Association of the Patient Protection and Affordable Care Act With Ambulatory Quality, Patient Experience, Utilization, and Cost, 2014-2016

Levine, David M.; Chalasani, Rohan; Linder, Jeffrey A.; Landon, Bruce E.

doi:10.1001/jamanetworkopen.2022.18167

Cited by 8 publications

(3 citation statements)

References 44 publications

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“…These findings align with other studies showing improved health outcomes following ACA implementation [11][12][13]. For instance, a study by Sommers et al (2017) found that the ACA improved conditions for patients with chronic conditions, including cancer, potentially contributing to better survival rates [14]. Another study by Siegel et al (2017) reported improvements in cancer survival rates post-ACA, emphasizing the role of early detection and access to care [15].…”

Section: Impact Of Aca On Cancer-specific Survivalsupporting

confidence: 84%

Causal Effects of the Affordable Care Act (ACA) Implementation on Non-Hodgkin's Lymphoma Survival: A Difference-in-Differences Analysis

Akinyemi,

Weldeslase,

Fasokun

et al. 2024

Cureus

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Introduction: Non-Hodgkin's Lymphoma (NHL) accounts for a substantial number of cancer cases in the United States, with a significant prevalence and mortality rate. The implementation of the Affordable Care Act (ACA) has the potential to impact cancer-specific survival among NHL patients by improving access to healthcare services and treatments.Objective: This study aims to assess the impact of the implementation of the ACA on cancer-specific survival among patients diagnosed with NHL.Methodology: In this retrospective analysis, we leveraged data from the Surveillance, Epidemiology, and End Results (SEER) registry to assess the impact of the ACA on cancer-specific survival among NHL patients. The study covered the years 2000-2020, divided into pre-ACA (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) and post-ACA (2017-2020) periods, with a three-year washout (2014)(2015)(2016). Using a Difference-in-Differences approach, we compared Georgia (a non-expansion state) to New Jersey (an expansion state since 2014). We adjusted for patient demographics, income, metropolitan status, disease stage, and treatment modalities.Results: Among 74,762 patients, 56.2% were in New Jersey (42,005), while 43.8% were in Georgia (32,757). The pre-ACA period included 32,851 patients (51.7% in Georgia and 56.7% in New Jersey), and 27,447 patients were in the post-ACA period (48.3% in Georgia and 43.4% in New Jersey). The post-ACA period exhibited a 34% survival improvement (OR=0.66, 95% CI 0.58-0.75). ACA implementation was associated with a 16% survival boost among NHL patients in New Jersey (OR=0.84, 95% CI 0.74-0.95). Other factors linked to improved survival included surgery (OR=0.86, 95% CI 0.81-0.91), radiotherapy (OR=0.77, 95% CI 0.72-0.82), and married status (OR=0.67, 95% CI 0.64-0.71). Conclusion:The study underscores the ACA's potential positive impact on cancer-specific survival among NHL patients, emphasizing the importance of healthcare policy interventions in improving patient outcomes.

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Section: Impact Of Aca On Cancer-specific Survivalsupporting

confidence: 84%

Causal Effects of the Affordable Care Act (ACA) Implementation on Non-Hodgkin's Lymphoma Survival: A Difference-in-Differences Analysis

Akinyemi,

Weldeslase,

Fasokun

et al. 2024

Cureus

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“…In addition, our study spanned several years with influential policy implementation, such as the 2014 Affordable Care Act expansion; however, previous studies have found little or no change in quality over long-term follow-up for ambulatory care following this implementation. 36 An additional limitation of the study is a follow-up period of 1 year. However, adjusting the follow-up period to 2 years did not statistically change the results (eTable 3 in Supplement 1 ).…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Quality Care Among Adults With Rheumatoid Arthritis

