The impacts of the 340B Program on health care quality for low-income patients
To assess the effects of hospital 340B eligibility on quality of inpatient care provided to Medicaid and uninsured patients and for all patients. Agency for Health Care Research and Quality's Healthcare Cost and Utilization Project State Inpatient Data, Hospital Cost Reporting Information Syste...
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| Veröffentlicht in: | Health services research 2023-10, Vol.58 (5), p.1089-1097 |
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| creator | Smith, Kyle Padmanabhan, Prianca Chen, Alan Glied, Sherry Desai, Sunita |
| description | To assess the effects of hospital 340B eligibility on quality of inpatient care provided to Medicaid and uninsured patients and for all patients.
Agency for Health Care Research and Quality's Healthcare Cost and Utilization Project State Inpatient Data, Hospital Cost Reporting Information System Data, Office of Pharmacy Affairs Information System Data, and American Hospital Association Annual Survey.
Regression discontinuity design comparing hospitals just above the DSH percentage program eligibility threshold to those just below. Quality measures include all-cause mortality and 30-day readmission rates as well as condition-specific measures.
Inpatient data from general acute care hospitals from 2008 to 2014 in 15 states. Data linked on hospital 340B eligibility and participation.
We did not find discontinuities in inpatient care quality across the Program eligibility threshold for Medicaid and uninsured patients; specifically, on all-cause mortality (beta = -0.04 percentage points, 95% CI: -0.16, 0.08), 30-day readmission rates (beta = -0.16 percentage points, 95% CI: -0.81, 0.5), or other measures. Among insured and non-Medicaid patients, we found discontinuities for acute myocardial infarction (beta = -0.87 percentage points, 95% CI: -1.55, -0.2) and postoperative sepsis (beta = -0.15 percentage points, 95% CI: -0.23, -0.07) mortality.
340B Program participation has not demonstrated improved quality of inpatient care among Medicaid or uninsured patients. |
| doi_str_mv | 10.1111/1475-6773.14204 |
| format | Article |
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Agency for Health Care Research and Quality's Healthcare Cost and Utilization Project State Inpatient Data, Hospital Cost Reporting Information System Data, Office of Pharmacy Affairs Information System Data, and American Hospital Association Annual Survey.
Regression discontinuity design comparing hospitals just above the DSH percentage program eligibility threshold to those just below. Quality measures include all-cause mortality and 30-day readmission rates as well as condition-specific measures.
Inpatient data from general acute care hospitals from 2008 to 2014 in 15 states. Data linked on hospital 340B eligibility and participation.
We did not find discontinuities in inpatient care quality across the Program eligibility threshold for Medicaid and uninsured patients; specifically, on all-cause mortality (beta = -0.04 percentage points, 95% CI: -0.16, 0.08), 30-day readmission rates (beta = -0.16 percentage points, 95% CI: -0.81, 0.5), or other measures. Among insured and non-Medicaid patients, we found discontinuities for acute myocardial infarction (beta = -0.87 percentage points, 95% CI: -1.55, -0.2) and postoperative sepsis (beta = -0.15 percentage points, 95% CI: -0.23, -0.07) mortality.
340B Program participation has not demonstrated improved quality of inpatient care among Medicaid or uninsured patients.</description><identifier>ISSN: 0017-9124</identifier><identifier>ISSN: 1475-6773</identifier><identifier>EISSN: 1475-6773</identifier><identifier>DOI: 10.1111/1475-6773.14204</identifier><identifier>PMID: 37475113</identifier><language>eng</language><publisher>United States: Health Research and Educational Trust</publisher><subject>Acute services ; Care and treatment ; Company business management ; Cost analysis ; Discontinuity ; Drugstores ; Economic aspects ; Eligibility ; Evaluation ; Extraction ; Government programs ; Health aspects ; Health care ; Health care costs ; Health care expenditures ; Health Care Quality ; Hospital costs ; Hospital patients ; Hospitalization ; Hospitals ; Humans ; Indigent care ; Information systems ; Inpatient care ; Management ; Medicaid ; Medical care ; Medical care quality ; Medical care, Cost of ; Medical research ; Medically Uninsured ; Medically uninsured persons ; Mortality ; Myocardial infarction ; Patients ; Pharmacy ; Quality management ; Quality of care ; Quality of Health Care ; Readmission ; Research Brief ; Sepsis ; Uninsured people ; United States</subject><ispartof>Health services research, 2023-10, Vol.58 (5), p.1089-1097</ispartof><rights>2023 Health Research and Educational Trust.</rights><rights>COPYRIGHT 2023 Health Research and Educational Trust</rights><rights>2023 Health Research and Educational Trust</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c621t-d785d624eb8cb533ccfd1ec306aa727a3a28cdb916c82e0710bd577ea98647423</cites><orcidid>0000-0001-5079-8389 ; 0000-0001-9432-1662 ; 0000-0002-7962-5091</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27922,27923,30997</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37475113$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Smith, Kyle</creatorcontrib><creatorcontrib>Padmanabhan, Prianca</creatorcontrib><creatorcontrib>Chen, Alan</creatorcontrib><creatorcontrib>Glied, Sherry</creatorcontrib><creatorcontrib>Desai, Sunita</creatorcontrib><title>The impacts of the 340B Program on health care quality for low-income patients</title><title>Health services research</title><addtitle>Health Serv Res</addtitle><description>To assess the effects of hospital 340B eligibility on quality of inpatient care provided to Medicaid and uninsured patients and for all patients.
