Abstract:
Background:Little is known about whether insurance expansion affects the location and type of emergency department (ED) use. Understanding these changes can inform state-level decisions about the Medicaid expansion under the Patient Protection and Affordable Care Act (ACA). Objective:To investigate the effect of the 2014 ACA Medicaid expansion on the location, insurance status, and type of ED visits. Design:Quasi-experimental observational study from 2012 to 2014. Setting:126 investor-owned, hospital-based EDs. Participants:Uninsured and Medicaid-insured adults aged 18 to 64 years. Intervention:ACA expansion of Medicaid in January 2014. Measurements:Number of ED visits overall, type of visit (for example, nondiscretionary or nonemergency), and average travel time to the ED. Interrupted time-series analyses comparing changes from the end of 2013 to end of 2014 for patients from Medicaid expansion versus nonexpansion states were done. Results:There were 1.06 million ED visits among patients from 17 Medicaid expansion states, and 7.87 million ED visits among patients from 19 nonexpansion states. The EDs treating patients from Medicaid expansion states saw an overall 47.1% decrease in uninsured visits (95% CI, -65.0% to -29.3%) and a 125.7% (CI, 89.2% to 162.6%) increase in Medicaid visits after 12 months of ACA expansion. Average travel time for nondiscretionary conditions requiring immediate medical care decreased by 0.9 minutes (-6.2% [CI, -8.9% to -3.5%]) among all Medicaid patients from expansion states. We found little evidence of similar changes among patients from nonexpansion states. Limitation:Results reflect shifts in ED care at investor-owned facilities, which limits generalizability to other hospital types. Conclusion:Meaningful changes in insurance status and location and type of ED visits in the first year of ACA Medicaid expansion were found, suggesting that expansion provides patients with a greater choice of hospital facilities. Primary Funding Source:Robert Wood Johnson Foundation.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Garthwaite C,Gross T,Notowidigdo M,Graves JAdoi
10.7326/M16-0086subject
Has Abstractpub_date
2017-02-07 00:00:00pages
172-179issue
3eissn
0003-4819issn
1539-3704pii
2593599journal_volume
166pub_type
杂志文章,多中心研究abstract::A 17-year-old girl with a clinical diagnosis of adult-type juvenile rheumatoid arthritis developed a severe hepatotoxic reaction to 3.6 g of aspirin per day. This was associated with a microangiopathic anemia and transient congestive cardiac failure. She responded well to steroids, and when all laboratory test finding...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-86-2-183
更新日期:1977-02-01 00:00:00
abstract::Evidence on the safety and efficacy of methotrexate as a second- or third-line agent for treating patients with rheumatoid arthritis is reviewed. Four placebo-controlled clinical trials have documented short-term benefit from methotrexate; although true remission is rare, patients receiving methotrexate showed a 26% (...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,评审
doi:10.7326/0003-4819-107-2-358
更新日期:1987-09-01 00:00:00
abstract::A case of a patient with metastatic cancer raises the issues of patient refusal of treatment, euthanasia, and unintended side effects of therapy. For each management dilemma, there are relevant ethical and legal considerations, justifications, and conclusions. In addition, psychological and social influences on the de...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:
更新日期:1980-01-01 00:00:00
abstract::For an estimated 10 million trips abroad by U.S. residents in 2002, "visiting friends and relatives" (VFR) was a purpose for travel. Made up largely of foreign-born U.S. residents and their children, this population shows disparities in the number of reported cases of many preventable travel-related illnesses compared...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-142-1-200501040-00013
更新日期:2005-01-04 00:00:00
abstract::Treatment advances and outcomes data have raised new concerns about how to optimize care for patients with HIV infection. This paper reviews evidence on 1) the relation between experience and type of training and patient outcomes, 2) the relation between the components of primary care and patient outcomes, and 3) prim...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-131-2-199907200-00011
更新日期:1999-07-20 00:00:00
abstract::The diagnosis of gout depends on showing urate crystals in synovial effusions or, with less certainty, recognizing a characteristic clinical presentation. The management of gout has four phases: control of inflammation, diagnostic evaluation, education of the patient, and treatment for the hyperuricemia. Sound logical...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-90-5-812
更新日期:1979-05-01 00:00:00
