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.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project--Cooperative Agreements (U01)
Project #
Application #
Study Section
Special Emphasis Panel (ZHL1)
Program Officer
Bonds, Denise
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Boston Medical Center
United States
Zip Code
Lin, Meng-Yun; Kressin, Nancy R; Paasche-Orlow, Michael K et al. (2018) Is 30-Day Posthospitalization Mortality Lower Among Racial/Ethnic Minorities?: A Reexamination. Med Care 56:665-672
Khazanie, Prateeti; Al-Khatib, Sana M; Wang, Tracy Y et al. (2018) Training cardiovascular outcomes researchers: A survey of mentees and mentors to identify critical training gaps and needs. Am Heart J 196:170-177
Khazanie, Prateeti; Krumholz, Harlan M; Kiefe, Catarina I et al. (2017) Priorities for Cardiovascular Outcomes Research: A Report of the National Heart, Lung, and Blood Institute's Centers for Cardiovascular Outcomes Research Working Group. Circ Cardiovasc Qual Outcomes 10:
Tikkanen, Roosa Sofia; Woolhandler, Steffie; Himmelstein, David U et al. (2017) Hospital Payer and Racial/Ethnic Mix at Private Academic Medical Centers in Boston and New York City. Int J Health Serv 47:460-476
Hanchate, Amresh D; McCormick, Danny; Lasser, Karen E et al. (2017) Impact of Massachusetts Health Reform on Inpatient Care Use: Was the Safety-Net Experience Different Than in the Non-Safety-Net? Health Serv Res 52:1647-1666
Kapoor, Alok; Shaffer, Nicholas; Hanchate, Amresh et al. (2016) Massachusetts Health Reform Cost Less and Was More Effective for Uninsured Individuals With Venous Thromboembolism: A Cost-Effectiveness Analysis. Med Care 54:474-82
Kressin, Nancy R; Chapman, Sheila E; Magnani, Jared W (2016) A Tale of Two Patients: Patient-Centered Approaches to Adherence as a Gateway to Reducing Disparities. Circulation 133:2583-92
Lasser, Karen E; Hanchate, Amresh D; McCormick, Danny et al. (2016) Massachusetts Health Reform's Effect on Hospitals' Racial Mix of Patients and on Patients' Use of Safety-net Hospitals. Med Care 54:827-36
Hanchate, Amresh D; Kapoor, Alok; Katz, Jeffrey N et al. (2015) Massachusetts health reform and disparities in joint replacement use: difference in differences study. BMJ 350:h440
McCormick, Danny; Hanchate, Amresh D; Lasser, Karen E et al. (2015) Effect of Massachusetts healthcare reform on racial and ethnic disparities in admissions to hospital for ambulatory care sensitive conditions: retrospective analysis of hospital episode statistics. BMJ 350:h1480

Showing the most recent 10 out of 15 publications