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Research ArticleOriginal Research

How An Academic Direct Primary Care Clinic Served Patients from Vulnerable Communities

Winston Liaw, Ben King, Henry Olaisen, Sara Pastoor, Amin Kiaghadi, Nina Cloven, Brian Reed, Omar Matuk-Villazon, Steven Waldren and Stephen Spann
The Journal of the American Board of Family Medicine May 2024, 37 (3) 455-465; DOI: https://doi.org/10.3122/jabfm.2023.230346R1
Winston Liaw
From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (WL, BK); Agency for Healthcare Research and Quality, Rockville, MD; American Academy of Family Physicians, Washington, DC (HO); Elation Health, San Antonio, TX (SP); Texas Water Development Board (AK); Elation Health, Houston, TX (NC); Department of Clinical Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (BR); Suvida Healthcare, Houston, TX (OMV); American Academy of Family Physicians, Overland Park, KS (SW); University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (SS).
MD, MPH
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Ben King
From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (WL, BK); Agency for Healthcare Research and Quality, Rockville, MD; American Academy of Family Physicians, Washington, DC (HO); Elation Health, San Antonio, TX (SP); Texas Water Development Board (AK); Elation Health, Houston, TX (NC); Department of Clinical Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (BR); Suvida Healthcare, Houston, TX (OMV); American Academy of Family Physicians, Overland Park, KS (SW); University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (SS).
PhD, MPH
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Henry Olaisen
From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (WL, BK); Agency for Healthcare Research and Quality, Rockville, MD; American Academy of Family Physicians, Washington, DC (HO); Elation Health, San Antonio, TX (SP); Texas Water Development Board (AK); Elation Health, Houston, TX (NC); Department of Clinical Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (BR); Suvida Healthcare, Houston, TX (OMV); American Academy of Family Physicians, Overland Park, KS (SW); University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (SS).
PhD, PMP
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Sara Pastoor
From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (WL, BK); Agency for Healthcare Research and Quality, Rockville, MD; American Academy of Family Physicians, Washington, DC (HO); Elation Health, San Antonio, TX (SP); Texas Water Development Board (AK); Elation Health, Houston, TX (NC); Department of Clinical Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (BR); Suvida Healthcare, Houston, TX (OMV); American Academy of Family Physicians, Overland Park, KS (SW); University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (SS).
MD, MHA
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Amin Kiaghadi
From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (WL, BK); Agency for Healthcare Research and Quality, Rockville, MD; American Academy of Family Physicians, Washington, DC (HO); Elation Health, San Antonio, TX (SP); Texas Water Development Board (AK); Elation Health, Houston, TX (NC); Department of Clinical Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (BR); Suvida Healthcare, Houston, TX (OMV); American Academy of Family Physicians, Overland Park, KS (SW); University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (SS).
PhD
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Nina Cloven
From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (WL, BK); Agency for Healthcare Research and Quality, Rockville, MD; American Academy of Family Physicians, Washington, DC (HO); Elation Health, San Antonio, TX (SP); Texas Water Development Board (AK); Elation Health, Houston, TX (NC); Department of Clinical Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (BR); Suvida Healthcare, Houston, TX (OMV); American Academy of Family Physicians, Overland Park, KS (SW); University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (SS).
MHA
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Brian Reed
From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (WL, BK); Agency for Healthcare Research and Quality, Rockville, MD; American Academy of Family Physicians, Washington, DC (HO); Elation Health, San Antonio, TX (SP); Texas Water Development Board (AK); Elation Health, Houston, TX (NC); Department of Clinical Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (BR); Suvida Healthcare, Houston, TX (OMV); American Academy of Family Physicians, Overland Park, KS (SW); University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (SS).
MD
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Omar Matuk-Villazon
From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (WL, BK); Agency for Healthcare Research and Quality, Rockville, MD; American Academy of Family Physicians, Washington, DC (HO); Elation Health, San Antonio, TX (SP); Texas Water Development Board (AK); Elation Health, Houston, TX (NC); Department of Clinical Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (BR); Suvida Healthcare, Houston, TX (OMV); American Academy of Family Physicians, Overland Park, KS (SW); University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (SS).
MD, MBA
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Steven Waldren
From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (WL, BK); Agency for Healthcare Research and Quality, Rockville, MD; American Academy of Family Physicians, Washington, DC (HO); Elation Health, San Antonio, TX (SP); Texas Water Development Board (AK); Elation Health, Houston, TX (NC); Department of Clinical Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (BR); Suvida Healthcare, Houston, TX (OMV); American Academy of Family Physicians, Overland Park, KS (SW); University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (SS).
MD, MS
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Stephen Spann
From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (WL, BK); Agency for Healthcare Research and Quality, Rockville, MD; American Academy of Family Physicians, Washington, DC (HO); Elation Health, San Antonio, TX (SP); Texas Water Development Board (AK); Elation Health, Houston, TX (NC); Department of Clinical Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (BR); Suvida Healthcare, Houston, TX (OMV); American Academy of Family Physicians, Overland Park, KS (SW); University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (SS).
MD, MBA
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  • Article
  • Figures & Data
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Article Figures & Data

