Assessing Community Cancer care after insurance ExpanSionS (ACCESS) study protocol

H Angier, N Huguet, M Marino, M Mori, K Winters-Stone, J Shannon, L Raynor, H Holderness, J E DeVoe, H Angier, N Huguet, M Marino, M Mori, K Winters-Stone, J Shannon, L Raynor, H Holderness, J E DeVoe

Abstract

Background: Cancer is the second most common cause of mortality in the United States. Cancer screening and prevention services have contributed to improved overall cancer survival rates in the past 40 years. Vulnerable populations (i.e., uninsured, low-income, and racial/ethnic minorities) are disproportionately affected by cancer, receive significantly fewer cancer prevention services, poorer healthcare, and subsequently lower survival rates than insured, white, non-Hispanic populations. The Affordable Care Act (ACA) aims to provide health insurance to all low-income citizens and legal residents, including an expansion of Medicaid eligibility for those earning ≤138% of federal poverty level. As of 2012, Medicaid was expanded in 32 states and the District of Columbia, while 18 states did not expand, creating a 'natural experiment' to assess the impact of Medicaid expansion on cancer prevention and care.

Methods: We will use electronic health record data from up to 990 community health centers available up to 24-months before and at least one year after Medicaid expansion. Primary outcomes include health insurance and coverage status, and type of insurance. Additional outcomes include healthcare delivery, number and types of encounters, and receipt of cancer prevention and screening for all patients and preventive care and screening services for cancer survivors.

Discussion: Cancer morbidity and mortality is greatly reduced through screening and prevention, but uninsured patients are much less likely than insured patients to receive these services as recommended. This natural policy experiment will provide valuable information about cancer-related healthcare services as the US tackles the distribution of healthcare resources and future health reform.

Trial registration: Clinicaltrails.gov identifier NCT02936609.

Keywords: Affordable Care Act; Cancer; Medicaid; Natural experiment; Preventive services; Screening.

Conflict of interest statement

Competing interests The authors declare that they have no competing interests.

References

    1. American Cancer Society . vol. 2015. American Cancer Society; Atlanta, GA: 2015. Cancer Facts & Figures. (Accessed 16 June 2017)
    1. U.S. Cancer Statistics Working Group . U.S. Department of Health and Human Services, Centers for Disease Control, and Prevention and National Cancer Institute; Atlanta: 2009. United States Cancer Statistics: 1999–2005 Incidence and Mortality Web-based Report. (Accessed 16 June 2017)
    1. Ward E., Jemal A., Cokkinides V. Cancer disparities by race/ethnicity and socioeconomic status. CA A Cancer J. Clin. 2004;54(2):78–93.
    1. Mandelblatt J.S., Yabroff K.R., Kerner J.F. Equitable access to cancer services: a review of barriers to quality care. Cancer. 1999;86:2378–2390.
    1. Robinson J.M., Shavers V. The role of health insurance coverage in cancer screening utilization. J. Health Care Poor Underserved. 2008;19(3):842–856.
    1. Ward E., Halpern M., Schrag N. Association of insurance with cancer care utilization and outcomes. CA Cancer J. Clin. 2008;58(1):9–31.
    1. The Henry J Kaiser Family Foundation . Focus on Health Reform; Menlo Park, CA: 2013. Summary of the Affordable Care Act.
    1. Supreme Court of the United States . 2012. National Federation of Independent Business v Sebelius. Secondary National Federation of Independent Business v Sebelius. (Accessed 16 June 2017)
    1. The Henry J Kaiser Family Foundation . 2017. Status of State Action on the Medicaid Expansion Decision. Secondary Status of State Action on the Medicaid Expansion Decision. (Accessed 16 June 2017)
    1. DeVoe J.E., Gold R., Cottrell E. The ADVANCE network: accelerating data value across a national community health center network. J. Am. Med. Inf. Assoc. 2014;21(4):591–595.
    1. National Association of Community Health Centers . 2014. A Sketch of Community Health Centers, Chart Book 2014. Bethesda, M.D.
    1. Morgan D. 2012. Health Centers for Poor, Uninsured See Ranks Swell. Secondary Health Centers for Poor, Uninsured See Ranks Swell. (Accessed 16 June 2017)
    1. Rosenbaum S., Shin P., Jones E., Tolbert J. August 2010. Community Health Centers: Opportunities and Challenges of Health Reform. Washington, DC.
    1. The White House . 2012. The Obama Administration and Community Health Centers. Secondary the Obama Administration and Community Health Centers. (Accessed 16 June 2017)
    1. Mao J.J., Bowman M.A., Stricker C.T. Delivery of survivorship care by primary care physicians: the perspective of breast cancer patients. J. Clin. Oncol. 2009;27(6):933–938.
    1. Snyder C.F., Earle C.C., Herbert R.J., Neville B.A., Blackford A.L., Frick K.D. Preventive care for colorectal cancer survivors: a 5-year longitudinal study. J. Clin. Oncol. 2008;26(7):1073–1079.
    1. Roberts R.O., Bergstralh E.J., Schmidt L., Jacobsen S.J. Comparison of self-reported and medical record health care utilization measures. J. Clin. Epidemiol. 1996;49(9):989–995.
    1. Ritter P.L., Stewart A.L., Kaymaz H., Sobel D.S., Block D.A., Lorig K.R. Self-reports of health care utilization compared to provider records. J. Clin. Epidemiol. 2001;54(2):136–141.
    1. National Cancer Institute . 2017. NCI Dictionary of Cancer Terms. Secondary NCI Dictionary of Cancer. (Accessed 16 June 2017)
    1. Murphy D.R., Laxmisan A., Reis B.A. Electronic health record-based triggers to detect potential delays in cancer diagnosis. BMJ Qual. Saf. 2014;23(1):8–16.
    1. Thompson C.A., Kurian A.W., Luft H.S. Linking electronic health records to better understand breast cancer patient pathways within and between two health systems. EGEMS. 2015;3(1):1127.
    1. United States Department of labor . 2017. Bureau of Labor Statistics. Secondary Bureau of Labor Statistics. (Accessed 16 June 2017)
    1. United States Census Bureau . 2017. Current Population Survey (CPS). Secondary Current Population Survey (CPS) (Accessed 16 June 2017)
    1. 2013. U.S. Preventive Services Task Force. Secondary U.S. Preventive Services Task Force. (Accessed 16 June 2017)
    1. National Comprehensive Cancer Network . 2016. NCCN Guidelines. Secondary NCCN Guidelines. (Accessed 16 June 2017)
    1. Bertrand M., Duflo E., Mullainathan S. How much should we trust differences-in-differences estimates? Q. J. Econ. 2004;119(1):249–275.
    1. Donald S., Lang K. Inference with difference-in-differences and other panel data. Rev. Econ. Stat. 2007;89(2):221–233.
    1. Dean C.B., Nielsen J.D. Generalized linear mixed models: a review and some extensions. Lifetime Data Anal. 2007;13(4):497–512.
    1. Athey S., Imbens G.W. Identification and inference in nonlinear difference-in-differences models. Econometrica. 2006;74(2):431–497.
    1. Guo S., Fraser M.W. Sage Publications, Inc.; Thousand Oaks, CA: 2014. Propensity Score Analysis: Statistical Methods and Applications.
    1. O'Malley J.P., O'Keeffe-Rosetti M., Lowe R.A. Health Care utilization rates after Oregon's 2008 medicaid expansion: within-group and between-group differences over time among new, returning, and continuously insured enrollees. Med. Care. 2016;54(11):984–991.
    1. Polsky D., Richards M., Basseyn S. Appointment availability after increases in Medicaid payments for primary care. N. Engl. J. Med. 2015;372(6):537–545.
    1. Saloner B., Kenney G., Polsky D. The Urban Instutite; 2014. The Availability of New Patient Appointments for Primary Care at Federally Qualified Health Centers: Findings from an Audit Study. (Accessed 16 June 2017)
    1. Angier H., Hoopes M., Gold R. An early look at rates of uninsured safety net clinic visits after the affordable care act. Ann. Fam. Med. 2015;13(1):10–16.
    1. Hoopes M.J., Angier H., Gold R. Utilization of community health centers in medicaid expansion and non-expansion states, 2013-2014. J. Ambul. Care Manag. 2016;39(4):290–298.
    1. DeVoe J.E., Gold R., McIntire P., Puro J., Chauvie S., Gallia C.A. Electronic health records vs Medicaid claims: completeness of diabetes preventive care data in community health centers. Ann. Fam. Med. 2011;9(4):351–358.
    1. Bailey S.R., Heintzman J.D., Marino M. Measuring preventive care delivery: comparing rates across three data sources. Am. J. Prev. Med. 2016;51(5):752–761.
    1. Heintzman J., Bailey S.R., Hoopes M.J. Agreement of Medicaid claims and electronic health records for assessing preventive care quality among adults. J. Am. Med. Inf. Assoc. 2014;21(4):720–724.
    1. Little T.D., Schnabel K.U., Baumert J. Lawrence Earlbaum Associates; New Jersey: 2000. Modeling Longitudinal and Multilevel Data 2000.
    1. Little R.J.A., Rubin D.B. John Wiley & Sons; Hoboken, NJ: 2002. Statistical Analysis with Missing Data.

Source: PubMed

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