Melissa M. Parker|Howard H. Moffet|Dean Schillinger|Nancy E. Adler|Alicia Fernández|Paul Ciechanowski|Andrew J. Karter
Ethnic Differences in Appointment?Keeping and Implications for the Patient?Centered Medical Home—Findings from the Diabetes Study of <scp>N</scp>orthern <scp>C</scp>alifornia (<scp>DISTANCE</scp>)
Kaiser Permanente|Kaiser Permanente|San Francisco General Hospital|University of California, San Francisco|San Francisco General Hospital|University of Washington|Kaiser Permanente|University of Washington
examine ethnic differences appointmentkeeping managed care settingkaiser permanente diabetes study northern california distance 20052007 n 12957cohort study poor appointmentkeeping pak defined missing 13 planned primary care appointments poisson regression models used estimate ethnicspecific relative risks pak adjusting demographic socioeconomic health status facility effectsadministrativeelectronic health records survey responsespoor appointmentkeeping rates differed 2fold across ethnicities latinos 12 percent african americans 10 percent filipinos 7 percent caucasians 6 percent asians 5 percent also varied medical center receiving 50 percent outpatient care via sameday appointments associated 4fold greater pak rate pak associated 20 30 40 percent increased risk elevated hba1c 7 percent lowdensity lipoprotein 100 mmdl systolic blood pressure 130 mmhg respectivelylatinos african americans highest risk missing planned primary care appointments pak associated greater reliance sameday visits substantively poorer clinical outcomes results important implications public health health plan policy primary care rapidly expands toward open access care supported patientcentered medical home model