Navigation Links
Federally funded clinics for low-income patients as effective as private practices
Date:7/9/2012

San Diego, CA, July 10, 2012 The federal government has committed $11 billion to expand the operating capacity of Federally Qualified Health Centers (FQHC), which receive federal funding and enhanced Medicaid and Medicare reimbursement, and "look-alike" clinics that receive enhanced reimbursement but no federal grants. These clinics, which serve primarily the poor and uninsured, are expected to be part of the solution to anticipated primary care shortages, as up to 32 million currently uninsured people begin to seek health care as a result of the Patient Protection and Affordable Care Act. Despite concerns that these clinics may provide less effective care because they serve more medically and socially complex patients, a new study has found that they are as effective as private primary care practices, and better on some quality measures. The study is published in the August issue of the American Journal of Preventive Medicine.

"While overall adherence to guidelines varied, physicians working at FQHC and look-alike clinics demonstrated greater adherence to guidelines than primary care physicians at private practices on six of 18 quality measures and, except for diet counseling in at-risk adolescents, similar adherence on the remaining measures despite providing care to patients with limited or no insurance and a higher burden of comorbidities," says lead investigator L. Elizabeth Goldman, MD, MCR, from the Department of Medicine at the University of California, San Francisco.

Researchers used data from the 2006-2008 National Ambulatory Medical Care Survey (NAMCS) conducted by the National Center for Health Statistics, which collects information on ambulatory medical care provided by FQHC and look-alikes and nonfederal, office-based, direct care physicians. They evaluated quality of care using 18 previously established quality measures. The sample consisted of 31,133 visits, 22,691 to private primary care physicians and the remaining to FQHC and look-alikes.

The study evaluated four categories of quality measures: pharmacologic management of common chronic diseases, including atrial fibrillation, heart failure, coronary artery disease, asthma, and depression; preventive counseling regarding smoking cessation, diet and exercise for individuals at high risk of coronary artery disease; appropriate use of screening tests for blood pressure, electrocardiogram, and urinalysis; and appropriate prescribing in elderly patients.

Adherence to guidelines for seven of 18 measures was less than 50% for both FQHC and look-alikes and private practice physicians, with the lowest adherence for preventive counseling and the highest for statin use in coronary disease. FQHC and look-alikes performed higher on six measures, lower on one measure, and no differently than primary care physicians on eleven measures. FQHC and look-alikes demonstrated higher performance across the pharmacologic management of chronic disease and appropriate use of screening tests categories.

"Overall, adherence was greatest for many of the chronic disease measures, likely, in part, due to the strength of evidence supporting those measures," notes Dr. Goldman. "Lower adherence to the provision of exercise counseling to adults and adolescents at high risk of coronary artery disease may be related to the lack of evidence supporting the impact of such counseling on patient health outcomes."

Although the study did not specifically identify the mechanisms by which FQHC and look-alikes achieved higher performance, the authors suggest a number of factors may be at work. Patients at FQHC and look-alikes are more likely to be insured by Medicaid or uninsured, and traditionally have limited access to subspecialty care. Therefore, those with chronic diseases may be more likely to be managed in the clinic. Federal grants to develop stable, locally recruited workforces, and expand clinic capacity often require participation in quality improvement and performance measurement, and may also contribute to the study's findings.

"In the setting of healthcare reform, FQHC and look-alikes may need to accommodate many newly enrolled Medicaid recipients," Dr. Goldman says. "Further research is needed to monitor these and other measures to assess whether appropriated funds meet the needs of these centers so that they can continue to provide quality care, and how new reimbursement models will impact the comparative effectiveness of these clinics."


'/>"/>
Contact: Beverly Lytton
eAJPM@ucsd.edu
858-534-9340
Elsevier Health Sciences
Source:Eurekalert

Related medicine news :

1. Ivy Neurological Sciences Internship program funded at TGen
2. University of Louisville study dispels concerns about drive-thru flu clinics
3. Social ties have mixed impact on encouraging healthy behaviors in low-income areas
4. Low-Income Mothers May Overfeed Their Infants
5. Higher-spending hospitals have fewer deaths for emergency patients
6. Researchers uncover a viable way for colorectal cancer patients to overcome drug resistance
7. Vaccine yielded encouraging long-term survival rates in certain patients with NSCLC
8. Study finds doctors have exaggerated fears when starting patients on insulin
9. Diagnostic Scans Tied to Radiation Risk for Gastro Patients
10. Predictors identified for rehospitalization among post-acute stroke patients
11. Pulse pressure elevation could presage cerebrovascular disease in Alzheimers patients
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:5/26/2016)... ... May 26, 2016 , ... Catalent Pharma Solutions, ... biologics, consumer health and global clinical supply services, today announced two key appointments ... company’s continued investment and strategic growth plans in the Asia Pacific region. , ...
(Date:5/26/2016)... ... May 26, 2016 , ... Leadership of Life ... announced the organization has earned its ISO 13485 certification, indicating the company’s quality ... all rules and policies associated with ISO quality standard 13485. , BSI ...
(Date:5/26/2016)... York, NY (PRWEB) , ... May 26, 2016 ... ... researcher, founder of Mehling Orthopedics and chief medical officer of Blue Horizon International ... Disease and Regeneration. The conference was held during May 5-6, 2016 in Chicago, ...
(Date:5/26/2016)... ... May 26, 2016 , ... OncLive® , ... National Cancer Institute-designated University of Virginia (UVA) Cancer Center to its ... editorial and marketing teams will publicize and promote public awareness of UVA Cancer ...
(Date:5/26/2016)... ... May 26, 2016 , ... Metcalf & Associates’ ... 20 years of experience in leading technology and human resources operations for health ... teaching, Morrow-Fox will be featured on Metcalf’s VoiceAmerica radio show , Innovative ...
Breaking Medicine News(10 mins):
(Date:5/25/2016)... 25, 2016 Digital Health Dialog, LLC ... by the US Patent and Trademark Office of ... proprietary processes for electronic opt-­in and processing of ... programs, HIPAA compliance and otherwise. Logo - ... "Our technology allows for individuals to ...
(Date:5/24/2016)... 24, 2016 Niederländische Chirurgen ... die es Ärzten erlaubt, ihre Expertise weltweit zu ... kombiniert Live Streaming mit einer Instant-Messaging-Funktion und der ... Mediziner in Europa, Afrika, Asien und den ... die Plattform registriert. Information und Weiterbildung   ...
(Date:5/24/2016)... May 24, 2016  Diana Russell suffers from a ... from the inside out.  This disease has put her ... her children and grandchildren to leave her home.  Because ... family cannot haul the wheelchair.  So if there is ... and Diana is left to wait for the bus. ...
Breaking Medicine Technology: