Federally Qualified Health Centers Patients Research Articles

Human technology intermediation to reduce cognitive load: understanding healthcare staff members' practices to facilitate telehealth access in a Federally Qualified Health Center patient population.

The aim of this study was to investigate how healthcare staff intermediaries support Federally Qualified Health Center (FQHC) patients' access to telehealth, how their approaches reflect cognitive load theory (CLT) and determine which approaches FQHC patients find helpful and whether their perceptions suggest cognitive load (CL) reduction. Semistructured interviews with staff (n = 9) and patients (n = 22) at an FQHC in a Midwestern state. First-cycle coding of interview transcripts was performed inductively to identify helping processes and participants' evaluations of them. Next, these inductive codes were mapped onto deductive codes from CLT. Staff intermediaries used 4 approaches to support access to, and usage of, video visits and patient portals for FQHC patients: (1) shielding patients from cognitive overload; (2) drawing from long-term memory; (3) supporting the development of schemas; and (4) reducing the extraneous load of negative emotions. These approaches could contribute to CL reduction and each was viewed as helpful to at least some patients. For patients, there were beneficial impacts on learning, emotions, and perceptions about the self and technology. Intermediation also resulted in successful visits despite challenges. Staff intermediaries made telehealth work for FQHC patients, and emotional support was crucial. Without prior training, staff discovered approaches that aligned with CLT and helped patients access technologies. Future healthcare intermediary interventions may benefit from the application of CLT in their design. Staff providing brief explanations about technical problems and solutions might help patients learn about technologies informally over time. CLT can help with developing intermediary approaches for facilitating telehealth access.

Associations of Primary Care Provider Burnout with Quality Improvement, Patient Experience Measurement, Clinic Culture, and Job Satisfaction.

Burnout among providers negatively impacts patient care experiences and safety. Providers at Federally Qualified Health Centers (FQHC) are at high risk for burnout due to high patient volumes; inadequate staffing; and balancing the demands of patients, families, and team members. Examine associations of provider burnout with their perspectives on quality improvement (QI), patient experience measurement, clinic culture, and job satisfaction. We conducted a cross-sectional provider survey about their perspectives including the single-item burnout measure. We fit separate regression models, controlling for provider type, gender, being multilingual, and fixed effects for clinic predicting outcome measures from burnout. Seventy-four providers from 44 clinics in large, urban FQHC (52% response rate; n = 174). Survey included a single-item, self-defined burnout measure adapted from the Physician Worklife Survey, and measures from the RAND AMA Study survey, Heath Tracking Physician survey, TransforMed Clinician and Staff Questionnaire, Physician Worklife Survey, Minimizing Errors Maximizing Outcomes survey, and surveys by Friedberg et al.31 and Walling et al.32 RESULTS: Thirty percent of providers reported burnout. Providers in clinics with more facilitative leadership reported not being burned out (compared to those reporting burnout; p-values < 0.05). More pressures related to patient care and lower job satisfaction were associated with burnout (p-values < 0.05). Creating provider-team relationships and environments where providers have the time and space necessary to discuss changes to improve care, ideas are shared, leadership supports QI, and QI is monitored and discussed were related to not being burned out. Reducing time pressures and improving support needed for providers to address the high-need levels of FQHC patients can also decrease burnout. Such leadership and support to improving care may be a separate protective factor against burnout. Research is needed to further examine which aspects of leadership drive down burnout and increase provider involvement in change efforts and improving care.

Determinants of Bluetooth-Enabled Self-Measured Blood Pressure Monitoring in Federally Qualified Health Centers.

In 2021, the Health Resources and Services Administration (HRSA) launched the National Hypertension Control Initiative (HTN Initiative) with the goal to enhance HTN control through Bluetooth-enabled self-measured blood pressure (BT-SMBP) monitoring and use this data to inform clinical decisions in Federally Qualified Health Centers (FQHCs) with a large proportion of their population with uncontrolled blood pressure (BP). We sought to understand the experience of Michigan-based FQHCs in implementing the HTN initiative. Staff from three Michigan-based FQHCs were invited to participate in semi-structured interviews from September to November 2022. Interviews were conducted in-person and were based on the Tailored Implementation in Chronic Diseases framework. Content analysis was performed by three coders. Ten staff participated in interviews (FQHC 1: n = 6, FQHC 2: n = 1, FQHC 3: n = 3). The FQHCs differed in their stage of implementation and their approach. FQHC 1 created a large-scale, community health worker driven program, FQHC 2 created a small-scale, short term, BP device loan program, and FQHC 3 created a primarily outsourced, large-scale program through a contracted partner. Positive staff attitudes and outcome expectations, previous experience with SMBP grants, supportive clinic leadership, social support, and free BP cuff resources were identified as facilitators to implementation. Patients' high social needs, SMBP-related Technology, and insufficient workforce and staff capacity were identified as barriers. BT-SMBP among FQHC patients is promising but challenges in integrating SMBP data into clinic workflow, workforce capacity to support the high social needs of participants, and to assist in reacting to the more frequent BP data remain to be overcome.

Abstract PR020: Predictors of cancer screening in federally qualified health centers in the United States: A cross sectional study

