title: Testing health information technology tools to facilitate health insurance support: a protocol for an effectiveness-implementation hybrid randomized trial.
abstract: 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
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Clinical trial NTC02355262.
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA. devoej@ohsu.edu.|OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA. devoej@ohsu.edu.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: DeVoe
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA. huguetn@ohsu.edu.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Huguet
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA. likumahu@ohsu.edu.
authors.forename: Sonja
authors.initials: S
authors.lastname: Likumahuwa-Ackman
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA. angierh@ohsu.edu.
authors.forename: Heather
authors.initials: H
authors.lastname: Angier
authors.affiliation: OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA. nelsonc@ochin.org.
authors.forename: Christine
authors.initials: C
authors.lastname: Nelson
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA. marinom@ohsu.edu.
authors.forename: Miguel
authors.initials: M
authors.lastname: Marino
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA. cohendj@ohsu.edu.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cohen
authors.affiliation: OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA. sumica@ochin.org.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Sumic
authors.affiliation: OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA. hoopesm@ochin.org.
authors.forename: Megan
authors.initials: M
authors.lastname: Hoopes
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA. hardingr@ohsu.edu.
authors.forename: Rose L
authors.initials: RL
authors.lastname: Harding
authors.affiliation: OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA. dearingm@ochin.org.
authors.forename: Marla
authors.initials: M
authors.lastname: Dearing
authors.affiliation: OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA. Rachel.Gold@kpchr.org.|Center for Health Research Northwest, Kaiser Permanente, 3800 N. Interstate Avenue, Portland, OR, 97227, USA. Rachel.Gold@kpchr.org.
authors.forename: Rachel
authors.initials: R
authors.lastname: Gold
mesh_terms: D003151:Community Health Centers / Q000458:organization & administration*; D055088:Early Detection of Cancer / Q000191:economics; D057286:Electronic Health Records / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000458:organization & administration*; D007348:Insurance, Health / Q000458:organization & administration*; D008484:Medicaid / Q000706:statistics & numerical data; D008490:Medical Informatics / Q000458:organization & administration*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D057216:Propensity Score; D012107:Research Design; D014481:United States