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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

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.

Condition or disease Intervention/treatment
Cardiovascular Disease Cancer Other: Insurance Intervention

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).

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Study Type : Observational
Actual Enrollment : 308283 participants
Observational Model: Case-Control
Time Perspective: Retrospective
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

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Medicaid

Group/Cohort Intervention/treatment
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

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



Primary Outcome Measures :
  1. 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.


Secondary Outcome Measures :
  1. 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)



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Ages Eligible for Study:   19 Years to 64 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
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.
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

Information from the National Library of Medicine

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


Sponsors and Collaborators
Oregon Health and Science University
Kaiser Foundation Hospitals, Center for Health Research
OCHIN, Inc.
National Heart, Lung, and Blood Institute (NHLBI)
Investigators
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Principal Investigator: Jennifer E DeVoe, MD, DPhil Oregon Health and Science University
Study Director: Heather Angier, MPH Oregon Health & Science Univerisity
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Jennifer E DeVoe, MD DPhil, Associate Professor, Oregon Health and Science University
ClinicalTrials.gov Identifier: NCT02355132    
Other Study ID Numbers: IRB00007327
R01HL107647 ( U.S. NIH Grant/Contract )
First Posted: February 4, 2015    Key Record Dates
Last Update Posted: May 19, 2016
Last Verified: October 2015
Keywords provided by Jennifer E DeVoe, MD DPhil, Oregon Health and Science University:
Medicaid
public insurance
cardiovascular disease
prevention
community health centers
electronic health records
cancer prevention
Additional relevant MeSH terms:
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Cardiovascular Diseases