Patient navigation programs have demonstrated intervention efficacy associated with barrier reduction and health outcome improvements in the context of cancer care. Greater characterization of barriers and barrier resolution likelihoods may support program optimization. A 3-month longitudinal, non-comparative community-focused (i.e., lay navigator) patient navigation program was implemented at an NCI-designed cancer center between 2018 and 2021. Barriers to cancer care were reported by patients (n = 207) at pre-intervention and re-assessed at post-intervention. Descriptive analyses examined patient-level associations among pre-intervention barriers and post-intervention rates of barrier resolution. Logistic regressions were conducted at the barrier level and patient level to estimate the likelihood of barrier resolution associated with Health Access, Financial, and Psychosocial barrier domains. Participants reported an average of 3.54 distinct barriers to cancer care. Barriers associated with Health Access and Financial domains were most frequently endorsed. Post-navigation, barriers were found to differ in their resolution rates. At the barrier domain level, resolution rates differed significantly (X2(2) = 7.826, p = 0.02), with Financial barriers significantly less likely (OR = 0.61; 95

Background: Obesity is a well-established risk factor of renal cell carcinoma (RCC), however the impact of obesity on surgical outcomes for racial and ethnic minority patients with RCC is unclear. This study investigated whether a higher body mass index (BMI) or obesity (BMI >= 30 kg/m(2)) was associated with worse perioperative outcomes and if there were heterogeneous effects based on race, ethnicity, and neighborhood-level socioeconomic factor. Methods: In this single-center cross-sectional study, medical records of patients who underwent partial or radical nephrectomy between 2010 and 2022 were retrospectively reviewed. Logistic regression analysis was performed to assess associations of BMI and perioperative outcomes [ischemia time, estimated blood loss (EBL), and length of hospital stay]. Results: A total of 432 patients, including 49.8% non-Hispanic White (NHW), 35.0% Hispanic, and 6.9% American Indian (AI) patients, were included. Median [interquartile range (IQR)] BMI was 30.2 (26.3-35.2) kg/m(2), and Hispanic (31.5) and AI (32.5) patients had higher median BMI than NHW (29.1) patients (P=0.006). Median ischemia time, EBL, and length of hospital stay were 18.5 (IQR, 15.0-22.4) minutes, 150 (IQR, 75.0-300.0) mL, and 3 (IQR, 2-5) days. BMI >= 35 kg/m(2) was associated with a longer ischemia time [>18.5 minutes; odds ratio (OR), 5.17; 95% confidence interval (CI): 1.81-14.76; P=0.002], and the association was stronger in NHW than Hispanic patients (BMI continuous OR, 1.13; 95% CI: 1.04-1.22; P=0.004 in NHW and OR, 1.07; 95% CI: 0.98-1.17; P=0.12 in Hispanics). Class I and II/III obese patients had over two-fold increased odds of a larger EBL (>150 mL) than patients with normal weight (OR, 2.17; 95% CI: 1.03-4.59; P=0.04 for class I and OR, 2.24; 95% CI: 1.04-4.84; P=0.04 for class II/III obese patients). This association was stronger in patients from neighborhoods with high social deprivation index (SDI) and in NHW patients (BMI >= 30 vs. <30 kg/m(2) , OR, 3.53; 95% CI: 1.57-7.97; P=0.002 in high SDI neighborhoods and OR, 2.38; 95% CI: 1.10-5.14; P=0.03 in NHW). BMI was not associated with a longer hospital stay. Conclusions: In this study, obesity increased likelihood of worse perioperative outcomes, and the associations varied based on race and ethnicity and neighborhood-level socioeconomic factors.

