Health Center Library

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? 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? 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? The study examined health center mental health staffing and found that health centers need at least one full-time mental health provider (regardless of provider type) to significantly increase the likelihood that patients who need mental health care will access these services onsite or in the community. The researchers analyzed data from the 2014 Health Center Patient Survey (HCPS)) and the 2013 Uniform Data System (UDS).

What are the implications for the Health Center Program? Follow-up initiatives should evaluate the effects of increasing funding to co-locate mental health staff on mental health care access for health center 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 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.

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.

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.

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.

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.

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? 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.

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.

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.

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.

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.

What does this study add? Using the 2014 Health Center Patient Survey, researchers found that health centers 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.

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.

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.

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.

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.

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.

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.