Joseph A Ladapo1, Dave A Chokshi. 1. David Geffen School of Medicine at UCLA, 911 Broxton Ave, Los Angeles, CA 90024. E-mail: jladapo@mednet.ucla.edu.
Abstract
OBJECTIVES: Physicians are gatekeepers to preventive care recommended by the US Preventive Services Task Force (USPSTF). We aimed to determine whether the Affordable Care Act (ACA) was associated with changes in physicians' provision of preventive cardiovascular services, focusing primarily on patients with employer-sponsored health plans. STUDY DESIGN: Quasi-experimental, difference-in-differences (DID) approach. METHODS: We analyzed National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data from 2006 to 2013. Using a quasi-experimental DID approach with multivariate logistic models, we compared trends in preventive cardiovascular services delivered during physician visits among target and control populations prior to the ACA's provisions. RESULTS: The ACA was associated with an increase in use of diabetes screening (3.9% in 2006-2010 [third quarter] to 7.6% in 2010 [fourth quarter]-2013; DID, +3.5 per 100 visits; 95% CI, 1.1-5.9), tobacco use screening in adults (64.4% in 2006-2010 to 74.5% in 2010-2013; DID, +11.6 per 100 visits; 95% CI, 4.8-18.3), aspirin therapy in men (11.1% in 2006-2010 to 13.5% in 2010-2013; DID, +2.9 per 100 visits; 95% CI, 1.1-4.6), and hypertension screening (73.2% in 2006-2010 to 76.4% in 2010-2013; DID, +9.9 per 100 visits; 95% CI, 2.8-16.9). CONCLUSIONS: Provision of cardiovascular preventive care increased for some USPSTF-recommended services following enactment of the ACA, with evidence of a sex disparity in aspirin use. Other complementary policy approaches may further enhance uptake of evidence-based clinical preventive services.
OBJECTIVES: Physicians are gatekeepers to preventive care recommended by the US Preventive Services Task Force (USPSTF). We aimed to determine whether the Affordable Care Act (ACA) was associated with changes in physicians' provision of preventive cardiovascular services, focusing primarily on patients with employer-sponsored health plans. STUDY DESIGN: Quasi-experimental, difference-in-differences (DID) approach. METHODS: We analyzed National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data from 2006 to 2013. Using a quasi-experimental DID approach with multivariate logistic models, we compared trends in preventive cardiovascular services delivered during physician visits among target and control populations prior to the ACA's provisions. RESULTS: The ACA was associated with an increase in use of diabetes screening (3.9% in 2006-2010 [third quarter] to 7.6% in 2010 [fourth quarter]-2013; DID, +3.5 per 100 visits; 95% CI, 1.1-5.9), tobacco use screening in adults (64.4% in 2006-2010 to 74.5% in 2010-2013; DID, +11.6 per 100 visits; 95% CI, 4.8-18.3), aspirin therapy in men (11.1% in 2006-2010 to 13.5% in 2010-2013; DID, +2.9 per 100 visits; 95% CI, 1.1-4.6), and hypertension screening (73.2% in 2006-2010 to 76.4% in 2010-2013; DID, +9.9 per 100 visits; 95% CI, 2.8-16.9). CONCLUSIONS: Provision of cardiovascular preventive care increased for some USPSTF-recommended services following enactment of the ACA, with evidence of a sex disparity in aspirin use. Other complementary policy approaches may further enhance uptake of evidence-based clinical preventive services.
Authors: Paul Muntner; Shakia T Hardy; Lawrence J Fine; Byron C Jaeger; Gregory Wozniak; Emily B Levitan; Lisandro D Colantonio Journal: JAMA Date: 2020-09-22 Impact factor: 56.272