Performance Improvement 2000. Community Health Centers

01/01/2000

Assessment of Domestic Violence Interventions and Staff Training Protocols in Community-Based Primary Care Health Care Settings

The purposes of this study are to examine a) the characteristics/components of the domestic violence protocols used in HRSA-funded community-based primary health care centers; b) the effect that these protocols have on the reporting of violence, clinical diagnoses, and referrals to local community services among female clients; and c) how other BPHC-funded programs can develop domestic violence interventions in their organizations and communities. Health providers often treat abused women without recognizing or addressing the underlying causes of their health condition. A 1995 survey of 10 BPHC-funded primary health care sites found that only half had a formal tool for assessing domestic violence. This study will analyze time series data to compare the effects of incorporating a protocol on domestic violence. Statistical analysis will control for sociodemographic characteristics and other known confounders. In-depth telephone interviews will be conducted with health care center staff (protocol developers, trainers, and key program coordinators). Documentation, screening, and reporting procedures will be reviewed. Training and referral strategies will be analyzed. Nine sites will be selected for study based on a comprehensive literature review of domestic violence interventions during the past five years. A Steering Committee for Family and Intimate Partner Prevention Violence, comprised of HRSA staff, will provide advice on methods.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Shannon, Kathleen
301-594-3621

PIC ID: 7284

PERFORMER: North American Management Company
Alexandria, VA

EXPECTED DATE OF COMPLETION: 09/19/2000

Determinants of Change in Health Center Revenues, Service Capacity, and Payor Mix at the Marketplace Level

The purpose of this study is to examine the impact of changes in environmental and management factors in the health care system on the revenues, service capacity, and payor mix of Community Health Centers (CHCs). A previous study found that nationally, Medicaid users have decreased, uninsured users have increased, and Medicaid revenues per user have decreased somewhat. This study will explore CHC-specific data in selected areas of the country. Independent variables to be studied include the percentage of Medicaid recipients in managed care and the overall managed care penetration; the percentage and growth of uninsured; the number and nature of HMOs providing Medicaid services; the safety net provider capacity; Medicaid enrollment; patient access/satisfaction; participation in integrated delivery systems and networks; extent of CHC participation in managed care and; CHC performance (based on nine measures used in BPHC's health center reinvestment process). Data will be drawn from the 12 areas in the RWJ Community tracking study, complemented by BPHC Market Place Analysis information for 4-5 areas. Relevant State Insurance Department and State Hospital Association data, and the Dartmouth Atlas will be reviewed. Data for CHCs will be drawn from BPHC's Uniform Data System.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Regan, Jerrilynn
301-594-4283

PIC ID: 6784

PERFORMER: Zuvekas, Ann, Consultant
Annandale, VA

EXPECTED DATE OF COMPLETION: 09/30/2000

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

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: Darling, Elizabeth
301-594-4308

PIC ID: 4918.1

PERFORMER: MDS Associates, Inc.
Wheaton, MD

EXPECTED DATE OF COMPLETION: 11/30/1999

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

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: Butler, Fred, Jr.
301-549-4281

PIC ID: 7126

PERFORMER: MDS Associates, Inc.
Wheaton, MD

EXPECTED DATE OF COMPLETION: 10/29/1999

Health Care Status Outcome Measures for the Bureau of Primary Health Care: The Assessment of Ambulatory Care Sensitive Conditions Through State Medicaid Research Files

This project will compare the relative risk of inpatient hospitalizations for Community Health Center (CHC) users with non- CHC users for ambulatory care sensitive conditions. Ambulatory care sensitive conditions are those considered preventable, treatable, or controllable in an outpatient setting. The project will design and test a methodology using selected areas in selected states from the newly available State Medicaid Research Files (SMRF). Major research questions for the study include: (1) the best methodological design to assess relative risk of inpatient hospitalizations for selected ambulatory conditions; (2) the relative risk of inpatient hospitalizations.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Wells, Barbara, Ph.D.
301-594-4463

PIC ID: 6364

PERFORMER: MDS Associates, Inc.
Wheaton, MD

EXPECTED DATE OF COMPLETION: 06/30/1999

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

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 (ACSCs). 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 ACSCs, 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 lower hospitalization rates 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: Wells, Barbara, Ph.D.
301-594-4463

PIC ID: 7127

PERFORMER: MDS Associates, Inc.
Wheaton, MD

EXPECTED DATE OF COMPLETION: 06/30/2000

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

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 review will address: (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: Wells, Barbara, Ph.D.
301-594-4463

PIC ID: 6802

PERFORMER: The Lewin Group
Fairfax, VA

EXPECTED DATE OF COMPLETION: 10/31/1999

Impact of Publicly Funded Insurance Programs on Pediatric Safety -Net Providers

The purposes of this study are to a) describe the relationship between characteristics of publicly- funded programs and the survival/financial viability of pediatric safety-net providers; b) determine the differential effects of Medicaid Managed Care (MMC) and the implementation of the State Children's Health Insurance Program (S-CHIP) for pediatric safety-net hospitals relative to pediatric Federally Qualified Health Centers (FQHCs); c) investigate institutional and organizational factors among pediatric safety-net providers; and d) examine the success and failures that these providers have experienced in confronting changes in their community. Improved understanding of the impact of major policy changes on the viability of community pediatric safety-net health care providers can facilitate program strategies to lessen adverse consequences for vulnerable children. Case studies and interviews will be conducted to examine changes in the financial status of these institutions. A logistic regression model will be used to estimate the impact of hospital, market, and policy factors on closure of safety-net providers. Hospital cost, revenue, and profit equations will be estimated using a fixed effects regression model.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Collins, Felicia L.
301-594-3732

PIC ID: 6039

PERFORMER: Northwestern University, Institute for Health Services Research and Policy Studies
Evanston IL

EXPECTED DATE OF COMPLETION: 09/30/2002

Year 2000 Community Health Center and National Health Service Corps User/Visit Survey

The purpose of this study is to conduct: 1) a personal interview survey of users of Community Health Center/Maternal and Child Bureau sites; 2) a separate record-based study of visits to these sites; and 3) a pilot test of the feasibility of a prospective sampling strategy for use in the Community Health Center and National Health Service Corps User/Visit Survey. The user and visit survey will provide in-depth information about the socio-demographic characteristics of users, their risk behaviors and health status, the reasons they seek care, most frequent diagnoses, satisfaction with care, monitoring of chronic conditions, and the services used in a medical encounter. Attention will be paid to whether the sites provide care that meet or exceeds the Healthy People 2000 and 2010 national objectives. A sample of 50-60 grantee health centers and 15 non-grantee, freestanding sites will be selected, and a sample of 40-50 clients per center/site from medical records. Sampling from the 48 contiguous States will involve urban /rural and the West, Midwest, Northeast, and South Census regions. Questions will be taken from the National Health Interview Survey to allow comparisons with the national population. A retrospective sample of visits will be drawn to obtain a profile of the kinds of conditions treated and services provided.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Regan, Jerrilynn
301-594-4283

PIC ID: 6811

PERFORMER: Research Triangle Park
Research Park, NC

EXPECTED DATE OF COMPLETION: 04/30/2001