title: Characteristics and Service Use of Medicare Beneficiaries Using Federally Qualified Health Centers.
abstract: BACKGROUND
  Federally Qualified Health Centers (FQHCs) provide primary care for millions of Americans, but little is known about Medicare beneficiaries who use FQHCs.
  
  
  OBJECTIVE
  To compare patient characteristics and health care service use among Medicare beneficiaries stratified by FQHC use.
  
  
  METHODS
  Cross-sectional analysis of 2011 Medicare fee-for-service beneficiaries aged 65 years and older.
  
  
  METHODS
  Subjects included beneficiaries with at least 1 evaluation and management (E&M) visit in 2011, categorized as FQHC users (≥1 E&M visit to FQHCs) or nonusers living in the same primary care service areas as FQHC users. Users were subclassified as predominant if the majority of their E&M visits were to FQHCs.
  
  
  METHODS
  Demographic characteristics, physician visits, and inpatient care use.
  
  
  RESULTS
  Most FQHC users (56.6%) were predominant users. Predominant and nonpredominant users, compared with nonusers, markedly differed by prevalence of multiple chronic conditions (18.2%, 31.7% vs. 22.7%) and annual mortality (2.8%, 3.8% vs. 4.0%; all P<0.05). In adjusted analyses (reference: nonusers), predominant users had fewer physician visits (RR=0.81; 95% CI, 0.81-0.81) and fewer hospitalizations (RR=0.84; 95% CI, 0.84-0.85), whereas nonpredominant users had higher use of both types of service (RR=1.18, 95% CI, 1.18-1.18; RR=1.09, 95% CI, 1.08-1.10, respectively).
  
  
  CONCLUSIONS
  Even controlling for primary care delivery markets, nonpredominant FQHC users had a higher burden of chronic illness and service use than predominant FQHC users. It will be important to monitor Medicare beneficiaries using FQHCs to understand whether primary care only payment incentives for FQHCs could induce fragmented care.
authors.affiliation: *The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover †Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Chiang-Hua
authors.initials: CH
authors.lastname: Chang
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Lewis
authors.forename: Ellen
authors.initials: E
authors.lastname: Meara
authors.forename: Jon D
authors.initials: JD
authors.lastname: Lurie
authors.forename: Julie P W
authors.initials: JP
authors.lastname: Bynum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003151:Community Health Centers / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003710:Demography; D018588:Fee-for-Service Plans; D005260:Female; D005102:Health Expenditures; D006296:Health Services; D006801:Humans; D008297:Male; D006278:Medicare; D011320:Primary Health Care; D014481:United States