Figures

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  • Figure 1.
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    Figure 1.

    Count of patients across Harris County census tracts.

  • Figure 2.
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    Figure 2.

    The calculated localized Social Vulnerability Index for Harris County census tracts overlayed with the tracts with at least 1 patient to the clinic.

  • Figure 3.
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    Figure 3.

    Bivariate visualization of the number of patients per census tracts and the calculated localized Social Vulnerability Index values.

  • Appendix Figure 1:
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    Appendix Figure 1:

    Patient and appointment flow diagram.

Tables

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    Table 1.

    Demographic Characteristics of Users of the Direct Primary Care Clinic

    Demographics (n = 322)MedianIQR
    Age45.535 to 55
    n%
     0 to 18134.0%
     19 to 293912.1%
     30 to 395617.4%
     40 to 498626.7%
     50 to 598125.2%
     60 to 693711.5%
     70 to 7972.2%
     80+30.9%
    Female18858.4%
    Spanish-speaking12037.3%
    Race
     American Indian or Alaska Native41.2%
     Asian41.2%
     Black or African American299.0%
     Declined to specify10.3%
     No race specified26983.5%
     White154.7%
    Ethnicity
     Hispanic or Latino15949.4%
     No ethnicity specified13241.0%
     Not Hispanic or Latino319.6%
    Month of first visit
     October 202130.9%
     November 20217322.7%
     December 20213310.2%
     January 20229028.0%
     February 20225416.8%
     March 2022226.8%
     April 2022237.1%
     May 2022165.0%
     June 202282.5%
    Appointments (n = 772)
     Number of visits
      November 2021324.1%
      December 20218210.6%
      January 202211214.5%
      February 202212115.7%
      March 202212015.5%
      April 202210713.9%
      May 202210413.5%
      June 20229412.2%
    Mode
     Video364.7%
     In person73695.3%
    Duration (in minutes)
     2039451.0%
     30374.8%
     4022629.3%
     6011514.9%
    Visit type
     New Adult Patient Appointment31240.4%
     New Pediatric Patient Appointment101.3%
     Follow-Up Appointment37548.6%
     Sick Visit Appointment243.1%
     Procedure70.9%
     Well Woman Exam60.8%
     Lab Visit20.3%
     Nurse Visit10.1%
     Telehealth Appointment354.5%
    • Abbreviation: IQR, interquartile range.

    • View popup
    Table 2.

    Summary of ICD-10 Diagnosis Code Descriptions (4% Prevalence or Higher)

    ICD-10 DescriptionICD-10 CodeICD-10 Count per PatientPercent of Patient Sample
    Essential hypertensionI108039%
    ObesityE66.01, E66.97838%
    HyperlipidemiaE78.2, E78.55928%
    Type 2 diabetes mellitusE11.65, E11.93818%
    OverweightE66.32311%
    ProteinuriaR80.92110%
    Other problems (lifestyle)Z72.892010%
    Abnormal glucose tolerance testR73.03199%
    Nicotine dependence and tobacco useZ87.891, F17.200178%
    Gastro-esophageal reflux disease without esophagitisK21.9126%
    HypothyroidismE03.9115%
    Iron deficiency anemiaD50.994%
    InsomniaG47.0084%
    Chronic PainG89.2984%
    • Note: The denominator is 322 (total patients in the sample).

