Clinical trial NCT02355132: Assessing a Medicaid Randomized Insurance Experiment Within Community Clinics
Official title: Assessing a Medicaid Randomized Insurance Experiment Within Community Clinics
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Cardiovascular Disease
Cancer
Keywords: Medicaid
public insurance
cardiovascular disease
prevention
community health centers
electronic health records
cancer prevention
Lead sponsor: Oregon Health and Science University
Sponsor class: OTHER
Collaborators: name: Kaiser Foundation Hospitals, Center for Health Research
name: OCHIN, Inc.
name: National Heart, Lung, and Blood Institute (NHLBI)
First posted: 2015-02-04
Enrollment: 308283
Sex: ALL
Minimum age (years): 19
Maximum age (years): 64
Standard ages: ADULT
Accepts healthy volunteers: yes
Observational model: CASE_CONTROL
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Adult individuals on the Oregon Experiment 'reservation list' (applied for the Oregon Experiment) linked to individual patients in an Oregon safety net clinic that is part of the OCHIN, Inc network using Link Plus software and demographic variables common to both datasets.

Brief summary: 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: 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).

Eligibility criteria: 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

Primary outcomes:
measure: Preventive service receipt
timeFrame: 36 months post Oregon Experiment selection (post-period)
Secondary outcomes:
measure: Ambulatory healthcare utilization
timeFrame: 36 months post Oregon Experiment selection (post-period)
Other outcomes:
Locations:
Study officials:
affiliation: Oregon Health and Science University
name: Jennifer E DeVoe, MD, DPhil
role: PRINCIPAL_INVESTIGATOR
affiliation: Oregon Health & Science Univerisity
name: Heather Angier, MPH
role: STUDY_DIRECTOR
References:
citation: Hatch B, Marino M, Killerby M, Angier H, Hoopes M, Bailey SR, Heintzman J, O'Malley JP, DeVoe JE. Medicaid's Impact on Chronic Disease Biomarkers: A Cohort Study of Community Health Center Patients. J Gen Intern Med. 2017 Aug;32(8):940-947. doi: 10.1007/s11606-017-4051-9. Epub 2017 Apr 3.
citation: Bailey SR, Heintzman JD, Marino M, Hoopes MJ, Hatch BA, Gold R, Cowburn SC, Nelson CA, Angier HE, DeVoe JE. Measuring Preventive Care Delivery: Comparing Rates Across Three Data Sources. Am J Prev Med. 2016 Nov;51(5):752-761. doi: 10.1016/j.amepre.2016.07.004. Epub 2016 Aug 10.
citation: DeVoe JE, Marino M, Gold R, Hoopes MJ, Cowburn S, O'Malley JP, Heintzman J, Gallia C, McConnell KJ, Nelson CA, Huguet N, Bailey SR. Community Health Center Use After Oregon's Randomized Medicaid Experiment. Ann Fam Med. 2015 Jul-Aug;13(4):312-20. doi: 10.1370/afm.1812.