Harvard Pilgrim Health Care Institute, Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts.
School of Public Affairs, Department of Public Administration and Policy, American University, Washington, DC.
JAMA Intern Med. 2020 May 1;180(5):753-759. doi: 10.1001/jamainternmed.2020.0473.
The rate of opioid-related emergency department (ED) visits and inpatient hospitalizations has increased rapidly in recent years. Medicaid expansions have the potential to reduce overall opioid-related hospital events by improving access to outpatient treatment for opioid use disorder.
To examine the association between Medicaid expansions and rates of opioid-related ED visits and inpatient hospitalizations.
DESIGN, SETTING, AND PARTICIPANTS: A difference-in-differences observational design was used to compare changes in opioid-related hospital events in US nonfederal, nonrehabilitation hospitals in states that implemented Medicaid expansions between the first quarter of 2005 and the last quarter of 2017 with changes in nonexpansion states. All-payer ED and hospital discharges from 45 states in the Healthcare Cost and Utilization Project FastStats were included.
State implementation of Medicaid expansions between 2005 and 2017.
Rates of all opioid-related ED visits and inpatient hospitalizations, measured as the quarterly numbers of treat-and-release ED discharges and hospital discharges related to opioid abuse, dependence, and overdose, per 100 000 state population.
In the 46 states and District of Columbia included in the study, 1524 observations of emergency department data and 2219 observations of opioid-related inpatient hospitalizations were analyzed. The post-2014 Medicaid expansions were associated with a 9.74% (95% CI, -18.83% to -0.65%) reduction in the rate of opioid-related inpatient hospitalizations. There appeared to be no association between the pre-2014 or post-2014 Medicaid expansions and the rate of opioid-related ED visits (post-2014 Medicaid expansions, -3.98%; 95% CI, -14.69% to 6.72%; and pre-2014 Medicaid expansions, 1.02%; 95% CI, -5.25% to 7.28%).
Medicaid expansion appears to be associated with meaningful reductions in opioid-related hospital use, possibly attributable to improved care for opioid use disorder in other settings.
近年来，阿片类药物相关的急诊部（ED）就诊和住院治疗的发生率迅速上升。医疗补助计划的扩大有可能通过改善阿片类药物使用障碍的门诊治疗机会来减少整体阿片类药物相关的住院事件。
研究医疗补助计划的扩大与阿片类药物相关的 ED 就诊和住院治疗率之间的关联。
设计、地点和参与者：采用差异中的差异观察性设计，比较 2005 年第一季度至 2017 年最后一个季度期间实施医疗补助计划的美国非联邦、非康复医院与非扩张州的阿片类药物相关住院事件的变化。所有支付者 ED 和医院出院数据来自 Healthcare Cost and Utilization Project FastStats 的 45 个州。
2005 年至 2017 年期间医疗补助计划的实施。
所有阿片类药物相关的 ED 就诊和住院治疗率，以每 10 万州人口的治疗后释放 ED 出院和与阿片类药物滥用、依赖和过量相关的医院出院的季度数量来衡量。
在研究中包括的 46 个州和哥伦比亚特区中，分析了 1524 次急诊部数据观察和 2219 次阿片类药物相关住院治疗的观察。2014 年后的医疗补助计划扩张与阿片类药物相关住院治疗率降低 9.74%（95%CI，-18.83%至-0.65%）相关。在 2014 年前或 2014 年后的医疗补助计划扩张与阿片类药物相关的 ED 就诊率之间似乎没有关联（2014 年后的医疗补助计划扩张，-3.98%；95%CI，-14.69%至 6.72%；2014 年前的医疗补助计划扩张，1.02%；95%CI，-5.25%至 7.28%）。
医疗补助计划的扩大似乎与阿片类药物相关的住院治疗使用的显著减少有关，这可能归因于其他环境中对阿片类药物使用障碍的治疗改善。
