Department of Sociology & Anthropology, Montana State University, P.O. Box 172380, Bozeman, MT, 59717-2380, USA.
Jake Jabs College of Business and Entrepreneurship, Montana State University, P.O. Box 173040, Bozeman, MT, 59717-3040, USA.
Soc Sci Med. 2019 Apr;226:143-152. doi: 10.1016/j.socscimed.2019.02.043. Epub 2019 Mar 1.
Community health centers (CHCs) provide comprehensive medical services to medically under-served Americans, helping to reduce health disparities. This study aimed to identify the unique compositions and contexts of CHCs to better understand variation in access to early prenatal care and rates of low birth weights (LBW). Data include CHC-level data from the Uniform Data System, and regional-level data from the US Census American Community Survey and Behavioral Risk Factor Surveillance System. First, latent class analysis was conducted to identify unobserved subgroups of CHCs. Second, data envelopment analysis was performed to evaluate the operational efficiency of CHCs. Third, we used generalized linear models to examine the associations between the CHC subgroups, efficiency, and perinatal outcomes. Seven classes of CHCs were identified, including two rural classes, one suburban, one with large centers serving poor minorities in low poverty areas, and three urban classes. Many of these classes were characterized by the racial compositions of their patients. Findings indicate that CHCs serving white patients in rural areas have greater access to early prenatal care. Health centers with greater efficiency have lower rates of LBW, as do those who serve largely white patient populations in rural areas. CHCs serving poor racial minorities living in low-poverty areas had particularly low levels of access to early prenatal care and high rates of LBW. Findings highlight that significant diversity exists in the sociodemographic composition and regional context of US health centers, in ways that are associated with their operations, delivery of care, and health outcomes. Results from this study highlight that while the provision of early prenatal care and the efficiency with which a health center operates may improve the health of the women served by CHCs and their babies, the underlying social and economic conditions facing patients ultimately have a larger association with their health.
社区卫生中心（CHC）为医疗服务不足的美国人提供全面的医疗服务，有助于减少健康差距。本研究旨在确定 CHC 的独特组成和背景，以更好地了解获得早期产前护理的机会和低出生体重（LBW）率的差异。数据包括来自统一数据系统的 CHC 级数据，以及来自美国人口普查美国社区调查和行为风险因素监测系统的区域级数据。首先，进行潜在类别分析以确定 CHC 的未观察到的亚组。其次，进行数据包络分析以评估 CHC 的运营效率。第三，我们使用广义线性模型检查 CHC 亚组、效率和围产期结局之间的关联。确定了 7 类 CHC，包括 2 个农村类、1 个郊区类、1 个拥有大型中心为贫困少数民族服务的低贫困地区类，以及 3 个城市类。这些类别中的许多都以患者的种族构成为特征。研究结果表明，在农村地区为白人患者服务的 CHC 获得早期产前护理的机会更多。效率较高的卫生中心 LBW 率较低，在农村地区主要为白人患者服务的卫生中心也是如此。为生活在低贫困地区的贫困少数族裔提供服务的 CHC 获得早期产前护理的机会特别低，LBW 率特别高。研究结果表明，美国卫生中心在社会人口构成和区域背景方面存在显著差异，这与它们的运作、医疗服务的提供以及健康结果有关。本研究的结果表明，尽管提供早期产前护理和卫生中心的运营效率可能会改善 CHC 服务的妇女及其婴儿的健康状况，但患者面临的基本社会和经济条件最终与他们的健康状况有更大的关联。
