Table 2.
Unadjusted and adjusted visit rates pre- versus post-Affordable Care Act in expansion versus non-expansion states stratified by diabetes status, ADVANCE CDRN 2012–2015
| Unadjusted | Covariate Adjusted | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Non-expansion | Expansion | Non-expansion | Absolute rate difference | Expansion | Absolute rate difference | |||||
| Visit Rate | Visit Rate | Visit Rate | Visit Rate | |||||||
| Pre | Post | Pre | Post | Pre | Post | Pre | Post | |||
| Uninsured | ||||||||||
| Diabetes | 61.2 | 52.0 | 75.3 | 33.2 | 43.2 | 36.7 | −6.5 | 63.1 | 27.8 | −35.3 |
| Pre-diabetes | 52.6 | 45.1 | 52.4 | 25.2 | 39.8 | 34.1 | −5.7 | 50.1 | 24.1 | −26.0 |
| No Diabetes | 30.2 | 24.6 | 31.4 | 14.7 | 27.6 | 22.5 | −5.1 | 37.2 | 17.4 | −19.8 |
| Medicaid | ||||||||||
| Diabetes | 37.4 | 37.1 | 80.0 | 125.6 | 35.8 | 35.5 | −0.3 | 62.7 | 98.4 | 35.7 |
| Pre-diabetes | 29.4 | 31.4 | 70.4 | 120.0 | 27.9 | 29.9 | 2.0 | 48.9 | 83.5 | 34.6 |
| No Diabetes | 15.0 | 15.0 | 31.7 | 50.6 | 20.6 | 20.5 | −0.1 | 36.5 | 58.3 | 21.8 |
| Privately-insured | ||||||||||
| Diabetes | 9.7 | 26.9 | 34.0 | 37.5 | 16.0 | 44.2 | 28.2 | 19.2 | 21.2 | 2.0 |
| Pre-diabetes | 9.9 | 31.5 | 31.3 | 34.5 | 18.0 | 57.0 | 39.0 | 20.2 | 22.3 | 2.1 |
| No Diabetes | 4.7 | 12.6 | 18.4 | 19.5 | 12.0 | 32.3 | 20.3 | 14.5 | 15.4 | 0.9 |
| Other Public | ||||||||||
| Diabetes | 36.4 | 28.8 | 39.9 | 43.2 | 47.7 | 37.7 | −10.0 | 21.6 | 23.4 | 1.8 |
| Pre-diabetes | 28.7 | 24.1 | 26.9 | 28.0 | 48.3 | 40.5 | −7.8 | 15.8 | 16.4 | 0.6 |
| No Diabetes | 13.2 | 9.7 | 7.8 | 7.0 | 29.6 | 21.7 | −7.9 | 6.1 | 5.5 | −0.6 |
| Total Visits | ||||||||||
| Diabetes | 144.8 | 144.8 | 229.2 | 239.5 | 169.9 | 169.9 | 0.0 | 177.8 | 185.8 | 8.0 |
| Pre-diabetes | 120.6 | 132.1 | 181.0 | 207.7 | 148.8 | 163.0 | 14.2 | 140.2 | 160.9 | 20.7 |
| No Diabetes | 63.1 | 61.9 | 89.3 | 91.9 | 99.1 | 97.2 | −1.9 | 90.9 | 93.6 | 2.7 |
| Primary Care Visits | ||||||||||
| Diabetes | 122.6 | 120.6 | 190.1 | 195.8 | 132.9 | 130.7 | −2.2 | 140.7 | 144.9 | 4.2 |
| Pre-diabetes | 103.6 | 111.6 | 152.8 | 173.6 | 120.9 | 130.2 | 9.3 | 118.0 | 134.1 | 16.1 |
| No Diabetes | 54.8 | 52.7 | 75.4 | 76.6 | 90.8 | 87.4 | −3.4 | 86.2 | 87.7 | 1.5 |
| Preventive Care Visits | ||||||||||
| Diabetes | 4.7 | 5.9 | 4.1 | 4.6 | 6.6 | 8.3 | 1.7 | 2.9 | 3.2 | 0.3 |
| Pre-diabetes | 7.0 | 9.4 | 5.2 | 6.8 | 10.2 | 13.8 | 3.6 | 4.5 | 5.9 | 1.4 |
| No Diabetes | 5.8 | 7.0 | 4.6 | 5.1 | 9.9 | 11.9 | 2.0 | 4.3 | 4.7 | 0.4 |
| Glucose Testing | ||||||||||
| Diabetes | 67.4 | 81.9 | 76.6 | 87.6 | 65.4 | 79.5 | 14.1 | 78.2 | 89.5 | 11.3 |
| Pre-diabetes | 36.3 | 45.0 | 35.8 | 44.2 | 33.9 | 42.0 | 8.1 | 35.3 | 43.6 | 8.3 |
| No Diabetes | 12.2 | 14.7 | 11.1 | 14.3 | 18.5 | 22.3 | 3.8 | 19.3 | 24.8 | 5.5 |
| HbA1c Screening | ||||||||||
| Diabetes | 52.3 | 76.3 | 65.5 | 82.7 | 53.8 | 78.4 | 24.6 | 70.9 | 89.5 | 18.6 |
| Pre-diabetes | 16.0 | 28.0 | 10.2 | 20.3 | 14.4 | 25.3 | 10.9 | 10.4 | 20.7 | 10.3 |
| No Diabetes | 2.6 | 4.3 | 1.3 | 3.0 | 3.2 | 5.5 | 2.3 | 2.3 | 5.2 | 2.9 |
ADVANCE CDRN: Accelerating Data Value Across a National Community Health Center Network clinical data research network. Non-expansion states: FL, KS, MO, NC. Expansion states: CA, HI, MD, NM, OH, OR, RI, WA, WI. Visit rates were by dividing the number of visits in a given interval (i.e., pre- or post-ACA period) by the total number of adult patients seen in a clinic over the study period, scaled to 1,000 patients per month. Total visits: CPT 99201–99205, 99212–99215, 99241–99245, 99381–99384, 99385–99387, or 99391–99397 with MD, DO, NP, PA, midwife, or resident with no specialty listed. Generalized estimating equation Poisson models adjusted for clinic-level demographic distributions (sex, age, federal poverty level, primary language, race, and ethnicity), state-level factors (marketplace type, 2013 minimum wage and unemployment rates, and 2013 uninsured rate), and 2013 state-level CHCs diabetes prevalence (https://bphc.hrsa.gov/datareporting/index.html) clustered by facility to account for within-facility correlation.