathy, heart failure, and ischemic heart disease (IHD) for DBEs, compared to neuropathy, nephropathy, and IHD for NDBEs. CONCLUSIONS Our study provides data that can be used for assessing the health care resources needed for managing DRCs and evaluating cost-effectiveness of interventions to prevent and management DRCs.
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Affiliation(s)
- Boon Peng Ng
- College of Nursing & Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, United States of America; Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Germany; German Center of Diabetes Research (DZD), Neuherberg-Munich, Germany; Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America; Technical University of Munich, Department of Sport and Health Science, Munich, Germany
| | - Sundar S Shrestha
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Robin E Soler
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Michael J Cannon
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Bryce D Smith
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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16
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Litchman ML, Oser TK, Wawrzynski SE, Walker HR, Oser S. The Underground Exchange of Diabetes Medications and Supplies: Donating, Trading, and Borrowing, Oh My! J Diabetes Sci Technol 2020; 14:1000-1009. [PMID: 31801370 PMCID: PMC7645126 DOI: 10.1177/1932296819888215] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The cost of diabetes medications and supplies is rising, resulting in access challenges. This study assessed the prevalence of and factors predicting underground exchange activities-donating, trading, borrowing, and purchasing diabetes medications and supplies. RESEARCH DESIGN AND METHODS A convenience sample of people affected by diabetes was recruited online to complete a survey. Mixed method analysis was undertaken, including logistic regression to examine the relationship between self-reported difficulty purchasing diabetes medications and supplies and engagement in underground exchange activity. Thematic qualitative analysis was used to examine open-text responses. RESULTS Participants (N = 159) self-reported engagement in underground exchange activities, including donating (56.6%), donation receiving (34.6%), trading (23.9%), purchasing (15.1%), and borrowing (22%). Such activity took place among a variety of individuals, including friends, family, coworkers, online acquaintances and strangers. Diabetes-specific financial stress predicted engagement in trading diabetes mediations or supplies (OR 6.3, 95% CI 2.2-18.5) and receiving donated medications or supplies (OR 2.8, 95% CI 1.1-7.2). One overarching theme, unmet needs, and three subthemes emerged: (1) factors influencing underground exchange activity, (2) perceived benefits of underground exchange activity, and (3) perceived consequences of underground exchange activity. CONCLUSION Over half of the participants in this study engaged in underground exchange activities out of necessity. Providers must be aware about this underground exchange and inquire about safety and possible alternative resources. There is an urgent need to improve access to medications that are essential for life. Our study points to a failure in the US healthcare system since such underground exchanges may not be necessary if medications and supplies were accessible.
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Affiliation(s)
- Michelle L. Litchman
- University of Utah College of Nursing, Salt Lake City, UT, USA
- Michelle L. Litchman, PhD, FNP-BC, FAANP, University of Utah College of Nursing, 10 South 2000 East, Salt Lake City, UT 84112, USA.
| | - Tamara K. Oser
- University of Colorado Denver, School of Medicine, CO, USA
| | | | | | - Sean Oser
- University of Colorado Denver, School of Medicine, CO, USA
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17
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Abstract
BACKGROUND A key goal of the Patient Protection and Affordable Care Act (ACA) was to increase health insurance coverage for people with chronic disease. Little is known about progress toward this goal over the first 5 years of ACA implementation. OBJECTIVE The objective of this study was to assess changes in coverage for nonelderly adults with and without chronic disease over the first 5 years of ACA implementation, and the effects of state-level Medicaid eligibility expansions on coverage for these populations. RESEARCH DESIGN Multivariable and difference-in-differences regression models. PARTICIPANTS A total of 2,007,271 adults aged 18-64 years in the nationally representative Behavioral Risk Factor Surveillance System 2011-2018 data. MEASURES Self-reported insurance coverage. RESULTS Over the first 5 years of ACA implementation, coverage increased among nonelderly adults with versus without chronic disease by 6.9 versus 5.4 percentage points, respectively (95% confidence interval: 6.1-7.6, P<0.001, and 4.4-6.3, P<0.001, respectively). State-level Medicaid eligibility expansions were associated with a coverage increase among people with chronic disease of 2.8 percentage points (95% confidence interval: 1.7-3.8, P<0.001). After ACA implementation diminished in 2017, coverage gains for people with chronic disease declined by 0.9 percentage points (P<0.001). CONCLUSIONS Coverage significantly improved for people with chronic disease during the first 5 years of ACA implementation, with ACA Medicaid expansions increasing coverage further. After ACA implementation diminished in 2017, coverage gains decreased.
