Association between community health center and rural health clinic presence and county-level hospitalization rates for ambulatory care sensitive conditions: an analysis across eight US states

Janice C Probst,Sarah B Laditka,James N Laditka

doi:10.1186/1472-6963-9-134

Abstract

BackgroundFederally qualified community health centers (CHCs) and rural health clinics (RHCs) are intended to provide access to care for vulnerable populations. While some research has explored the effects of CHCs on population health, little information exists regarding RHC effects. We sought to clarify the contribution that CHCs and RHCs may make to the accessibility of primary health care, as measured by county-level rates of hospitalization for ambulatory care sensitive (ACS) conditions.MethodsWe conducted an ecologic analysis of the relationship between facility presence and county-level hospitalization rates, using 2002 discharge data from eight states within the US (579 counties). Counties were categorized by facility availability: CHC(s) only, RHC(s) only, both (CHC and RHC), and neither. US Agency for Healthcare Research and Quality definitions were used to identify ACS diagnoses. Discharge rates were based on the individual's county of residence and were obtained by dividing ACS hospitalizations by the relevant county population. We calculated ACS rates separately for children, working age adults, and older individuals, and for uninsured children and working age adults. To ensure stable rates, we excluded counties having fewer than 1,000 residents in the child or working age adult categories, or 500 residents among those 65 and older. Multivariate Poisson analysis was used to calculate adjusted rate ratios.ResultsAmong working age adults, rate ratio (RR) comparing ACS hospitalization rates for CHC-only counties to those of counties with neither facility was 0.86 (95% Confidence Interval, CI, 0.78–0.95). Among older adults, the rate ratio for CHC-only counties compared to counties with neither facility was 0.84 (CI 0.81–0.87); for counties with both CHC and RHC present, the RR was 0.88 (CI 0.84–0.92). No CHC/RHC effects were found for children. No effects were found on estimated hospitalization rates among uninsured populations.ConclusionOur results suggest that CHCs and RHCs may play a useful role in providing access to primary health care. Their presence in a county may help to limit the county's rate of hospitalization for ACS diagnoses, particularly among older people.

Highlights

Qualified community health centers (CHCs) and rural health clinics (RHCs) are intended to provide access to care for vulnerable populations
ambulatory care sensitive (ACS) hospitalization rates in the working age and age 65 or above populations were significantly lower in counties with a CHC than in counties with neither facility; rates in counties with an RHC only, or both facilities, did not differ from those in counties with neither facility
The presence of a CHC or RHC in the county was associated with ACS hospitalization rates for children only for the comparison of counties with both a CHC and RHC with those having neither facility

Summary

Introduction

Qualified community health centers (CHCs) and rural health clinics (RHCs) are intended to provide access to care for vulnerable populations. We sought to clarify the contribution that CHCs and RHCs may make to the accessibility of primary health care, as measured by county-level rates of hospitalization for ambulatory care sensitive (ACS) conditions. Two principal types of federally designated safety net facilities serve these areas: federally qualified community health centers (CHCs) and rural health clinics (RHCs). CHCs and RHCs are located in counties with demonstrated high need for care among at risk populations, and those that have been designated as rural, respectively. Assessments of CHC and RHC effects on population health We sought to clarify the contribution that CHCs and RHCs may make to the accessibility of primary health care, as measured by rates of hospitalization for ambulatory care sensitive (ACS) conditions. ACS conditions are those for which, in the consensus of medical experts, primary care of acceptable quality can reduce the frequency of hospitalization. [10,11,12,13,14,15,16]

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