Medicaid Expansion and Hospitalization for Ambulatory Care-Sensitive Conditions Among Nonelderly Adults With Diabetes.
Ontology highlight
ABSTRACT:
SUBMITTER: Mondesir FL
PROVIDER: S-EPMC6710100 | biostudies-literature | 2019 Oct/Dec
REPOSITORIES: biostudies-literature
Publications
Medicaid Expansion and Hospitalization for Ambulatory Care-Sensitive Conditions Among Nonelderly Adults With Diabetes.
Mondesir Favel L FL Kilgore Meredith L ML Shelley John P JP Levitan Emily B EB Huang Lei L Riggs Kevin R KR Pisu Maria M Li Yufeng Y Bronstein Janet M JM Agne April A Cherrington Andrea L AL
The Journal of ambulatory care management 20191001 4
Among nonelderly adults with diabetes, we compared hospitalizations for ambulatory care-sensitive conditions from 2013 (pre-Medicaid expansion) and 2014 (post-Medicaid expansion) for 13 expansion and 4 nonexpansion states using State Inpatient Databases. Medicaid expansion was associated with decreases in proportions of hospitalizations for chronic conditions (difference between 2014 and 2013 -0.17 percentage points in expansion and 0.37 in nonexpansion states, P = .04), specifically diabetes sh ...[more]
Similar Datasets
Project description:PurposeThis study aimed to examine 12-year trends in hospitalization rates for ambulatory care sensitive conditions (ACSC) and factors affecting hospitalization.Materials and methodsThis study used data on Korean National Health Insurance and Medical Aid patients aged 19 and over who used medical services at least once between January 2008 and December 2019 with an ACSC as their major diagnosis. As of 2019, a total of 12324071 patients were included. To check for any changes in hospitalization, age- and sex-standardized hospitalization rates were obtained for each condition and insurance type, and multiple logistic regression was performed to identify factors affecting hospitalization.ResultsThe collective average ACSC hospitalization rate decreased from 5.0% in 2008 to 4.2% in 2019. Specifically, hospitalization rates for hypertension (1.4% in 2008; 0.8% in 2019), diabetes (5.8% in 2008; 3.3% in 2019), and chronic obstructive pulmonary disease and asthma (4.1% in 2008; 3.2% in 2019) decreased, while rates for pneumonia (24.5% in 2008; 28.1% in 2019) and urinary tract infection (UTI) (5.7% in 2008; 6.4% in 2019) increased. The rate for heart failure decreased 2.3% between 2008 and 2012 and then rebounded. The odds of hospitalization among Medical Aid patients were 1.45-4.20 times higher than those of National Health Insurance patients.ConclusionDifferences in trends were confirmed for ACSC hospitalization rates among different conditions and insurance types in Korea. These results suggest the need for policy reforms aimed at reducing hospitalization for heart failure, pneumonia, and UTI, especially among Medical Aid patients.
| S-EPMC9520050 | biostudies-literature
Project description:ObjectiveTo investigate the impact of implementation of the Statewide Medicaid Managed Care (SMMC) program in Florida on access to and quality of primary care for Medicaid enrollees, measured by hospitalizations for ambulatory care sensitive conditions (ACSCs).Data sourcesWe examine inpatient data obtained from the Agency for Health Care Administration for 285 hospitals in Florida from January 2010 to June 2015. The analysis includes 3,645,515 discharges for Florida residents between the ages 18 and 64 with a primary payer of Medicaid or private insurance.Study designWe use a difference-in-differences approach, comparing the change in the incidence of ACSC-related inpatient visits among Medicaid patients before and after the implementation of SMMC, relative to the change among the privately insured.Principal findingsAfter implementation of SMMC, Medicaid patients experienced a 0.35 percentage point slower growth in overall ACSC-related inpatient visits, and a 0.21 percentage point slower growth in chronic ACSC-related inpatient visits. The effects were significant in counties with above median Medicaid managed care penetration rates.ConclusionsImplementing mandatory managed care in Medicaid in Florida leads to slower growth in inpatient visits for conditions that can potentially be prevented with improved access to outpatient care.
