328597
Mending the net: Factors determining patient retention and continuity of care in Safety Net clinics serving immigrant populations in a large and diverse Medicaid health plan
Continuity is interrupted when patients switch doctors or clinics, or let coverage lapse, often missing services until the next serious illness, harming health and raising public costs. What preserves continuity-of-care for patients in Safety Net clinics? Attrition due to poor service is preventable, but not well-researched.
(1) Setting: The study examines the association between quality of services and patient retention for Safety Net clinic patients in a large and diverse Medicaid health plan in the southwestern United States.
(2) Study design: The analysis uses data from a large-sample CAHPS patient experience survey in 2011 to measure quality of services, matched to patient-level data on subsequent retention status at the Safety Net clinic. Immigrant status is coarsely proxied by self-reported ethnicity and language preference.
(3) Analysis: The study examines factors promoting patient retention in Safety Net clinics. The analysis focuses on the quality of services, as a determinant of retention and continuity-of-care. In addition to analysis by ethnicity and language, the results are broken down by gender and age cohort (adult-vs-pediatric).
(4) Applications: Implications for immigrant health are discussed; with insights for strengthening Safety Net clinic viability by retaining patients through improved quality.
Learning Areas:
Biostatistics, economicsConduct evaluation related to programs, research, and other areas of practice
Diversity and culture
Program planning
Public health administration or related administration
Systems thinking models (conceptual and theoretical models), applications related to public health
Learning Objectives:
Describe three noteworthy consequences for patients’ health from interruptions in care.
Name two advantages and two disadvantages of Safety Net clinics for serving immigrant populations.
Describe how Safety Net clinics perform on six dimensions of health care service quality.
Assess the validity of self-reported ethnicity and language as proxies in determining immigrant status in a study design.
Compare patient retention rates between four ethnic and language groups.
Among those same four groups, describe how high or low quality of service impacts retention rates (and hence continuity-of-care).
Identify two tangible impacts of patient attrition on the viability of a health care delivery organization.
Describe two strategies for improving quality of services in clinics with little revenue.
Keyword(s): Immigrant Health, Quality Improvement
Qualified on the content I am responsible for because: Have served 12 years as a statistician at the largest public health plan in the United States, which serves low-income and immigrant patients in an ethnically diverse urban county in the southwest United States. Managed CAHPS patient experience survey from 2006 to 2015, with a focus on making the survey results actionable in designing quality improvement interventions. Designed analyses of the quality of health care services received by immigrant patients compared with other demographics.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.