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Affiliation(s)
- Rebecca Myerson
- Department of Population Health Sciences, Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Samuel Crawford
- Department of Pharmaceutical and Health Economics, School of Pharmacy, Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
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18
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Wolf RA, Haw JS, Paul S, Spezia Faulkner M, Cha E, Findley MK, Khan F, Markley Webster S, Alexopoulos AS, Mehta K, Alfa DA, Ali MK. Hospital admissions for hyperglycemic emergencies in young adults at an inner-city hospital. Diabetes Res Clin Pract 2019; 157:107869. [PMID: 31560962 PMCID: PMC6914263 DOI: 10.1016/j.diabres.2019.107869] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/18/2019] [Accepted: 09/23/2019] [Indexed: 12/16/2022]
Abstract
AIMS There is limited information characterizing young adults (18-35 years) (YA) with diabetes, especially those admitted for hyperglycemic emergencies. The study aims were to examine associations of patient-level characteristics with hyperglycemic emergency hospitalization and to identify variations based on diabetes type and glycemic control. METHODS We conducted retrospective analysis of 273 YA admitted to an inner-city hospital with diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHS). T-tests, Chi-Square tests, and ANOVA identified differences in demographics, diabetes history, clinical indicators, complications/comorbidities, and hospital admission stratified separately by diabetes type (1 vs 2) and admission HbA1c < 9% (75 mmol/mol), ≥9% to 12% (108 mmol/mol), ≥12%). RESULTS Mean admission HbA1c was 12.4% (112 mmol/ml). HbA1c was ≥9.0% for 90.5%. The main DKA/HHS trigger was medication nonadherence (57.9%), with 35.6% presenting with new-onset type 2 diabetes. Only 3.7% utilized outpatient diabetes clinics, 38.8% were re-hospitalized within the year, and 69% lacked insurance. Diabetes complications (44.7%) and psychiatric co-morbidities (35.5%) were common. Significantly more YA with type 1 diabetes had insurance, whereas YA with type 2 diabetes had higher admission HbA1c. YA with HbA1c ≥12% were more likely to be Black and lack insurance. CONCLUSIONS YA hospitalized for DKA/HHS in an inner-city hospital tended to have severely uncontrolled diabetes. Many already had comorbidities and diabetes complications, high use of acute care services and low use of diabetes specialty services. YA characteristics varied by diabetes type and HbA1c. Overall, a substantial percentage lacked insurance, potentially impacting healthcare utilization patterns and medication adherence, and leading to DKA/HHS admissions.
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Affiliation(s)
- Rachel A Wolf
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States.
| | - J Sonya Haw
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Melissa Spezia Faulkner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States; School of Nursing, Georgia State University, Atlanta, GA, United States
| | - EunSeok Cha
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States; Chungnam National University, College of Nursing, Daejeon, South Korea
| | - M K Findley
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Farah Khan
- School of Medicine, Emory University, Atlanta, GA, United States; Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, United States
| | | | | | - Komal Mehta
- School of Medicine, Emory University, Atlanta, GA, United States
| | - David A Alfa
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Mohammed K Ali
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States; Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Gordon SH, Sommers BD, Wilson I, Galarraga O, Trivedi AN. The Impact of Medicaid Expansion on Continuous Enrollment: a Two-State Analysis. J Gen Intern Med 2019; 34:1919-1924. [PMID: 31228048 PMCID: PMC6712155 DOI: 10.1007/s11606-019-05101-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/22/2019] [Accepted: 05/01/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Discontinuous Medicaid insurance erodes access to care, increases administrative costs, and exposes enrollees to substantial out-of-pocket spending. OBJECTIVE To assess the impact of Medicaid expansion under the Affordable Care Act on continuity of Medicaid coverage among those enrolled prior to expansion. DESIGN Using a difference-in-differences framework, we compared Colorado, a state that expanded Medicaid, to Utah, a nonexpansion state, before and after Medicaid expansion implementation. PARTICIPANTS Adults ages 18-62 who were enrolled in Medicaid coverage in Colorado and Utah prior to expansion, from the Utah and Colorado All Payer Claims Databases, 2013-2015. MAIN MEASURES The primary outcomes were the duration of Medicaid enrollment and rates of disrupted coverage. KEY RESULTS Following Medicaid expansion, enrollees in Colorado gained an additional 2 months of coverage over two years of follow-up and were 16 percentage points less likely to experience a coverage disruption in a given year relative to enrollees in Utah. CONCLUSIONS Increasing Medicaid eligibility levels under the Affordable Care Act appears to be an effective strategy to reduce churning in the Medicaid program, with important implications for other states that are considering Medicaid expansion.
