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Ethnic Differences in Appointment‐Keeping and Implications for the Patient‐Centered Medical Home—Findings from the Diabetes Study of N orthern C alifornia ( DISTANCE )
Author(s) -
Parker Melissa M.,
Moffet Howard H.,
Schillinger Dean,
Adler Nancy,
Fernandez Alicia,
Ciechanowski Paul,
Karter Andrew J.
Publication year - 2012
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/j.1475-6773.2011.01337.x
Subject(s) - medicine , poisson regression , ethnic group , demography , health care , family medicine , diabetes mellitus , medical record , public health , gerontology , cohort study , cohort , environmental health , nursing , population , economics , economic growth , endocrinology , sociology , anthropology
Objective To examine ethnic differences in appointment‐keeping in a managed care setting. Data Sources/Study Setting Kaiser Permanente Diabetes Study of N orthern C alifornia ( DISTANCE ), 2005–2007, n = 12,957. Study Design Cohort study. Poor appointment‐keeping ( PAK ) was defined as missing >1/3 of planned, primary care appointments. Poisson regression models were used to estimate ethnic‐specific relative risks of PAK (adjusting for demographic, socio‐economic, health status, and facility effects). Data Collection/Extraction Methods Administrative/electronic health records and survey responses. Principal Findings Poor appointment‐keeping rates differed >2‐fold across ethnicities: L atinos (12 percent), A frican A mericans (10 percent), F ilipinos (7 percent), C aucasians (6 percent), and A sians (5 percent), but also varied by medical center. Receiving >50 percent of outpatient care via same‐day appointments was associated with a 4‐fold greater PAK rate. PAK was associated with 20, 30, and 40 percent increased risk of elevated HbA1c (>7 percent), low‐density lipoprotein (>100 mm/dl), and systolic blood pressure (>130 mmHg), respectively. Conclusions L atinos and A frican A mericans were at highest risk of missing planned primary care appointments. PAK was associated with a greater reliance on same‐day visits and substantively poorer clinical outcomes. These results have important implications for public health and health plan policy, as primary care rapidly expands toward open access to care supported by the patient‐centered medical home model.