Health Center Library

What does this study add? Patients who used health centers as their usual source of care for three or more years visited the emergency department less often than patients who used health centers for less than three years. Overall, the study explored how patient experiences and care management approaches at health centers might affect how often patients visit the emergency department by analyzing 2014 Health Center Patient Survey (HCPS) data and 2014 Uniform Data System (UDS) data.

What are the implications for the Health Center Program? The findings suggest that patients who regularly access primary care at health centers make fewer visits to the emergency department in the long term. This means upfront costs for primary care may help avoid larger downstream costs. Other HRSA-funded research, such as this article on care for patients with Medicaid coverage and opioid use disorder, also finds that health centers may reduce overall spending on health care.

What does this study add? The study examined associations between weight management practices at HRSA-funded health centers and selected health outcomes. The researchers determined a greater proportion of patients who are obese reported receiving provider interventions compared to overweight patients, and patients who received a provider diagnosis of weight as a problem and/or recommendations to change their diet had better odds of improved health status.
 
What are the implications for public health practice? These findings demonstrate the importance of provider weight management interventions in improving patient health outcomes and the need for more consistent interventions across patients who are obese and overweight. Providers should continue to engage motivational interviewing techniques, initiate culturally appropriate discussions about weight, and work to address social determinants of health like lack of safe spaces for exercise and availability of healthy nutrition. 

What does this study add? The study examined whether Patient-Centered Medical Home (PCMH) recognition promoted health center staffing structures that were more team-based and integrated by assessing growth of multidisciplinary medical or non-medical providers per primary care physicians (team-based ratio) and per 2,000 patients (colocation ratio). Researchers found that among three cohorts of health centers that received PCMH recognition in 2013, 2014, and 2015, all three had significantly larger colocation ratios after PCMH adoption. Additionally, 2013 and 2014 adopters of PCMH had significant increases in team-based ratios.  
 
What are the implications for the Health Center Program? These research findings indicate progress by HRSA-funded health centers to provide team-based care and integrated care delivery and the potential role of PCMH recognition in promoting transformational change. 

What does this study add? Health centers play an integral role in addressing social determinants of health (SDOH) among medically underserved populations, yet information on how health centers utilize SDOH data to inform care is limited. HRSA-funded researchers conducted a systematic review to understand how health centers integrate SDOH into primary care practices. Researchers found that many health centers are making progress on collecting SDOH data using standardized reporting tools and other initiatives, but they may require more support to use the data in primary care practices and program evaluation efforts.

What are the implications for the Health Center Program? Health care delivery models that emphasize accountability for patient outcomes should support initiatives for primary care providers to integrate SDOH data in efforts to improve care quality and outcomes.

What does this study add? HRSA-funded researchers analyzed associations between health center characteristics and receipt of Quality Improvement Awards (QIA) from 2014-2018. Researchers found that almost all participating health centers (99.7%) received at least one QIA during the study period, and health centers with Electronic Health Record (EHR) reporting and Patient-Centered Medical Home (PCMH) recognition earned higher award funding even after excluding bonus payments for these two capacities.

What are the implications for the Health Center Program? Although the QIA program has since evolved into other value-based funding mechanisms, the findings suggest that investments in EHR and PCMH accreditation may have supported broader clinical quality improvement and that health centers are able to implement value-based payment initiatives to improve patient experiences and health outcomes. The findings also suggest that HRSA award programs should set clinical quality benchmarks ahead of time.

What does this study add? HRSA-funded researchers found that health centers provide equitable diabetes care, including HbA1c testing and eye exams, and advance racial/ethnic parity in diabetes-specific outcomes. Researchers also identified opportunities to further advance health equity by improving foot exams, individual treatment plans, and cholesterol checks for racial and ethnic minority patients.

What are the implications for the Health Center Program? Findings suggest that health centers are uniquely positioned to advance equity in access and quality in care. This study highlights opportunities for health centers to scale more tailored diabetes care management approaches that are culturally competent and facilitate equitable access to diabetes management services such as individual treatment plans and cholesterol checks. 

What does this study add? This study assessed health center value-based payment (VBP) participation in seven states and found increased participation over time as well as associations with improved health center financial outcomes. Researchers found that in these seven states VBP participation grew from 35% to 58% from 2013 to 2017. During the same time period, health centers increasingly participated in more advanced payment models, which allowed them to improve care coordination and quality and cost outcomes.

What are the implications for the Health Center Program? To increase health center patient participation in VBP, research findings highlight the importance of financial incentives from Medicaid agencies and Medicaid managed plans as well as health center-Medicaid collaboration under strong Primary Care Association (PCA) and health center leadership. 

