Assessing a Medicaid Randomized Insurance Experiment Within Community Clinics

Study Overview
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Brief Summary
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This study examines the impact of a randomized insurance experiment on preventive services receipt and healthcare utilization in safety net patients using linked public insurance claims and safety net clinics' electronic health record (EHR) data.

Detailed Description
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In 2008, the Oregon Medicaid program used a lottery (Oregon Experiment) to allocate limited insurance resources to low income adults who did not categorically qualify for traditional Medicaid coverage. Thousands were randomly selected to apply for Medicaid; many others were not selected. This natural policy experiment is the first population-level randomization of insurance coverage since Rand's 1971-1982 experiment. We will use data from safety net clinics that share a common electronic health record (EHR) operated by OCHIN, a non-profit organization in Portland, Oregon. As one of the nation's largest linked community health center networks, the OCHIN EHR database records nearly all visits to safety net clinics in Oregon with one patient chart linked across >100 community health centers. We will link Medicaid claims data and the OCHIN database to determine patients that had applied to participate in the Oregon Experiment, as well as to determine those that gained insurance via this experiment. We will test the hypothesis that public insurance coverage is associated with higher rates of receiving preventive care services and increased healthcare utilization among persons with a usual source of primary care. To that end, we will analyze preventive care and utilization patterns among the OCHIN clinic patients affected by Oregon's Medicaid Experiment. This study capitalizes on two unique opportunities: an EHR database linking >100 community health centers, and the quasi-experimental design of Oregon's randomized Medicaid experiment. The specific aims related to the Oregon Experiment are: 1) To compare post-intervention rates of preventive services receipt among OCHIN patients randomized to the Oregon Experiment group (intervention group), compared to those not in the coverage group (comparison group); and 3) To compare post-intervention rates of ambulatory healthcare utilization among OCHIN patients randomized to the Oregon Experiment group (intervention group), compared to those not in the coverage group (comparison group).

Official Title
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Assessing a Medicaid Randomized Insurance Experiment Within Community Clinics

Conditions
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Cardiovascular Disease, Cancer

Intervention / Treatment
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* Other: Insurance Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: must have applied for the Oregon Experiment in 2006 must have been a patient in an Oregon safety net clinic that is part of the OCHIN, Inc network for preventive services outcomes only, matched patients had to have been at a clinic with an electronic health record system by 3/11/08 Exclusion Criteria: under 19 years of age over 64 years of age not alive at the end of the 36 month post-period unknown/missing gender

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 64 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Insurance Intervention Arm<br>Oregon OCHIN patients that put their names on the reservation list for the Oregon Experiment and were randomly chosen to apply for insurance coverage via the Oregon Experiment | Other: Insurance Intervention<br>* Random selection to apply for Medicaid coverage through Oregon Experiment drawings held between March and October 2008<br>|
| Control<br>Oregon OCHIN patients that put their names on the reservation list for the Oregon Experiment and were not chosen to apply for insurance coverage via the Oregon Experiment | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Preventive service receipt | Number of patients with receipt of the following preventive services in the post-period (each outcome assessed individually by whether person met age, gender, and diagnosis criteria (if applicable): body mass index, blood pressure, smoking, pap test, mammography, colorectal cancer screening, chlamydia screening, lipid test, flu vaccination, pneumococcal vaccination, HbA1c test, glucose test) using ICD-9-CM diagnosis and procedure codes, CPT and HCPCS codes, LOINC codes, medication codes, relevant code groupings and codes specific to the OCHIN EHR. | 36 months post Oregon Experiment selection (post-period) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ambulatory healthcare utilization | Number of visits in the post-period for the following services: total primary care office visits, total behavioral/mental health visits, labs, referrals, immunizations, imaging) | 36 months post Oregon Experiment selection (post-period) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Medicaid, public insurance, cardiovascular disease, prevention, community health centers, electronic health records, cancer prevention