| S-EPMC5785303 | biostudies-literature
Project description:BACKGROUND:Ambulatory Care Sensitive Conditions (ACSCs) are health conditions for which adequate management, treatment and interventions delivered in the ambulatory care setting could potentially prevent hospitalization. Which conditions are sensitive to ambulatory care varies according to the scope of health care services and the context in which the indicator is used. The need for a country-specific validated list for Portugal has already been identified, but currently no national list exists. The objective of this study was to develop a list of Ambulatory Care Sensitive Conditions for Portugal. METHODS:A modified web-based Delphi panel approach was designed, in order to determine which conditions can be considered ACSCs in the Portuguese adult population. The selected experts were general practitioners and internal medicine physicians identified by the most relevant Portuguese scientific societies. Experts were presented with previously identified ACSC and asked to select which could be accepted in the Portuguese context. They were also asked to identify other conditions they considered relevant. We estimated the number and cost of ACSC hospitalizations in 2017 in Portugal according to the identified conditions. RESULTS:After three rounds the experts agreed on 34 of the 45 initially proposed items. Fourteen new conditions were proposed and four achieved consensus, namely uterine cervical cancer, colorectal cancer, thromboembolic venous disease and voluntary termination of pregnancy. In 2017 133,427 hospitalizations were for ACSC (15.7% of all hospitalizations). This represents a rate of 1685 per 100,000 adults. The most frequent diagnosis were pneumonia, heart failure, chronic obstructive pulmonary disease/chronic bronchitis, urinary tract infection, colorectal cancer, hypertensive disease atrial fibrillation and complications of diabetes mellitus. CONCLUSIONS:New ACSC were identified. It is expected that this list could be used henceforward by epidemiologic studies, health services research and for healthcare management purposes. ACSC lists should be updated frequently. Further research is necessary to increase the specificity of ACSC hospitalizations as an indicator of healthcare performance.
| S-EPMC7429814 | biostudies-literature
Project description:ObjectiveTo compare trends in Medicaid expenditures among adults with diabetes who were newly eligible due to the Affordable Care Act (ACA) Medicaid expansion to trends among those previously eligible.Research design and methodsUsing Oregon Medicaid administrative data from 1 January 2014 to 30 September 2016, a retrospective cohort study was conducted with propensity score-matched Medicaid eligibility groups (newly and previously eligible). Outcome measures included total per-member per-month (PMPM) Medicaid expenditures and PMPM expenditures in the following 12 categories: inpatient visits, emergency department visits, primary care physician visits, specialist visits, prescription drugs, transportation services, tests, imaging and echography, procedures, durable medical equipment, evaluation and management, and other or unknown services.ResultsTotal PMPM Medicaid expenditures for newly eligible enrollees with diabetes were initially considerably lower compared with PMPM expenditures for matched previously eligible enrollees during the first postexpansion quarter (mean values $561 vs. $793 PMPM, P = 0.018). Within the first three postexpansion quarters, PMPM expenditures of the newly eligible increased to a similar but slightly lower level. Afterward, PMPM expenditures of both groups continued to increase steadily. Most of the overall PMPM expenditure increase among the newly eligible was due to rapidly increasing prescription drug expenditures.ConclusionsNewly eligible Medicaid enrollees with diabetes had slightly lower PMPM expenditures than previously eligible Medicaid enrollees. The increase in PMPM prescription drug expenditures suggests greater access to treatment over time.
| S-EPMC7035584 | biostudies-literature
Project description:ObjectivesTo explore effects of disease prevalence adjustment on ambulatory care-sensitive hospitalization (ACSH) rates used for quality comparisons.Data sources/study settingCounty-level hospital administrative data on adults discharged from German hospitals in 2011 and prevalence estimates based on administrative ambulatory diagnosis data were used.Study designA retrospective cross-sectional study using in- and outpatient secondary data was performed.Data collectionHospitalization data for hypertension, diabetes, heart failure, chronic obstructive pulmonary disease, and asthma were obtained from the German Diagnosis Related Groups (DRG) database. Prevalence estimates were obtained from the German Central Research Institute of Ambulatory Health Care.Principal findingsCrude hospitalization rates varied substantially across counties (coefficients of variation [CV] 28-37 percent across conditions); this variation was reduced by prevalence adjustment (CV 21-28 percent). Prevalence explained 40-50 percent of the observed variation (r = 0.65-0.70) in ACSH rates for all conditions except asthma (r = 0.07). Between 30 percent and 38 percent of areas moved into or outside condition-specific control limits with prevalence adjustment.ConclusionsUnadjusted ACSH rates should be used with caution for high-stakes public reporting as differences in prevalence may have a marked impact. Prevalence adjustment should be considered in models analyzing ACSH.
