When Patients Govern: Federal Grant Funding and Uncompensated Care at Federally Qualified Health Centers

Wright, Brad; Ricketts, Thomas C.

doi:10.1353/hpu.2013.0068

Cited by 10 publications

(5 citation statements)

References 32 publications

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“…Our findings corroborate previous research finding that governing board patient members are not demographically representative of the clinic's patient population [17]. A lack of representativeness may have implications for service delivery; one study found that the proportion of representative patients participating in leadership positions within governing boards was predictive of scope of accessenabling services [18].…”

Section: Discussionsupporting

confidence: 85%

Patient Engagement in Community Health Center Leadership: How Does it Happen?

et al. 2018

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Patient engagement in primary care leadership is an important means to involve community voices at community health centers. Federally qualified health centers (FQHCs) are mandated to have patient representation within their governing boards, while practices seeking patient-centered medical home certification receive credit for implementing patient advisory councils (PACs). Our objective was to compare and contrast how community health centers engage patients in clinic management, decision-making and planning within governing boards versus PACs. Qualitative study conducted from August 2016 to June 2017 at community health centers in California, Arizona and Hawaii. We interviewed practice leaders of patient engagement programs at their site. Eligible clinics had patient representatives within their governing board, PAC, or both. We assessed patient demographics, roles and responsibilities of patients participating, and extent of involvement in quality improvement among governing boards versus PACs. We interviewed 19 sites, of which 17 were FQHCs that had governing boards. Of the 17 FQHCs, 11 had also implemented PACs. Two non-FQHC safety-net sites had PACs but did not have governing boards. Governing board members had formal, structured membership responsibilities such as finances and hiring personnel. PAC roles were more flexible, focusing on day-to-day clinic operations. Clinics tended to recruit governing board patient members for their skill set and professional experience; PAC member recruitment focused more on demographic representation of the clinic's patient population. Both groups worked on quality improvement, but governing boards tended to review clinic performance metrics, while PAC members were involved in specific project planning and implementation to improve clinical outcomes and patient experience. Patient involvement in clinic improvement in CHCs includes higher-level decision-making and governance through mechanisms such as governing boards, as well as engagement in day-to-day practice improvement through PACs. These roles offer differing, but valuable insights to clinic programs and policies.

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Section: Discussionsupporting

confidence: 85%

Patient Engagement in Community Health Center Leadership: How Does it Happen?

et al. 2018

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“…All three studies that examined organizational contextual variables included provider characteristics in the analysis. Variables examined include the type and level of grant funding (Lo Sasso and Byck, 2010), board composition (Wright and Ricketts, 2013), staffing level, service mix, financial health (Shi et al , 2000; Wells et al , 2009) and location (Wells et al , 2009). On the other hand, in the two studies examining environmental contextual variables as predictors of FQHC strategy, market factors as well as institutional changes were considered – change in supply of healthcare professionals and a cut in state Medicaid funding respectively (Ku et al , 2014; Zuckerman et al , 2009).…”

Section: Resultsmentioning

confidence: 99%

The context, strategy and performance of the American safety net primary care providers: a systematic review

Choi

Weech‐Maldonado

Powers

2020

JHOM

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PurposeThe objective of this research is to synthesize evidence on the relationship between context, strategies and performance in the context of federally qualified health centers (FQHCs), a core safety net health services provider in the United States. The research also identifies prior approaches to measure contextual factors, FQHC strategy and performance. Gaps in the research are identified, and directions for future research are provided.Design/methodology/approachA systematic review of peer-reviewed journal articles published between the years 1997 and 2017 was conducted using a bibliographic search of PubMed, Business Source Premier and ABI/Inform databases.Findings28 studies were selected for the analysis. Results supported associations among contextual factors (organizational and environmental) and FQHC strategy and FQHC performance. The research also indicates that previous research was primarily emphasized on clinical performance with less focus on other types of FQHC performance. In addition, there exists a wide variability in terms of measuring context, FQHC strategy and performance.Originality/valueOperating in resource-scarce and highly constraining environments, FQHCs have demonstrated the ability to stay innovative and competent as serving often unhealthier and costlier patient populations. To date, there has been no study that reviewed the relationships between context, FQHC strategy and FQHC performance. In addition, there is an absence of consensus on how context, FQHC strategy and FQHC performance are measured. This study is the first that examined context–strategy–performance relationships in the context of FQHCs.

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“…9 As such, community health clinics and federally qualified health centers are where undocumented immigrants receive most of their health care. 10 Immigrant populations can receive services, such as primary medical care, dental care, and behavioral health, at these nonprofit health care centers that now exist in urban, suburban, and rural areas.…”

Section: Introductionmentioning

confidence: 99%

Critical Incidences in U.S. Health Care Systems Experienced by Undocumented Young Adults

Chavez

Vences

Ruiz³

et al. 2021

Health Equity

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Purpose: Undocumented (“illegal immigrant”) young adults and families face many barriers when seeking health care, including discrimination, which contributes to health disparities. Using critical race theory, an investigation of experiences of health care among undocumented young adults was conducted to highlight their limitations to health care access. Methods: Using a community-based participatory paradigm, a qualitative research approach was used to explore the experiences of 13 participants via a semistructured interview. Upon transcription and broad theme analysis conducted by the primary team members, a gathering of community experts was arranged. This gathering consisted of the primary team members as well as community young adults who identified as undocumented or of mixed-status families, in which all engaged in a collaborative analysis of themes and confirmation of corresponding illustrative data. Furthermore, community experts provided feedback on their insights for the necessary next steps. Results: Through collaborative thematic analysis and confirmation of illustrative data, four themes emerged: (1) emotional and financial stress, (2) fear of exposure, (3) dependence on community health clinics, and (4) hospitals as a last resource. Conclusion: Undocumented young adults and their families make great attempts to access health care, however, because of systemic barriers, they engage in strategies to preserve their safety in such attempts. Due to lack of insurance and financial strain, undocumented families depend on resources they most trust, typically health clinics. However, as many families depend on this resource, they may hinder efficiency in getting the specific help they need, especially if they do not have the capacity to adequately address medical issues that require immediate attention.

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When Patients Govern: Federal Grant Funding and Uncompensated Care at Federally Qualified Health Centers

Cited by 10 publications

References 32 publications

Patient Engagement in Community Health Center Leadership: How Does it Happen?

Patient Engagement in Community Health Center Leadership: How Does it Happen?

The context, strategy and performance of the American safety net primary care providers: a systematic review

Critical Incidences in U.S. Health Care Systems Experienced by Undocumented Young Adults

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