IMPACCT for Kids' Care

NCT ID: NCT02298361

Last Updated: 2016-06-02

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

27251 participants

Study Classification

OBSERVATIONAL

Study Start Date

2013-03-31

Study Completion Date

2016-02-29

Brief Summary

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Health insurance is important for children. Public insurance programs are available to many children, but some families report being confused about how to get and keep this insurance. Community Health Centers (CHCs) can help families get and keep health insurance for their children.

The investigators will work with families, policy makers, and community health care providers and staff to develop and test new computer health information technology (IT) tools to help health care clinics find pediatric patients in need of insurance and communicate with their families about public insurance programs. These tools will be based on technologies currently used to help patients and clinics manage chronic diseases. The investigators will test the tools by comparing four clinics using the tools and four clinics not using the tools. The investigators will look to see if children in the clinics using the tools are more likely to have health insurance and also more likely to receive certain health care services, compared to children in the clinics without such tools. The investigators will also look at health insurance rates and health care services for a larger population of Oregon children.

Detailed Description

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Summary of protocol changes made:

1. Changes to eligibility criteria. We changed patient eligibility to include all pediatric patients through age 19 with \>=1 clinical visit in the study period. These decisions were based on: 1) at age 20, individuals are no longer eligible for children's Medicaid or CHIP in Oregon; 2) identification of PCP assignment was difficult in the EHR.
2. Added second comparison group/study arm. In the intervention clinics, the tools were used on a smaller number of pediatric patients than anticipated, and there were significant demographic differences between intervention and control site patients, despite the clinics being matched. Thus we added a second comparison group, "within-clinic comparison patients" as pediatric patients with \>=1 visit at an intervention clinic in the study period but on whom the tools were NOT used. This provided a comparison group that accounted for clinic-level effects and was more demographically similar to the "intervention patients" on whom tools were used.
3. Revision of Aim 3 - CHIPRA recommended care assessment. We did not pursue assessment of CHIPRA quality care measures due to 1) limited follow-up time due to the need to implement iterative modifications to the study HIT tools, and 2) the tools were used on a smaller set of pediatric patients than anticipated, thus we had a very limited denominator for these analyses.

Conditions

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Insurance Status/Stability

Study Design

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Study Time Perspective

PROSPECTIVE

Study Groups

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Intervention patients

Community Health Centers that implemented health insurance outreach IT tools: active patients on whom tools were used

Health insurance outreach IT tools

Intervention Type OTHER

IT tools that support Community Health Centers in children's health insurance outreach efforts ("insurance outreach IT tools"), adapted from tools proven to support chronic disease management.

Within-clinic comparison patients

Community Health Centers that implemented health insurance outreach IT tools: active patients on whom tools were not used

No interventions assigned to this group

Control clinic comparison patients

Matched Community Health Centers that did not implement health insurance outreach IT tools: active patients

No interventions assigned to this group

Interventions

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Health insurance outreach IT tools

IT tools that support Community Health Centers in children's health insurance outreach efforts ("insurance outreach IT tools"), adapted from tools proven to support chronic disease management.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* age 0-19
* established patient (\>=1 clinical visit at a study clinic in the assessment period)

Exclusion Criteria

* age \> 19
* not an established patient
Maximum Eligible Age

19 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Oregon Health and Science University

OTHER

Sponsor Role collaborator

OCHIN, Inc.

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jennifer DeVoe, MD, DPhil

Role: PRINCIPAL_INVESTIGATOR

OCHIN, OHSU

Christine Nelson, RN, PhD

Role: STUDY_DIRECTOR

OCHIN, Inc.

References

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Devoe JE. Being uninsured is bad for your health: can medical homes play a role in treating the uninsurance ailment? Ann Fam Med. 2013 Sep-Oct;11(5):473-6. doi: 10.1370/afm.1541.

Reference Type BACKGROUND
PMID: 24019280 (View on PubMed)

Angier H, Gold R, Crawford C, P O'Malley J, J Tillotson C, Marino M, DeVoe JE. Linkage methods for connecting children with parents in electronic health record and state public health insurance data. Matern Child Health J. 2014 Nov;18(9):2025-33. doi: 10.1007/s10995-014-1453-8.

Reference Type BACKGROUND
PMID: 24562505 (View on PubMed)

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 Manage. 2014 Apr-Jun;37(2):148-54. doi: 10.1097/JAC.0000000000000016.

Reference Type BACKGROUND
PMID: 24594562 (View on PubMed)

DeVoe JE, Tillotson CJ, Angier H, Wallace LS. Predictors of children's health insurance coverage discontinuity in 1998 versus 2009: parental coverage continuity plays a major role. Matern Child Health J. 2015 Apr;19(4):889-96. doi: 10.1007/s10995-014-1590-0.

Reference Type BACKGROUND
PMID: 25070735 (View on PubMed)

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 Dec;132(6):e1584-91. doi: 10.1542/peds.2013-1470. Epub 2013 Nov 18.

Reference Type BACKGROUND
PMID: 24249814 (View on PubMed)

Angier H, Likumahuwa S, Finnegan S, Vakarcs T, Nelson C, Bazemore A, Carrozza M, DeVoe JE. Using geographic information systems (GIS) to identify communities in need of health insurance outreach: An OCHIN practice-based research network (PBRN) report. J Am Board Fam Med. 2014 Nov-Dec;27(6):804-10. doi: 10.3122/jabfm.2014.06.140029.

