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Checkup Visits in Adult Federally Qualified Health Center Patients: a Retrospective Cohort Study

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Abstract

Background

Checkup visits (i.e., general health checks) can increase preventive service completion and lead to improved treatment of new chronic illnesses. After the onset of the COVID-19 pandemic, preventive service completion decreased in many groups that receive care in safety net settings.

Objective

To examine potential benefits associated with checkups in federally qualified health center (FQHC) patients.

Design

Retrospective cohort study, from March 2018 to February 2022.

Patients

Adults at seven FQHCs in Illinois.

Interventions

Checkups during a two-year Baseline (i.e., pre-COVID-19) period and two-year COVID-19 period.

Main Measures

The primary outcome was COVID-19 period checkup completion. Secondary outcomes were: mammography completion; new diagnoses of four common chronic illnesses (hypertension, diabetes, depression, or high cholesterol), and; initiation of chronic illness medications.

Key Results

Among 106,114 included patients, race/ethnicity was most commonly Latino/Hispanic (42.1%) or non-Hispanic Black (30.2%). Most patients had Medicaid coverage (40.4%) or were uninsured (33.9%). While 21.0% of patients completed a checkup during Baseline, only 15.3% did so during the COVID-19 period. In multivariable regression analysis, private insurance (versus Medicaid) was positively associated with COVID-19 period checkup completion (adjusted relative risk [aRR], 1.15; 95% confidence interval, [CI], 1.10–1.19), while non-Hispanic Black race/ethnicity (versus Latino/Hispanic) was inversely associated with checkup completion (aRR, 0.89; 95% CI, 0.85–0.93). In secondary outcome analysis, COVID-19 period checkup completion was associated with 61% greater probability of mammography (aRR, 1.61; 95% CI, 1.52–1.71), and significantly higher probability of diagnosis, and treatment initiation, for all four chronic illnesses. In exploratory interaction analysis, checkup completion was more modestly associated with diagnosis and treatment of hypertension and high cholesterol in some younger age groups (versus age ≥ 65).

Conclusions

In this large FQHC cohort, checkup completion markedly decreased during the pandemic. Checkup completion was associated with preventive service completion, chronic illness detection, and initiation of chronic illness treatment.

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Acknowledgements:

We wish to acknowledge and thank all of the FQHCs that contributed data to this study. Funding support was provided through institutional funds at AllianceChicago. Interim results were presented at the Illinois Primary Health Care Association Annual Leadership Conference in Chicago, IL on October 6, 2022.

Funding

Funding support was provided through institutional funds at AllianceChicago.

Author information

Authors and Affiliations

  1. Health Services Research Scientist, AllianceChicago, 225 W. Illinois Street, 5Th Floor, Chicago, IL, 60654, USA

    David T. Liss PhD, Ta-Yun Yang MS, Magdalena Hamielec MPH & Nivedita Mohanty MD

  2. Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    David T. Liss PhD

  3. Friend Family Health Center, Chicago, IL, USA

    Kathleen McAuliff PhD, MA

  4. Howard Brown Health, Chicago, IL, USA

    Laura K. Rusie ScM

  5. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Nivedita Mohanty MD

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Liss, D.T., Yang, TY., Hamielec, M. et al. Checkup Visits in Adult Federally Qualified Health Center Patients: a Retrospective Cohort Study. J GEN INTERN MED (2023). https://doi.org/10.1007/s11606-023-08561-1

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