Primary care and survival among American Indian patients with diabetes in the Southwest United States: Evaluation of a cohort study at Gallup Indian Medical Center, 2009–2016

• Published in: Primary care diabetes Vol. 12; no. 3; pp. 212 - 217
• Main Authors: King, Caroline, Atwood, Sidney, Brown, Chris, Nelson, Adrianne Katrina, Lozada, Mia, Wei, Jennie, Merino, Maricruz, Curley, Cameron, Muskett, Olivia, Sabo, Samantha, Gampa, Vikas, Orav, John, Shin, Sonya
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.06.2018
• Subjects: Access to care; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; American Indian; Cause of Death; Child; Cohort Studies; Databases, Factual; Diabetes; Diabetes Mellitus - diagnosis; Diabetes Mellitus - ethnology; Diabetes Mellitus - mortality; Diabetes Mellitus - therapy; Female; Health systems strengthening; Hospitalization - statistics & numerical data; Humans; Indians, North American - statistics & numerical data; Kaplan-Meier Estimate; Male; Middle Aged; Navajo; Primary care; Primary Health Care - methods; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Sex Factors; Southwestern United States; Statistics, Nonparametric; STROBE; Survival Analysis; Young Adult; Southwestern United States; Access to care; Health systems strengthening; STROBE; Diabetes; Navajo; American Indian; Primary care
• ISSN: 1751-9918; 1878-0210
• DOI: 10.1016/j.pcd.2017.11.003

•This study evaluated the effect of primary care engagement on survival after an admission for patients with diabetes.•Seeing a primary care provider was associated with improved survival after admission.•This result was consistent across all Cox proportional hazards models, the log-rank test, and sensitivity analysis testing. To evaluate the role of primary care healthcare delivery on survival for American Indian patients with diabetes in the southwest United States. Data from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using a log-rank test and Cox Proportional Hazards analyses. Of the 2661 patients included in analysis, 286 patients died during the study period. Having visited a primary care provider in the year prior to first admission of the study period was protective against all-cause mortality in unadjusted analysis (HR (95% CI)=0.47 (0.31, 0.73)), and after adjustment. The log-rank test indicated there is a significant difference in overall survival by primary care engagement history prior to admission (p<0.001). The median survival time for patients who had seen a primary care provider was 2322days versus 2158days for those who had not seen a primary care provider. Compared with those who did not see a primary care provider in the year prior to admission, having seen a primary care provider was associated with improved survival after admission.