262447 Electronic health records in community health centers: A tool for cervical cancer preventive service surveillance among the uninsured

Monday, October 29, 2012

Stuart Cowburn, MS , Research Department, OCHIN, Inc., Portland, OR
Jennifer DeVoe, MD DPhil , Department of Family Medicine, Oregon Health and Science University, Portland, OR
Rachel Gold, PhD MPH , Northwest Center for Health Research, Kaiser Permanente, Portland, OR
Christine Nelson, PhD, RN , Research Department, OCHIN, Inc., Portland, OR
Jon Puro, MPH-HA , Research Department, OCHIN, Inc., Portland, OR
Background: Increasing use of electronic health records (EHRs) in community health centers (CHCs) offers new opportunities for surveillance among uninsured and underinsured populations. We leveraged a unique EHR database to examine associations between insurance coverage and utilization of cervical cancer preventive services in a network of CHCs. Methods: Data were supplied by OCHIN, a non-profit that provides EHRs to CHCs across the US. Bi-level (individual and clinic) random-intercept logit models were fit to data from 30 clinics in 2 states. Two outcomes were examined: (1) receipt of >= 1 Pap screening test in 3 years (females aged 18-64, n=11,951), and (2) receipt of >=1 dose of human papillomavirus (HPV) vaccine (females age 9-26, n=18,311). The primary predictor was duration of insurance coverage, adjusted for age, race/ethnicity, and income. Results: Compared to the continuously insured, the continuously uninsured had significantly lower odds of receiving a Pap test (OR 0.75; 95%CI .65-.88) and of receiving an HPV vaccination (OR 0.59; 95%CI .51-.67). There was no significant difference in the odds of service receipt between partially insured and continuously insured women. Women from racial/ethnic minority groups were significantly more likely to receive Pap screening than white women, a finding that challenges the results of previous survey-based studies. Conclusions: Insurance coverage among safety net patients is often fluid and may change frequently, potentially impacting utilization of preventive healthcare services. EHR systems in CHCs provide a new

Learning Areas:
Biostatistics, economics
Communication and informatics

Learning Objectives:
1. Identify the advantages and limitations of electronic health record data for research among uninsured and underinsured populations. 2. Describe the association between insurance coverage, adjusted for other sociodemographic factors, and cervical cancer preventive service utilization in a population of women who access care in safety net clinics.

Keywords: Health Information Systems, Cancer Screening

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a student in the Masters of Public Health program, Epidemiology/Biostatistics track, at Oregon Health and Sciences University. I am also employed as a Research Analyst at OCHIN Inc., where I am responsible for data management and statistical analysis related to several federally-funded health services research projects. The content of the proposed abstract represents unfunded work that I have independently completed to fulfill the thesis requirement of my Masters degree program.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.