Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid, Access, Continuity of Care (Caseload), Community Health Centers

Intervention Description: N/A

Intervention Results: We found the probability of unmet need for medical and dental care to be lower among HRSA HC patients than individuals whose usual source of care were not HRSA HCs.

Conclusion: HRSA HC patients have lower probabilities of unmet need for medical and dental care. This is likely because HRSA HCs provide accessible, affordable, and comprehensive primary care services. Expanding capacity of these organizations will help reduce unmet need and its consequences.

Study Design: We used logistic regression models to compare the predicted probabilities of unmet need for uninsured and Medicaid individuals whose usual source of care is HRSA HCs versus clinics in general or private physicians.

Setting: Nationally representative survey of low income, adult patients who identified HRSA HCs as their usual source of care

Population of Focus: HRSA HC patients

Sample Size: ?

Age Range: 18+

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access, Access, Community Health Centers

Intervention Description: The study did not involve an intervention. Instead, it focused on analyzing the operational efficiency, patient composition, and regional context of U.S. health centers and their associations with access to early prenatal care and low birth weight. The study utilized data from multiple sources to examine the quality of prenatal care and birth outcomes of patients served at Community Health Centers (CHCs) operating in the United States in 2015. The research involved analyzing existing data to understand the relationships between sociodemographic composition of CHCs and the efficiency of health centers, as well as how CHC demographics and efficiency are associated with the numbers of patients served and patient health outcomes relating to pregnancy and childbirth

Intervention Results: The study found that there were significant differences in the association between latent classes and access to prenatal care in the first trimester. CHCs in Class 2, characterized by patients who are Older Rural Whites, had the highest rate of access to prenatal care in the first trimester. Compared to other classes, CHCs in Class 2 had more prenatal patients who received early prenatal care. The study also found that greater efficiency at health centers was associated with lower rates of low birth weight (LBW), even controlling for the sociodemographic composition of CHC patients and regional context. However, greater efficiency was not associated with improved access to early prenatal healthcare. The study noted several limitations, including that their measure of prenatal care only captured the timing of initiation of care and did not capture other dimensions of prenatal care quality. Additionally, the study was unable to identify and separate what share of the labor and financial inputs to their DEA model were being used specifically for pregnancy-related services.

Conclusion: The study concluded that Community Health Centers (CHCs) play a crucial role in providing prenatal care, particularly in rural areas where access to obstetric services is declining. The findings highlighted the importance of CHCs in addressing the unique challenges of providing prenatal and perinatal health care in rural communities. The study also emphasized the persistent racial inequalities in prenatal care and birth outcomes, with CHCs serving predominantly white patients having the highest rates of early access to prenatal care and the lowest rates of low birth weight (LBW) births. Conversely, CHCs serving a larger share of Black and Hispanic patients had significantly lower rates of early access to prenatal care and higher rates of LBW births. The study suggested that patient and regional sociodemographic factors had a stronger association with lower or higher rates of LBW at health centers than either patient access to early prenatal care or the relative efficiency of the centers. Additionally, the study highlighted the need for future research to examine how patient characteristics within particular regional settings of healthcare are associated with patient engagement in care and health outcomes.

Study Design: The study design was a cross-sectional analysis of data from the Uniform Data System (UDS) of the Health Resources and Services Administration (HRSA) for the year 2015. The study used a combination of latent class analysis (LCA), data envelopment analysis (DEA), and generalized linear models with a fractional response to analyze the associations between operational efficiency, patient composition, regional context of U.S. health centers, and access to early prenatal care and low birth weight. The study aimed to identify and classify diversity among health centers in terms of their patient populations and regional contexts and to understand how these factors are associated with the degree of access to early prenatal care for patients and the health outcomes of prenatal patients and their babies.

Setting: The setting of this study is the United States, specifically community health centers (CHCs) that provide primary care services to underserved populations. The study used data from the Uniform Data System (UDS) of the Health Resources and Services Administration (HRSA) to analyze the associations between operational efficiency, patient composition, regional context of U.S. health centers, and access to early prenatal care and low birth weight.

Population of Focus: The target audience for this study includes researchers, policymakers, and practitioners interested in improving maternal and child health through the community health center (CHC) system in the United States. Additionally, stakeholders involved in healthcare delivery, public health, and health disparities may also find the findings of this study relevant to their work.

Sample Size: The initial sample size for this study was 1,331 community health centers (CHCs) funded by the Community Health Center (CHC) Program. However, 79 health centers were excluded, resulting in a final sample of 1,252 CHCs for the latent class analysis (LCA). For the data envelopment analysis (DEA) model, an additional 187 CHCs were excluded, reducing the sample to 1,065. Finally, 24 CHCs were excluded from the sample for analyses predicting the proportion of births born at low birth weight (LBW), resulting in a final sample of 1,041 CHCs for LBW analyses.

Age Range: The study did not have a specific target age group. Instead, the study focused on perinatal health outcomes, which includes health outcomes related to pregnancy and childbirth. The study analyzed data on patient demographics, health outcomes, quality of care indicators, costs, and revenues for all 1,375 federally-qualified health centers (FQHCs) in the United States. The study also used regional zip code tabulation area (ZCTA)-level data from the US Census American Community Survey (ACS; 2010–2014) and Behavioral Risk Factor Surveillance System (BRFSS; 2009–2012) to obtain regional data associated with each CHC's service area.