    • View popup
    Table 3.

    Summary of ICD-10 Block Categories

    ICD-10 Block CategoryPercent of Appointment Sample
    Endocrine, nutritional and metabolic diseases39%
    Diseases of the circulatory system13%
    Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified9%
    Factors influencing health status and contact with health services8%
    Diseases of the musculoskeletal system and connective tissue7%
    Diseases of the digestive system6%
    Mental and behavioral disorders5%
    Diseases of the genitourinary system4%
    Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism3%
    Diseases of the nervous system3%
    Diseases of the skin and subcutaneous tissue1%
    Certain infectious and parasitic diseases1%
    Neoplasms1%
    • Note: The denominator is 772 (total number of appointments).

    • View popup
    Table 4.

    Social Vulnerability Index Components for Census Tracts With and Without Patients

    VariableTracts without any patientsTracts with 1+ patientsP-Value for the Mann-Whitney U Test
    MedianIQRMedianIQR
    Calculated Localized SVI0.4680.5090.5970.4219.30E-06
    Persons below 150% poverty23.129.530.224.0754.90E-04
    Civilian (age 16+) unemployed5.25.35.955.253.30E-02
    Housing cost-burdened occupied housing units with annual income less than $75,00030.719.632.119.5752.50E-02
    Persons (age 25+) with no high school13.824.621.0524.7752.10E-05
    Uninsured in the total civilian noninstitutionalized population18.520.422.816.5754.60E-05
    Persons aged 65 and older9.87.710.057.4256.80E-01
    Persons aged 17 and younger2610.527.159.4754.60E-02
    Civilian noninstitutionalized population with a disability8.96.29.255.452.30E-01
    Single-parent household with children under 187.28.98.47.9251.30E-03
    Persons (age 5+) who speak English “less than well6.115.211.3516.4251.00E-05
    Minority75.745.586.8528.49.80E-06
    Housing in structures with 10 or more units18.943.915.934.8758.60E-01
    Mobile homes01.401.69.10E-02
    At household level (occupied housing units), more people than rooms4.27.76.058.551.70E-03
    Households with no vehicle available3.98.858.5752.40E-02
    Persons in group quarters estimate00.100.35.30E-03
    • Note: P-values in green are < 0.05.

    • Abbreviations: IQR, interquartile range; SVI, social vulnerability index.

    • View popup
    Table 5.

    Memberships and Office Visits through June 2022

    Thru April 2022Thru June 2022
    Memberships
     Total Active Memberships200183
     Total Canceled  Memberships74123
    Office Visits  
     New Office Visits286318
     Follow-up Office Visits277446
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The Journal of the American Board of Family   Medicine: 37 (3)
The Journal of the American Board of Family Medicine
Vol. 37, Issue 3
May-June 2024
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How An Academic Direct Primary Care Clinic Served Patients from Vulnerable Communities
Winston Liaw, Ben King, Henry Olaisen, Sara Pastoor, Amin Kiaghadi, Nina Cloven, Brian Reed, Omar Matuk-Villazon, Steven Waldren, Stephen Spann
The Journal of the American Board of Family Medicine May 2024, 37 (3) 455-465; DOI: 10.3122/jabfm.2023.230346R1

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How An Academic Direct Primary Care Clinic Served Patients from Vulnerable Communities
Winston Liaw, Ben King, Henry Olaisen, Sara Pastoor, Amin Kiaghadi, Nina Cloven, Brian Reed, Omar Matuk-Villazon, Steven Waldren, Stephen Spann
The Journal of the American Board of Family Medicine May 2024, 37 (3) 455-465; DOI: 10.3122/jabfm.2023.230346R1
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