What does this study add? To better understand drivers of financial stability, HRSA researchers collaborated with the University of Chicago to review six measures of health center financial performance that provide insight into health centers’ long-term financial health. The researchers found that higher proportions of Medicaid patients and non-physician healthcare providers (e.g., nurse practitioners, physician assistants, etc.) have positive associations with a health center’s financial sustainability. Patient-Centered Medical Home (PCMH) recognition was also associated with better financial health.

What are the implications for the Health Center Program? Ensuring that health centers remain in good financial health is essential to avoid the risk that these organizations close their doors or reduce vital scope of services. 

What does this study add? HRSA-funded researchers examined the relationship between smoking, mental health conditions and substance use disorders among adult patients served by HRSA-funded health centers. Using data from HRSA’s 2014 Health Center Patient Survey (HCPS), researchers found that smoking prevalence among adult health center patients is twice as high as the general U.S. population and is associated with mental health conditions and substance use disorders. 

What are the implications for the Health Center Program? Study results suggest that health center patients most benefit from smoking cessation interventions that are integrated into routine primary care and delivered in a patient-centered care environment that promotes open communication and shared decision making.  Results highlight the important role health centers play in providing tobacco cessation interventions tailored to the needs of underserved communities.

What does this study add? To estimate the impact of changes in revenue, HRSA-funded researchers simulated funding changes using statistical models that estimated the number of full-time equivalent staff (FTEs), number of patients served, and number of visits as outcomes of Medicaid revenue, Section 330 grant funding, other revenue, patient characteristics, and county-level characteristics.

What are the implications for the Health Center Program? HRSA-funded health centers could support care to over 2,000 additional patients with an increase of $1 million dollars in grants provided under Section 330 of the Public Health Service Act.

What does this study add? HRSA-funded researchers identified innovative and effective approaches to improve diabetes care for Medicaid enrollees in health center primary care settings. 

What are the implications for the Health Center Program? The key takeaway from this research is that a higher proportion of patients receive diabetes care at HRSA-funded health centers and that health centers are an important primary care practice setting for diabetes care. Additionally, compared to diabetes care in other primary care settings, diabetes patients at health centers received diabetes education more regularly, have a lower rate of hospitalizations, a higher rate of emergency department visits, and lower rates of laboratory-based tests for diabetes. 

What does this study add? HRSA-funded researchers found that primary care utilization and spending were higher for health center patients with Medicaid insurance who have been diagnosed with opioid use disorder compared to similar patients in other settings, but total healthcare costs were lower. The researchers determined that health center patients were more likely to receive timely behavioral health therapy and less likely to fill inappropriate co-prescriptions, demonstrating the strength of holistic and coordinated care in the Health Center Program. However, health center patients were less likely to receive timely Medication-Assisted Treatment (MAT), which may be partly attributed to the availability of providers with MAT waivers at the time of this study.

What are the implications for the Health Center Program? Health centers are uniquely positioned to provide integrated primary and behavioral health care to medically underserved populations. 

What does this study add? HRSA-funded researchers found that, among five social determinant of health (SDOH) indicator categories, health care access and utilization had the largest relative contribution to self-reported fair or poor health and diagnoses of diabetes, hypertension, cardiovascular disease, and depression or anxiety. The relative contributions of the other SDOH indicator categories (i.e., health behaviors, social factors, economic factors, quality of care, and physical environment) varied by each health status measure.

What are the implications for the Health Center Program? The study highlights how health centers can prioritize which SDOH to target for interventions based on patients’ specific health conditions. An improved understanding of which SDOH most strongly influence their patients’ health outcomes can help health centers develop proactive and appropriate interventions. 

What does this study add? The study identified health center patients with complex health conditions who are high health care utilizers. The researchers categorized patients as those with mental health conditions (32%), multiple chronic conditions (27%), or low risk (41%). The researchers also categorized patients as low utilizers (73%), high utilizers (24%), and super high utilizers (3%). The findings determined high and super high utilizers with mental health conditions often had comorbid conditions of obesity, smoking, hypertension and cardiovascular disease.

What are the implications for the Health Center Program? These results indicate that concurrent mental health and physical chronic conditions are major drivers of high health care system utilization. The findings highlight the importance of primary and mental health care coordination and the Patient-Centered Medical Home (PCMH) model to meet the needs of health center patients with complex conditions.

What does this study add? The study examined how patient-provider communication is associated with increased adherence to cholesterol management advice using the 2014 Health Center Patient Survey (HCPS). Patients were more likely to take prescribed medication when their provider always knew their medical history. Patients were more likely to report following physical activity advice when their provider always knew their medical history, spent enough time with them, and provided information that was easy to understand. 

