Community Health Center Visit Rates Before and After Affordable Care Act in Expansion and Nonexpansion States, Accelerating Data Value Across a National Community Health Center Network Clinical Data Research Network from 2012 to 2015
| Patient Information | Model Excluding State-Level Factors* | Model Adjusting for State-Level Factors Excluding DM Prevalence† | Model Adjusting for State-Level Factors and State DM Prevalence‡ | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Nonexpansion Visit Rate | Expansion Visit Rate | Nonexpansion Visit Rate | Expansion Visit Rate | Nonexpansion Visit Rate | Expansion Visit Rate | |||||||
| Pre | Post | Pre | Post | Pre | Post | Pre | Post | Pre | Post | Pre | Post | |
| Uninsured | ||||||||||||
| DM | 50.1 | 42.6 | 62.9 | 27.8 | 43.2 | 36.7 | 63.1 | 27.8 | 46.6 | 39.6 | 61.9 | 27.3 |
| Pre-DM | 44.8 | 38.4 | 45.4 | 21.8 | 39.8 | 34.1 | 50.1 | 24.1 | 42.8 | 36.7 | 48.6 | 23.3 |
| No DM | 36.5 | 29.8 | 40.1 | 18.8 | 27.6 | 22.5 | 37.2 | 17.4 | 29.4 | 23.9 | 35.7 | 16.7 |
| Medicaid | ||||||||||||
| DM | 32.9 | 32.7 | 67.8 | 106.3 | 35.8 | 35.5 | 62.7 | 98.4 | 37.0 | 36.7 | 62.8 | 98.5 |
| Pre-DM | 25.2 | 27.0 | 53.6 | 91.4 | 27.9 | 29.9 | 48.9 | 83.5 | 28.6 | 30.7 | 48.5 | 82.7 |
| No DM | 19.1 | 19.1 | 40.0 | 63.9 | 20.6 | 20.5 | 36.5 | 58.3 | 20.8 | 20.7 | 35.9 | 57.3 |
| Privately insured | ||||||||||||
| DM | 9.4 | 26.0 | 27.8 | 30.7 | 16.0 | 44.2 | 19.2 | 21.2 | 16.6 | 46.0 | 19.2 | 21.2 |
| Pre-DM | 10.4 | 33.1 | 30.8 | 34.0 | 18.0 | 57.0 | 20.2 | 22.3 | 18.6 | 58.9 | 19.9 | 22.0 |
| No DM | 6.0 | 16.1 | 19.5 | 20.6 | 12.0 | 32.3 | 14.5 | 15.4 | 12.1 | 32.8 | 14.1 | 15.0 |
| Other public | ||||||||||||
| DM | 27.5 | 21.7 | 32.1 | 34.8 | 47.7 | 37.7 | 21.6 | 23.4 | 49.2 | 38.8 | 21.4 | 23.2 |
| Pre-DM | 26.3 | 22.1 | 23.5 | 24.4 | 48.3 | 40.5 | 15.8 | 16.4 | 49.7 | 41.6 | 15.6 | 16.2 |
| No DM | 15.0 | 11.0 | 8.0 | 7.2 | 29.6 | 21.7 | 6.1 | 5.5 | 30.4 | 22.2 | 6.0 | 5.4 |
| Total visit | ||||||||||||
| DM | 139.1 | 139.1 | 210.0 | 219.5 | 169.9 | 169.9 | 177.8 | 185.8 | 180.6 | 180.7 | 176.7 | 184.7 |
| Pre-DM | 116.8 | 128.0 | 160.5 | 184.1 | 148.8 | 163.0 | 140.2 | 160.9 | 157.0 | 171.9 | 137.3 | 157.6 |
| No DM | 74.9 | 73.4 | 99.4 | 102.3 | 99.1 | 97.2 | 90.9 | 93.6 | 102.6 | 100.6 | 87.7 | 90.3 |
| Primary care | ||||||||||||
| DM | 109.1 | 107.3 | 162.9 | 167.7 | 132.9 | 130.7 | 140.7 | 144.9 | 140.3 | 138.0 | 140.3 | 144.5 |
| Pre-DM | 96.4 | 103.8 | 134.5 | 152.7 | 120.9 | 130.2 | 118.0 | 134.1 | 126.6 | 136.4 | 116.0 | 131.7 |
| No DM | 70.4 | 67.8 | 94.8 | 96.3 | 90.8 | 87.4 | 86.2 | 87.7 | 93.5 | 90.0 | 83.5 | 84.9 |
| Preventive care | ||||||||||||
| DM | 4.7 | 5.9 | 4.1 | 4.7 | 6.6 | 8.3 | 2.9 | 3.2 | 7.1 | 8.9 | 2.9 | 3.2 |
| Pre-DM | 6.6 | 8.9 | 6.0 | 7.8 | 10.2 | 13.8 | 4.5 | 5.9 | 10.8 | 14.7 | 4.4 | 5.7 |
| No DM | 5.6 | 6.7 | 4.8 | 5.3 | 9.9 | 11.9 | 4.3 | 4.7 | 10.4 | 12.5 | 4.1 | 4.5 |
| Glucose testing | ||||||||||||
| DM | 71.6 | 87.0 | 71.5 | 81.8 | 65.4 | 79.5 | 78.2 | 89.5 | 64.0 | 77.8 | 78.6 | 89.8 |
| Pre-DM | 38.3 | 47.5 | 33.2 | 40.9 | 33.9 | 42.0 | 35.3 | 43.6 | 33.2 | 41.2 | 35.6 | 43.9 |
| No DM | 20.9 | 25.2 | 18.2 | 23.5 | 18.5 | 22.3 | 19.3 | 24.8 | 18.2 | 21.9 | 19.5 | 25.1 |
| HbA1c screening | ||||||||||||
| DM | 58.8 | 85.7 | 68.5 | 86.4 | 53.8 | 78.4 | 70.9 | 89.5 | 57.3 | 83.5 | 70.3 | 88.7 |
| Pre-DM | 15.7 | 27.6 | 9.9 | 19.8 | 14.4 | 25.3 | 10.4 | 20.7 | 15.2 | 26.7 | 10.1 | 20.2 |
| No DM | 3.4 | 5.9 | 2.2 | 5.0 | 3.2 | 5.5 | 2.3 | 5.2 | 3.3 | 5.7 | 2.2 | 5.1 |
ACA, Affordable Care Act; DM, diabetes mellitus; pre, pre-ACA; post, post-ACA.
↵* Adjusted for clinic-level distributions of sex, age, race/ethnicity, and federal poverty level, urban vs. rural clinic location.
↵† Adjusted for clinic-level distributions of sex, age, race/ethnicity, and federal poverty level, urban vs. rural clinic location, and state-level factors (type of health insurance marketplace [state-run or federally facilitated], 2013 minimum wage, 2013 uninsured rate, and 2013 unemployment rate).
↵‡ Adjusted for clinic-level distributions of sex, age, race/ethnicity, and federal poverty level, urban vs. rural clinic location, and state-level factors (type of health insurance marketplace [state-run or federally facilitated], 2013 minimum wage, 2013 uninsured rate, and 2013 unemployment rate), state-level 2013 CHCs DM prevalence (source, HRSA, Health Center Data & Reporting, https://bphc.hrsa.gov/datareporting/index.html).