Using Research to Help Vulnerable Patients Overcome Barriers to Care

“As a family physician, I’ve seen many patients who have significant barriers accessing basic primary care and preventive services. AHRQ funding has helped my research have a real-world impact on improving access and quality of primary care.”

We've all had those "a-ha" moments, when a solution to a problem suddenly appears or a situation is seen in a new light.

For family physician and health researcher Jennifer E. DeVoe, M.D., D.Phil., those moments have fueled investigations that expanded access to health insurance for millions of children through State and Federal legislation, including the Affordable Care Act.

As a postdoctoral fellow funded by the Agency for Healthcare Research and Quality (AHRQ), Dr. DeVoe led a study in 2004 to identify health insurance barriers among Oregon families. It revealed that children who were eligible for public insurance who had uninsured parents were 14 times more likely to be uninsured than children with insured parents. 

"One of the a-ha moments we had was when we looked across the State and saw how many children were uninsured despite a number of programs being available to families," recalled Dr. DeVoe, now a professor of family medicine at Oregon Health & Sciences University (OHSU), Portland. The widely published findings informed expansion of public health insurance programs for children, including Oregon's "HealthyKids" program and later, the Federal reauthorization of the Children's Health Insurance Program.

Building on the strength of that evidence, Dr. DeVoe, who is also the Chair of the Department of Family Medicine at OHSU, was awarded an AHRQ K08 Career Development Grant in 2006 to identify predictors of uninsurance among U.S. children and adolescents with parents who have health insurance. The study she led, published in the Journal of the American Medical Association in 2008, revealed the surprising discovery that more than 3 percent of uninsured U.S. children had at least one parent with health insurance. Children who were uninsured were more likely to be from low- and middle-income families, while children whose parents were covered by public insurance were more likely to have coverage themselves.

In addition to the high-profile publication in JAMA, the findings from Dr. DeVoe's study received significant national attention, including a presentation at the National Press Club in Washington, D.C., that was featured in more than 370 radio and TV broadcasts. 

More significantly, perhaps, her research provided the evidence that created expanded coverage opportunities for children under the Affordable Care Act (ACA). Under the Act, States are required to better align their coverage by expanding Medicaid eligibility to all eligible individuals under age 65, including children, with incomes up to 133 percent of the Federal poverty level.

Growing up in Montana, Dr. DeVoe saw the value of physicians who were trained in a broad spectrum of practice. And her primary care training led her to recognize the role of science in providing evidence and using it "in everyday practice to improve patient and population health."

Sparked by an a-ha moment more than a decade ago, Dr. DeVoe's research on access to insurance coverage will have a lasting impact on the health and well-being of children and families. "The work we've done has contributed to the evidence to expand insurance and to really develop policies to help all people in the United States," she said. Dr. DeVoe's AHRQ training awards have led to her receiving several additional Federal grants to study health policy experiments and improve access to health care and health insurance for vulnerable Americans.

Jennifer E. DeVoe, M.D., D.Phil., AHRQ K-Award Grantee (35 seconds)

In 2021, Dr. DeVoe drew on this expertise as co-author of the National Academy of Science report, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care (PDF, 178 KB), which outlines five objectives for high-quality primary care in the U.S. She also chaired the committee that produced the Vibrant and Healthy Kids report (PDF, 660 KB), which outlines steps needed to move children who are at risk for negative outcomes toward positive health trajectories, reducing health disparities.

For more information on Dr. DeVoe's work at OHSU, please visit OHSU School of Medicine Alumni Association 2016 Awards.

Interview Transcript

Principal Investigator: Jennifer E. DeVoe, M.D., D.Phil., Professor of Family Medicine
Institution: Oregon Health & Sciences University
Grantee Since: 2004
Type of Grant: Multiple

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