Abstract Background Hispanics and American Indians (AI) have high kidney cancer incidence and mortality rates in Arizona. This study assessed: (1) whether racial and ethnic minority patients and patients from neighborhoods with high social vulnerability index (SVI) experience a longer time to surgery after clinical diagnosis, and (2) whether time to surgery, race and ethnicity, and SVI are associated with upstaging to pT3/pT4, disease‐free survival (DFS), and overall survival (OS). Methods Arizona Cancer Registry (2009–2018) kidney and renal pelvis cases (n = 4592) were analyzed using logistic regression models to assess longer time to surgery and upstaging. Cox‐regression hazard models were used to test DFS and OS. Results Hispanic and AI patients with T1 tumors had a longer time to surgery than non‐Hispanic White patients (median time of 56, 55, and 45 days, respectively). Living in neighborhoods with high (≥75) overall SVI increased odds of a longer time to surgery for cT1a (OR 1.54, 95% CI: 1.02–2.31) and cT2 (OR 2.32, 95% CI: 1.13–4.73). Race and ethnicity were not associated with time to surgery. Among cT1a patients, a longer time to surgery increased odds of upstaging to pT3/pT4 (OR 1.95, 95% CI: 0.99–3.84). A longer time to surgery was associated with PFS (HR 1.52, 95% CI: 1.17–1.99) and OS (HR 1.63, 95% CI: 1.26–2.11). Among patients with cT2 tumor, living in high SVI neighborhoods was associated with worse OS (HR 1.66, 95% CI: 1.07–2.57). Conclusions High social vulnerability was associated with increased time to surgery and poor survival after surgery.

Abstract Background: Obesity is more prevalent in minoritized groups, including Hispanics, American Indian (AI), and non-Hispanic Black (NHB), and these groups have higher renal cell carcinoma (RCC) incidence and mortality rates than non-Hispanic White (NHW). However, the role of abdominal adiposity in RCC disparities are still unknown. To address this gap, we investigated body composition variation and associations with RCC pathological characteristics accounting for neighborhood characteristics. Methods: Social vulnerability index (SVI) scores were linked to the zip code of patient’s residence. Preoperative CT and MRI scans were obtained. SliceOmatic software was used to measure intermuscular, visceral, and subcutaneous adipose tissue and skeletal muscle areas and were normalized for height to obtain intermuscular, visceral, and subcutaneous adipose tissue index (IMATI, VATI, and SATI) and skeletal muscle index (SMI). Non-parametric tests were used to examine correlations, and logistic regression analyses were performed to obtain odds ratio (OR) and confidence interval (CI). Results: A total of 235 patients, including 70 (29.8%) Hispanic, 17 (7.2%) AI, and 20 (8.5%) NHB, were included. Obesity was more common in Hispanic (58.6%), AI (70.6%), and NHB (60.0%) than NHW (47.9%) patients. Compared to NHW patients, SATI was higher in Hispanic (P<0.001) and AI (P=0.002), and VATI was higher in Hispanic patients (P=0.04). Patients from minoritized racial and ethnic groups were more likely to come from neighborhoods with high SVI. SVI was significantly positively correlated with BMI (P=0.02) and SATI (P<0.001). Among SVI themes, socioeconomic, housing and transportation, and minority and language characteristics were significantly positively correlated with SATI (P<0.01). All body composition measurements were significantly positively correlate with BMI (P<0.001). Patients from minoritized racial and ethnic groups were also more likely to have hypertension and diabetes, and patients with both conditions had higher BMI (P=0.002), IMATI (P<0.001), VATI (P<0.001), and SATI (P=0.01) than patients without either condition. Obesity was associated with reduced odds of high grade RCC (OR 0.53, 95% CI 0.29-0.93). After including comorbidities in the model, association was no longer significant. In the same model, AI patients showed a trend for increased odds of high grade (OR 3.28, 95% CI 0.85-12.62, P=0.08) compared to NHW patients. AI patients also had significantly increased odds of having advanced stage RCC (OR 3.72, 95% CI 1.14-12.19). The highest quartile of IMATI significantly increased odds of advanced stage (OR 4.53, 95% CI 1.43-14.36) and clear cell subtype (OR 5.87, 95% CI 1.17-29.55) compared to the lowest quartile with significant P for trend (0.009 and 0.03 respectively). The third quartile of VATI was also significantly associated with clear cell subtype (OR 13.27, 95% CI 13.27). Conclusion: Obesity rates and body composition vary among racially and ethnically diverse RCC patients and are associated with RCC pathological characteristics. Citation Format: Ken Batai, Juan Adrover Claudio, Robert M. Blew, Benjamin R. Lee, Hina Arif Tiwari, Patrick Wightman, Qian Liu, Charles L. Roche, Evan W Davis, Rikki Cannioto, Eric C. Kauffman, Jennifer W. Bea. Racial and ethnic variation in obesity rates and body composition and their associations with renal cell carcinoma grade, stage, and histologic subtype [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A059.

