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Dr. Erika Cottrell is a senior investigator and director of social policy research at OCHIN. She is also an associate professor in the Department of Medical Informatics and Clinical Epidemiology at Oregon Health & Science University (OHSU). Trained as a sociologist with expertise in qualitative and quantitative methods, Erika has a robust research portfolio focused on health equity, health policy, social and structural drivers of health, reproductive health, and patient health experiences.
Since joining the OCHIN research department in 2013, she has led studies funded by the Agency for Healthcare Research and Quality (AHRQ), National Institutes of Health (NIH), Patient Centered Outcomes Research (PCORI), and Robert Wood Johnson Foundation (RWJF). Her research focuses on the impact of state and federal policy on patterns of reproductive health care in community health centers; the feasibility of using community- and individual-level social drivers of health data to inform decisions about health care performance and payment; developing and testing electronic health record (EHR)-based tools for integrating social risk screening and action into primary care; and understanding people’s experiences of opioid use disorder and treatment.
Currently, she is principal investigator (PI) of Accelerating Data Value across a National Community Health Center Network (ADVANCE), one of eight clinical research networks (CRNs) in the National Patient-Centered Clinical Research Network (PCORnet); multiple principal investigator (MPI) on the Network for Community-Engaged Primary Care Research (NCPCR), funded by NIH; and director of health experiences research for the Oregon Clinical & Translational Research Institute (OCTRI) at OHSU, which works to elevate patient voices in clinical and translational research.
A key contributor to growing health disparities across the United States are social drivers of health (SDOH), the non-medical factors that shape the conditions in which we are born, grow, work, and live. Erika was the OCHIN site PI on three NIH-funded projects related to SDOH screening and action in primary care. The first was a stakeholder-engaged process to develop and pilot test the first set of EHR-embedded social risk screening tools, which were activated in >400 OCHIN community health centers (CHCs) in June 2016. The second assessed the impact of a set of implementation support strategies for helping CHCs routinely identify and address the SDOH-related risks for patients with or at risk of diabetes. The third explored strategies for adjusting care plans to account for patient social risks. Erika was co-PI of a PCORnet-funded health systems demonstration project to understand the impact of community-level social factors (or community vital signs) on disparities in health outcomes and clinical quality metrics. This project leveraged geocoded data from a variety of sources (e.g., the U.S. Census, American Community Survey) and linked to patient EHR data using information on patient address to evaluate the impact of community-level social risk factors on diabetes control. Additional papers from this study evaluated the overlap between community- and individual-level measures of social risk. This work has contributed to ongoing debates about the best methods for measuring and/or accounting for community- and patient-level social risk factors in the assessment of clinical quality and performance metrics. Erika was PI of a mixed-methods, AHRQ-funded Research Project Grant (R01) to understand the impact of the Affordable Care Act (ACA) and other state and local policies on the utilization of reproductive health services in CHCs. Using EHR data, they compared rates of reproductive service utilization in Medicaid expansion versus non-expansion states pre- and post-ACA. Quantitative findings were augmented through qualitative interviews among CHC staff and patients to understand barriers and facilitators associated with providing and receiving reproductive care in CHC settings. In 2013, Oregon recently launched the Alternative Payment Methodology (APM) demonstration project. Participating CHCs receive a monthly payment based on the size and composition of their patient population. This shifts the paradigm from the number of doctor visits to the provision of high-quality, team-based, patient-centered care. Erika was principal investigator of a RWJF-funded qualitative study to investigate the impact of APM on the delivery of primary care in systemically underserved populations. She was also OCHIN site PI for an AHRQ-funded R01 to evaluate the impact of APM on health care utilization, quality, and outcomes. Cottrell EK, O’Malley J, Dambrun K, Thayer E, Jacob L, Pinnock W, Ashou C, Heintzman J. Understanding and Documenting New Ways of Delivering Care During the Medicaid Alternative Payment Method Natural Experiment in Oregon. Journal of the American Board of Family Medicine. 2021 Jan-Feb;34(1):78-88. doi: 10.3122/jabfm.2021.01.200027. PMID: 33452085. As a K12 scholar, Erika contributed to several projects related to developing methodology for stakeholder engagement in research and systematic reviews. Findings from these projects suggested that current methods of engagement often fail to reach low-income, minority, and vulnerable patients who are known to have a higher risk of disparities in health care access and outcomes, thus highlighting the need for innovative methods to engage and understand the health experiences of a wider range of patients. Her current work builds on this foundation by leveraging the Database of Individual Patient Experiences (DIPEx) methodology, developed in 2001 by researchers at Oxford University, to conduct and disseminate rigorous qualitative research on patient health experiences that can enhance and augment patient engagement in research and provide a more representative and in-depth understanding of patient experiences of health and illness. She is chair of the DIPEx USA Steering Committee (launched in 2014), was PI on an AHRQ-funded Small Research Grant (R03) to evaluate the feasibility of this approach for amplifying the voices of systemically underserved patients in research, and is currently director of the Health Experiences Research core function for the Oregon Clinical and Translational Research Institute.
Social risk screening and action in community health centers
Assessing the relationship between community- and patient-level social risk factors and health
Evaluating the impact of state and federal policy changes on reproductive health care utilization and quality in community health centers
Payment reform/alternative payment methodologies
Methods for patient engagement and understanding patient health experiences
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