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| Name | Class |
|---|---|
| Oregon Health and Science University | OTHER |
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Health insurance is important for children. Public insurance programs are available to many children, but some families report being confused about how to get and keep this insurance. Community Health Centers (CHCs) can help families get and keep health insurance for their children.
The investigators will work with families, policy makers, and community health care providers and staff to develop and test new computer health information technology (IT) tools to help health care clinics find pediatric patients in need of insurance and communicate with their families about public insurance programs. These tools will be based on technologies currently used to help patients and clinics manage chronic diseases. The investigators will test the tools by comparing four clinics using the tools and four clinics not using the tools. The investigators will look to see if children in the clinics using the tools are more likely to have health insurance and also more likely to receive certain health care services, compared to children in the clinics without such tools. The investigators will also look at health insurance rates and health care services for a larger population of Oregon children.
Summary of protocol changes made:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention patients | Community Health Centers that implemented health insurance outreach IT tools: active patients on whom tools were used |
| |
| Within-clinic comparison patients | Community Health Centers that implemented health insurance outreach IT tools: active patients on whom tools were not used | ||
| Control clinic comparison patients | Matched Community Health Centers that did not implement health insurance outreach IT tools: active patients |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Health insurance outreach IT tools | Other | IT tools that support Community Health Centers in children's health insurance outreach efforts ("insurance outreach IT tools"), adapted from tools proven to support chronic disease management. |
| Measure | Description | Time Frame |
|---|---|---|
| Percent of Study Period Covered by Medicaid | Percent of total days in 22-month assessment period that each child was covered by Medicaid insurance. Assessed using state administrative records linked to EHR data; this outcome was assessed among the subset of participants with a Medicaid ID (and thus could be linked between the two data sources). | 6 months pre- through 16 months post-tool implementation |
| Proportion of Patients Who Gained Medicaid Coverage | Proportion of participants who gained Medicaid coverage after a period of uninsurance. Assessed using state administrative records linked to EHR data; this outcome was assessed among the subset of participants with a Medicaid ID (and thus could be linked between the two data sources) and who had partial coverage during the study period (i.e., patients with 100% coverage were not 'eligible' to gain coverage). | 6 months pre- through 16 months post-tool implementation |
| Proportion of Patients Who Lost Medicaid Coverage | Proportion of participants who lost Medicaid coverage after a period of insurance. Assessed using state administrative records linked to EHR data; this outcome was assessed among the subset of participants with a Medicaid ID (and thus could be linked between the two data sources) and who had partial coverage during the study period (i.e., patients with 100% coverage were not 'eligible' to lose coverage). | 6 months pre- through 16 months post-tool implementation |
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Inclusion Criteria:
Exclusion Criteria:
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For the analysis of the primary study outcome, our study population will include all children who are "established" patients at an intervention or control clinic. Children will be considered "established" patients if they had >=1 clinical visit at a study clinic during the 18-month study period.
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| Name | Affiliation | Role |
|---|---|---|
| Jennifer DeVoe, MD, DPhil | OCHIN, OHSU | Principal Investigator |
| Christine Nelson, RN, PhD | OCHIN, Inc. | Study Director |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24019280 | Background | Devoe JE. Being uninsured is bad for your health: can medical homes play a role in treating the uninsurance ailment? Ann Fam Med. 2013 Sep-Oct;11(5):473-6. doi: 10.1370/afm.1541. | |
| 24562505 | Background | Angier H, Gold R, Crawford C, P O'Malley J, J Tillotson C, Marino M, DeVoe JE. Linkage methods for connecting children with parents in electronic health record and state public health insurance data. Matern Child Health J. 2014 Nov;18(9):2025-33. doi: 10.1007/s10995-014-1453-8. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Intervention Patients | Community Health Centers that implemented health insurance outreach IT tools: active patients on whom tools were used |
