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Assessing a Medicaid Randomized Insurance Experiment Within Community Clinics (AMRIC)

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ClinicalTrials.gov Identifier: NCT02355132
Recruitment Status : Completed
First Posted : February 4, 2015
Last Update Posted : May 19, 2016
Sponsor:
Collaborators:
Kaiser Foundation Hospitals, Center for Health Research
OCHIN, Inc.
National Heart, Lung, and Blood Institute (NHLBI)
Information provided by (Responsible Party):
Jennifer E DeVoe, MD DPhil, Oregon Health and Science University

Tracking Information
First Submitted Date January 30, 2015
First Posted Date February 4, 2015
Last Update Posted Date May 19, 2016
Study Start Date August 2011
Actual Primary Completion Date March 2016   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures
 (submitted: January 30, 2015)
Preventive service receipt [ Time Frame: 36 months post Oregon Experiment selection (post-period) ]
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.
Original Primary Outcome Measures Same as current
Change History
Current Secondary Outcome Measures
 (submitted: January 30, 2015)
Ambulatory healthcare utilization [ Time Frame: 36 months post Oregon Experiment selection (post-period) ]
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)
Original Secondary Outcome Measures Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title Assessing a Medicaid Randomized Insurance Experiment Within Community Clinics
Official Title Assessing a Medicaid Randomized Insurance Experiment Within Community Clinics
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).

Study Type Observational
Study Design Observational Model: Case-Control
Time Perspective: Retrospective
Target Follow-Up Duration Not Provided
Biospecimen Not Provided
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.
Condition
  • Cardiovascular Disease
  • Cancer
Intervention Other: Insurance Intervention
Random selection to apply for Medicaid coverage through Oregon Experiment drawings held between March and October 2008
Study Groups/Cohorts
  • Insurance Intervention Arm
    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
    Intervention: Other: Insurance Intervention
  • Control
    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
Publications *

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status Completed
Actual Enrollment
 (submitted: May 18, 2016)
308283
Original Actual Enrollment
 (submitted: January 30, 2015)
34849
Actual Study Completion Date March 2016
Actual Primary Completion Date March 2016   (Final data collection date for primary outcome measure)
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
Sex/Gender
Sexes Eligible for Study: All
Ages 19 Years to 64 Years   (Adult)
Accepts Healthy Volunteers Yes
Contacts Contact information is only displayed when the study is recruiting subjects
Listed Location Countries Not Provided
Removed Location Countries  
 
Administrative Information
NCT Number NCT02355132
Other Study ID Numbers IRB00007327
R01HL107647 ( U.S. NIH Grant/Contract )
Has Data Monitoring Committee No
U.S. FDA-regulated Product Not Provided
IPD Sharing Statement Not Provided
Responsible Party Jennifer E DeVoe, MD DPhil, Oregon Health and Science University
Study Sponsor Oregon Health and Science University
Collaborators
  • Kaiser Foundation Hospitals, Center for Health Research
  • OCHIN, Inc.
  • National Heart, Lung, and Blood Institute (NHLBI)
Investigators
Principal Investigator: Jennifer E DeVoe, MD, DPhil Oregon Health and Science University
Study Director: Heather Angier, MPH Oregon Health & Science Univerisity
PRS Account Oregon Health and Science University
Verification Date October 2015