Assessing the effect of virtual navigation interventions to improve health insurance literacy and decrease financial burden: A CCSS randomized trial

评估虚拟导航干预措施对提高健康保险知识和减轻经济负担的效果：一项 CCSS 随机试验

• 批准号: 10632063
• 负责人: Anne C Kirchhoff
• 金额: $ 70.77万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10632063
• 关键词: 21 year old; Acute; Address; Adherence; Adolescent and Young Adult; Adult; Affordable Care Act; Age; Area; Awareness; Behavioral Model; Cancer Survivor; Caring; Characteristics; Childhood; Childhood Cancer Survivor Study; Chronic; Cohort Studies; Complex; Data Collection; Diagnosis; Ensure; Ethnic Origin; Face; Financial Hardship; Health; Health Care Costs; Health Care Reform; Health Insurance; Health Promotion; Health Services Accessibility; Healthcare; Healthcare Systems; Insurance; Insurance Benefits; Insurance Coverage; Intervention; Knowledge; Long-Term Effects; Malignant Neoplasms; Medicaid; Medical Care Costs; Medical History; Medical Surveillance; Methods; Monitor; Morbidity - disease rate; Outcome; Pamphlets; Patients; Pharmaceutical Preparations; Policies; Race; Randomized; Recommendation; Recording of previous events; Research; Risk; Sampling; Siblings; Survivors; Testing; Underinsured; Visit; barrier to care; childhood cancer survivor; cohort; comparison intervention; cost; cost effective; deprivation; design; digital; digital delivery; digital health; digital intervention; effectiveness evaluation; effectiveness/implementation trial; experience; follow-up; health care service; health care service utilization; health service use; implementation evaluation; implementation intervention; improved; indexing; innovation; intervention delivery; intervention effect; literacy; mHealth; patient navigation; patient navigator; patient portal; prevent; primary outcome; psychoeducation; psychoeducational; randomized trial; recruit; response; screening; secondary outcome; skills; sociodemographics; survivorship; synchronous contact; synchronous delivery; three-arm trial; tool; treatment as usual; trial comparing; virtual

Childhood cancer survivors often have complex health needs that require medical surveillance, requiring them to navigate the complexities of the health care system. Despite the Affordable Care Act’s expansion of insurance, many childhood cancer survivors continue to experience underinsurance and barriers to care. Adequate health insurance literacy is a key skill for survivors to obtain and utilize health insurance and to prevent high out-of-pocket costs or unmet health care needs. Interventions are critically needed to support childhood cancer survivors in addressing issues of insurance, but to date no intervention has been developed to improve childhood survivors’ health insurance literacy. Guided by Andersen and Aday’s Behavioral Model of Health Services Use, we developed a patient navigation intervention and health insurance booklet, targeted for survivors. We conducted a pilot randomized trial comparing intervention, Health Insurance Navigation Tools (HINT-S), delivered synchronously via Zoom, to enhanced usual care (EUC; digital health insurance booklet only) among 82 survivors in the Childhood Cancer Survivor Study (CCSS) cohort. HINT-S incorporates a strong psychoeducational component, with 4 45-minute sessions designed to improve survivors’ conceptual knowledge of health insurance and cost. Preliminary results support its feasibility, acceptability, and preliminary efficacy. In response to RFA-CA-20-027, we propose a Type 1 hybrid effectiveness-implementation trial to test HINT-S vs. EUC to promote health insurance literacy, as well as improving downstream financial hardship and health care. We will randomize 520 survivors from the CCSS cohort to: HINT-S, HINT-A (4 prerecorded, asynchronous navigator sessions, which has the potential to be cost-effective and scalable), and EUC. All study activities, including recruitment, data collection, and navigation, will be conducted virtually, via the CCSS mHealth platform and patient portal. We will investigate whether HINT-S improves health insurance literacy over EUC at 6 months (primary outcome) and explore the relative difference in effect size and cost of HINT-S compared to HINT-A. We will explore moderators (e.g., sociodemographics, insurance status, state Medicaid expansion status, cancer and health history, and baseline literacy) of the intervention effects. The association of health insurance literacy with longer-term outcomes, such as financial hardship (worry, unmet healthcare needs, and financial consequences of medical costs), decreases in out-of-pocket-costs, and improvements in healthcare utilization at 18 months will be investigated. Implementation evaluation will assess the intervention’s reach, engagement, acceptability, fidelity, and sustainability (including cost). This study is innovative for the 1) comparison of digital intervention delivery, 2) focus on health insurance literacy, and 3) access to a national sample of long-term childhood cancer survivors. Digitally-delivered interventions that address health insurance literacy can lead to national sustainable improvements in childhood survivors’ health care costs and care.

儿童癌症幸存者往往有复杂的健康需求，需要医疗监测，需要他们