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Effect of Massachusetts health reform on chronic disease outcomes.

Publication ,  Journal Article
Stryjewski, TP; Zhang, F; Eliott, D; Wharam, JF
Published in: Health Serv Res
December 2014

OBJECTIVE: To determine whether Massachusetts Health Reform improved health outcomes in uninsured patients with hyperlipidemia, diabetes, or hypertension. DATA SOURCE: Partners HealthCare Research Patient Data Registry (RPDR). STUDY DESIGN: We examined 1,463 patients with hyperlipidemia, diabetes, or hypertension who were uninsured in the 3 years before the 2006 Massachusetts Health Reform implementation. We assessed mean quarterly total cholesterol, glycosylated hemoglobin, and systolic blood pressure in the respective cohorts for five follow-up years compared with 3,448 propensity score-matched controls who remained insured for the full 8-year study period. We used person-level interrupted time series analysis to estimate changes in outcomes adjusting for sex, age, race, estimated household income, and comorbidity. We also analyzed the subgroups of uninsured patients with poorly controlled disease at baseline, no evidence of established primary care in the baseline period, and those who received insurance in the first follow-up year. PRINCIPAL FINDINGS: In 5 years after Massachusetts Health Reform, patients who were uninsured at baseline did not experience detectable trend changes in total cholesterol (-0.39 mg/dl per quarter, 95 percent confidence interval [-1.11 to 0.33]), glycosylated hemoglobin (-0.02 percent per quarter [-0.06 to 0.03]), or systolic blood pressure (-0.06 mmHg per quarter [-0.29 to 0.18]). Analyses of uninsured patients with poorly controlled disease, no evidence of established primary care in the baseline period, and those who received insurance in the first follow-up year yielded similar findings. CONCLUSIONS: Massachusetts Health Reform was not associated with improvements in hyperlipidemia, diabetes, or hypertension control after 5 years. Interventions beyond insurance coverage might be needed to improve the health of chronically ill uninsured persons.

Duke Scholars

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Published In

Health Serv Res

DOI

EISSN

1475-6773

Publication Date

December 2014

Volume

49 Suppl 2

Issue

Suppl 2

Start / End Page

2086 / 2103

Location

United States

Related Subject Headings

  • Young Adult
  • Patient Outcome Assessment
  • Middle Aged
  • Medically Uninsured
  • Massachusetts
  • Male
  • Hypertension
  • Hyperlipidemias
  • Humans
  • Health Policy & Services
 

Citation

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Stryjewski, T. P., Zhang, F., Eliott, D., & Wharam, J. F. (2014). Effect of Massachusetts health reform on chronic disease outcomes. Health Serv Res, 49 Suppl 2(Suppl 2), 2086–2103. https://doi.org/10.1111/1475-6773.12196
Stryjewski, Tomasz P., Fang Zhang, Dean Eliott, and J Frank Wharam. “Effect of Massachusetts health reform on chronic disease outcomes.Health Serv Res 49 Suppl 2, no. Suppl 2 (December 2014): 2086–2103. https://doi.org/10.1111/1475-6773.12196.
Stryjewski TP, Zhang F, Eliott D, Wharam JF. Effect of Massachusetts health reform on chronic disease outcomes. Health Serv Res. 2014 Dec;49 Suppl 2(Suppl 2):2086–103.
Stryjewski, Tomasz P., et al. “Effect of Massachusetts health reform on chronic disease outcomes.Health Serv Res, vol. 49 Suppl 2, no. Suppl 2, Dec. 2014, pp. 2086–103. Pubmed, doi:10.1111/1475-6773.12196.
Stryjewski TP, Zhang F, Eliott D, Wharam JF. Effect of Massachusetts health reform on chronic disease outcomes. Health Serv Res. 2014 Dec;49 Suppl 2(Suppl 2):2086–2103.
Journal cover image

Published In

Health Serv Res

DOI

EISSN

1475-6773

Publication Date

December 2014

Volume

49 Suppl 2

Issue

Suppl 2

Start / End Page

2086 / 2103

Location

United States

Related Subject Headings

  • Young Adult
  • Patient Outcome Assessment
  • Middle Aged
  • Medically Uninsured
  • Massachusetts
  • Male
  • Hypertension
  • Hyperlipidemias
  • Humans
  • Health Policy & Services