Access to Federally Qualified Health Centers and Emergency Department Use Among Uninsured and Medicaid‐insured Adults: California, 2005 to 2013

Nath, Julia B.; Costigan, Shaughnessy; Lin, Feng; Vittinghoff, Eric; Hsia, Renee Y.

doi:10.1111/acem.13494

Cited by 13 publications

(16 citation statements)

References 28 publications

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“…While the receipt of primary care in general-and at FQHCs specifically-has been previously associated with a reduction in ED visits, nonemergent ED visits, and potentially avoidable hospitalizations, few of these studies have included dual enrollees, fewer still have been national in scope, and most have used aggregated-rather than person-level-data. [30][31][32][33][34][35][36]56 This limits the ability to examine the relationship between FQHC use and hospital-based care. By contrast,…”

Section: Discussionmentioning

confidence: 99%

Health center use and hospital‐based care among individuals dually enrolled in Medicare and Medicaid, 2012–2018

Wright

Akiyama

Potter

et al. 2022

Health Services Research

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Objective To examine the relationship between federally qualified health center (FQHC) use and hospital‐based care among individuals dually enrolled in Medicare and Medicaid. Data Sources Data were obtained from 2012 to 2018 Medicare claims. Study Design We modeled hospital‐based care as a function of FQHC use, person‐level factors, a Medicare prospective payment system (PPS) indicator, and ZIP code fixed effects. Outcomes included emergency department (ED) visits (overall and nonemergent), observation stays, hospitalizations (overall and for ambulatory care sensitive conditions), and 30‐day unplanned returns. We stratified all models on the basis of eligibility and rurality. Data Extraction Methods Our sample included individuals dually enrolled in Medicare and Medicaid for at least two full consecutive years, residing in a primary care service area with an FQHC. We excluded individuals without primary care visits, who died, or had end‐stage renal disease. Principal Findings After the Medicare PPS was introduced, FQHC use in rural counties was associated with fewer ED and nonemergent ED visits per 100 person‐years among both age‐eligible (−14.8 [−17.5, −12.1]; −6.6 [−7.5, −5.6]) and disability‐eligible duals (−11.3 [−14.4, −8.3]; −6 [−7.4, −4.6]) as well as a lower probability of observation stays (−0.8 pp age‐eligible; −0.4 pp disability‐eligible) and unplanned returns (−2.1 pp age‐eligible; −1.9 pp disability‐eligible). In urban counties, FQHC use was associated with more ED and nonemergent ED visits per 100 person‐years (10.6 [8.4, 12.8]; 4.0 [2.6, 5.4]) among disability‐eligible duals (a decrease of more than 60% compared with the pre‐PPS period) and increases in the probability of hospitalization (1.1 pp age‐eligible; 0.8 pp disability‐eligible) and ACS hospitalization (0.5 pp age‐eligible; 0.3 pp disability‐eligible) (a decrease of roughly 50% compared with the pre‐PPS period). Conclusions FQHC use is associated with reductions in hospital‐based care among dual enrollees after introduction of the Medicare PPS. Further research is needed to understand how FQHCs can tailor care to best serve this complex population.

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Section: Discussionmentioning

confidence: 99%

Health center use and hospital‐based care among individuals dually enrolled in Medicare and Medicaid, 2012–2018

Wright

Akiyama

Potter

et al. 2022

Health Services Research

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“…Although we had no information on the quality or level of behavioral health integration of primary care delivered at CHCs, previous work may help contextualize our findings. Nath and colleagues (26) found that an increase in geographic density of CHCs within a county corresponds with reduced ED visits (for any condition) only among the uninsured population. It remains plausible that general primary care visits at CHCs may have identified unmet mental health care needs for the uninsured population and substituted for psychiatric ED care.…”

Section: Discussionmentioning

confidence: 99%

Psychiatric Emergency Department Visits After Regional Expansion of Community Health Centers

