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Bettering Asthma Care in Kids - Geographic Social Determinants Data to Understand Disparities (BACKGROUND)


Term: 09/26/2017 – 06/30/2022
Grantee: Oregon Health & Science University
Sub-recipients: OCHIN, Inc.
Funding Agency: NIMHD
Grant Number: R01MD011404

Summary: Latino children have poorer asthma-related outcomes than non-Hispanic white children. This disease-specific morbidity and mortality comes in spite of longstanding, well-known, evidence-based approaches shown to improve asthma outcomes and symptoms. In the setting of these significant gaps in the literature and limitations in prior data sources, we will use a robust, comprehensive electronic health record (EHR) data set, linked to geographically coded social determinants of health (SDOH) data, serving thousands of Latino children over a 10-year span, to longitudinally and objectively study the multi-level factors affecting the asthma care of low-income Latinos across a nationwide network of community health centers (CHCs). We will use EHR data from the OCHIN network and the ADVANCE clinical data research network (CDRN).

Potential Impact: Our analyses of children being seen in CHCs with EHR data linked to individual- and community-level social determinants of health will constitute a robust, rigorous, longitudinal, and multi-level study of healthcare disparities in this disease. Clearer links between care utilization and the built environment can better inform legislators and other policy makers as they weigh policies that will affect these environments. It will also aid health care providers caring for this population; better population-based data will help tailor clinic workflows and programs to improve asthma care quality in vulnerable children. Children could be better “risk stratified” according to important community and individual features, allowing clinics and providers to either intensify or adjust their approach to chronic disease management in these children and better their chance of successful asthma management.

Accessing Community Cancer Care After Insurance Expansion (ACCESS)

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Term: 04/01/16 – 03/31/21

Grantee: Oregon Health & Science University

Sub-recipient: OCHIN, Inc.

Funding Agency: National Institutes of Health/National Cancer Institute

Grant Number: R01CA204267

Summary: Some states implemented Affordable Care Act (ACA) Medicaid expansions while other states did not, thus creating a natural experiment to study the impact of increased access to health insurance on cancer screening, cancer preventive services, and cancer survivor care. This innovative, timely study will use electronic health record (EHR) data from the ADVANCE clinical data research network (CDRN) of PCORnet, which has EHR data from 718 community health centers (CHCs), including 476 CHCs in 13 states that expanded Medicaid (n=576,711 patients), and 242 CHCs in eight states that did not expand Medicaid (n=361,421 patients). The ADVANCE CDRN dataset uniquely positions us to assess cancer screening, prevention, and survivor care among vulnerable populations immediately after the ACA Medicaid expansions, and to follow these patients for several years after this landmark health policy natural experiment.

Potential Impact: This study is significant, as it will assess the natural experiment resulting from some US states implementing ACA Medicaid expansion, while others have not. It addresses scientific knowledge gaps (how Medicaid expansion impacts receipt of cancer prevention and survivor care) and technology gaps (prior lack of novel data sources for studying populations not found reliably in claims or self-reported data). Findings from this study will have national relevance and will contribute to NCI’s priorities regarding improving cancer prevention knowledge.

Aging in Community Health Clinics: Multimorbidity Patterns among Middle-Aged and Older Adults (ACHES)

Term: 09/01/2019 – 04/30/24

Grantee: Oregon Health & Science University

Sub-recipient: OCHIN, Inc.

Funding Agency: NIH/NIA

Grant Number: R01AG061386

Summary: The objective of this project is to determine the extent and impact of multimorbidity among CHC patients and to identify specific multimorbidity combinations associated with chronic disease complications, frequent healthcare utilizations, and death.

