Change in geographic access to community health centers after Health Center Program expansion

Abstract

Objective To examine geographic access to community health centers (CHC accessibility) before and after Health Center Program expansion in three Southern states. Data Sources Community health center data were from the Health Resources and Services Administration (1967‐2016). Population estimates and sociodemographic characteristics were from the American Community Survey (2006‐2015). Study Design We used the two‐step floating catchment area method to calculate CHC accessibility for census tracts in 2008 and 2016. We mapped census tract‐level variation and used spatial regression to assess to what extent indicators of potential CHC need were associated with change in accessibility from 2008 to 2016. Principal Findings Community health center accessibility increased by 192 percent overall, and the proportion of tracts with no accessibility decreased by 65 percent. Indicators of potential need were not associated with greater gains in CHC accessibility from 2008 to 2016, but census tracts with less accessibility at baseline saw larger accessibility increases. Conclusions Community health center accessibility substantially increased from 2008 to 2016, but increases did not differentially impact groups with greater potential need. This approach for measuring CHC accessibility offers significant improvement in granularity over traditional CHC accessibility measures.

Concept Analysis and Proposed Definition ofCommunity Health Center

“…1,10,17,42,50,56,[61][62][63] In the United States, the primary mandate of FQHCs is to provide access to care for individuals with financial barriers. 1,2,8,22,42,49,50,[64][65][66] The second context for accessibility was of a temporal nature that accounted for ability of clients to schedule appointments with providers in a timely manner, and included factors such as hours of operation, scheduling, and waiting times. 16,17,22,55,61 The third context was of a resource nature, namely the availability of appropriate care providers, services, and resources to meet specific client needs.…”

“…7,35,37,42,68,69 The fourth context was the ability of clients to physically access CHCs due to factors such as logistics of transportation, physical limitations, and socioeconomic factors. 1,10,12,35,49,50,65 Several articles offered solutions to enhance accessibility to care, such as locating required programs in neighborhoods with high-risk populations, providing outreach programs, and increasing ambulatory care services. 1,7,8,20,28,67 Preventative care.…”

“…We identified a range of quantitative and qualitative methods to measure, evaluate, or compare empirical referents of CHCs, including validated tools, surveys, chart audits, analysis of databases, interviews, and observations. 33,35,54,58,60,62,[64][65][66][67]82,83 Two main examples of empirical referents in our literature search were for primary care and accessibility. Primary care was the most commonly evaluated attribute of CHCs for a wide variety of dimensions including service utilization, health outcomes, client satisfaction, and so forth.…”

“…46,62,76 Accessibility was another frequently evaluated attribute, and often evaluated in situations where CHCs had a specific mandate to serve specific communities or populations; this was particularly evident for agencies, such as FQHCs, whose funding might be tied to demonstrating benchmark criteria such as demographics of clients, availability of providers, and location of the CHC and associated services. 22,65,76 Aspects such as flexibility in scheduling appointments, wait time, and availability of after hour appointments were used as empirical references to determine accessibility to CHCs. 22,27,55,83 The relationship of accessibility to client satisfaction or service utilization demonstrated other empirical referents for CHCs, including the impact of interactions between clients and providers.…”

“…), and/or cultural considerations. 7,8,18,20,35,49,56,62,64,65,72 Often in these situations, CHCs were designed to provide comprehensive services for populations that have poor health outcomes "with medically and socially complex issues that are not served well by traditional health services" 7 (p. 26). Other specific populations served by CHCs included women and children, older adults, the LGBTQ populations, and individuals residing in rural settings.…”