Dion Anna E, Roake James, Mayeda Kate, Elich Nicholas, Parro David, Nuckols Tom, Tseng Marilyn, Phelan Suzanne
Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407-0386, USA.
SLO Noor Foundation, San Luis Obispo, CA, USA.
J Community Health. 2025 Apr;50(2):259-269. doi: 10.1007/s10900-024-01417-7. Epub 2024 Oct 19.
Free clinics are a widespread, yet limited research has examined the health status of people served and the cost effectiveness of free clinics. The purpose of this study was to describe the sociodemographic characteristics and prevalence of chronic conditions in patients seen at a free clinic and estimate the clinic's cost-effectiveness. The study was a retrospective chart review of 350 randomly selected paper medical charts (2009-2020) and 1,676 electronic medical records (2020-2022) at the Noor free clinic in California supported by private donors, non-profits, and foundations. Cost-effectiveness was calculated from annual clinic operating costs, services provided, quality-adjusted life years (QALYs) saved, and projected savings from preventing emergency department visits. Of the 350 paper charts reviewed, 336 met inclusion criteria. Patients had an average age of 46.6 years, with most identifying as female (60%), Hispanic (69%), Spanish-speaking (62%), and employed (59%). About 64% had incomes below the federal poverty line. Chronic conditions included overweight/obesity (75%), chronic pain (46%), hypertension (28%), hyperlipidemia (24%), type 2 diabetes (24%), and mood disorders (23%). A quarter of patients had at least one chronic condition, and over half had multiple conditions. The clinic's services in 2022 resulted in an estimated 146 QALYs saved, $11.5 million in cost savings, and a return on investment of $13.18 per $1 invested. The free clinic provided medical care to low-income, Hispanic populations without insurance who historically have been disenfranchised from healthcare access. Cost-effectiveness analysis suggested that it provided significant health benefits and cost savings.
免费诊所分布广泛，但针对其服务对象的健康状况及成本效益的研究却很有限。本研究旨在描述一家免费诊所患者的社会人口学特征和慢性病患病率，并评估该诊所的成本效益。该研究是一项回顾性图表审查，涉及加利福尼亚州努尔免费诊所随机抽取的350份纸质病历（2009 - 2020年）和1676份电子病历（2020 - 2022年），该诊所由私人捐赠者、非营利组织和基金会提供支持。成本效益是根据诊所年度运营成本、提供的服务、挽救的质量调整生命年（QALY）以及预防急诊就诊预计节省的费用来计算的。在审查的350份纸质病历中，336份符合纳入标准。患者的平均年龄为46.6岁，大多数为女性（60%）、西班牙裔（69%）、说西班牙语（62%）且有工作（59%）。约64%的患者收入低于联邦贫困线。慢性病包括超重/肥胖（75%）、慢性疼痛（46%）、高血压（28%）、高脂血症（24%）、2型糖尿病（24%）和情绪障碍（23%）。四分之一的患者至少患有一种慢性病，超过一半的患者患有多种慢性病。该诊所2022年的服务估计挽救了146个QALY，节省了1150万美元的成本，投资回报率为每投入1美元获得13.18美元的回报。这家免费诊所为历史上被剥夺医疗保健权利的低收入、无保险的西班牙裔人群提供医疗服务。成本效益分析表明，它带来了显著的健康益处和成本节约。
