title: Do patients have a voice? The social stratification of health center governing boards.
abstract: BACKGROUND
  To ensure community responsiveness, federally qualified health centres (FQHCs) in the United States are required to be governed by a patient majority. However, to the extent that these patient trustees resemble the typical low-income patients served by FQHCs, status generalization theory suggests that they will be passed over for leadership positions within the board in favour of more prestigious individuals.
  
  
  METHODS
  Using 4 years of data on health centre governing boards obtained from the Health Resources and Services Administration via a Freedom of Information Act Request, the likelihood of holding executive committee office is modelled as a function of trustee characteristics using Chamberlain's conditional logistic regressions.
  
  
  RESULTS
  The results indicate that representative patient trustees are significantly less likely than other trustees to hold a position on the executive committee or serve as board chair.
  
  
  CONCLUSIONS
  Given the power of the board leadership to set the agenda, the reduced likelihood of representative patient trustees serving in leadership positions may ultimately limit the representative voice given to patients, making FQHCs potentially less responsive to their communities. These findings also have important implications for other settings where engaging and empowering patients is sought.
authors: Center for Gerontology and Healthcare Research, Brown University, Providence, RI, USA.
authors: Brad
authors: B
authors: Wright
mesh_terms: D006075:Governing Board / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D010358:Patient Participation / Q000379:methods / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014341:Trustees / Q000458:organization & administration / Q000706:statistics & numerical data; D014481:United States
keywords: FQHC; federally qualified health centres; patient governance; representation; social stratification