Patients Hospitalized for Complications of Cirrhosis may Have Benefited From Medicaid Expansion Under the Affordable Care Act

Autor: Xiao Jing Wang, MD, Bijan Borah, PhD, Ricardo Rojas, BA, Marielle J. Kamath, BS, James Moriarty, MS, Alina M. Allen, MD, Patrick S. Kamath, MD
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 6, Iss 4, Pp 291-301 (2022)
Druh dokumentu: article
ISSN: 2542-4548
DOI: 10.1016/j.mayocpiqo.2022.05.002
Popis: Objective: The benefit of the Affordable Care Act (ACA) for patients with cirrhosis is unclear. We determined the impact of ACA expansion on outcomes in patients hospitalized for complications of cirrhosis. Patients and Methods: We compared hospitalizations; in-hospital outcomes; and readmissions among patients with cirrhosis identified using International Classification of Diseases, Ninth Revision, and International Classification of Diseases, 10th Revision, codes in states that expanded Medicaid under ACA (expanded [E] states) and those that did not (nonexpanded [NE] states). Data from the State Inpatient Databases were obtained for 3 pairs of contiguous E and NE states with both pre-ACA expansion and post-ACA expansion data. The difference-in-difference analysis was performed to compare the pre- and post-ACA data between the E and NE states. The outcomes were admission rates, hospital complications, resource utilization, length of stay, in-hospital mortality, discharge destination, cost of initial hospitalization, and readmission characteristics. Results: There were 228,349 admissions (E states, 149,705; NE states, 78,644). After ACA implementation, the E states had lower rates of admission increase per 100,000 population (22.9 in E states vs 25.5 in NE states, P=.005), sepsis (relative risk, 0.884; P=.0084), and hepatic coma (relative risk, 0.763; P
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