Innovative methods for parents and clinics to create tools (IMPACCT) for kids' care
Patients for whom the tool was used had higher rates of continuous insurance coverage during follow-up (62% vs 59%), and were 76% more likely to gain insurance and 29% less likely to lose insurance coverage compared with those for whom the tools were not used. Among patients with an uninsured visit,...
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| Format: | eBook |
| Language: | English |
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[Washington, D.C.]
Patient-Centered Outcomes Research Institute (PCORI)
2018, [2018]
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| Series: | Final research report
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Patients for whom the tool was used had higher rates of continuous insurance coverage during follow-up (62% vs 59%), and were 76% more likely to gain insurance and 29% less likely to lose insurance coverage compared with those for whom the tools were not used. Among patients with an uninsured visit, those for whom the tools were used were 83% more likely to have a return visit and 54% less likely to be uninsured at all return visits. Intervention patients had significantly higher rates of several recommended care quality indicators, including well-child visits, human papillomavirus vaccination, and up-to-date childhood and adolescent immunization status. LIMITATIONS: The intervention was not randomly allocated. Despite statistical regression adjustment, unmeasured differences among participating clinics may have affected results. The follow-up period may have been too short to adequately assess tool uptake and impact. Concurrent policy initiatives also may have affected tool use. BACKGROUND: Although children's health insurance coverage has expanded, some eligible children are still uninsured and others experience frequent coverage gaps. Community health centers (CHCs) care for low-income patients, many of whom are eligible for public coverage; thus, CHCs are an ideal setting for testing interventions to increase children's health insurance coverage rates. OBJECTIVES: We designed an intervention that used electronic health record (EHR)-based tools to help CHCs provide children's insurance enrollment assistance. We hypothesized that the group of children for whom the tool was used would have increased odds of gaining and maintaining coverage, increased likelihood of having return visit(s) after an uninsured visit, lower odds of being uninsured at subsequent visits, and increased rates of receiving recommended pediatric care. METHODS: We implemented EHR-based tools in 4 intervention CHCs and selected 4 matched control CHCs that did not implement the tools. CONCLUSIONS: Tool use was low but had significant impact. This pragmatic trial, the first to evaluate EHR-based health insurance enrollment support tools, suggests such tools can increase insurance enrollment, prevent coverage loss among CHC patients, and promote delivery of recommended pediatric care services. Future efforts should engage diverse stakeholders in collaboratively designing tools that can be adapted to changing initiatives and clinic environments and can support enrolling family units Using mixed methods, we assessed tool adoption and impact of tool use on insurance coverage, care utilization, and receipt of recommended care over 18 months after tool implementation, comparing 3 pediatric groups: (1) patients in the intervention clinics for whom the tools were used (n = 2240), (2) patients in the intervention clinics for whom the tools were not used (n = 12 784), and (3) patients from matched control clinics (n = 12 227). We quantitatively measured whether tool use affected insurance coverage, care utilization, and pediatric care quality. RESULTS: Overall use of the insurance assistance tool was low. The most commonly used tool, the Tracking and Documentation Form, was applied to 15% of targeted patients; it was also used, unexpectedly, among children with no clinic visit and adult patients (often when their child was being assisted). A key factor underlying these results was the effect of concurrent policy initiatives. |
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| Physical Description: | 1 PDF file (70 pages) illustrations |