Lavelle Tara A, Rose Adam J, Timbie Justin W, Setodji Claude M, Wensky Suzanne G, Giuriceo Katherine D, Friedberg Mark W, Malsberger Rosalie, Kahn Katherine L
RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02116, USA.
Tufts University School of Medicine, Boston, MA, USA.
BMC Health Serv Res. 2018 Jan 25;18(1):41. doi: 10.1186/s12913-018-2847-x.
Previous studies have disagreed on whether patients who receive primary care from federally qualified health centers (FQHCs) have different utilization patterns than patients who receive care elsewhere. Our objective was to compare patterns of healthcare utilization between Medicare beneficiaries who received primary care from FQHCs and Medicare beneficiaries who received primary care from another source.
We compared characteristics and ambulatory, emergency department (ED), and inpatient utilization during 2013 between 130,637 Medicare beneficiaries who visited an FQHC for the majority of their primary care in 2013 (FQHC users) and a random sample of 1,000,000 Medicare fee-for-service (FFS) beneficiaries who did not visit an FQHC (FQHC non-users). We then created a propensity-matched sample of 130,569 FQHC users and 130,569 FQHC non-users to account for differences in observable patient characteristics between the two groups and repeated all comparisons.
Before matching, the two samples differed in terms of age (42% below age 65 for FQHC users vs. 16% among FQHC non-users, p < 0.001 for all comparisons), disability (52% vs. 24%), eligibility for Medicaid (56% vs. 21%), severe mental health disorders (17% vs. 10%), and substance abuse disorders (6% vs. 3%). FQHC users had fewer ambulatory visits to primary care or specialist providers (10.0 vs. 12.0 per year), more ED visits (1.2 vs. 0.8), and fewer hospitalizations (0.3 vs. 0.4). In the matched sample, FQHC users still had slightly lower utilization of ambulatory visits to primary care or specialist providers (10.0 vs. 11.2) and slightly higher utilization of ED visits (1.2 vs. 1.0), compared to FQHC users. Hospitalization rates between the two groups were similar (0.3 vs. 0.3).
In this population of Medicare FFS beneficiaries, FQHC users had slightly lower utilization of ambulatory visits and slightly higher utilization of ED visits, compared to FQHC non-users, after accounting for differences in case mix. This study suggests that FQHC care and non-FQHC care are associated with broadly similar levels of healthcare utilization among Medicare FFS beneficiaries.
先前的研究对于从联邦合格健康中心（FQHCs）接受初级保健的患者与在其他地方接受治疗的患者是否有不同的利用模式存在分歧。我们的目标是比较从FQHCs接受初级保健的医疗保险受益人与从其他来源接受初级保健的医疗保险受益人之间的医疗保健利用模式。
我们比较了2013年期间130,637名在2013年大部分初级保健就诊于FQHC的医疗保险受益人（FQHC使用者）与1,000,000名未就诊于FQHC的医疗保险按服务收费（FFS）受益人的随机样本（FQHC非使用者）的特征、门诊、急诊科（ED）和住院利用情况。然后，我们创建了一个倾向匹配样本，其中包括130,569名FQHC使用者和130,569名FQHC非使用者，以考虑两组之间可观察到的患者特征差异，并重复所有比较。
在匹配之前，两个样本在年龄方面存在差异（FQHC使用者中42%年龄低于65岁，而FQHC非使用者中为16%，所有比较的p< 0.001）、残疾（52%对24%）、医疗补助资格（56%对21%）、严重精神健康障碍（17%对10%）和药物滥用障碍（6%对3%）。FQHC使用者对初级保健或专科医生的门诊就诊次数较少（每年10.0次对12.0次），急诊科就诊次数较多（1.2次对0.8次），住院次数较少（0.3次对0.4次）。在匹配样本中，与FQHC非使用者相比，FQHC使用者对初级保健或专科医生的门诊利用仍然略低（10.0次对11.2次），急诊科就诊利用略高（1.2次对1.0次）。两组之间的住院率相似（0.3次对0.3次）。
在这一医疗保险FFS受益人群体中，在考虑病例组合差异后，与FQHC非使用者相比，FQHC使用者的门诊利用略低，急诊科就诊利用略高。这项研究表明，在医疗保险FFS受益人中，FQHC护理和非FQHC护理与大致相似的医疗保健利用水平相关。
