EHR useful for pediatric health insurance surveillance

Image: PD/L. Dexter US Navy

1. Electronic health records databases can be used by providers to track insurance coverage of their patients.

2. In this study, 30% of children who were uninsured on their first clinic visit remained uninsured at subsequent visits, suggesting the need for insurance surveillance and intervention.

Evidence Rating Level: 2 (Good)

Study Rundown: Insurance coverage options are changing rapidly following the 2012 passage of the Affordable Care Act. Although pediatric patients previously had access to public insurance programs under the Children’s Health Insurance Program, many experienced gaps in coverage or had difficulty accessing the program. In order to best assist primary care providers in tracking patient’s insurance coverage status and to identify families requiring additional support to obtain and maintain coverage, this study used electronic health records (EHR) to characterize uninsured patients in a member-based, nonprofit community health clinic provider network. Patients who visited the primary care network between 2010 and 2011, were included in the study and, of these, 21% were uninsured at their first visit and 30% remained uninsured during subsequent visits. Within this cohort, children between 15-18 were more likely to be uninsured, and, differing from previous reports, racial and ethnic minorities were less likely to be uninsured. This study demonstrates that information collected via EHR may be useful when assessing health insurance status among discrete clinic patients to identify those in need of  coverage support. Despite the short, 1-year study period, EHR tracking provides a simple means of identifying vulnerable populations and may assist policy makers in understanding patterns of insurance access.

Click to read the study published today in Pediatrics

Relevant Reading: Disruptions in insurance coverage: patterns and relationship to health care access, unmet need, and utilization before enrollment in the State Children’s Health Insurance Program

In-Depth [retrospective cohort study]: This study analyzed EHR data collected through the Oregon Community Health Information Network (OCHIN), a collaborative of community health centers employing a common EHR, to evaluate health insurance coverage among pediatric patients within the network. A total of 185 989 children visited OCHIN sites during the January 2010 through December 2011 study period. Information collected included patients’ health insurance status, age, gender, household income, race, ethnicity and preferred language. Multiple regression analysis was completed to assess the potential relationship between insurance status and other variables. Of the patients identified, 21% were uninsured at their first clinic visit. The uninsured included 19% of children 0-14 years of age, and 29% of children 15-18 years of age. A total of 18% of nonwhite or Hispanic children were uninsured, compared with 24% of white, non-Hispanic children. Although nonwhite and/or Hispanic children had a lower odds of being uninsured than having Medicaid/Medicare (aOR, 0.73, 95% CI:  0.71-0.75), they had higher odds of being uninsured rather than having commercial insurance (aOR 1.50, 95% CI: 1.44-1.56). In addition, children from rural areas had lower odds of being uninsured than having Medicaid/Medicare coverage when compared to urban children (aOR, 0.89, 95% CI: 0.87-0.92). Of those identified without coverage, 30% were uninsured at all subsequent clinic visits, and 47% had no additional visits.

By Emilia Hermann and Leah H. Carr

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