TY  - BOOK
AU  - Al-Refaie, Waddah B
AU  - Bouchard, Megan
AU  - Cohen, Brian
AU  - McDermott, James
AU  - Shara, Nawar M
AU  - Zeymo, Alexander
TI  - Increased Access to Cardiac Surgery Did Not Improve Outcomes: Early Look Into Medicaid Expansion
PY  - 2021///
KW  - IN PROCESS -- NOT YET INDEXED
KW  - MedStar Health Research Institute
KW  - MedStar Washington Hospital Center
KW  - MedStar General Surgery Residency
KW  - MedStar Georgetown University Hospital/MedStar Washington Hospital Center
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
N2  - BACKGROUND: Cardiac surgery utilization has increased after passage of the Affordable Care Act. This multistate study examined whether changes in access after Medicaid expansion (ME) have led to improved outcomes, overall and particularly among ethnoracial minorities; CONCLUSIONS: Despite an increase in cardiac surgery utilization after ME, outcomes remained unchanged in the early period after implementation, overall and among ethnoracial minorities. Future research is needed to confirm long-term trends and examine reasons behind this lack of improved outcomes. Copyright (c) 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved; METHODS: State Inpatient Databases were used to identify nonelderly adults (ages 18-64 years) who underwent coronary artery bypass grafting, aortic valve replacement, mitral valve replacement, or mitral valve repair in 3 expansion (Kentucky, New Jersey, Maryland) vs 2 nonexpansion states (North Carolina, Florida) from 2012 to 2015. Linear and logistic interrupted time series were used with 2-way interactions and adjusted for patient-level, hospital-level, and county-level factors to compare trends and instantaneous changes at the point of ME implementation (quarter 1 of 2014) for mortality, length of stay, and elective status. Interrupted time series models estimated expansion effect, overall and by race-ethnicity; RESULTS: Analysis included 22 038 cardiac surgery patients from expansion states and 33 190 from nonexpansion states. In expansion states, no significant trend changes were observed for mortality (odds ratio, 1.01; P = .83) or length of stay (beta = -0.05, P = .20), or for elective surgery (odds ratio, 1.00; P = .91). There were similar changes seen in nonexpansion states. Among ethnoracial minorities, ME did not impact outcomes or elective status
UR  - https://dx.doi.org/10.1016/j.athoracsur.2021.09.025
ER  -