Publications by authors named "Jean P O'Malley"

Background: Neighborhood socioeconomic marginalization and racial residential segregation are associated with differential health outcomes in adulthood and pregnancy, but the intergenerational effects of these exposures on early childhood growth are underexplored. Our objective was to investigate racial and ethnic differences in the association between neighborhood deprivation and early childhood growth trajectories, with modification by neighborhood racial concentration.

Methods: Using longitudinal clinical data among 58,860 children receiving care in community-based clinics in the ADVANCE Clinical Data Research Network, we identified four early childhood (0-24 months) body mass index (BMI) trajectories using group-based trajectory modeling: Low, Catch-Up, Moderate, and High.

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Research Objective: There is interest in using clinic- and area-level data to inform cancer control, but it is unclear what value these sources may add in combination with patient-level data sources. This study aimed to investigate associations of up-to-date colorectal and cervical cancer screenings at community health centers (CHCs) with ethnicity and language variables at patient-, clinic-, and area-levels, while exploring whether patient-level associations differed based on clinic-level patient language and ethnicity distributions.

Study Design: This was a cross-sectional study using data from multiple sources, including electronic health records, clinic patient panel data, and area-level demographic data.

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Objective: To examine analgesic methadone prescriptions among community health center (CHC) patients with chronic pain.

Design: Observational; two cross-sectional periods.

Setting: Oregon and California CHCs.

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Few have studied the COVID-19 pandemic's impact on tobacco use status assessment and cessation counseling. Electronic health record data from 217 primary care clinics were examined from January 1, 2019 to July 31, 2021. Data included telehealth and in-person visits for 759,138 adult patients (aged ≥18 years).

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Purpose: In an age of value-based payment, primary care providers are increasingly scrutinized on performance metrics that assess quality of care, including the outcomes of their patient population in key areas such as diabetes control. Although such measures often adjust for patient clinical risk factors or clinical complexity, most do not account for the social complexity of patient populations, despite research demonstrating the strong association between social factors and health.

Methods: Using patient electronic health record data from 2 large community health center networks serving safety net patients, we assessed the effect of both clinical and social risk factors on poor glucose control among diabetics.

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Background/aims: Evidence suggests that Medicaid beneficiaries in the United States are prescribed opioids more frequently than are people who are privately insured, but little is known about opioid prescribing patterns among Medicaid enrollees who gained coverage via the Affordable Care Act Medicaid expansions. This study compared the prevalence of receipt of opioid prescriptions and opioid use disorder (OUD), along with time from OUD diagnosis to medication-assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014 or returned to Medicaid coverage after expansion.

Design: Cross-sectional study using inverse-propensity weights to adjust for differences among insurance groups.

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Purpose: Implausible anthropometric measures are typically identified using population outlier definitions, conflating implausible and extreme measures. We determined the impact of a longitudinal outlier approach on prevalence of body mass index (BMI) categories and mean change in anthropometric measures in pediatric electronic health record data.

Methods: We examined 996,131 observations from 147,375 children (10-18 years) in the ADVANCE Clinical Data Research Network, a national network of community health centers.

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Health insurance coverage facilitates access to preventive screenings and other essential health care services, and is linked to improved health outcomes; therefore, it is critical to understand how well coverage information is documented in the electronic health record (EHR) and which characteristics are associated with accurate documentation. Our objective was to evaluate the validity of EHR data for monitoring longitudinal Medicaid coverage and assess variation by patient demographics, visit types, and clinic characteristics. We conducted a retrospective, observational study comparing Medicaid status agreement between Oregon community health center EHR data linked at the patient-level to Medicaid enrollment data (gold standard).

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Background: Children with health insurance have increased access to healthcare and receive higher quality care. However, despite recent initiatives expanding children's coverage, many remain uninsured. New technologies present opportunities for helping clinics provide enrollment support for patients.

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Background: There is interest in assessing health care utilization and expenditures among new Medicaid enrollees after the 2014 Medicaid expansion. Recent studies have not differentiated between newly enrolled individuals and those returning after coverage gaps.

Objectives: To assess health care expenditures among Medicaid enrollees in the 24 months after Oregon's 2014 Medicaid expansions and examine whether expenditure patterns were different among the newly, returning, and continuously insured (CI).

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Background: Understanding the impact of health insurance is critical, particularly in the era of Affordable Care Act Medicaid expansion. The electronic health record (EHR) provides new opportunities to quantify health outcomes.

Objective: To assess changes in biomarkers of chronic disease among community health center (CHC) patients who gained Medicaid coverage with the Oregon Medicaid expansion (2008-2011).

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Background: It is hypothesized that Affordable Care Act (ACA) Medicaid expansions could substantially improve access to health insurance and healthcare services for patients at risk for diabetes mellitus (DM), with pre-DM, or already diagnosed with DM. The ACA called for every state to expand Medicaid coverage by 2014. In a 2012 legal challenge, the US Supreme Court ruled that states were not required to implement Medicaid expansions.