Abstract Background: Patients from medically underserved populations are less likely to have access to cancer screening. Federally Qualified Health Centers (FQHCs) provide primary care services for medically under-served communities on a sliding-fee scale and are well-positioned to increase equity in cancer screening access. However, there is limited data about predictors and patterns of cancer screening among FQHC patients. The purpose of our study was to evaluate predictors and patterns of breast, colorectal, and cervical cancer screening in FQHCs across the United States. Methods: Data on the FQHCs was obtained from publicly available data sets from the Health Resources and Services Administration and included locations across the United States. Primary outcomes included breast, colorectal, and cervical cancer screening percentages. Primary exposures included the number of patients; percentages of patients by race/ethnicity, primary language, poverty threshold, and insurance status. Descriptive statistics (median and IQR) were obtained for all continuous variables. Spearman’s correlation coefficients were estimated to evaluate the association between cancer screening percentages and primary exposures. Results: We analyzed data from 1,375 FQHCs. The median population size served was 12,404 (IQR 6,084-24,757) patients, with 12% (IQR 2-38) Black/African American, 18% (IQR 5-48) Hispanic/Latino, 1% (IQR 1-3) Asian, and 1% (IQR 0-2) American Indian/Alaska Native patients. The median percentage of patients below the 100% poverty line was 66% (IQR 52-78), the percentage of uninsured patients was 19% (IQR 11-31), and the percentage of patients with Medicaid was 42% (IQR 28-57). 13% of patients preferred receiving care in a language other than English (IQR 3-32). Median percentage of mammography screening was 44% (IQR 31-56).  Percentage of uninsured patients was negatively correlated with mammography screening percentages (r = -0.23, p &amp;lt; 0.001). Median percentage of colorectal cancer screening was 39% (IQR 27-51). Percentage of uninsured patients (r = -0.29, p &amp;lt; 0.001) and percentage of patients below 100% of the poverty line (r = -0.24, p &amp;lt; 0.001) were negatively correlated with colorectal cancer screening percentages. Median percentage of cervical cancer screening 48% (IQR 37-59). Percentage of Hispanic patients (r = +0.22, p &amp;lt; 0.001) and percentage of patients for whom English is not their first language (r = +0.29, p &amp;lt; 0.001) were positively correlated with cervical cancer screening percentages. Conclusions: Compared with national averages, patients who are served by FQHCs are less likely to receive recommended breast, colorectal, and cervical cancer screening tests, likely driven by social determinants of health. FQHCs represent trusted healthcare providers who serve high proportions of uninsured, Medicaid, low-income, diverse patients. Health care researchers and practitioners interested in reducing cancer disparities should consider working with FQHCs to conduct targeted outreach initiatives. Citation Format: Ashley M. Stuckwisch, Anand K. Narayan. Predictors of cancer screening in federally qualified health centers in the United States: A cross sectional study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR020.

National and State-Level Trends in Mental Health and Substance Use Disorder Services at Federally Qualified Health Centers, 2012-2019.

A disproportionate share of Federally Qualified Health Center (FQHC) users have a behavioral health condition, but there exists limited research examining changes in behavioral health provision in FQHCs. The objectives of this study were to describe how the provision of behavioral health services by FQHCs to the population of people with behavioral health conditions has changed over time in the US, how these trends varied across states, and whether the proportion of total delivered services that are behavioral health services has changed within FQHCs over time. Descriptive analysis using the Uniform Data System and Global Burden of Disease Datasets from years 2012 to 2019. From 2012 to 2019, FQHC behavioral health visits per 1,000 population with any behavioral health condition grew 103%, with a 26-fold difference in average rates across states during the study period. Annual behavioral health visits per patient increased from 3.2 to 2012 to 3.4 in 2019. From 2012 to 2019, the number of behavioral health visits per 1,000 FQHC patients grew by 51%, whereas the rate of asthma visits declined by 14%, heart disease visits declined by 4%, and hypertension and diabetes related visits remained stable (changing < 1% for both). Behavioral health visit growth at FQHCs outpaced national prevalence of behavioral health conditions. This growth was driven by FQHCs serving an increasing number of patients with behavioral health conditions, without sacrificing the frequency of visits for individual patients with behavioral health conditions.

Virtual Music Therapy for Substance Use Disorders in a Federally Qualified Health Center.

Music therapy (MT) is an effective adjunctive treatment for substance use disorders (SUD), which is primarily available in inpatient treatment centers and rarely provided in outpatient primary care. We evaluated the feasibility and acceptability of a virtual group MT program for SUD in a Federally Qualified Health Center (FQHC), and secondarily assessed patient perceptions of its effect. Feasibility was measured by implementation-related process measures, attendance and use of technology. Qualitative interviews eliciting participant perceptions were conducted to evaluate acceptability and effect. Mood scores, substance use and craving were measured before and after the intervention. Onboarding of the music therapist took 3.5 months. All MT sessions were attended by 1 to 5 individuals out of 6. Participants reported that group MT was "soothing" and "calming," gave them tools to treat cravings and stress, and created a sense of community. They reported that during sessions their cravings decreased. Anxiety and depression scores trended down, as did the number of days of substance use. They all stated they would seek out MT again. Our results suggest that remote group MT is feasible and acceptable to our FQHC patients with SUD. Patients reported an improvement in mood and their ability to manage stress, and a decrease in substance use. We wish to build on the results of this study to enhance our understanding of the effects of MT in the outpatient setting, and broaden our patients' access to MT in primary care.

Cancer screening and socioeconomic insecurity in FQHCs: The COVID-19 pandemic and state Medicaid expansion.

112 Background: Previous studies reported improvements in multiple care quality measures, including cancer screening, in patients served in federally qualified health centers (FQHCs) located in Medicaid expansion states compared to non-expansion states. However, the COVID-19 pandemic disrupted delivery of routine primary care. Little is known about whether the COVID-19 pandemic disrupted or worsened cancer screening and socioeconomic insecurity in FQHC patients. Methods: Data on breast, cervical and colorectal cancer screening, and socioeconomic insecurity (food insecurity, financial strain, and lack of transportation to care) were obtained from the 2020 and 2021 Uniform Data System (UDS), a national report of care delivered by FQHCs. To balance clinic characteristics, the inverse probability of treatment weighting method was employed. Using a propensity score, the probability of being in a state that expanded Medicaid as of January 1, 2020, was measured. Clinics were then weighted conditional on the proportion best served in a language other than English and privately insured as well as rural location and which funding streams were received from section 330 of the Public Health Service Act. A weighted generalized estimating equation adjusted for random clustering of FQHCs within state with a Poisson distribution produced the prevalence ratios. Results: Between 2020-2021, approximately 2700 and 1300 clinics reported on cancer screening and socioeconomic insecurity. In 2020 and 2021, FQHCs in Medicaid expansion states had a higher patient screening prevalence for colorectal (2020: aPR: 1.16, 95% CI: 1.1-1.23; 2021: 1.13, 1.07-1.19) and breast (2020: 1.1, 1.05-1.17; 2021: 1.09, 1.03-1.14) cancer compared to clinics in non-Medicaid expansion states. Additionally, patient food (2021: 0.59, 0.36-0.97) and financial (2020: 0.57, 0.38-0.86; 2021: 0.58, 0.41-0.82) insecurity prevalence was lower in clinics in Medicaid expansion v. non-expansion states. Conclusions: State Medicaid expansion status was associated with higher cancer screening and lower socioeconomic insecurity within FQHCs during the COVID-19 pandemic. It remains an important policy intervention for vulnerable populations to receive care and mitigate disparities.[Table: see text]

