Health Center Library

Search peer-reviewed articles related to the Health Center Program, including those presented by HRSA authors and partner agencies, in four areas: Health Care Access, Quality, Cost, and Equity.

Contact: Submit inquiries about Health Center Program research to the BPHC Contact Form under Health Center Data and Research, Health Center Program Research.

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26-41 of 41 Journals

Estimating the Impact of Medicaid Expansion and Federal Funding Cuts on FQHC Staffing and Patient Capacity

Author(s): Shiyin Jiao, R Tamara Konetzka, Harold A Pollack, Elbert S Huang
Journal: Milbank Quarterly
Publication Year: 2022
Topic: Cost of Care; Federally Qualified Health Centers (FQHC); Medicaid

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.

Disparities in Smoking Prevalence and Associations with Mental Health and Substance Use Disorders in Underserved Communities across the U.S.

Author(s): Sue C Lin, Naomie Gathua, Cheryl Thompson, Alek Sripipatana, Laura Makaroff
Journal: Cancer
Publication Year: 2022
Topic: Cancer; Mental Health; Substance Use

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.

Factors Associated with Federally Qualified Health Center Financial Performance

Author(s): Daniel Jung, Elbert S. Huang, Eric Mayeda, Rachel Tobey, Eric Turer, James Maxwell, Allison Coleman, Jennifer Saber, Susan Petrie, Joshua Bolton, Daniel Duplantier, Hank Hoang, Alek Sripipatana, Robert Nocon
Journal: Health Services Research
Publication Year: 2022
Topic: Federally Qualified Health Centers (FQHC); Medicaid; Uniform Data System (UDS)

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 Factors Are Associated with Medicaid Patients’ Use of Health Centers?

Author(s): Yihe N. Gao, Robert S. Nocon, Ravi Sharma, and Elbert S. Huang
Journal: Journal of Primary Care & Community Health
Publication Year: 2017

What does this study add? Among Medicaid patients, Black, Hispanic, and patients with Temporary Assistance for Needy Families (TANF) were more likely to seek care at health centers. However, patients with high chronic disease burden were less likely to use health centers. Local health center presence also predicted higher health center use.

What are the implications for the Health Center Program? These findings suggest that patients with greater medical needs might seek care from hospitals or specialty care providers instead of health centers. At the same time, the fact that health centers have a long history of culturally competent care and their boards of directors are comprised of health center users might attract patients who identify as racial and ethnic minorities. Additionally, health centers often provide services such as transportation assistance, translation, and benefits counseling that may appeal to those in greater financial need.

Colorectal cancer screening at US community health centers: Examination of sociodemographic disparities and association with patient-provider communication

Author(s): Sue C Lin, Duane McKinley, Alek Sripipatana, Laura Makaroff
Journal: Cancer
Publication Year: 2017

What does this study add? The researchers used 2014 Health Center Patient Survey (HCPS) data to assess whether sociodemographic variables and patient-provider communication are associated with colorectal cancer screening. The results show patients between the ages of 65 and 75 and patients not in the labor force had higher odds of receiving colorectal cancer screening, while patients who were uninsured and patients who were best served in a language other than English had lower odds. Patient-provider communication was not associated with the receipt of colorectal cancer screening.

What are the implications for the Health Center Program? The high ratings of patient-provider communication, regardless of screening status, suggest progress toward patient-centered practice transformation. Addressing insurance coverage and making culturally and linguistically appropriate patient education materials available are critical for increasing future colorectal screening rates.

Access to Care and Satisfaction Among Health Center Patients with Chronic Conditions

Author(s): Leiyu Shi, De-Chih Lee, Geraldine Pierre Haile, Hailun Liang, Michelle Chung, Alek Sripipatana
Journal: Journal of Ambulatory Care Management
Publication Year: 2017

What does this study add? This study examined access to care and satisfaction among health center patients with chronic conditions using data from the 2009 Health Center Patient Survey (HCPS). The researchers determined that patients with chronic conditions were more likely to report barriers to care access than those without chronic conditions. However, there was no significant difference in overall satisfaction.

What are the implications for the Health Center Program? Patients with multiple chronic conditions often need more extensive health care that might be more challenging to obtain. Given the unmet health care needs of these health center patients, health centers might require more resources to provide comprehensive and continuous care to patients with chronic conditions. 

