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  • Individual Author: Zogg, Cheryl K.; Scott, John W.; Metcalfe, David; Gluck, Abbe R.; Curfman, Gregory D.; Davis, Kimberly A.; Dimick, Justin B.; Haider, Adil H.
    Reference Type: Journal Article
    Year: 2019

    Importance Trauma is a leading cause of death and disability for patients of all ages, many of whom are also among the most likely to be uninsured. Passage of the Patient Protection and Affordable Care Act was intended to improve access to care through improvements in insurance. However, despite nationally reported changes in the payer mix of patients, the extent of the law’s impact on insurance coverage among trauma patients is unknown, as is its success in improving trauma outcomes and promoting increased access to rehabilitation.

    Objective To use rigorous quasi-experimental regression techniques to assess the extent of changes in insurance coverage, outcomes, and discharge to rehabilitation among adult trauma patients before and after Medicaid expansion and implementation of the remainder of the Patient Protection and Affordable Care Act.

    Design, Setting, and Participants Quasi-experimental, difference-in-difference analysis assessed adult trauma in patients aged 19 to 64 years in 5 Medicaid expansion (Colorado,...

    Importance Trauma is a leading cause of death and disability for patients of all ages, many of whom are also among the most likely to be uninsured. Passage of the Patient Protection and Affordable Care Act was intended to improve access to care through improvements in insurance. However, despite nationally reported changes in the payer mix of patients, the extent of the law’s impact on insurance coverage among trauma patients is unknown, as is its success in improving trauma outcomes and promoting increased access to rehabilitation.

    Objective To use rigorous quasi-experimental regression techniques to assess the extent of changes in insurance coverage, outcomes, and discharge to rehabilitation among adult trauma patients before and after Medicaid expansion and implementation of the remainder of the Patient Protection and Affordable Care Act.

    Design, Setting, and Participants Quasi-experimental, difference-in-difference analysis assessed adult trauma in patients aged 19 to 64 years in 5 Medicaid expansion (Colorado, Illinois, Minnesota, New Jersey, and New Mexico) and 4 nonexpansion (Florida, Nebraska, North Carolina, and Texas) states.

    Interventions/Exposure Policy implementation in January 2014.

    Main Outcomes and Measures Changes in insurance coverage, outcomes (mortality, morbidity, failure to rescue, and length of stay), and discharge to rehabilitation.

    Results A total of 283 878 patients from Medicaid expansion states and 285 851 patients from nonexpansion states were included (mean age [SD], 41.9 [14.1] years; 206 698 [36.3%] women). Adults with injuries in expansion states experienced a 13.7 percentage point increase in discharge to rehabilitation (95% CI, 7.0-7.8; baseline: 14.7%) that persisted across inpatient rehabilitation facilities (4.5 percentage points), home health agencies (2.9 percentage points), and skilled nursing facilities (1.0 percentage points). There was also a 2.6 percentage point drop in failure to rescue and a 0.84-day increase in length of stay. Rehabilitation changes were most pronounced among patients eligible for rehabilitation coverage under the 2-midnight (8.4 percentage points) and 60% (10.2 percentage points) Medicaid payment rules. Medicaid expansion increased rehabilitation access for patients with the most severe injuries and conditions requiring postdischarge care (eg, pelvic fracture). It mitigated race/ethnicity-, age-, and sex-based disparities in which patients use rehabilitation.

    Conclusions and relevance This multistate assessment demonstrated significant changes in insurance coverage and discharge to rehabilitation among adult trauma patients that were greater in Medicaid expansion than nonexpansion states. By targeting subgroups of the trauma population most likely to be uninsured, rehabilitation gains associated with Medicaid have the potential to improve survival and functional outcomes for more than 60 000 additional adult trauma patients nationally in expansion states. (Author abstract)

  • Individual Author: Greenfield, Jennifer C.; Reichman, Nancy; Cole, Paula M.; Galgiani, Hannah
    Reference Type: Report
    Year: 2019

    Colorado is poised this year to consider passing a comprehensive paid family and medical leave measure. Despite several unsuccessful attempts in recent years, changes in the state legislature and in voter sentiment point to building momentum in support of the policy. Passing it would make Colorado the seventh state in the U.S., plus the District of Columbia, to pass a statewide initiative. Drawing from data about similar programs in other states, this report examines what a comprehensive paid family and medical leave initiative might look like in Colorado. Specifically, we estimate that approximately 5% of eligible workers per year are likely to access leave benefits under the new program, with an average weekly benefit of about $671. To fund the program, workers and private-sector employers will each need to contribute about .34% of wages each year. At this premium rate, the program will be able to fully fund a wage replacement scheme that matches or comes close to matching wages of the lowest earners, with a maximum weekly benefit cap of either $1000 or $1200/week. Overall, the...

    Colorado is poised this year to consider passing a comprehensive paid family and medical leave measure. Despite several unsuccessful attempts in recent years, changes in the state legislature and in voter sentiment point to building momentum in support of the policy. Passing it would make Colorado the seventh state in the U.S., plus the District of Columbia, to pass a statewide initiative. Drawing from data about similar programs in other states, this report examines what a comprehensive paid family and medical leave initiative might look like in Colorado. Specifically, we estimate that approximately 5% of eligible workers per year are likely to access leave benefits under the new program, with an average weekly benefit of about $671. To fund the program, workers and private-sector employers will each need to contribute about .34% of wages each year. At this premium rate, the program will be able to fully fund a wage replacement scheme that matches or comes close to matching wages of the lowest earners, with a maximum weekly benefit cap of either $1000 or $1200/week. Overall, the program seems feasible and is likely to bring a number of important benefits to workers and employers across the state, in exchange for a modest investment in the form of premium contributions. (Author abstract)