Bruckner

Singh

Chakravarthy

et al. 2019

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Regional primary health care system capacity may affect the demand for psychiatric visits to the emergency department (ED). In the United States, community health centers (CHCs), which serve low-income regions regardless of individuals' ability to pay, expanded primary care services by over 70% in the past decade. No research, however, evaluates whether this expansion affects overall psychiatric ED visits. This hypothesis is tested in 143 U.S. counties that expanded CHC services.Methods: For the years 2006 through 2011, 18.84 million psychiatric outpatient ED visits were aggregated by county-year for the 143 U.S. counties with a participating CHC. The rate of psychiatric ED cases in a county-year is the dependent variable. Two independent variables were examined: total patients seen at CHCs and total patients receiving mental health services at CHCs. Fixed-effects regression methods controlled for county effects, year effects, and other health care and sociodemographic factors.Results: Psychiatric ED visits fell below expected levels in county-years where the volume of overall CHC patients rose (coefficient=-0.059; standard error=0.027, p=0.03). Findings indicate no relation between the volume of mental health patients seen at CHCs and psychiatric ED visits.Conclusions: An increase in general primary health care to an underserved population, in the form of CHCs, corresponds with a decline in psychiatric ED visits. This result coheres with a recent Medicaid expansion experiment in which increased access to general primary care reduced the prevalence of undiagnosed and untreated depression. Findings, if replicated, may hold policy implications for regional health systems.

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“…The prior literature that examines area-level effects of FQHC availability or expansions have used a range of catchment areas for FQHCs, including county, metropolitan statistical area, and hospital referral region [ 4 , 5 , 10 ]. However, the actual service areas of FQHCs depend on the number, size, and geographic spread of each FQHC’s delivery sites and the local availability of non-FQHC primary care providers; the actual service areas could cross boundaries of predefined catchment areas.…”

Section: Methodsmentioning

confidence: 99%

“…The existing evidence on FQHC use and ED visits is largely based on cross-sectional comparisons and has mixed findings [6][7][8][9]. One countylevel study in California that examined the impact of expanded FQHC capacity found that increased geographic density of FQHCs reduced ED visits for uninsured residents, but not Medicaid enrollees; other measures of local FQHC capacity were not associated with changes in ED visits [10].…”

Section: Introductionmentioning

confidence: 99%

The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts

et al. 2020

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Importance Federally qualified health centers (FQHCs) receive federal funding to serve medically underserved areas and provide a range of services including comprehensive primary care, enabling services, and behavioral health care. Greater funding for FQHCs could increase the local availability of clinic-based care and help reduce more costly resource use, such as emergency department visits (ED). Objective To examine the impact of funding increases for FQHCs after the ACA on the use of FQHCs and EDs. Methods Retrospective study using the Massachusetts All Payer Claims Database (APCD) 2010–2013 that included APCD enrollees in 559 Massachusetts ZIP codes (N = 6,173,563 in 2010). We calculated shift-share predictions of changes in FQHC funding at the ZIP code-level for FQHCs that received Community Health Center funds in any year, 2010–13 (N = 31). Outcomes were the number of ZIP code enrollees with visits to FQHCs and EDs, overall and for emergent and non-emergent diagnoses. Results In 2010, 4% of study subjects visited a FQHC, and they were more likely to be younger, have Medicaid, and live in low-income areas. We found that a standard deviation increase in prior year FQHC funding (+31 percentage point (pp)) at the ZIP code level was associated with a 2.3pp (95% CI 0.7pp to 3.8pp) increase in enrollees with FQHC visits and a 1.3pp (95% CI -2.3pp to -0.3pp) decrease in enrollees with non-emergent ED visits, but no significant change in emergent ED visits (0.3pp, 95% CI -0.8pp to 1.4pp). Conclusions We found that areas exposed to greater FQHC funding increases had more growth in the number of enrollees seen by FQHCs and greater reductions in ED visits for non-emergent conditions. Investment in FQHCs could be a promising approach to increase access to care for underserved populations and reduce costly ED visits, especially for primary care treatable or non-emergent conditions.

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Access to Federally Qualified Health Centers and Emergency Department Use Among Uninsured and Medicaid‐insured Adults: California, 2005 to 2013

Cited by 13 publications

References 28 publications

Health center use and hospital‐based care among individuals dually enrolled in Medicare and Medicaid, 2012–2018

Health center use and hospital‐based care among individuals dually enrolled in Medicare and Medicaid, 2012–2018

Psychiatric Emergency Department Visits After Regional Expansion of Community Health Centers

The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts

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