title: Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients.
abstract: OBJECTIVE
  This study compared the preventive service utilization of uninsured patients receiving care at Oregon community health centers (CHCs) in 2008 through 2011 with that of continuously insured patients at the same CHCs in the same period, using electronic health record (EHR) data.
  
  
  METHODS
  We performed a retrospective cohort analysis, using logistic mixed effects regression modeling to calculate odds ratios and rates of preventive service utilization for patients without insurance, or with continuous insurance.
  
  
  RESULTS
  CHCs provided many preventive services to uninsured patients. Uninsured patients were less likely than continuously insured patients to receive 5 of 11 preventive services, ranging from OR 0.52 (95% CI: 0.35-0.77) for mammogram orders to 0.75 (95% CI: 0.66-0.86) for lipid panels. This disparity persisted even in patients who visited the clinic regularly.
  
  
  CONCLUSIONS
  Lack of insurance is a barrier to preventive service utilization, even in patients who can access care at a CHC. Policymakers in the United States should continue to address this significant prevention disparity.
authors.affiliation: Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Rd., FM, Portland, OR 97239, United States. Electronic address: heintzma@ohsu.edu.
authors.forename: John
authors.initials: J
authors.lastname: Heintzman
authors.affiliation: Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Rd., FM, Portland, OR 97239, United States. Electronic address: marinom@ohsu.edu.
authors.forename: Miguel
authors.initials: M
authors.lastname: Marino
authors.affiliation: OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR 97201, United States. Electronic address: hoopesm@ochin.org.
authors.forename: Megan
authors.initials: M
authors.lastname: Hoopes
authors.affiliation: Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Rd., FM, Portland, OR 97239, United States. Electronic address: bailstef@ohsu.edu.
authors.forename: Steffani
authors.initials: S
authors.lastname: Bailey
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1098, United States. Electronic address: Rachel.gold@kpchr.org.
authors.forename: Rachel
authors.initials: R
authors.lastname: Gold
authors.affiliation: Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Rd., FM, Portland, OR 97239, United States. Electronic address: crawfordc@ohsu.edu.
authors.forename: Courtney
authors.initials: C
authors.lastname: Crawford
authors.affiliation: OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR 97201, United States. Electronic address: cowburns@ochin.org.
authors.forename: Stuart
authors.initials: S
authors.lastname: Cowburn
authors.affiliation: Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Rd., FM, Portland, OR 97239, United States. Electronic address: omalleyj@ohsu.edu.
authors.forename: Jean
authors.initials: J
authors.lastname: O'Malley
authors.affiliation: OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR 97201, United States. Electronic address: nelsonc@ochin.org.
authors.forename: Christine
authors.initials: C
authors.lastname: Nelson
authors.affiliation: Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Rd., FM, Portland, OR 97239, United States. Electronic address: devoej@ohsu.edu.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: DeVoe
mesh_terms: D000328:Adult; D003151:Community Health Centers / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000208:ethnology / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D009922:Oregon; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Community health centers; Electronic medical records; Health insurance; Preventive services