No abstract

We sought to understand how Affordable Care Act (ACA) Medicaid expansion insurance coverage gains are associated with changes in diabetes-related biomarkers. RESEARCH DESIGN AND METHODSThis was a retrospective observational cohort study using electronic health record data from 178 community health centers (CHCs) in the ADVANCE (Accelerating Data Value Across a National Community Health Center Network) network. We assessed changes in diabetes-related biomarkers among adult patients with diabetes in 10 Medicaid expansion states (n 5 25,279), comparing newly insured with continuously insured, discontinuously insured, and continuously uninsured patients pre-to post-ACA expansion. Primary outcomes included changes from 24 months pre-to 24 months post-ACA in glycosylated hemoglobin (HbA 1c ), systolic (SBP) and diastolic (DBP) blood pressure, and LDL cholesterol levels. RESULTSNewly insured patients exhibited a reduction in adjusted mean HbA 1c levels (8.24% [67 mmol/mol] to 8.17% [66 mmol/mol]), which was significantly different from continuously uninsured patients, whose HbA 1c levels increased (8.12% [65 mmol/ mol] to 8.29% [67 mmol/mol]; difference-in-differences [DID] 20.24%; P < 0.001). Newly insured patients showed greater reductions than continuously uninsured patients in adjusted mean SBP (DID 21.8 mmHg; P < 0.001), DBP (DID 21.0 mmHg; P < 0.001), and LDL (DID 23.3 mg/dL; P < 0.001). Among patients with elevated HbA 1c in the 3 months prior to expansion, newly insured patients were more likely than continuously uninsured patients to have a controlled HbA 1c measurement by 24 months post-ACA (hazard ratio 1.25; 95% CI 1.02-1.54]. CONCLUSIONSPost-ACA, newly insured patients had greater improvements in diabetes-related biomarkers than continuously uninsured, discontinuously insured, or continuously insured patients. Findings suggest that health insurance gain via ACA facilitates access to appropriate diabetes care, leading to improvements in diabetes-related biomarkers.Diabetes is a leading cause of morbidity and mortality in the U.S. (1,2). Secondary preventive services for patients with diabetes, such as screening for and addressing glycosylated hemoglobin (HbA 1c ) and lipid levels, limit complications and improve health outcomes (3-5). Uninsured patients have higher average HbA 1c levels than do those with health insurance ( 4) and yet are less likely to receive secondary prevention (6-8). Prior research showed that even when uninsured patients with diabetes visited community health centers (CHCs), "safety net" clinics that provide care regardless of patients' ability

No abstract

Background and Objectives: The optimal length of residency training in family medicine is under debate. This study compared applicant type, number of applicants, match positions filled, matched applicant type, and ranks to fill between 3-year (3YR) and 4-year (4YR) residencies. Methods: The Length of Training Pilot (LOTP) is a case-control study comparing 3YR (seven residencies) and 4YR (six residencies) training models. We collected applicant and match data from LOTP programs from 2012 to 2018 and compared data between 3YR and 4YR programs. National data provided descriptive comparisons. An annual resident survey captured resident perspectives on training program selection. Summary statistics and corresponding t-tests and χ2 tests of independence were performed to assess differences between groups. We used a linear mixed model to account for repeated measures over time within programs. Results: There were no differences in the mean number of US MD, US DO, and international medical graduate applicants between 3YR and 4YR programs. Both the 3YR and 4YR programs had a substantially higher number of US MD and DO applicants compared to national averages. The percentages of positions filled in the match and positions filled by US MDs, DOs and IMGs were not different between groups. The percentage of residents in 4YR programs who think training in family medicine requires a fourth year varied significantly during the study period, from 35% to 25% (P&lt;.001). The predominant reasons for pursuing training in a 4YR program was a desire for more flexibility in training and a desire to learn additional skills beyond clinical skills. Conclusions: The applicant pool and match performance of the residencies in the LOTP was not affected by length of training. Questions yet to be addressed include length of training’s impact on medical knowledge, scope of practice, and clinical preparedness.

No abstract