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. Issue 3 (June 2018) - King, Caroline
Highlights: 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. Abstract: Objectives: To evaluate the role of primary care healthcare delivery on survival for American Indian patients with diabetes in the southwest United States. Methods: 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. Results: 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 2322 days versus 2158 days for those who had not seen a primary care provider. Conclusions: 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.