Insurance Status/Stability
Conditions
Keywords
Adolescent, Child, Child Health Services/organization & administration*, Child, Preschool, Cohort Studies, Community Health Centers/organization & administration, Community Health Centers/standards, Electronic Health Records, Feasibility Studies, Female, Health Services Accessibility/economics, Humans, Infant, Infant, Newborn, Insurance Coverage, Insurance Coverage/statistics & numerical data, Insurance Coverage/trends, Insurance, Health, Insurance, Health/legislation & jurisprudence, Insurance, Health/statistics & numerical data, Insurance, Health/trends, Logistic Models, Longitudinal Studies, Male, Medicaid, Medicaid/statistics & numerical data, Medicaid/trends, Medicaid/utilization, Medically Uninsured, Medicare/statistics & numerical data, Medicare/trends, Medicare/utilization, Multivariate Analysis, Oregon, Patient Protection and Affordable Care Act, Patient-Centered Care, Pediatrics/legislation & jurisprudence, Pediatrics/standards, Population Surveillance/methods, Primary Health Care/economics, Quality Assurance, Health Care/legislation & jurisprudence, Quality Assurance, Health Care/methods, Quality Indicators, Health Care, Retrospective Studies, Socioeconomic Factors, United States, Young Adult
Brief summary
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.
Detailed description
Summary of protocol changes made: 1. Changes to eligibility criteria. We changed patient eligibility to include all pediatric patients through age 19 with \>=1 clinical visit in the study period. These decisions were based on: 1) at age 20, individuals are no longer eligible for children's Medicaid or CHIP in Oregon; 2) identification of PCP assignment was difficult in the EHR. 2. Added second comparison group/study arm. In the intervention clinics, the tools were used on a smaller number of pediatric patients than anticipated, and there were significant demographic differences between intervention and control site patients, despite the clinics being matched. Thus we added a second comparison group, within-clinic comparison patients as pediatric patients with \>=1 visit at an intervention clinic in the study period but on whom the tools were NOT used. This provided a comparison group that accounted for clinic-level effects and was more demographically similar to the intervention patients on whom tools were used. 3. Revision of Aim 3 - CHIPRA recommended care assessment. We did not pursue assessment of CHIPRA quality care measures due to 1) limited follow-up time due to the need to implement iterative modifications to the study HIT tools, and 2) the tools were used on a smaller set of pediatric patients than anticipated, thus we had a very limited denominator for these analyses.
Interventions
OTHERHealth insurance outreach IT tools
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.
Sponsors
Oregon Health and Science University
OCHIN, Inc.
Study design
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
No minimum to 19 Years
Healthy volunteers
Yes
Inclusion criteria
* age 0-19 * established patient (\>=1 clinical visit at a study clinic in the assessment period)
Exclusion criteria
* age \> 19 * not an established patient
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent of Study Period Covered by Medicaid | 6 months pre- through 16 months post-tool implementation | 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). |
| Proportion of Patients Who Gained Medicaid Coverage | 6 months pre- through 16 months post-tool implementation | 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). |
| Proportion of Patients Who Lost Medicaid Coverage | 6 months pre- through 16 months post-tool implementation | 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). |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Intervention Patients Community Health Centers that implemented health insurance outreach IT tools: active patients on whom tools were used | 2,240 |
| Within-clinic Comparison Patients Community Health Centers that implemented health insurance outreach IT tools: active patients on whom tools were not used | 12,784 |
| Control Clinic Comparison Patients Matched Community Health Centers that did not implement health insurance outreach IT tools: active patients | 12,227 |
| Total | 27,251 |
Baseline characteristics
| Characteristic | Intervention Patients | Within-clinic Comparison Patients | Control Clinic Comparison Patients | Total |
|---|---|---|---|---|
| Age, Categorical <=18 years | 2170 Participants | 12306 Participants | 11783 Participants | 26259 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 70 Participants | 478 Participants | 444 Participants | 992 Participants |
| Age, Continuous | 9.3 years STANDARD_DEVIATION 5.4 | 8.6 years STANDARD_DEVIATION 5.9 | 8.2 years STANDARD_DEVIATION 5.9 | 8.5 years STANDARD_DEVIATION 5.8 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2128 Participants | 8270 Participants | 7266 Participants | 17664 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 103 Participants | 4031 Participants | 4831 Participants | 8965 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 9 Participants | 483 Participants | 130 Participants | 622 Participants |