The Association of Patient-centered Medical Home Designation With Quality of Care of HRSA-funded Health Centers: A Longitudinal Analysis of 2012-2015

Author(s): Ruwei Hu, Leiyu Shi, Alek Sripipatana, Hailun Liang, Ravi Sharma, Suma Nair, Michelle Chung, De-Chih Lee
Journal: Medical Care
Publication Year: 2018

What does this study add? The study assessed whether health centers with Patient-Centered Medical Home (PCMH) recognition provided better quality clinical care than those without PCMH recognition, and whether quality improvement varied by  length of  PCMH recognition. Researchers found that health centers with PCMH recognition generally performed better on clinical quality measures than those without recognition, and that health centers with longer periods of PCMH recognition showed more quality improvement than those with fewer years of recognition. The researchers used data from the 2012 to 2015 Uniform Data System and the Area Health Resource File.

What are the implications for the Health Center Program? Adopting the PCMH model may help health centers improve the quality of their primary care services. The findings suggest that PCMH transformation takes time, and improvement is likely to continue as health centers gain more experience applying this model of care.

The association between dental, general, and mental health status among underserved and vulnerable populations served at health centers in the US

Author(s): Vy H. Nguyen, Sue C. Lin, David P. Cappelli, and Suma Nair
Journal: Journal of Public Health Dentistry
Publication Year: 2018

What does this study add? The study explored the potential relationship between acute dental needs and general and mental health status among health center patients using data from the 2014 Health Center Patient Survey (HCPS). Researchers found that patients who rated their general health status as fair or poor were more likely to have an acute dental need compared to patients with better general health. Patients who had ever experienced a mental illness were also more likely to have an acute dental need, as were those without health insurance that pays for dental care.

What are the implications for the Health Center Program? The findings highlight the need for a team-based multidisciplinary model of care to meet the needs of health center patients with multiple concurrent conditions. Health centers may be able to identify opportunities to expand the integration of oral health in primary care settings, which could reduce patients’ risk of progression towards acute dental problems.

Telehealth In Health Centers: Key Adoption Factors, Barriers, And Opportunities

Author(s): Ching-Ching Claire Lin, Anne Dievler, Carolyn Robbins, Alek Sripipatana, Matt Quinn, and Suma Nair
Journal: Health Affairs
Publication Year: 2018
Topic: Telehealth

What does this study add? Using the 2016 Uniform Data System (UDS), the study found that 38% of health centers were using telehealth, with many others reporting exploring future use. Factors most strongly associated with telehealth use were rural location, mental health services, and state-level Medicaid policies allowing reimbursement for virtual services. Among health centers not using telehealth, cost and reimbursement were the top barriers reported.
 
What are the implications for the Health Center Program? Telehealth adoption provides health centers the opportunity to expand access to health care services, including mental health care, to people living in rural areas where specialists are less common. In addition, telehealth use in health centers could facilitate care coordination across providers and the integration of primary and behavioral health care. Medicaid reimbursement for telehealth services is likely important for expanding use. 

Improving Quality of Care in Federally Qualified Health Centers Through Ambulatory Care Accreditation

Author(s): Suma Nair, Jie Chen
Journal: Journal for Healthcare Quality
Publication Year: 2018

What does this study add? The researchers assessed the association between ambulatory care accreditation and clinical quality measures. The results show that accredited health centers achieved higher performance on adult weight screening and follow up, tobacco cessation intervention, and use of lipid-lowering therapy.

What are the implications for the Health Center Program? The results show that accreditation could result in over 550,000 additional adult patients receiving weight screening and follow-up, over 150,000 receiving tobacco cessation intervention, and over 25,000 receiving lipid-lowering therapy.

Assessing the Impact of Patient-Centered Medical Home Principles on Hypertension Outcomes Among Patients of HRSA-Funded Health Centers

Author(s): Nadereh Pourat, Xiao Chen, Christopher Lee, Weihao Zhou, Marlon Daniel, Hank Hoang, and Alek Sripipatana
Journal: American Journal of Hypertension
Publication Year: 2019

What does this study add? Using the 2014 Health Center Patient Survey, researchers found that health center following Patient-Centered Medical Home (PCMH) principles were associated with receipt of needed hypertension services, more patient self-management, and better hypertension control. For example, patients of health centers that coached patients on hypertension self-care were more likely to have normal blood pressure at their last visit and fewer emergency department visits. Patients of health centers that used individual hypertension treatment plans or offered behavioral health counseling were more likely to report confidence in caring for their hypertension.

