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Grant Details

Grant Number: 5R01CA181452-05 Interpret this number
Primary Investigator: Devoe, Jennifer
Organization: Oregon Health & Science University
Project Title: Community-Based Hit Tools for Cancer Screening and Health Insurance Promotion
Fiscal Year: 2018
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Abstract

DESCRIPTION (provided by applicant): Cancer morbidity and mortality risks can be greatly reduced through screening and prevention. Patients without health insurance are much less likely to receive evidence-based cancer screenings and preventive care. Interventions that optimize and stabilize health insurance coverage could substantially increase rates of receipt of timely cancer preventive care. As many patients with unstable coverage receive care at Community Health Centers (CHCs), CHCs are well-positioned to provide such interventions. Recent advances in CHCs' health information technology (HIT) create new opportunities for using automated processes and data to support insurance outreach efforts. We propose to conduct a clinic-level cluster randomized trial in 12 CHCs (~47,000 patients aged 18-64) to test the effectiveness of Community-based HIT Tools for Cancer Screening and Health Insurance Promotion ("CATCH-UP" tools) at improving rates of (1) cancer screening and prevention services, and (2) health insurance coverage. The CATCH-UP tools are designed to identify and reach uninsured CHC patients who are eligible for enrollment in public insurance coverage, and to encourage re-enrollment of publicly-insured patients before coverage gaps occur. Modeled after HIT tools proven effective for chronic disease management, the CATCH-UP tools include a panel management / data aggregator system coupled with automated patient outreach and communication. We will partner with OCHIN, a non-profit community HIT network that hosts one of the nation's largest CHC electronic health record platforms. We hypothesize that patients of CHCs that have these tools will have higher rates of continuous insurance coverage, and as a result, higher rates of up-to-date age- and gender-appropriate cancer screening and prevention services, compared to patients of CHCs without such tools. Our aims are as follows. Aim 1: Evaluate the effect of the CATCH-UP intervention on up-to-date status of cancer screening and preventive care received by patients. We will assess gender- and age-appropriate rates of screening and assessment (colorectal cancer, cervical cancer, breast cancer, smoking, obesity); immunization (human papillomavirus vaccination); and counseling (smoking, weight). Aim 2: Evaluate the effect of the CATCH-UP intervention on patients' insurance coverage rates. To accomplish Aims 1 and 2, we will conduct clinic- and patient-level difference-in-differences quantitative analyses to compare pre- and post-intervention changes between control and intervention groups. Aim 3: Evaluate the intervention implementation process, patient and CHC staff acceptance and use of the CATCH-UP tools, and the patient-, provider-, and system-level factors associated with successful implementation and sustainability of the tools, using mixed methods. Understanding how HIT tools in CHCs and other community primary care settings can support insurance enrollment and retention efforts will be key to successfully expanding insurance coverage and reducing disparities in cancer screening and prevention services.

