Electronic health record tools to assist with children’s insurance coverage: a mixed methods study

DeVoe, Jennifer E.; Hoopes, Megan; Nelson, Christine A.; Cohen, Deborah J.; Sumic, Aleksandra; Hall, Jennifer; Angier, Heather; Marino, Miguel; O’Malley, Jean P.; Gold, Rachel

doi:10.1186/s12913-018-3159-x

BMC Health Services Research

Table 4 CHIPRA measures of recommended care receipt in the 18 months after intervention

From: Electronic health record tools to assist with children’s insurance coverage: a mixed methods study

	Intent to Treat (ITT)					Effect of Treatment on the Treated (ETOT)(Intervention clinic patients only)
	Intervention clinic patients N = 15024		Control clinic patients N = 12227			Patients with tool use N = 2240		Patients without tool use N = 12784
	N eligible	N (%) received	N eligible	N (%) received	Adjusted OR (95% CI)	N eligible	N (%) received	N eligible	N (%) received	Adjusted OR (95% CI)
Well-child visits in first 15 months^a	1141	483 (42.3)	1078	570 (52.9)**	0.57 (0.38, 0.85)	161	101 (62.7)	980	382 (39.0)**	1.54 (1.06, 2.25)
Well-child visit in 3rd-6th year^b	4367	3926 (89.9)	3753	3389 (90.3)	1.09 (0.94, 1.26)	670	638 (95.2)	3697	3288 (88.9)**	1.44 (0.84, 2.46)
Adolescent well-care visit^c	5899	5065 (85.9)	4429	3806 (85.9)	1.05 (0.71, 1.55)	917	824 (89.9)	4982	4241 (85.1)**	1.06 (0.82, 1.38)
BMI assessment for children/adolescents^d	12101	11610 (95.9)	9581	9243 (96.5)*	0.81 (0.58, 1.14)	1927	1857 (96.4)	10,174	9753 (95.9)	1.07 (0.97, 1.18)
Human papillomavirus vaccine for female adolescents (HPV)^e	927	358 (38.6)	689	262 (38.0)	1.10 (0.74, 1.64)	141	76 (53.9)	786	282 (35.9)**	1.44 (1.12, 1.84)
Chlamydia screening in women^f	1596	450 (28.2)	1263	565 (44.7)**	0.49 (0.36, 0.70)	228	65 (28.5)	1368	385 (28.1)	1.24 (0.94, 1.62)
Childhood immunization status^g
Diphtheria, tetanus and pertussis (DTaP)^h	1891	1458 (77.1)	1727	1362 (78.9)	0.92 (0.74, 1.15)	286	256 (89.5)	1605	1202 (74.9)**	1.38 (1.09, 1.74)
Inactivated polio (IPV)ⁱ	1891	1670 (88.3)	1727	1514 (87.7)	1.13 (0.87, 1.48)	286	277 (96.9)	1605	1393 (86.8)**	1.73 (0.83, 3.60)
Measles-Mumps-Rubella (MMR)^j	1891	533 (28.2)	1727	656 (38.0)**	0.61 (0.43, 0.86)	286	92 (32.2)	1605	441 (27.5)	1.10 (0.69, 1.77)
Haemophilus influenza type b (Hib)^k	1891	1681 (88.9)	1727	1517 (87.8)	1.23 (0.94, 1.60)	286	278 (97.2)	1605	1403 (87.4)**	1.83 (0.78, 4.26)
Hepatitis B^l	1891	1697 (89.7)	1727	1544 (89.4)	1.15 (0.79, 1.69)	286	279 (97.6)	1605	1418 (88.4)**	2.03 (0.92, 4.44)
Varicella zoster virus (VZV)^m	1891	1655 (87.5)	1727	1516 (87.8)	1.12 (0.76, 1.66)	286	269 (94.1)	1605	1386 (86.4)**	1.13 (0.74, 1.73)
Pneumococcal conjugate (PCV)ⁿ	1891	1424 (75.3)	1727	1258 (72.8)	1.20 (0.95, 1.52)	286	249 (87.1)	1605	1175 (73.2)**	1.20 (0.87, 1.65)
Hepatitis A^o	1891	1640 (86.7)	1727	1515 (87.7)	1.04 (0.71, 1.53)	286	268 (93.7)	1605	1372 (85.5)**	1.10 (0.79, 1.53)
Rotavirus (RV)^p	1891	1249 (66.1)	1727	1088 (63.0)	1.13 (0.89, 1.45)	286	233 (81.5)	1605	1016 (63.3)**	1.45 (1.03, 2.04)
Influenza^q	1891	850 (44.9)	1727	807 (46.7)	0.91 (0.73, 1.13)	286	177 (61.9)	1605	673 (41.9)**	1.47 (1.16, 1.86)
Combination 10q^r	1891	211 (11.2)	1727	243 (14.1)*	0.74 (0.38, 1.43)	286	51 (17.8)	1605	160 (10.0)**	1.22 (0.72, 2.05)
Immunizations for adolescents^s
Meningococcal^t	1837	1400 (76.2)	1352	999 (73.9)	1.36 (1.00, 1.86)	304	255 (83.9)	1533	1145 (74.7)**	1.06 (0.78, 1.45)
Tetanus, diphtheria, pertussis/Tetanus, diphtheria (Tdap/Td)^u	1837	1485 (80.8)	1352	1020 (75.4)**	1.65 (1.26, 2.15)	304	261 (85.9)	1533	1224 (79.8)*	0.93 (0.77, 1.12)
Combination 1^v	1837	1355 (73.8)	1352	903 (66.8)**	1.65 (1.23, 2.21)	304	243 (79.9)	1533	1112 (72.5)*	0.93 (0.70, 1.23)

