Consumer Governance and the Provision of Enabling Services That Facilitate Access to Care at Community Health Centers

Wright, Brad

doi:10.1097/mlr.0b013e3182551763

Cited by 17 publications

(8 citation statements)

References 29 publications

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“…The literature quotes other similar reasons including fear of reprisal due to illegal immigration to be correlated with underutilization of free community clinics [ 13 ]. Other frequently mentioned reasons include lower satisfaction with FQHC [ 19 ], perceived complexities in healthcare system navigation and payer status, limited hours of FQHC operation, long waiting times, and lack of sufficient enabling services including transportation, translation, on-site child-care, and case management [ 8 , 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Certain barriers have been described in the literature including lack of health insurance [ 7 ], perceived complexities in healthcare system navigation and payer status, fear of deportation among undocumented residents, limited hours of FQHC operation, limited walk-in hours, and long wait times [ 8 , 13 ]. Lack of sufficient enabling services including transportation, translation, on-site child-care, and case management were also frequently mentioned reasons for lack of accessibility [ 8 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Role of community health outreach program “living for health”® in improving access to federally qualified health centers in Miami-dade county, Florida: a cross-sectional study

Almufleh

Gabriel

Tokayer

et al. 2015

BMC Health Serv Res

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BackgroundCare of the underserved remains one of the most compelling challenges to American healthcare. Federally Qualified Health Centers (FQHCs) address uninsurance and underinsurance by providing primary and preventive care to vulnerable populations with fees charged based on ability to pay. Our goal is to study the effectiveness of FQHCs system in engaging patients and the barriers to utilization, which have not been well defined.MethodsRetrospective analysis was performed on data from “Living for Health” (L4H) program participants from 2008 to 2012. Univariate and multivariate logistic regression analysis were performed to determine factors associated with FQHC utilization.ResultsAmong 9453 subjects screened, 1889 were referred to a FQHC, but only 201(11%) actually sought treatment. Public insurance, non-Hispanic ethnicity, and hypertension were associated with higher rates of FQHC utilization. Inability to afford costs, cultural factors and inflexible appointment times were the most common reasons for FQHC underutilization.ConclusionThe current status of FQHC utilization is sub-optimal. Community outreach programs like L4H can improve the access and utilization of FQHCs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role of community health outreach program “living for health”® in improving access to federally qualified health centers in Miami-dade county, Florida: a cross-sectional study

Almufleh

Gabriel

Tokayer

et al. 2015

BMC Health Serv Res

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show abstract

“…17 However, for a positive result, additional supportive services, such as transportation to needed services and social support for diet (eg, resources for finding healthy food on a fixed income) and exercise (provide motivation for sustained physical activity), will likely be needed in this lower socioeconomic status population to address long-term diabetes complications and improve patient quality of life. 18,19…”

Section: Discussionmentioning

confidence: 99%

The Diabetes Healthy Outcomes Program

BeLue

Figaro

Peterson³

et al. 2013

J Prim Care Community Health

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“…[20][21][22] They offer enabling services (e.g., transportation, case management) designed to improve access that may be especially important for dual enrollees given the significant barriers to care they face. 23,24 Moreover, the nature of these barriers likely differs between rural and urban areas and FQHCs have consumer majority governing boards intended to make them responsive to local needs. [23][24][25][26] In 2018, 1362 FQHCs cared for over 28 million patients at nearly 12,000 delivery sites.…”

Section: Introductionmentioning

confidence: 99%

“…23,24 Moreover, the nature of these barriers likely differs between rural and urban areas and FQHCs have consumer majority governing boards intended to make them responsive to local needs. [23][24][25][26] In 2018, 1362 FQHCs cared for over 28 million patients at nearly 12,000 delivery sites. 27 FQHCs are increasingly important primary care providers for dual enrollees.…”

Section: Introductionmentioning

confidence: 99%

Health center use and hospital‐based care among individuals dually enrolled in Medicare and Medicaid, 2012–2018

Wright

Akiyama

Potter

et al. 2022

Health Services Research

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Objective To examine the relationship between federally qualified health center (FQHC) use and hospital‐based care among individuals dually enrolled in Medicare and Medicaid. Data Sources Data were obtained from 2012 to 2018 Medicare claims. Study Design We modeled hospital‐based care as a function of FQHC use, person‐level factors, a Medicare prospective payment system (PPS) indicator, and ZIP code fixed effects. Outcomes included emergency department (ED) visits (overall and nonemergent), observation stays, hospitalizations (overall and for ambulatory care sensitive conditions), and 30‐day unplanned returns. We stratified all models on the basis of eligibility and rurality. Data Extraction Methods Our sample included individuals dually enrolled in Medicare and Medicaid for at least two full consecutive years, residing in a primary care service area with an FQHC. We excluded individuals without primary care visits, who died, or had end‐stage renal disease. Principal Findings After the Medicare PPS was introduced, FQHC use in rural counties was associated with fewer ED and nonemergent ED visits per 100 person‐years among both age‐eligible (−14.8 [−17.5, −12.1]; −6.6 [−7.5, −5.6]) and disability‐eligible duals (−11.3 [−14.4, −8.3]; −6 [−7.4, −4.6]) as well as a lower probability of observation stays (−0.8 pp age‐eligible; −0.4 pp disability‐eligible) and unplanned returns (−2.1 pp age‐eligible; −1.9 pp disability‐eligible). In urban counties, FQHC use was associated with more ED and nonemergent ED visits per 100 person‐years (10.6 [8.4, 12.8]; 4.0 [2.6, 5.4]) among disability‐eligible duals (a decrease of more than 60% compared with the pre‐PPS period) and increases in the probability of hospitalization (1.1 pp age‐eligible; 0.8 pp disability‐eligible) and ACS hospitalization (0.5 pp age‐eligible; 0.3 pp disability‐eligible) (a decrease of roughly 50% compared with the pre‐PPS period). Conclusions FQHC use is associated with reductions in hospital‐based care among dual enrollees after introduction of the Medicare PPS. Further research is needed to understand how FQHCs can tailor care to best serve this complex population.

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Consumer Governance and the Provision of Enabling Services That Facilitate Access to Care at Community Health Centers

Cited by 17 publications

References 29 publications

Role of community health outreach program “living for health”® in improving access to federally qualified health centers in Miami-dade county, Florida: a cross-sectional study

Role of community health outreach program “living for health”® in improving access to federally qualified health centers in Miami-dade county, Florida: a cross-sectional study

The Diabetes Healthy Outcomes Program

Health center use and hospital‐based care among individuals dually enrolled in Medicare and Medicaid, 2012–2018

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