Background: Hispanic Americans (HAs) and American Indians (AIs) in Arizona experience marked disparities in renal cell carcinoma (RCC) with a younger age at diagnosis, higher stage, and higher mortality rates compared to non-Hispanic Whites (NHWs). The underlying factors causing the disparities are still under investigation. This study explored relationships between neighborhood characteristics, race/ethnicity, and obesity in RCC patients. Methods: Medical records of patients who underwent RCC surgical treatment between 2010 and 2021 at Banner University Medical Center Tucson/University of Arizona were reviewed. Social Deprivation Index (SDI) score was calculated using American Community Survey data and linked to the zip code of patient’s residence. Logistic regression analysis was performed to assess associations of SDI, race/ethnicity, and BMI with RCC characteristics and perioperative outcomes. Results: A total of 379 patients (49.9% NHWs, 34.6% HAs, and 7.4% AIs) with SDI data were included in this study. They lived in 116 zip code areas (86 in NHWs, 49 in HAs, and 13 in AIs). 18 patients (4.7%) lived in the most common zip code area. 51.7% of zip codes had only one patient living in the area. HAs and AIs were more likely to have an earlier age of diagnosis and higher BMI and live in high SDI neighborhoods compared to NHWs. SDI were positively associated with BMI in the total dataset and HAs, but not in NHWs. HA ethnicity and high BMI were significantly associated with earlier age of diagnosis. HAs had increased odds of having clear cell RCC, but the association was not significant after adjusting for SDI. HAs had an increased odds of clear cell RCC only in patients living in high SDI neighborhoods (OR 3.33, 95% CI 1.00-11.07). In patients living in low SDI neighborhoods, HAs had increased odds of advanced stage (OR 2.52, 95% CI 1.17-5.45), but not in patients living high SDI neighborhoods (P-interaction=0.02). BMI≥35 was associated with advanced stage in NHWs (OR 3.08, 95% CI 1.14-8.35), but not in HAs (P-interaction=0.07). SDI was not associated with advanced stage. SDI was associated with high grade in NHWs (OR 3.08, 95% CI 1.14-8.35), but not in HAs (P-interaction=0.06). Next, we investigated impacts of obesity on perioperative outcomes adjusting for SDI. BMI≥35 was associated with a longer ischemia time (OR 3.41, 95% CI 1.06-11.2), and this association was stronger in patients living in low SDI than high SDI neighborhoods and in HAs than NHWs. HAs with BMI 30-35 had increased odds (OR 7.83, 954% CI 1.18-51.81) of a greater estimated blood loss during the surgery. Patients with BMI 25-30 had significantly increased odds (OR 6.95 95% CI 1.18-41.00) of longer hospital stay after surgery. A stronger association was observed in NHWs, and the association was not significant in HAs. Conclusion: This study revealed that SDI is an underlying factor of obesity in RCC patients. The relationships between SDI, race/ethnicity, and obesity are complex, and obesity is impacting racial/ethnic groups differently. Citation Format: Ken Batai, Waheed Asif, Patrick Wightman, Alejandro Cruz, Celina I. Valencia, Francine C. Gachupin, Chiu-Hsieh Hsu, Juan Chipollini, Benjamin R. Lee. Intersectionality of neighborhood socioeconomic deprivation, race/ethnicity, and obesity in renal cell carcinoma disparities in Hispanics and American Indians in Arizona [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C085.

