Medicaid Expansions and Cervical Cancer Screening for Low‐Income Women

Sabik, Lindsay M.; Tarazi, Wafa W.; Hochhalter, Stephanie; Dahman, Bassam

doi:10.1111/1475-6773.12732

Cited by 39 publications

(30 citation statements)

References 27 publications

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“…This is one of the first comprehensive investigations into CRC EBI interventions and corresponding implementation strategies at FQHCs. Additionally, we had representation from health centers across diverse states with varying degrees of urban and rural representation, racial/ethnic composition, and Medicaid expansion which has been linked to better access to cancer screening [46–48]. Finally, the survey was developed based upon an extensive and rigorous literature review to identify all possible constructs and EBIs.…”

Section: Discussionmentioning

confidence: 99%

Use of Evidence-Based Interventions and Implementation Strategies to Increase Colorectal Cancer Screening in Federally Qualified Health Centers

et al. 2018

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While colorectal cancer (CRC) screening rates have been increasing in the general population, rates are considerably lower in Federally Qualified Health Centers (FQHCs), which serve a large proportion of uninsured and medically vulnerable patients. Efforts to screen eligible patients must be accelerated if we are to reach the national screening goal of 80% by 2018 and beyond. To inform this work, we conducted a survey of key informants at FQHCs in eight states to determine which evidence-based interventions (EBIs) to promote CRC screening are currently being used, and which implementation strategies are being employed to ensure that the interventions are executed as intended. One hundred and forty-eight FQHCs were invited to participate in the study, and 56 completed surveys were received for a response rate of 38%. Results demonstrated that provider reminder and recall systems were the most commonly used EBIs (44.6%) while the most commonly used implementation strategy was the identification of barriers (84.0%). The mean number of EBIs that were fully implemented at the centers was 2.4 (range 0-7) out of seven. Almost one-quarter of respondents indicated that their FQHCs were not using any EBIs to increase CRC screening. Full implementation of EBIs was correlated with higher CRC screening rates. These findings identify gaps as well as the preferences and needs of FQHCs in selecting and implementing EBIs for CRC screening.

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Section: Discussionmentioning

confidence: 99%

Use of Evidence-Based Interventions and Implementation Strategies to Increase Colorectal Cancer Screening in Federally Qualified Health Centers

et al. 2018

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“…This methodology has been used widely to study the impact of Medicaid expansion on insurance coverage and other patient characteristics. 5,7 For this study, the non-expansion states served as the control group and the January 2014 expansion states served as the experimental group. For any given variable, we first identified the change between time periods for the nonexpansion states, described in absolute and relative terms.…”

Section: Abbreviations and Acronymsmentioning

confidence: 99%

“…Early reports have suggested that cancer screening and early diagnosis have improved with Medicaid expansion, but some of the findings are inconsistent. [4][5][6][7][8][9][10][11] Colon cancer is a disease that can be particularly affected by access to care, given its high prevalence and effective screening protocols. In addition, nearly one-half of cases occur in patients younger than 65 years and the incidence among younger adults has been increasing in recent years.…”

mentioning

confidence: 99%

Association Between Medicaid Expansion and Diagnosis and Management of Colon Cancer

Hoehn

Rieser

Phelos

et al. 2021

Journal of the American College of Surgeons

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BACKGROUND: The Affordable Care Act facilitated improved insurance coverage for states that expanded Medicaid coverage, but the impact on cancer outcomes is unclear. This study compared changes in the diagnosis and management of colon cancer in states that did and did not participate in Medicaid expansion. STUDY DESIGN: Using a quasi-experimental difference-indifferences (DID) approach, we analyzed Medicaid and uninsured patients in the National Cancer Data Base during 2 time periods: pre (2011-2012) and post expansion (2015-2016). Patients in non-expansion states were compared with those in January 2014 expansion states with regard to changes in patient and facility characteristics, cancer staging, treatment decisions, and surgical outcomes. RESULTS: Along with increased Medicaid coverage (DID ¼ 20.27; p < 0.001), patients in expansion states had an increase in stage I diagnoses (DID ¼ 2.97; p ¼ 0.035), distance traveled (miles, DID ¼ 6.67; p ¼ 0.005), and treatment at integrated network programs (DID ¼ 2.67; p ¼ 0.045). More early-stage patients were treated within 30 days (DID ¼ 7.24; p ¼ 0.035) and more stage IV patients received palliative care (DID ¼ 5.01; p ¼ 0.048). Among surgical patients, Medicaid expansion correlated with fewer urgent cases (< 7 days, DID ¼ e5.88; p ¼ 0.008) and more minimally invasive surgery (DID ¼ 5.00; p ¼ 0.022). There were no observed differences in postoperative outcomes or adjuvant chemotherapy. CONCLUSIONS: Medicaid expansion correlated with earlier diagnosis, enhanced access, and improved surgical care for colon cancer patients. These findings highlight the importance of improving health insurance coverage and can help guide future policy efforts.

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“…Expansions of Medicaid eligibility to women of reproductive age before the ACA were found to increase insurance coverage, use of prenatal care services and cervical cancer screens, and timely initiation of prenatal care among low-income pregnant women (Currie & Gruber, 1996;Dubay, Joyce, Kaestner, & Kenney, 2001;Howell, 2001;Sabik, Tarazi, Hochhalter, Dahman, & Bradley, 2017). A number of recent papers have studied the effects of the ACA Medicaid expansion on low-income individuals, finding that expansions increased coverage through Medicaid programs (Antonisse et al, 2016;Courtemanche et al, 2017;McMorrow et al, 2017;Miller & Wherry, 2017;Simon et al, 2017;Sommers et al, 2015;Wherry & Miller, 2016).…”

Section: Earlier Studiesmentioning

confidence: 99%

Impacts of the Affordable Care Act's Medicaid Expansion on Women of Reproductive Age: Differences by Parental Status and State Policies

Johnston

Strahan

Joski

et al. 2018

Women's Health Issues

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Medicaid Expansions and Cervical Cancer Screening for Low‐Income Women

Cited by 39 publications

References 27 publications

Use of Evidence-Based Interventions and Implementation Strategies to Increase Colorectal Cancer Screening in Federally Qualified Health Centers

Use of Evidence-Based Interventions and Implementation Strategies to Increase Colorectal Cancer Screening in Federally Qualified Health Centers

Association Between Medicaid Expansion and Diagnosis and Management of Colon Cancer

Impacts of the Affordable Care Act's Medicaid Expansion on Women of Reproductive Age: Differences by Parental Status and State Policies

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