Chang Chiang-Hua, Lewis Valerie A, Meara Ellen, Lurie Jon D, Bynum Julie P W
*The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover †Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Med Care. 2016 Aug;54(8):804-9. doi: 10.1097/MLR.0000000000000564.
Federally Qualified Health Centers (FQHCs) provide primary care for millions of Americans, but little is known about Medicare beneficiaries who use FQHCs.
To compare patient characteristics and health care service use among Medicare beneficiaries stratified by FQHC use.
Cross-sectional analysis of 2011 Medicare fee-for-service beneficiaries aged 65 years and older.
Subjects included beneficiaries with at least 1 evaluation and management (E&M) visit in 2011, categorized as FQHC users (≥1 E&M visit to FQHCs) or nonusers living in the same primary care service areas as FQHC users. Users were subclassified as predominant if the majority of their E&M visits were to FQHCs.
Demographic characteristics, physician visits, and inpatient care use.
Most FQHC users (56.6%) were predominant users. Predominant and nonpredominant users, compared with nonusers, markedly differed by prevalence of multiple chronic conditions (18.2%, 31.7% vs. 22.7%) and annual mortality (2.8%, 3.8% vs. 4.0%; all P<0.05). In adjusted analyses (reference: nonusers), predominant users had fewer physician visits (RR=0.81; 95% CI, 0.81-0.81) and fewer hospitalizations (RR=0.84; 95% CI, 0.84-0.85), whereas nonpredominant users had higher use of both types of service (RR=1.18, 95% CI, 1.18-1.18; RR=1.09, 95% CI, 1.08-1.10, respectively).
Even controlling for primary care delivery markets, nonpredominant FQHC users had a higher burden of chronic illness and service use than predominant FQHC users. It will be important to monitor Medicare beneficiaries using FQHCs to understand whether primary care only payment incentives for FQHCs could induce fragmented care.
联邦合格健康中心（FQHCs）为数百万美国人提供初级医疗服务，但对于使用FQHCs的医疗保险受益人了解甚少。
比较按FQHC使用情况分层的医疗保险受益人的患者特征和医疗服务使用情况。
对2011年65岁及以上的医疗保险按服务收费受益人进行横断面分析。
研究对象包括在2011年至少有1次评估与管理（E&M）就诊的受益人，分为FQHC使用者（≥1次到FQHCs的E&M就诊）或与FQHC使用者居住在相同初级医疗服务区域的非使用者。如果使用者的大多数E&M就诊是在FQHCs，则被归类为主要使用者。
人口统计学特征、看医生次数和住院治疗使用情况。
大多数FQHC使用者（56.6%）是主要使用者。与非使用者相比，主要使用者和非主要使用者在多种慢性病患病率（18.2%、31.7%对22.7%）和年度死亡率（2.8%、3.8%对4.0%；所有P<0.05）方面存在显著差异。在调整分析中（参照：非使用者），主要使用者看医生次数较少（RR=0.81；95%CI，0.81 - 0.81），住院次数也较少（RR=0.84；95%CI，0.84 - 0.85），而非主要使用者两种服务的使用频率更高（分别为RR=1.18，95%CI，1.18 - 1.18；RR=1.09，95%CI，1.08 - 1.10）。
即使控制了初级医疗服务市场，非主要FQHC使用者比主要FQHC使用者有更高的慢性病负担和服务使用量。监测使用FQHCs的医疗保险受益人，以了解仅针对FQHCs的初级医疗付费激励措施是否会导致医疗服务碎片化，这将很重要。