BACKGROUNDIn the current nationwide study, the authors used latent class analysis (LCA) to identify classes of cancer patient navigators (CPNs) and examined whether class membership and 12 indicators were related to navigator role retention.METHODSBy using data from 460 CPNs in the United States, LCA identified classes (ie, homogenous subgroups) of CPNs with the following indicators: type of CPN (clinical vs nonclinical), education level, area(s) of the cancer care continuum in which the CPN provided patient navigation, region and urbanity where the CPN provided services, organizational work setting, and patient navigation program funding source. The associations of navigator retention with class membership and each indicator were examined using χ2 tests.RESULTSLCA identified 3 classes of CPNs. Classes 1 and 3 were conceptualized as distinct, homogeneous subgroups of clinical CPNs that appeared to differ mainly on their likelihood of engagement in outreach, survivorship, palliative care, and end‐of‐life patient navigation. Class 2 was conceptualized as a nonclinical CPN subgroup that was distinct primarily based on their high endorsement of employment in programs, which are at least partially funded by grants and engagement in earlier stages of patient navigation (eg, early detection). The provision of survivorship and treatment patient navigation was related to navigator role retention, with senior CPNs providing these patient navigation services more than novice CPNs.CONCLUSIONSThe current study highlights 3 distinct classes of CPNs, provides initial information regarding determinants of navigator retention, and makes several recommendations for future patient navigation research.

Navajo children disproportionately experience poor asthma outcomes. Following a one-year community engagement period with key stakeholders from the Navajo Nation, the Community Asthma Program (CAP) was created using evidenced based programs with the goal of reducing asthma disparities among Navajo children. CAP is being evaluated with a six-year, multi-site step-wedge design in three Navajo communities: Tuba City, Chinle and Fort Defiance, Arizona. The primary outcome is asthma exacerbations defined as use of systemic oral corticosteroids, asthma hospitalizations, asthma related ED visits, and ICU admissions. Asthma exacerbations will be measured using data from the electronic medical records of the three community health care centers. Secondary outcomes include will changes in asthma-related events and asthma control. The RE-AIM (Reach and representativeness, 2) Effectiveness, 3) Adoption, 4) Implementation, and 5) Maintenance) framework is being used to guide the implementation evaluation which includes iterative collection and analysis of process data to identify facilitators and barriers, describe relevant organizational contexts, and inform strategies for dissemination. The CAP intervention requires community engagement and participation, building community capacity, incorporating evidenced-based guidelines and practices while ensuring program strategies actively involve Navajo community members during all steps of the intervention. The outcome of this trial will allow us to determine the effectiveness of a multi-component, community-focused intervention to improve asthma in a tribal community.

BACKGROUNDA nationwide survey was conducted to examine differences between clinical and nonclinical oncology navigators in their service provision, engagement in the cancer care continuum, personal characteristics, and program characteristics.METHODSUsing convenience sampling, 527 oncology navigators participated and completed an online survey. Descriptive statistics, χ2 statistics, and t tests were used to compare nonclinical (eg, community health worker) and clinical (eg, nurse navigators) navigators on the provision of various navigation services, personal characteristics, engagement in the cancer care continuum, and program characteristics.RESULTSMost participants were clinical navigators (76.1%). Compared to nonclinical navigators, clinical navigators were more likely to have a bachelor's degree or higher (88.6% vs 69.6%, P < .001), be funded by operational budgets (84.4% vs 35.7%, P < .001), and less likely to work at a community‐based organization or nonprofit (2.0% vs 36.5%, P < .001). Clinical navigators were more likely to perform basic navigation (P < .001), care coordination (P < .001), treatment support (P < .001), and clinical trial/peer support (P = .005). Clinical navigators were more likely to engage in treatment (P < .001), end‐of‐life (P < .001), and palliative care (P = .001) navigation.CONCLUSIONSThere is growing indication that clinical and nonclinical oncology navigators perform different functions and work in different settings. Nonclinical navigators may be more likely to face job insecurity because they work in nonprofit organizations and are primarily funded by grants.

