Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

Electronic health record tools to assist with children’s insurance coverage: a mixed methods study

Authors: Jennifer E. DeVoe, Megan Hoopes, Christine A. Nelson, Deborah J. Cohen, Aleksandra Sumic, Jennifer Hall, Heather Angier, Miguel Marino, Jean P. O’Malley, Rachel Gold

Published in: BMC Health Services Research | Issue 1/2018

Login to get access

Abstract

Background

Children with health insurance have increased access to healthcare and receive higher quality care. However, despite recent initiatives expanding children’s coverage, many remain uninsured. New technologies present opportunities for helping clinics provide enrollment support for patients. We developed and tested electronic health record (EHR)-based tools to help clinics provide children’s insurance assistance.

Methods

We used mixed methods to understand tool adoption, and to assess impact of tool use on insurance coverage, healthcare utilization, and receipt of recommended care. We conducted intent-to-treat (ITT) analyses comparing pediatric patients in 4 intervention clinics (n = 15,024) to those at 4 matched control clinics (n = 12,227). We conducted effect-of-treatment-on-the-treated (ETOT) analyses comparing intervention clinic patients with tool use (n = 2240) to intervention clinic patients without tool use (n = 12,784).

Results

Tools were used for only 15% of eligible patients. Qualitative data indicated that tool adoption was limited by: (1) concurrent initiatives that duplicated the work associated with the tools, and (2) inability to obtain accurate insurance coverage data and end dates. The ITT analyses showed that intervention clinic patients had higher odds of gaining insurance coverage (adjusted odds ratio [aOR] = 1.32, 95% confidence interval [95%CI] 1.14–1.51) and lower odds of losing coverage (aOR = 0.77, 95%CI 0.68–0.88), compared to control clinic patients. Similarly, ETOT findings showed that intervention clinic patients with tool use had higher odds of gaining insurance (aOR = 1.83, 95%CI 1.64–2.04) and lower odds of losing coverage (aOR = 0.70, 95%CI 0.53–0.91), compared to patients without tool use. The ETOT analyses also showed higher rates of receipt of return visits, well-child visits, and several immunizations among patients for whom the tools were used.

Conclusions

This pragmatic trial, the first to evaluate EHR-based insurance assistance tools, suggests that it is feasible to create and implement tools that help clinics provide insurance enrollment support to pediatric patients. While ITT findings were limited by low rates of tool use, ITT and ETOT findings suggest tool use was associated with better odds of gaining and keeping coverage. Further, ETOT findings suggest that use of such tools may positively impact healthcare utilization and quality of pediatric care.