What are the implications for the Health Center Program? Findings confirmed the value PCMH principles to improve care and outcomes of health center patients with hypertension. The findings support investments by HRSA in promoting PCMH accreditation among health centers.  

Enabling Services Improve Access to Care, Preventive Services, And Satisfaction Among Health Center Patients

Author(s): Dahai Yue, Nadereh Pourat, Xiao Chen, Connie Lu, Weihao Zhou, Marlon Daniel, Hank Hoang, Alek Sripipatana, Ninez A Ponce
Journal: Health Affairs
Publication Year: 2019

What does this study add? The study used 2014 Health Center Patient Survey data to compare patient satisfaction and the use of preventive services between patients who did versus did not receive enabling services. Enabling services are non-clinical services to improve access to care and the receipt of social benefits such as translation or transportation services. Findings showed that patients who received enabling services had more health center visits, were more likely to have a routine checkup or flu shot, and were more satisfied with care.

What are the implications for the Health Center Program? The findings confirm the value of enabling services to address structural barriers health center patients face when accessing health care and social benefits. The study highlights the importance of policies that support enabling services to promote better care and improve long-term outcomes among health center patients. 

Exploring racial/ethnic disparities in hypertension care among patients served by health centers in the United States

Author(s): Alek Sripipatana, Nadereh Pourat, Xiao Chen, Weihao Zhou, Connie Lu
Journal: Journal of Clinical Hypertension
Publication Year: 2019

What does this study add? The study examined whether patients with hypertension who identified as racial and ethnic minorities experienced differences in care and outcomes compared to non-Hispanic or Latino/a white patients using the 2014 Health Center Patient Survey (HCPS). Some racial and ethnic minorities (Asians and African Americans) were more likely to follow exercise recommendations and less likely to have high blood pressure. However, certain groups (African Americans and Alaskan Natives and American Indians) were more likely to visit the emergency department or be hospitalized for hypertension-related reasons.

What are the implications for the Health Center Program? The study shows health centers’ success in managing hypertension among patients disproportionately affected by this condition. It also highlights a need to better understand why certain patients may differ in receiving or adhering to medical recommendations and visiting the emergency department.

Organizational Factors Associated with Disparities in Cervical and Colorectal Cancer Screening Rates in Community Health Centers

Author(s): Emmeline Chuang, Nadereh Pourat, Xiao Chen, Christopher Lee, Weihao Zhao, Marlon Daniel, Hank Hoang, and Alek Sripipatana
Journal: Journal of Health Care for the Poor and Underserved
Publication Year: 2019

What does this study add? This study examined how health center characteristics influence screening rates for cervical and colorectal cancer using data from the 2015 Uniform Data System and Area Health Resource File. Higher cancer screening rates were associated with provider-patient staffing ratios, utilization of electronic health records (EHR), revenue from public capitated managed care contracts, and availability of local primary care providers. Health centers with more patients experiencing homelessness had lower rates of cancer screening.

What are the implications for the Health Center Program? Increasing provider-patient ratios, automating reminders via EHR systems, and tailoring approaches for patients experiencing homelessness, may increase equitable screening rates for preventable and treatable cancer types, which could improve long-term health outcomes among underserved populations.

Improving Outcomes of Care for HRSA-Funded Health Center Patients Who Have Mental Health Conditions and Substance Use Disorders

Author(s): Nadereh Pourat, Xiao Chen, Christopher Lee, Weihao Zhou, Marlon Daniel, Hank Hoang, Alek Sripipatana
Journal: Journal of Behavioral Health Services and Research
Publication Year: 2020

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.

The availability of community health center services and access to medical care

Author(s): James B Kirby, Ravi Sharma
Journal: Healthcare

What does this study add? Researchers used data to examine whether community health centers improve access to ambulatory care services. The availability of health center services was positively associated with having a usual source of care among those with Medicaid and private insurance as well as those without insurance.

What are the implications for the Health Center Program? The findings suggest that the Health Center Program could be an important resource to support the efficacy of expanded Medicaid coverage under the Affordable Care Act and, ultimately, improve access to quality primary care for underserved Americans.