Background Patient navigation improves cancer care delivery for those most at risk for poor outcomes. Lack of sustainable funding threatens the full integration of navigation services into health care delivery systems. Standardized navigation metrics that document impact and identify best practices are necessary to support sustainability. Methods The National Navigation Roundtable administered a web-based, cross-sectional survey to oncology patient navigation programs to identify barriers and facilitators to the use of navigation metrics. The 38-item survey asked about data-collection practices and specific navigation metrics used by the program. Exploratory and descriptive statistics were used to identify factors associated with data collection and reporting. Results Seven hundred fifty respondents from across the country represented navigation programs across the continuum of care. Although 538 respondents (72%) reported participating in routine data collection, only one-half of them used data for reporting purposes. For the 374 programs that used electronic health records, only 40% had discrete, reportable navigation fields, and 25% had an identifier for navigated patients. Program funding was identified as the only characteristic associated with data collection, whereas the type of data collected was associated with work setting, participation in alternative payment models, and where on the continuum navigation services are provided. Respondents participating in an oncology accreditation program were more likely to collect specific outcome metrics across the continuum and to use those data for reporting purposes. The most common barriers to data collection were time (55%) and lack of support for complex data systems and/or platforms (50%). Conclusions Inconsistent data collection and reporting of oncology navigation programs remain a threat to sustainability. Aligning data collection with oncology accreditation, funding, and reimbursement is a viable path forward.

Abstract Background Arizona’s Health Start Program is a statewide community health worker (CHW) maternal and child health home visiting intervention. The objective of this study was to test if participation in Health Start during 2006–2016 improved early childhood vaccination completion rates. Methods This retrospective study used 11 years of administrative, birth certificate, and immunization records. Propensity score matching was used to identify control groups, based on demographic, socioeconomic, and geographic characteristics. Results are reported by historically disadvantaged subgroups and/or with a history of low vaccine uptake, including Hispanic/Latinx and American Indian children, and children of low socioeconomic status and from rural areas, children with teen mothers and first-born children. The average treatment-on-the-treated (ATT) effect estimated the impact of Health Start on timely completion of seven early childhood vaccine series: diphtheria/tetanus toxoids and acellular/whole-cell pertussis (DTaP/DTP), Haemophilus influenzae type b (Hib), hepatitis B (Hep. B), measles-mumps-rubella (MMR), pneumococcal conjugate vaccine (PCV13), poliovirus, and varicella. Results Vaccination completion rates (by age five) were 5.0% points higher for Health Start children as a group, and on average 5.0% points higher for several subgroups of mothers: women from rural border counties (ATT 5.8), Hispanic/Latinx women (ATT 4.8), American Indian women (ATT 4.8), women with less than high school education (ATT 5.0), teen mothers (ATT 6.1), and primipara women (ATT 4.5), compared to matched control groups (p-value ≤ 0.05). Time-to-event analyses show Health Start children complete vaccination sooner, with a hazard rate for full vaccination 13% higher than their matches. Conclusion A state-operated home visiting intervention with CHWs as the primary interventionist can effectively promote early childhood vaccine completion, which may reduce the incidence of preventable diseases and subsequently improve children’s health. Effects of CHW interventions on vaccination uptake is particularly relevant given the rise in vaccine-preventable diseases in the US and globally. Trial registration Approved by the University of Arizona Research Institutional Review Board (Protocol 1701128802), 25 January 2017.

