Testing health information technology tools to facilitate health insurance support: a protocol for an effectiveness-implementation hybrid randomized trial

Jennifer E DeVoe, Nathalie Huguet, Sonja Likumahuwa-Ackman, Heather Angier, Christine Nelson, Miguel Marino, Deborah Cohen, Aleksandra Sumic, Megan Hoopes, Rose L Harding, Marla Dearing, Rachel Gold, Jennifer E DeVoe, Nathalie Huguet, Sonja Likumahuwa-Ackman, Heather Angier, Christine Nelson, Miguel Marino, Deborah Cohen, Aleksandra Sumic, Megan Hoopes, Rose L Harding, Marla Dearing, Rachel Gold

Abstract

Background: Patients with gaps in health insurance coverage often defer or forgo cancer prevention services. These delays in cancer detection and diagnoses lead to higher rates of morbidity and mortality and increased costs. Recent advances in health information technology (HIT) create new opportunities to enhance insurance support services that reduce coverage gaps through automated processes applied in healthcare settings. This study will assess the implementation of insurance support HIT tools and their effectiveness at improving patients' insurance coverage continuity and cancer screening rates.

Methods/design: This study uses a hybrid cluster-randomized design-a combined effectiveness and implementation trial-in community health centers (CHCs) in the USA. Eligible CHC clinic sites will be randomly assigned to one of two groups in the trial's implementation component: tools + basic training (Arm I) and tools + enhanced training + facilitation (Arm II). A propensity score-matched control group of clinics will be selected to assess the tools' effectiveness. Quantitative analyses of the tools' impact will use electronic health record and Medicaid data to assess effectiveness. Qualitative data will be collected to evaluate the implementation process, understand how the HIT tools are being used, and identify facilitators and barriers to their implementation and use.

Discussion: This study will test the effectiveness of HIT tools to enhance insurance support in CHCs and will compare strategies for facilitating their implementation in "real-world" practice settings. Findings will inform further development and, if indicated, more widespread implementation of insurance support HIT tools.

Trial registration: Clinical trial NTC02355262.

Trial registration: ClinicalTrials.gov NCT02355262.

