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.

儿童期癌症表面表面通常具有复杂的健康需求，需要医疗监测，需要它们 浏览医疗保健系统的复杂性。尽管有负担得起的护理法案的扩展 保险，许多儿童癌症的生存继续经历不足和护理障碍。 足够的健康保险素养是获得和利用健康保险和利用健康保险和使用的关键技能 防止高自付成本或未满足的医疗保健需求。迫切需要干预措施以支持 儿童期癌症在解决保险问题时的存活，但迄今为止尚未开发干预 改善童年幸存者的健康保险素养。在安德森（Andersen）和阿达（Aday）的行为模型的指导下 健康服务使用，我们开发了一个患者导航干预和健康保险手册，针对 幸存者。我们进行了一项试验随机试验，以比较干预，健康保险导航工具 （Hint-S），通过Zoom同步交付，以增强常规护理（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个冲浪者中。 Hint-s融合了 强大的心理教育成分，有445分钟的会议旨在改善生存的概念 了解健康保险和成本。初步结果支持其可行性，可接受性和初步 有效。为了响应RFA-CA-20-027，我们提出了一项1型混合有效性试验进行测试 Hint-S与EUC促进健康保险素养以及改善下游财务困难和 卫生保健。我们将从CCSS队列中随机将520个冲浪者随机，为：Hint-S，hint-a（4个预先记录， 异步导航器会话，具有具有成本效益和可扩展性的潜力）和EUC。全部 研究活动，包括招聘，数据收集和导航，实际上将通过CCSS进行 MHealth平台和患者门户网站。我们将调查Hint-S是否提高健康保险素养 超过6个月的EUC（主要结果），并探索hint-S的影响大小和成本的相对差异 与提示A相比。我们将探索主持人（例如，社会人口统计学，保险状态，州医疗补助 干预效果的扩张状态，癌症和健康史以及基线素养）。协会 具有长期成果的健康保险素养，例如财务困难（担心，未满足医疗保健 需求和医疗费用的财务后果），自付费用下降，并改善 将研究18个月的医疗保健利用。实施评估将评估干预措施 覆盖，参与，可接受性，忠诚和可持续性（包括成本）。这项研究对1个具有创新性） 数字干预交付的比较，2）专注于健康保险素养，3）进入国家 长期儿童癌症存活样本。数字交付的干预措施，以解决健康保险 识字可以导致国家可持续发展的儿童生存的医疗保健费用和护理。