BACKGROUND For this study, the authors examined whether specific programmatic factors were associated with the sustainability of patient navigation programs. METHODS This cross-sectional survey explored navigation programmatic factors associated with 3 measures of sustainability: 1) length of program existence, 2) reliance on sustainable funding, and 3) participation in alternative payment models. In total, 750 patient navigators or program administrators affiliated with oncology navigation programs in clinical-based and community-based settings completed the survey between April and July 2019. RESULTS Associations were observed between both accreditation and work setting and measures of program sustainability. Accredited programs and larger, more resourced clinical institutions were particularly likely to exhibit multiple measures of sustainability. The results also identified significant gaps at the programmatic level in data collection and reporting among navigation programs, but no association was observed between programmatic data collection/reporting and sustainability. CONCLUSIONS Navigation is not currently a reimbursable service and has historically been viewed as value-added in oncology settings. Therefore, factors associated with sustainability are critical to understand how to build a framework for successful navigation programs within the current system and also to develop the case for potential reimbursement in the future.

Social and structural barriers drive disparities in prenatal care utilization among minoritized women in the United States. This study examined the impact of Arizona’s Health Start Program, a community health worker (CHW) home visiting intervention, on prenatal care utilization among an ethno-racially and geographically diverse cohort of women. We used Health Start administrative and state birth certificate data to identify women enrolled in the program during 2006–2016 (n = 7,117). Propensity score matching was used to generate a statistically-similar comparison group (n = 53,213) of women who did not participate in the program. Odds ratios were used to compare rates of prenatal care utilization. The process was repeated for select subgroups, with post-match regression adjustments applied where necessary. Health Start participants were more likely to report any (OR 1.24, 95

The impact of COVID‐19 on cancer care during the first 6 months of the pandemic has been significant. The National Navigation Roundtable Workforce Development Task Group conducted a national survey to highlight the role of patient navigators (PNs).

Objective To test if participation in the Health Start Programme, an Arizona statewide Community Health Worker (CHW) maternal and child health (MCH) home visiting programme, reduced rates of low birth weight (LBW), very LBW (VLBW), extremely LBW (ELBW) and preterm birth (PTB).Design Quasi-experimental retrospective study using propensity score matching of Health Start Programme enrolment data to state birth certificate records for years 2006–2016.Setting Arizona is uniquely racially and ethnically diverse with comparatively higher proportions of Latino and American Indian residents and a smaller proportion of African Americans.Participants 7212 Health Start Programme mothers matched to non-participants based on demographic, socioeconomic and geographic characteristics, health conditions and previous birth experiences.Intervention A statewide CHW MCH home visiting programme.Primary and secondary outcome measures LBW, VLBW, ELBW and PTB.Results Using Health Start Programme’s administrative data and birth certificate data from 2006 to 2016, we identified 7212 Health Start Programme participants and 53 948 matches. Programme participation is associated with decreases in adverse birth outcomes for most subgroups. Health Start participation is associated with statistically significant lower rates of LBW among American Indian women (38%; average treatment-on-the-treated effect (ATT): 2.30; 95% CI −4.07 to –0.53) and mothers with a pre-existing health risk (25%; ATT: -3.06; 95% CI −5.82 to –0.30). Among Latina mothers, Health Start Programme participation is associated with statistically significant lower rates of VLBW (36%; ATT: 0.35; 95% CI −0.69 to –0.01) and ELBW (62%; ATT: 0.31; 95% CI (−0.52 to –0.10)). Finally, Health Start Programme participation is associated with a statistically significant lower rate of PTB for teen mothers (30%; ATT: 2.81; 95% CI −4.71 to –0.91). Other results were not statistically significant.Conclusion A state health department-operated MCH home visiting intervention that employs CHWs as the primary interventionist may contribute to the reduction of LBW, VLBW, ELBW and PTB and could improve birth outcomes statewide, especially among women and children at increased risk for MCH inequity.

