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.
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.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Health Resources and Services Administration. HRSA Health Center Program. Available at: https://bphc.hrsa.gov/sites/default/files/bphc/about/healthcenterfactsheet.pdf. Published 2018. Accessed September 26, 2019.
Rosenbaum S, Paradise J, Markus A, Sharac J, Tran C, Reynolds D. Community Health Centers : Recent Growth and the Role of the ACA. Washington, DC; 2016.
American College of Physicians. High Value Care. Available at: https://www.acponline.org/clinical-information/high-value-care. Accessed September 26, 2019.
Laiteerapong N, Kirby J, Gao Y, et al. Health care utilization and receipt of preventive care for patients seen at federally funded health centers compared to other sites of primary care. Health Serv Res 2012;49(5):1498-1518. doi:https://doi.org/10.1111/1475-6773.12178
Goldman LE, Chu PW, Tran H, Romano MJ, Stafford RS. Federally qualified health centers and private practice performance on ambulatory care measures. Am J Prev Med 2012;43(2):142-149.
ABIM Foundation. Choosing Wisely: Promoting conversations between patients and clinicians. Available at: http://www.choosingwisely.org/. Accessed September 26, 2019.
Wright B, Potter AJ, Trivedi AN. Use of federally qualified health centers and potentially preventable hospital utilization among older Medicare-Medicaid enrollees. J Ambul Care Manage 2017;40(2):139-149. doi:https://doi.org/10.1097/JAC.0000000000000158
Falik M, Needleman J, Herbert R, Wells B, Politzer R, Benedict MB. Comparative effectiveness of health centers as regular source of care: Application of sentinel ACSC events as performance measures. J Ambul Care Manage 2006;29(1):24-35. doi:https://doi.org/10.1097/00004479-200601000-00004
Gurewich D, Tyo KR, Zhu J, Shepard DS. Comparative performance of community health centers and other usual sources of primary care. J Ambul Care Manage 2011;34(4):380-390. doi:https://doi.org/10.1097/JAC.0b013e31822cbc59
Barnett ML, Linder JA, Clark CR, Sommers BD. Low-value medical services in the safety-net population. JAMA Intern Med 2017;177(6):829-837. doi:https://doi.org/10.1001/jamainternmed.2017.0401
Health Resources & Services Administration. Health Center Program Compliance Manual. Washington, DC; 2018. Available at: https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-3.html. Accessed September 26, 2019.
National Center for Health Statistics. NCHS public-use data files and documentation: National Ambulatory Medical Care Survey (NAMCS)—2010, 2011, 2012. Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS. Accessed September 26, 2019.
Ma J, Stafford RS. Quality of US outpatient care: temporal changes and racial/ethnic disparities. Arch Intern Med 2005;165(12):1354-1361.
Linder JA, Bates DW, Middleton B, et al. Electronic health record use and the quality of ambulatory care in the United States. JAMA Intern Med 2007;167(13):1400-1405. doi:https://doi.org/10.1001/archinte.167.13.1400
Edwards ST, Mafi JN, Landon BE. Trends and quality of care in outpatient visits to generalist and specialist physicians delivering primary care in the United States, 1997-2010. J Gen Intern Med 2014;29(6):947-955. doi:https://doi.org/10.1007/s11606-014-2808-y
Kale MS, Bishop TF, Federman AD, Keyhani S. Trends in the overuse of ambulatory health care services in the United States. JAMA Intern Med 2013;173(2):142-148. doi:https://doi.org/10.1001/2013.jamainternmed.1022
Mehrotra A, Gidengil CA, Setodji CM, Burns RM, Linder JA. Antibiotic prescribing for respiratory tract infections at retail clinics, physician practices, and emergency departments. Am J Manag Care 2015;21(4):294-302. doi:https://doi.org/10.1370/afm.1090.INTRODUCTION
Mafi JN, Edwards ST, Pedersen NP, Davis RB, McCarthy EP, Landon BE. Trends in the ambulatory management of headache: analysis of NAMCS and NHAMCS data 1999–2010. J Gen Intern Med 2015;30(5):548-555. doi:https://doi.org/10.1007/s11606-014-3107-3
Mafi JN, McCarthy EP, Davis RB, Landon BE. Worsening trends in the management and treatment of back pain. JAMA Intern Med 2013;173(17):1573-1581. doi:https://doi.org/10.1001/jamainternmed.2013.8992
Mehrotra A, Zaslavsky AM, Ayanian JZ. Preventive health examinations and preventive gynecological examinations in the United States. Arch Intern Med 2007;167(17):1876-1883. doi:https://doi.org/10.1001/archinte.167.17.1876
National Center for Health Statistics. Using ultimate cluster models with NAMCS and NHAMCS public use files. Available at: https://www.cdc.gov/nchs/data/ahcd/ultimatecluster.pdf. Published 2004. Accessed September 26, 2019.
