ADVANCING THE HEALTH OF UNDERSERVED COMMUNITIES ACROSS THE UNITED STATES: OPPORTUNITIES TO IMPROVE HEALTH CENTER QUALITY OF CARE AND PATIENT EXPERIENCE

Abstract

1 in 13 people in the United States receives care at a community health center. As health center services become an increasing percentage of all primary care services delivered in the United States, their success is vital to national efforts to advance health and manage costs. This dissertation presents three studies, addressing critical gaps in our understanding of health center quality and quality improvement opportunities.

The first study examined the association between ambulatory care accreditation and 14 clinical quality measures in 1,198 health centers. Results demonstrated that accredited centers achieved higher performance on adult weight screening and follow up, tobacco cessation intervention, and use of lipid-lowering therapy. Universal accreditation could lead to an additional 552,087 patients receiving weight screening and follow up, 157,434 receiving tobacco cessation interventions, and 25,289 receiving lipid-lowering therapy. Findings suggest universal accreditation could contribute to quality gains and facilitate health disparity reduction.

The second study used the first nationally representative dataset of health center PEC, to investigate the association between five measures of PEC (access to care, provider communication, office staff interactions, follow up on results and overall provider rating) and patient and health center characteristics. Results demonstrated that PEC ratings varied significantly by race/ethnicity, health and mental health status, education and income levels, and language. Findings highlight PEC improvement opportunities as well as the importance of patient-mix adjustment of PEC ratings in value-based payment.

The third study evaluated the association between PEC and health center quality of care. Quality of care metrics included receipt of care, health behaviors, patient activation, and clinical outcomes in health center patients. Results showed that PEC ratings were associated with receipt of care, as well as patient adherence and activation. The findings support the importance of measuring PEC as a key determinant of quality, as well improving PEC as a driver for improvement for other aspects of care quality.

All three studies were the first to our knowledge to use nationally representative health center data to examine these dimensions of quality and provide significant contributions towards our understanding of health center quality and related quality improvement and policy implications.