Figures

Fig. 1
Fig. 1
Effectiveness-implementation hybrid design

References

    1. Shi L, Lebrun LA, Zhu J, Tsai J. Cancer screening among racial/ethnic and insurance groups in the United States: a comparison of disparities in 2000 and 2008. J Health Care Poor Underserved. 2011;22(3):945–61. doi: 10.1353/hpu.2011.0079.
    1. Farkas DT, Greenbaum A, Singhal V, Cosgrove JM. Effect of insurance status on the stage of breast and colorectal cancers in a safety-net hospital. Am J Manag Care. 2012;18(5 Spec No. 2):SP65–70.
    1. Carney PA, O'Malley J, Buckley DI, Mori M, Lieberman DA, Fagnan LJ, et al. Influence of health insurance coverage on breast, cervical, and colorectal cancer screening in rural primary care settings. Cancer. 2012;118(24):6217–25. doi: 10.1002/cncr.27635.
    1. American Cancer Society. Cancer facts and figures, 2008. . Accessed September 15 2009.
    1. Robinson JMSV. The role of health insurance coverage in cancer screening utilization. J Health Care Poor Underserved. 2008;19(3):842–56. doi: 10.1353/hpu.0.0048.
    1. Swan JBN, Coates RJ, Rimer BK, Lee NC. Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer. 2003;97(6):1528–40. doi: 10.1002/cncr.11208.
    1. DeVoe J, Fryer G, Phillips R, Green L. Receipt of preventive care among adults: insurance status and usual source of care. Am J Public Health. 2003;93:786–91. doi: 10.2105/AJPH.93.5.786.
    1. Mandelblatt JS, Yabroff KR, Kerner JF. Equitable access to cancer services: a review of barriers to quality care. Cancer. 1999;86:2378–90. doi: 10.1002/(SICI)1097-0142(19991201)86:11<2378::AID-CNCR28>;2-L.
    1. Baicker K, Finkelstein A. The effects of Medicaid expansion: learning from the Oregon experiment. N Engl J Med. 2011;365(8):683–5. doi: 10.1056/NEJMp1108222.
    1. McWilliams JM, Zaslavsky AM, Meara E, Ayanian JZ. Impact of Medicare coverage on basic clinical services for previously uninsured adults. JAMA. 2003;290(6):757–64. doi: 10.1001/jama.290.6.757.
    1. McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Use of health services by previously uninsured Medicare beneficiaries. N Engl J Med. 2007;357(2):143–53. doi: 10.1056/NEJMsa067712.
    1. Busch SH, Duchovny N. Family coverage expansions: impact on insurance coverage and health care utilization of parents. J Health Econ. 2005;24(5):876–90. doi: 10.1016/j.jhealeco.2005.03.007.
    1. Bednarek HL, Steinberg SB. Variation in preventive service use among the insured and uninsured: does length of time without coverage matter? J Health Care Poor Underserved. 2003;14(3):403–19. doi: 10.1353/hpu.2010.0529.
    1. Bradley CJ, Gandhi SO, Neumark D, Garland S, Retchin SM. Lessons for coverage expansion: a Virginia primary care program for the uninsured reduced utilization and cut costs. Health Aff (Millwood) 2012;31(2):350–9. doi: 10.1377/hlthaff.2011.0857.
    1. Siminoff LA, Ross L. Access and equity to cancer care in the USA: a review and assessment. Postgrad Med J. 2005;81(961):674–9. doi: 10.1136/pgmj.2005.032813.
    1. Slatore CG, Au DH, Gould MK, American Thoracic Society Disparities in Healthcare Group An official American Thoracic Society systematic review: insurance status and disparities in lung cancer practices and outcomes. Am J Respir Crit Care Med. 2010;182(9):1195–205. doi: 10.1164/rccm.2009-038ST.
    1. Bradley CJ, Dahman B, Bear HD. Insurance and inpatient care: differences in length of stay and costs between surgically treated cancer patients. Cancer. 2012;118(20):5084–91. doi: 10.1002/cncr.27508.
    1. Roetzheim RG, Pal N, Gonzalez EC, Ferrante JM, Van Durme DJ, Krischer JP. Effects of health insurance and race on colorectal cancer treatments and outcomes. Am J Public Health. 2000;90(11):1746–54. doi: 10.2105/AJPH.90.11.1746.
    1. Schootman M, Walker MS, Jeffe DB, Rohrer JE, Baker EA. Breast cancer screening and incidence in communities with a high proportion of uninsured. Am J Prev Med. 2007;33(5):379–86. doi: 10.1016/j.amepre.2007.07.032.
    1. Harvin JA, Van Buren G, Tsao K, Cen P, Ko TC, Wray CJ. Hepatocellular carcinoma survival in uninsured and underinsured patients. J Surg Res. 2011;166(2):189–93. doi: 10.1016/j.jss.2010.04.036.
    1. Miller DC, Litwin MS, Bergman J, Stepanian S, Connor SE, Kwan L, et al. Prostate cancer severity among low income, uninsured men. J Urol. 2009;181(2):579–84. doi: 10.1016/j.juro.2008.10.010.
    1. Ward E, Halpern M, Schrag N, Cokkinides V, DeSantis C, Bandi P, et al. Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin. 2008;58(1):9–31. doi: 10.3322/CA.2007.0011.
    1. Morgan D. Health centers for poor, uninsured see ranks swell. 2012. . Accessed February 21 2013.
