title: Effect of Massachusetts healthcare reform on racial and ethnic disparities in admissions to hospital for ambulatory care sensitive conditions: retrospective analysis of hospital episode statistics.
abstract: OBJECTIVE
  To examine the impact of Massachusetts healthcare reform on changes in rates of admission to hospital for ambulatory care sensitive conditions (ACSCs), which are potentially preventable with good access to outpatient medical care, and racial and ethnic disparities in such rates, using complete inpatient discharge data (hospital episode statistics) from Massachusetts and three control states.
  
  
  METHODS
  Difference in differences analysis to identify the change, overall and according to race/ethnicity, adjusted for secular changes unrelated to reform.
  
  
  METHODS
  Hospitals in Massachusetts, New York, New Jersey, and Pennsylvania, United States.
  
  
  METHODS
  Adults aged 18-64 (those most likely to have been affected by the reform) admitted for any of 12 ACSCs in the 21 months before and after the period during which reform was implemented (July 2006 to December 2007).
  
  
  METHODS
  Admission rates for a composite of all 12 ACSCs, and subgroup composites of acute and chronic ACSCs.
  
  
  RESULTS
  After adjustment for potential confounders, including age, race and ethnicity, sex, and county income, unemployment rate and physician supply, we found no evidence of a change in the admission rate for overall composite ACSC (1.2%, 95% confidence interval -1.6% to 4.1%) or for subgroup composites of acute and chronic ACSCs. Nor did we find a change in disparities in admission rates between black and white people (-1.9%, -8.5% to 5.1%) or white and Hispanic people (2.0%, -7.5% to 12.4%) for overall composite ACSC that existed in Massachusetts before reform. In analyses limited to Massachusetts only, we found no evidence of a change in admission rate for overall composite ACSC between counties with higher and lower rates of uninsurance at baseline (1.4%, -2.3% to 5.3%).
  
