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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 8 of 8 Research Studies Displayed
Darney BG, Jacob RL, Hoopes M
Evaluation of Medicaid expansion under the Affordable Care Act and contraceptive care in US community health centers.
This study examined whether Medicaid expansion under the Affordable Care Act increased contraceptive use for women who are underserved in the US health care safety net. The authors used electronic health record (EHR) data from a clinical research network of community health centers across 24 states. The sample included all female patients ages 15 to 44 years at risk for pregnancy with an ambulatory care visit. The study compared receipt of contraception before (2013) vs immediately after (2014) and then in 2016 after a longer period of Medicaid expansion. The sample included 310,132 women from expansion states and 234,508 women from nonexpansion states. There was an associated increase in long-acting reversible contraceptive method prescriptions among women in the expansion states, with adolescents having the largest increase.
Citation: Darney BG, Jacob RL, Hoopes M . Evaluation of Medicaid expansion under the Affordable Care Act and contraceptive care in US community health centers. JAMA Netw Open 2020 Jun;3(6):e206874. doi: 10.1001/jamanetworkopen.2020.6874..
Keywords: Medicaid, Women, Policy, Sexual Health, Safety Net
Darney BG, Biel FM, Rodriguez MI
Payment for contraceptive services in safety net clinics: roles of Affordable Care Act, Title X, and state programs.
This study examined trends in uninsured contraceptive visits before and after Medicaid expansion under the Affordable Care Act (ACA) in a large network of safety-net clinics. Their sample included 237 safety net clinics in 11 states with a common electronic health record. The authors identified 162,666 contraceptive visits in 219 clinics and found a significant decline in uninsured visits. There was a slightly greater decline in expansion states than in non-expansion states.
AHRQ-funded; HS022981; HS025155.
Citation: Darney BG, Biel FM, Rodriguez MI . Payment for contraceptive services in safety net clinics: roles of Affordable Care Act, Title X, and state programs. Med Care 2020 May;58(5):453-60. doi: 10.1097/mlr.0000000000001309..
Keywords: Sexual Health, Safety Net, Policy, Uninsured, Women
Cottrell E, Darney BG, Marino M
Study protocol: a mixed-methods study of women's healthcare in the safety net after Affordable Care Act implementation - EVERYWOMAN.
In this paper, the authors describe a 5-year, mixed-methods study comparing women's contraceptive, preventive, prenatal and postpartum care before and after ACA implementation and between Medicaid expansion and non-expansion states. They conclude that the findings will be relevant to policy and practice, informing efforts that enhance the provision of timely, evidence-based reproductive care, to improve health outcomes, and to reduce disparities among women. Patient, provider and practice-level interviews will serve to contextualize their findings and to develop subsequent studies and interventions to support women's healthcare provision in community health center settings.
Citation: Cottrell E, Darney BG, Marino M . Study protocol: a mixed-methods study of women's healthcare in the safety net after Affordable Care Act implementation - EVERYWOMAN. Health Res Policy Syst 2019 Jun 11;17(1):58. doi: 10.1186/s12961-019-0445-y..
Keywords: Women, Safety Net, Access to Care, Medicaid, Policy, Prevention, Pregnancy, Maternal Care, Sexual Health
Huguet N, Springer R, Marino M
The impact of the Affordable Care Act (ACA) Medicaid expansion on visit rates for diabetes in safety net health centers.
The objectives of this study were to: (1) compare clinic-level uninsured, Medicaid-insured, and privately insured visit rates within and between expansion and nonexpansion states before and after the Affordable Care Act (ACA) Medicaid expansion among the 3 cohorts of patient populations; and (2) assess whether there was a change in clinic-level overall, primary care visits, preventive care visits, and diabetes screening rates in expansion versus nonexpansion states from pre-ACA to post-ACA Medicaid expansion.
Citation: Huguet N, Springer R, Marino M . The impact of the Affordable Care Act (ACA) Medicaid expansion on visit rates for diabetes in safety net health centers. J Am Board Fam Med 2018 Nov-Dec;31(6):905-16. doi: 10.3122/jabfm.2018.06.180075..
Keywords: Diabetes, Healthcare Utilization, Policy, Medicaid, Safety Net
Wu VY, Fingar KR, Jiang HJ
AHRQ Author: Jiang HJ
Early impact of the Affordable Care Act coverage expansion on safety-net hospital inpatient payer mix and market shares.
The purpose of the study was to examine the impact of the Affordable Care Act's coverage expansion on safety-net hospitals (SNHs). The investigators concluded that postexpansion, non-SNHs experienced a greater percentage increase in Medicaid stays than did SNHs, which may reflect patients choosing non-SNHs over SNHs or a crowd-out of private insurance.
AHRQ-authored; AHRQ-funded; 290201300002.
Citation: Wu VY, Fingar KR, Jiang HJ . Early impact of the Affordable Care Act coverage expansion on safety-net hospital inpatient payer mix and market shares. Health Serv Res 2018 Oct;53(5):3617-39. doi: 10.1111/1475-6773.12812..
Keywords: Policy, Healthcare Cost and Utilization Project (HCUP), Hospitals, Medicaid, Safety Net
Sommers BD, Stone J, Kane N
Predictors of payer mix and financial performance among safety net hospitals prior to the Affordable Care Act.
The objective of this study was to use audited hospital financial statements to identify predictors of payer mix and financial performance in safety net hospitals prior to the Affordable Care Act. It found that university governance was the strongest positive predictor of operating margin. Safety net hospital financial performance varied considerably. Academic hospitals had higher operating margins, while more generous Medicaid eligibility and reimbursement policies improved hospitals' ability to recoup costs.
Citation: Sommers BD, Stone J, Kane N . Predictors of payer mix and financial performance among safety net hospitals prior to the Affordable Care Act. Int J Health Serv 2016;46(1):166-84. doi: 10.1177/0020731415586408.
Keywords: Safety Net, Hospitals, Policy, Policy, Medicaid
Ramamonjiarivelo Z, Weech-Maldonado R, Hearld L
Public hospitals in financial distress: Is privatization a strategic choice?
The purpose of this study was to investigate whether financial distress is associated with privatization among public hospitals. It found that public hospitals in financial distress had greater odds of being privatized than public hospitals not in financial distress. The study population consisted of all U.S. nonfederal acute care public hospitals in 1997 tracked through 2009.
Citation: Ramamonjiarivelo Z, Weech-Maldonado R, Hearld L . Public hospitals in financial distress: Is privatization a strategic choice? Health Care Manage Rev 2015 Oct-Dec;40(4):337-47. doi: 10.1097/hmr.0000000000000032.
Keywords: Hospitals, Safety Net, Policy, Healthcare Costs
Lyles CR, Aulakh V, Jameson W
Innovation and transformation in California's safety net health care settings: an inside perspective.
The authors investigated how safety net settings will innovate in order to achieve transformation of care delivery. Through informant interviews, they found that safety net systems have already begun implementing innovative practices supporting their key priority areas, but that more support is needed, specifically to accelerate the change needed to succeed under health reform.
Citation: Lyles CR, Aulakh V, Jameson W . Innovation and transformation in California's safety net health care settings: an inside perspective. Am J Med Qual 2014 Nov-Dec;29(6):538-45. doi: 10.1177/1062860613507474.
Keywords: Healthcare Delivery, Policy, Innovations and Emerging Issues, Organizational Change, Safety Net