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Publications

Medicaid coverage accuracy in electronic health records.
Authors: Marino M. , Angier H. , Valenzuela S. , Hoopes M. , Killerby M. , Blackburn B. , Huguet N. , Heintzman J. , Hatch B. , O'Malley J.P. , et al. .
Source: Preventive Medicine Reports, 2018 Sep; 11, p. 297-304.
EPub date: 2018-07-27 00:00:00.0.
PMID: 30116701
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Implementation of Health Insurance Support Tools in Community Health Centers.
Authors: Huguet N. , Hatch B. , Sumic A. , Tillotson C. , Hicks E. , Nelson J. , DeVoe J.E. .
Source: Journal Of The American Board Of Family Medicine : Jabfm, 2018 May-Jun; 31(3), p. 410-416.
PMID: 29743224
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Oregon Medicaid Expenditures After the 2014 Affordable Care Act Medicaid Expansion: Over-time Differences Among New, Returning, and Continuously Insured Enrollees.
Authors: Springer R. , Marino M. , O'Malley J.P. , Lindner S. , Huguet N. , DeVoe J.E. .
Source: Medical Care, 2018-03-23 00:00:00.0; , .
EPub date: 2018-03-23 00:00:00.0.
PMID: 29578955
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Uninsured Primary Care Visit Disparities Under the Affordable Care Act.
Authors: Angier H. , Hoopes M. , Marino M. , Huguet N. , Jacobs E.A. , Heintzman J. , Holderness H. , Hood C.M. , DeVoe J.E. .
Source: Annals Of Family Medicine, 2017 Sep; 15(5), p. 434-442.
PMID: 28893813
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Medicaid Expansion Produces Long-Term Impact on Insurance Coverage Rates in Community Health Centers.
Authors: Huguet N. , Hoopes M.J. , Angier H. , Marino M. , Holderness H. , DeVoe J.E. .
Source: Journal Of Primary Care & Community Health, 2017-05-01 00:00:00.0; , p. 2150131917709403.
EPub date: 2017-05-01 00:00:00.0.
PMID: 28513249
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Protocol For The Analysis Of A Natural Experiment On The Impact Of The Affordable Care Act On Diabetes Care In Community Health Centers
Authors: Huguet N. , Angier H. , Marino M. , McConnell K.J. , Hoopes M.J. , O'Malley J.P. , Raynor L.A. , Likumahuwa-Ackman S. , Holderness H. , DeVoe J.E. .
Source: Implementation Science : Is, 2017-02-10 00:00:00.0; 12(1), p. 14.
PMID: 28183354
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A new role for primary care teams in the United States after "Obamacare:" Track and improve health insurance coverage rates.
Authors: DeVoe J. , Angier H. , Hoopes M. , Gold R. .
Source: Family Medicine And Community Health, 2016 Dec; 4(4), p. 63-67.
EPub date: 2016-12-01 00:00:00.0.
PMID: 28966926
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Utilization of Community Health Centers in Medicaid Expansion and Nonexpansion States, 2013-2014.
Authors: Hoopes M.J. , Angier H. , Gold R. , Bailey S.R. , Huguet N. , Marino M. , DeVoe J.E. .
Source: The Journal Of Ambulatory Care Management, 2016 Oct-Dec; 39(4), p. 290-8.
PMID: 26765808
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Using the electronic health record for assessment of health insurance in community health centers.
Authors: Hatch B. , Tillotson C. , Angier H. , Marino M. , Hoopes M. , Huguet N. , DeVoe J. .
Source: Journal Of The American Medical Informatics Association : Jamia, 2016 Sep; 23(5), p. 984-90.
PMID: 26911812
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Patterns Of Electronic Portal Use Among Vulnerable Patients In A Nationwide Practice-based Research Network: From The Ochin Practice-based Research Network (pbrn)
Authors: Wallace L.S. , Angier H. , Huguet N. , Gaudino J.A. , Krist A. , Dearing M. , Killerby M. , Marino M. , DeVoe J.E. .
Source: Journal Of The American Board Of Family Medicine : Jabfm, 2016 Sep-Oct; 29(5), p. 592-603.
PMID: 27613792
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Trends in Type of Health Insurance Coverage for US Children and Their Parents, 1998-2011.
Authors: DeVoe J.E. , Tillotson C.J. , Marino M. , O'Malley J. , Angier H. , Wallace L.S. , Gold R. .
Source: Academic Pediatrics, 2016 Mar; 16(2), p. 192-9.
PMID: 26297668
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Testing health information technology tools to facilitate health insurance support: a protocol for an effectiveness-implementation hybrid randomized trial.
Authors: DeVoe J.E. , Huguet N. , Likumahuwa-Ackman S. , Angier H. , Nelson C. , Marino M. , Cohen D. , Sumic A. , Hoopes M. , Harding R.L. , et al. .
Source: Implementation Science : Is, 2015-08-25 00:00:00.0; 10, p. 123.
EPub date: 2015-08-25 00:00:00.0.
PMID: 26652866
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Innovative Methods For Parents And Clinics To Create Tools For Kids' Care (impacct Kids' Care) Study Protocol
Authors: Angier H. , Marino M. , Sumic A. , O'Malley J. , Likumahuwa-Ackman S. , Hoopes M. , Nelson C. , Gold R. , Cohen D. , Dickerson K. , et al. .
Source: Contemporary Clinical Trials, 2015-08-17 00:00:00.0; , .
PMID: 26291916
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IMPACCT Kids' Care: a real-world example of stakeholder involvement in comparative effectiveness research.
Authors: Likumahuwa-Ackman S. , Angier H. , Sumic A. , Harding R.L. , Cottrell E.K. , Cohen D.J. , Nelson C.A. , Burdick T.E. , Wallace L.S. , Gallia C. , et al. .
Source: Journal Of Comparative Effectiveness Research, 2015 Aug; 4(4), p. 351-7.
PMID: 26274796
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Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data?
Authors: Heintzman J. , Marino M. , Hoopes M. , Bailey S.R. , Gold R. , O'Malley J. , Angier H. , Nelson C. , Cottrell E. , Devoe J. .
Source: Journal Of The American Medical Informatics Association : Jamia, 2015 Jul; 22(4), p. 909-13.
PMID: 25888586
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An early look at rates of uninsured safety net clinic visits after the Affordable Care Act.
Authors: Angier H. , Hoopes M. , Gold R. , Bailey S.R. , Cottrell E.K. , Heintzman J. , Marino M. , DeVoe J.E. .
Source: Annals Of Family Medicine, 2015 Jan-Feb; 13(1), p. 10-6.
PMID: 25583886
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Improve Synergy Between Health Information Exchange and Electronic Health Records to Increase Rates of Continuously Insured Patients.
Authors: Gold R. , Burdick T. , Angier H. , Wallace L. , Nelson C. , Likumahuwa-Ackman S. , Sumic A. , DeVoe J.E. .
Source: Egems (washington, Dc), 2015; 3(1), p. 1158.
PMID: 26355818
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Health information technology: an untapped resource to help keep patients insured.
Authors: DeVoe J.E. , Angier H. , Burdick T. , Gold R. .
Source: Annals Of Family Medicine, 2014 Nov-Dec; 12(6), p. 568-72.
PMID: 25384821
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