title: Effect of Massachusetts health reform on chronic disease outcomes.
abstract: OBJECTIVE
  To determine whether Massachusetts Health Reform improved health outcomes in uninsured patients with hyperlipidemia, diabetes, or hypertension.
  
  
  METHODS
  Partners HealthCare Research Patient Data Registry (RPDR).
  
  
  METHODS
  We examined 1,463 patients with hyperlipidemia, diabetes, or hypertension who were uninsured in the 3 years before the 2006 Massachusetts Health Reform implementation. We assessed mean quarterly total cholesterol, glycosylated hemoglobin, and systolic blood pressure in the respective cohorts for five follow-up years compared with 3,448 propensity score-matched controls who remained insured for the full 8-year study period. We used person-level interrupted time series analysis to estimate changes in outcomes adjusting for sex, age, race, estimated household income, and comorbidity. We also analyzed the subgroups of uninsured patients with poorly controlled disease at baseline, no evidence of established primary care in the baseline period, and those who received insurance in the first follow-up year.
  
  
  RESULTS
  In 5 years after Massachusetts Health Reform, patients who were uninsured at baseline did not experience detectable trend changes in total cholesterol (-0.39 mg/dl per quarter, 95 percent confidence interval [-1.11 to 0.33]), glycosylated hemoglobin (-0.02 percent per quarter [-0.06 to 0.03]), or systolic blood pressure (-0.06 mmHg per quarter [-0.29 to 0.18]). Analyses of uninsured patients with poorly controlled disease, no evidence of established primary care in the baseline period, and those who received insurance in the first follow-up year yielded similar findings.
  
  
  CONCLUSIONS
  Massachusetts Health Reform was not associated with improvements in hyperlipidemia, diabetes, or hypertension control after 5 years. Interventions beyond insurance coverage might be needed to improve the health of chronically ill uninsured persons.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Tomasz P
authors.initials: TP
authors.lastname: Stryjewski
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.forename: Dean
authors.initials: D
authors.lastname: Eliott
authors.forename: J Frank
authors.initials: JF
authors.lastname: Wharam
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D018166:Health Care Reform; D006801:Humans; D006949:Hyperlipidemias / Q000628:therapy*; D006973:Hypertension / Q000628:therapy*; D008297:Male; D008404:Massachusetts; D017057:Medically Uninsured; D008875:Middle Aged; D063868:Patient Outcome Assessment; D055815:Young Adult
keywords: Health reform; observational data; time series analysis