Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients

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When compared with individuals with continuous health insurance coverage, the uninsured population in the United States are less likely to be up to-date on recommended preventive health services, regardless of gender, age, race, ethnicity, and socioeconomic status. This study compared the preventive service utilization rate of the uninsured using electronic health record (EHR) data. [1]


The authors used two data sources: EHR data from OCHIN and longitudinal health insurance coverage information obtained from Oregon Medicaid enrollment data. The study included non-pregnant patients (aged 19–64) who had one or more face-to-face encounter visits at an OCHIN Community Health Center (CHC) with an EHR between 2008 and 2011 (9,938 uninsured compared with 8,106 insured patients).


The study evaluated 18,044 insured and uninsured patients and found no significant differences in how the patients received the services in six of the eleven services (blood pressure screening, body mass index assessment, smoking assessment, chlamydia screening, fecal occult blood testing (FOBT), and pneumococcal vaccination). However, the study did identify significant differences between the uninsured and the insured patients in five of the eleven services (lipid screening, glucose screening, pap smears, flu vaccine, and mammography orders); specifically, the uninsured are less likely to receive glucose screening or pneumococcal vaccine.


This study used EHR data to evaluate patients over 4-year time period and the results demonstrate that Oregon CHCs provide many recommended, evidence-based preventive services to uninsured patients; however, uninsured CHC patients were less likely than the insured to receive preventive services when those services required an order or referral which demonstrates the barrier that lack of insurance poses to quality care. The study also identified that the uninsured group was disproportionately Hispanic/Latino and Spanish speaking.


CHCs provide important preventative services to uninsured and insured patients; however, the uninsured were less likely to receive some preventative services that required an order or a referral. According to the authors, this will result in reduced access to preventative services for the uninsured that cannot obtain health insurance coverage with the Affordable Care Act.


This was an interesting article comparing preventative health services received by uninsured and insured CHC patients. I was surprised to read that there were no significant differences between the uninsured and insured in only five of eleven services, I expected to see more similarities across the services. I would like additional information on why there is a gap between the uninsured and insured at CHCs when it comes to referrals and orders.

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  1. Heintzman 2014. Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients