The Impact of Medicaid Expansion on Acute Diabetes Complication by Care Delivery Settings
Objective: This study evaluates whether gaining Medicaid following the Affordable Care Act (ACA) expansion led to changes in the rate of acute diabetes complications diagnosed in primary care settings, relative to in inpatient, emergency department (ED), or urgent care (UC) settings. Methods: This r...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2025-02-01
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| Series: | Journal of Primary Care & Community Health |
| Online Access: | https://doi.org/10.1177/21501319251320161 |
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| author | Danielle Kulbak Dang Dinh Annie E. Larson Andrew Suchocki Rachel Springer Miguel Marino Jennifer E. DeVoe Jun Hwang Nathalie Huguet |
| author_facet | Danielle Kulbak Dang Dinh Annie E. Larson Andrew Suchocki Rachel Springer Miguel Marino Jennifer E. DeVoe Jun Hwang Nathalie Huguet |
| author_sort | Danielle Kulbak |
| collection | DOAJ |
| description | Objective: This study evaluates whether gaining Medicaid following the Affordable Care Act (ACA) expansion led to changes in the rate of acute diabetes complications diagnosed in primary care settings, relative to in inpatient, emergency department (ED), or urgent care (UC) settings. Methods: This retrospective cohort study used Medicaid administrative claims data linked to electronic health records for 3767 patients, aged 19 to 64 years, who experienced acute preventable complications of diabetes between 2014 and 2019 diagnosed in inpatient, ED, UC, or primary care settings in the state of Oregon. These patients were classified as either continuously Medicaid-insured or having gained Medicaid. Results: Annual rates of acute complications diagnosed in primary care and inpatient/ED/UC settings increased for both continuously [Adjusted Rate Ratio (aRR) = 2.20, 95% CI = 1.65-2.91] and newly Medicaid-insured patients (aRR = 2.67, 95% CI = 2.05-3.47) after the ACA. Among newly Medicaid-insured, annual rates of abnormal blood glucose diagnosed in primary care settings significantly increased with time while those diagnosed in inpatient/ED/UC decreased (2014 vs 2016 aRR = 3.36, 95% CI = 1.60-7.09). Conclusion: We found a significantly greater rate of abnormal blood glucose diagnosed in primary care clinics among patients who gained Medicaid post-ACA and a corresponding decline in diagnosis in inpatient/ED/UC settings. |
| format | Article |
| id | doaj-art-41fb85303c2146cea8d81de4012d576f |
| institution | DOAJ |
| issn | 2150-1327 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Primary Care & Community Health |
| spelling | doaj-art-41fb85303c2146cea8d81de4012d576f2025-08-20T03:11:39ZengSAGE PublishingJournal of Primary Care & Community Health2150-13272025-02-011610.1177/21501319251320161The Impact of Medicaid Expansion on Acute Diabetes Complication by Care Delivery SettingsDanielle Kulbak0Dang Dinh1Annie E. Larson2Andrew Suchocki3Rachel Springer4Miguel Marino5Jennifer E. DeVoe6Jun Hwang7Nathalie Huguet8A.T. Still University, Mesa, AZ, USAOregon Health & Science University, Portland, OR, USAOCHIN Inc., Portland, OR, USAClackamas Health Centers, Oregon City, OR, USAOregon Health & Science University, Portland, OR, USAOregon Health & Science University, Portland, OR, USAOregon Health & Science University, Portland, OR, USAOregon Health & Science University, Portland, OR, USAOregon Health & Science University, Portland, OR, USAObjective: This study evaluates whether gaining Medicaid following the Affordable Care Act (ACA) expansion led to changes in the rate of acute diabetes complications diagnosed in primary care settings, relative to in inpatient, emergency department (ED), or urgent care (UC) settings. Methods: This retrospective cohort study used Medicaid administrative claims data linked to electronic health records for 3767 patients, aged 19 to 64 years, who experienced acute preventable complications of diabetes between 2014 and 2019 diagnosed in inpatient, ED, UC, or primary care settings in the state of Oregon. These patients were classified as either continuously Medicaid-insured or having gained Medicaid. Results: Annual rates of acute complications diagnosed in primary care and inpatient/ED/UC settings increased for both continuously [Adjusted Rate Ratio (aRR) = 2.20, 95% CI = 1.65-2.91] and newly Medicaid-insured patients (aRR = 2.67, 95% CI = 2.05-3.47) after the ACA. Among newly Medicaid-insured, annual rates of abnormal blood glucose diagnosed in primary care settings significantly increased with time while those diagnosed in inpatient/ED/UC decreased (2014 vs 2016 aRR = 3.36, 95% CI = 1.60-7.09). Conclusion: We found a significantly greater rate of abnormal blood glucose diagnosed in primary care clinics among patients who gained Medicaid post-ACA and a corresponding decline in diagnosis in inpatient/ED/UC settings.https://doi.org/10.1177/21501319251320161 |
| spellingShingle | Danielle Kulbak Dang Dinh Annie E. Larson Andrew Suchocki Rachel Springer Miguel Marino Jennifer E. DeVoe Jun Hwang Nathalie Huguet The Impact of Medicaid Expansion on Acute Diabetes Complication by Care Delivery Settings Journal of Primary Care & Community Health |
| title | The Impact of Medicaid Expansion on Acute Diabetes Complication by Care Delivery Settings |
| title_full | The Impact of Medicaid Expansion on Acute Diabetes Complication by Care Delivery Settings |
| title_fullStr | The Impact of Medicaid Expansion on Acute Diabetes Complication by Care Delivery Settings |
| title_full_unstemmed | The Impact of Medicaid Expansion on Acute Diabetes Complication by Care Delivery Settings |
| title_short | The Impact of Medicaid Expansion on Acute Diabetes Complication by Care Delivery Settings |
| title_sort | impact of medicaid expansion on acute diabetes complication by care delivery settings |
| url | https://doi.org/10.1177/21501319251320161 |
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