Differences in Rates of High-Value and Low-Value Care Between Community Health Centers and Private Practices

  • Carlos Irwin A. OronceEmail author
  • Robert J. FortunaEmail author
Original Research



Community health centers (CHCs) are an integral part of the health care safety net. As health systems seek to improve value, it is important to understand the quality of care provided by CHCs.


To evaluate the performance of CHCs compared with private practices on a comprehensive set of high-value and low-value care measures.


This cross-sectional study used data from the National Ambulatory Medical Care Survey from 2010 through 2012. We compared CHCs with private practices using logistic regression models that adjusted for age, sex, race/ethnicity, insurance, number of chronic illnesses, rural versus urban location, region of country, and survey year.


We included outpatient visits to generalist physicians at either CHCs or private practices by patients 18 years and older.

Main Measures

We examined 12 measures of high-value care and 7 measures of low-value care.


A total of 29,155 physician visits, representing 584,208,173 weighted visits, from 2010 through 2012 were included. CHCs were more likely to provide high-value care by ordering beta-blockers in CHF (46.9% vs. 36.5%; aOR 2.56; 95%CI 1.18–5.56), statins in diabetes (37.0% vs 35.5%; aOR 1.35; 95%CI 1.02–1.79), and providing treatment for osteoporosis (35.7% vs 23.2%; aOR 1.77; 95%CI 1.05–3.00) compared with private practices. CHCs were more likely to avoid low-value screening EKGs (98.7% vs. 88.0%; aOR 11.03; 95%CI 2.67–45.52), CBCs (75.9% vs. 65.7%; aOR 1.72; 95%CI 1.18–2.53), or urinalyses (86.0% vs. 80.5%; aOR 1.87; 95%CI 1.11–3.14) during a general medical exam. CHCs were also less likely to prescribe antibiotics for a URI (48.3% vs. 63.1%; aOR 0.59; 95%CI 0.40–0.88).


On a number of high-value and low-value measures of care, CHCs performed similar to or better than private practices. As healthcare delivery reforms continue to progress, CHCs are well positioned to provide high-value healthcare.


high-value care low-value care quality of care community health centers federally qualified health centers 



Dr. Oronce was an internal medicine resident at the University of Rochester Medical Center at the time the study was completed. He is currently supported by the VA Office of Academic Affiliations through the VA/National Clinicians Scholars Program.

Compliance with Ethical Standards


The contents do not represent the views of the U.S. Department of Veterans Affairs or the US Government.

Ethical Approval

The University of Rochester Research Subjects Review Board approved this study.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.VA Greater Los Angeles Healthcare SystemLos AngelesUSA
  2. 2.National Clinician Scholars Program and the Division of General Internal Medicine and Health Services ResearchUniversity of CaliforniaLos AngelesUSA
  3. 3.Department of MedicineUniversity of Rochester Medical CenterRochesterUSA
  4. 4.Department of PediatricsUniversity of Rochester Medical CenterRochesterUSA
  5. 5.Center for Primary Care, Culver Medical GroupUniversity of Rochester Medical CenterRochesterUSA

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