abstract:BACKGROUND:In previous open-label noncomparative clinical trials, both fluconazole and itraconazole were effective therapy for progressive forms of coccidioidomycosis. OBJECTIVE:To determine whether fluconazole or itraconazole is superior for treatment of nonmeningeal progressive coccidioidal infections. DESIGN:Rando...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-133-9-200011070-00009
更新日期:2000-11-07 00:00:00
abstract:BACKGROUND:Questions remain about the importance of smoking and smoking cessation after incident myocardial infarction. OBJECTIVE:To assess the association between smoking status and risk for recurrent coronary events. DESIGN:Retrospective, population-based, inception cohort study. SETTING:Health maintenance organiz...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-137-6-200209170-00009
更新日期:2002-09-17 00:00:00
abstract::The hospital-based generalist physician is a recent organizational innovation in health care in the United States. Does the hospitalist model provide improved health care? The answer to this question lies in a rigorous evaluation of the hospitalist system in the clinical setting. This paper describes key outcomes that...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-130-4-199902161-00010
更新日期:1999-02-16 00:00:00
abstract:BACKGROUND:Medical students may be at high risk for occupational exposures to blood. OBJECTIVE:To measure the frequency of medical students' exposure to infectious body substances, to identify factors that affect the probability of such exposure, and to suggest targets for the prevention of such exposure. DESIGN:Revi...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-130-1-199901050-00009
更新日期:1999-01-05 00:00:00
abstract::In addition to gonorrhea and syphilis, both of which may develop primarily at anorectal or pharyngeal sites, a number of conditions, including Neisseria meningitidis urethritis, nonspecific urethritis, anorectal herpes, condyloma acuminatum, amebiasis, giardiasis, shigellosis, typhoid fever, enterobiasis, and hepatiti...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-92-6-805
更新日期:1980-06-01 00:00:00
abstract::Past efforts to reverse or limit the effects of acute stroke have been largely unsuccessful, in part because of the inability to evaluate and treat most patients soon after stroke onset. One important factor in the delay of treatment has been the nihilistic attitude of medical personnel, including physicians, toward t...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:
更新日期:1995-04-15 00:00:00
abstract::Hearing loss is highly prevalent and may significantly affect how we age. Although the population is aging, relatively few adults receive treatment for hearing loss. Internists are a critical partner to audiologists and otolaryngologists in caring for the adult population with hearing loss. This review provides a prim...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/AITC202012010
更新日期:2020-12-01 00:00:00
abstract::The irritable bowel syndrome is a common chronic disorder having a broad clinical spectrum of severity. Although only a small proportion of those afflicted seek medical help for their symptoms, a subset have severe and intractable symptoms. A positive diagnosis should be established from the history and physical exami...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-116-12-1009
更新日期:1992-06-15 00:00:00
abstract:OBJECTIVE:To define the incidence of and possible risk factors for invasive Haemophilus influenzae disease in adults. DESIGN:Prospective, population-based surveillance of hospital and referral bacteriology laboratories. SETTING:Metropolitan Atlanta, Georgia community. PATIENTS:All patients with H. influenzae isolate...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-116-10-806
更新日期:1992-05-15 00:00:00
abstract::We performed immunohistopathologic studies on biopsied lung tissue obtained from two patients with lupus pneumonitis using immunofluorescence, immunoperoxidase, electron microscopy, and acid-microelution. In both patients, immunofluorescence showed granular deposits of IgG, the third component of complement (C3), and ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-91-1-30
更新日期:1979-07-01 00:00:00
abstract::Bacteremia caused by rapidly growing mycobacteria are usually due to Mycobacterium fortuitum or M. chelonei. Other rapidly growing mycobacteria generally are considered to be nonpathogenic. We report the case of a patient with bacteremia due to an unidentified, rapidly growing, scotochromogenic mycobacteria that was d...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-99-4-475
更新日期:1983-10-01 00:00:00
abstract:BACKGROUND:Exercise therapy encompasses a heterogeneous group of interventions. There continues to be uncertainty about the most effective exercise approach in chronic low back pain. PURPOSE:To identify particular exercise intervention characteristics that decrease pain and improve function in adults with nonspecific ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-142-9-200505030-00014
更新日期:2005-05-03 00:00:00
