Patient Safety and Quality

Community health centers provide poorer quality of care to the uninsured with chronic disease

Federally funded community health centers (CHCs) provide a safety net of care for more than 15 million disadvantaged and minority patients in the United States, nearly one-fourth of whom are uninsured. While CHCs don't provide optimal quality chronic disease care, it is similar to that delivered at other sites that provide care for underserved populations, such as hospital-affiliated clinics. However, CHCs provide markedly lower quality of care to the uninsured, according to a new study. The number of uninsured patients served by CHCs is likely to grow in the future, due to anticipated changes in Medicaid eligibility rules, decreases in State-funded insurance programs, and the rising cost of private insurance.

Researchers examined the medical records of patients from a nationally representative sample of Federally funded CHCs in 1999 and 2000. Over one-third of CHC patients were uninsured. The researchers compared CHC care with various care guidelines for asthma, diabetes, and hypertension. Fewer than half of eligible patients received appropriate care for 15 of 22 quality of care indicators examined. Actual performance ranged from 14 percent for a documented asthma management plan to 74 percent for hypertensive patients who had at least one creatinine check to screen for renal dysfunction.

The overall mean care quality scores were 36.8 percent for diabetes, 58.6 percent for hypertension, and 36.8 percent for asthma, with higher scores indicating better quality of care. After adjusting for other factors affecting care, including CHC organizational characteristics, uninsured patients received recommended care less often than patients who were insured. Disparities by race and ethnicity in quality of care for all three chronic conditions were eliminated after adjustment for insurance status. The findings suggest the need to provide additional resources to meet the needs of uninsured patients at CHCs. The study was supported in part by the Agency for Healthcare Research and Quality (HS13653).

See "The quality of chronic disease care in U.S. community health centers," by LeRoi S. Hicks, M.D., M.P.H., A. James O'Malley, Ph.D., Tracey A. Lieu, M.D., M.P.H., and others, in the November 2006 Health Affairs 25(6), pp. 1712-1723.

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