Evaluating Control of Hypertension - Effect of Social Determinants
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 1,939,783
- 试验地点
- 1
- 主要终点
- Hypertension incidence
研究概览
简要总结
This study evaluates the impact of a large-scale, national expansion of Medicaid on hypertension incidence, screening, treatment, and management. Social Determinants of Health will be assessed as moderators, and comparing states that did versus states that did not expand Medicaid will also be evaluated.
详细描述
The Affordable Care Act (ACA) enacted several provisions intended to improve healthcare for vulnerable populations,including expanding Medicaid eligibility to those earning ≤138% of the federal poverty level (FPL). Since the expansion was not required, as of March 2018, 32 states (and District of Columbia) implemented the expansion and 18 did not. Simulated models predicted the ACA would improve health outcomes and reduce disparities for patients with hypertension, yet actual changes are not yet available. In addition, there is new interest in tracking and utilizing Social Determinants of Health (SDH) in the primary care setting but there is currently little information on how this information will impact Hypertension (HTN) care, especially related to changes to health insurance availability. This study will build on current understanding of how health insurance impacts HTN incidence, screening, treatment, and management by comparing states that did versus did not expand Medicaid as part of the ACA and seeks to understand the influence of SDH on these changes. the investigators will address the following specific aims: Aim 1: Compare HTN incidence, prevalence of undiagnosed HTN, and rates of HTN screening, in Medicaid expansion versus non-expansion states before and after the ACA. Aim 2: Compare HTN treatment (e.g., medication use), and management (e.g., HTN control, systolic and diastolic blood pressure change, risk factors related to HTN control) in Medicaid expansion versus non-expansion states before and after the ACA. Aim 3: Assess the extent to which rates of HTN incidence, screening, and treatment effectiveness among patients who gained insurance versus those continuously insured or uninsured, pre-post ACA, are moderated by individual-level SDH (e.g., race, ethnicity), in expansion states. Aim 4: Explore the interaction between community-level SDH (e.g., neighborhood racial segregation and deprivation) and HTN incidence, screening, treatment, and management among patients who gained insurance relative to those who were continuously insured or uninsured, in expansion states. The findings from this project will be extremely relevant to policy and practice, informing further improvements in the US healthcare system to ensure access to healthcare for vulnerable populations.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Control
- 时间视角
- Prospective
入排标准
- 年龄范围
- 19 Years 至 64 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients in intervention and control states aged 19-64
排除标准
- •Patients outside of age range 19-64
结局指标
主要结局
Hypertension incidence
时间窗: 24 months prior to Medicaid expansion vs 24 months post
Rates of hypertension diagnosis using the following codes in the EHR: ICD-9: 401.00-401.99, 402.00-405.99 or ICD-10: I10-I15.
Hypertension treatment
时间窗: 24 months prior to Medicaid expansion vs 24 months post
the number of anti-hypertensive medications prescribed in EHR
Hypertension screening
时间窗: 24 months prior to Medicaid expansion vs 24 months post
rate of blood pressure screening marked in EHR
Undiagnosed hypertension
时间窗: 24 months prior to Medicaid expansion vs 24 months post
high blood pressure but no diagnosis or medications can be noted in the EHR diagnostic codes that can be used to document why a diagnosis of hypertension was not made including ICD-10 R03.0 (i.e., white coat syndrome without HTN) and ICD-9 796.2 (i.e., elevated BP without HTN).
Hypertension management
时间窗: 24 months prior to Medicaid expansion vs 24 months post
blood pressure control: last measure within range of normal for age/risk(s); percent Y/N at last visit, value/date of last measure
次要结局
- Hypertension related complications(24 months prior to Medicaid expansion vs 24 months post)
- Insurance status and rates of coverage(24 months prior to Medicaid expansion vs 24 months post)
- Service Utilization(24 months prior to Medicaid expansion vs 24 months post)
- Preventive service receipt(24 months prior to Medicaid expansion vs 24 months post)
研究者
Jennifer E DeVoe, MD DPhil
Chair of the Department of Family Medicine
Oregon Health and Science University