背景:2019年,纽约市(NYC)推出了NYCCare(NYCC),通过NYCHealth+Hospitals(H+H)为没有资格获得联邦资助的健康保险计划或无法通过StateMarketplace购买保险的个人提供医疗服务计划,主要是没有证件的人。
目的:为了检查社会人口统计学特征,医疗保健使用模式,与在NYCHH观察到的Medicaid患者相比,NYCC患者中糖尿病(DM)和高血压的慢性疾病质量测量。
方法:观察性研究。
方法:截至2022年1月1日,18岁及以上的成年人参加了NYCC(N=83,003)或Medicaid(N=512,012)。如果患者在2021年1月1日至2021年12月31日之间至少有一次访问,则包括在内。
方法:社会人口统计学特征,医疗保健使用模式,以及DM和高血压的质量测量。
结果:NYCC患者(n=83,003)为,平均而言,年长的,更有可能是西班牙裔,西班牙语是他们的首选语言,有更多的合并症,与Medicaid患者(n=512,012)相比,初级保健(调整后的发病率比2.75[95%置信区间2.71,2.80])和专科护理(2.22[2.17,2.26])就诊次数更多.两组急诊就诊率相似(1.02[1.00,1.04]),但NYCC患者的住院治疗相对较少(0.64[0.62,0.67]).患有DM或高血压的NYCC患者在2022年分别有更高的血红蛋白A1c或血压记录,和临床上相似的慢性疾病控制率(糖尿病患者血红蛋白A1c的平均差异-0.05[-0.09,-0.01]和血压的平均差异-0.38[-0.67,-0.10]/-0.64[-0.82,-0.46])与Medicaid患者相比。
结论:NYCC有效地招募了大量未参保的参与者,并为他们提供了类似于医疗补助患者的医疗保健服务。未来的研究应该评估NYCC注册对医疗保健利用和疾病结果的影响。
BACKGROUND: In 2019, New York City (NYC) launched NYC Care (NYCC), a healthcare access program through NYC Health + Hospitals (H + H) for individuals who are ineligible for federally funded health insurance programs or cannot purchase insurance through the State Marketplace, predominantly undocumented individuals.
OBJECTIVE: To examine the sociodemographic characteristics, healthcare use patterns, and chronic disease quality measures for diabetes mellitus (DM) and hypertension among NYCC patients compared with Medicaid patients seen at NYC H + H.
METHODS: Observational study.
METHODS: Adults aged 18 years and older enrolled in NYCC (N = 83,003) or Medicaid (N = 512,012) as of January 1, 2022. Patients were included if they had at least one visit between January 1, 2021, and December 31, 2021.
METHODS: Sociodemographic characteristics, healthcare use patterns, and quality measures for DM and hypertension.
RESULTS: NYCC patients (n = 83,003) were, on average, older, more likely to be Hispanic with Spanish as their preferred language, had more comorbidities, and had more primary care (adjusted incidence rate ratio 2.75 [95% confidence interval 2.71, 2.80]) and specialty care (2.22 [2.17, 2.26]) visits compared to Medicaid patients (n = 512,012). Rates of emergency department visits were similar between the two groups (1.02 [1.00, 1.04]), but NYCC patients had relatively fewer hospitalizations (0.64 [0.62, 0.67]). NYCC patients with DM or hypertension had higher rates of having a documented hemoglobin A1c or blood pressure in 2022, respectively, and clinically similar rates of chronic disease control (mean difference in hemoglobin A1c - 0.05 [- 0.09, - 0.01] in patients with DM and mean difference in blood pressure - 0.38 [- 0.67, - 0.10]/ - 0.64 [- 0.82, - 0.46]) compared with Medicaid patients.
CONCLUSIONS: NYCC effectively enrolled a large number of uninsured participants and provided them with healthcare access similar to that of Medicaid patients. Future studies should evaluate the impact of NYCC enrollment on healthcare utilization and disease outcomes.