Objective: To describe the process, benefits, and challenges of linking Arizona's prehospital registry to hospital discharge data. Methods: Data were queried from the Arizona Prehospital Information and Emergency Medical Services Registry System (AZ-PIERS) and the Arizona Hospital Discharge Database (HDD) for the calendar year 2015. To maximize the number of matched records, the databases were deterministically linked in 17 steps using different combinations/variations of patient personal identifiers. Random samples of at least 1% of matched pairs from each of 16 linkage steps (excluding Step 1) were manually reviewed to assess the rate of false positive matches. Results: A total of 626,413 records were reported to AZ-PIERS in 2015. Of those, 503,715 qualified for linkage. These records were matched against 3,125,689 discharge records reported to the HDD in 2015. The first step, which involved exact matching on first name, last name, date of birth, gender, and date of incident/date of admission, yielded a linkage of 64.6% (n = 325,156). The 16 successive steps yielded a further linkage of 26.6% (n = 134,006) for a total linkage of 91.2% (n = 459,162). The manual review indicated an overall false positive match rate for the 16 reviewed steps of 6.96% (n = 99). The 2 steps with the highest false positive match rates were Step 16 (43.02%, n = 77) and Step 17 (31.43%, n = 11). Conclusion: It is feasible to link prehospital and hospital data using stepwise deterministic linkage; this method returns a high linkage rate with a low false positive error rate. Data linkage is vital to identifying and bridging gaps in the continuum of care and is a useful tool in statewide and agency-specific research and quality improvement.

BACKGROUND:The Affordable Care Act (ACA) has been associated with increased heart transplant listings among blacks, who are disproportionately uninsured. It is unclear whether the ACA is also associated with increased ventricular assist device implantation in blacks.METHODS:Using Healthcare Cost and Utilization Project Data State Inpatient Databases from 19 states and Washington DC, we analyzed 1157 patients from early-adopter states (ACA Medicaid expansion by January 2014) and 785 patients from nonadopter states (no implementation from 2013 to 2014). Piecewise Poisson regression with a discontinuity was used to estimate change in census-adjusted rates of ventricular assist device implants by race and ACA adopter status 1 year before and after January 2014.RESULTS:Following the ACA Medicaid expansion, the proportional change in rate increased significantly among blacks from early adopter (1.40 [95% CI, 1.12-1.75], pre 0.57/100 000 to post-ACA 0.80/100 000) but not nonadopter states (1.25 [95% CI, 0.98-1.58], pre 0.40/100 000 to post-ACA 0.50/100 000). However, the early and nonadopter changes in implantation rates were not statistically different from each other (P=0.50). There were no immediate changes in whites in either state group following the ACA Medicaid expansion (early adopter, 1.12 [95% CI, 0.98-1.29], pre 0.27/100 000 to post-ACA 0.30/100 000; nonadopter, 0.98 [95% CI, 0.82-1.16], pre 0.27/100 000 to post-ACA 0.26/100 000).CONCLUSIONS:Among eligible states participating in Healthcare Cost and Utilization Project Data State Inpatient Databases, the ACA was not associated with immediate changes in ventricular assist device implantation rates by race. Although a significant increase in implantation rate was observed among blacks from early-adopter states, the change was not statistically different from the change seen in nonadopter states.

IntroductionEmerging evidence suggests community health workers (CHWs) delivering preventive maternal and child health (MCH) interventions through home visiting improve several important health outcomes, including initiation of prenatal care, healthy birth weight and uptake of childhood immunisations.Methods and analysisThe Arizona Health Start Program is a behavioral-based home visiting intervention, which uses CHWs to improve MCH outcomes through health education, referral support, and advocacy services for at-risk pregnant and postpartum women with children up to 2 years of age. We aim to test our central hypothesis that mothers and children exposed to this intervention will experience positive health outcomes in the areas of (1) newborn health; (2) maternal health and healthcare utilisation; and (3) child health and development. This paper outlines our protocol to retrospectively evaluate Health Start Program administrative data from 2006 to 2015, equaling 15 576 enrollees. We will use propensity score matching to generate a statistically similar control group. Our analytic sample size is sufficient to detect meaningful programme effects from low-frequency events, including preterm births, low and very low birth weights, maternal morbidity, and differences in immunisation and hospitalisation rates.Ethics and disseminationThis work is supported through an inter-agency contract from the Arizona Department of Health Services and is approved by the University of Arizona Research Institutional Review Board (Protocol 1701128802, approved 25 January 2017). Evaluation of the three proposed outcome areas will be completed by June 2020.