Differences in Rates of High-Value and Low-Value Care Between Community Health Centers and Private Practices

被引:11
作者
Oronce, Carlos Irwin A. [1 ,2 ,3 ]
Fortuna, Robert J. [4 ,5 ,6 ]
机构
[1] VA Greater Los Angeles Healthcare Syst, Los Angeles, CA USA
[2] Univ Calif Los Angeles, Natl Clinician Scholars Program, 1100 Glendon Ave Ste 900, Los Angeles, CA 90034 USA
[3] Univ Calif Los Angeles, Div Gen Internal Med & Hlth Serv Res, 1100 Glendon Ave Ste 900, Los Angeles, CA 90034 USA
[4] Univ Rochester, Med Ctr, Dept Med, Rochester, NY 14642 USA
[5] Univ Rochester, Med Ctr, Dept Pediat, Rochester, NY 14642 USA
[6] Univ Rochester, Med Ctr, Ctr Primary Care, Culver Med Grp, Rochester, NY 14642 USA
关键词
high-value care; low-value care; quality of care; community health centers; federally qualified health centers; QUALITY-OF-CARE; AMBULATORY-CARE; PERFORMANCE; TRENDS; ASSOCIATION; MANAGEMENT; OWNERSHIP; SERVICES;
D O I
10.1007/s11606-019-05544-z
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background Community health centers (CHCs) are an integral part of the health care safety net. As health systems seek to improve value, it is important to understand the quality of care provided by CHCs. Objective To evaluate the performance of CHCs compared with private practices on a comprehensive set of high-value and low-value care measures. Design This cross-sectional study used data from the National Ambulatory Medical Care Survey from 2010 through 2012. We compared CHCs with private practices using logistic regression models that adjusted for age, sex, race/ethnicity, insurance, number of chronic illnesses, rural versus urban location, region of country, and survey year. Setting/Participants We included outpatient visits to generalist physicians at either CHCs or private practices by patients 18 years and older. Main Measures We examined 12 measures of high-value care and 7 measures of low-value care. Results A total of 29,155 physician visits, representing 584,208,173 weighted visits, from 2010 through 2012 were included. CHCs were more likely to provide high-value care by ordering beta-blockers in CHF (46.9% vs. 36.5%; aOR 2.56; 95%CI 1.18-5.56), statins in diabetes (37.0% vs 35.5%; aOR 1.35; 95%CI 1.02-1.79), and providing treatment for osteoporosis (35.7% vs 23.2%; aOR 1.77; 95%CI 1.05-3.00) compared with private practices. CHCs were more likely to avoid low-value screening EKGs (98.7% vs. 88.0%; aOR 11.03; 95%CI 2.67-45.52), CBCs (75.9% vs. 65.7%; aOR 1.72; 95%CI 1.18-2.53), or urinalyses (86.0% vs. 80.5%; aOR 1.87; 95%CI 1.11-3.14) during a general medical exam. CHCs were also less likely to prescribe antibiotics for a URI (48.3% vs. 63.1%; aOR 0.59; 95%CI 0.40-0.88). Conclusions On a number of high-value and low-value measures of care, CHCs performed similar to or better than private practices. As healthcare delivery reforms continue to progress, CHCs are well positioned to provide high-value healthcare.
引用
收藏
页码:994 / 1000
页数:7
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