Screening for Prediabetes and Diabetes in a National Network of Federally Qualified Health Centers: An Observational Study.

In 2021, the U.S. Preventive Services Task Force (USPSTF) recommended screening for prediabetes and diabetes among adults aged 35-70years with overweight or obesity. Studying dysglycemia screening in federally qualified health centers (FQHCs) that serve vulnerable patient populations is needed to understand health equity implications of this recommendation. To investigate screening practices among FQHC patients who would be eligible according to the 2021 USPSTF recommendation. Retrospective cohort study analyzing electronic health records from a national network of 282 FQHC sites. We included 183,329 patients without prior evidence of prediabetes or diabetes, who had ≥ 1 office visit from 2018-2020. Screening eligibility was based on age and measured body mass index (BMI). The primary outcome, screening completion, was ascertained using hemoglobin A1c or fasting plasma glucose results from 2018-2020. Among 89,543 patients who would be eligible according to the 2021 USPSTF recommendation, 53,263 (59.5%) were screened. Those who completed screening had higher BMI values than patients who did not (33.0 ± 6.7kg/m2 vs. 31.9 ± 6.2kg/m2, p < 0.001). Adults aged 50-64years had greater odds of screening completion relative to younger patients (OR 1.13, 95% CI: 1.10-1.17). Patients from racial and ethnic minority groups, as well as those without health insurance, were more likely to complete screening than White patients and insured patients, respectively. Clinical risk factors for diabetes were also associated with dysglycemia screening. Among patients who completed screening, 23,588 (44.3%) had values consistent with prediabetes or diabetes. Over half of FQHC patients who would be eligible according to the 2021 USPSTF recommendation were screened. Screening completion was higher among middle-aged patients, those with greater BMI values, as well as vulnerable groups with a high risk of developing diabetes. Future research should examine adoption of the 2021 USPSTF screening recommendation and its impact on health equity.

The Relationship Between Obesity and Depression Among Federally Qualified Health Center Patients

The Relationship Between Obesity and Depression Among Federally Qualified Health Center Patients

COVID-19 vaccination likelihood among federally qualified health center patients: Lessons learned for future health crises

BackgroundTo prepare for rollout of a COVID-19 vaccine in fall 2020, there was an urgent need to understand barriers to ensuring equitable access and addressing vaccine skepticism and resistance. This study aimed to understand the association between trusted sources of COVID-19 information and likelihood of vaccination during that time, focusing on lessons learned to prepare for future public health crises. MethodsFrom December 2020-March 2021, we surveyed a probability-based, cross-sectional sample of 955 patients across seven federally qualified health centers (FQHCs) serving predominantly low-income, Black and White populations in southeastern Louisiana. Vaccination likelihood was measured on a 7-point scale; “very likely to vaccinate” was defined as score=7. Trust in healthcare provider was measured with a single survey item. High trust in personal contacts, government, and media, respectively, were defined as the highest tertiles of summative scores of trust items. Weighted multivariable logistic regression estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for being very likely to vaccinate. ResultsParticipants were 56% Black, 64% women, mean age 44.6 years; 33% were very likely to vaccinate. High trust in healthcare provider (aOR=4.14, 95% CI 2.26–7.57) and government sources (aOR=3.23, 95% CI 1.98–5.28) were associated with being very likely to vaccinate. ConclusionsDuring initial COVID-19 vaccination rollout, trust in healthcare providers and government sources of COVID-19 information was associated with likelihood to vaccinate in FQHC patients. To inform public health planning for future crises, we highlight lessons learned for translating community-relevant insights into direct action to reach those most impacted.

Uptake of colorectal cancer screening after mailed fecal immunochemical test (FIT) outreach in a newly eligible 45–49-year-old community health center population

PurposeWe assessed fecal immunochemical test (FIT) uptake following a mailed FIT intervention among 45–49-year-olds newly eligible for colorectal cancer (CRC) screening based on 2021 United States Preventive Services Task Force screening recommendations. We also tested the effect of an enhanced versus plain mailing envelope on FIT uptake.MethodsIn February 2022 we mailed FITs to eligible 45–49-year-olds at one Federally Qualified Health Center (FQHC) clinic. We determined the proportion who completed FITs within 60 days. We also conducted a nested randomized trial comparing uptake using an enhanced envelope (padded with tracking label and colored messaging sticker) versus plain envelope. Finally, we determined the change in CRC screening by any modality (e.g., FIT, colonoscopy) among all clinic patients in this age group (i.e., clinic-level screening) between baseline and 6 months post-intervention.ResultsWe mailed FITs to 316 patients. Sample characteristics: 57% female, 58% non-Hispanic Black, and 50% commercially insured. Overall, 54/316 (17.1%) returned a FIT within 60 days, including 34/158 (21.5%) patients in the enhanced envelope arm versus 20/158 (12.7%) in the plain envelope arm (difference 8.9 percentage points, 95% CI: 0.6–17.2). Clinic-level screening among all 45–49-year-olds increased 16.6 percentage points (95% CI: 10.9–22.3), from 26.7% at baseline to 43.3% at 6 months.ConclusionCRC screening appeared to increase following a mailed FIT intervention among diverse FQHC patients aged 45–49. Larger studies are needed to assess acceptability and completion of CRC screening in this younger population. Visually appealing mailers may improve uptake when implementing mailed interventions.Trial registration The trial was registered on May 28, 2020 at ClinicalTrials.gov (identifier NCT04406714).

