Performance Improvement 1999. Community Health Centers and National Health Service Corps

02/01/1999

TITLE: Construction and Pretest of the Year 2000 User/Visit Survey

ABSTRACT: In 1997, the Health Resources and Services Administration (HRSA) completed a study (PIC ID 5737) to obtain nationally representative data about the users of Community Health Centers (CHCs) and the services provided to them. This study permitted a comparison of the CHC estimates with estimates derived from the National Health Interview Survey and the National Ambulatory Medical Care Survey administered by the National Center for Health Statistics (NCHS). The current study is developing the sampling frame and revising and pilot testing questionnaires in preparation for a second User/Visit Survey in the year 2000. The year 2000 survey will be the first in which information will be collected on National Health Service Corps (NHSC) users and visits. The HRSA's intent is to conduct this survey every few years to evaluate change over time within the CHC and NHSC programs, and in comparison with the general U.S. population as reflected in the NCHS estimates. Findings from the year 2000 survey itself will be used to measure program performance as required by the Government Performance and Results Act (GPRA).

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Jerrilynn Regan

PHONE NUMBER: 301-594-4280

PIC ID: 7128

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC

PROJECTED DATE OF COMPLETION: 9/30/99
 

TITLE: Effect of Medicaid Managed Care Beneficiary Enrollment and Autoassignment Practices on FQHCs and Their Patients

ABSTRACT: Under most Medicaid managed care programs, beneficiaries who do not select a plan are automatically assigned to one. This study is describing the impact of enrollment and autoenrollment (automatic assignment) policies and practices under mandatory Medicaid managed care on federally qualified health centers (FQHCs), FQHC networks and plans, and their patients. Autoenrollment practices are of interest to the Health Resources and Services Administration (HRSA) because of their possible implications for cultural and linguistic competence of providers, and for existing patient/provider relationships. This study is reviewing autoenrollment rates experienced across the U.S. in Medicaid waiver programs, and is examining Medicaid service areas where FQHCs have experienced high levels of patient dislocation due to State autoassignment and enrollment policies. Potential uses of the findings are: (1) to improve the accuracy and helpfulness of information on plans and providers given to beneficiaries, so that they will be better able to choose a plan; (2) develop strategies for improving the enrollment process; (3) identify common interests among the States, managed care plans, FQHCs and beneficiaries; and (4) generate collaborative problem solving between public and private policymakers.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Dana Jones

PHONE NUMBER: 301-594-4058

PIC ID: 6803

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/31/99
 

TITLE: Evaluation of the Effectiveness and Impact of Community and Migrant Health Centers: Implementation Phase

ABSTRACT: This comprehensive evaluation of the effectiveness and impact of Community Health Centers (CHCs), begun in 1994, has two components. The content of care component will assess CHC clinical performance and suggest indicators of targets of opportunity for improving patient health status. The Medicaid analysis portion of the study is using Medicaid claims data from seven States (one with Medicaid managed care) to examine three questions: (1) Is there a difference in case mix between Medicaid beneficiaries using CHCs and beneficiaries using other providers of primary care? (2) Are there differences in utilization and expenditures between CHC users and non-users, and what is the effect of adjusting for case mix on these differences? (3) How do CHC characteristics contribute to differences in use and expenditures among CHC users? The findings from this study will identify opportunities and challenges for health centers in both fee-for-service and managed care settings. (See PIC ID 4918)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Elizabeth Darling

PHONE NUMBER: 301-594-4308

PIC ID: 4918.1

PERFORMER ORGANIZATION: MDS Associates, Inc., Wheaton, MD

PROJECTED DATE OF COMPLETION: 8/31/99
 

TITLE: Evaluation of the Relationship Between Enabling Services and Patient Access and Outcomes

ABSTRACT: Community and Migrant Health Centers (C/MHCs) provide extensive enabling services to facilitate access to care for vulnerable populations. These services, which include transportation, translation, case management, health education, nutrition counseling and outreach, are not typically reimbursed under managed care. The purpose of this study is to analyze the types and levels of enabling services provided by C/MHCs, how these services have changed over time, and whether enabling services improve outcomes and reduce costs. Study findings will be used to inform national program expectations and to guide C/MHCs in structuring their enabling services to maximize access to primary care and preventive services.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Vilma Cokkinides, Ph.D.

PHONE NUMBER: 301-594-3730

PIC ID: 7126

PERFORMER ORGANIZATION: MDS Associates, Inc., Wheaton, MD

PROJECTED DATE OF COMPLETION: 12/15/99
 

TITLE: Health Status Outcomes for the Bureau of Primary Health Care: A Pilot Study Assessing Physiologic Measures Through Medical Record Review

ABSTRACT: Through a review of medical records, this study will assess changes in health status among a sample of adult patients of Community Health Centers (CHCs). The conditions selected for evaluation are hypertension and diabetes mellitus. The methodology addresses: (1) the definition of a CHC "user"; (2) confirmation of a diagnosis; (3) patient stratification by severity and/or onset of the condition; (4) expected attrition rates; (5) inclusion of insurance/payer status as a control variable; (6) the time frame in which the two conditions will be measured; (7) protocol for sampling medical records; (8) development of an index of co-morbidities; (9) preparation of a taxonomy of CHC site characteristics; and (10) the appropriate instrument for extracting pertinent data. This project continues the HRSA's systematic effort to identify health status outcomes that may be used to measure the effectiveness of primary care programs.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Barbara Wells, Ph.D.

PHONE NUMBER: 301-594-4463

PIC ID: 6802

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 10/31/99
 

TITLE: Health Status Outcome Measures for the Bureau of Primary Health Care: Examination of Episodes of Care for Diabetes, Hypertension, Asthma and Other Ambulatory Care Sensitive Conditions Using State Medicaid Research Files

ABSTRACT: A consensus conference in December, 1995 recommended the use of Medicaid data to examine changes in utilization patterns for Community Health Center (CHC) patients diagnosed with ambulatory care sensitive conditions (ACSC). These are conditions which frequently can be managed with timely and effective treatment in outpatient settings, thus preventing the need for hospitalization. The purpose of this study is to compare episodes of ambulatory care for CHC users to those of non-CHC users when both have been hospitalized with a primary diagnosis of diabetes, hypertension, asthma, or other ACSC, as well as when neither has been hospitalized. A previous study (See PIC ID 6001) showed that Medicaid beneficiaries who received most of their care from CHCs had a lower hospitalization rate for ACSCs than did non-CHC users. Findings of the current study will improve understanding as to why CHC users experience lower hospitalization rates for ACSCs, and may have different patterns of ambulatory care use. Findings should also identify the major strengths and limitations of the State Medicaid Research Files for examining episodes of care for a comparison of CHC users and non-CHC users.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Barbara Wells, Ph.D.

PHONE NUMBER: 301-594-4463

PIC ID: 7127

PERFORMER ORGANIZATION: MDS Associates, Inc., Wheaton, MD

PROJECTED DATE OF COMPLETION: 6/30/00