    1. National Association of Community Health Centers. A sketch of community health centers, chart book 2014. Bethesda, M.D: National Association of Community Health Centers. 2014. Accessed August 17 2015.
    1. Henry J. Kaiser Family Foundation. Summary of the Affordable Care Act. Menlo Park, CA: Henry J. Kaiser Family Foundation. 2013 Contract No.: 8061-02. Accessed August 17 2015.
    1. Young AS, Chaney E, Shoai R, Bonner L, Cohen AN, Doebbeling B, et al. Information technology to support improved care for chronic illness. J Gen Intern Med. 2007;22(Suppl 3):425–30. doi: 10.1007/s11606-007-0303-4.
    1. Sequist TD, Zaslavsky AM, Marshall R, Fletcher RH, Ayanian JZ. Patient and physician reminders to promote colorectal cancer screening: a randomized controlled trial. Arch Intern Med. 2009;169(4):364–71. doi: 10.1001/archinternmed.2008.564.
    1. Nease DE, Jr, Ruffin MT, Klinkman MS, Jimbo M, Braun TM, Underwood JM. Impact of a generalizable reminder system on colorectal cancer screening in diverse primary care practices: a report from the prompting and reminding at encounters for prevention project. Med Care. 2008;46(9 Suppl 1):S68–73. doi: 10.1097/MLR.0b013e31817c60d7.
    1. DeVoe JE, Angier H, Likumahuwa S, Hall J, Nelson C, Dickerson K, et al. 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 of Ambul Care Manage. 2014;37(2):148–54. doi: 10.1097/JAC.0000000000000016.
    1. DeVoe JE, Angier H, Burdick T, Gold R. Health information technology—an untapped resource for patient-centered medical homes to help keep patients insured. Ann Fam Med. 2014;12(6):568–72. doi: 10.1370/afm.1721.
    1. Gold R, Nelson C, Cowburn S, Bunce A, Hollombe C, Davis J, et al. Feasibility and impact of implementing a private care system’s diabetes quality improvement intervention in the safety net: a cluster-randomized trial. Implement Sci. 2015;10:83. doi: 10.1186/s13012-015-0259-4.
    1. Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217–26. doi: 10.1097/MLR.0b013e3182408812.
    1. DeVoe J, Angier H, Likumahuwa S, Hall J, Nelson C, Dickerson K, et al. 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;37(2):148–54. doi: 10.1097/JAC.0000000000000016.
    1. Gold R, Muench J, Hill C, Turner A, Mital M, Milano C, et al. Collaborative development of a randomized study to adapt a diabetes quality improvement initiative for federally qualified health centers. J Health Care Poor Underserved. 2012;23(3 Suppl):236–46. doi: 10.1353/hpu.2012.0132.
    1. Heintzman J, Gold R, Krist A, Crosson J, Likumahuwa S, DeVoe JE. Practice-based research networks (PBRNs) are promising laboratories for conducting dissemination and implementation research. J Am Board Fam Med. 2014;27(6):759–62. doi: 10.3122/jabfm.2014.06.140092.
    1. Cully JA, Armento ME, Mott J, Nadorff MR, Naik AD, Stanley MA, et al. Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design. Implement Sci. 2012;7:64. doi: 10.1186/1748-5908-7-64.
    1. Smith JD, Stormshak EA, Kavanagh K. Results of a pragmatic effectiveness-implementation hybrid trial of the family check-up in community mental health agencies. Adm Policy Ment Health. 2014. doi:10.1007/s10488-014-0566-0
    1. van Dijk-de Vries A, van Bokhoven MA, Terluin B, van der Weijden T, van Eijk JT. Integrating nurse-led Self-Management Support (SMS) in routine primary care: design of a hybrid effectiveness-implementation study among type 2 diabetes patients with problems of daily functioning and emotional distress: a study protocol. BMC Fam Pract. 2013;14:77. doi: 10.1186/1471-2296-14-77.
    1. D'Agostino RB., Jr Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17(19):2265–81. doi: 10.1002/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>;2-B.
    1. Rosenbaum PR, Rubin DB. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Statistician. 1985;39:33–8.
    1. Guo SY, Fraser MW. Propensity score analysis: statistical methods and 716 applications. Thousand Oaks, CA: Sage Publications. 2014.
    1. Henry J. Kaiser Family Foundation. Status of state action on the Medicaid expansion decision, 2014. Menlo Park, CA. 2014. . Accessed August 20 2014.
    1. Centers for Disease Control and Prevention (CDC) Cancer screening—United States, 2010. Morb Mortal Wkly Rep. 2012;61(3):41–5.
    1. Ivers NM, Halperin IJ, Barnsley J, Grimshaw JM, Shah BR, Tu K, et al. Allocation techniques for balance at baseline in cluster randomized trials: a methodological review. Trials. 2012;13:120. doi: 10.1186/1745-6215-13-120.
    1. Bridges CB, Coyne-Beasley T, Advisory Committee on Immunization P Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older: United States, 2014. Ann Intern Med. 2014;160(3):190. doi: 10.7326/M13-2826.