  • Individual Author: Helms, Veronica E.; Steffen, Barry L.; Rudd, Elizabeth C.; Sperling, Jon
    Reference Type: Report
    Year: 2018

    The U.S. Department of Housing and Urban Development (HUD) and the National Center for Health Statistics agreed in 2011 to link administrative records for individuals receiving housing assistance from HUD with records from the National Health Interview Survey. This report uses the linked data for 2006 through 2012 to present nationally representative estimates of demographic characteristics, health diagnoses and conditions, and health care access and utilization for HUD-assisted children ages 0–17. To provide context, similar estimates are provided for two other relevant subgroups: children residing in unassisted renter households with incomes below the federal poverty line and all children in the U.S. population. The report presents raw prevalence estimates to reflect actual conditions for each subgroup, and does not make statistical adjustments for age or other factors to support cross-group comparison of health conditions for similar individuals. Results demonstrate that assisted children suffer disproportionately from serious health conditions. (Author abstract)

     

    The U.S. Department of Housing and Urban Development (HUD) and the National Center for Health Statistics agreed in 2011 to link administrative records for individuals receiving housing assistance from HUD with records from the National Health Interview Survey. This report uses the linked data for 2006 through 2012 to present nationally representative estimates of demographic characteristics, health diagnoses and conditions, and health care access and utilization for HUD-assisted children ages 0–17. To provide context, similar estimates are provided for two other relevant subgroups: children residing in unassisted renter households with incomes below the federal poverty line and all children in the U.S. population. The report presents raw prevalence estimates to reflect actual conditions for each subgroup, and does not make statistical adjustments for age or other factors to support cross-group comparison of health conditions for similar individuals. Results demonstrate that assisted children suffer disproportionately from serious health conditions. (Author abstract)

     

  • Individual Author: Foster, Diana Greene; Biggs, M. Antonia; Raifman, Sarah; Gipson, Jessica; Kimport, Katrina; Rocca, Corinne H.
    Reference Type: Journal Article
    Year: 2018

    Importance  Evidence indicates that there are potential health, development, and maternal bonding consequences for children born from unwanted pregnancies.

    Objective  To examine the association of women receiving or being denied a wanted abortion with their children’s health and well-being.

    Design, Setting, and Participants  A 5-year longitudinal observational study with a quasi-experimental design conducted between January 18, 2008, and January 25, 2016, examined women who received abortions just under the gestational age limit of 30 abortion facilities across the United States and women who were denied abortion just beyond the gestational age limit in these facilities. Analyses compared the children of 146 women who were denied an abortion (index children) with children born to 182 women who received an abortion and had a subsequent child within 5 years (subsequent children). Interview-to-interview retention averaged 94.5% (6895 of 7293) across the 11 semi-annual interviews.

    Exposures  ...

    Importance  Evidence indicates that there are potential health, development, and maternal bonding consequences for children born from unwanted pregnancies.

    Objective  To examine the association of women receiving or being denied a wanted abortion with their children’s health and well-being.

    Design, Setting, and Participants  A 5-year longitudinal observational study with a quasi-experimental design conducted between January 18, 2008, and January 25, 2016, examined women who received abortions just under the gestational age limit of 30 abortion facilities across the United States and women who were denied abortion just beyond the gestational age limit in these facilities. Analyses compared the children of 146 women who were denied an abortion (index children) with children born to 182 women who received an abortion and had a subsequent child within 5 years (subsequent children). Interview-to-interview retention averaged 94.5% (6895 of 7293) across the 11 semi-annual interviews.

    Exposures  Being born after denial of abortion vs after a new pregnancy subsequent to an abortion.Main Outcomes and Measures  Perinatal outcomes and child health, child development, maternal bonding, socioeconomics, and household structure.

    Results  This study included 328 women who had children during the study period (mean [SD] age at study recruitment, 23.7 [4.9] years). There were no differences by study group in consent to participate in the study, completion of first interview, or continuation in the study. Among the 328 children in the study (146 index children and 182 subsequent children), there were 163 girls and 165 boys. Perinatal and child health outcomes were not different between subsequent and index children, and there was no clear pattern of delayed child development. However, mixed-effects models adjusting for clustered recruitment and multiple observations per child revealed that poor maternal bonding was more common for index children compared with subsequent children (9% vs 3%; adjusted odds ratio, 5.14; 95% CI, 1.48-17.85). Index children lived in households with lower incomes relative to the federal poverty level than did subsequent children (101% vs 132% of federal poverty level; adjusted regression coefficient, –0.31; 95% CI, –0.52 to –0.10), and were more likely to live in households without enough money to pay for basic living expenses (72% vs 55%; adjusted odds ratio, 5.16; 95% CI, 2.34-11.40).

    Conclusions and Relevance  These findings suggest that access to abortion enables women to choose to have children at a time when they have more financial and emotional resources to devote to their children. (Author abstract)

  • Individual Author: Agency for Healthcare Research and Quality
    Reference Type: Report
    Year: 2018

    The National Healthcare Quality and Disparities Report assesses the performance of our healthcare system and identifies areas of strengths and weaknesses, as well as disparities, for access to healthcare and quality of healthcare. Quality is described in terms of six priorities: patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. The report is based on more than 250 measures of quality and disparities covering a broad array of healthcare services and settings. (Author introduction)

     

    The National Healthcare Quality and Disparities Report assesses the performance of our healthcare system and identifies areas of strengths and weaknesses, as well as disparities, for access to healthcare and quality of healthcare. Quality is described in terms of six priorities: patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. The report is based on more than 250 measures of quality and disparities covering a broad array of healthcare services and settings. (Author introduction)

     

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