Patient-level factors associated with receipt of preventive care in the safety net

Brigit Hatch, Carrie Tillotson, Megan Hoopes, Nathalie Huguet, Miguel Marino, Jennifer DeVoe

Research output: Contribution to journalArticlepeer-review


Prevention is critical to optimizing health, yet most people do not receive all recommended preventive services. As the complexity of preventive recommendations increases, there is a need for new measurements to capture the degree to which a person is up to date, and identify individual-level barriers and facilitators to receiving needed preventive care. We used electronic health record data from a national network of community health centers (CHCs) in the United States (US) during 2014–2017 to measure patient-level up-to-date status with preventive ratios (measuring up-to-date person-time denoted as a percent) for 12 preventive services and an aggregate preventive index. We use negative binomial regression to identify factors associated with up-to-date preventive care. We assessed 267,767 patients across 165 primary care clinics. Mean preventive ratios ranged from 8.7% for Hepatitis C screening to 83.3% for blood pressure screening. The mean aggregate preventive index was 43%. Lack of health insurance, smoking, and homelessness were associated with lower preventive ratios for most cancer and cardiovascular screenings (p < 0.05). Having more ambulatory visits, better continuity of care, and enrollment in the patient portal were positively associated with the aggregate preventive index (p < 0.05) and higher preventive ratios for all services (p < 0.05) except chlamydia and HIV screening. Overall, receipt of preventive services was low. CHC patients experience many barriers to receiving needed preventive care, but certain healthcare behaviors – regular visits, usual provider continuity, and patient portal enrollment – were consistently associated with more up-to-date preventive care. These associations should inform future efforts to improve preventive care delivery.

Original languageEnglish (US)
Article number107024
JournalPreventive medicine
StatePublished - May 2022

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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