title: Using the electronic health record for assessment of health insurance in community health centers.
abstract: To demonstrate use of the electronic health record (EHR) for health insurance surveillance and identify factors associated with lack of coverage.
  
  
  
  Using EHR data, we conducted a retrospective, longitudinal cohort study of adult patients (n = 279 654) within a national network of community health centers during a 2-year period (2012-2013).
  
  
  
  Factors associated with higher odds of being uninsured (vs Medicaid-insured) included: male gender, age >25 years, Hispanic ethnicity, income above the federal poverty level, and rural residence (P < .01 for all). Among patients with no insurance at their initial visit (n = 114 000), 50% remained uninsured for every subsequent visit.
  
  
  
  During the 2 years prior to 2014, many patients utilizing community health centers were unable to maintain stable health insurance coverage.
  
  
  
  As patients gain access to health insurance under the Affordable Care Act, the EHR provides a novel approach to help track coverage and support vulnerable patients in gaining and maintaining coverage.
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland Oregon, USA adamusb@ohsu.edu.
authors.forename: Brigit
authors.initials: B
authors.lastname: Hatch
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland Oregon, USA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Tillotson
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland Oregon, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Angier
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland Oregon, USA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Marino
authors.affiliation: OCHIN, Inc, Research Division, Portland, Oregon, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Hoopes
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland Oregon, USA.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Huguet
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland Oregon, USA OCHIN, Inc, Research Division, Portland, Oregon, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: DeVoe
mesh_terms: D000328:Adult; D003151:Community Health Centers; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
keywords: Patient Protection and Affordable Care Act; community health centers; electronic health records; health insurance; health services accessibility