| FG001 | Within-clinic Comparison Patients | Community Health Centers that implemented health insurance outreach IT tools: active patients on whom tools were not used |
| FG002 | Control Clinic Comparison Patients | Matched Community Health Centers that did not implement health insurance outreach IT tools: active patients |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Intervention Patients | Community Health Centers that implemented health insurance outreach IT tools: active patients on whom tools were used |
| BG001 | Within-clinic Comparison Patients |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Percent of Study Period Covered by Medicaid | Percent of total days in 22-month assessment period that each child was covered by Medicaid insurance. Assessed using state administrative records linked to EHR data; this outcome was assessed among the subset of participants with a Medicaid ID (and thus could be linked between the two data sources). | Posted | Number | participants | 6 months pre- through 16 months post-tool implementation |
|
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Adverse events not monitored; not applicable to the study.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Intervention Patients | Community Health Centers that implemented health insurance outreach IT tools: active patients on whom tools were used |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Jennifer E. DeVoe, MD, DPhil | OCHIN, Inc. | 503-943-2618 | devoej@ohsu.edu |
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| ID | Term |
|---|---|
| D010342 | Patient Acceptance of Health Care |
| ID | Term |
|---|---|
| D000074822 | Treatment Adherence and Compliance |
| D015438 | Health Behavior |
| D001519 | Behavior |
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| 24594562 | Background | DeVoe J, Angier H, Likumahuwa S, Hall J, Nelson C, Dickerson K, Keller S, Burdick T, Cohen D. Use of qualitative methods and user-centered design to develop customized health information technology tools within federally qualified health centers to keep children insured. J Ambul Care Manage. 2014 Apr-Jun;37(2):148-54. doi: 10.1097/JAC.0000000000000016. |
| 25070735 | Background | DeVoe JE, Tillotson CJ, Angier H, Wallace LS. Predictors of children's health insurance coverage discontinuity in 1998 versus 2009: parental coverage continuity plays a major role. Matern Child Health J. 2015 Apr;19(4):889-96. doi: 10.1007/s10995-014-1590-0. |
| 24249814 | Background | Hatch B, Angier H, Marino M, Heintzman J, Nelson C, Gold R, Vakarcs T, Devoe J. Using electronic health records to conduct children's health insurance surveillance. Pediatrics. 2013 Dec;132(6):e1584-91. doi: 10.1542/peds.2013-1470. Epub 2013 Nov 18. |
| 25381078 | Background | Angier H, Likumahuwa S, Finnegan S, Vakarcs T, Nelson C, Bazemore A, Carrozza M, DeVoe JE. Using geographic information systems (GIS) to identify communities in need of health insurance outreach: An OCHIN practice-based research network (PBRN) report. J Am Board Fam Med. 2014 Nov-Dec;27(6):804-10. doi: 10.3122/jabfm.2014.06.140029. |
| 25384821 | Background | DeVoe JE, Angier H, Burdick T, Gold R. Health information technology: an untapped resource to help keep patients insured. Ann Fam Med. 2014 Nov-Dec;12(6):568-72. doi: 10.1370/afm.1721. |
| 25583886 | Background | Angier H, Hoopes M, Gold R, Bailey SR, Cottrell EK, Heintzman J, Marino M, DeVoe JE. An early look at rates of uninsured safety net clinic visits after the Affordable Care Act. Ann Fam Med. 2015 Jan-Feb;13(1):10-6. doi: 10.1370/afm.1741. |
| 25888586 | Background | Heintzman J, Marino M, Hoopes M, Bailey SR, Gold R, O'Malley J, Angier H, Nelson C, Cottrell E, Devoe J. Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data? J Am Med Inform Assoc. 2015 Jul;22(4):909-13. doi: 10.1093/jamia/ocv033. Epub 2015 Apr 17. |
| 25874876 | Background | DeVoe JE, Crawford C, Angier H, O'Malley J, Gallia C, Marino M, Gold R. The Association Between Medicaid Coverage for Children and Parents Persists: 2002-2010. Matern Child Health J. 2015 Aug;19(8):1766-74. doi: 10.1007/s10995-015-1690-5. |
| 26355818 | Background | Gold R, Burdick T, Angier H, Wallace L, Nelson C, Likumahuwa-Ackman S, Sumic A, DeVoe JE. Improve Synergy Between Health Information Exchange and Electronic Health Records to Increase Rates of Continuously Insured Patients. EGEMS (Wash DC). 2015 Aug 6;3(1):1158. doi: 10.13063/2327-9214.1158. eCollection 2015. |
| 26297668 | Background | DeVoe JE, Tillotson CJ, Marino M, O'Malley J, Angier H, Wallace LS, Gold R. Trends in Type of Health Insurance Coverage for US Children and Their Parents, 1998-2011. Acad Pediatr. 2016 Mar;16(2):192-9. doi: 10.1016/j.acap.2015.06.009. Epub 2015 Aug 18. |
