Use of a Preventive Index to Examine Clinic-Level Factors Associated With Delivery of Preventive Care

Brigit A. Hatch, Carrie J. Tillotson, Nathalie Huguet, Megan J. Hoopes, Miguel Marino, Jennifer Devoe

Research output: Contribution to journalArticle

Abstract

Introduction: There is an increasing need for the development of new methods to understand factors affecting delivery of preventive care. This study applies a new measurement approach and assesses clinic-level factors associated with preventive care delivery. Methods: This retrospective longitudinal cohort study of 94 community health centers used electronic health record data from the OCHIN community health information network, 2014–2015. Clinic-level preventive ratios (time covered by a preventive service/time eligible for a preventive service) were calculated in 2017 for 12 preventive services with A or B recommendations from the U.S. Preventive Services Task Force along with an aggregate preventive index for all services combined. For each service, multivariable negative binomial regression modeling and calculated rate ratios assessed the association between clinic-level variables and delivery of care. Results: Of ambulatory community health center visits, 59.8% were Medicaid-insured and 10.4% were uninsured. Ambulatory community health centers served 16.9% patients who were Hispanic, 13.1% who were nonwhite, and 68.7% who had household incomes <138% of the federal poverty line. Clinic-level preventive ratios ranged from 3% (hepatitis C screening) to 93% (blood pressure screening). The aggregate preventive index including all screening measures was 47% (IQR, 42%–50%). At the clinic level, having a higher percentage of uninsured visits was associated with lower preventive ratios for most (7 of 12) preventive services. Conclusions: Approaches that use individual preventive ratios and aggregate prevention indices are promising for understanding and improving preventive service delivery over time. Health insurance remains strongly associated with access to needed preventive care, even for safety net clinic populations.

Original languageEnglish (US)
Pages (from-to)241-249
Number of pages9
JournalAmerican journal of preventive medicine
Volume57
Issue number2
DOIs
StatePublished - Aug 1 2019

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Community Health Centers
Preventive Medicine
Ambulatory Care Facilities
Safety-net Providers
Community Networks
Information Services
Electronic Health Records
Medicaid
Advisory Committees
Poverty
Health Insurance
Hepatitis C
Hispanic Americans
Longitudinal Studies
Cohort Studies
Blood Pressure
Population

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

Cite this

Use of a Preventive Index to Examine Clinic-Level Factors Associated With Delivery of Preventive Care. / Hatch, Brigit A.; Tillotson, Carrie J.; Huguet, Nathalie; Hoopes, Megan J.; Marino, Miguel; Devoe, Jennifer.

In: American journal of preventive medicine, Vol. 57, No. 2, 01.08.2019, p. 241-249.

Research output: Contribution to journalArticle

Hatch, Brigit A. ; Tillotson, Carrie J. ; Huguet, Nathalie ; Hoopes, Megan J. ; Marino, Miguel ; Devoe, Jennifer. / Use of a Preventive Index to Examine Clinic-Level Factors Associated With Delivery of Preventive Care. In: American journal of preventive medicine. 2019 ; Vol. 57, No. 2. pp. 241-249.
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