Cancer morbidity and mortality risks can be greatly reduced through screening and prevention. Patients without health insurance are much less likely to receive evidence-based cancer screenings and preventive care. Interventions that optimize and stabilize health insurance coverage could substantially increase rates of receipt of timely cancer preventive care. As many patients with unstable coverage receive care at Community Health Centers (CHCs), CHCs are well-positioned to provide such interventions. Recent advances in CHCs' health information technology (HIT) create new opportunities for using automated processes and data to support insurance outreach efforts. We propose to conduct a clinic-level cluster randomized trial in 12 CHCs (~47,000 patients aged 18-64) to test the effectiveness of Community-based HIT Tools for Cancer Screening and Health Insurance Promotion (CATCH-UP tools) at improving rates of (1) cancer screening and prevention services, and (2) health insurance coverage. The CATCH-UP tools are designed to identify and reach uninsured CHC patients who are eligible for enrollment in public insurance coverage, and to encourage re-enrollment of publicly-insured patients before coverage gaps occur. Modeled after HIT tools proven effective for chronic disease management, the CATCH-UP tools include a panel management / data aggregator system coupled with automated patient outreach and communication. We will partner with OCHIN, a non-profit community HIT network that hosts one of the nation's largest CHC electronic health record platforms. We hypothesize that patients of CHCs that have these tools will have higher rates of continuous insurance coverage, and as a result, higher rates of up-to-date age- and gender-appropriate cancer screening and prevention services, compared to patients of CHCs without such tools.
Our aims are as follows.
Aim 1 : Evaluate the effect of the CATCH-UP intervention on up-to-date status of cancer screening and preventive care received by patients. We will assess gender- and age-appropriate rates of screening and assessment (colorectal cancer, cervical cancer, breast cancer, smoking, obesity); immunization (human papillomavirus vaccination); and counseling (smoking, weight).
Aim 2 : Evaluate the effect of the CATCH-UP intervention on patients' insurance coverage rates. To accomplish Aims 1 and 2, we will conduct clinic- and patient-level difference-in-differences quantitative analyses to compare pre- and post-intervention changes between control and intervention groups.
Aim 3 : Evaluate the intervention implementation process, patient and CHC staff acceptance and use of the CATCH-UP tools, and the patient-, provider-, and system-level factors associated with successful implementation and sustainability of the tools, using mixed methods. Understanding how HIT tools in CHCs and other community primary care settings can support insurance enrollment and retention efforts will be key to successfully expanding insurance coverage and reducing disparities in cancer screening and prevention services.
Patients without health insurance are much less likely to receive recommended cancer screening and prevention services, and Community Health Centers (CHCs) provide a health care safety net for many of these uninsured patients. We will conduct a cluster-randomized trial in 12 CHCs to test the effectiveness of implementing Community-based HIT Tools for Cancer Screening and Health Insurance Promotion ('CATCH- UP' tools) at improving rates of (1) cancer screening and prevention services; and (2) health insurance coverage. Using mixed-methods, we will also evaluate the intervention implementation process, patients' and CHC staff members' acceptance and use of the CATCH-UP tools, and factors associated with successful implementation and sustainability of the tools.
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