 

What are the implications for the Health Center Program? This study highlights the importance of patient-provider communication and how health center providers positively influence patient adherence to lifestyle modification advice and medication prescription. The study shows that it is important for providers to know their patients’ medical histories and provide information that is easy for their patients to understand to support them in cholesterol management. 

What does this study add? The study found that health center patients with obesity were more likely to have mental health conditions and multiple other chronic conditions at the same time than other health center patients. Researchers analyzed data from HRSA’s 2014 Health Center Patient Survey (HCPS) to obtain these results. The researchers found over 75% of Health Center patients are overweight or have obesity. Additionally, 41% of health center patients have multimorbidity and 49% have diagnoses of mental health conditions.  

What are the implications for the Health Center Program? The high prevalence rates of multimorbidity, obesity, and mental health conditions among health center patients reflect a high-need patient population using the Health Center Program, which highlights the importance of promoting an integrated approach to managing care for these patients. 

What does this study add? The researchers used the Social Deprivation Index (SDI), which measures social determinants of health related to income, education, employment, housing, and other factors. The researchers determined that patients at health centers in areas of high social deprivation are more likely to use enabling services like transportation, case management, and interpretation services. Researchers also determined that health centers in these areas perform better on seven of twelve quality process measures, including cervical cancer screening and childhood immunization rates, but have lower scores on measures like rates of uncontrolled diabetes and low birth weight.

What are the implications for the Health Center Program? The results indicate the important role of enabling services in overcoming structural barriers to healthcare delivery and reinforces the importance of social determinants of health even in cases where healthcare quality processes are improved.  

What does this study add? During June 26 - November 6, 2020 of the COVID-19 pandemic, health centers reported 30.2% of weekly visits occurred via telehealth. Telehealth visits declined as the number of new COVID-19 cases decreased but leveled out when the number of cases increased toward the end of the measurement period. Health centers in the South and rural areas consistently reported the lowest average percentage of weekly telehealth visits.

 

What are the implications for the Health Center Program? Although the percentage of telehealth visits in the Health Center Program has declined since 2020, maintaining telehealth as a care delivery option could continue to contribute to increased access to care for health center patients.

What does this study add? Increases in dental staff in health centers continue to be met with increases in dental visits, providing access to oral health care. Patients with higher self-reported oral health need were more likely to visit the health center for their dental services than other health care providers. Lastly, the study showed that patients who visited the health center for 3 or more years were more likely to receive dental services at the health center than other providers if they received dental care at all, although these patients did not receive more dental care overall.

What are the implications for the Health Center Program? The findings suggest increasing the dental workforce at health centers could promote access to dental services, and that patients with a high level of need for oral health care may prefer to receive care at health centers. It also shows that newer patients at health centers may require additional assistance to access dental services. 

What does this study add? The researchers found health centers address geographic disparities by delivering equitable performance in all but one clinical quality measure. Rural health centers had lower rates of linking patients newly diagnosed with HIV to care. 

What are the implications for the Health Center Program? The findings highlight health centers’ contributions in addressing rural disparities in quality of care and identify opportunities for improvement in HIV care. Performance in both rural and urban health centers may be improved by supporting programs that increase the availability of providers, training, and provision of technical resources.

What does this study add? Researchers evaluated staffing capacity for substance use disorder services in health centers between 2010 and 2017. Between 2010 to 2015, 20% of health center organizations had substance use disorder (SUD) staff with an average of one full-time equivalent SUD employee. By 2016 and 2017, SUD capacity grew by 43% and 22% respectively. The researchers also measured Medication-Assisted Treatment (MAT) capacity in 2016 and 2017, and it grew by 29% between those years. Health centers that received supplementary grants were more likely to have SUD capacity.

What are the implications for the Health Center Program? The significant growth of health center offering SUD services is likely due to supplemental SUD-specific HRSA grants. Expanding SUD capacity in health centers is an important step in increasing SUD treatment access for low-income and uninsured populations.

What does this study add? The study examined health care use between health center patients with a mental health condition or substance use disorder (SUD) who received integrated behavioral health services and those that did not. Researchers determined patients with a mental health condition who received health education were less likely to visit the emergency department or be hospitalized, as were patients with SUD who received medical support services, compared to patients with those conditions who did not receive these services.

What are the implications for the Health Center Program? By integrating behavioral health services such as health education and medical support services for patients with mental health conditions or SUD, health centers can potentially reduce emergency department use and hospitalizations among these populations.