Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
JAMA Health Forum. 2024 Aug 2;5(8):e242547. doi: 10.1001/jamahealthforum.2024.2547.
Federally qualified health centers (FQHCs) provide care to 30 million patients in the US and have shown better outcomes and processes than other practice types. Little is known about how the COVID-19 pandemic contributed to FQHC capabilities compared with other practices.
To compare postpandemic operational characteristics and capabilities of FQHCs with non-FQHC safety net practices and non-FQHC, non-safety net practices.
DESIGN, SETTING, AND PARTICIPANTS: This nationally representative survey conducted from June 2022 to February 2023 with an oversampling of safety net practices in the US included practice leaders working in stratified random selection of practices based on FQHC status, Area Deprivation Index category, and ownership type per a health care network dataset.
Practice type: FQHC vs non-FQHC safety net and non-FQHC practices.
Primary care capabilities, including 2 measures of access and 11 composite measures.
A total of 1245 practices (221 FQHC and 1024 non-FQHC) responded of 3498 practices sampled. FQHCs were more likely to be independently owned and have received COVID-19 funding. FQHCs and non-FQHC safety net practices were more likely to be in rural areas. FQHCs significantly outperformed non-FQHCs on several capabilities even after controlling for practice size and ownership, including behavioral health provision (mean score, 0.53; 95% CI, 0.51-0.56), culturally informed services (mean score, 0.55; 95% CI, 0.53-0.58), screening for social needs (mean score, 0.43; 95% CI, 0.39-0.47), social needs referrals (mean score, 0.53; 95% CI, 0.48-0.57), social needs referral follow-up (mean score, 0.31; 95% CI, 0.27-0.36), and shared decision-making and motivational interviewing training (mean score, 0.53; 95% CI, 0.51-0.56). No differences were found in behavioral and substance use screening, care processes for patients with complex and high levels of need, use of patient-reported outcome measures, decision aid use, or after-hours access. Across all practices, most of the examined capabilities showed room for improvement.
The results of this survey study suggest that FQHCs outperformed non-FQHC practices on important care processes while serving a patient population with lower incomes who are medically underserved compared with patients in other practice types. Legislation to expand funding for the FQHC program should improve services for underserved populations and target current non-FQHC safety net practices to serve these populations. Increased support for these practices could improve primary care for rural populations.
联邦合格的健康中心 (FQHC) 为美国的 3000 万名患者提供服务，并且在结果和流程方面优于其他类型的医疗机构。对于与其他实践类型相比，COVID-19 大流行如何影响 FQHC 能力，我们知之甚少。
比较大流行后 FQHC 与非 FQHC 安全网实践和非 FQHC 非安全网实践的运营特点和能力。
设计、地点和参与者：这是一项全国代表性调查，于 2022 年 6 月至 2023 年 2 月期间在美国进行，对安全网实践进行了超额抽样，调查对象为根据医疗保健网络数据集按 FQHC 状态、区域贫困指数类别和所有权类型分层随机选择实践的实践领导者。
实践类型：FQHC 与非 FQHC 安全网和非 FQHC 实践。
初级保健能力，包括 2 项获得性措施和 11 项综合措施。
在抽样的 3498 家实践中，共有 1245 家实践（221 家 FQHC 和 1024 家非 FQHC）做出了回应。FQHC 更有可能是独立拥有的，并获得了 COVID-19 资金。FQHC 和非 FQHC 安全网实践更有可能位于农村地区。即使控制了实践规模和所有权，FQHC 在多项能力上的表现也明显优于非 FQHC，包括提供行为健康服务（平均得分 0.53；95%CI，0.51-0.56）、提供文化意识服务（平均得分 0.55；95%CI，0.53-0.58）、社会需求筛查（平均得分 0.43；95%CI，0.39-0.47）、社会需求转介（平均得分 0.53；95%CI，0.48-0.57）、社会需求转介后续（平均得分 0.31；95%CI，0.27-0.36）和共同决策和动机访谈培训（平均得分 0.53；95%CI，0.51-0.56）。在行为和药物使用筛查、为有复杂和高度需求的患者提供护理过程、使用患者报告的结果衡量标准、决策辅助工具的使用或夜间就诊方面，没有发现差异。在所有实践中，大多数检查过的能力都有改进的空间。
这项调查研究的结果表明，与其他类型的实践相比，FQHC 在重要的护理过程方面优于非 FQHC 实践，同时为收入较低、医疗服务不足的患者提供服务，而这些患者的医疗服务水平低于其他实践类型的患者。扩大 FQHC 计划资金的立法应该改善服务不足人群的服务，并针对当前的非 FQHC 安全网实践，以服务这些人群。增加对这些实践的支持可以改善农村人口的初级保健。