Relationship Between Sexual Orientation, Gender Identity, and Mental Health and Substance Use Disorder Disparities Among Federally Qualified Health Center Adult Patients: A Cross-Sectional Study

Sexual and gender minorities (SGMs) are at increased risk of adverse physical and mental health outcomes. Federally qualified health centers (FQHCs) provide healthcare to underserved and vulnerable populations to address socioeconomic health disparities. This study aims to explore whether SGM adult patients at a large, multisite FQHC in Connecticut, USA, are more likely than heterosexual, cisgender (cis) patients to have indications or diagnoses of depression, suicidal thoughts, and/or substance use disorders (SUDs) in their medical charts. We used retrospective data from the electronic health records of FQHC patients with a medical visit between April 2016 and June 2019 who had sexual orientation and gender identity documented in their chart. In addition to demographic variables, the extracted data included patients’ most recent Patient Health Questionnaire-9 and diagnostic codes for depression, suicidal thoughts, and SUDs. We conducted hierarchical logistic regressions and generalized linear and latent mixed models to answer our research questions. In comparison to heterosexual and cis patients, SGM patients had significantly higher odds of reporting severe depression, any depression, and/or suicidal thoughts. Compared to heterosexual women, sexual minority women were more likely to have an SUD in their medical chart. Bisexual men had higher odds of cannabis use disorder compared to heterosexual men. Compared to cis women, transgender women had higher odds of alcohol and opioid use disorders and having one or more SUDs. This study provides evidence of mental health and substance use disparities experienced by SGM patients at FQHCs.

Reach and effectiveness of a centralized navigation program for patients with positive fecal immunochemical tests requiring follow-up colonoscopy

Completion rates for follow-up colonoscopies after an abnormal fecal immunochemical test (FIT) are suboptimal in federally qualified health center (FQHC) settings. We implemented a screening intervention that included mailed FIT outreach to North Carolina FQHC patients from June 2020 to September 2021 and centralized patient navigation to support patients with abnormal FITs in completing follow-up colonoscopy. We evaluated the reach and effectiveness of navigation using electronic medical record data and navigator call logs detailing interactions with patients. Reach assessments included the proportion of patients successfully contacted by phone and who agreed to participate in navigation, intensity of navigation provided (including types of barriers to colonoscopy identified and total navigation time), and differences in these measures by socio-demographic characteristics. Effectiveness outcomes included colonoscopy completion, timeliness of follow-up colonoscopy (i.e., within 9 months), and bowel prep adequacy. Among 514 patients who completed a mailed FIT, 38 patients had an abnormal result and were eligible for navigation. Of these, 26 (68%) accepted navigation, 7 (18%) declined, and 5 (13%) could not be contacted. Among navigated patients, 81% had informational needs, 38% had emotional barriers, 35% had financial barriers, 12% had transportation barriers, and 42% had multiple barriers to colonoscopy. Median navigation time was 48.5 min (range: 24–277 min). Colonoscopy completion differed across groups – 92% of those accepting navigation completed colonoscopy within 9 months, versus 43% for those declining navigation. We found that centralized navigation was widely accepted in FQHC patients with abnormal FIT, and was an effective strategy, resulting in high colonoscopy completion rates.

Modeling the impact of digital readiness in recruiting and sustaining underrepresented groups: Data from the All of Us research program.

The All of Us Research Program (All of Us or Program) is an ongoing longitudinal data collection operated by the National Institutes of Health (NIH). The Program aims to improve healthcare for all through the development of a biomedical research resource reflective of the diversity of the United States that includes Underrepresented in Biomedical Research (UBR) groups. Federally Qualified Health Centers (FQHCs) are a key recruitment stream of UBR participants, which are community based and provide primary care and preventive services in medically underserved areas. Over 90% of FQHC patients enrolled in All of Us to date are UBR. The COVID-19 pandemic caused a pause in All of Us activities. Re-starting the activities was a challenge, especially due to the digital divide faced by FQHC participants, and that most Program activities are primarily completed via web-based portal from a computer or a mobile device. This paper investigates the extent to which digital readiness impacted recruitment and sustainment of a pre-pandemic sample of 2,791 FQHC participants to the Program. Digital readiness was defined by access to home-based or other internet-accessing devices, and participants' comfort level using such devices. Results from multivariable logistic regression models showed that lower age, more education, female gender identity, and higher income were associated with higher digital readiness (p ≤ 0.01). Race, rurality, and sexual orientation status were not significant factors associated with digital readiness. Older participants had higher odds of completing Program activities, even though less digitally ready than their younger peers, as they often completed the activities during their in-person clinical visits. A subsequent weighted model demonstrated that FQHC participants who were digitally ready had 27% higher odds of completing Program activities than those not digitally ready. The data highlight the need for improved connectivity and sustainment between longitudinal data collection, research programs, and UBR participants, particularly among those facing the digital divide. Quantifying digital challenges provide operational insights for longitudinal data collection (All of Us, or others), and broadly, other aspects of digital medicine such as telehealth or patient portals by recognizing digital readiness of participants and patients, and the level of support required for success.

Recent Telehealth Utilization at a Large Federally Qualified Health Center System: Evidence of Disparities Even Within Telehealth Modalities.