* χ² Tests of independence p < .05
** χ² Tests of independence p < .001
Odds ratios from logistic GEE model accounting for clustering within clinic, adjusted for sex (where appropriate), age (where appropriate), race/ethnicity, primary language, FPL, new vs. established patient status, family member on Medicaid case (Y/N), and length of time family had been established with the clinic
BOLD = adjusted odds ratio significantly different from 1.0 (p < .05)
^apercentage of children aged 15 months with ≥6 well-child visits in first 15 months of life
^bpercentage of children ages 3 to 6 with ≥1 well-child visis
^cpercentage of children ages 12 to 21 with ≥1 comprehensive well-care visit
^dpercentage of children ages 3 to 17 with BMI documentation
^epercentage of females aged 13 years with 3 doses of HPV vaccine by their 13th birthday
^fpercentage of sexually active females ages 16 to 20 with ≥1 test for chlamydia
^gpercentage of children aged 2 years with specific vaccines by their second birthday
^h≥4 DTaP vaccinations with different dates of service, ≥42 days after birth
ⁱ≥3 IPV vaccinations with different dates of service, ≥42 days after birth
^j≥1 MMR vaccine; or ≥ 1 measles & rubella vaccine plus 1 mumps vaccine; or ≥ 1 measles, ≥1 mumps, & ≥1 rubella vaccine
^k≥3 Hib vaccinations with different dates of service, ≥42 days after birth
^l≥3 HepB vaccinations with different dates of service
^m≥1 VZV vaccination or history of varicella zoster
ⁿ≥4 PCV vaccinations with different dates of service, ≥42 days after birth
^o≥1 HepA vaccination or history of HepA illness
^p≥2 doses of 2-dose RV on different dates; or ≥ 3 doses of 3-dose RV on different dates; or ≥ 1 dose of 2-dose RV + ≥2 doses of 3-dose RV on different dates of service; ≥42 days after birth
^q≥2 flu vaccinations with different dates of service, ≥180 days after birth
^rchildren who were numerator compliant for all 10 above vaccinations
^spercentage of adolescents aged 13 with specific vaccines by their 13th birthday
^t≥1 meningococcal vaccination between 11th and 13th birthdays
^u≥1 Tdap; or ≥ 1 Td; or ≥ 1 tetanus and ≥ 1 diphtheria between 10th and 13th birthdays
^vadolescents who were numerator compliant for both above vaccinations

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ISSN: 1472-6963

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