Impact Of Transportation Barriers On High-Quality Anticoagulation Management In Underserved Patients

Objective: To evaluate the relationship between transportation barriers to anticoagulation monitoring visits and the quality of anticoagulation control in an inner-city underserved population. Methods: We conducted a cross sectional survey of patients treated with warfarin at the University of Illinois at Chicago Hospital and Health Sciences System Antithrombosis Clinic, between September 2010 and February 2011. A 23-item survey was administered to participants to elicit responses to variables such as access to health care barriers, socio-economic characteristics, and opinions regarding anticoagulation patient-centered management models. Additional data on patient demographics, clinical characteristics and outcomes were extracted from the Electronic Health Record for a total follow-up period of 12 months prior to survey administration. Descriptive statistics were performed to characterize the sample stratified by transportation barriers. Chi-square, Fisher’s exact, student’s t-test, and Wilcoxon signed rank test, were used as appropriate to examine differences between covariates and the exposure variable. Multivariate linear regression analysis was used to determine the association between transportation barriers and quality of anticoagulation control, while adjusting for potential confounders. Results: Patients with transportation barriers compared to patients without transportation barriers were older (57.89 + 17.37 vs. 51.24 + 16.55), more likely to be female (72.67% vs. 61.42%), more likely to be African American (64.67% vs. 58.27%) or Hispanic (24% vs. 18.11%), more likely to have their primary language other than English (14.67 vs. 7.20), more likely to have less than a 12th grade education (41.38% vs. 21.26%), more likely to have an annual income of < $15,000 (52.82% vs. 31.45%), less likely to have private insurance (8.67% vs. 38.58%), and more likely to be dependent on a caregiver (48.99% vs. 3.97%), all values significant (p<0.05). After adjusting for confounders, quality of anticoagulation control was lower in patients with transportation barriers than in those without transportation barriers (absolute difference 6.04%, p=0.009). Summary: Our study is among the first to evaluate the relationship between transportation barriers and anticoagulation related clinical outcomes such as quality of anticoagulation control in a largely minority, underserved population. Understanding this relationship is especially important in underserved, minority patients who are at highest risk for anticoagulation related complications.