Results Summary

What was the research about?

Medicaid is public health insurance for people who don’t have insurance and can’t afford to pay for it on their own. Women who are new to Medicaid may need help getting care from a primary care doctor, such as regular checkups or vaccines.

In this study, the research team wanted to learn if an offer by phone for support from a community health worker helped women new to a Medicaid health plan get care. Community health workers teach people about health and link them to health services. The team compared two groups of women. In one group, health plan staff called women and offered assistance from a community health worker. In the other group, women didn’t receive a call offering community health worker assistance. All women in the study got standard health plan information.

What were the results?

Overall, the study found no difference in getting care from a primary care doctor between women that health plan staff called and those who they didn’t call. However, health plan staff couldn’t reach 78 percent of the women they called.

Who was in the study?

The study included 2,267 women ages 18 to 39 who had just joined the University Family Care Medicaid health plan in southern Arizona. Of these, 39 percent were white, 15 percent were other races, 32 percent were Hispanic, and 14 percent didn’t indicate a race or ethnicity. The average age was 27.

What did the research team do?

The research team assigned women to one of two groups by chance. Health plan staff called women in the first group to offer them help from a community health worker. Staff tried calling women three times. They called at different times and days of the week and left a message if no one answered the phone. The second group didn’t get a phone call from health plan staff. After six months, the team looked at healthcare records for women in both groups to see if the groups differed in whether they got care from a primary care doctor.

What were the limits of the study?

The research team designed the study to look at whether the offer of community health worker support was helpful to women in getting primary care. The study didn’t compare women who worked with community health workers with those who didn’t.

Future studies could look at other ways to offer help to women new to Medicaid.

How can people use the results?

Health plans could consider the results from this study when deciding how to offer help to new members.

Final Research Report

View this project's final research report.

More About This Research

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • Reviewers noted that the report’s conclusions overstated the success of the intervention since most of the differences favoring the intervention were not statistically significant. The researchers explained that since the nonsignificant findings were in one direction, it was reasonable to assume that the intervention had some effect. However, with further urging from reviewers, the researchers removed the assertions that the intervention affected outcomes despite the lack of statistically significant differences.
  • Reviewers pointed out that a major finding of the study related to the reachability of study participants, rather than the intervention outcomes. The researchers acknowledged this point and added language to their report describing their lessons learned about contacting and engaging participants. The researchers argued further that despite the very low participation and completion rates for the intervention and control groups, the results could be generalizable to other populations.
  • Reviewers expressed concern about the potential for post-randomization selection bias. The study randomized participants before inviting them to the program itself, which meant that people who entered the program could differ from those who did not, as well as from those participants randomized to the uninvited group. Therefore, it is possible that the benefits seen in the intervention group were because the participants who were easier to contact to issue the invitation to were also those who would respond better to the intervention. The researchers acknowledged this potential confounder but were not comfortable concluding that the observed benefit among program recipients was due entirely to the ease of contacting such recipients about participating in the program. However, the researchers revised their conclusions to acknowledge the potential effect of selection bias for as-treated analyses.

Conflict of Interest Disclosures

View the COI disclosure form.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • Reviewers noted that the report’s conclusions overstated the success of the intervention since most of the differences favoring the intervention were not statistically significant. The researchers explained that since the nonsignificant findings were in one direction, it was reasonable to assume that the intervention had some effect. However, with further urging from reviewers, the researchers removed the assertions that the intervention affected outcomes despite the lack of statistically significant differences.
  • Reviewers pointed out that a major finding of the study related to the reachability of study participants, rather than the intervention outcomes. The researchers acknowledged this point and added language to their report describing their lessons learned about contacting and engaging participants. The researchers argued further that despite the very low participation and completion rates for the intervention and control groups, the results could be generalizable to other populations.
  • Reviewers expressed concern about the potential for post-randomization selection bias. The study randomized participants before inviting them to the program itself, which meant that people who entered the program could differ from those who did not, as well as from those participants randomized to the uninvited group. Therefore, it is possible that the benefits seen in the intervention group were because the participants who were easier to contact to issue the invitation to were also those who would respond better to the intervention. The researchers acknowledged this potential confounder but were not comfortable concluding that the observed benefit among program recipients was due entirely to the ease of contacting such recipients about participating in the program. However, the researchers revised their conclusions to acknowledge the potential effect of selection bias for as-treated analyses.

Conflict of Interest Disclosures

Project Information

Francisco Garcia, MD, MPH
University of Arizona
$1,228,632
10.25302/10.2019.IHS.130604356

Key Dates

43 months
December 2013
October 2018
2013
2018

Study Registration Information

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Last updated: October 20, 2021