Objective: To explore overall trends as well as racial/ethnic disparities in utilization of different telehealth modalities (telephone vs. televideo) at federally qualified health centers (FQHCs) during the COVID-19 pandemic. Methods: Using electronic health record data from a large New York-based FQHC system, we aggregated (separately) Behavioral Health and Family Practice visits per month occurring in-person, by telephone, or by televideo and graphed monthly trends in visits across the pre-pandemic, peak-pandemic, and post-peak-pandemic periods. We calculated fractions of visits conducted by modality for each patient demographic (race/ethnicity, primary language, age, gender, insurance type, and geography) and conducted bivariate assessments to test relationships between patient characteristics and modality. Results: Our data contained 121,072 unique patients and 811,105 visits overall. Telehealth use peaked in April 2020 but continued to account for a significant fraction of FQHC visits-nearly 25% (N = 4,908) of monthly Family Practice visits and a massive 98% (N = 14,173) of Behavioral Health visits as late as June 2021. Of all telehealth visits, nearly half were by telephone. Moreover, demographic factors differed between FQHC patients using telephone visits versus those using televideo: Black, non-English speaking, older, and Medicaid patients had significantly higher utilization of telephone visits than televideo visits (e.g., 25.9% of all Black patients' visits were via telephone vs. 17.1% via televideo; p < 0.001). In contrast, younger, Asian, and privately insured patients had significantly higher televideo visits. Conclusions: Our results suggest that telephone visits remain critical to the provision of health care for FQHC patients. They also suggest that disparities extend beyond the telehealth versus in-person dichotomy and inequities exist even within the type of telehealth used. This has implications for patient health, FQHC quality outcomes, as well as optimal Medicaid telehealth reimbursement policy.

Improving Access to Home Blood Pressure Monitors at a Federally Qualified Health Center.

Background: Self-monitoring of blood pressure (BP) clinically decreases BP. However, cost can limit access, especially in underserved populations. Objective: This mixed-methods pilot study aims to determine the impact of providing home BP monitors free of charge to patients at a federally qualified health center (FQHC) by quantifying the effect on BP and surveying patients to measure satisfaction and engagement. Methods: One hundred eighty patients with clinically diagnosed hypertension received BP monitors. Patient charts were reviewed to collect demographics and office BP readings 3 months before and after receiving a monitor. A 13-question phone survey was conducted to a sample of patients addressing satisfaction and engagement. Answers were based on a Likert scale and dichotomous yes/no. Results were analyzed with descriptive statistics and paired t tests. Results: The chart review demonstrated a significant mean decrease in systolic BP by 5.44 mm Hg (P < 0.001, -8.03 to -2.84) and a mean decrease in diastolic BP by 2.70 mm Hg (P < 0.001, -4.08 to -1.32) after the intervention. For those included who responded to the survey (13%), there was a significant mean increase in the frequency of checking BP per week by 1.5 Likert points (P < 0.00001, -1.0 to -1.9), and a majority (57.8%) felt slightly or much more active in their health care in addition to other benefits. Conclusion: Providing BP monitors to FQHC patients free of charge may have contributed to a significantly decreased office BP, improved engagement, and satisfaction. This program removed cost barriers and allowed patients to be more active in their health care.

Reducing Disparities in Postpartum Care Utilization: Development of a Clinical Risk Assessment Tool.

Patients receiving care at Federally Qualified Health Centers (FQHCs) have low postpartum care attendance. Perinatal morbidity and mortality disproportionately affect patients with low-income and are potentially preventable. The purpose of this study was to develop a clinical decision support tool to identify FQHC patients less likely to return for postpartum care. To accomplish this purpose, we evaluated established predictors and novel risk factors in our patient population. This is a retrospective, secondary data analysis of 50,022 patients who received prenatal care past 24 weeks' gestation in FQHCs between 2012 and 2017. The postpartum visit was defined using Healthcare Effectiveness Data and Information Set measures as early care (birth to 21 days) and later care (21-84 days). Anderson's Behavioral Model for Access to Healthcare guided inclusion of potentially predictive factors. We stratified data by postpartum care attendance, and a final predictive model was selected by model fit statistics and clinical relevance. In our sample, 64% of birthing persons attended postpartum care at FQHCs. Of those who returned for care, 38% returned within 21 days postbirth and 62% returned between 21 and 84 days, with 28% returning for both early and later care. Predictors for postpartum care attendance included maternal age, parity, gestational age at first visit, and number of prenatal care visits. A clinical decision support tool for identifying patients less likely to return for care was created. An easy to implement clinical decision support tool can help identify FQHC patients at risk for postpartum nonattendance. Future interventions to improve adequacy of prenatal care can encourage early entry into prenatal care and sufficient prenatal visits. These efforts may improve postpartum care attendance and maternal health.

Impact on Heath Services Utilization, Payment, and Quality in Federally Qualified Health Centers of Washington State's Value-Based Payment Model.

