Assessing Community Cancer Care After Insurance ExpanSionS

NCT02936609 | Completed

• 1 other identifier: 1R01CA204267
• Study Type: observational
• Target: 1,939,783
• Locations: 0 countries
• Sites: N/A

Brief Summary

This innovative and timely study will measure the impact of Affordable Care Act (ACA) Medicaid expansions on cancer screenings and preventive services. To assess this natural policy experiment, the investigators will use electronic health record data from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) clinical data research network (CDRN) of the National Patient-Centered Clinical Research Network (PCORnet).

Conditions

Cancer

Keywords

healthcare access; healthcare utilization; preventive services; cancer survivors

Outcome Measures

Primary Outcomes (1)

• Change in number of preventive services received

  Preventive services and screenings for cervical, colorectal, and breast cancers, HPV vaccinations, smoking screening ad interventions, and obesity screening and interventions.

  Less than or equal to 24 months prior to Medicaid expansion vs greater than or equal to 24 months post

Secondary Outcomes (4)

• Change in type of preventive services received

  Less than or equal to 24 months prior to Medicaid expansion vs greater than or equal to 24 months post

• Change of health insurance status

  Less than or equal to 24 months prior to Medicaid expansion vs greater than or equal to 24 months post

• Change in number of primary care visits

  Less than or equal to 24 months prior to Medicaid expansion vs greater than or equal to 24 months post

• Change in type of primary care visits

  Less than or equal to 24 months prior to Medicaid expansion vs greater than or equal to 24 months post

Study Arms (2)

Medicaid Expansion States

Patients receiving care in community health centers in states that expanded Medicaid (intervention group)

Other: Medicaid Expansion

Medicaid Non-Expansion States

Patients receiving care in community health centers in states that did not expand Medicaid (control group)

Other: Medicaid Expansion

Interventions

Medicaid Expansion OTHER

There will be no direct intervention, but rather an observation of change based on whether a state expanded Medicaid or not

Medicaid Expansion States; Medicaid Non-Expansion States

Eligibility Criteria

• Age: 19 Years - 64 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)
• Sampling Method: Non-Probability Sample

Study Population

Study eligible patients within electronic health record data from the ADVANCE CDRN of PCORnet

You may qualify if:

• Patients in intervention and control states aged 19-64

You may not qualify if:

• Patients at intervention and control clinics outside of the age range 19-64

Sponsors & Collaborators

• OHSU Knight Cancer Institute: lead
• OCHIN, Inc.: collaborator
• Health Choice Network: collaborator
• Fenway Community Health: collaborator
• National Cancer Institute (NCI): collaborator
• National Institutes of Health (NIH): collaborator

Related Publications (6)

• Bailey SR, Marino M, Ezekiel-Herrera D, Schmidt T, Angier H, Hoopes MJ, DeVoe JE, Heintzman J, Huguet N. Tobacco Cessation in Affordable Care Act Medicaid Expansion States Versus Non-expansion States. Nicotine Tob Res. 2020 May 26;22(6):1016-1022. doi: 10.1093/ntr/ntz087.

  PMID: 31123754 RESULT

• Hoopes M, Schmidt T, Huguet N, Winters-Stone K, Angier H, Marino M, Shannon J, DeVoe J. Identifying and characterizing cancer survivors in the US primary care safety net. Cancer. 2019 Oct 1;125(19):3448-3456. doi: 10.1002/cncr.32295. Epub 2019 Jun 7.

  PMID: 31174231 RESULT

• Hoopes M, Voss R, Angier H, Marino M, Schmidt T, DeVoe JE, Soule J, Huguet N. Assessing Cancer History Accuracy in Primary Care Electronic Health Records Through Cancer Registry Linkage. J Natl Cancer Inst. 2021 Jul 1;113(7):924-932. doi: 10.1093/jnci/djaa210.

  PMID: 33377908 RESULT

• Huguet N, Angier H, Rdesinski R, Hoopes M, Marino M, Holderness H, DeVoe JE. Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion. Prev Med. 2019 Jul;124:91-97. doi: 10.1016/j.ypmed.2019.05.003. Epub 2019 May 8.

  PMID: 31077723 RESULT

• Angier HE, Marino M, Springer RJ, Schmidt TD, Huguet N, DeVoe JE. The Affordable Care Act improved health insurance coverage and cardiovascular-related screening rates for cancer survivors seen in community health centers. Cancer. 2020 Jul 15;126(14):3303-3311. doi: 10.1002/cncr.32900. Epub 2020 Apr 15.

  PMID: 32294251 RESULT

• Angier H, Huguet N, Marino M, Mori M, Winters-Stone K, Shannon J, Raynor L, Holderness H, DeVoe JE. Assessing Community Cancer care after insurance ExpanSionS (ACCESS) study protocol. Contemp Clin Trials Commun. 2017 Sep;7:136-140. doi: 10.1016/j.conctc.2017.06.011. Epub 2017 Jun 24.

  PMID: 29473059 DERIVED

MeSH Terms

Conditions

Neoplasms

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: PROSPECTIVE
• Target Duration: 9 Years
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: October 14, 2016
• First Posted: October 18, 2016
• Study Start: April 1, 2016
• Primary Completion: March 1, 2021
• Study Completion: March 1, 2021
• Last Updated: April 28, 2022

Record last verified: 2022-04

Data Sharing

• IPD Sharing: Will not share