Agency for Health Care Research and Quality's Healthcare Cost and Utilization Project State Inpatient Data, Hospital Cost Reporting Information System Data, Office of Pharmacy Affairs Information System Data, and American Hospital Association Annual Survey.
Regression discontinuity design comparing hospitals just above the DSH percentage program eligibility threshold to those just below. Quality measures include all-cause mortality and 30-day readmission rates as well as condition-specific measures.
Inpatient data from general acute care hospitals from 2008 to 2014 in 15 states. Data linked on hospital 340B eligibility and participation.
We did not find discontinuities in inpatient care quality across the Program eligibility threshold for Medicaid and uninsured patients; specifically, on all-cause mortality (beta = -0.04 percentage points, 95% CI: -0.16, 0.08), 30-day readmission rates (beta = -0.16 percentage points, 95% CI: -0.81, 0.5), or other measures. Among insured and non-Medicaid patients, we found discontinuities for acute myocardial infarction (beta = -0.87 percentage points, 95% CI: -1.55, -0.2) and postoperative sepsis (beta = -0.15 percentage points, 95% CI: -0.23, -0.07) mortality.
340B Program participation has not demonstrated improved quality of inpatient care among Medicaid or uninsured patients.</description><subject>Acute services</subject><subject>Care and treatment</subject><subject>Company business management</subject><subject>Cost analysis</subject><subject>Discontinuity</subject><subject>Drugstores</subject><subject>Economic aspects</subject><subject>Eligibility</subject><subject>Evaluation</subject><subject>Extraction</subject><subject>Government programs</subject><subject>Health aspects</subject><subject>Health care</subject><subject>Health care costs</subject><subject>Health care expenditures</subject><subject>Health Care Quality</subject><subject>Hospital costs</subject><subject>Hospital patients</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Indigent care</subject><subject>Information systems</subject><subject>Inpatient care</subject><subject>Management</subject><subject>Medicaid</subject><subject>Medical care</subject><subject>Medical care quality</subject><subject>Medical care, Cost of</subject><subject>Medical research</subject><subject>Medically Uninsured</subject><subject>Medically uninsured persons</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Patients</subject><subject>Pharmacy</subject><subject>Quality management</subject><subject>Quality of care</subject><subject>Quality of Health Care</subject><subject>Readmission</subject><subject>Research Brief</subject><subject>Sepsis</subject><subject>Uninsured people</subject><subject>United States</subject><issn>0017-9124</issn><issn>1475-6773</issn><issn>1475-6773</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>N95</sourceid><sourceid>7QJ</sourceid><recordid>eNp9kl1v0zAUhiMEYmVwzR2KhIRAIp2_GrtXaFQwkCrGxbi2HOck8eTYXewA-_e4tJQGVdiSLdvP-fJ5s-w5RnOcxgVmfFGUnNM5ZgSxB9nscPMwmyGEebHEhJ1lT0K4RQgJKtjj7IzyRGFMZ9mXmw5y02-UjiH3TR7TkTL0Pv86-HZQfe5d3oGyscu1GiC_G5U18T5v_JBb_6MwTvse8o2KBlwMT7NHjbIBnu338-zbxw83q0_F-vrq8-pyXeiS4FjUXCzqkjCohK4WlGrd1Bg0RaVSnHBFFRG6rpa41IIA4hhV9YJzUEtRMs4IPc_e7fxuxqqHWqfYg7JyM5heDffSKyOnL850svXfJUZMpG9AycPrvYfB340QouxN0GCtcuDHIIlgGBEkME_oy3_QWz8OLtWXqBIjRFJRf6lWWZDGNT4F1lun8pKXvCSILkWiihNUCw5Slt5BY9L1hJ-f4NOsoTf6pMGbiUFiIvyMrRpDkOJq_b9k9qz21kILMnVsdT3lXx3xO1kEb8dovAtT8O0RWI3BOAhpCabtYtjlMsEvdrgefAgDNIdGYiS3OpdbVcutquVvnSeLF8f9P_B_hE1_AXNn8bY</recordid><startdate>20231001</startdate><enddate>20231001</enddate><creator>Smith, Kyle</creator><creator>Padmanabhan, Prianca</creator><creator>Chen, Alan</creator><creator>Glied, Sherry</creator><creator>Desai, Sunita</creator><general>Health Research and Educational Trust</general><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>N95</scope><scope>XI7</scope><scope>8GL</scope><scope>7QJ</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5079-8389</orcidid><orcidid>https://orcid.org/0000-0001-9432-1662</orcidid><orcidid>https://orcid.org/0000-0002-7962-5091</orcidid></search><sort><creationdate>20231001</creationdate><title>The impacts of the 340B Program on health care quality for low-income patients</title><author>Smith, Kyle ; Padmanabhan, Prianca ; Chen, Alan ; Glied, Sherry ; Desai, Sunita</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c621t-d785d624eb8cb533ccfd1ec306aa727a3a28cdb916c82e0710bd577ea98647423</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Acute services</topic><topic>Care and treatment</topic><topic>Company business management</topic><topic>Cost analysis</topic><topic>Discontinuity</topic><topic>Drugstores</topic><topic>Economic aspects</topic><topic>Eligibility</topic><topic>Evaluation</topic><topic>Extraction</topic><topic>Government