Ethnic Differences in Appointment‐Keeping and Implications for the Patient‐Centered Medical Home—Findings from the Diabetes Study of orthern alifornia ()

Objective

To examine ethnic differences in appointment‐keeping in a managed care setting.

Data Sources/Study Setting

Kaiser Permanente Diabetes Study of orthern alifornia (), 2005–2007,  = 12,957.

Study Design

Cohort study. Poor appointment‐keeping () was defined as missing >1/3 of planned, primary care appointments. Poisson regression models were used to estimate ethnic‐specific relative risks of (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: atinos (12 percent), frican mericans (10 percent), ilipinos (7 percent), aucasians (6 percent), and 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 rate. was associated with 20, 30, and 40 percent increased risk of elevated (>7 percent), low‐density lipoprotein (>100 mm/dl), and systolic blood pressure (>130 mmHg), respectively.

Conclusions

atinos and frican mericans were at highest risk of missing planned primary care appointments. 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.