title: Younger Dual-Eligibles Who Use Federally Qualified Health Centers Have More Preventable Emergency Department Visits, but Some Have Fewer Hospitalizations.
abstract: OBJECTIVE
  To determine whether younger dual-eligibles receiving care at federally qualified health centers (FQHCs) have lower rates of ambulatory care sensitive (ACS) hospitalization and emergency department (ED) visits.
  
  
  METHODS
  We used the 100% Medicare Part A and Part B institutional claims from 2007 to 2010 for dual-eligibles younger than 65 years, enrolled in traditional fee-for-service Medicare, who received care at an FQHC or lived in a primary care service area with an FQHC.
  
  
  METHODS
  Our cross-sectional analysis used negative binomial regressions to model ACS hospitalizations and ED visits as a function of prior year FQHC use. The model adjusted for beneficiary age, gender, race, and chronic diseases, as well as county fixed effects, time trends, and race-FQHC use interactions.
  
  
  RESULTS
  FQHC use is associated with a decrease in ACS hospitalization rates for whites (2.8 per 1000 persons), but an increase among blacks (2.5 per 1000 persons). FQHC use is also associated with an increase in ACS ED visits, from 27 to 33 more visits per 1000 persons per year, depending on patient race.
  
  
  CONCLUSIONS
  ACS hospital use is higher for FQHC users than nonusers, but white FQHC users have fewer ACS hospitalizations. More research is needed to understand how this relationship varies within and between centers.
authors.affiliation: 1 University of Iowa, Iowa City, IA, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Potter
authors.affiliation: 2 Brown University, Providence, RI, USA.|3 Providence Veterans Affairs Medical Center, Providence, RI, USA.
authors.forename: Amal N
authors.initials: AN
authors.lastname: Trivedi
authors.affiliation: 1 University of Iowa, Iowa City, IA, USA.
authors.forename: Brad
authors.initials: B
authors.lastname: Wright
keywords: ambulatory care sensitive conditions; emergency department; federally qualified health center; hospitalization; younger dual-eligibles