Impact on Heath Services Utilization, Payment, and Quality in Federally Qualified Health Centers of Washington State's Value-Based Payment Model Douglas A. Conrad, PhD (bio), Bailey Ingraham, MS, PhC (bio), Paul Fishman, PhD (bio), Lingmei Zhou, MS (bio), David Grembowski, PhD (bio), Norma B. Coe, PhD (bio), Aniyar Izguttinov, MPH (bio), Suzanne J. Wood, PhD (bio), Jordan Banks, PhD Candidate (bio), and Lydia Andris, MPA (bio) Federally qualified health centers (FQHCs) were created in 1965 to provide comprehensive primary, behavioral health, and dental care as well as enabling services that include transportation, translation, and case management services to all Americans regardless of their insurance status or ability to pay.1 As of 2021, more than 1,400 health centers with over 12,000 care sites provided health services to nearly 30 million individuals (8% of the United States population).2 Federally qualified health centers must either be in medically underserved areas (MUA) or serve medically underserved populations (MUPs), as a result, FQHCs are a critical source of care for the most vulnerable Americans. For example, approximately half of all FQHC patients are insured through Medicaid, one third of whom live in poverty, 1.4 million are homeless, and 885,000 are children served at school-based clinics.2 Federally qualified health centers are funded through two federal programs: the Health Center Program and the Community Health Center Fund2 which was established through the Affordable Care Act (ACA). Together these programs provided [End Page 1905] $5.78 billion in funding to FQHCs in fiscal year 2021—more than twice the amount allocated 10 years earlier. In 29 states, FQHCs receive state-specific support to supplement federal resources. Increased federal and state support for FQHCs was motivated in large part by the increased demand for their services from individuals newly insured through the ACA.2 The growth in demand for FQHC services and increased ACA-driven funding has focused attention on these centers as models for providing value-driven care designed to achieve the triple aims of patient-centered, high-quality, and cost-efficient care. To support this effort, the Centers for Medicare and Medicaid Services (CMS) are transitioning primary care payment from the prevailing prospective payment per encounter (PPS) model2 to alternative payment models (APMs) in the form of value-based care delivery and payment.2 The Centers for Medicare and Medicaid Services also gave states the option to create APMs, provided the affected FQHCs did not receive lower payments than would have occurred under PPS. For example, Washington State Medicaid adopted prospective per member per month (PMPM) for primary care, with financial incentives to meet population quality and performance indicators set at the beginning of the contractual period. Several states have explored APMs for FQHCs,2 but there is little current peer-reviewed evidence of their impact on health, use, cost, and quality of care. The best evidence to date is from Oregon's experience with an FQHC APM introduced in 2013.3,4,5 Oregon FQHCs are paid a capitated PMPM with quality-based financial incentives tied to colorectal cancer and depression screening, blood sugar control for individuals with diabetes, and measures related to childhood nutrition and weight and hypertension control. Cottrell et al.'s3 qualitative examination of the Oregon initiative found innovations in scheduling (longer patient visits; dedicated time for care coordination); changes in visit types (group visits; telephone visits); transformations in use of human resources (use of an online patient portal); and changing team composition (adding a clinical pharmacist; altering role descriptions [e.g., for medical assistants]). Initial results among the first 10 centers that participated in the APM showed small reductions in ER visits and hospital use, with some increases in quality, patient experience, and access.3 Ukhanova et al.5 examined the APM's impact on preventive service use and found that it "did not negatively impact delivery of preventive care,"5[p.1] based on screening rates among affected clinics not falling as much as those in comparator clinics. Lindner et. al estimated that the Oregon APM led to a 42.4% relative reduction in price-weighted primary care services compared with comparator clinics, almost fully due to the decline...

EFFECTS OF IMPLEMENTING THE ASTHMA IMPAIRMENT AND RISK QUESTIONNAIRE (AIRQ) AND AN ASSOCIATED GUIDELINE-BASED ASSESSMENT TOOL ON CLINICAL DECISION-MAKING IN PRIMARY CARE