et al. 2022

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ImportanceAlthough quality care markers exist for patients with rheumatoid arthritis (RA), the predictors of meeting these markers are unclear.ObjectiveTo explore factors associated with quality care among patients with RA.Design, Setting, and ParticipantsA retrospective cohort study using insurance claims from 2009 to 2017 was conducted, and 6 sequential logistic regression models were built to evaluate quality care markers. Quality care markers were measured at 1 year post-RA diagnosis for each patient. The MarketScan Research Database, which contains commercial and Medicare Advantage administrative claims data from more than 100 million individuals in the US, was used to identify patients aged 18 to 64 years with a diagnosis claim for RA. Patients with conditions presenting similar to RA and missing demographic characteristics were excluded. Data analysis occurred between February 18 and May 5, 2022.ExposuresSuccess or failure to meet selected RA quality care markers within 1 year after RA diagnosis.Main Outcomes and MeasuresPrevalence of meeting successive quality care markers for RA.ResultsAmong 581 770 patients, 430 843 (74.1%) were women and the mean (SD) age was 48.9 (11.3) years. Most patients (236 285 [40.6%]) resided in the South and had an income less than or equal to $45 200 (490 366 [84.3%]). Of the total study population, 399 862 individuals (68.7%) met at least 1 quality care marker and 181 908 (31.3%) met 0 markers. Most commonly, patients met annual laboratory testing (299 323 [51.5%]) and referral to a rheumatologist (256 765 [44.1%]) markers. The least met marker was receiving hepatitis B screening prior to initiation of disease-modifying antirheumatic drug (DMARD) therapy (18 548 [3.2%]). Women were most likely to meet all quality care markers except receiving DMARDs with hepatitis B screening (odds ratio, 1.14; 95% CI, 1.12-1.16). Individuals with lower median household income had lower odds of receiving a rheumatologist referral, an annual physical examination, or annual laboratory testing, but greater odds of receiving the other quality care markers. Patients with Medicare and those with comorbidities were generally less likely to meet quality care markers.Conclusions and RelevanceIn this cohort study of patients with RA, findings indicated downstream associations with rheumatologist referral and receiving DMARDs and varied associations between meeting quality care markers and patient characteristics. These findings suggest that prioritizing early care, especially for vulnerable patients, will ensure that quality care continues.

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“…Healthcare systems regularly navigate a variety of external stressors, including policy changes, natural disasters, workplace violence committed by patients or other community members, and emerging infectious diseases [1][2][3][4] . These phenomena threaten usual delivery of patient care, and while strategies exist to anticipate and manage these challenges 5 , there is a lack of data regarding how health care systems experience and address concurrent organizational stressors.…”

Section: Introductionmentioning

confidence: 99%

“Like One Long Battle:” Employee Perspectives of the Simultaneous Impact of COVID-19 and an Electronic Health Record Transition

Rucci,

Ball,

Brunner

et al. 2023

J GEN INTERN MED

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Background Healthcare organizations regularly manage external stressors that threaten patient care, but experiences handling concurrent stressors are not well characterized. Objective To evaluate the experience of Veterans Affairs (VA) clinicians and staff navigating simultaneous organizational stressors—an electronic health record (EHR) transition and the COVID-19 pandemic—and identify potential strategies to optimize management of co-occurring stressors. Design Qualitative case study describing employee experiences at VA’s initial EHR transition site. Participants Clinicians, nurses, allied health professionals, and local leaders at VA’s initial EHR transition site. Approach We collected longitudinal qualitative interview data between July 2020 and November 2021 once before and 2–4 times after the date on which the health system transitioned; this timing corresponded with local surges of COVID-19 cases. Interviewers conducted coding and analysis of interview transcripts. For this study, we focused on quotes related to COVID-19 and performed content analysis to describe recurring themes describing the simultaneous impact of COVID-19 and an EHR transition. Key Results We identified five themes related to participants’ experiences: (1) efforts to mitigate COVID-19 transmission led to insufficient access to EHR training and support, (2) clinical practice changes in response to the pandemic impacted EHR workflows in unexpected ways, (3) lack of clear communication and inconsistent enforcement of COVID-19 policies intensified pre-existing frustrations with the EHR, (4) managing concurrent organizational stressors increased work dissatisfaction and feelings of burnout, and (5) participants had limited bandwidth to manage competing demands that arose from concurrent organizational stressors. Conclusion The expected challenges of an EHR transition were compounded by co-occurrence of the COVID-19 pandemic, which had negative impacts on clinician experience and patient care. During simultaneous organizational stressors, health care facilities should be prepared to address the complex interplay of two stressors on employee experience.

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Association of the Patient Protection and Affordable Care Act With Ambulatory Quality, Patient Experience, Utilization, and Cost, 2014-2016

Cited by 8 publications

References 44 publications

Causal Effects of the Affordable Care Act (ACA) Implementation on Non-Hodgkin's Lymphoma Survival: A Difference-in-Differences Analysis

Causal Effects of the Affordable Care Act (ACA) Implementation on Non-Hodgkin's Lymphoma Survival: A Difference-in-Differences Analysis

Factors Associated With Quality Care Among Adults With Rheumatoid Arthritis

“Like One Long Battle:” Employee Perspectives of the Simultaneous Impact of COVID-19 and an Electronic Health Record Transition

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