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Affiliation(s)
- Sarah H Gordon
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
| | - Benjamin D Sommers
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Ira Wilson
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Omar Galarraga
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Amal N Trivedi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.,Providence VA Medical Center, Providence, RI, USA
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20
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Gomes MB, Santos DC, Pizarro MH, Melo LGN, Barros BSV, Montenegro R, Fernandes V, Negrato CA. Relationship between health care insurance status, social determinants and prevalence of diabetes-related microvascular complications in patients with type 1 diabetes: a nationwide survey in Brazil. Acta Diabetol 2019; 56:697-705. [PMID: 30868316 DOI: 10.1007/s00592-019-01308-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/14/2019] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate the relationship between social determinants, health care insurance status and occurrence of diabetes-related chronic complications (DRCC) in Brazilian patients with type 1 diabetes. METHODS A multicenter cross-sectional study conducted between August 2011 and August 2014 in 14 public clinics in 10 Brazilian cities. Data were obtained from 1760 patients, aged 29.9 ± 11.9 years, with diabetes duration of 15.5 ± 9.3 years; 55.9% female, 54.5% Caucasians, 69.7% were attended exclusively by the public Brazilian National Health Care System (BNHCS) and 30.3% had also private health care insurance. Patients' information was obtained through a questionnaire and a chart review form. RESULTS The social determinants associated with having both private and public health care insurance were being employed, belonging to medium or high socioeconomic status, having more years of school attendance and having younger age. Regarding DRCC, patients that had private and public health care had lower rates of diabetic retinopathy and of any other DRCC. Chronic kidney disease was not associated with health care coverage status after adjusting for classical clinical risk factors. CONCLUSIONS Brazilian patients with type 1 diabetes had better clinical control and lower rates of DRCC, mainly retinopathy, when also having private health care insurance. These patients presented less frequently predictors of chronic complications such as high levels of HbA1c and blood pressure. BNHCS should change the approach for screening DRCC such as diabetic retinopathy, using methods such as telemedicine that would lead to earlier diagnosis, better outcomes and will be cost-effective sometime after its implementation.
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Affiliation(s)
- Marilia Brito Gomes
- Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Deborah Conte Santos
- Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcela Haas Pizarro
- Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Laura Gomes Nunes Melo
- Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Renan Montenegro
- Department of Internal Medicine, Federal University of Ceara, Fortaleza, Ceará, Brazil
| | - Virginia Fernandes
- Department of Internal Medicine, Federal University of Ceara, Fortaleza, Ceará, Brazil
| | - Carlos Antonio Negrato
- Bauru's Diabetics Association, Rua Saint Martin 27-07, Bauru, São Paulo, CEP 17012-433, Brazil.
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21
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Rogers MA, Kim C, Tipirneni R, Basu T, Lee JM. Duration of Insulin Supply in Type 1 Diabetes: Are 90 Days Better or Worse Than 30 Days? Diabetes Spectr 2019; 32:139-144. [PMID: 31168285 PMCID: PMC6528389 DOI: 10.2337/ds18-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There have been few studies regarding the duration of insulin prescriptions and patient outcomes. This study evaluated whether A1C varied with the duration of insulin prescription in patients with type 1 diabetes. METHODS We conducted a longitudinal investigation (from 2001 to 2015) within a nationwide private health insurer. A cohort study was first used to compare A1C after 30-day only, 90-day only, and a combination (30-day and 90-day) of insulin prescriptions. Second, a self-controlled case series was used to compare A1C levels after 30-day versus 90-day prescriptions for the same person. RESULTS In the cohort study, there were 16,725 eligible patients. Mean A1C was 8.33% for patients with 30-day prescriptions compared to 7.69% for those with 90-day prescriptions and 8.05% for those who had a combination of 30- and 90-day prescriptions (P <0.001). Results were similar when stratified by age and sex. Mean A1C was 7.58% when all prescriptions were mailed versus 8.21% when they were not. In the self-controlled case series, there were 1,712 patients who switched between 30- and 90-day prescriptions. Mean A1C was 7.87% after 30-day prescriptions and 7.69% after 90-day prescriptions (P <0.001). Results were similar when stratified by sex. For this within-person comparison, the results remained significant for those ≥20 years of age (n = 1,536, P <0.001), but not for youth (n = 176, P = 0.972). CONCLUSION There was a statistically significant but clinically modest decrease in A1C with 90-day versus 30-day insulin prescriptions in adults. A mailed 90-day insulin prescription may be a reasonable choice for adults with type 1 diabetes.
