Federally qualified health centers and private practice performance on ambulatory care measures.
BACKGROUND
The 2010 Affordable Care Act relies on Federally Qualified Health Centers (FQHCs) and FQHC look-alikes (look-alikes) to provide care for newly insured patients, but ties increased funding to demonstrated quality and efficiency.


OBJECTIVE
To compare FQHC and look-alike physician performance with private practice primary care physicians (PCPs) on ambulatory care quality measures.


METHODS
The study was a cross-sectional analysis of visits in the 2006-2008 National Ambulatory Medical Care Survey. Performance of FQHCs and look-alikes on 18 quality measures was compared with private practice PCPs. Data analysis was completed in 2011.


RESULTS
Compared to private practice PCPs, FQHCs and look-alikes performed better on six measures (p<0.05); worse on diet counseling in at-risk adolescents (26% vs 36%, p=0.05); and no differently on 11 measures. Higher performance occurred in ACE inhibitors use for congestive heart failure (51% vs 37%, p=0.004); aspirin use in coronary artery disease (CAD; 57% vs 44%, p=0.004); β-blocker use for CAD (59% vs 47%, p=0.01); no use of benzodiazepines in depression (91% vs 84%, p=0.008); blood pressure screening (90% vs 86%, p<0.001); and screening electrocardiogram (EKG) avoidance in low-risk patients (99% vs 93%, p<0.001). Adjusting for patient characteristics yielded similar results, except that private practice PCPs no longer performed better on any measures.


CONCLUSIONS
FQHCs and look-alikes demonstrated equal or better performance than private practice PCPs on select quality measures despite serving patients who have more chronic disease and socioeconomic complexity. These findings can provide policymakers with some reassurance as to the quality of chronic disease and preventive care at Federally Qualified Health Centers and look-alikes, as they plan to use these health centers to serve 20 million newly insured individuals.
Department of Medicine, University of California San Francisco, 94110, USA. legoldman@medsfgh.ucsf.edu
L Elizabeth
LE
Goldman
Philip W
PW
Chu
Huong
H
Tran
Max J
MJ
Romano
Randall S
RS
Stafford
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D058007:Physicians, Primary Care / Q000458:organization & administration / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards; D011331:Private Practice / Q000458:organization & administration / Q000592:standards; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D055815:Young Adult