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Contraceptive services in the safety net: Interdisciplinary innovations in using EHR data to study the impact of the ACA

Blair Darney, Oregon Health & Science University

Project abstract

This proposal builds on the results of our successful Interdisciplinary Innovation planning grant and proposes a rigorous research protocol to evaluate the impact of Medicaid expansion under the Affordable Care Act (ACA) on contraceptive service provision in safety net clinics in the US. There is a paucity of national patient-level clinical data on family planning service provision in safety net primary care settings. Our Specific Aims are: 1) Describe contraceptive visits in safety net clinics pre and post ACA expansion; 2) Identify clinic, and state - level correlates of contraceptive provision; 3) Compare payer for contraceptive visits by expansion status. We include 17 states (9 Medicaid expansion states and 8 non-expansion states) and over 3.5 million face-to-face visits in the pre (2010-2013) and post (2014-2015) expansion periods to evaluate the impact of Medicaid expansion on contraceptive provision in safety net primary care clinics. Our primary analytic approach will utilize difference-in-differences (DID) methodology. This proposal directly addresses several of SFP's top research priorities: (4) Integrating family planning services into primary care; (16) Assessing the impact of the ACA on access to care, utilization, and outcomes; and (18) Assessing the impact of insurance practices on FP access. Investment in this interdisciplinary team will result in peer-reviewed publications, presentations at national conferences, dissemination to state health policy audiences, federal grant proposals, and add to an ongoing body of work on the impact of Medicaid expansion, ensuring that contraception is at the center of ACA evaluation efforts.

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