Potential Impact: This project examines the number and type of chronic conditions vulnerable adults are living with and identifies adults most at risk for worsened symptoms, escalation of chronic disease-related problems, and additional diagnoses that are accumulated over time. The proposed work will inform intervention programs for adults in the safety-net. By identifying disease combinations that are most predictive of complications, intensive use of health care services, and death, future work can test best practices and delivery models that are more attuned to the needs of individuals with the most challenging combinations of chronic disease. Our proposed research leverages clinical electronic health record (EHR) data from large networks of CHCs and non-CHCs. We anticipate important insights from findings that will inform clinical processes (workflow, clinical care decision-making) and policies that serve safety-net populations by identifying multimorbidity patterns predictive of rapid health downturns.

Accelerating Data Value Across a National Community Health Center Network (ADVANCE)

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Term: 03/01/2016 – 08/01/2018

Grantee: OCHIN, Inc.

Funding Agency: Patient-Centered Outcomes Research Institute

Grant Number: CDRN-1306–04716

Summary: The ADVANCE Clinical Data Research Network (CDRN) is led by OCHIN in partnership with Health Choice Network (HCN), Fenway Health, Robert Graham Center, Oregon Health & Science University, Kaiser Permanente Center for Health Research, and Legacy Health. The goal of ADVANCE is to build and maintain a “community laboratory” of Federally-Qualifi ed Health Centers (FQHC) serving safety net patients, including the uninsured, underinsured, undocumented immigrants, and other vulnerable populations. The ADVANCE Research Data Warehouse (RDW) maintains data on over 3 million patients and is the nation’s most comprehensive dataset on care and health outcomes in safety net patients. These patients are often underrepresented in claimsbased datasets and academic hospital-based research studies. ADVANCE is one of 13 CDRNs participating in the Patient Centered Outcomes Research Institute’s (PCORI) distributed research network, called PCORnet. The goal of PCORnet is to create a national network of representative data for conducting comparative effectiveness and clinical outcomes research (www.

Potential Impact: It is anticipated that ADVANCE will result in greatly heightened capacity to conduct comparative effectiveness research in the safety net and to collaborate with diverse partners on such eff orts. It will also yield the nation’s largest database on safety net patient care and outcomes. Research conducted in this dataset has the potential to address myriad questions about improving care quality and outcomes among our nation’s most vulnerable patients.

ECHOES - Evaluating Control of Hypertension - Effect of Social Determinants

Term: 04/01/2018 – 03/31/2022
Grantee: Oregon Health & Science University
Sub-recipients: OCHIN, Inc.
Funding Agency: National Heart, Lung and Blood Institute 
Grant Number: 1R01HL136575-01A1

Summary: The Affordable Care Act (ACA) called for every state to significantly expand Medicaid coverage by 2014; a Supreme Court decision made it optional for states to expand Medicaid to all adults with household incomes up to 138% of the federal poverty level. We will use this unprecedented natural experiment to study the effect of state-level Medicaid expansion on rates of hypertension incidence, screening, treatment, and management. In addition, access to care may be insufficient to reduce barriers to hypertension care. Thus, other social determinants of health ([SDOH]; e.g., individual- and community-level factors) may differentially affect the relationship between gaining insurance and receiving hypertension care. We will use electronic health record (EHR) data from the ADVANCE clinical data research network, linked to community-level SDOH. From this dataset, we will collect detailed information on changes in hypertension incidence, screening, treatment, and management comparing states that expanded Medicaid, and those that did not.

Potential Impact: Hypertension is the most common chronic condition among adults in the United States. Uninsured adults are more likely to have undiagnosed hypertension, less likely to receive regular screening, and less likely to have their hypertension under control than insured adults. The Affordable Care Act (ACA) called for every state to significantly expand Medicaid coverage by 2014; it is hypothesized that the ACA’s Medicaid expansion could substantially (i) improve access to essential preventive services for previously uninsured patients, and (ii) facilitate better access to routine healthcare for those who gain new health insurance. Little is yet known about how ACA Medicaid expansions are impacting hypertension care. The 2012 US Supreme Court ruling that made ACA Medicaid expansion optional for states created a natural experiment to answer this important question. As of April 2016, 32 states and the District of Columbia had expanded Medicaid.

