Introduction Hypertension is a common chronic health condition. Having health insurance reduces hypertension risk; health insurance coverage could improve hypertension screening, treatment and management. The Medicaid eligibility expansion of the Affordable Care Act was ruled not to be required by the US Supreme Court. Subsequently, a ‘natural experiment’ was produced with some states expanding Medicaid eligibility while others did not. This presents a unique opportunity to learn whether and to what extent Medicaid expansion can affect healthcare access and services for patients at risk for and diagnosed with hypertension, and patients with undiagnosed hypertension. Additionally, social determinants of health (SDH), at both the individual- and community-level, influence diagnosis and care for hypertension and it is important to understand how they interact with health insurance coverage changes.
Methods/design We will use electronic health record (EHR) data from the Accelerating Data Value Across a National Community Health Center Network clinical data research network, which has data from community health centres in 22 states, some that did and some that did not expand Medicaid. Data include information on changes in health insurance, service receipt and health outcomes from 2012 through the most recent data available. We will include patients between the ages of 19 and 64 years (n=1 524 241) with ≥1 ambulatory visit to a community health centre. We will estimate differences in outcomes using difference-in-difference and difference-in-difference-in-difference approaches. We will test three-way interactions with insurance group, time and social determinants of health factors to compare the potential effect of gaining insurance on our proposed outcomes.
Ethics and dissemination This study uses secondary data analysis and therefore approval for consent to participate was waived. The Institutional Review Board for OHSU approved this study. Approval reference number is: IRB00011858. We plan to disseminate our findings at relevant conferences, meetings and through peer-reviewed journals.
Trial registration number NCT03545763.
- affordable care act
- natural experiment
- community health centers
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Contributors JD is PI and led the writing of the grant application, with input from NH, HA, RG and BG. MM was responsible for biostatistics analysis planning. HA led the writing of the protocol manuscript with significant contributions from JD, NH, MM, BG, HH, RG and MH. All authors read and approved the final manuscript.
Funding This work was supported by the National Lung, Heart, and Blood Institute, grant number R01HL136575. ADVANCE (Accelerating Data Value Across a National Community Health Center Network) is led by the OCHIN Community Health Information Network in partnership with the Health Choice Network (HCN), Fenway Health, Care Oregon, Kaiser Permanente Center for Health Research, Legacy Health, Oregon Health and Science University (OHSU) and the Robert Graham Center. This study was made possible by the National Heart, Lung, and Blood Institute Grant #R01HL136575.
Competing interests None declared.
Ethics approval This study uses secondary data analysis and therefore approval for consent to participate was waived. The Institutional Review Board for Oregon Health & Science University approved this study. Approval reference number is: IRB00011858. We plan to disseminate our findings at relevant conferences, meetings and through peer-reviewed journals.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Not required.
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