Background
The 2010 Affordable Care Act relies on Federally Qualified Health Centers (FQHCs)
and FQHC look-alikes (look-alikes) to provide care for newly insured patients, but
ties increased funding to demonstrated quality and efficiency.
Purpose
To compare FQHC and look-alike physician performance with private practice primary
care physicians (PCPs) on ambulatory care quality measures.
Methods
The study was a cross-sectional analysis of visits in the 2006–2008 National Ambulatory
Medical Care Survey. Performance of FQHCs and look-alikes on 18 quality measures was
compared with private practice PCPs. Data analysis was completed in 2011.
Results
Compared to private practice PCPs, FQHCs and look-alikes performed better on six measures
(p<0.05); worse on diet counseling in at-risk adolescents (26% vs 36%, p=0.05); and no differently on 11 measures. Higher performance occurred in ACE inhibitors
use for congestive heart failure (51% vs 37%, p=0.004); aspirin use in coronary artery disease (CAD; 57% vs 44%, p=0.004); β-blocker use for CAD (59% vs 47%, p=0.01); no use of benzodiazepines in depression (91% vs 84%, p=0.008); blood pressure screening (90% vs 86%, p<0.001); and screening electrocardiogram (EKG) avoidance in low-risk patients (99%
vs 93%, p<0.001). Adjusting for patient characteristics yielded similar results, except that
private practice PCPs no longer performed better on any measures.
Conclusions
FQHCs and look-alikes demonstrated equal or better performance than private practice
PCPs on select quality measures despite serving patients who have more chronic disease
and socioeconomic complexity. These findings can provide policymakers with some reassurance
as to the quality of chronic disease and preventive care at Federally Qualified Health
Centers and look-alikes, as they plan to use these health centers to serve 20 million
newly insured individuals.
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References
- Understanding the affordable care act: about the law.DHHS, Washington DC2011
- Trends in physician participation in Medicaid.J Ambul Care Manage. 2003; 26: 334-343
- Catching a wave—implementing health care reform in California.N Engl J Med. 2011; 364: 1487-1489
- Bureau of Primary Health Care. Health Center Program Expectations (BPHC Policy Information Notice: 98-23).DHHS, Washington DC1998
- Federally Qualified Health Center: Rural Health Fact Sheet Series.DHHS, Washington DC2011
- Characteristics of ambulatory care patients and services: a comparison of community health centers and physicians' offices.J Health Care Poor Underserved. 2010; 21: 1169-1183
- Ambulatory care sensitive hospitalizations and emergency visits: experiences of Medicaid patients using federally qualified health centers.Med Care. 2001; 39: 551-561
- Comparative effectiveness of health centers as regular source of care: application of sentinel ACSC events as performance measures.J Ambul Care Manage. 2006; 29: 24-35
- Medicaid patients seen at federally qualified health centers use hospital services less than those seen by private providers.Health Aff (Millwood). 2011; 30: 1335-1342
- The role of community health centers in delivering primary care to the underserved: experiences of the uninsured and Medicaid insured.J Ambul Care Manage. 2007; 30: 159-170
- Inequality in America: the contribution of health centers in reducing and eliminating disparities in access to care.Med Care Res Rev. 2001; 58: 234-248
- Primary care of patients without insurance by community health centers.J Ambul Care Manage. 2001; 24: 47-59
Shi L. A review of community health centers: issues and opportunities. Washington DC, 2005.
- Level of evidence of the value of care in federally qualified health centers for policy making.Prog Community Health Partnersh. 2007; 1: 75-82
- Costs vs quality in different types of primary care settings.JAMA. 1994; 272: 1903-1908
- Housing instability and food insecurity as barriers to health care among low-income Americans.J Gen Intern Med. 2006; 21: 71-77
- Association of health literacy with diabetes outcomes.JAMA. 2002; 288: 475-482
- Food insecurity is associated with hypoglycemia and poor diabetes self-management in a low-income sample with diabetes.J Health Care Poor Underserved. 2010; 21: 1227-1233
- Crossing the quality chiasm: a new health system for the 21st century.National Academy of Sciences, Washington DC2001
- Electronic health records and clinical decision support systems: impact on national ambulatory care quality.Arch Intern Med. 2011; 17: 1077-1085
- Quality of U.S. outpatient care: temporal changes and racial/ethnic disparities.Arch Intern Med. 2005; 165: 1354-1361
- Public use microdata file documentation, National Hospital Ambulatory Medical Care Survey, 2006.National Technical Information Service, Hyattsville MD2008
- Ambulatory health care data: welcome NAMCS participants.
- National Ambulatory Medical Care Survey methods: what clinicians need to know.CDC, Atlanta GA2007
- www.uspreventiveservicestaskforce.org/recommendations.htmDate: December 2010
Cornell University Law School: Legal Information Institute. 42 U.S.C. 254b (2010). Chapter 6A, Subchapter II, Part D, subpart i.
- Efforts to expand and accelerate health center program quality improvement.DHHS, Washington DC2010
- 2011 HEDIS aggregate report for the Medi-Cal Managed Care Program: Medi-Cal Managed Care Division.California Department of Health Care Services, 2011
- Improving the management of chronic disease at community health centers.N Engl J Med. 2007; 356: 921-934
- Improving and sustaining diabetes care in community health centers with the health disparities collaboratives.Med Care. 2007; 45: 1135-1143
- Physician and patient influences on provider performance: beta-blockers in postmyocardial infarction management in the MI-Plus study.Circ Cardiovasc Qual Outcomes. 2011; 4: 99-106
- HRSA electronic handbooks (EHB) grants data.HRSA, Rockville MD2002–2007
- HHS awards Affordable Care Act funds to expand access to health care.
- Initiatives Related to the Affordable Care Act.DHHS, Washington DC2011
- Primary health care in community health centers and comparison with office-based practice.J Community Health. 2011; 36: 406-413
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© 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
