One of the central policy assumptions in the U.S. today is that expanding health insurance coverage will improve access to health care, improve health outcomes, and make each more equitable for all Americans. Indeed, lack of health insurance is associated with less use of cardiovascular (CV) and other care, poor health outcomes, and increased mortality. Limited access to care is one of strongest contributors to disparities in outcomes. Massachusetts (MA) is the site of a key policy-relevant natural experiment, whereby recent legislation has resulted in 97% of the state's residents obtaining health insurance;it is thus the ideal setting in which to monitor and evaluate CV health outcomes, and disparities in such outcomes. We propose to develop the "Center for Health Insurance Reform, Cardiovascular Outcomes, and Disparities" at Boston University School of Medicine and Boston Medical Center, New England's largest safety net hospital. We will examine the effects of MA health reform on CV care and outcomes, and in disparities in each, through two studies. The first will evaluate whether expanded insurance coverage will be associated with fewer preventable inpatient admissions for ambulatory care sensitive CV conditions and readmissions for CV conditions. This project will also assess rates of referral-sensitive cardiac procedures, and the use of safety-net hospitals by racial/ethnic minority patients. The second project will examine care and outcomes of care for venous thromboembolism (VTE) both pre- and post-reform, examining whether increased access to primary and home care, and to outpatient pharmacy services, will be associated with better clinical outcomes, as well as improved health related quality of life, survival and cost-effectiveness.
The specific aims of our Center are: 1) To conduct research to evaluate the effects of health reform in MA on CV outcomes;2) To complement and collaborate with other existing centers in CV outcomes research. 3) To develop three Early Stage Investigators into seasoned CV outcomes researchers who are well versed in the issues, topics and methods in the field, and who, upon the completion of the center activities, will be poised to make substantial future contributions to the field of CV outcomes research.
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