| Household income as percent of Federal Poverty Level <=138% FPL | 2083 participants | 11253 participants | 9998 participants | 23334 participants |
| Household income as percent of Federal Poverty Level 139-199% FPL | 114 participants | 734 participants | 918 participants | 1766 participants |
| Household income as percent of Federal Poverty Level >=200% FPL | 29 participants | 283 participants | 1204 participants | 1516 participants |
| Household income as percent of Federal Poverty Level Unknown | 14 participants | 514 participants | 107 participants | 635 participants |
| Primary language English | 241 participants | 5629 participants | 5103 participants | 10973 participants |
| Primary language Other | 22 participants | 622 participants | 1125 participants | 1769 participants |
| Primary language Spanish | 1976 participants | 6490 participants | 5803 participants | 14269 participants |
| Primary language Unknown | 1 participants | 43 participants | 196 participants | 240 participants |
| Race (NIH/OMB) American Indian or Alaska Native | 2 Participants | 26 Participants | 166 Participants | 194 Participants |
| Race (NIH/OMB) Asian | 8 Participants | 198 Participants | 297 Participants | 503 Participants |
| Race (NIH/OMB) Black or African American | 17 Participants | 407 Participants | 1345 Participants | 1769 Participants |
| Race (NIH/OMB) More than one race | 1 Participants | 26 Participants | 260 Participants | 287 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 3 Participants | 30 Participants | 128 Participants | 161 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 213 Participants | 1339 Participants | 1569 Participants | 3121 Participants |
| Race (NIH/OMB) White | 1996 Participants | 10758 Participants | 8462 Participants | 21216 Participants |
| Sex: Female, Male Female | 1119 Participants | 6524 Participants | 6128 Participants | 13771 Participants |
| Sex: Female, Male Male | 1121 Participants | 6260 Participants | 6099 Participants | 13480 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
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).
Time frame: 6 months pre- through 16 months post-tool implementation
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Intervention Patients | Percent of Study Period Covered by Medicaid | 0% covered | 30 participants |
| Intervention Patients | Percent of Study Period Covered by Medicaid | 1-49% covered | 113 participants |
| Intervention Patients | Percent of Study Period Covered by Medicaid | 50-99% covered | 648 participants |
| Intervention Patients | Percent of Study Period Covered by Medicaid | 100% covered | 1289 participants |
| Within-clinic Comparison Patients | Percent of Study Period Covered by Medicaid | 100% covered | 6823 participants |
| Within-clinic Comparison Patients | Percent of Study Period Covered by Medicaid | 0% covered | 451 participants |
| Within-clinic Comparison Patients | Percent of Study Period Covered by Medicaid | 50-99% covered | 3198 participants |
| Within-clinic Comparison Patients | Percent of Study Period Covered by Medicaid | 1-49% covered | 1062 participants |
| Control Clinic Comparison Patients | Percent of Study Period Covered by Medicaid | 100% covered | 7113 participants |
| Control Clinic Comparison Patients | Percent of Study Period Covered by Medicaid | 1-49% covered | 933 participants |
| Control Clinic Comparison Patients | Percent of Study Period Covered by Medicaid | 50-99% covered | 3386 participants |
| Control Clinic Comparison Patients | Percent of Study Period Covered by Medicaid | 0% covered | 297 participants |
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).
Time frame: 6 months pre- through 16 months post-tool implementation
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Intervention Patients | Proportion of Patients Who Gained Medicaid Coverage | 444 participants |
| Within-clinic Comparison Patients | Proportion of Patients Who Gained Medicaid Coverage | 2611 participants |
| Control Clinic Comparison Patients | Proportion of Patients Who Gained Medicaid Coverage | 2426 participants |
95% CI: [1.6, 1.93]Generalized estimating equation
95% CI: [1.91, 2.72]Generalized estimating equation
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).
Time frame: 6 months pre- through 16 months post-tool implementation
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Intervention Patients | Proportion of Patients Who Lost Medicaid Coverage | 377 participants |
| Within-clinic Comparison Patients | Proportion of Patients Who Lost Medicaid Coverage | 1873 participants |
| Control Clinic Comparison Patients | Proportion of Patients Who Lost Medicaid Coverage | 2173 participants |
95% CI: [0.53, 0.94]Generalized estimating equation
95% CI: [0.45, 0.67]Generalized estimating equation