A patient receives care at the Hubert Humphrey Medical Clinic in Los Angeles,… (Margaret Cheatham Williams…)
Federally funded community health centers perform equal to or better than private practices on a number of quality-care measures, according to a new study. The results demonstrate that community health centers are capable of providing high-quality care to an often complex patient population.
When the Patient Protection and Affordable Care Act goes into full effect in 2014, the government hopes it will add somewhere between 29 million and 32 million Americans to the rolls of the insured, many of whom will receive their care through a large expansion of Medicaid. But with the expansion comes a worry: Who will give primary care to all the newly insured, many of whom currently avoid the doctor or receive all their medical attention in hospital emergency rooms?
The Obama administration has pinned its hopes in part on so-called Federally Qualified Health Centers, which receive special reimbursement perks in exchange for providing primary care to underserved communities. But little research had evaluated whether such centers provided adequate care to their communities.
In the new study, researchers at UC San Francisco, Stanford, and Johns Hopkins analyzed data from a large, three-year government survey of visits to primary care physicians in different types of medical settings. The survey collected information on four categories of care: drug management of common chronic diseases, preventive counseling for smoking cessation, diet and exercise, appropriate use of common screening tests (like blood pressure tests and electrocardiograms), and appropriate writing of prescriptions for elderly patients. The researchers compared how the doctors in different settings performed against accepted standards of care.
The authors of the new study hypothesized that the federally funded centers might have lower performance on these measures in comparison with private practices because of the social and medical complexities of their patient populations. But instead, the researchers found that the centers did at least as well, and often better.
On six of 18 measures, the federally funded centers performed better; those measures were clustered in the drug management and appropriate use of screening test categories. The centers performed worse only when it came to diet counseling in at-risk adolescents. The authors argue that federal programs designed to improve care at such centers probably contributes to their superior performance.
Lest the federally funded centers get too excited, the study also revealed that all doctors have a long way to go in sticking to accepted standards of care: adherence to guidelines for seven of 18 quality measures was below 50% for both the federally funded centers and the private practice physicians.