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National estimates of the impact of the affordable care act on healthcare utilization, outcomes and quality among hispanics

Award Number: R01MD011594
ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 04/20/2018
PERIOD OF PERFORMANCE END DATE: 11/30/2024

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National estimates of the impact of the affordable care act on healthcare utilization, outcomes and quality among hispanics - A central policy assumption 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. Despite its uncertain future, the Affordable Care Act (ACA) of 2010, the most important legislation in health care since the passage of Medicare and Medicaid , holds great promise for reducing racial/ethnic disparities in healthcare access and population health. With the objective of evaluating the impact of the 2014 ACA coverage expansion on racial/ethnic disparities in healthcare access, utilization, outcomes and quality, the proposed study has three foci. First, we will examine measures based on actual healthcare inpatient and emergency department (ED) utilization. Second, to better focus on Hispanics, the largest racial/ethnic minority with higher uninsurance rate (41%) than among non-Hispanic whites (15%), non-Hispanic blacks (21%) and Asians (26%), we will develop a near-national database by combining state inpatient discharge data from 22 states that together account for over 88 percent of the national Hispanic population; corresponding ED data is available from a subset of 13 states. Third, far from being an uniform intervention, ACA expansion engendered wide variation in implementation, particularly across states; we will evaluate how reform effects among Hispanics are modified by language barriers, national origin, baseline uninsurance, state Medicaid generosity, and provider availability. To estimate changes associated with the 2014 ACA insurance expansion by race/ethnicity, we will use a difference-in-differences design, wherein pre-expansion (2010-2013) to post-expansion (2014-2017) changes in the study outcome measures are contrasted with those in a comparison cohort that experienced no insurance expansion. Our specific aims are to estimate the changes associated with ACA coverage expansion in rates of (1) ambulatory care sensitive condition admissions and ED visits, (2) major elective procedures, (3) inpatient mortality and 30-day readmission, and (4) use of safety-net hospitals vs. non- safety-net hospitals, and disparities in such rates by race/ethnicity. We will examine changes in outcomes among subgroups of Hispanics by English language proficiency, national origin, sex and socioeconomic status. Our proposal has unique strengths: the data used represents a near-national population of Hispanics; it delineates impact across vulnerable subgroups of Hispanics; it identifies the role of potential facilitating and inhibiting factors, such as, provider availability and state Medicaid policy.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = -$418,282 )
2025	2022	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Minority Health and Health Disparities Research	003	5	4/16/2025	NON-COMPETING CONTINUATION	$476,298
2025	2022	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Minority Health and Health Disparities Research	001	5	4/10/2025	NON-COMPETING CONTINUATION	-$476,298
2025	2022	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Minority Health and Health Disparities Research	004	5	5/1/2025	NON-COMPETING CONTINUATION	-$418,282
2025	2021	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Minority Health and Health Disparities Research	000	4	4/10/2025	NON-COMPETING CONTINUATION	-$43,030
2025	2021	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Minority Health and Health Disparities Research	002	4	4/16/2025	NON-COMPETING CONTINUATION	$43,030
														Subtotal = -$418,282

Issue Date FY: 2024 ( Subtotal = $0 )
2024	2022	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Minority Health and Health Disparities Research	000	5	11/14/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2023 ( Subtotal = $0 )
2023	2022	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Minority Health and Health Disparities Research	000	5	1/18/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2022 ( Subtotal = $476,298 )
2022	2022	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Minority Health and Health Disparities Research	000	5	11/18/2021	NON-COMPETING CONTINUATION	$428,668
2022	2022	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Minority Health and Health Disparities Research	001	5	4/27/2022	NON-COMPETING CONTINUATION	$47,630
														Subtotal = $476,298

Issue Date FY: 2021 ( Subtotal = $430,084 )
2021	2021	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Minority Health and Health Disparities Research	000	4	11/3/2020	NON-COMPETING CONTINUATION	$382,454
2021	2021	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Minority Health and Health Disparities Research	001	4	3/15/2021	NON-COMPETING CONTINUATION	$47,630
														Subtotal = $430,084

Issue Date FY: 2020 ( Subtotal = $539,366 )
2020	2020	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Minority Health and Health Disparities Research	004	3	2/9/2020	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$395,044
2020	2020	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Minority Health and Health Disparities Research	002	3	12/30/2019	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$53,937
2020	2020	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Minority Health and Health Disparities Research	001	3	11/26/2019	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$485,429
2020	2019	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CENTER PL STE 1	BOSTON	MA	02118	SUFFOLK	USA	Minority Health and Health Disparities Research	003	2	2/9/2020	NON-COMPETING CONTINUATION	-$395,044
2020	2019	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CENTER PL STE 1	BOSTON	MA	02118	SUFFOLK	USA	Minority Health and Health Disparities Research	000	2	11/26/2019	NON-COMPETING CONTINUATION	$0
														Subtotal = $539,366

Issue Date FY: 2019 ( Subtotal = $692,648 )
2019	2019	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CENTER PL STE 1	BOSTON	MA	02118	SUFFOLK	USA	Minority Health and Health Disparities Research	000	2	11/21/2018	NON-COMPETING CONTINUATION	$692,648
														Subtotal = $692,648

Issue Date FY: 2018 ( Subtotal = $811,240 )
2018	2018	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CENTER PL STE 1	BOSTON	MA	02118	SUFFOLK	USA	Minority Health and Health Disparities Research	000	1	4/20/2018	NEW	$730,117
2018	2018	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CENTER PL STE 1	BOSTON	MA	02118	SUFFOLK	USA	Minority Health and Health Disparities Research	001	1	6/29/2018	NEW	$81,123
														Subtotal = $811,240

Grand Total All Awards = $2,531,354

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National estimates of the impact of the affordable care act on healthcare utilization, outcomes and quality among hispanics

Award Number: R01MD011594

ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 04/20/2018

PERIOD OF PERFORMANCE END DATE: 11/30/2024

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