SESSION TITLE: Asthma in Children and AdultsSESSION TYPE: Rapid Fire Original InvPRESENTED ON: 10/19/2022 11:15 am - 12:15 pmPURPOSE: 50% of adults and 38% of children with asthma in the US have uncontrolled disease and 60% are seen in primary care. Guidelines can reduce asthma morbidity, but studies show primary care clinicians have less self-efficacy and adherence to guidelines than specialists (Cloutier et al. J Allergy Clin Immunol Pract. 2018;6[3]:886-94). We assessed the effects of implementing AIRQ, a 10-item, yes/no asthma control assessment, and Asthma Checklist, a guidelines-based decision support tool, on management decisions in primary care.METHODS: 351 primary care patients with asthma aged ≥13 yrs participated in a study in which AIRQ and Asthma Checklist were integrated into clinical visits. 201 were in 2 private practices (PP) and 150 in 3 Federally Qualified Health Centers (FQHC) treating the underserved. During the visit, clinicians rated patients’ asthma as completely, well, somewhat, poorly, or not controlled. Demographic and clinical characteristics were compared for PP vs FQHC. Management choices relative to AIRQ score (Well-controlled [WC], 0-1 yes responses; Not Well-controlled [NWC], 2-4; Very Poorly Controlled [VPC], 5-10) were analyzed overall and by practice type (chi square; significance p≤0.05).RESULTS: Patients in PP vs FQHC were older (mean[SD] age 53[17] vs 42[20] yrs) and more were male (32% vs 25%) and commercially (65% vs 26%) vs Medicaid (12% vs 47%) insured (p<0.05 for each). FQHC vs PP patients were more likely to use short-acting bronchodilators alone (64% vs 38%, p<0.001) and less likely to use inhaled corticosteroid-based maintenance therapy (37% vs 54%, p<0.002). Overall, 49% were WC, 36% NWC, and 15% VPC by AIRQ. More PP vs FQHC patients were WC (55% vs 41%) and fewer VPC (11% vs 21%, p<0.05). Clinicians rated 59% of patients as completely/well-controlled (60% PP, 57% FQHC, pNS); however, 13% of these patients reported daily activity limitation from symptoms (10% PP, 18% FQHC; pNS), and 8% reported prior-year oral corticosteroid bursts for asthma (4% PP, 13% FQHC; p<0.03). Therapy was stepped-up for 29% (22% PP, 39% FQHC), 20% were considered for add-on or advanced therapies (6% PP, 39% FQHC), and 5% were referred to a specialist (1% PP, 11% FQHC; p<0.001 for each); the percentage of patients recommended for these Asthma Checklist options increased with worsening AIRQ control category (p<0.001).CONCLUSIONS: AIRQ identified half of all patients as having uncontrolled asthma, with greater morbidity in FQHC vs PP. The clinicians assessed more patients as controlled than AIRQ, which may be due in part to under-recognition of daily impact of asthma and exacerbation history.CLINICAL IMPLICATIONS: Implementing AIRQ and Asthma Checklist was feasible and resulted in management decisions concordant with level of control. Prospective evaluation of patient morbidity and sustainability of AIRQ and Asthma Checklist use will determine if these tools can improve asthma treated in primary care.DISCLOSURES: Advisory Committee Member relationship with AstraZeneca Please note: $20001 - $100000 by David Beuther, value=Consulting feeAdvisory Committee Member relationship with AstraZeneca Please note: 2020-present Added 03/31/2022 by Jo Ann Brooks, value=Consulting feeEmployee relationship with Astrazeneca Please note: >$100000 by James Eudicone, value=SalaryEmployee relationship with Astrazeneca Please note: >$100000 by Hitesh Gandhi, value=SalaryEmployee relationship with AstraZeneca Please note: >$100000 by Ileen Gilbert, value=SalaryStock relationship with AstraZeneca Please note: $20001 - $100000 by Ileen Gilbert, value=StockMy spouse/partner as a Consultant relationship with Abott Please note: $20001 - $100000 by Ileen Gilbert, value=Consulting feeEmployee relationship with AstraZeneca Please note: Ongoing Added 03/30/2022 by Ileen Gilbert, value=SalaryConsultant relationship with AstraZeneca Please note: >$100000 by Gale Harding, value=Consulting feeRemoved 04/13/2022 by Gale HardingConsultant relationship with AstraZeneca Please note: 2019-2022 Added 04/13/2022 by Gale Harding, value=Consulting feeConsultant relationship with AstraZeneca Please note: Jan 2021 to Present Added 04/06/2022 by Mary Ladd, value=Consulting feeCorporate sponsor relationship with Amgen Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/ResearchCorporate sponsor relationship with AstraZeneca Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with Aimmune Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with Amphastar Please note: 1/1/2022-12/31-2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with Bristol Myers Squibb Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/ResearchCorporate sponsor relationship with Genentech Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with GlaxoSmithKline Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with DBV Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with Johnson & Johnson Please note: 1/1/2022-12/31-2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with Merck Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with Novartis Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with Regeneron Please note: 1/2/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with PhRMA Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with PCMA Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with Viatris Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportConsultant relationship with Astra Zeneca Please note: $5001 - $20000 by Siddhartha Singh, value=Consulting feeSpeaker/Speaker's Bureau relationship with Astra Zeneca Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Speakers FeesSpeaker/Speaker's Bureau relationship with Washington University in St. Louis Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Speakers FeesSpeaker/Speaker's Bureau relationship with Weill Cornell Medicine Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Speakers FeesBoard Member relationship with International Society of Hypertension in Blacks Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Board MemberBoard Member relationship with The Spanish and Portuguese Synagogue Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Board MemberConsultant relationship with GSK Please note: 2020 - 2022 Added 03/30/2022 by Barbara Yawn, value=Consulting feeAdvisory Committee Member relationship with BI Please note: 2019 - 2022 Added 03/30/2022 by Barbara Yawn, value=HonorariaAdvisory Committee Member relationship with AZ Please note: 2019 - 2022 Added 03/30/2022 by Barbara Yawn, value=HonorariaAdvisory Committee Member relationship with TEVA Please note: 11/2019-12/2021 by Barbara Yawn, value=Consulting feeConsultant relationship with Pulmonx Please note: 2021 Added 03/30/2022 by Barbara Yawn, value=Consulting feeAdvisory Committee Member relationship with GSK Please note: 2019 - 2022 Added 03/30/2022 by Barbara Yawn, value=HonorariaAdvisory Committee Member relationship with TEVA Please note: 2019 - 2022 Added 03/30/2022 by Barbara Yawn, value=HonorariaConsultant relationship with BI Please note: 2020 - 2022 Added 03/30/2022 by Barbara Yawn, value=Consulting feeConsultant relationship with TEVA Please note: 2020 - 2022 Added 03/30/2022 by Barbara Yawn, value=Consulting feeOther relationship with GSK Please note: 2018 - 2021 Added 03/30/2022 by Barbara Yawn, value=Grant/Research Support SESSION TITLE: Asthma in Children and Adults SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: 50% of adults and 38% of children with asthma in the US have uncontrolled disease and 60% are seen in primary care. Guidelines can reduce asthma morbidity, but studies show primary care clinicians have less self-efficacy and adherence to guidelines than specialists (Cloutier et al. J Allergy Clin Immunol Pract. 2018;6[3]:886-94). We assessed the effects of implementing AIRQ, a 10-item, yes/no asthma control assessment, and Asthma Checklist, a guidelines-based decision support tool, on management decisions in primary care. METHODS: 351 primary care patients with asthma aged ≥13 yrs participated in a study in which AIRQ and Asthma Checklist were integrated into clinical visits. 201 were in 2 private practices (PP) and 150 in 3 Federally Qualified Health Centers (FQHC) treating the underserved. During the visit, clinicians rated patients’ asthma as completely, well, somewhat, poorly, or not controlled. Demographic and clinical characteristics were compared for PP vs FQHC. Management choices relative to AIRQ score (Well-controlled [WC], 0-1 yes responses; Not Well-controlled [NWC], 2-4; Very Poorly Controlled [VPC], 5-10) were analyzed overall and by practice type (chi square; significance p≤0.05). RESULTS: Patients in PP vs FQHC were older (mean[SD] age 53[17] vs 42[20] yrs) and more were male (32% vs 25%) and commercially (65% vs 26%) vs Medicaid (12% vs 47%) insured (p<0.05 for each). FQHC vs PP patients were more likely to use short-acting bronchodilators alone (64% vs 38%, p<0.001) and less likely to use inhaled corticosteroid-based maintenance therapy (37% vs 54%, p<0.002). Overall, 49% were WC, 36% NWC, and 15% VPC by AIRQ. More PP vs FQHC patients were WC (55% vs 41%) and fewer VPC (11% vs 21%, p<0.05). Clinicians rated 59% of patients as completely/well-controlled (60% PP, 57% FQHC, pNS); however, 13% of these patients reported daily activity limitation from symptoms (10% PP, 18% FQHC; pNS), and 8% reported prior-year oral corticosteroid bursts for asthma (4% PP, 13% FQHC; p<0.03). Therapy was stepped-up for 29% (22% PP, 39% FQHC), 20% were considered for add-on or advanced therapies (6% PP, 39% FQHC), and 5% were referred to a specialist (1% PP, 11% FQHC; p<0.001 for each); the percentage of patients recommended for these Asthma Checklist options increased with worsening AIRQ control category (p<0.001). CONCLUSIONS: AIRQ identified half of all patients as having uncontrolled asthma, with greater morbidity in FQHC vs PP. The clinicians assessed more patients as controlled than AIRQ, which may be due in part to under-recognition of daily impact of asthma and exacerbation history. CLINICAL IMPLICATIONS: Implementing AIRQ and Asthma Checklist was feasible and resulted in management decisions concordant with level of control. Prospective evaluation of patient morbidity and sustainability of AIRQ and Asthma Checklist use will determine if these tools can improve asthma treated in primary care. DISCLOSURES: Advisory Committee Member relationship with AstraZeneca Please note: $20001 - $100000 by David Beuther, value=Consulting fee Advisory Committee Member relationship with AstraZeneca Please note: 2020-present Added 03/31/2022 by Jo Ann Brooks, value=Consulting fee Employee relationship with Astrazeneca Please note: >$100000 by James Eudicone, value=Salary Employee relationship with Astrazeneca Please note: >$100000 by Hitesh Gandhi, value=Salary Employee relationship with AstraZeneca Please note: >$100000 by Ileen Gilbert, value=Salary Stock relationship with AstraZeneca Please note: $20001 - $100000 by Ileen Gilbert, value=Stock My spouse/partner as a Consultant relationship with Abott Please note: $20001 - $100000 by Ileen Gilbert, value=Consulting fee Employee relationship with AstraZeneca Please note: Ongoing Added 03/30/2022 by Ileen Gilbert, value=Salary Consultant relationship with AstraZeneca Please note: >$100000 by Gale Harding, value=Consulting fee Removed 04/13/2022 by Gale Harding Consultant relationship with AstraZeneca Please note: 2019-2022 Added 04/13/2022 by Gale Harding, value=Consulting fee Consultant relationship with AstraZeneca Please note: Jan 2021 to Present Added 04/06/2022 by Mary Ladd, value=Consulting fee Corporate sponsor relationship with Amgen Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Corporate sponsor relationship with AstraZeneca Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with Aimmune Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with Amphastar Please note: 1/1/2022-12/31-2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with Bristol Myers Squibb Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Corporate sponsor relationship with Genentech Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with GlaxoSmithKline Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with DBV Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with Johnson & Johnson Please note: 1/1/2022-12/31-2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with Merck Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with Novartis Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with Regeneron Please note: 1/2/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with PhRMA Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with PCMA Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with Viatris Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Consultant relationship with Astra Zeneca Please note: $5001 - $20000 by Siddhartha Singh, value=Consulting fee Speaker/Speaker's Bureau relationship with Astra Zeneca Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Speakers Fees Speaker/Speaker's Bureau relationship with Washington University in St. Louis Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Speakers Fees Speaker/Speaker's Bureau relationship with Weill Cornell Medicine Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Speakers Fees Board Member relationship with International Society of Hypertension in Blacks Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Board Member Board Member relationship with The Spanish and Portuguese Synagogue Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Board Member Consultant relationship with GSK Please note: 2020 - 2022 Added 03/30/2022 by Barbara Yawn, value=Consulting fee Advisory Committee Member relationship with BI Please note: 2019 - 2022 Added 03/30/2022 by Barbara Yawn, value=Honoraria Advisory Committee Member relationship with AZ Please note: 2019 - 2022 Added 03/30/2022 by Barbara Yawn, value=Honoraria Advisory Committee Member relationship with TEVA Please note: 11/2019-12/2021 by Barbara Yawn, value=Consulting fee Consultant relationship with Pulmonx Please note: 2021 Added 03/30/2022 by Barbara Yawn, value=Consulting fee Advisory Committee Member relationship with GSK Please note: 2019 - 2022 Added 03/30/2022 by Barbara Yawn, value=Honoraria Advisory Committee Member relationship with TEVA Please note: 2019 - 2022 Added 03/30/2022 by Barbara Yawn, value=Honoraria Consultant relationship with BI Please note: 2020 - 2022 Added 03/30/2022 by Barbara Yawn, value=Consulting fee Consultant relationship with TEVA Please note: 2020 - 2022 Added 03/30/2022 by Barbara Yawn, value=Consulting fee Other relationship with GSK Please note: 2018 - 2021 Added 03/30/2022 by Barbara Yawn, value=Grant/Research Support