  
  CONCLUSIONS
  Massachusetts reform was not associated with significantly lower overall or racial and ethnic disparities in rates of admission to hospital for ACSCs. In the US, and Massachusetts in particular, additional efforts might be needed to improve access to outpatient care and reduce preventable admissions.
authors.affiliation: Harvard Medical School, Department of Medicine, Cambridge Health Alliance, 1493 Cambridge, MA 02139, USA danny_mccormick@hms.harvard.edu.
authors.forename: Danny
authors.initials: D
authors.lastname: McCormick
authors.affiliation: Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
authors.forename: Amresh D
authors.initials: AD
authors.lastname: Hanchate
authors.affiliation: Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Lasser
authors.affiliation: Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
authors.forename: Meredith G
authors.initials: MG
authors.lastname: Manze
authors.affiliation: Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
authors.forename: Mengyun
authors.initials: M
authors.lastname: Lin
authors.affiliation: Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
authors.forename: Chieh
authors.initials: C
authors.lastname: Chu
authors.affiliation: Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Kressin
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000553:Ambulatory Care; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009515:New Jersey; D009518:New York; D010414:Pennsylvania; D012189:Retrospective Studies; D044465:White People; D055815:Young Adult
references.citation: N Engl J Med. 2011 Aug 25;365(8):683-5
references.pmid: 21774703
references.citation: J Epidemiol Community Health. 2012 Dec;66(12):1182-6
references.pmid: 22577181
references.citation: J Public Econ. 2012 Dec 1;96(11-12):909-929
references.pmid: 23180894
references.citation: J Clin Pharm Ther. 2002 Aug;27(4):299-309
references.pmid: 12174032
references.citation: JAMA. 2007 Dec 26;298(24):2886-94
references.pmid: 18159058
references.citation: Health Aff (Millwood). 2011 Feb;30(2):247-55
references.pmid: 21289346
references.citation: Eur J Public Health. 2013 Jun;23(3):356-60
references.pmid: 22645236
references.citation: Health Aff (Millwood). 2010 Mar-Apr;29(3):522-9
references.pmid: 20133357
references.citation: Am Econ Rev. 2009 May;99(2):508-11
references.pmid: 29508963
references.citation: J Gen Intern Med. 2010 Dec;25(12):1356-62
references.pmid: 20730503
references.citation: Circulation. 2014 Jun 17;129(24):2528-38
references.pmid: 24727094
references.citation: Health Aff (Millwood). 2008 Mar-Apr;27(2):447-55
references.pmid: 18332501
references.citation: Cancer. 2013 Jan 15;119(2):250-8
references.pmid: 22833148
references.citation: Med Care Res Rev. 2005 Feb;62(1):3-30
references.pmid: 15643027
references.citation: Inquiry. 2012-2013 Winter;49(4):317-26
references.pmid: 23469675
references.citation: Ann Intern Med. 2008 Dec 16;149(12):854-60
references.pmid: 19075204
references.citation: Med Care Res Rev. 2006 Dec;63(6):719-41
references.pmid: 17099123
references.citation: Med Care Res Rev. 2008 Oct;65(5):596-616
references.pmid: 18490268
references.citation: Q J Econ. 2012 Aug;127(3):1057-1106
references.pmid: 23293397
references.citation: Health Aff (Millwood). 2008 Jul-Aug;27(4):w285-97
references.pmid: 18522949
references.citation: Soc Sci Med. 2003 Oct;57(8):1429-41
references.pmid: 12927473
references.citation: Med Care Res Rev. 2000;57 Suppl 1:85-107
references.pmid: 11092159
references.citation: Milbank Q. 2013 Dec;91(4):663-89
references.pmid: 24320165
references.citation: N Engl J Med. 2012 Sep 13;367(11):1025-34
references.pmid: 22830435
references.citation: Ann Intern Med. 2001 Sep 4;135(5):352-66
references.pmid: 11529699
references.citation: Health Aff (Millwood). 2012 Feb;31(2):444-51
references.pmid: 22282572
references.citation: BMJ. 2014 Mar 31;348:g2329
references.pmid: 24687184
references.citation: Health Aff (Millwood). 2013 Mar;32(3):571-8
references.pmid: 23459737
references.citation: J Health Econ. 1990;9(4):411-28
references.pmid: 10113569
references.citation: JAMA. 1995 Jul 26;274(4):305-11
references.pmid: 7609259
references.citation: Health Aff (Millwood). 2008 Jul-Aug;27(4):w270-84
references.pmid: 18522948
references.citation: J Gen Intern Med. 2012 Nov;27(11):1548-54
references.pmid: 22825807
references.citation: JAMA. 1992 Nov 4;268(17):2388-94
references.pmid: 1404795
references.citation: N Engl J Med. 2014 Oct 23;371(17):1567-70
references.pmid: 25337745
references.citation: Health Aff (Millwood). 2011 Aug;30(8):1451-60
references.pmid: 21821562
references.citation: BMJ. 2013 Feb 21;346:f549
references.pmid: 23430282
references.citation: Am J Prev Med. 2011 Jul;41(1):1-8
references.pmid: 21665057
references.citation: JAMA. 2002 Mar 13;287(10):1288-94
references.pmid: 11886320
references.citation: Med Care. 2008 Oct;46(10):1049-54
references.pmid: 18815526
references.citation: Health Serv Res. 2014 Dec;49 Suppl 2:2086-103
references.pmid: 25039480
references.citation: Am J Public Health. 2010 Nov;100(11):2235-40
references.pmid: 20864718
references.citation: Brookings Pap Econ Act. 2013 Fall;2013:261-302
references.pmid: 25418992
references.citation: Int J Health Serv. 2010;40(3):507-23
references.pmid: 20799673
references.citation: Ann Intern Med. 2014 May 6;160(9):585-93
references.pmid: 24798521
references.citation: Annu Rev Public Health. 2008;29:399-409
references.pmid: 18031224
references.citation: Ann Emerg Med. 2011 Sep;58(3):225-234.e1
references.pmid: 21570157
references.citation: BMJ. 2015 Feb 20;350:h440
references.pmid: 25700849
references.citation: Health Aff (Millwood). 2011 Feb;30(2):322-31
references.pmid: 21289354
references.citation: Am J Prev Med. 2010 Apr;38(4):381-8
references.pmid: 20307806