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Clinical Quality Performance in U.S. Health Centers

Authors

  • Leiyu Shi,

    1. Department of Health Policy and Management Director, Bloomberg School of Public Health, Johns Hopkins University, Johns Hopkins Primary Care Policy Center, Baltimore, MD
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  • Lydie A. Lebrun,

    Corresponding author
    • U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality and Data, Rockville, MD
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  • Jinsheng Zhu,

    1. Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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  • Arthur S. Hayashi,

    1. U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Rockville, MD
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  • Ravi Sharma,

    1. U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality and Data, Rockville, MD
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  • Charles A. Daly,

    1. U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality and Data, Rockville, MD
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  • Alek Sripipatana,

    1. U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality and Data, Rockville, MD
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  • Quyen Ngo-Metzger

    1. U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality and Data, Rockville, MD
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Address correspondence to Lydie A. Lebrun, Ph.D., M.P.H., Public Health Analyst, U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality and Data, 5600 Fishers Lane, 6A-55, Rockville, MD 20857; e-mail: llebrun@hrsa.gov

Abstract

Objective

To describe current clinical quality among the nation's community health centers and to examine health center characteristics associated with performance excellence.

Data Sources

National data from the 2009 Uniform Data System.

Data Collection/Extraction Methods

Health centers reviewed patient records and reported aggregate data to the Uniform Data System.

Study Design

Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance.

Principal Findings

Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well.

Conclusions

Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients.

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