Trial registration

ClinicalTrials.gov, NCT02298361; retrospectively registered on November 5, 2014.
Appendix
Available only for authorised users
Literature
1.
Hoffman C, Paradise J. Health insurance and access to health care in the United States. Ann N Y Acad Sci. 2008;1136:149–60.CrossRefPubMed
2.
Courtemanche CJ, Zapata D. Does universal coverage improve health? The Massachusetts experience. J Policy Anal Manag. 2014;33:36–69.CrossRef
3.
Newacheck PW, Stoddard JJ, Hughes DC, Pearl M. Health insurance and access to primary care for children. N Engl J Med. 1998;338:513–9.CrossRefPubMed
4.
Schoen C, DesRoches C. Uninsured and unstably insured: the importance of continuous insurance coverage. Health Serv Res. 2000;35:187–206.PubMedPubMedCentral
5.
Olson LM, Tang SF, Newacheck PW. Children in the United States with discontinuous health insurance coverage. N Engl J Med. 2005;353:382–91.CrossRefPubMed
6.
Cassedy A, Fairbrother G, Newacheck PW. The impact of insurance instability on children's access, utilization, and satisfaction with health care. Ambul Pediatr. 2008;8:321–8.CrossRefPubMed
7.
Cummings JR, Lavarreda SA, Rice T, Brown ER. The effects of varying periods of uninsurance on children's access to health care. Pediatrics. 2009;123:e411–8.CrossRefPubMed
8.
DeVoe JE, Ray M, Krois L, Carlson MJ. Uncertain health insurance coverage and unmet children's health care needs. Fam Med. 2010;42:121–32.PubMedPubMedCentral
9.
Federico SG, Steiner JF, Beaty B, Crane L, Kempe A. Disruptions in insurance coverage: patterns and relationship to health care access, unmet need, and utilization before enrollment in the state Children's health insurance program. Pediatrics. 2007;120:e1009–16.CrossRefPubMed
10.
11.
12.
Aiken KD, Freed G, Davis M. When insurance status is not static: insurance transitions of low-income children and implications for health and health care. Acad Pediatr. 2004;4:237–43.
13.
Fairbrother GL, Emerson HP, Partridge L. How stable is medicaid coverage for children? Health Aff. 2007;26:520–8.CrossRef
14.
Sommers BD. Why millions of children eligible for Medicaid and SCHIP are uninsured: poor retention versus poor take-up. Health Aff. 2007;26:w560–7.CrossRef
15.
16.
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;132:e1584–91.CrossRefPubMedPubMedCentral
17.
Blumenthal D. Performance improvement in health care--seizing the moment. N Engl J Med. 2012;366:1953–5.CrossRefPubMed
18.
Bates DW, Bitton A. The future of health information technology in the patient-centered medical home. Health Aff (Millwood). 2010;29:614–21.CrossRef
19.
Blumenthal D. Implementation of the federal health information technology initiative. N Engl J Med. 2011;365:2426–31.CrossRefPubMed
20.
Buntin MB, Burke MF, Hoaglin MC, Blumenthal D. The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Aff (Millwood). 2011;30:464–71.CrossRef
21.
Angier H, Marino M, Sumic A, O'Malley J, Likumahuwa-Ackman S, Hoopes M, Nelson C, Gold R, Cohen D, Dickerson K, et al. Innovative methods for parents and clinics to create tools for kids' care (IMPACCT Kids' care) study protocol. Contemp Clin Trials. 2015;4:159–63.CrossRef
22.
23.
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 Manag. 2014;37:148–54.CrossRef
24.
Likumahuwa-Ackman S, Angier H, Sumic A, et al. IMPACCT kids’ care: a real-world example of stakeholder involvement in comparative effectiveness research. J Comp Eff Res. 2015;4:351–7.CrossRefPubMedPubMedCentral
25.
DeVoe JE, Gold R, Spofford M, Chauvie S, Muench J, Turner A, Likumahuwa S, Nelson C. Developing a network of community health centers with a common electronic health record: description of the safety net west practice-based research network (SNW-PBRN). J Am Board Med. 2011;24:597–604.CrossRef
26.
Devoe JE, Sears A. The OCHIN community information network: bringing together community health centers, information technology, and data to support a patient-centered medical village. J Am Board Fam Med. 2013;26:271–8.CrossRefPubMed
27.
Rosenbaum PR, Rubin DB. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat. 1985;39:33–8.
28.
Angier H, Gold R, Gallia C, Casciato A, Tillotson CJ, Marino M, Mangione-Smith R, DeVoe JE. Variation in outcomes of quality measurement by data source. Pediatrics. 2014;133:e1676–82.CrossRefPubMedPubMedCentral
29.
Gold R, Angier H, Mangione-Smith R, Gallia C, McIntire PJ, Cowburn S, Tillotson C, DeVoe JE. Feasibility of evaluating the CHIPRA care quality measures in electronic health record data. Pediatrics. 2012;130:139–49.CrossRefPubMedPubMedCentral
30.
Angier H, Gold R, Crawford C, P O’Malley J, J Tillotson C, Marino M, JE DV. Linkage methods for connecting children with parents in electronic health record and state public health insurance data. Matern Child Health J. 2014;18:2025–33.CrossRefPubMedPubMedCentral
31.
Centers for Medicare & Medicaid Services. Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP (Child Core Set): Technical Specifications and Resource Manual for Federal Fiscal Year 2015 Reporting.
32.
33.
Glaser BG. Conceptualization: on theory and theorizing using grounded theory. Int J Qual Methods. 2002;1:23–38.CrossRef
34.
HRSA Health Center Program. Health Center Outreach and Enrollment Technical Assistance.
35.
36.
37.
DeVoe JE, Huguet N, Likumahuwa-Ackman S, Angier H, Nelson C, Marino M, Cohen D, Sumic A, Hoopes M, Harding RL, et al. Testing health information technology tools to facilitate health insurance support: a protocol for an effectiveness-implementation hybrid randomized trial. Implement Sci. 2015;10:123.CrossRefPubMedPubMedCentral
38.
DeVoe JE, Tillotson CJ, Lesko SE, Wallace LS, Angier H. The case for synergy between a usual source of care and health insurance coverage. J Gen Intern Med. 2011;26:1059–66.CrossRefPubMedPubMedCentral
Metadata
Title
Electronic health record tools to assist with children’s insurance coverage: a mixed methods study
Authors
Jennifer E. DeVoe
Megan Hoopes
Christine A. Nelson
Deborah J. Cohen
Aleksandra Sumic
Jennifer Hall
Heather Angier
Miguel Marino
Jean P. O’Malley
Rachel Gold
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3159-x

Other articles of this Issue 1/2018

BMC Health Services Research 1/2018 Go to the issue

Research article

State variation in opioid treatment policies and opioid-related hospital readmissions

Research article

Exploring reasoning mechanisms in ward rounds: a critical realist multiple case study

Research article

Cross-sectoral integration in youth-focused health and social services in Canada: a social network analysis

Research article

Self-reported use of family physician, chiropractor and physiotherapy services among adult Canadians with chronic back disorders: an observational study

Research article

Services according to mental health needs for youth in foster care? – A multi-informant study

Research article

Health literacy profile of recently hospitalised patients in the private hospital setting: a cross sectional survey using the Health Literacy Questionnaire (HLQ)