Abstract 135: Impact of Massachusetts Health Care Reform on the Risk of Hospitalization for Cardiovascular Ambulatory Care Sensitive Conditions.

Abstract

Research Objective: Massachusetts (MA) health reform increased the number of insured residents, particularly among racial/ethnic minorities. Yet, it is not known if this insurance expansion translated into improvements or decreased racial/ethnic disparities in access to medical care. Ambulatory care sensitive conditions (ACSCs) such as congestive heart failure (CHF), hypertension and angina are a set of medical conditions for which good outpatient care can potentially prevent the need for hospitalization. Thus, we used changes in rates of hospitalization for these 3 ACSCs to assess potential changes in access to care following MA health care reform. Methods: Using complete data on acute care hospital admissions in MA and in two states that did not implement comprehensive health care reform, New York (NY) and Pennsylvania (PA), we identified all hospital admissions for cardiovascular ACSCs (CHF, angina and hypertension) during the 21 months preceding and following health reform implementation (7/1/2006-12/31/2007). Using US census population data we calculated pre- and post-reform age- and sex-standardized admission rates for the 3 ACSCs combined among patients 18-64 (those affected by reform). Treating MA as the intervention cohort, and NY and PA together as the control cohort we used multivariate Poisson regression models to conduct “difference-in-difference” analyses to estimate post-reform changes in admission rates in MA adjusted for contemporaneous changes occurring in control states. The models were also adjusted for age, gender and race. Using this approach, we also assessed whether health reform was associated with decreases in admission rates for racial and ethnic minorities compared with whites. Principal Findings: There were 84,286 hospital admissions for CHF, angina and hypertension combined in the pre- and post-reform periods in MA and 535,726 during the same time periods in control states. The hospital admission rate (number/100k population) for ACSCs declined in MA (128.7 to 121.7 [5.4%]) and in control states (232.2 to 208.4 [10.2%] from the pre- to post-reform period. When adjusted for secular trends in control states, age, gender and race, however, there was a 6.2% (95% CI, 2.9-9.6) increase in admissions in MA. After adjustment, there was no significant change in the admission rate for blacks compared with whites in MA (+3.7% [95% CI, -11.1 - 4.5]) or for Hispanics compared with whites in MA (+9.3% [95% CI, -18.2 - 0.6]). Conclusions: Hospital admissions for cardiovascular ACSCs did not decline in MA as a whole, or for minorities relative to whites, in comparison with 2 large control states that did not implement health reform. Additional insurance or health care system reforms in MA may be needed to decrease potentially avoidable hospitalizations and improve access to care.