Browsing by Author "Peterson, Pamela N."

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    Is the Affordable Care Act Medicaid Expansion Associated with Receipt of Heart Failure Guideline-Directed Medical Therapy By Race and Ethnicity?
    (Elsevier, 2022) Breathett, Khadijah K.; Xu, Haolin; Sweitzer, Nancy K.; Calhoun, Elizabeth; Matsouaka, Roland A.; Yancy, Clyde W.; Fonarow, Gregg C.; DeVore, Adam D.; Bhatt, Deepak L.; Peterson, Pamela N.; Medicine, School of Medicine
    Background: Uninsurance is a known contributor to racial/ethnic health inequities. Insurance is often needed for prescriptions and follow-up appointments. Therefore, we determined whether the Affordable Care Act(ACA) Medicaid Expansion was associated with increased receipt of guideline-directed medical treatment(GDMT) at discharge among patients hospitalized with heart failure(HF) by race/ethnicity. Methods: Using Get With The Guidelines-HF registry, logistic regression was used to assess odds of receiving GDMT(HF medications; education; follow-up appointment) in early vs non-adopter states before(2012 - 2013) and after ACA Medicaid Expansion(2014 - 2019) within each race/ethnicity, accounting for patient-level covariates and within-hospital clustering. We tested for an interaction(p-int) between GDMT and pre/post Medicaid Expansion time periods. Results: Among 271,606 patients(57.5% early adopter, 42.5% non-adopter), 65.5% were White, 22.8% African American, 8.9% Hispanic, and 2.9% Asian race/ethnicity. Independent of ACA timing, Hispanic patients were more likely to receive all GDMT for residing in early adopter states compared to non-adopter states (P <.0001). In fully-adjusted analyses, ACA Medicaid Expansion was associated with higher odds of receipt of ACEI/ARB/ARNI in Hispanic patients [before ACA:OR 0.40(95%CI:0.13,1.23); after ACA:OR 2.46(1.10,5.51); P-int = .0002], but this occurred in the setting of an immediate decline in prescribing patterns, particularly among non-adopter states, followed by an increase that remained lowest in non-adopter states. The ACA was not associated with receipt of GDMT for other racial/ethnic groups. Conclusions: Among GWTG-HF hospitals, Hispanic patients were more likely to receive all GDMT if they resided in early adopter states rather than non-adopter states, independent of ACA Medicaid Expansion timing. ACA implementation was only associated with higher odds of receipt of ACEI/ARB/ARNI in Hispanic patients. Additional steps are needed for improved GDMT delivery for all.
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    Strategies to Reduce Low-Value Cardiovascular Care: A Scientific Statement From the American Heart Association
    (American Heart Association, 2022) Kini, Vinay; Breathett, Khadijah; Groeneveld, Peter W.; Ho, P. Michael; Nallamothu, Brahmajee K.; Peterson, Pamela N.; Rush, Pam; Wang, Tracy Y.; Zeitler, Emily P.; Borden, William B.; American Heart Association Council on Quality of Care and Outcomes Research; Medicine, School of Medicine
    Low-value health care services that provide little or no benefit to patients are common, potentially harmful, and costly. Nearly half of the patients in the United States will receive at least 1 low-value test or procedure annually, creating risk of avoidable complications from subsequent cascades of care and excess costs to patients and society. Reducing low-value care is of particular importance to cardiovascular health given the high prevalence and costs of cardiovascular disease in the United States. This scientific statement describes the current scope and impact of low-value cardiovascular care; reviews existing literature on patient-, clinician-, health system-, payer-, and policy-level interventions to reduce low-value care; proposes solutions to achieve meaningful and equitable reductions in low-value care; and suggests areas for future research priorities.
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    The Groundwater of Racial and Ethnic Disparities Research. A Statement from Circulation: Cardiovascular Quality & Outcomes
    (American Heart Association, 2021) Breathett, Khadijah; Spatz, Erica S.; Kramer, Daniel B.; Essien, Utibe R.; Wadhera, Rishi K.; Peterson, Pamela N.; Ho, P. Michael; Nallamothu, Brahmajee K.; Medicine, School of Medicine
    The Fish. The Pond. The Groundwater. Imagine that you have a personal pond filled with fish. When viewing your pond, you notice that one fish has died, floating belly-up. You decide that the fish must have been ill and think nothing more of it. The next day, you notice that half of the fish in your pond are now dead. You are alarmed and decide to contact the neighborhood management services to investigate your pond. Something must be wrong with the local system. The following day, however, you discover that all of your neighbors with ponds have noticed the same thing. In fact, half of the fish are dead throughout all waterways in the entire state. At this point, it is clear something deeper must be wrong. This is when you need to analyze the groundwater feeding these ponds. The fish are not at fault, and not even the local systems. Rather the underlying structures through which the fish seek life has failed. Imagine that instead of fish, we are discussing patients. —Paraphrase of Groundwater Approach Metaphor by Love and Hayes-Greene of The Racial Equity Institute.