Impact of immigration policy changes on missed primary care visits: a quasi-experimental evaluation

Client: Cambridge Health Alliance (Dr. Lara Jirmanus)
Topic Area: Immigrant health
Services: Applied Research, Data Services

Fear of immigration enforcement and increasing anti-immigrant political rhetoric may lead immigrant patients to avoid accessing preventative healthcare. The goal of this policy evaluation project was to analyze prevalence of missed primary care appointments at two safety-net hospitals in Massachusetts, prior to and following 2017 immigration policy changes. We assessed change over time in missed visits, comparing a population of individuals who were likely immigrants with a comparison group of non-immigrants. This difference-in-difference quasi-experimental design accounts for temporal changes in missed appointments that would have been expected across the sample without the policy change, and allowed us to isolate change in missed appointments specifically related to the policy change. Using a data set containing roughly 800,000 primary care visits across the time period of interest, ICH epidemiologists performed data cleaning, descriptive analysis, and statistical modeling. We also assisted with manuscript preparation and partnered with the client to assess the strengths and limitations of the quantitative evaluation design and place the research findings in context. Our goal is for this work to add to the growing literature exploring the relationship between immigration policies and health of immigrant communities.