Quality of Care for US Adults With Medicaid Insurance and Type 2 Diabetes in Federally Qualified Health Centers Compared With Other Primary Care Settings.

The objective of this study was to evaluate indicators of diabetes quality of care for US nonelderly, adult Medicaid enrollees with type 2 diabetes and compare federally qualified health centers (FQHCs) versus non-FQHCs. We analyzed diabetes process measures and acute health services utilization with 2012 US fee-for-service and managed care Medicaid claims in all 50 states and DC. We compared FQHC (N=121,977) to non-FQHC patients (N=700,401) using propensity scores to balance covariates and generalized estimating equation models. Overall, laboratory-based process measures occurred more frequently (range, 65.7%-76.6%) than measures requiring specialty referrals (retinal examinations, 33.3%; diabetes education, 3.4%). Compared with non-FQHC patients, FQHC patients had about 3 percentage point lower rates of each process measure, except for higher rates of diabetes education [relative risk=1.09, 95% confidence interval (CI): 1.03-1.16]. FQHC patients had fewer overall [incident rate ratio (IRR)=0.87, 95% CI: 0.86-0.88] and diabetes-related hospitalizations (IRR=0.79, 95% CI: 0.77-0.81), but more overall (IRR=1.06, 95% CI: 1.05-1.07) and diabetes-related emergency department visits (IRR=1.10, 95% CI: 1.08-1.13). This national analysis identified opportunities to improve diabetes management among Medicaid enrollees with type 2 diabetes, especially for retinal examinations or diabetes education. Overall, we found slightly lower rates of most diabetes care process measures for FQHC patients versus non-FQHC patients. Despite having higher rates of emergency department visits, FQHC patients were significantly less likely to be hospitalized than non-FQHC patients. These findings emphasize the need to identify innovative, effective approaches to improve diabetes care for Medicaid enrollees, especially in FQHC settings.