RT Journal Article
SR Electronic
T1 Observational study protocol for evaluating control of hypertension and the effects of social determinants
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e025975
DO 10.1136/bmjopen-2018-025975
VO 9
IS 3
A1 Heather Angier
A1 Nathalie Huguet
A1 Miguel Marino
A1 Beverly Green
A1 Heather Holderness
A1 Rachel Gold
A1 Megan Hoopes
A1 Jennifer DeVoe
YR 2019
UL http://bmjopen.bmj.com/content/9/3/e025975.abstract
AB 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.