Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
BMJ Open Diabetes Res Care. 2021 Dec;9(Suppl 1). doi: 10.1136/bmjdrc-2021-002204.
Access to care is essential for patients with diabetes to maintain health and prevent complications, and is important for health equity. New York State's Health Homes (HHs) provide care management services to Medicaid-insured patients with chronic conditions, including diabetes, and aim to improve quality of care and outcomes. There is inconsistent evidence on the impact of HHs, and care management programs more broadly, on access to care.
Using a cohort of patients with diabetes derived from electronic health records from the INSIGHT Clinical Research Network, we analyzed Medicaid data for HH enrollees and a matched comparison group of HH non-enrollees. We estimated HH impacts on several access measures using natural experiment methods.
We identified and matched 11 646 HH enrollees; patients were largely non-Hispanic Black (29.9%) and Hispanic (48.7%), and had high rates of dual eligibility (33.0%), Supplemental Security Income disability enrollment (49.1%), and multiple comorbidities. In the 12 months following HH enrollment, HH enrollees had one more month of Medicaid coverage (p<0.001) and 4.6 more outpatient visits than expected (p<0.001, evenly distributed between primary and specialty care). There were also positive impacts on the proportions of patients with follow-up visits within 7 days (4 percentage points (pp), p<0.001) and 30 days (6pp, p<0.001) after inpatient care, and on the proportion of patients with follow-up visits within 30 days after emergency department (ED) care (4pp, p<0.001). We did not find meaningful differences in continuity of care. We found small positive impacts on the proportion of patients with an inpatient visit and the proportion with an ED visit.
New York State's HH program improved access to care for Medicaid recipients with diabetes. These findings have implications for New York State Medicaid as well as other providers and care management programs.
患者获得医疗照护对于维持健康和预防并发症至关重要，这对医疗公平也很重要。纽约州的健康之家（HHs）为包括糖尿病在内的慢性病的医疗补助保险患者提供护理管理服务，旨在改善护理质量和结果。HHs 和更广泛的护理管理计划对获得医疗服务的影响证据不一。
我们利用 INSIGHT 临床研究网络的电子健康记录中的糖尿病患者队列，分析了 HHs 参保者和 HHs 非参保者匹配对照组的医疗补助数据。我们使用自然实验方法估计 HHs 对若干获得医疗服务指标的影响。
我们确定并匹配了 11646 名 HHs 参保者；患者主要是非西班牙裔黑人（29.9%）和西班牙裔（48.7%），双重资格（33.0%）、补充保障收入残疾登记（49.1%）和多种合并症的比例很高。在 HHs 参保后的 12 个月内，HHs 参保者的医疗补助覆盖期多了一个月（p<0.001），门诊就诊次数多了 4.6 次（p<0.001，在初级保健和专科保健之间平均分配）。在门诊就诊后 7 天（4 个百分点（pp），p<0.001）和 30 天（6pp，p<0.001）内有后续就诊的患者比例、在住院后 30 天内有后续就诊的患者比例（4pp，p<0.001）以及在急诊科就诊后 30 天内有后续就诊的患者比例（4pp，p<0.001）也有积极影响。我们没有发现连续性护理方面的显著差异。我们发现，患者住院和急诊科就诊的比例略有增加。
纽约州的 HHs 计划改善了医疗补助受助人中糖尿病患者获得医疗服务的机会。这些发现对纽约州医疗补助以及其他提供者和护理管理计划都有影响。