EVERYWOMAN | Reproductive Care in the Safety-Net: Women’s Health Care after Affordable Care Act Implementation

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Term: 09/01/2017 – 05/31/2022
Grantee: OCHIN, Inc.
Sub-recipients: Oregon Health & Science University, Health Choice
Network, Fenway Health
Funding Agency: Agency for Healthcare Research and Quality
Grant Number: 1R01HS025155-01

Summary: EVERYWOMAN will examine the impact of the Affordable Care Act (ACA) and state level reproductive health policies on the full spectrum of women’s health care provision and health experiences in safety-net populations. EVERYWOMAN applies a mixed-methods approach comprising patient-level electronic health record (EHR) data for large scale quantitative analyses, qualitative observations, and semi-structured interviews with patients and providers to understand perceptions and patterns of care delivery and utilization, and review of state-level reproductive health policies in inform our analyses.

Potential Impact: Findings from this study will identify practice and policy efforts to strengthen the provision of timely, effective, evidence-based reproductive health care. Study findings will impact patients and providers through relevant practice and policy changes to improve health outcomes and reduce disparities among low-income vulnerable populations of women.

Meaningful Use and Treatment of Smoking in Federally-Qualified Health Centers

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Term: 12/01/14 – 11/30/19

Grantee: Oregon Health & Science University

Sub-recipient: OCHIN, Inc.

Funding Agency: National Institute on Drug Abuse

Grant Number: K23 DA037453

Summary: This study examines the impact of implementation of Stage 1 MU program on the screening and treatment of smoking among adults using linked EHR from a network of community health centers (CHCs). Most CHC patients are uninsured or Medicaid recipients, have incomes below the FPL, and have disproportionately high rate of smoking compared to patients seen in private primary care clinics.Potential Impact This study provides timely data on the eff

Potential Impact: This study provides timely data on the eff ectiveness of the MU implementation on improving rates of assessment and treatment of nicotine dependence in underserved populations, as well as examining changes in smoking over time. Given the amounts of resources invested in this EHR technology incentive program, it is critical to determine if these eff orts result in measurable improvements in patient care, and ultimately, in patient health outcomes.

Prevention and Social Determinants: Disparities and Utilization in Latino Elders (PAST DUE)

Term: 09/30/2018 – 05/31/2023
Grantee: Oregon Health & Science University
Sub-recipients: OCHIN, Inc.
Funding Agency: NIA
Grant Number: R01AG056337

Summary: Recommended preventive health care is underutilized in the United States, especially in older populations, despite evidence-based recommendations for providing these services. Cardiovascular disease prevention, cancer screening, adult immunizations, and fracture risk reduction are underutilized among older persons overall and are disparately utilized in racial / ethnic minority populations. Latino (the largest ethnic minority in the United States) seniors are significantly less likely, in general, to receive appropriate prevention measures, compared to non-Hispanic whites. Our goal is to better understand how the use of preventive services by older adults differs between Latino seniors and non-Hispanic whites over time, and the relative contribution of various social determinants of health among low-income Latino seniors.

Potential Impact: Results of this study will shed light on how individual and community-level SDH impact receipt of preventive health care services, providing important contextual information for public health professionals developing targeted interventions and health care providers serving elder Latinos populations. 

Post ACA Reform: Evaluation of Community Health Center Care for Diabetes (PREVENT-D)

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Term: 09/30/2015 – 09/29/2020

Grantee: Oregon Health & Science University

Sub-recipient: OCHIN, Inc.

Funding Agency: Center for Disease Control and Prevention/National Institute of Diabetes and Digestive and Kidney Diseases

Grant Number: U18 DP006116

Summary: Little is known about the impact of Aff ordable Care Act (ACA) Medicaid expansion on health care access and services for patients at risk for diabetes mellitus (DM) or diagnosed with DM. As many persons aff ected by both DM and the ACA Medicaid expansions receive primary care in safety net community health centers (CHCs), this study will compare pre-post access to and receipt of health care services and Medicaid expenditures within CHCs in states that did and did not expand Medicaid; compare prepost receipt of primary and secondary DM preventive services in expansion versus non-expansion states; compare pre-post changes in DM-related biomarkers among the newly insured compared to already insured and uninsured patients in expansion states; and measure pre-post changes in Medicaid expenditures among newly insured compared to those already insured in Oregon.

