Evidence map›Paper›PMID 32414376›Full record

Trial reportBMC health services research2020

Implementation and adoption of a health insurance support tool in the electronic health record: a mixed methods analysis within a randomized trial.

Brigit Hatch, Carrie Tillotson, Nathalie Huguet, Miguel Marino, Andrea Baron, Joan Nelson, Aleksandra Sumic, Deborah Cohen, Jennifer E DeVoe

Registry-linked trialOpen access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02355262 (Community-Based HIT Tools for Cancer Screening and Health Insurance Promotion), which is not on this map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
2.4field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02355262 completednot on this map

Community-Based HIT Tools for Cancer Screening and Health Insurance Promotion (CATCH-UP)

TypeobservationalSponsorOHSU Knight Cancer InstituteRan2014 to 2020Enrolled45ConditionsBreast Carcinoma, Cervical Carcinoma, Colorectal Carcinoma, Health Status UnknownArmsInformational Intervention
3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 11 citations in OpenAlex.

  1. Review
  2. Article
  3. Observational
  4. Article
  5. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Brigit HatchOregon Health & Science University, 3405 SW Perimeter Court, Portland, OR, 97239, USA. adamusb@ohsu.edu.ORCID http://orcid.org/0000-0002-1828-7279
Carrie TillotsonOCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA.
Nathalie HuguetOregon Health & Science University, 3405 SW Perimeter Court, Portland, OR, 97239, USA.
Miguel MarinoOregon Health & Science University, 3405 SW Perimeter Court, Portland, OR, 97239, USA.
Andrea BaronOregon Health & Science University, 3405 SW Perimeter Court, Portland, OR, 97239, USA.
Joan NelsonOCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA.
Aleksandra SumicOCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA.
Deborah CohenOregon Health & Science University, 3405 SW Perimeter Court, Portland, OR, 97239, USA.
Jennifer E DeVoeOregon Health & Science University, 3405 SW Perimeter Court, Portland, OR, 97239, USA.
Oregon Health & Science University · USOchin · US

Funding

Community-based HIT Tools for Cancer Screening and Health Insurance PromotionR01CA181452 · NCI · OREGON HEALTH & SCIENCE UNIVERSITY · PI DEVOE, JENNIFER E · 2014 to 2018
$3.1M
NCI NIH HHS R01 CA181452NCI NIH HHS R01CA181452
6 · The paper itself

Abstract

backgroundIn addition to delivering vital health care to millions of patients in the United States, community health centers (CHCs) provide needed health insurance outreach and enrollment support to their communities. We developed a health insurance enrollment tracking tool integrated within the electronic health record (EHR) and conducted a hybrid implementation-effectiveness trial in a CHC-based research network to assess tool adoption using two implementation strategies.

methodsCHCs were recruited from the OCHIN practice-based research network. Seven health center systems (23 CHC clinic sites) were recruited and randomized to receive basic educational materials alone (Arm 1), or these materials plus facilitation (Arm 2) during the 18-month study period, September 2016-April 2018. Facilitation consisted of monthly contacts with clinic staff and utilized audit and feedback and guided improvement cycles. We measured total and monthly tool utilization from the EHR. We conducted structured interviews of CHC staff to assess factors associated with tool utilization. Qualitative data were analyzed using an immersion-crystallization approach with barriers and facilitators identified using the Consolidated Framework for Implementation Research.

resultsThe majority of CHCs in both study arms adopted the enrollment tool. The rate of tool utilization was, on average, higher in Arm 2 compared to Arm 1 (20.0% versus 4.7%, p < 0.01). However, by the end of the study period, the rate of tool utilization was similar in both arms; and observed between-arm differences in tool utilization were largely driven by a single, large health center in Arm 2. Perceived relative advantage of the tool was the key factor identified by clinic staff as driving tool utilization. Implementation climate and leadership engagement were also associated with tool utilization.

conclusionsUsing basic education materials and low-intensity facilitation, CHCs quickly adopted an EHR-based tool to support critical outreach and enrollment activities aimed at improving access to health insurance in their communities. Though facilitation carried some benefit, a CHC's perceived relative advantage of the tool was the primary driver of decisions to implement the tool.

trial registrationClinicalTrials.gov: NCT02355262, Posted February 4, 2015.

Indexed as

Community Health CentersElectronic Health RecordsHumansInsurance, HealthQualitative ResearchUnited StatesCommunity health centersElectronic health recordHealth information technology toolsHealth insuranceHybrid implementation-effectivenessMixed methodsOutreach and enrollment

Identifiers

PMID32414376
PMCPMC7227079
OpenAlexW3026070401

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.