| 26291916 | Background | Angier H, Marino M, Sumic A, O'Malley J, Likumahuwa-Ackman S, Hoopes M, Nelson C, Gold R, Cohen D, Dickerson K, DeVoe JE. Innovative methods for parents and clinics to create tools for kids' care (IMPACCT Kids' Care) study protocol. Contemp Clin Trials. 2015 Sep;44:159-163. doi: 10.1016/j.cct.2015.08.010. Epub 2015 Aug 18. |
| 26355135 | Background | Arkind J, Likumahuwa-Ackman S, Warren N, Dickerson K, Robbins L, Norman K, DeVoe JE. Lessons Learned from Developing a Patient Engagement Panel: An OCHIN Report. J Am Board Fam Med. 2015 Sep-Oct;28(5):632-8. doi: 10.3122/jabfm.2015.05.150009. |
| 26274796 | Background | Likumahuwa-Ackman S, Angier H, Sumic A, Harding RL, Cottrell EK, Cohen DJ, Nelson CA, Burdick TE, Wallace LS, Gallia C, DeVoe JE. IMPACCT Kids' Care: a real-world example of stakeholder involvement in comparative effectiveness research. J Comp Eff Res. 2015 Aug;4(4):351-7. doi: 10.2217/cer.15.24. |
| 26765808 | Background | Hoopes MJ, Angier H, Gold R, Bailey SR, Huguet N, Marino M, DeVoe JE. Utilization of Community Health Centers in Medicaid Expansion and Nonexpansion States, 2013-2014. J Ambul Care Manage. 2016 Oct-Dec;39(4):290-8. doi: 10.1097/JAC.0000000000000123. |
| 26911812 | Background | Hatch B, Tillotson C, Angier H, Marino M, Hoopes M, Huguet N, DeVoe J. Using the electronic health record for assessment of health insurance in community health centers. J Am Med Inform Assoc. 2016 Sep;23(5):984-90. doi: 10.1093/jamia/ocv179. Epub 2016 Jan 23. |
| 29747644 | Derived | DeVoe JE, Hoopes M, Nelson CA, Cohen DJ, Sumic A, Hall J, Angier H, Marino M, O'Malley JP, Gold R. Electronic health record tools to assist with children's insurance coverage: a mixed methods study. BMC Health Serv Res. 2018 May 10;18(1):354. doi: 10.1186/s12913-018-3159-x. |
Community Health Centers that implemented health insurance outreach IT tools: active patients on whom tools were not used
| BG002 | Control Clinic Comparison Patients | Matched Community Health Centers that did not implement health insurance outreach IT tools: active patients |
| BG003 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Primary language | Number | participants |
|
| Household income as percent of Federal Poverty Level | Number | participants |
|
| OG002 | Control Clinic Comparison Patients | Matched Community Health Centers that did not implement health insurance outreach IT tools: active patients |
|
|
| Primary | Proportion of Patients Who Gained Medicaid Coverage | Proportion of participants who gained Medicaid coverage after a period of uninsurance. Assessed using state administrative records linked to EHR data; this outcome was assessed among the subset of participants with a Medicaid ID (and thus could be linked between the two data sources) and who had partial coverage during the study period (i.e., patients with 100% coverage were not 'eligible' to gain coverage). | Posted | Number | participants | 6 months pre- through 16 months post-tool implementation |
|
|
|
|
| Primary | Proportion of Patients Who Lost Medicaid Coverage | Proportion of participants who lost Medicaid coverage after a period of insurance. Assessed using state administrative records linked to EHR data; this outcome was assessed among the subset of participants with a Medicaid ID (and thus could be linked between the two data sources) and who had partial coverage during the study period (i.e., patients with 100% coverage were not 'eligible' to lose coverage). | Posted | Number | participants | 6 months pre- through 16 months post-tool implementation |
|
|
|
|
| 0 |
| 0 |
| 0 |
| 0 |
| EG001 | Within-clinic Comparison Patients | Community Health Centers that implemented health insurance outreach IT tools: active patients on whom tools were not used | 0 | 0 | 0 | 0 |
| EG002 | Control Clinic Comparison Patients | Matched Community Health Centers that did not implement health insurance outreach IT tools: active patients | 0 | 0 | 0 | 0 |
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| Generalized estimating equation |
GEE model clustered by clinic, adjusted for demographics, number of visits, new/established patient at first visit, and household factors. |
| Odds Ratio (OR) |
| 2.28 |
| 2-Sided |
| 95 |
| 1.91 |
| 2.72 |
Adjusted odds of gaining Medicaid: intervention patients (numerator) relative to control clinic comparison patients (denominator) |
| No |
| Superiority or Other |
| Generalized estimating equation |
GEE model clustered by clinic, adjusted for demographics, number of visits, new/established patient at first visit, and household factors. |
| Odds Ratio (OR) |
| 0.55 |
| 2-Sided |
| 95 |
| 0.45 |
| 0.67 |
Adjusted odds of losing Medicaid: intervention patients (numerator) relative to control clinic comparison patients (denominator) |
| No |
| Superiority or Other |