Diabetes patients with no insurance or lapsed coverage are less likely to get preventive care

New TCHR study is the first to use electronic medical data from a network of safety-net clinics, developed with help from TCHR and KPNW

(PORTLAND, Ore.)—In the April issue of Medical Care, TCHR reports new research comparing how diabetes patients with varying levels of insurance continuity use preventive services at safety-net clinics. TCHR’s Rachel Gold, PhD, MPH, and colleagues discovered that diabetes patients with continuous insurance coverage are more likely than those with interrupted or no coverage to get recommended cholesterol, blood glucose, and kidney disease screenings and flu shots at safety-net clinics. In other words, for diabetes patients seeking preventive care at these clinics, having lapses in insurance coverage was as strong a deterrent as having no coverage at all. (Diabetes patients who don’t get preventive care have an increased risk of complications and use more urgent and emergency care services.)

Dr. Gold collaborated with colleagues from OHSU, the Multnomah County Health Department, and OCHIN, which provides Epic-brand software to a network of more than 100 safety-net clinics serving more than 300,000 patients in Oregon, California, and other states.

Dr. Gold’s is the first published study to use OCHIN’s electronic practice-management database. Several years ago, TCHR foresaw the research and administrative value of capturing health information on safety-net clinic patients. While KPNW’s rich electronic medical record (EMR) system with more than 400,000 records remains one of our greatest research assets, it is not representative of highly vulnerable populations. So we arranged for KPNW to make a substantial community benefits grant to the Northwest Health Foundation to implement an EpicCare EMR at OCHIN member clinics. Today OCHIN has one of the country’s most comprehensive electronic medical databases—a rarity in ambulatory care and unique among safety-net clinics.

Dr. Gold’s study gives us two valuable pieces of information: first, insurance continuity improves preventive care for diabetes patients; second, insurance discontinuity may be as harmful as lack of health coverage. As the Obama Administration seeks solutions for the nearly 50 million Americans with no health insurance and as we work to identify and remedy health disparities for the under- and uninsured, we are encouraged to see the tremendous research potential afforded by OCHIN’s electronic data resources.

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