Table 1 Baseline demographics of empaneled individuals eligible for CCS

Age

 21–29

2383 (30.1%)

5524 (69.9%)

7907 (100.0%)

 30–39

2762 (22.3%)

9609 (77.7%)

12,371 (100.0%)

 40–49

1658 (18.8%)

7163 (81.2%)

8821 (100.0%)

 50–59

1247 (18.9%)

5357 (81.1%)

6604 (100.0%)

 60–65

713 (19.1%)

3017 (80.9%)

3730 (100.0%)

Race

 White

6533 (20.0%)

26,126 (80.0%)

32,659 (100.0%)

 Black or African American

852 (36.6%)

1478 (63.4%)

2330 (100.0%)

 Asian

794 (29.1%)

1936 (70.9%)

2730 (100.0%)

 American Indian/Alaskan Native

32 (21.1%)

120 (78.9%)

152 (100.0%)

 Native Hawaii/Pacific Islander

14 (29.8%)

33 (70.2%)

47 (100.0%)

 Unknown

199 (30.7%)

449 (69.3%)

648 (100.0%)

 N-Missing

339

528

867

Ethnicity

 Hispanic

539 (28.5%)

1349 (71.5%)

1888 (100.0%)

 Non-Hispanic

7917 (21.6%)

28,792 (78.4%)

36,709 (100.0%)

 Unknown

307 (36.7%)

529 (63.3%)

836 (100.0%)

Preferred language

 English

8103 (21.5%)

29,600 (78.5%)

37,703 (100.0%)

 Arabic

64 (36.4%)

112 (63.6%)

176 (100.0%)

 Chinese (Mandarin)

35 (28.9%)

86 (71.1%)

121 (100.0%)

 Other

160 (34.4%)

305 (65.6%)

465 (100.0%)

 Somali

233 (47.4%)

259 (52.6%)

492 (100.0%)

 Spanish

130 (37.5%)

217 (62.5%)

347 (100.0%)

 Vietnamese

23 (22.3%)

80 (77.7%)

103 (100.0%)

 Unknown

15 (57.7%)

11 (42.3%)

26 (100.0%)

Country of Origin

 USA

6968 (20.4%)

27,236 (79.6%)

34,204 (100.0%)

 Somalia

291 (44.6%)

362 (55.4%)

653 (100.0%)

 India

149 (36.8%)

256 (63.2%)

405 (100.0%)

 China

97 (27.0%)

262 (73.0%)

359 (100.0%)

 Mexico

110 (33.5%)

218 (66.5%)

328 (100.0%)

 Other

1010 (30.8%)

2266 (69.2%)

3276 (100.0%)

 Unknown

138 (66.3%)

70 (33.7%)

208 (100.0%)

Provider gender

 Male

2331 (24.6%)

7142 (75.4%)

9473 (100.0%)

 Female

6432 (21.5%)

23,528 (78.5%)

29,960 (100.0%)

Marital status

 N-Missing

61

81

142

 Married

4123 (17.6%)

19,292 (82.4%)

23,415 (100.0%)

 Single

3860 (31.1%)

8536 (68.9%)

12,396 (100.0%)

 Divorced/separated/widowed

642 (20.7%)

2464 (79.3%)

3106 (100.0%)

 Life Partnership

77 (20.6%)

297 (79.4%)

374 (100.0%)

HOUSES quartile

 Q4

2097 (18.0%)

9561 (82.0%)

11,658 (100.0%)

 Q3

1906 (20.3%)

7483 (79.7%)

9389 (100.0%)

 Q2

1882 (23.6%)

6096 (76.4%)

7978 (100.0%)

 Q1

2347 (27.2%)

6289 (72.8%)

8636 (100.0%)

 missing

531 (30.0%)

1241 (70.0%)

1772 (100.0%)

ADI quartile

 Q1

963 (18.0%)

4375 (82.0%)

5338 (100.0%)

 Q2

4339 (21.0%)

16,338 (79.0%)

20,677 (100.0%)

 Q3

2575 (24.6%)

7884 (75.4%)

10,459 (100.0%)

 Q4

324 (31.0%)

720 (69.0%)

1044 (100.0%)

 missing

562 (29.3%)

1353 (70.7%)

1915 (100.0%)

Charlson index (age weighted-Deyo)

 healthy (0)

5618 (24.8%)

17,032 (75.2%)

22,650 (100.0%)

 mild (1–2)

2459 (19.0%)

10,497 (81.0%)

12,956 (100.0%)

 moderate (3–4)

425 (16.9%)

2086 (83.1%)

2511 (100.0%)

 severe (5 +)

261 (19.8%)

1055 (80.2%)

1316 (100.0%)

Years with visit (last 5)

 0

297 (87.4%)

43 (12.6%)

340 (100.0%)

 1

1243 (52.9%)

1108 (47.1%)

2351 (100.0%)

 2

1496 (40.2%)

2228 (59.8%)

3724 (100.0%)

 3

1568 (32.5%)

3251 (67.5%)

4819 (100.0%)

 4

1608 (22.8%)

5435 (77.2%)

7043 (100.0%)

 5

2551 (12.1%)

18,605 (87.9%)

21,156 (100.0%)

MyChart status

 UNKNOWN STATUS

15 (100.0%)

0 (0.0%)

15 (100.0%)

 ACTIVATED

8048 (21.1%)

30,056 (78.9%)

38,104 (100.0%)

 INACTIVATED

253 (51.1%)

242 (48.9%)

495 (100.0%)

 NON-STANDARD MYCHART STATUS

20 (90.9%)

2 (9.1%)

22 (100.0%)

 PATIENT DECLINED

19 (31.7%)

41 (68.3%)

60 (100.0%)

 PENDING ACTIVATION

408 (55.4%)

329 (44.6%)

737 (100.0%)