programs</topic><topic>Health aspects</topic><topic>Health care</topic><topic>Health care costs</topic><topic>Health care expenditures</topic><topic>Health Care Quality</topic><topic>Hospital costs</topic><topic>Hospital patients</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Indigent care</topic><topic>Information systems</topic><topic>Inpatient care</topic><topic>Management</topic><topic>Medicaid</topic><topic>Medical care</topic><topic>Medical care quality</topic><topic>Medical care, Cost of</topic><topic>Medical research</topic><topic>Medically Uninsured</topic><topic>Medically uninsured persons</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>Patients</topic><topic>Pharmacy</topic><topic>Quality management</topic><topic>Quality of care</topic><topic>Quality of Health Care</topic><topic>Readmission</topic><topic>Research Brief</topic><topic>Sepsis</topic><topic>Uninsured people</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Smith, Kyle</creatorcontrib><creatorcontrib>Padmanabhan, Prianca</creatorcontrib><creatorcontrib>Chen, Alan</creatorcontrib><creatorcontrib>Glied, Sherry</creatorcontrib><creatorcontrib>Desai, Sunita</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale Business: Insights</collection><collection>Business Insights: Essentials</collection><collection>Gale In Context: High School</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Health services research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Smith, Kyle</au><au>Padmanabhan, Prianca</au><au>Chen, Alan</au><au>Glied, Sherry</au><au>Desai, Sunita</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impacts of the 340B Program on health care quality for low-income patients</atitle><jtitle>Health services research</jtitle><addtitle>Health Serv Res</addtitle><date>2023-10-01</date><risdate>2023</risdate><volume>58</volume><issue>5</issue><spage>1089</spage><epage>1097</epage><pages>1089-1097</pages><issn>0017-9124</issn><issn>1475-6773</issn><eissn>1475-6773</eissn><abstract>To assess the effects of hospital 340B eligibility on quality of inpatient care provided to Medicaid and uninsured patients and for all patients.
Agency for Health Care Research and Quality's Healthcare Cost and Utilization Project State Inpatient Data, Hospital Cost Reporting Information System Data, Office of Pharmacy Affairs Information System Data, and American Hospital Association Annual Survey.
Regression discontinuity design comparing hospitals just above the DSH percentage program eligibility threshold to those just below. Quality measures include all-cause mortality and 30-day readmission rates as well as condition-specific measures.
Inpatient data from general acute care hospitals from 2008 to 2014 in 15 states. Data linked on hospital 340B eligibility and participation.
We did not find discontinuities in inpatient care quality across the Program eligibility threshold for Medicaid and uninsured patients; specifically, on all-cause mortality (beta = -0.04 percentage points, 95% CI: -0.16, 0.08), 30-day readmission rates (beta = -0.16 percentage points, 95% CI: -0.81, 0.5), or other measures. Among insured and non-Medicaid patients, we found discontinuities for acute myocardial infarction (beta = -0.87 percentage points, 95% CI: -1.55, -0.2) and postoperative sepsis (beta = -0.15 percentage points, 95% CI: -0.23, -0.07) mortality.
340B Program participation has not demonstrated improved quality of inpatient care among Medicaid or uninsured patients.</abstract><cop>United States</cop><pub>Health Research and Educational Trust</pub><pmid>37475113</pmid><doi>10.1111/1475-6773.14204</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-5079-8389</orcidid><orcidid>https://orcid.org/0000-0001-9432-1662</orcidid><orcidid>https://orcid.org/0000-0002-7962-5091</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Applied Social Sciences Index & Abstracts (ASSIA); Wiley Online Library All Journals; Alma/SFX Local Collection |
| subjects | Acute services Care and treatment Company business management Cost analysis Discontinuity Drugstores Economic aspects Eligibility Evaluation Extraction Government programs Health aspects Health care Health care costs Health care expenditures Health Care Quality Hospital costs Hospital patients Hospitalization Hospitals Humans Indigent care Information systems Inpatient care Management Medicaid Medical care Medical care quality Medical care, Cost of Medical research Medically Uninsured Medically uninsured persons Mortality Myocardial infarction Patients Pharmacy Quality management Quality of care Quality of Health Care Readmission Research Brief Sepsis Uninsured people United States |
| title | The impacts of the 340B Program on health care quality for low-income patients |
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