Assessing the effect of virtual navigation interventions to improve health insurance literacy and decrease financial burden: A CCSS randomized trial

评估虚拟导航干预措施对提高健康保险知识和减轻经济负担的效果：一项 CCSS 随机试验

• 批准号: 10458154
• 负责人: Anne C Kirchhoff
• 金额: $ 69万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10458154
• 关键词: 21 year old; Acute; Address; Adherence; Adolescent and Young Adult; Adult; Affordable Care Act; Area; Awareness; Behavioral Model; Cancer Survivor; Caring; Characteristics; Childhood; Childhood Cancer Survivor Study; Chronic; Code; Cohort Studies; Complex; Data Collection; Diagnosis; Ensure; Ethnic Origin; Face; Financial Hardship; Health; Health Care Costs; Health Care Reform; Health Insurance; Health Promotion; Health Services Accessibility; Healthcare; Healthcare Systems; Insurance; Insurance Benefits; Insurance Coverage; Intervention; Knowledge; Lead; Long-Term Effects; Malignant Neoplasms; Medicaid; Medical Care Costs; Medical History; Medical Surveillance; Methods; Monitor; Morbidity - disease rate; Outcome; Pamphlets; Patients; Pharmaceutical Preparations; Policies; Race; Randomized; Recording of previous events; Research; Risk; Sampling; Siblings; Survivors; Testing; Time; Underinsured; Visit; barrier to care; cancer therapy; childhood cancer survivor; cohort; comparison intervention; cost; cost effective; deprivation; design; digital; digital delivery; digital health; digital intervention; effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; experience; follow-up; health care service; health care service utilization; health service use; implementation evaluation; implementation intervention; improved; indexing; innovation; intervention delivery; intervention effect; literacy; mHealth; patient portal; prevent; primary outcome; psychoeducational; randomized trial; recruit; response; secondary outcome; skills; sociodemographics; survivorship; synchronous contact; synchronous delivery; three-arm trial; tool; treatment as usual; trial comparing; virtual

Childhood cancer survivors often have complex health needs that require medical surveillance, requiring them to navigate the complexities of the health care system. Despite the Affordable Care Act’s expansion of insurance, many childhood cancer survivors continue to experience underinsurance and barriers to care. Adequate health insurance literacy is a key skill for survivors to obtain and utilize health insurance and to prevent high out-of-pocket costs or unmet health care needs. Interventions are critically needed to support childhood cancer survivors in addressing issues of insurance, but to date no intervention has been developed to improve childhood survivors’ health insurance literacy. Guided by Andersen and Aday’s Behavioral Model of Health Services Use, we developed a patient navigation intervention and health insurance booklet, targeted for survivors. We conducted a pilot randomized trial comparing intervention, Health Insurance Navigation Tools (HINT-S), delivered synchronously via Zoom, to enhanced usual care (EUC; digital health insurance booklet only) among 82 survivors in the Childhood Cancer Survivor Study (CCSS) cohort. HINT-S incorporates a strong psychoeducational component, with 4 45-minute sessions designed to improve survivors’ conceptual knowledge of health insurance and cost. Preliminary results support its feasibility, acceptability, and preliminary efficacy. In response to RFA-CA-20-027, we propose a Type 1 hybrid effectiveness-implementation trial to test HINT-S vs. EUC to promote health insurance literacy, as well as improving downstream financial hardship and health care. We will randomize 520 survivors from the CCSS cohort to: HINT-S, HINT-A (4 prerecorded, asynchronous navigator sessions, which has the potential to be cost-effective and scalable), and EUC. All study activities, including recruitment, data collection, and navigation, will be conducted virtually, via the CCSS mHealth platform and patient portal. We will investigate whether HINT-S improves health insurance literacy over EUC at 6 months (primary outcome) and explore the relative difference in effect size and cost of HINT-S compared to HINT-A. We will explore moderators (e.g., sociodemographics, insurance status, state Medicaid expansion status, cancer and health history, and baseline literacy) of the intervention effects. The association of health insurance literacy with longer-term outcomes, such as financial hardship (worry, unmet healthcare needs, and financial consequences of medical costs), decreases in out-of-pocket-costs, and improvements in healthcare utilization at 18 months will be investigated. Implementation evaluation will assess the intervention’s reach, engagement, acceptability, fidelity, and sustainability (including cost). This study is innovative for the 1) comparison of digital intervention delivery, 2) focus on health insurance literacy, and 3) access to a national sample of long-term childhood cancer survivors. Digitally-delivered interventions that address health insurance literacy can lead to national sustainable improvements in childhood survivors’ health care costs and care.

儿童癌症幸存者往往有复杂的健康需求，需要医疗监测，要求他们 尽管平价医疗法案扩大了医疗保健系统的复杂性。 保险，许多儿童癌症幸存者仍然面临保险不足和护理障碍。 足够的健康保险知识是幸存者获得和利用健康保险以及 迫切需要采取干预措施来支持高额自付费用或未满足的医疗保健需求。 儿童癌症幸存者解决保险问题，但迄今为止尚未制定任何干预措施 以安徒生和阿戴的行为模型为指导，提高儿童幸存者的健康保险素养。 健康服务用途，我们开发了患者导航干预和健康保险手册，针对 我们进行了一项随机试验，比较干预措施、健康保险导航工具。 (HINT-S)，通过 Zoom 同步交付，以增强日常护理（EUC；数字健康保险手册） 仅）在儿童癌症幸存者研究 (CCSS) 队列中的 82 名幸存者中纳入了一项 HINT-S。 强大的心理教育成分，包括 4 次 45 分钟的课程，旨在提高幸存者的概念 初步结果支持其可行性、可接受性和初步性。 为了响应 RFA-CA-20-027，我们提出了 1 类混合有效性实施试验来测试。 HINT-S 与 EUC 相比，旨在提高健康保险知识，以及改善下游财务困难和 我们将从 CCSS 队列中随机分配 520 名幸存者：HINT-S、HINT-A（4 名预先记录的、 异步导航器会话，具有成本效益和可扩展性）和 EUC 全部。 研究活动，包括招募、数据收集和导航，将通过 CCSS 虚拟进行 我们将调查 HINT-S 是否可以提高健康保险知识。 6 个月时的 EUC（主要结果）并探讨 HINT-S 的效果大小和成本的相对差异 与 HINT-A 相比，我们将探索调节因素（例如，社会人口统计、保险状况、州医疗补助） 干预效果的关联性。 具有长期结果的健康保险知识，例如经济困难（担忧、未得到满足的医疗保健 需求和医疗费用的财务后果），自付费用的减少以及 将调查 18 个月时的医疗保健利用情况，以评估干预措施的效果。 覆盖范围、参与度、可接受性、忠诚度和可持续性（包括成本） 本研究的创新之处在于 1)。 数字干预实施的比较，2) 关注健康保险知识，3) 获得国家 长期儿童癌症幸存者的样本，以数字方式提供解决健康保险问题的干预措施。 扫盲可以使全国儿童幸存者的医疗保健费用和护理得到可持续改善。