Delivery of preventive services to older black patients using neighborhoodhealth centers

OBJECTIVES: Older black patients are at risk for underutilization of preven tive services. Our objectives were to assess the delivery of five preventiv e services in Title 330-funded health centers in low income neighborhoods i n Cleveland, Ohio, and to determine the association of health system factor s and health status with the delivery of these services. DESIGN: A cross-se ctional study. SETTING: Four neighborhood health centers in low income neighborhoods of Cl eveland, Ohio. PARTICIPANTS: A total of 683 black men and women, aged 70 and older, who re garded the health center as their primary source of outpatient care. MEASUREMENTS: Demographic characteristics, independence in basic and instru mental activities of daily living, comorbidity scores, and perceived access were determined by telephone interview. We reviewed charts to determine wh ether each of five preventive service goals were obtained: influenza vaccin ation within 1 year; pneumococcal vaccination at any time; mammography with in 2 years; Papanicolau screening within 1 year or twice at any time in the past with documentation of normal results; and fecal occult blood testing within 2 years. RESULTS: The defined goals for influenza vaccination, pneumococcal vaccinat ion, mammography, Papanicolau screening, and fecal occult blood testing wer e achieved for 59%, 64%, 59%, 51%, and 17% of patients, respectively. Influ enza and pneumococcal vaccines were obtained more often in persons with gre ater comorbidity. Mammography and Papanicolau smear were obtained more ofte n in patients without of ADL or IADL impairments. The four clinical sites v aried substantially in the delivery of each preventive service. More Freque nt office visits were associated with greater delivery of all five preventi ve services. This relationship persisted in multivariable analyses controll ing for health status and clinical site. CONCLUSIONS: This study shows that Title 330 federally supported neighborho od health center sites providing primary care to older blacks in Cleveland achieved high rates of performance in four of the five recommended preventi ve services. in addition, preventive services practices were associated wit h prognostically relevant health status information. The frequency of offic e visits was related strongly and consistently to the performance of the va rious preventive services, indicating that more, not fewer, office visits m ay be necessary to achieve Healthy People 2000 targets.