Community health centers: medical homes for children?

Pediatric Provider and Staff Burnout in Federally Qualified Community Health Centers

This study examined changes in provider and staff burnout in 4 Boston-area federally qualified community health centers (FQHCs) participating in a pediatric behavioral health integration project. Utilizing the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSSMP), the study found that emotional exhaustion among primary care providers ( M = 20.5; confidence interval [CI], 17.8-23.2) was higher ( P = .001) than that among behavioral health clinicians ( M = 13.6; CI, 10.4-16.8) and ( P = .00005) community health workers ( M = 10.8; CI, 7.3-14.2). Emotional exhaustion among staff increased ( P = .04) from baseline ( M = 16.8; CI, 15.0-18.6) to follow-up ( M = 20.8; CI, 17.5-24.2), but burnout at follow-up was lower than national averages. FQHCs are integral in caring for marginalized patients; therefore, supporting a stable workforce by minimizing burnout is essential.

The Effects of Community Health Center Care on Medical Expenditures for Children and Adults: Propensity Score Analyses

This study examines whether community health center (CHC) patients have lower medical expenditures. Using 2011-2012 Medical Expenditure Panel Survey data, propensity score methods are used to compare annual expenditures for adults and children receiving at least half their ambulatory care at CHCs versus those who did not. For children, CHC use was associated with 35.3% lower total medical expenditures ($627), 40.0% lower ambulatory expenditures ($279), and 49.1% lower prescription drug expenditures ($157) (all Ps < .05). For adults, the reduction in hospital expenditures for CHC users ($529) was statistically significant at a P < .10 threshold. Estimated differences in total expenditures and other expenditure categories were not statistically significant for adults.

Off to the Right Start: Well-Child Visit Attendance Among Health Center Users

INTRODUCTION

This study examines correlates of past-year well-child visit attendance, reasons for choosing to receive care at a health center, and patient experience among pediatric federally qualified health center users.

METHOD

This observational study used cross-sectional 2009 Health Center Patient Survey data. Descriptive statistics, bivariate analysis, and multivariable models were utilized.

RESULTS

This study found that 83.0% of children who visited a health center in the past year had a well-child visit in the past year and 88.5% had a usual source of care, with no disparities based on race/ethnicity or insurance status. A usual source of care, especially a health center, enhanced well-child visit attendance. The top reasons for seeking care at a health center include convenience (31.6%), quality (24.5%), accessibility (17.7%), and co-located nonmedical services (11.5%).

DISCUSSION

Well-child visit attendance is high but there is room for improvement, particularly among patients who lack a usual source of care.

Characterizing Key Components of a Medical Home Among Rural Adolescents

PURPOSE

Adolescents in rural areas have higher unmet medical needs and receive fewer preventive health care visits than their urban counterparts. This community health assessment aimed to describe adolescent experiences of key components of a medical home in rural Washington.

METHODS

A cross-sectional survey using questions from two validated measures was created with input from a community advisory group using community-based participatory research principles. The survey was administered to a convenience sample of high-school students in one rural town. Responses within each medical home domain were grouped to create composite scores. Linear and logistic regression analyses identified characteristics associated with receiving medical home services.

RESULTS

A total of 217 adolescents aged 13-19 years completed the survey. Eighty-five percent identified as Latino/Hispanic. Respondents described usually or always feeling listened to by providers (80%), respected by providers (89%), and welcomed at their clinic (79%). Fewer reported having a personal health provider (56%), meeting alone with a provider (56%), or knowing the visit was confidential (60%). Those who identified having a primary provider had 2.48 greater odds (95% confidence interval = 1.13-5.45) of reporting a well visit in the previous year and had higher composite scores for compassionate and patient-centered care.

CONCLUSIONS

This sample of rural adolescents reported receiving many characteristics of a medical home but had limited experience with personal providers and confidential services. Improving adolescent access to confidential care may be especially important in small, rural communities. The association of a primary provider with improved medical home experience highlights this key characteristic in an adolescent medical home.