| S-EPMC5867184 | biostudies-literature
Project description:ObjectiveTo determine the association between OA and risk of hospitalization for ambulatory care-sensitive conditions (HACSCs).MethodsWe included all individuals aged 40-85 years who resided in Skåne, Sweden on 31 December 2005 with at least one healthcare consultation during 1998-2005 (n = 515 256). We identified those with a main diagnosis of OA between 1 January 1998 and 31 December 2016. People were followed from 1 January 2006 until an HACSC, death, relocation outside Skåne, or 31 December 2016 (whichever occurred first). OA status was treated as a time-varying covariate (those diagnosed before 1 January 2006 considered as exposed for whole study period). We assessed relative [hazard ratios (HRs) using Cox proportional hazard model] and absolute (hazard difference using additive hazard model) effects of OA on HACSCs adjusted for potential confounders.ResultsCrude incidence rates of HACSCs were 239 (95% CI: 235, 242) and 151 (150, 152) per 10 000 person-years among OA and non-OA persons, respectively. The OA persons had an increased risk of HACSCs [HR (95% CI) 1.11 (1.09, 1.13)] and its subcategories of medical conditions except chronic obstructive pulmonary disease [HR (95% CI) 0.86 (0.81, 0.90)]. There were 20 (95% CI: 16, 24) more HACSCs per 10 000 person-years in OA compared with non-OA persons. While HRs for knee and hip OA were generally comparable, only knee OA was associated with increased risk of hospitalization for diabetes.ConclusionOA is associated with an increased risk of HACSCs, highlighting the urgent need to improve outpatient care for OA patients.
| S-EPMC8410004 | biostudies-literature
Project description:BACKGROUND:The teach-back method, also known as the "show-me" method, has been endorsed by many medical and health care societies. However, limited investigation has been conducted regarding its association with patient outcomes. OBJECTIVES:To examine the association between patient teach-back experience and the risk of hospitalizations and length of hospital stay among patients with ambulatory care sensitive conditions (ACSCs). DESIGN:A matched cohort study. SETTING:Data from the 2011-2015 Longitudinal Medical Expenditure Panel Survey (panels 16-19). PARTICIPANTS:Three thousand nine hundred ninety-four US adults aged ??18 years with any of 5 ACSCs (hypertension, type 2 diabetes, heart disease, asthma, and chronic obstructive pulmonary disease [COPD]). MEASUREMENTS:Hospital admissions (all-cause or ACSC-related) and the length of stay of the first admission were examined by teach-back during interaction with a health provider. RESULTS:Patients with teach-back experience were less likely to experience hospitalization for an ACSC-related condition (relative risk, 0.85; 95% CI, 0.71 to 0.99) and had a lower risk for a condition-related readmission (hazard ratio, 0.77; 95% CI, 0.60 to 0.99), compared with those without teach-back experience. The median length of hospital stay did not differ between patients with teach-back experience and those without teach-back experience (median 3 days [IQR 1 to 8 days] and median 3 days [IQR 0 to 8 days], respectively; P?= 0.84). Subgroup analysis showed that the association of reported teach-back experience on the outcomes was relatively stable among those with hypertension, diabetes, and heart disease, but was not among those with asthma or COPD. LIMITATION:Teach-back exposure relied on patient self-reported information. CONCLUSIONS:Our findings suggest that patient teach-back method is associated with reduced risk of hospitalization for those with ACSCs, especially among patients with cardiovascular diseases and type 2 diabetes. Encouraging providers to utilize the teach-back method at every visit has the potential to further reduce hospitalizations for individuals with ACSCs.
| S-EPMC6816654 | biostudies-literature
Project description:BackgroundHospitalizations for ambulatory care-sensitive conditions (ACSCs), conditions that should not require inpatient treatment if timely and appropriate ambulatory care is provided, may be an important contributor to rising healthcare costs and public health burden.ObjectiveTo examine if probable major depression is independently associated with hospitalization for an ACSC in patients with diabetes.DesignSecondary analysis of data from a prospective cohort study.ParticipantsPopulation-based cohort of 4,128 patients with diabetes ? 18 years old seen in primary care, who were enrolled between 2000 and 2002 and followed for 5 years (through 2007).Main measuresDepressive symptoms were assessed with the Patient Health Questionnaire-9. Outcomes of interest included time to initial hospitalization for an ACSC and total number of ACSC-related hospitalizations. We used Cox proportional hazards regression models to ascertain an association between probable major depression and time to ACSC-related hospitalization, as well as Poisson regression for models examining probable major depression and number of ACSC-related hospitalizations.Key resultsPatients' mean age at study enrollment was 63.4 years (Standard Deviation: 13.4 years). Over the 5-year follow-up period, 981 patients in the study were hospitalized a total of 1,721 times for an ACSC, comprising 45.1 % of all hospitalizations. After adjusting for baseline demographic, clinical and health-risk behavioral factors, probable major depression was associated with initial ACSC-related hospitalization (Hazard Ratio: 1.41, 95 % Confidence Interval [95 % CI]: 1.15, 1.72) and number of ACSC-related hospitalizations (Relative Risk: 1.37, 95 % CI: 1.12, 1.68).ConclusionsProbable major depression in patients with diabetes is independently associated with hospitalization for an ACSC. Additional research is warranted to ascertain if effective interventions for depression in patients with diabetes could reduce the risk of hospitalizations for ACSCs and their associated adverse outcomes.