    1. US Preventive Services Task Force. USPSTF A and B recommendations. October 2014. . Accessed February 3 2015.
    1. Beyer H, Holtzblatt K. Design: defining customer-centered systems. San Diego: Academic Press; 1998.
    1. Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009;28(25):3083–107. doi: 10.1002/sim.3697.
    1. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–7. doi: 10.2105/AJPH.89.9.1322.
    1. Crabtree BF, Miller WL. Doing qualitative research. 2. Thousand Oaks: Sage Publications, Inc.; 1999.
    1. Miller WL, Crabtree BF. The dance of interpretation. Doing qualitative research. 2. Thousand Oaks: Sage Publications, Inc; 1999. pp. 127–43.
    1. Borkan J. Immersion/crystallization. In: Crabtree BF, Miller WL, editors. Doing qualitative research. 2. Thousand Oaks: Sage Publications, Inc.; 1999. pp. 179–94.
    1. Cuttler L, Kenney G. State Children’s Health Insurance Program and Pediatrics. Arch Pediatr Adolesc Med. 2007;161(7):630–3. doi: 10.1001/archpedi.161.7.630.
    1. Sommers BD, Rosenbaum S. Issues in health reform: how changes in eligibility may move millions back and forth between Medicaid and insurance exchanges. Health Aff. 2011;230(2):228–36. doi: 10.1377/hlthaff.2010.1000.
    1. Klein K, Glied S, Ferry D. Entrances and exits: health insurance churning, 1998–2000. Issue Brief (Commonwealth Fund) 2005;855:1–12.
    1. Fairbrother G, Park H, Haidery A, Gray B. Periods of unmanaged care in Medicaid managed care. J Health Care Poor Underserved. 2005;16(3):444–52. doi: 10.1353/hpu.2005.0049.
    1. DeVoe JE, Krois L, Edlund C, Smith J, Carlson NE. Uninsured but eligible children: are their parents insured? Recent findings from Oregon. Med Care. 2008;46(1):3. doi: 10.1097/MLR.0b013e31815b97ac.
    1. US Census Bureau. 2008 Survey of Income and Program Government, Washington DC.. Accessed February 21 2009.
    1. Miller JE, Gaboda D, Cantor JC, Videon TM, Diaz Y. Demographics of disenrollment from SCHIP: evidence from NJ KidCare. J Health Care Poor Underserved. 2004;15(1):113–26. doi: 10.1353/hpu.2004.0007.
    1. Phillips JA, Miller JE, Cantor JC, Gaboda D. Context or composition: what explains variation in SCHIP disenrollment? Health Serv Res. 2004;39(4 Pt 1):865–85. doi: 10.1111/j.1475-6773.2004.00262.x.
    1. Cousineau MR, Stevens GD, Farias A. Measuring the impact of outreach and enrollment strategies for public health insurance in California. Health Serv Res. 2011;46(1 Pt 2):319–35. doi: 10.1111/j.1475-6773.2010.01202.x.
    1. Meng Q, Yuan B, Jia L, Wang J, Garner P. Outreach strategies for expanding health insurance coverage in children [Review] Cochrane Database Syst Rev. 2010. 8(CD008194).
    1. Wachino V, Artiga S, Rudowitz R. How is the ACA impacting Medicaid enrollment? 2014. . Accessed March 3 2015.
    1. Bright TJ, Wong A, Dhurjati R, Bristow E, Bastian L, Coeytaux RR, et al. Effect of clinical decision-support systems: a systematic review. Ann Intern Med. 2012;157(1):29–43. doi: 10.7326/0003-4819-157-1-201207030-00450.
    1. Gold R, Nichols G, Muench J, Hill C, Mital M, Dudl J et al., editors. Implementing an integrated care setting’s diabetes QI initiative in safety net clinics: a practice-based randomized trial. 5th annual NIH conference on the science of dissemination and implementation: science at the crossroads; 2012. Bethesda, MD.
    1. Gold R, DeVoe J, Shah A, Chauvie S. Insurance continuity and receipt of diabetes preventive care in Oregon’s CHCs. Med Care. 2008;47(4):431–9. doi: 10.1097/MLR.0b013e318190ccac.
    1. DeVoe JE, Gold R, McIntire P, Puro J, Chauvie S, Gallia CA. Electronic health records vs Medicaid claims: completeness of diabetes preventive care data in community health centers. Ann Fam Med. 2011;9(4):351–8. doi: 10.1370/afm.1279.
    1. Gold R, Angier H, Mangione-Smith R, Gallia C, McIntire PJ, Cowburn S, et al. Feasibility of evaluating the CHIPRA care quality measures in electronic health record data. Pediatrics. 2012;130(1):139–49. doi: 10.1542/peds.2011-3705.
    1. Gold R, DeVoe JE, McIntire PJ, Puro JE, Chauvie SL, Shah AR. Receipt of diabetes preventive care among safety net patients associated with differing levels of insurance coverage. J Am Board Fam Med. 2012;25:42–9. doi: 10.3122/jabfm.2012.01.110142.
    1. US Department of Health and Human Services. Strategic goal 1: strengthen health care. n.d. . Accessed December 23 2014.
    1. Smith JC, Medalia C, US Census Bureau. Health insurance coverage in the United States: 2013. Washington, DC: U.S. Department of Commerce Economics and Statistics Administration. 2014
    1. Centers for Disease Control and Prevention. Cancer Screening — United States, 2010. MMWR 2012;61(03):41-45.

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