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Affiliation(s)
- Mary A.M. Rogers
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Catherine Kim
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Renuka Tipirneni
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Tanima Basu
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Joyce M. Lee
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Pediatric Endocrinology, Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, MI
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Ferdinand AO, Akinlotan MA, Callaghan T, Towne SD, Bolin J. Diabetes-related hospital mortality in the U.S.: A pooled cross-sectional study of the National Inpatient Sample. J Diabetes Complications 2019; 33:350-355. [PMID: 30910276 DOI: 10.1016/j.jdiacomp.2019.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 01/22/2023]
Abstract
AIMS Despite advancements in the diagnosis and treatment of diabetes in the U.S., place-based disparities still exist. The purpose of this study is to determine place-based and other individual-level variations in diabetes-related hospital deaths. METHODS A pooled cross-sectional study of the 2009-2015 National Inpatient Sample was conducted to examine the odds of a diabetes-related hospital death. The main predictors were rurality and census region. Individual-level socio-demographic factors were also examined. RESULTS Approximately 1.5% (n = 147,069) of diabetes-related hospitalizations resulted in death. In multivariable analysis, the odds of diabetes-related hospital deaths increased across the urban-rural continuum, except for large fringe metropolitan areas, with the highest odds of such deaths occurring among residents of micropolitan (OR = 1.16, 95% C.I. = 1.14, 1.18) and noncore areas (OR = 1.21, 95% C.I. = 1.19, 1.24). Compared to residents of the Northeast, residents in the South, West and Midwest regions were significantly more likely to experience a diabetes-related hospital death. Asian or Pacific Islanders, Medicaid-covered patients and the uninsured were also more likely to die during a diabetes-related hospitalization. CONCLUSIONS Place-based disparities in diabetes-related hospital deaths exist. Targeted focus should be placed on the control of diabetic complications in the South, West and Midwest census regions, and among rural residents.
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Affiliation(s)
- Alva O Ferdinand
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, United States of America; Southwest Rural Health Research Center, School of Public Health, Texas A&M University, College Station, TX, United States of America.
| | - Marvellous A Akinlotan
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, United States of America; Southwest Rural Health Research Center, School of Public Health, Texas A&M University, College Station, TX, United States of America
| | - Timothy Callaghan
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, United States of America; Southwest Rural Health Research Center, School of Public Health, Texas A&M University, College Station, TX, United States of America
| | - Samuel D Towne
- Southwest Rural Health Research Center, School of Public Health, Texas A&M University, College Station, TX, United States of America; Department of Health Management and Informatics, University of Central Florida, Orlando, FL, United States of America; Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, United States of America
| | - Jane Bolin
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, United States of America; Southwest Rural Health Research Center, School of Public Health, Texas A&M University, College Station, TX, United States of America
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23
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McCoy RG, Kidney RSM, Holznagel D, Peters T, Madzura V. Challenges for younger adults with diabetes. MINNESOTA MEDICINE 2019; 102:34-36. [PMID: 31889734 PMCID: PMC6936754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Rozalina G McCoy
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic
| | - Renée S M Kidney
- Diabetes Unit in the Minnesota Department of Health's Division of Health Promotion and Chronic Disease
| | | | - Tina Peters
- Minnesota Department of Health, Health Care Homes Program
| | - Vimbai Madzura
- Community and Care Integration Division, Minnesota Department of Human Services
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24
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Rogers MAM, Rogers BS, Basu T. Prevalence of Type 1 Diabetes Among People Aged 19 and Younger in the United States. Prev Chronic Dis 2018; 15:E143. [PMID: 30468421 PMCID: PMC6266542 DOI: 10.5888/pcd15.180323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Mary A M Rogers
- Department of Internal Medicine, University of Michigan, Bldg 16, Rm 422W North Campus Research Complex, 2800 Plymouth Rd, Ann Arbor, MI 48109. .,Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Benjamin S Rogers
- Department of Geography, Bowling Green State University, Bowling Green, Ohio
| | - Tanima Basu
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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