Boston Medical Center (BMC) has been awarded a four year, $5.7 million grant from the National Heart, Lung and Blood Institute (NHLBI) for investigators from Boston University School of Medicine (BUSM) to create the Center for Health Insurance Reform, Cardiovascular Outcomes and Disparities. The goal of the Center will be to better understand the effects of Massachusetts health reform on cardiovascular (CV) care and outcomes, and in disparities in each. This will be done through two research projects that share a common underlying question: Is expanded insurance coverage in Massachusetts associated with improved CV outcomes?"
In Massachusetts, the primary focus among policy makers has been on maximizing the percentage of the population covered by insurance, rather than whether or how having insurance will affect individuals' use/receipt of care, or on health outcomes related to insurance or use of care.
"The main objective of the Center is to conduct two research projects to evaluate the effects of health reform in Massachusetts, examining whether increased access to health care, through provision of insurance to a majority of state residents, leads to improved CV outcomes, and reduced disparities in them," said Nancy Kressin, PhD, principal investigator of the Center and director of the health care disparities research program in the department of medicine at BUSM. "We will focus on patients especially vulnerable to CV disease and poor access - low-income minority patients," she added.
Researchers at the Center will utilize the "MA Health Disparities Monitoring System" data registry (also funded by NHLBI) for extensive clinical information on patients from BMC, New England's largest urban safety net hospital, which serves a largely poor and impoverished population, including many immigrants and minorities.
In addition, the Center hopes to complement and collaborate with other existing centers in cardiovascular outcomes research as well as developing early stage investigators into seasoned CV outcomes researchers who are well versed in the issues, topics and methods in the field, and who, upon the completion of the center activities, will be poised to make substantial future contributions to the field of CV outcomes research.
The first study will evaluate whether expanded insurance coverage is associated with fewer preventable inpatient admissions for ambulatory care sensitive CV conditions (those thought to be preventable with the receipt of adequate outpatient care) and readmissions for CV conditions. This project also will assess rates of referral-sensitive cardiac procedures, and the use of safety-net hospitals by racial/ethnic minority patients.
In the second study, the researchers will examine care and outcomes of care for blood clots within veins both pre- and post-reform, examining whether expanded coverage (with increased access to primary and home care, and to outpatient pharmacy services), will be associated with better clinical outcomes (e.g. fewer recurrent VTEs, major hemorrhages, and deaths), as well as improved health related quality of life, survival and cost-effectiveness.
According to the researchers, lessons learned about the impact of Massachusetts health reform on access to care and clinical outcomes will have significant application to national health care reform.
Other sites funded to establish these centers include University of Massachusetts-Worcester and Yale.
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