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Grant Details

Grant Number: 5R01CA204267-05 Interpret this number
Primary Investigator: Devoe, Jennifer
Organization: Oregon Health & Science University
Project Title: ACCESS: Assessing Community Cancer Care After Insurance Expansions
Fiscal Year: 2020


 DESCRIPTION (provided by applicant): Cancer morbidity and mortality is greatly reduced through screening and prevention, but uninsured patients are much less likely than insured patients to receive these evidence-based services as recommended. Similarly, uninsured cancer survivors receive fewer primary and preventive care services than those with health insurance. The Affordable Care Act (ACA) called for every state to significantly expand Medicaid coverage by 2014; it is hypothesized that the ACA's Medicaid expansions could substantially (i) improve access to essential cancer preventive and screening services for previously uninsured patients, and (ii) facilitate better access to routine healthcare among cancer survivors who gain new health insurance. Little is yet known about how ACA Medicaid expansions are impacting the delivery of recommended cancer care. The 2012 United States (US) Supreme Court ruling that made ACA Medicaid expansions optional for states created a natural experiment to answer this important question. As of April 1, 2015, 30 states and the District of Columbia had expanded Medicaid, while 20 states had not. We will use this unprecedented natural experiment to study the effect of state-level Medicaid expansions on rates of cancer screening, cancer preventive services, and healthcare for cancer survivors. We will use electronic health record (EHR) data from the ADVANCE clinical data research network, which has data from 718 community health centers (CHCs), including 476 CHCs in 13 Medicaid expansion states and 242 CHCs in 8 non-expansion states. From this dataset, we will collect detailed information on changes in health insurance and healthcare service receipt, with data spanning 9 years (pre- and post-expansion), comparing states that expanded Medicaid, and those that did not. The specific aims are as follows: Aim 1. Compare pre-post receipt of cancer prevention and screening among CHC patients in Medicaid expansion versus non-expansion states. Aim 2. Compare pre-post insurance status, visits, and receipt of routine, recommended primary and preventive care among cancer survivors seen in CHCs in expansion versus non-expansion states. Aim 3. Compare pre-post cancer prevention, screening, and survivor care for newly insured (gained Medicaid in post-period), already insured (had Medicaid coverage in pre- and post-periods), and continuously uninsured (no coverage in pre- and post-periods) CHC patients in states that expanded Medicaid. This project builds on our team's experience studying health insurance, primary care, and receipt of preventive services. The ADVANCE dataset positions us uniquely to study national-level impacts of the ACA. Importantly, this project aligns with National Cancer Institute (NCI) goals to increase knowledge regarding cancer control and prevention. According to the NCI, "prevention has the potential to save more lives from cancer than treatment...which underlines the importance of strongly supporting this research area." Also, findings will be relevant to policy and practice, and will inform further improvements in the US healthcare system to mitigate disparities in cancer prevention and survivor care for vulnerable populations.


Private/marketplace insurance in community health centers 5 years post-affordable care act in medicaid expansion and non-expansion states.
Authors: Larson A.E. , Hoopes M. , Angier H. , Marino M. , Huguet N. .
Source: Preventive medicine, 2020 12; 141, p. 106271.
EPub date: 2020-10-09.
PMID: 33039451
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The Affordable Care Act improved health insurance coverage and cardiovascular-related screening rates for cancer survivors seen in community health centers.
Authors: Angier H.E. , Marino M. , Springer R.J. , Schmidt T.D. , Huguet N. , DeVoe J.E. .
Source: Cancer, 2020-07-15; 126(14), p. 3303-3311.
EPub date: 2020-04-15.
PMID: 32294251
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Using Electronic Health Records in Longitudinal Studies: Estimating Patient Attrition.
Authors: Huguet N. , Kaufmann J. , O'Malley J. , Angier H. , Hoopes M. , DeVoe J.E. , Marino M. .
Source: Medical care, 2020 06; 58 Suppl 6 Suppl 1, p. S46-S52.
PMID: 32412953
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Tobacco Cessation in Affordable Care Act Medicaid Expansion States Versus Non-expansion States.
Authors: Bailey S.R. , Marino M. , Ezekiel-Herrera D. , Schmidt T. , Angier H. , Hoopes M.J. , DeVoe J.E. , Heintzman J. , Huguet N. .
Source: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2020-05-26; 22(6), p. 1016-1022.
PMID: 31123754
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The Affordable Care Act Medicaid Expansion Positively Impacted Community Health Centers and Their Patients.
Authors: Tilhou A.S. , Huguet N. , DeVoe J. , Angier H. .
Source: Journal of general internal medicine, 2020 04; 35(4), p. 1292-1295.
EPub date: 2020-01-02.
PMID: 31898120
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Reply to Patients with incurable cancer as a separate group of survivors in the primary care setting.
Authors: Hoopes M. , Schmidt T. , Huguet N. , Winters-Stone K. , Angier H. , Marino M. , Shannon J. , DeVoe J. .
Source: Cancer, 2019-12-15; 125(24), p. 4542-4543.
EPub date: 2019-09-30.
PMID: 31568589
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Prevalence of Pre-existing Conditions Among Community Health Center Patients Before and After the Affordable Care Act.
Authors: Huguet N. , Angier H. , Hoopes M.J. , Marino M. , Heintzman J. , Schmidt T. , DeVoe J.E. .
Source: Journal of the American Board of Family Medicine : JABFM, 2019 Nov-Dec; 32(6), p. 883-889.
PMID: 31704757
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Identifying and characterizing cancer survivors in the US primary care safety net.
Authors: Hoopes M. , Schmidt T. , Huguet N. , Winters-Stone K. , Angier H. , Marino M. , Shannon J. , DeVoe J. .
Source: Cancer, 2019-10-01; 125(19), p. 3448-3456.
EPub date: 2019-06-07.
PMID: 31174231
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Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon.
Authors: Springer R. , Marino M. , Bailey S.R. , Angier H. , O'Malley J.P. , Hoopes M. , Lindner S. , DeVoe J.E. , Huguet N. .
Source: Addiction (Abingdon, England), 2019 10; 114(10), p. 1775-1784.
EPub date: 2019-06-30.
PMID: 31106483
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Use of a Preventive Index to Examine Clinic-Level Factors Associated With Delivery of Preventive Care.
Authors: Hatch B.A. , Tillotson C.J. , Huguet N. , Hoopes M.J. , Marino M. , DeVoe J.E. .
Source: American journal of preventive medicine, 2019 08; 57(2), p. 241-249.
PMID: 31326008
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Following Uninsured Patients Through Medicaid Expansion: Ambulatory Care Use and Diagnosed Conditions.
Authors: Huguet N. , Valenzuela S. , Marino M. , Angier H. , Hatch B. , Hoopes M. , DeVoe J.E. .
Source: Annals of family medicine, 2019 07; 17(4), p. 336-344.
PMID: 31285211
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Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion.
Authors: Huguet N. , Angier H. , Rdesinski R. , Hoopes M. , Marino M. , Holderness H. , DeVoe J.E. .
Source: Preventive medicine, 2019 07; 124, p. 91-97.
EPub date: 2019-05-08.
PMID: 31077723
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Racial/Ethnic Disparities in Health Insurance and Differences in Visit Type for a Population of Patients with Diabetes after Medicaid Expansion.
Authors: Angier H. , Ezekiel-Herrera D. , Marino M. , Hoopes M. , Jacobs E.A. , DeVoe J.E. , Huguet N. .
Source: Journal of health care for the poor and underserved, 2019; 30(1), p. 116-130.
PMID: 30827973
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The Impact of the Affordable Care Act (ACA) Medicaid Expansion on Visit Rates for Diabetes in Safety Net Health Centers.
Authors: Huguet N. , Springer R. , Marino M. , Angier H. , Hoopes M. , Holderness H. , DeVoe J.E. .
Source: Journal of the American Board of Family Medicine : JABFM, 2018 Nov-Dec; 31(6), p. 905-916.
PMID: 30413546
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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.
PMID: 30116701
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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 05; 56(5), p. 394-402.
PMID: 29578955
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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 Oct; 8(4), p. 206-212.
EPub date: 2017-05-17.
PMID: 28513249
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Assessing Community Cancer care after insurance ExpanSionS (ACCESS) study protocol.
Authors: Angier H. , Huguet N. , Marino M. , Mori M. , Winters-Stone K. , Shannon J. , Raynor L. , Holderness H. , DeVoe J.E. .
Source: Contemporary clinical trials communications, 2017 Sep; 7, p. 136-140.
EPub date: 2017-06-24.
PMID: 29473059
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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 09; 15(5), p. 434-442.
PMID: 28893813
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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; 12(1), p. 14.
EPub date: 2017-02-10.
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.
PMID: 28966926
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