Publications by authors named "Brigit A Hatch"

6 Publications

  • Page 1 of 1

Understanding Health Need and Services Received by Youth in Foster Care in Community Safety-Net Health Centers in Oregon.

J Health Care Poor Underserved 2021 ;32(2):783-798

Youth in foster care have significant unmet health needs. We assessed health needs and health service use among youth in foster care in Oregon using electronic health record data from 258 community health centers and Medicaid enrollment data from 2014-2016. We identified 2,140 youth in foster care and a matched comparison group of 6,304 youth from the same clinics who were not in foster care, and compared the groups on demographic characteristics, health needs, and health service use. Youth in foster care were significantly more likely to have at least one chronic health condition, at least one mental health condition, and at least one mental health service compared with controls. Youth in foster care were significantly less likely to have a primary care visit. Despite significant mental health needs among youth in foster care, few received mental health care; this lack was greater among African American and Hispanic youth.
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http://dx.doi.org/10.1353/hpu.2021.0105DOI Listing
January 2021

The Importance of Practice Facilitation in Primary Care When Pandemic Takes Hold: Relationships of Resilience.

J Prim Care Community Health 2021 Jan-Dec;12:21501327211014093

Oregon Health & Science University, Portland, OR, USA.

The COVID-19 pandemic is unprecedented in recent history as radically and forcefully changing healthcare delivery. Practice facilitators, who often use tools of improvement science, have long played a critical role in supporting routine primary care practice transformation when healthcare system and policy changes occur. However, current events have taken many healthcare systems to the brink of collapse. Our practice facilitation team, which has a long history of sustained primary care partnerships in rural under-resourced settings, is finding creative solutions to carry forward work in research and quality improvement, and the tools of improvement science are well-suited to address rapidly changing demands of primary care during such a crisis. We reflect here on practice facilitation through the pandemic-the value of applied improvement science, and the critical necessity of strong relationships, flexibility, and creativity to support ongoing primary care partnerships.
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http://dx.doi.org/10.1177/21501327211014093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114255PMC
June 2021

Uptake of Preventive Services Among Patients With and Without Multimorbidity.

Am J Prev Med 2020 11 22;59(5):621-629. Epub 2020 Sep 22.

Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.

Introduction: Patients with multiple chronic conditions (multimorbidity) are seen commonly in primary care practices and often have suboptimal uptake of preventive care owing to competing treatment demands. The complexity of multimorbidity patterns and their impact on receiving preventive services is not fully understood. This study identifies multimorbidity combinations associated with low receipt of preventive services.

Methods: This was a retrospective cohort study of U.S. community health center patients aged ≥19 years. Electronic health record data from 209 community health centers for the January 1, 2014-December 31, 2017 study period were analyzed in 2018-2019. Multimorbidity patterns included physical only, mental health only, and physical and mental health multimorbidity patterns, with no multimorbidity as a reference category. Electronic health record-based preventive ratios (number of months services were up-to-date/total months the patient was eligible for services) were calculated for the 14 preventive services. Negative binomial regression models assessed the relationship between multimorbidity physical and/or mental health patterns and the preventive ratio for each service.

Results: There was a variation in receipt of preventive care between multimorbidity groups: individuals with mental health only multimorbidity were less likely to be up-to-date with cardiometabolic and cancer screenings than the no multimorbidity group or groups with physical health conditions, and the physical only multimorbidity group had low rates of depression screening.

Conclusions: This study provided critical insights into receipt of preventive service among adults with multimorbidity using a more precise method for measuring up-to-date preventive care delivery. Findings would be useful to identify target populations for future intervention programs to improve preventive care.
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http://dx.doi.org/10.1016/j.amepre.2020.04.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577968PMC
November 2020

Use of a Preventive Index to Examine Clinic-Level Factors Associated With Delivery of Preventive Care.

Am J Prev Med 2019 08;57(2):241-249

Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; OCHIN, Inc., Portland, Oregon.

Introduction: There is an increasing need for the development of new methods to understand factors affecting delivery of preventive care. This study applies a new measurement approach and assesses clinic-level factors associated with preventive care delivery.

Methods: This retrospective longitudinal cohort study of 94 community health centers used electronic health record data from the OCHIN community health information network, 2014-2015. Clinic-level preventive ratios (time covered by a preventive service/time eligible for a preventive service) were calculated in 2017 for 12 preventive services with A or B recommendations from the U.S. Preventive Services Task Force along with an aggregate preventive index for all services combined. For each service, multivariable negative binomial regression modeling and calculated rate ratios assessed the association between clinic-level variables and delivery of care.

