The 130th Annual Meeting of APHA

Abstract #46957

Rebecca Kinney, MPH¹, Suzanne Cashman, ScD², Judith Savageau, MPH³, Celeste Lemay, RN, BSN³, Annette Hanson, MD⁴, and Patricia A. Reidy, RNC, FNP⁵. (1) Office of Community Programs, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, (2) Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, 508 856-2930, rebecca.kinney@umassmed.edu, (3) Family Medicine and Community Health, University of Massachusetts - Worcester, 55 Lake Avenue North, Worcester, MA 01655, (4) Office of Clinical Affairs, Massachusetts Division of Medical Assistance, 600 Washington Street, Boston, MA 02111, (5) Family Health abd Social Service Center, 26 Queen Street, Worcester, MA 01610

A retrospective study of 465 adult patients who were scheduled to receive primary care during one week in February 1999 was conducted. Over fifty percent of the study population had Medicaid as their primary source of insurance (n=258). Data abstracted from medical charts and public insurance records reflect utilization during a 30-month period. Missed appointment rates were developed using clinic scheduling and billing data; visits to the Emergency Department and hospitalizations were identified through medical record information and compared to public insurance data. Analyses compare characteristics of patients who fail to keep appointments with their appointment-keeping counterparts, identify characteristics of patients who use the ED inappropriately, and explore the relationship between the development of a multidisciplinary health care team and patient utilization patterns. Preliminary findings indicate that the medical record underreported significantly the number of patients who utilized the ED. Patients who missed one scheduled appointment were no more likely to utilize the ED. However, when patients missed two or more appointments, their likelihood of using the ED doubled (36% compared to 17%; p=.001). Twenty-one percent of these visits occurred outside clinic hours. A profile of the sample indicates that patients who were recorded as having at least one ED visit also had one or more chronic psychological problems listed in their medical chart (p=.001). Thirty-two percent (72/225) of patients who had missed at least one appointment had a diagnosis of depression. Male patients in the sample between the ages of 35-54 years missed more of their scheduled appointments than their counterparts (p=.058).

Learning Objectives:

• To describe patient utilization patterns (missed appointments, emergency department and hospital utilization) at one federally funded community health center. To explore the relationship between the development of a collaborative, multidisciplinary primary team and selected utilization patterns in the delivery of primary care.

Keywords: Health Care Delivery, Medicaid

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: University Of Massachusetts Medical School
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.