Collaborators Rachel Gold, PhD, MPH (left) and Jennifer DeVoe, MD, DPhil
OCTRI pilot award provides momentum for national grant from the Agency for Healthcare Research & Quality.
Great oaks from little acorns grow. This aphorism applies to the collaborative work of OHSU physician Jennifer DeVoe, M.D., DPhil, and Kaiser Permanente Center for Health Research epidemiologist Rachel Gold, Ph.D., M.P.H. On June 30, 2010, they were awarded a major federal grant to study how insurance instability among parents affects children’s access to health insurance and healthcare services. The $2 million grant from the Agency for Healthcare Research & Quality (AHRQ) was seeded by a $30,000 OCTRI pilot award. “Rachel and I already had a good start on collaborative work that led to this major AHRQ award,” said Jen, “and the OCTRI grant gave us added momentum to move ahead on solid footing.”
Jen and Rachel will study the impact of the 2008 Oregon Health Plan “lottery”, in which eligible Oregonians were randomly selected to receive public coverage. They will examine patterns in the use of health care services among children of parents who randomly gained coverage in the lottery, versus those who did not. And they will determine how changing national family health insurance patterns affect children’s health insurance stability and their use of healthcare services.
Central to the new AHRQ grant is the unparalleled OCHIN dataset—electronic health and administrative medical records linked across more than 200 community health clinic sites throughout Oregon, Washington, and northern California. OCHIN clinics serve more than 700,000 clients with nearly 1 million annual visits, and their dataset is one of the nation’s most comprehensive resources for tracking health care utilization data on uninsured and underinsured patients. Jen and Rachel will utilize this dataset as their primary tool for the new AHRQ study. “OCHIN has been incredibly generous in making this resource available,” said Jen. “Their leadership has fostered strong collaboration with OCTRI and a shared vision for the OCHIN data resource.”
Validating the Data for New Research
Jen and Rachel were able to write such a compelling grant to AHRQ because of prior collaborative work that was partially funded by OCTRI—research that validated the OCHIN database. In 2009, they received $30,000 in OCTRI pilot funding that enabled them to further the development and evaluation of methods for linking OCHIN’s data with Oregon’s Medicaid claims data, among OCHIN patients who receive Medicaid. Specifically, they studied receipt of diabetes preventive care to track Medicaid patients who went outside the OCHIN network for services. “This pilot funding was very important for our future work,” said Jen. “OCTRI’s increased emphasis on community research has been both refreshing and stimulating.”
What they found was, in fact, that only a small percent of OCHIN patients actually get care outside of the OCHIN clinic system. “We now know because of the pilot that most of these patients are not getting care elsewhere—and we really had to prove this to continue our own line of research using this dataset,” said Rachel. “We showed that the OCHIN database can support research and that it contains a robust collection of data.” This meant, ultimately, that OCHIN’s data are a good representation of primary care service use among their patient population. Demonstrating the reliability of the OCHIN dataset was an important strength of the AHRQ application.
Finding Common Ground
The story of this fruitful partnership dates back to 2006. Rachel was writing a guide to conducting research in the OCHIN data, at the time a little-known resource, with funding from KP Community Benefit Initiative funds. Jen had just won a career development grant from AHRQ, called a K Award, to study patterns of parents and child health insurance. Rachel presented her guide at a meeting of the Oregon Health Research & Evaluation Collaborative (OHREC, which “provides both policy makers and the public access to clearly presented non-partisan health services research through published research briefs and sponsored public forums where researchers discuss and present their findings”). At this meeting, Jen and Rachel quickly recognized their common research interests, particularly a shared focus on the impact of public insurance. Rachel had experience working with safety net clinic data, and Jen had expertise in health policy research, the Oregon Health Plan, and research on access to care.
So they started writing papers together on insurance continuity and diabetes care. Originally joined by their interest in public insurance, what’s solidified their professional partnership is that they really enjoy each other. “Ours was a nice meshing of skills, and we found that, personally, we worked well together,” said Rachel.
Laying Foundations for Future Collaboration
Rachel and Jen decided that in order to move ahead in their research—which relied heavily on the information found in OCHIN records—they needed to establish the validity of the OCHIN dataset. That’s when they turned to OCTRI for funding. They compared OCHIN services data with Medicaid insurance data to see how much the datasets overlapped, and proved the strength and completeness of the OCHIN data resource.
Because AHRQ has just developed measures of children’s healthcare, the DeVoe/Gold partnership is serendipitous. Many people will be looking to this team for definitive answers about how low-income families use healthcare services and how insurance continuity affects health. “The uninsured are invisible in health care research conducted using claims data,” Rachel said. “Our research is critically important right now as health care reform unfolds. We’re creating a real-time laboratory to study the effects of insurance inequity and insecurity—right as it happens.”