Reference Type BACKGROUND
PMID: 25381078 (View on PubMed)

DeVoe JE, Angier H, Burdick T, Gold R. Health information technology: an untapped resource to help keep patients insured. Ann Fam Med. 2014 Nov-Dec;12(6):568-72. doi: 10.1370/afm.1721.

Reference Type BACKGROUND
PMID: 25384821 (View on PubMed)

Angier H, Hoopes M, Gold R, Bailey SR, Cottrell EK, Heintzman J, Marino M, DeVoe JE. An early look at rates of uninsured safety net clinic visits after the Affordable Care Act. Ann Fam Med. 2015 Jan-Feb;13(1):10-6. doi: 10.1370/afm.1741.

Reference Type BACKGROUND
PMID: 25583886 (View on PubMed)

Heintzman J, Marino M, Hoopes M, Bailey SR, Gold R, O'Malley J, Angier H, Nelson C, Cottrell E, Devoe J. Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data? J Am Med Inform Assoc. 2015 Jul;22(4):909-13. doi: 10.1093/jamia/ocv033. Epub 2015 Apr 17.

Reference Type BACKGROUND
PMID: 25888586 (View on PubMed)

DeVoe JE, Crawford C, Angier H, O'Malley J, Gallia C, Marino M, Gold R. The Association Between Medicaid Coverage for Children and Parents Persists: 2002-2010. Matern Child Health J. 2015 Aug;19(8):1766-74. doi: 10.1007/s10995-015-1690-5.

Reference Type BACKGROUND
PMID: 25874876 (View on PubMed)

Gold R, Burdick T, Angier H, Wallace L, Nelson C, Likumahuwa-Ackman S, Sumic A, DeVoe JE. Improve Synergy Between Health Information Exchange and Electronic Health Records to Increase Rates of Continuously Insured Patients. EGEMS (Wash DC). 2015 Aug 6;3(1):1158. doi: 10.13063/2327-9214.1158. eCollection 2015.

Reference Type BACKGROUND
PMID: 26355818 (View on PubMed)

DeVoe JE, Tillotson CJ, Marino M, O'Malley J, Angier H, Wallace LS, Gold R. Trends in Type of Health Insurance Coverage for US Children and Their Parents, 1998-2011. Acad Pediatr. 2016 Mar;16(2):192-9. doi: 10.1016/j.acap.2015.06.009. Epub 2015 Aug 18.

Reference Type BACKGROUND
PMID: 26297668 (View on PubMed)

Angier H, Marino M, Sumic A, O'Malley J, Likumahuwa-Ackman S, Hoopes M, Nelson C, Gold R, Cohen D, Dickerson K, DeVoe JE. Innovative methods for parents and clinics to create tools for kids' care (IMPACCT Kids' Care) study protocol. Contemp Clin Trials. 2015 Sep;44:159-163. doi: 10.1016/j.cct.2015.08.010. Epub 2015 Aug 18.

Reference Type BACKGROUND
PMID: 26291916 (View on PubMed)

Arkind J, Likumahuwa-Ackman S, Warren N, Dickerson K, Robbins L, Norman K, DeVoe JE. Lessons Learned from Developing a Patient Engagement Panel: An OCHIN Report. J Am Board Fam Med. 2015 Sep-Oct;28(5):632-8. doi: 10.3122/jabfm.2015.05.150009.

Reference Type BACKGROUND
PMID: 26355135 (View on PubMed)

Likumahuwa-Ackman S, Angier H, Sumic A, Harding RL, Cottrell EK, Cohen DJ, Nelson CA, Burdick TE, Wallace LS, Gallia C, DeVoe JE. IMPACCT Kids' Care: a real-world example of stakeholder involvement in comparative effectiveness research. J Comp Eff Res. 2015 Aug;4(4):351-7. doi: 10.2217/cer.15.24.

Reference Type BACKGROUND
PMID: 26274796 (View on PubMed)

Hoopes MJ, Angier H, Gold R, Bailey SR, Huguet N, Marino M, DeVoe JE. Utilization of Community Health Centers in Medicaid Expansion and Nonexpansion States, 2013-2014. J Ambul Care Manage. 2016 Oct-Dec;39(4):290-8. doi: 10.1097/JAC.0000000000000123.

Reference Type BACKGROUND
PMID: 26765808 (View on PubMed)

Hatch B, Tillotson C, Angier H, Marino M, Hoopes M, Huguet N, DeVoe J. Using the electronic health record for assessment of health insurance in community health centers. J Am Med Inform Assoc. 2016 Sep;23(5):984-90. doi: 10.1093/jamia/ocv179. Epub 2016 Jan 23.

Reference Type BACKGROUND
PMID: 26911812 (View on PubMed)

DeVoe JE, Hoopes M, Nelson CA, Cohen DJ, Sumic A, Hall J, Angier H, Marino M, O'Malley JP, Gold R. Electronic health record tools to assist with children's insurance coverage: a mixed methods study. BMC Health Serv Res. 2018 May 10;18(1):354. doi: 10.1186/s12913-018-3159-x.

Reference Type DERIVED
PMID: 29747644 (View on PubMed)

Other Identifiers

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PCORI Award (308)

Identifier Type: -

Identifier Source: org_study_id

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