Community health centers compare well with private practices, researcher finds

Randall Stafford

Government-funded community health centers, which serve low-income and uninsured patients, provide better care than do private practices, a researcher at the Stanford University School of Medicine has found.

Randall Stafford, MD, PhD, professor of medicine at the Stanford Prevention Research Center, and colleagues at University of California-San Francisco looked at the actions physicians took when patients visited private practices versus the actions that were taken at community health centers, also referred to as Federally Qualified Health Centers and FQHC Look-Alikes, both of which receive government support.

Their study was published online July 10 in the American Journal of Preventive Medicine. Stafford is the senior author.

The results of the study are particularly encouraging given that the Affordable Care Act, which the U.S. Supreme Court upheld June 28, depends on community health centers to provide services to previously uninsured patients.

“If community health centers are going to be taking up some of the new demand, we can be confident that they’re giving relatively good care,” Stafford said.

Stafford and his colleagues analyzed records of 73,074 visits to private practices, FQHCs and FQHC Look-Alikes. Both FQHCs and Look-Alikes receive enhanced Medicare and Medicaid reimbursement; FQHCs also receive government grants. The researchers acquired the records from the National Ambulatory Medical Care Survey, which the National Center for Health Statistics gathered between 2006 and 2008.

They evaluated the physicians’ adherence to professional and federal guidelines for 18 measures, which included treatments for specific diseases, screening for certain conditions, and diet and lifestyle counseling. “We looked at fairly common conditions that are seen in primary care,” said lead author L. Elizabeth Goldman, MD, of UCSF.

The researchers found that community health center physicians performed as well as their private practice colleagues in 13 of the 18 measures. For the remaining five measures — use of ACE inhibitors for congestive heart failure, use of beta blockers, use of inhaled corticosteroids for adult asthmatics, blood pressure screening and avoidance of electrocardiograms in low-risk patients — the community physicians followed recommendations a higher percent of the time.

Given that patients at community health centers have more health and socioeconomic challenges and therefore take up more physician time, said Stafford, “The fact that community health centers look better is perhaps surprising.”

“On the other hand, having worked in community health centers, I can see how it makes sense,” he added. “These are centers where physicians are not as profit-driven and many have incentives more in line with providing quality care.”

Stafford added that the government has provided the centers with technology that helps manage patient care, which may explain their superior performance. And they are generally larger than private practices: “Having a number of colleagues helps you develop better practices. In a solo practice, you have rare opportunities to debate the best way to practice medicine.”

When the researchers adjusted the data so that the patients’ characteristics were statistically equal, the community health center physicians performed better on three additional measures: aspirin for congestive heart failure, statins for congestive heart failure, and avoidance of benzodiazepine, which has serious long-term side effects, for depression. (The statistical adjustment did not alter the balance in the other previous measures, and if anything, the magnitude of the difference increased in favor of the community physicians.)

The study was funded by awards from the Agency for Healthcare Research and Quality and the National Heart, Lung and Blood Institute. In addition to Stafford and Goldman, other researchers from UCSF and Johns Hopkins Medical School contributed to the study.

Information about Stanford’s Department of Medicine, which also supported this work, is available at http://med.stanford.edu/medicine.


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