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Medicaid Expansion and Hospitalization for Ambulatory Care–Sensitive Conditions Among Nonelderly Adults With Diabetes

Mondesir, Favel L., PhD, MSPH; Kilgore, Meredith L., PhD; Shelley, John P., BS; Levitan, Emily B., ScD; Huang, Lei, PhD; Riggs, Kevin R., MD, MPH; Pisu, Maria, PhD; Li, Yufeng, PhD; Bronstein, Janet M., PhD; Agne, April, MPH; Cherrington, Andrea L., MD, MPH

The Journal of Ambulatory Care Management: May 16, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/JAC.0000000000000280
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Among nonelderly adults with diabetes, we compared hospitalizations for ambulatory care–sensitive conditions from 2013 (pre-Medicaid expansion) and 2014 (post-Medicaid expansion) for 13 expansion and 4 nonexpansion states using State Inpatient Databases. Medicaid expansion was associated with decreases in proportions of hospitalizations for chronic conditions (difference between 2014 and 2013 −0.17 percentage points in expansion and 0.37 in nonexpansion states, P = .04), specifically diabetes short-term complications (difference between 2014 and 2013 −0.05 percentage points in expansion and 0.21 in nonexpansion states, P = .04). Increased access to care through Medicaid expansion may improve disease management in nonelderly adults with diabetes.

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Department of Epidemiology (Drs Mondesir, Levitan, and Huang) and Department of Health Care Organization and Policy (Drs Kilgore and Bronstein), School of Public Health, University of Alabama at Birmingham; and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (Mr Shelley, Drs Riggs, Pisu, Li, and Cherrington, and Ms Agne). Dr Mondesir is now at Division of Cardiovascular Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City. Mr Shelley is now at School of Medicine, Vanderbilt University, Nashville, Tennessee.

Correspondence: Andrea L. Cherrington, MD, MPH, Division of Preventive Medicine, Department of Medicine, Medical Towers 624, 1717 11th Ave South, Birmingham, AL 35205 (cherrington@uab.edu).

Deceased October 17, 2018.

Author Contributions: F.L.M. contributed to the design of the study and wrote the manuscript. M.L.K. (deceased) contributed to the conception and design of the study, analyzed the HCUP-SID data, wrote part of the methods section, provided expertise on Medicaid expansion, and revised prior drafts of the manuscript for intellectually important content. J.P.S. analyzed the BRFSS data, wrote part of the methods section, and revised the manuscript for intellectually important content. E.B.L. contributed to the conception and design of the study, provided expertise on the analysis plan, and revised the manuscript for intellectually important content. L.H. contributed to the analysis of the HCUP-SID data and revised the manuscript for intellectually important content. K.R.R. contributed to the design of the study, provided expertise on the analysis plan, and revised the manuscript for intellectually important content. M.P. contributed to the design of the study, provided expertise on the analysis plan, and revised the manuscript for intellectually important content. Y.L. contributed to the design of the study and revised the manuscript for intellectually important content. J.M.B. provided expertise on the analysis plan, contributed to the design of the study, and revised the manuscript for intellectually important content. A.A. contributed to the design of the study and revised the manuscript for intellectually important content. A.L.C. contributed to the conception and design of the study, provided expertise on diabetes, led the study team, and revised the manuscript for intellectually important content. M.L.K. (deceased), L.H., and J.P.S. had full access to the data. L.H. and J.P.S. take responsibility for the integrity of the data and the accuracy of the data analysis.

All authors excluding M.L.K. (deceased) have approved the final article.

The study was supported by R18 DK109501 from the National Institute of Diabetes and Digestive and Kidney Diseases. This work was also supported by American Heart Association Greater Southeast Affiliate Grant 16PRE29640015 (MONDESIR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Diabetes and Digestive and Kidney Diseases or the American Heart Association.

M.L.K. (deceased) received research funding from Amgen. E.B.L receives research funding from Amgen, has consulted for Novartis, and has served on an advisory board for Amgen. A.L.C. receives research funding from Boehringer Ingelheim and is on the advisory board for Astra Zeneca. F.L.M., J.P.S., L.H., M.P., K.R.R, A.A., Y.L., and J.M.B. have no relationships to disclose.

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