Health Center Library

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 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? 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? 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 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? 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 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? 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? 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? 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 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? This study examined access to care and satisfaction among health center patients with chronic conditions using data from the 2009 Health Center Patient Survey (HCPS). The researchers determined that patients with chronic conditions were more likely to report barriers to care access than those without chronic conditions. However, there was no significant difference in overall satisfaction.

What are the implications for the Health Center Program? Patients with multiple chronic conditions often need more extensive health care that might be more challenging to obtain. Given the unmet health care needs of these health center patients, health centers might require more resources to provide comprehensive and continuous care to patients with chronic conditions. 

What does this study add? The researchers used 2014 Health Center Patient Survey (HCPS) data to assess whether sociodemographic variables and patient-provider communication are associated with colorectal cancer screening. The results show patients between the ages of 65 and 75 and patients not in the labor force had higher odds of receiving colorectal cancer screening, while patients who were uninsured and patients who were best served in a language other than English had lower odds. Patient-provider communication was not associated with the receipt of colorectal cancer screening.

What are the implications for the Health Center Program? The high ratings of patient-provider communication, regardless of screening status, suggest progress toward patient-centered practice transformation. Addressing insurance coverage and making culturally and linguistically appropriate patient education materials available are critical for increasing future colorectal screening rates.

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.

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.