Potential Impact: Because the ACA legislation was designed, in part, to improve health and mitigate healthcare disparities, results of this work will formally evaluate the extent to which the ACA’s eff orts to expand insurance coverage to vulnerable populations actually reduces disparities among patients with DM risk or DM. Furthermore, knowing more about the impact of ACA Medicaid expansions on DM screening and primary prevention among patients at risk for DM will be useful for informing future national and state health policies.

Short and Long Term Effects of Antibiotics on Childhood Growth (PCORnet Obesity Observational Study)

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Term: 02/01/2016 – 01/31/2018

Grantee: OCHIN, Inc.

Sub-recipient: OCHIN, Inc.

Funding Agency: PCORI

Grant Number: OBS-1505-30699

Summary: The chief objectives are to assess the comparative eff ects of diff erent types, timing, and amount of antibiotic use in the fi rst 2 years of life with (Aim 1) body mass index (BMI) and obesity at ages 5 and 10 years and (Aim 2) growth trajectories to age 5 years. In Aim 3, we will examine eff ect modifi cation according to several a priori specifi ed socio-demographic, clinical, and maternal variables. Using individual patient-level data on the whole study population, we will evaluate the distributed data systems. Further, within subgroups of the study population with appropriate data, we will explore the extent to which observed associations are confounded by maternal and perinatal characteristics, and the extent to which using dispensing instead of prescribing data for medication use alters the fi ndings.

Potential Impact: The products of this study will enhance scientifi c understanding of the relationship between antibiotic use and weight gain among young children and how to communicate with stakeholders about prescribing antibiotics in childhood and provide valuable insight into the impact of future growth following early childhood exposure to antibiotics.

The Impact of Patient Complexity on Healthcare Performance (Health Systems Demonstration)

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Term: 09/01/2016 – 08/31/2017

Grantee: ADVANCE

Sub-recipient: OneFlorida

Funding Agency: PCORI

Grant Number: HSD-1603-34987

Summary: This study will conduct a demonstration project that utilizes linked community-level Social Determinants of Health (SDH), clinical, and claims data from the ADVANCE and OneFlorida enhanced common data models. Specifi cally, we will explore the impact of adding important data on social complexity to two diff erent, validated measures of clinical comorbidity to evaluate whether accounting for social complexity increases the proportion of variance in utilization (e.g., patient ED visit rates, preventable hospital admission) and quality of care measures (e.g., receipt of recommended preventive services) compared with accounting for clinical comorbidities alone. We will identify key community-level SDH variables that explain the greatest amount of variance in outcomes and test a generalized Social Deprivation Index (SDI), validated for prediction of population health outcomes and access, for correlation with patient preventive service and utilization rates. We will then assess the impact of a high social-clinical complexity score on health system care quality (e.g., summary measures of preventive and disease specifi c care delivery, rates of ED use, preventable hospital admissions.)

Potential Impact: Aim 1: Engage patients and clinicians to identify the community-level SDH that are critical to test in a model predicting health care utilization and engage health systems leaders to identify the quality of care measures (outcomes) of greatest interest. Aim 2: Assess whether clinic level summaries of patients’ clinical comorbidity and SDH correlate with variability in clinic-level preventive quality of care measures and rates of ED visits, avoidable hospitalizations, and other select primary quality measures. Determine whether the addition of community-level factors to measures of clinical comorbidity explains a larger proportion of variance in utilization and receipt of recommended services compared with current comorbidity measures alone (e.g., Charlson Comorbidity Index, 3M Clinical Risk Groups). Aim 3: Engage stakeholders to identify how clinic level measures of comorbidity and social complexity are useful to health system leaders, clinicians, and patients in managing population health, resources, and decision-making, delivering quality clinical care, improving treatment adherence and health.