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Impact of Affordable Care Act Insurance Expansion on Pre-Hospital Access to Care: Changes in Adult Perforated Appendix Admission Rates after Medicaid.

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Presentation on theme: "Impact of Affordable Care Act Insurance Expansion on Pre-Hospital Access to Care: Changes in Adult Perforated Appendix Admission Rates after Medicaid."— Presentation transcript:

1 Impact of Affordable Care Act Insurance Expansion on Pre-Hospital Access to Care: Changes in Adult Perforated Appendix Admission Rates after Medicaid Expansion and the Dependent Coverage Provision  Cheryl K. Zogg, MSPH, MHS, John W. Scott, MD, MPH, Nizar Bhulani, MD, MPH, Abbe R. Gluck, JD, Gregory D. Curfman, MD, Kimberly A. Davis, MD, MBA, FACS, Justin B. Dimick, MD, MPH, FACS, Adil H. Haider, MD, MPH, FACS  Journal of the American College of Surgeons  Volume 228, Issue 1, Pages e1 (January 2019) DOI: /j.jamcollsurg Copyright © 2018 American College of Surgeons Terms and Conditions

2 Figure 1 (A) Population: Medicaid expansion in the United States as of 2018 and study included Medicaid expansion vs nonexpansion states. (B) Graphic depiction of Affordable Care Act (ACA)-related insurance change and assessment of pre-implementation parallel trends: Changes in insurance coverage in Medicaid expansion vs nonexpansion states, calendar year: 2008 to Vertical dashed lines correspond to introduction of the Dependent Coverage Provision (DCP) in September 2010 and full implementation of the ACA in January 2014. Journal of the American College of Surgeons  , e1DOI: ( /j.jamcollsurg ) Copyright © 2018 American College of Surgeons Terms and Conditions

3 Figure 2 Testing the inpatient quality metric assumption: Unadjusted changes in adult acute appendicitis (A) admission counts and (B) perforation rates are plotted by quarter along with locally weighted scatterplot smoothing regressions to aid in visualization from January 2011 to September 2015 for data abstracted from the Florida (nonexpansion state) and New Jersey (Medicaid expansion state) Agency for Healthcare Research and Quality (AHRQ) State Inpatient Database (SID) and State Emergency Department Database (SEDD). Vertical dashed lines correspond to full implementation of the ACA in January 2014 (and previous wash-in period) and introduction of ICD-10-CM diagnosis codes at the end of September 2015. Journal of the American College of Surgeons  , e1DOI: ( /j.jamcollsurg ) Copyright © 2018 American College of Surgeons Terms and Conditions

4 Figure 3 Difference-in-difference results for 2014 Medicaid expansion showing absolute percentage-point changes in (A) insurance coverage (Medicaid, uninsured, private insurance) and (B) perforated appendix admission rates. Difference-in-difference results were taken from linear models comparing the rate of change over time in: (1) experimental group: Medicaid expansion states that also introduced state-level private insurance exchanges along with the remainder of the Affordable Care Act (ACA) vs (2) control group: states that did not expand Medicaid and only implemented the remainder of the ACA before (January 2011 to September 2013) and after (January 2014 to September 2015) Medicaid expansion in January *Models for the 2010 Dependent Coverage Provision (DCP) compared: (1) experimental group: policy-eligible young adults aged 19 to 25 years vs (2) control group: slightly older, policy-ineligible adults aged 26 to 34 years before (January 2008 to September 2010) and after (January 2011 to September 2013) DCP introduction in September to December 2010. Journal of the American College of Surgeons  , e1DOI: ( /j.jamcollsurg ) Copyright © 2018 American College of Surgeons Terms and Conditions

5 Figure 4 Difference-in-difference results for 2014 Medicaid expansion showing absolute percentage-point changes in (A) uninsured stratified by race/ethnicity; (B) perforated appendix admission rates stratified by race/ethnicity; (C) uninsured stratified by community income level; and (D) perforated appendix admission rates stratified by community income level. Difference-in-difference results were taken from linear models comparing the rate of change over time in: (1) experimental group: Medicaid expansion states that also introduced state-level private insurance exchanges along with the remainder of the Affordable Care Act (ACA) vs (2) control group: states that did not expand Medicaid and only implemented the remainder of the ACA before (January 2011 to September 2013) and after (January 2014 to September 2015) Medicaid expansion in January *Models for the 2010 Dependent Coverage Provision (DCP) compared: (1) experimental group: policy-eligible young adults aged 19 to 25 years vs (2) control group: slightly older, policy-ineligible adults aged 26 to 34 years before (January 2008 to September 2010) and after (January 2011 to September 2013) DCP introduction in September to December Two-sided p values indicate the extent of differences between stratified groups. Journal of the American College of Surgeons  , e1DOI: ( /j.jamcollsurg ) Copyright © 2018 American College of Surgeons Terms and Conditions

6 eFigure 1 Affordable Care Act (ACA)-related perforated appendix admission rate change and assessment of pre-implementation parallel trends: Changes in perforated appendix admission rates in Medicaid expansion vs nonexpansion states, calendar year: 2011 to 2015. Journal of the American College of Surgeons  , e1DOI: ( /j.jamcollsurg ) Copyright © 2018 American College of Surgeons Terms and Conditions

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