Using geographic information systems (GIS) to identify communities in need of health insurance outreach: An OCHIN practice-based research network (PBRN) report

Abstract

Background: Our practice-based research network (PBRN) is conducting an outreach intervention to increase health insurance coverage for patients seen in the network. To assist with outreach site selection, we sought an understandable way to use electronic health record (EHR) data to locate uninsured patients.

Methods: Health insurance information was displayed within a web-based mapping platform to demonstrate the feasibility of using geographic information systems (GIS) to visualize EHR data. This study used EHR data from 52 clinics in the OCHIN PBRN. We included cross-sectional coverage data for patients aged 0 to 64 years with at least 1 visit to a study clinic during 2011 (n = 228,284).

Results: Our PBRN was successful in using GIS to identify intervention sites. Through use of the maps, we found geographic variation in insurance rates of patients seeking care in OCHIN PBRN clinics. Insurance rates also varied by age: The percentage of adults without insurance ranged from 13.2% to 86.8%; rates of children lacking insurance ranged from 1.1% to 71.7%. GIS also showed some areas of households with median incomes that had low insurance rates.

Discussion: EHR data can be imported into a web-based GIS mapping tool to visualize patient information. Using EHR data, we were able to observe smaller areas than could be seen using only publicly available data. Using this information, we identified appropriate OCHIN PBRN clinics for dissemination of an EHR-based insurance outreach intervention. GIS could also be used by clinics to visualize other patient-level characteristics to target clinic outreach efforts or interventions.

Keywords: Electronic Medical Records; Geographic Information Systems; Health Insurance; Practice-based Research.

© Copyright 2014 by the American Board of Family Medicine.

Figures

Figure 1

Children and Adults without Health Insurance: Rates Visualized from Electronic Health Record Data from Clinics in the OCHIN Practice-based Research Network (PBRN), by ZIP code. (A) Percentage of children without insurance at first visit:

Figure 2

Areas with High Rates of Adults and Children without Insurance in OCHIN and Median Household Income Rates by Oregon County by ZIP code. (A) Percentage of children without insurance at first visit in Lincoln, Benton, Polk, Marion Counties, Oregon:

Figure 3

Use of Geographic Information Systems (GIS) to identify clinics with patients most likely to benefit from a health insurance outreach intervention. EHR, electronic health record.