| S-EPMC3682035 | biostudies-literature
Project description:Many countries worldwide are aging rapidly, and the complex care needs of older adults generate an unprecedented demand for health services. Common reasons for elderly emergency department (ED) visits frequently involve conditions triggered by preventable infections also known as ambulatory care sensitive conditions (ACSCs). This study aims to describe the trend and the associated disease burden attributable to ACSC-related ED visits made by elderly patients and to characterize their ED use by nursing home residence. We designed a population-based ecological study using administrative data on Taiwan EDs between 2002 and 2013. A total of 563,647 ED visits from individuals aged 65 or over were examined. All elderly ED visits due to ACSCs (tuberculosis, upper respiratory infection, pneumonia, sepsis, cellulitis and urinary tract infection (UTI)) were further identified. Subsequent hospital admissions, related deaths after discharge, total health care costs and disability-adjusted life years (DALYs) were compared among different ACSCs. Prevalence of ACSCs was then assessed between nursing home (NH) residents and non-NH residents. Within the 12-year observation period, we find that there was a steady increase in both the rate of ACSC ED visits and the proportion of elderly with a visit. Overall, pneumonia is the most prevalent among six ACSCs for elderly ED visits (2.10%; 2.06 to 2.14), subsequent hospital admissions (5.77%; 5.59 to 5.94) and associated mortality following admission (17.37%; 16.74 to 18.01). UTI is the second prevalent ACSC consistently across ED visits (2.02%; 1.98 to 2.05), subsequent hospital admissions (2.36%, 2.25 to 2.48) and mortality following admission (10.80%; 10.28 to 11.32). Sepsis ranks third highest in the proportion of hospitalization following ED visit (2.29%; 2.18 to 2.41) and related deaths after hospital discharge (7.39%; 6.95 to 7.83), but it accounts for the highest average total health care expenditure (NT$94,595 ± 120,239; ≈US$3185.02) per case. When examining the likelihood of ACSC-attributable ED use, significantly higher odds were observed in NH residents as compared with non-NH residents for: pneumonia (adjusted odds ratio (aOR): 5.01, 95% confidence interval (CI) 4.50-5.58); UTI (aOR: 4.44, 95% CI 3.97-4.98); sepsis (aOR: 3.54, 95% CI 3.06-4.10); and tuberculosis (aOR: 2.44, 95% CI 1.63-3.65). Here we examined the ACSC-related ED care and found that, among the six ACSCs studied, pneumonia, UTI and sepsis were the leading causes of ED visits, subsequent hospital admissions, related mortality, health care costs and DALYs in Taiwanese NH elderly adults. Our findings suggest that efficient monitoring and reinforcing of quality of care in the residential and community setting might substantially reduce the number of preventable elderly ED visits and alleviate strain on the health care system.
| S-EPMC6405841 | biostudies-other
Project description:BACKGROUND:While the Affordable Care Act's (ACA) Medicaid expansion has increased insurance coverage, its effects on health outcomes have been mixed. This may be because previous research did not disaggregate mental and physical health or target populations most likely to benefit. OBJECTIVE:To examine the association between Medicaid expansion and changes in mental health, physical health, and access to care among low-income childless adults with and without chronic conditions. DESIGN:We used a difference-in-differences analytical framework to assess differential changes in self-reported health outcomes and access to care. We stratified our analyses by chronic condition status. PARTICIPANTS:Childless adults, aged 18-64, with incomes below 138% of the federal poverty level in expansion (n = 69,620) and non-expansion states (n = 57,628). INTERVENTION:Active Medicaid expansion in state of residence. MAIN MEASURES:Self-reported general health; total days in past month with poor health, poor mental health, poor physical health, or health-related activity restrictions; disability; depression; insurance coverage; cost-related barriers; annual check-up; and personal doctor. KEY RESULTS:Medicaid expansion was associated with reductions in poor health days (-1.2 days [95% CI, -1.6,-0.7]) and days limited by poor health (-0.94 days [95% CI, -1.4,-0.43]), but only among adults with chronic conditions. Trends in general health measures appear to be driven by fewer poor mental health days (-1.1 days [95% CI, -1.6,-0.6]). Expansion was also associated with a reduction in depression diagnoses (-3.4 percentage points [95% CI, -6.1,-0.01]) among adults with chronic conditions. Expansion was associated with improvements in access to care for all adults. CONCLUSIONS:Medicaid expansion was associated with substantial improvements in mental health and access to care among low-income adults with chronic conditions. These positive trends are likely to be reversed if Medicaid expansion is repealed.
| S-EPMC5834959 | biostudies-literature