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Background: Although past research demonstrated that Medicaid expansions were associated with increased emergency department (ED) and primary care (PC) utilization, little is known about how long this increased utilization persists or whether postcoverage utilization is affected by prior insurance status.

Objectives: (1) To assess changes in ED, PC, mental and behavioral health care, and specialist care visit rates among individuals gaining Medicaid over 24 months postinsurance gain; and (2) to evaluate the association of previous insurance with utilization.

Methods: Using claims data, we conducted a retrospective cohort analysis of adults insured for 24 months following Oregon's 2008 Medicaid expansion.

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Background: Community health center (CHC) patients have high rates of smoking. Insurance coverage for smoking cessation assistance, such as that mandated by the Affordable Care Act, may aid in smoking cessation in this vulnerable population.

Objective: We aimed to determine if uninsured CHC patients who gain Medicaid coverage experience greater primary care utilization, receive more cessation medication orders, and achieve higher quit rates, compared to continuously uninsured smokers.

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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.

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Article Synopsis
  • The study investigates the long-term effects of Oregon's 2008 Medicaid expansion on the receipt of preventive health services in community health centers over 36 months.
  • Researchers compared data from adults who were randomly assigned to apply for Medicaid with those who were not, using electronic health records from 49 community health centers.
  • Results indicated that Medicaid coverage significantly increased the chances of receiving preventive services, and the findings suggest that expanding health insurance could help reduce health disparities among vulnerable populations.
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Purpose: There is debate about whether community health centers (CHCs) will experience increased demand from patients gaining coverage through Affordable Care Act Medicaid expansions. To better understand the effect of new Medicaid coverage on CHC use over time, we studied Oregon's 2008 randomized Medicaid expansion (the "Oregon Experiment").

Methods: We probabilistically matched demographic data from adults (aged 19-64 years) participating in the Oregon Experiment to electronic health record data from 108 Oregon CHCs within the OCHIN community health information network (originally the Oregon Community Health Information Network) (N = 34,849).

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Importance: In the United States, health insurance is not universal. Observational studies show an association between uninsured parents and children. This association persisted even after expansions in child-only public health insurance.

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Background: Lack of insurance is associated with suboptimal receipt of diabetes preventive care. One known reason for this is an access barrier to obtaining healthcare visits; however, little is known about whether insurance status is associated with differential rates of receipt of diabetes care during visits.

Purpose: To examine the association between health insurance and receipt of diabetes preventive care during an office visit.

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The objective of this study was to develop methodologies for creating child-parent 'links' in two healthcare-related data sources. We linked children and parents who were patients in a network of Oregon clinics with a shared electronic health record (EHR), using data that reported the child's emergency contact information or the 'guarantor' for the child's visits. We also linked children and parents enrolled in the Oregon Health Plan (OHP; Oregon's public health insurance programs), using administrative data; here, we defined a 'child' as aged <19 years and identified potential 'parents' from among adults sharing the same OHP household identification (ID) number.

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To compare the agreement of electronic health record (EHR) data versus Medicaid claims data in documenting adult preventive care. Insurance claims are commonly used to measure care quality. EHR data could serve this purpose, but little information exists about how this source compares in service documentation.

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Introduction: Health care reimbursement is increasingly based on quality. Little is known about how clinic-level patient characteristics affect quality, particularly in community health centers (CHCs).

Methods: Using data from electronic health records for 4019 diabetic patients from 23 primary care CHCs in the OCHIN practice-based research network, we calculated correlations between a clinic's patient panel characteristics and rates of delivery of diabetes preventive services in 2007.

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Background: Previous research on ascertainment of cancer family history and cancer screening has been conducted in urban settings.

Purpose: To examine whether documented family history of breast or colorectal cancer is associated with breast or colorectal cancer screening.

Methods: Medical record reviews were conducted on 3433 patients aged 55 and older from four primary care practices in two rural Oregon communities.

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Background And Objectives: Recognition of CKD by primary care practitioners is essential in rural communities where nephrology access is limited. This study determined the prevalence of undocumented CKD in patients cared for in rural primary care practices and evaluated characteristics associated with undocumented CKD as well as CKD management.

Design, Setting, Participants, & Measurements: A retrospective cohort study, conducted within the Oregon Rural Practice Based Research Network, consisted of 865 CKD patients with serum creatinine≥1.

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Background: Assessment of patient safety culture has recently expanded in inpatient settings, but the majority of medical encounters occurs in office settings, and less is known about the determinants of perceived quality and safety in ambulatory care. The Medical Office Survey of Patient Safety was developed to assess perceived quality of care and patient safety culture in medical offices, including a domain to assess the quality criteria as defined by the Institute of Medicine: patient-centered, effective, timely, efficient, and equitable.

Methods: We surveyed 6534 clinicians and staff in 306 medical practices from 11 practice based research networks (PBRNs) in 16 states.

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