Results: Of ambulatory community health center visits, 59.8% were Medicaid-insured and 10.4% were uninsured. Ambulatory community health centers served 16.9% patients who were Hispanic, 13.1% who were nonwhite, and 68.7% who had household incomes <138% of the federal poverty line. Clinic-level preventive ratios ranged from 3% (hepatitis C screening) to 93% (blood pressure screening). The aggregate preventive index including all screening measures was 47% (IQR, 42%-50%). At the clinic level, having a higher percentage of uninsured visits was associated with lower preventive ratios for most (7 of 12) preventive services.

Conclusions: Approaches that use individual preventive ratios and aggregate prevention indices are promising for understanding and improving preventive service delivery over time. Health insurance remains strongly associated with access to needed preventive care, even for safety net clinic populations.
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http://dx.doi.org/10.1016/j.amepre.2019.03.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6684138PMC
August 2019

Measuring Preventive Care Delivery: Comparing Rates Across Three Data Sources.

Am J Prev Med 2016 11 10;51(5):752-761. Epub 2016 Aug 10.

Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; OCHIN, Inc., Portland, Oregon.

Introduction: Preventive care delivery is an important quality outcome, and electronic data reports are being used increasingly to track these services. It is highly informative when electronic data sources are compared to information manually extracted from medical charts to assess validity and completeness.

Methods: This cross-sectional study used a random sample of Medicaid-insured patients seen at 43 community health centers in 2011 to calculate standard measures of correspondence between manual chart review and two automated sources (electronic health records [EHRs] and Medicaid claims), comparing documentation of orders for and receipt of ten preventive services (n=150 patients/service). Data were analyzed in 2015.

Results: Using manual chart review as the gold standard, automated EHR extraction showed near-perfect to perfect agreement (κ=0.96-1.0) for services received within the primary care setting (e.g., BMI, blood pressure). Receipt of breast and colorectal cancer screenings, services commonly referred out, showed moderate (κ=0.42) to substantial (κ=0.62) agreement, respectively. Automated EHR extraction showed near-perfect agreement (κ=0.83-0.97) for documentation of ordered services. Medicaid claims showed near-perfect agreement (κ=0.87) for hyperlipidemia and diabetes screening, and substantial agreement (κ=0.67-0.80) for receipt of breast, cervical, and colorectal cancer screenings, and influenza vaccination. Claims showed moderate agreement (κ=0.59) for chlamydia screening receipt. Medicaid claims did not capture ordered or unbilled services.

Conclusions: Findings suggest that automated EHR and claims data provide valid sources for measuring receipt of most preventive services; however, ordered and unbilled services were primarily captured via EHR data and completed referrals were more often documented in claims data.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5067199PMC
http://dx.doi.org/10.1016/j.amepre.2016.07.004DOI Listing
November 2016

Citizenship documentation requirement for Medicaid eligibility: effects on Oregon children.

Fam Med 2014 Apr;46(4):267-75

Department of Family Medicine, Oregon Health & Science University.

Background And Objectives: The Deficit Reduction Act (DRA) of 2005 mandated Medicaid beneficiaries to document citizenship. Using a prospective cohort (n=104,375), we aimed to (1) determine characteristics of affected children, (2) describe effects on health insurance coverage and access to needed health care, and (3) model the causal relationship between this new policy, known determinants of health care access, and receipt of needed health care.

Methods: We identified a stratified random sample of children shortly after the DRA was implemented and used state records and surveys to compare three groups: children denied Medicaid for inability to document citizenship, children denied for other reasons, and children accepted for coverage. To combat survey nonresponse, we used Medicaid records to identify differences between responders and nonrespondents and created survey weights to account for these differences. Weighted simple and multivariable logistic regression described the complete, originally identified population.

Results: Children denied Medicaid for inability to document citizenship were likely to be US citizens, were medically and socially more vulnerable than their peers, and went on to have gaps in health insurance coverage and unmet health care needs. The DRA led to persistent loss of insurance coverage, which decreased access to needed health care. Having a usual source of care was an effect modifier in this relationship.

Conclusions: Our findings demonstrate the negative consequences of the DRA and support the use of automated methods of citizenship verification allowed under the Patient Protection and Affordable Care Act.
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April 2014
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