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
|Condition or disease||Intervention/treatment|
|Cardiovascular Disease Cancer||Other: Insurance Intervention|
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|
|Actual Enrollment :||308283 participants|
|Official Title:||Assessing a Medicaid Randomized Insurance Experiment Within Community Clinics|
|Study Start Date :||August 2011|
|Actual Primary Completion Date :||March 2016|
|Actual Study Completion Date :||March 2016|
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
Other: Insurance Intervention
Random selection to apply for Medicaid coverage through Oregon Experiment drawings held between March and October 2008
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
- 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.
- 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)
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02355132
|Principal Investigator:||Jennifer E DeVoe, MD, DPhil||Oregon Health and Science University|
|Study Director:||Heather Angier, MPH||Oregon Health & Science Univerisity|