abstract:OBJECTIVE:To determine the causes of persistent dizziness in outpatients. DESIGN:Consecutive adult outpatients presenting with a chief complaint of dizziness. SETTING:Four clinics (internal medicine, walk-in, emergency room, and neurology) in a teaching hospital. PATIENTS:Of 185 patients presenting during the 10-mon...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-117-11-898
更新日期:1992-12-01 00:00:00
abstract:BACKGROUND:Hypertension often persists after adrenalectomy for primary aldosteronism. OBJECTIVE:To determine factors associated with resolution of hypertension after adrenalectomy for primary aldosteronism. DESIGN:Retrospective cohort study. SETTING:Tertiary care referral center in Rochester, Minnesota. PATIENTS:Al...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-135-4-200108210-00010
更新日期:2001-08-21 00:00:00
abstract:BACKGROUND:Screening for hereditary hemochromatosis is traditionally done by using serum iron studies. However, mutation analysis of the hemochromatosis-associated HFE gene has recently become available. OBJECTIVE:To compare the cost-effectiveness of no screening with four screening strategies that incorporate HFE gen...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-132-4-200002150-00003
更新日期:2000-02-15 00:00:00
abstract:OBJECTIVE:To compare trimethoprim-sulfamethoxazole (TMP-SMZ) and vancomycin regarding efficacy and safety in the therapy of serious Staphylococcus aureus infections. DESIGN:Randomized, double-blind comparative trial. SETTING:A tertiary-care hospital. PATIENTS:One hundred and one intravenous drug users hospitalized w...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-117-5-390
更新日期:1992-09-01 00:00:00
abstract:PURPOSE:To review clinical scenarios in which nonelectrophysiologist physicians may interact with patients who have implantable defibrillators. DATA SOURCES:Peer-reviewed original articles and reviews addressing aspects of implantable defibrillator therapy that are relevant to the clinician. DATA SYNTHESIS:The capaci...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-122-10-199505150-00007
更新日期:1995-05-15 00:00:00
abstract::Sixty-eight patients clinically suspected of having (33), or at high risk for (35), deep venous thrombosis were studied with contrast venography, radiofibrinogen leg scanning, and impedance plethysmography as well as ventilation and perfusion lung scans. Thrombosis limited to the veins in the calf of the leg (unilater...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-94-4-439
更新日期:1981-04-01 00:00:00
abstract::Experimental findings in animals and epidemiologic studies in humans provide strong evidence that hypertension promotes the onset and progression of atherosclerosis. However, effective antihypertensive therapy has not consistently reduced the incidence of cardiac events in the major trials of treatment for mild hypert...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,评审
doi:10.7326/0003-4819-110-12-1017
更新日期:1989-06-15 00:00:00
abstract::The Hospital Readmissions Reduction Program (HRRP) has penalized hospitals with higher 30-day readmission rates more than $3 billion to date. Clinicians and policy experts have raised concerns that the 30-day readmission measure used in this program provides an incomplete picture of performance because it does not cap...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M20-3486
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:Some physicians seem to be willing to sanction deception of insurance companies. Little is known about public attitudes regarding this practice. OBJECTIVE:To assess public attitudes regarding physician deception of insurance companies. DESIGN:Cross-sectional survey using clinical vignettes. SETTING:Philad...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-138-6-200303180-00011
更新日期:2003-03-18 00:00:00
abstract:BACKGROUND:Current magnetic resonance techniques generate high signal from venous blood and show thrombi as filling defects. Magnetic resonance direct thrombus imaging (MRDTI) directly visualizes acute thrombus. OBJECTIVE:To determine the accuracy of MRDTI for diagnosis of acute symptomatic deep venous thrombosis (DVT...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/0003-4819-136-2-200201150-00006
更新日期:2002-01-15 00:00:00
abstract:BACKGROUND:Although viral rebound follows cessation of suppressive antiretroviral therapy in chronic HIV infection, a viremic clinical syndrome has not been described. OBJECTIVE:To describe a retroviral syndrome associated with cessation of effective antiretroviral therapy in chronic HIV infection. DESIGN:Case report...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-133-6-200009190-00010
更新日期:2000-09-19 00:00:00
abstract::A recent, widely publicized meta-analysis of 42 clinical trials concluded that rosiglitazone was associated with an approximately 43% increased risk for myocardial infarction and an approximately 64% increased risk for cardiovascular death. The sensitivity of these conclusions to several methodological choices was not...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-147-8-200710160-00182
更新日期:2007-10-16 00:00:00