title: Healthcare Utilization After a Children's Health Insurance Program Expansion in Oregon.
abstract: OBJECTIVE
  The future of the Children's Health Insurance Program (CHIP) is uncertain after 2017. Survey-based research shows positive associations between CHIP expansions and children's healthcare utilization. To build on this prior work, we used electronic health record (EHR) data to assess temporal patterns of healthcare utilization after Oregon's 2009-2010 CHIP expansion. We hypothesized increased post-expansion utilization among children who gained public insurance.
  
  
  METHODS
  Using EHR data from 154 Oregon community health centers, we conducted a retrospective cohort study of pediatric patients (2-18 years old) who gained public insurance coverage during the Oregon expansion (n = 3054), compared to those who were continuously publicly insured (n = 10,946) or continuously uninsured (n = 10,307) during the 2-year study period. We compared pre-post rates of primary care visits, well-child visits, and dental visits within- and between-groups. We also conducted longitudinal analysis of monthly visit rates, comparing the three insurance groups.
  
  
  RESULTS
  After Oregon's 2009-2010 CHIP expansions, newly insured patients' utilization rates were more than double their pre-expansion rates [adjusted rate ratios (95 % confidence intervals); increases ranged from 2.10 (1.94-2.26) for primary care visits to 2.77 (2.56-2.99) for dental visits]. Utilization among the newly insured spiked shortly after coverage began, then leveled off, but remained higher than the uninsured group.
  
  
  CONCLUSIONS
  This study used EHR data to confirm that CHIP expansions are associated with increased utilization of essential pediatric primary and preventive care. These findings are timely to pending policy decisions that could impact children's access to public health insurance in the United States.
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA. bailstef@ohsu.edu.
authors.forename: Steffani R
authors.initials: SR
authors.lastname: Bailey
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.|School of Public Health, Division of Biostatistics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Marino
authors.affiliation: OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Hoopes
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
authors.forename: John
authors.initials: J
authors.lastname: Heintzman
authors.affiliation: OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.|Kaiser Permanente Center for Health Research Northwest, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Gold
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Angier
authors.affiliation: School of Public Health, Division of Biostatistics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
authors.forename: Jean P
authors.initials: JP
authors.lastname: O'Malley
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.|OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: DeVoe
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D065326:Children's Health Insurance Program; D057286:Electronic Health Records; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage / Q000639:trends*; D008297:Male; D009922:Oregon; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D012959:Socioeconomic Factors
keywords: CHIP; Children; Electronic health records; Health insurance; Medicaid; Utilization