Testing health information technology tools to facilitate health insurance support: a protocol for an effectiveness-implementation hybrid randomized trial
Testing health information technology tools to facilitate health insurance support: a protocol for an effectiveness-implementation hybrid randomized trial
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DOI：
10.1186/s13012-015-0311-4
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发表时间：
2015-08-25
影响因子：
7.2
通讯作者：
Gold, Rachel
中科院分区：
文献类型：
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作者：
DeVoe, Jennifer E.;Huguet, Nathalie;Gold, Rachel
背景：健康保险覆盖范围存在缺口的患者通常会推迟或放弃癌症预防服务。癌症检测和诊断方面的这些延误导致发病率和死亡率上升，费用增加。健康信息技术（HIT）的最新进展为加强保险支持服务创造了新的机会，这些服务通过应用于医疗保健环境的自动化流程缩小了覆盖范围。本研究将评估实施的保险支持HIT工具和他们的有效性，在改善患者的保险覆盖的连续性和癌症筛查rate.Methods/design：本研究采用了混合集群随机设计，结合有效性和实施试验，在美国的社区卫生中心（CHCs）。合格的CHC临床试验机构将被随机分配到试验实施部分的两组之一：工具+基础培训（I组）和工具+强化培训+促进（II组）。将选择倾向评分匹配的诊所对照组来评估工具的有效性。对工具影响的定量分析将使用电子健康记录和医疗补助数据来评估有效性。定性数据将被收集，以评估实施过程中，了解如何使用的HIT工具，并确定其实施和use.Discussion的促进者和障碍：本研究将测试HIT工具的有效性，以提高保险支持在社区卫生服务中心，并将比较战略，以促进其实施在“现实世界”的做法设置。调查结果将为进一步发展提供信息，如果有必要，还将更广泛地实施保险支持HIT工具。
Background: Patients with gaps in health insurance coverage often defer or forgo cancer prevention services. These delays in cancer detection and diagnoses lead to higher rates of morbidity and mortality and increased costs. Recent advances in health information technology (HIT) create new opportunities to enhance insurance support services that reduce coverage gaps through automated processes applied in healthcare settings. This study will assess the implementation of insurance support HIT tools and their effectiveness at improving patients' insurance coverage continuity and cancer screening rates.Methods/design: This study uses a hybrid cluster-randomized design-a combined effectiveness and implementation trial-in community health centers (CHCs) in the USA. Eligible CHC clinic sites will be randomly assigned to one of two groups in the trial's implementation component: tools + basic training (Arm I) and tools + enhanced training + facilitation (Arm II). A propensity score-matched control group of clinics will be selected to assess the tools' effectiveness. Quantitative analyses of the tools' impact will use electronic health record and Medicaid data to assess effectiveness. Qualitative data will be collected to evaluate the implementation process, understand how the HIT tools are being used, and identify facilitators and barriers to their implementation and use.Discussion: This study will test the effectiveness of HIT tools to enhance insurance support in CHCs and will compare strategies for facilitating their implementation in "real-world" practice settings. Findings will inform further development and, if indicated, more widespread implementation of insurance support HIT tools.