Chin MH, Drum ML, Guillen M, et al. Improving and sustaining diabetes care in community health centers with the health disparities collaboratives. Med Care 2007;45(12):1135-1143. doi:https://doi.org/10.1097/MLR.0b013e31812da80e
Lindner S, Solberg LI, Miller WL, et al. Does Ownership Make a Difference in Primary Care Practice? J Am Board Fam Med 2019;32(3):398-407. doi:https://doi.org/10.3122/jabfm.2019.03.180271
Fontil V, Bibbins-Domingo K, Nguyen OK, Guzman D, Goldman LE. Management of hypertension in primary care safety-net clinics in the United States: a comparison of community health centers and private physicians’ offices. Health Serv Res 2017;52(2):807-825. doi:https://doi.org/10.1111/1475-6773.12516
Shi L, Lock DC, Lee DC, et al. Patient-centered medical home capability and clinical performance in HRSA-supported health centers. Med Care 2015;53(5):389-395. doi:https://doi.org/10.1097/MLR.0000000000000331
Shi L, Lee D-C, Chung M, Liang H, Lock D, Sripipatana A. Patient-centered medical home recognition and clinical performance in U.S. community health centers. Health Serv Res 2017;52(3):984-1004. doi:https://doi.org/10.1111/1475-6773.12523
Hu R, Shi L, Sripipatana A, et al. The association of patient-centered medical home designation with quality of care of HRSA-funded health centers: a longitudinal analysis of 2012-2015. Med Care 2018;56(2):130-138. doi:https://doi.org/10.1097/MLR.0000000000000862
Hing E, Kurtzman E, Lau DT, Taplin C, Bindman AB. Characteristics of primary care physicians in patient-centered medical home practices: United States, 2013. Natl Health Stat Report 2017;(101).
Mafi JN, Wee CC, Davis RB, Landon BE. Association of primary care practice location and ownership with the provision of low-value care in the United States. JAMA Intern Med 2017;177(6):838-845. doi:https://doi.org/10.1001/jamainternmed.2017.0410
Tipirneni R, Patel MR, Kirch MA, Goold SD. Cost conversations between primary care providers and patients with expanded Medicaid coverage. J Gen Intern Med 2018;33(11):1845-1847. doi:https://doi.org/10.1007/s11606-018-4551-2
McConnell KJ, Renfro S, Chan BKS, et al. Early performance in Medicaid accountable care organizations a comparison of Oregon and Colorado. JAMA Intern Med 2017;177(4):538-545. doi:https://doi.org/10.1001/jamainternmed.2016.9098
Bhatia J, Tobey R, Hochman M. Value-based payment models for community health centers. JAMA. 2017;317(22):2275-2276. doi:https://doi.org/10.1001/jama.2017.5174
Roberts ET, Zaslavsky AM, Mcwilliams JM. The value-based payment modifier: Program outcomes and implications for disparities. Ann Intern Med 2018;168(4):255-265. doi:https://doi.org/10.7326/M17-1740
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.
The contents do not represent the views of the U.S. Department of Veterans Affairs or the US Government.
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.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This study was presented as an oral presentation at the Society of General Internal Medicine Annual Meeting, Denver CO, 11–14 April 2018.
About this article
Cite this article
Oronce, C.I.A., Fortuna, R.J. Differences in Rates of High-Value and Low-Value Care Between Community Health Centers and Private Practices. J GEN INTERN MED (2019). https://doi.org/10.1007/s11606-019-05544-z
- high-value care
- low-value care
- quality of care
- community health centers
- federally qualified health centers