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O'Malley, Ann S., Forrest, Christopher, Politzer, Robert, Wulu, John, and Leiyu, Shi. "Health Center Trends, 1994-2001: What Do They Portend For The Federal Growth Initaitive?" Health Affairs Vol.24 (2), 465-472, March/April 2005. Recent Studies from the National Association of Community Health Centers Peter Cunningham and Jack Hadley. "Expanding Care Versus Expanding Coverage: How To Improve Access To Care" Health Affairs, July/August 2004; 23(4): 234-244.
Roby, Dylan, Sara Rosenbaum and Dan Hawkins. "Exploring Healthcare Quality and Effectiveness at Federally-Funded Community Health Centers: Results from the Patient Experience Evaluation Report System (1991-2003)." National Association for Community Health Centers. March 2003.
Roby, Rosenbaum and Hawkins analyzed patient surveys collected nationally by Community Health Centers in 1993 and again in 2001. Among the findings in this study are patients’ increasing level of satisfaction with their care at CHCs.
Porterfield D.S. and Kinsinger L. “Quality of Care for Uninsured Patients with Diabetes in a Rural Area.” Diabetes Care. 25(2): 319-23, 2002, Feb. Porterfield and Kinsinger compared quality of care for uninsured patients with diabetes in private physician’s offices and community/migrant health centers (C/MHC) by conducting a cross sectional medical record review in a convenience sample of eight physician offices and three C/MHC sites in rural North Carolina. They found that the medical records of patients in C/MHCs demonstrated higher rates on four of six process measures of quality of care including measurement of HbA (1c), cholesterol, and urine protein.
2) Klein, J.D., et al. “Improving Adolescent Preventive Care in Community Health Centers.” Pediatrics. 107(2):318-27, 2001, Feb.
Klein, et al evaluated the implementation of the Guidelines for Adolescent Preventive Services (GAPS) in Community and Migrant Health Centers and found that implementing GAP increased the receipt of preventive services at the health centers. After guideline implementation, adolescents reported increases in having discussed prevention content with providers in 19 out of 31 content areas, including increased discussion of topics such as physical or sexual abuse (10% before to 22% after), sexual orientation (13% to 27%), fighting (6% to 21%), peer relations (37% to 52%), suicides (7% to 22%), eating disorders (11% to 28%), immunizations (19% to 48%), and others. The researchers conclude that GAPS implementation may help improve the quality of care for adolescents.
3) Ulmer, C. et al. “Assessing Primary Care Content: Four Conditions Common in Community Health Center Practice.” Journal of Ambulatory Care Management. 23(1):23-38, 2000, Jan. Ulmer, et al evaluated the results of medical records reviews assessing the quality of care at Community Health Centers (CHCs) for acute otitis media, diabetes, asthma, and hypertension. It was found that the CHCs meet or exceeded prevailing practices across other health care settings (though some variation existed among sites).
4) Chin, M.H. et al. “Quality of Diabetes Care in Community Health Centers.” American Journal of Public Health. 90(3):431-4, 2000, Mar.
Chin, et al assessed the quality of diabetes care in community health centers. In 55 Midwestern community health centers the charts of 2865 diabetic adults were reviewed to see if the American Diabetes Association’s measures of quality were met. Results found that on average, 70% of patients in Each CHC had elevated measurements of glycosylated hemoglobin (an average value of 8.6%), 26% had dilated eye examinations, 66% had diet intervention, and 51% received foot care. It was concluded that rates of adherence to process measures of quality of were relatively low among community health centers, compared with targets established by the American Diabetes Association.
5) St. Martin, E.E. “Community Health Centers and Quality of Care: A Goal to Provide Effective Health Care to the Community.” Journal of Community Health Nursing. 13(2):83-92, 1996.
St Martin finds that incorporating principles of Total Quality Management (TQM) is easy to do in a community health center setting and can enhance the effectiveness of health care delivery to a community and its members.
6) Starfield B. et al. “Costs vs Quality in Different Types of Primary Care Settings.” JAMA. 272(24):1951-2, 1994, Dec 28.
Starfield et al conducted a retrospective quality of care review of 2024 outpatient medical records of 135 providers sampled from system wide Medicaid claims data in Maryland. These providers came from three different practice settings: hospital outpatient clinics, community health centers, and physician’s offices. In the study, a sample of patients with the diagnoses of diabetes, hypertension, asthma, well-child care, or otitis media were identified from Medicaid claims forms from visits during 1988. To measure quality of care, several categories were analyzed using explicit criteria. These categories included: evidence of impaired access, evidence of compromised technical quality, evidence of inappropriate care, outcome of care, and several generic indicators of quality. The study concluded that although there were some systematic differences by type of facility in some aspects of quality of care, there were no consistent differences in quality of care overall for patients in different types of settings and no consistent relationships between cost-efficiency and quality of care. However, patients in medium-cost community health centers had the best or second best scores for most of the 21 comparisons of type of quality assessed. Thus policies generated toward the choice of low-cost vs. high-cost providers will not necessarily lead to a deterioration in the quality of care.
7) Falik, M. et al, “Ambulatory Care Sensitive Hospitalizations and Emergency Visits: Experiences of Medicaid Patients using Federally Qualified Health Centers.” Med Care, MDS Assoc. (June 2001)
Falik et al., compares admissions and emergency room visits for ambulatory care sensitive conditions (ACSCs) among Medicaid beneficiaries using Federally Qualified Health Centers (FQHCs) to other Medicaid beneficiaries. Admissions and emergency room visits for ACSCs are measured for both groups of beneficiaries. The report concludes that those with access to regular preventative care at FQHCs are much less likely to be taken to the ER or hospitalized than those without access to FQHCs.
8) Frick, et al, “Whether and Where Community Health Centers Users Obtain Screening Services.”Journal of Healthcare for the Poor and Underserved, Johns Hopkins Primary Care Policy Center for the Underserved (2001.)
Frick et al., examines the socioeconomic status of adult community health center users and their use of screening services for secondary prevention. From a selected group of CHCs, a random sample of users are interviewed with the Community Health Center User Survey and asked questions regarding whether screening services had been utilized in the past year and, if so, had these services been received at a CHC. Findings reveal that users of minority or lower socioeconomic status were not less likely to receive preventive screenings and the screenings conducted were most often at a CHC. The study concludes that CHC are indeed providing preventive services to vulnerable populations that would otherwise not have access to certain services
9) Carlson, B. L. et al, “Primary Care of Patients without Health Insurance by Community Health Centers.” Mathematica Policy Research Inc., under contract with the Department of Health and Human Services. Journal of Ambulatory Care (2001.)
Carlson et al., compares uninsured Community Health Centers (CHCs) users with the uninsured nationwide. The socioeconomic characteristics of the uninsured CHC users and the overall uninsured populations are compared. Health standard of CHC uninsured patients is weighed against the Healthy People 2000 goals. Analysis of whether CHC uninsured patients have greater access and satisfaction in health care is also conducted. Findings create a favorable picture of CHC and the importance of their work with the uninsured. Compared to the overall uninsured, CHC uninsured users usually live in poverty-stricken areas, are poorly educated, and are African American or Hispanic; yet, the uninsured CHC users had more regular contact with a physician and a usual source of care where as the overall uninsured did not.
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