Medicaid’s Impact on Chronic Disease Biomarkers: A Cohort Study of Community Health Center Patients

Hatch, Brigit; Killerby, Marie E.; Angier, Heather; Hoopes, Megan; Bailey, Steffani R.; Heintzman, John; O’Malley, Jean P.; DeVoe, Jennifer E.

doi:10.1007/s11606-017-4051-9

Cited by 14 publications

(45 citation statements)

References 49 publications

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“…However, our analyses adjusted for multiple factors that can influence achievement of control. Second, the funding agency set HbA1c < 9% for diabetes control, similar to other studies in Medicaid enrollees [20]. Yet, a reduction of HbA1c to < 9% would not protect against diabetes-related complications [21].…”

Section: Variablementioning

confidence: 99%

Telephone or Visit-Based Community Health Worker Care Management for Uncontrolled Diabetes Mellitus: A Longitudinal Study

et al. 2020

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Community health workers (CHWs) can reduce health disparities for low income patients but type of contact and outcomes has had limited study. Low-income Hispanic primary care patients with hemoglobin A1c [HbA1c] ≥ 9% received care managment (CM) over 6 months classified as: (CM1) telephone only; (CM2) clinic visit but no calls; (CM3) clinic visit with calls; and (CM4) ≥ 2 visits ± calls. Type of CM delivery and time to DM control (HbA1c < 9%) examined in Cox proportional hazards model and more rapid control within 6 months using logistic regression. Models adjusted for demographics, clinical, and health care variables. At baseline, 523 patients had mean HbA1c 10.9% (SD = 1.7%), mean age 57.9 years (SD = 10), 58.5% women, 87.6% Hispanic, and 55.5% uninsured. CM types for patients: 51 (9.8%) CM1; 192 (36.7%) CM2; 44 (8.4%) CM3; and 236 (45.4%) CM4. Median time to HbA1c control was 197 days (95% CI [71, 548]) and 41.5% achieved control within 6 months. Compared with CM1, control was more rapid for CM2 (Hazard ratio [HR] 1.45, 95% CI [1.01, 2.09], p = 0.043) and CM4 but not significant (HR [95% CI] 1.29 [0.91, 1.83], p = 0.15). Adjusted odds of more rapid control within 6 months were twofold higher for CM2 (p = 0.04) and CM4 (p = 0.055), respectively, versus CM1. CM2 did not differ from CM1. DM control was less likely for CM by telephone only than face-to-face in clinic. To benefit vulnerable patients with uncontrolled DM, in-person engagement may be required.

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Section: Variablementioning

confidence: 99%

Telephone or Visit-Based Community Health Worker Care Management for Uncontrolled Diabetes Mellitus: A Longitudinal Study

et al. 2020

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“…43 Additionally, patients with diabetes and hypertension were significantly more likely to gain control of uncontrolled hemoglobin A 1c levels and blood pressure readings when comparing insured with matched uninsured CHC patients. 44 The percentage of insured patients seen in a clinic also affects the clinic's ability to provide needed health care services to all patients. 45,46 For example, CHCs with a higher percentage of insured patients provided all patients with superior levels of recommended care than clinics caring for a lower percentage of insured patients.…”

Section: Implications For Patients and Chcsmentioning

confidence: 99%

Uninsured Primary Care Visit Disparities Under the Affordable Care Act

et al. 2017

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The lower rates of uninsured visits for all racial and ethnic groups after ACA implementation suggest progress in expanding coverage to CHC patients; this progress, however, was not uniform when comparing expansion with nonexpansion states and among all racial and ethnic minority subgroups. These findings suggest the need for continued and more equitable insurance expansion efforts to eliminate health insurance disparities.

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“…After the ACA Medicaid expansion, CHCs in expansion states improved in 4 out of 8 measures of preventive and chronic disease management relative to CHCs in nonexpansion states (Cole et al, 2017). One study using laboratory test results for patients in the Oregon Health Insurance Experiment found that individuals gaining coverage experienced improved control of diabetes and high blood pressure, but not high cholesterol, in the 2 years after insurance expansion compared with a matched group of uninsured patients at the CHCs (Hatch et al, 2017).…”

Section: Resultsmentioning

confidence: 99%

Community Health Centers and Access to Care Among Underserved Populations: A Synthesis Review

2019

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Community health centers (CHCs) deliver affordable health services to underserved populations, especially uninsured and Medicaid enrollees. Since the early 2000s, CHCs have grown because of federal investments in CHC capacity and expansions of Medicaid eligibility. We review 24 relevant studies from 2000 to 2017 to evaluate the relationship between CHCs, policies that invest in services for low-income individuals, and access to care. Most included studies use quasi-experimental designs. Greater spending on CHCs improves access to care, especially for low-income and minority individuals. Medicaid expansions also increase CHC use. Some studies indicate that CHC investments complement Medicaid expansions to increase access cost-effectively. Further research should explore patient preferences and patterns of CHC utilization versus other sites of care and population subgroups for which expanding CHC capacity improves access to care most. Researchers should endeavor to use measures and sample definitions that facilitate comparisons with other estimates in the literature.

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Medicaid’s Impact on Chronic Disease Biomarkers: A Cohort Study of Community Health Center Patients

Abstract: NCT02355132 [ https://clinicaltrials.gov/ct2/show/NCT02355132 ].

Cited by 14 publications

References 49 publications

Telephone or Visit-Based Community Health Worker Care Management for Uncontrolled Diabetes Mellitus: A Longitudinal Study

Telephone or Visit-Based Community Health Worker Care Management for Uncontrolled Diabetes Mellitus: A Longitudinal Study

Uninsured Primary Care Visit Disparities Under the Affordable Care Act

Community Health Centers and Access to Care Among Underserved Populations: A Synthesis Review

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