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.
Health Centers and Social Determinants of Health: An Analysis of Enabling Services Provision and Clinical Quality
What does this study add? The researchers found health centers that provided the most enabling services performed better on nine of ten clinical quality process measures. However, these health centers had more patients with uncontrolled high blood pressure and diabetes.
What are the implications for the Health Center Program? These findings suggest enabling services may have a stronger positive correlation with clinical quality process measures than outcome measures. However, it is unlikely that enabling services have a detrimental effect on outcome measures, and it is more plausible that enabling services are unable to independently address certain poor health outcomes. Enabling services are intended to increase access to care, which is an example of a process measure, while other factors contribute to final health outcomes throughout the continuum of care. Even so, better clinical process performance shows that these services might mitigate some effects of social risk factors.
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.
Trends in Use of Telehealth Among Health Centers During the COVID-19 Pandemic —United States, June 26-November 6, 2020
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.
The Role of Dentist Supply, Need for Care and Long‐term Continuity in Health Resources and Services Administration‐funded Health Centers in the United States
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.
Patient-Provider Communication and Adherence to Cholesterol Management Advice: Findings from a Cross-Sectional Survey
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.
Exploring the Association of Social Determinants of Health and Clinical Quality Measures and Performance in HRSA-Funded Health Centers
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.
The concurrent burden of multimorbidity, mental health conditions, and severe obesity among United States health center patients
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.
Examining trends in substance use disorder capacity and service delivery by Health Resources and Services Administration-funded health centers: A time series regression analysis
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.
Telehealth Practice Among Health Centers During the COVID-19 Pandemic — United States, July 11–17, 2020
What does this study add? During July 11–17, 2020 of the COVID-19 pandemic, 963 of 1,009 (95.4%) HRSA-funded health centers that responded to a voluntary weekly survey reported providing telehealth services. Health centers in urban areas were more likely to provide >30% of visits virtually than were those in rural areas.
What are the implications for the Health Center Program? Telehealth is a promising approach to promoting and expanding access to care, especially in the South and rural areas. This cost-effective option helped to prevent transmission of SARS-CoV-2 and other respiratory illnesses while supporting continuity of care during the COVID-19 pandemic.
Preventive Care and Chronic Disease Management: Comparison of Appalachian and Non-Appalachian Community Health Centers in the United States
What does this study add? Health centers play a key role in addressing geographic health disparities. Appalachian health center performance on clinical quality measures was better than or comparable to performance at their non-Appalachian counterparts. Patients at Appalachian health centers are more likely to receive colorectal cancer (CRC) screening and pediatric weight assessment and counseling than at non-Appalachian health centers. There were no significant differences in performance observed among other clinical quality measures.
What are the implications for the Health Center Program? Positive associations between Appalachian health centers and clinical quality measures may reflect targeted clinical quality improvement (QI) initiatives by health centers and professional organizations. Future research on QI programs, insurance payer mix, and practice size among Appalachian health centers could replicate clinical quality success for clinics in similar underserved communities.
Mental health status among women of reproductive age from underserved communities in the United States and the associations between depression and physical health. A cross-sectional study
What does this study add? The study used the 2014 Health Center Patient Survey (HCPS) and found 40.8% of female patients of reproductive age reported depression; 28.8% reported generalized anxiety; and 15.2% met the criteria for serious psychological distress. Furthermore, patients with depression had two to three times higher odds of experiencing co-occurring physical health conditions.
What are the implications for the Health Center Program? The high prevalence of depression and serious psychological distress and strong links between depression and chronic diseases among female health center patients of reproductive age underscores the need to prioritize women's health and integrate behavioral and primary health care through strategic training and technical assistance. This integration may reduce inter-related physical and mental health risks that impact maternal health, pregnancy outcomes, and life course trajectory.
Impact of health information technology optimization on clinical quality performance in health centers: A national cross-sectional study
What does this study add? Health centers with advanced health information technology (HIT) showed better results in 11 out of 12 electronic clinical quality measures (eCQMs) for preventive and chronic care. Health centers with enhanced HIT, Patient-Centered Medical Home (PCMH) accreditation, and large practices tended to perform better on most eCQMs. Overall, this study explored how health centers' adoption of advanced EHR features and the factors supporting HIT upgrades impacted their eCQM performance using data from the 2016 Uniform Data System (UDS).
What are the implications for the Health Center Program? The findings suggest that when primary care practices participate in HIT optimization, it leads to better quality care. This improvement comes from better data management, improved coordination of care, and a reduction in unnecessary acute care. Investing in HIT optimization in health centers and aligning their CQM reporting with eCQMs can lead to enhanced patient outcomes.
Assessing clinical quality performance and staffing capacity differences between urban and rural Health Resources and Services Administration-funded health centers in the United States: A cross sectional study
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.
Health Center Testing for SARS-CoV-2 During the COVID-19 Pandemic — United States, June 5–October 2, 2020
What does this study add? Health centers have provided racial and ethnic minority populations access to SARS-CoV-2 testing. Improving health centers’ ability to reach groups at increased risk for COVID-19 might reduce transmission.
What are the implications for the Health Center Program? Efforts to improve coordination of COVID-19-related activities between state and local public health departments and HRSA-funded health centers could increase access to testing and follow-up care for populations at increased risk for COVID-19.
Influenza vaccination among U.S. pediatric patients receiving care from federally funded health centers
What did this study add? This study estimates influenza vaccination rates for health center patients aged 2-17. Using 2009 and 2014 Health Center Patient Survey (HCPS) data, researchers found an increase from 47% (2009) to 68% (2014). After considering multiple risk factors, there were minor differences in subgroup vaccination coverage. Notably, American Indian/Alaska Native children had a 31% higher vaccination rate than non-Hispanic White children, while children living in the South saw a 26% decline compared to their Northeastern counterparts.
What are the implications for the Health Center Program? There are few disparities in childhood influenza vaccinations, with many subgroups exceeding national standards. This highlights health centers' potential to boost vaccination rates among underserved children by ensuring equitable access to seasonal flu shots through enabling services, culturally competent care, and improvements to influenza vaccine uptake in the Southern United States.
Staffing transformation following Patient-Centered Medical Home recognition among Health Resources & Services Administration-funded health centers
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? 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.
Factors associated with frequent emergency department visits among health centre patients receiving primary care
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.
Disparities in Smoking Prevalence and Associations with Mental Health and Substance Use Disorders in Underserved Communities across the U.S.
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.
Estimating the Impact of Medicaid Expansion and Federal Funding Cuts on FQHC Staffing and Patient Capacity
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.
Health care use and spending for Medicaid patients diagnosed with opioid use disorder receiving primary care in Federally Qualified Health Centers and other primary care settings
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.
The Relative Contribution of Social Determinants of Health Among Health Resources and Services Administration-Funded Health Centers
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.
Quality of Care for US Adults with Medicaid Insurance and Type 2 Diabetes in Federally Qualified Health Centers Compared with Other Primary Care Settings
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? 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.
Health Centers and Value-Based Payment: A Framework for Health Center Payment Reform and Early Experiences in Medicaid Value-Based Payment in Seven States
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.