AHRQ Study: Web-Based Mapping Platform Can Identify Areas for Health Insurance Outreach

Web-based mapping tools to visualize and identify geographic areas where patients have low rates of health insurance can enable more effective outreach that can lead to uninsured patients obtaining coverage, a new AHRQ study concludes. It used electronic health records from 52 Oregon health clinics, segmented by ZIP code. Differences in coverage were observed within smaller geographic areas using Web-based mapping tools than would be possible using publicly available data. The visualizations were particularly helpful in identifying areas where the need for outreach might be unexpected. For example, more than 34 percent of patients in one ZIP code were uninsured, despite living in an area with incomes near the national average. The authors concluded that the technology shows potential for broader use in identifying areas of uninsured patients, as well as identifying other health care practice and community needs. “Using Geographic Information Systems (GIS) to Identify Communities in Need of Health Insurance Outreach: An OCHIN Practice-based Research Network (PBRN) Report” and the abstract were published in the November-December issue of The Journal of the American Board of Family Medicine.

2014 Nov-Dec;27(6):804-10. doi: 10.3122/jabfm.2014.06.140029.

Using geographic information systems (GIS) to identify communities in need of health insurance outreach: An OCHIN practice-based research network (PBRN) report.

Angier H1, Likumahuwa S2, Finnegan S2, Vakarcs T2, Nelson C2, Bazemore A2, Carrozza M2, DeVoe JE2.

Author information

Abstract

BACKGROUND:

Our practice-based research network (PBRN) is conducting an outreach intervention to increase health insurance coverage for patients seen in the network. To assist with outreach site selection, we sought an understandable way to use electronic health record (EHR) data to locate uninsured patients.

METHODS:

Health insurance information was displayed within a web-based mapping platform to demonstrate the feasibility of using geographic information systems (GIS) to visualize EHR data. This study used EHR data from 52 clinics in the OCHIN PBRN. We included cross-sectional coverage data for patients aged 0 to 64 years with at least 1 visit to a study clinic during 2011 (n = 228,284).

RESULTS:

Our PBRN was successful in using GIS to identify intervention sites. Through use of the maps, we found geographic variation in insurance rates of patients seeking care in OCHIN PBRN clinics. Insurance rates also varied by age: The percentage of adults without insurance ranged from 13.2% to 86.8%; rates of children lacking insurance ranged from 1.1% to 71.7%. GIS also showed some areas of households with median incomes that had low insurance rates.

DISCUSSION:

EHR data can be imported into a web-based GIS mapping tool to visualize patient information. Using EHR data, we were able to observe smaller areas than could be seen using only publicly available data. Using this information, we identified appropriate OCHIN PBRN clinics for dissemination of an EHR-based insurance outreach intervention. GIS could also be used by clinics to visualize other patient-level characteristics to target clinic outreach efforts or interventions.