Federally Qualified Health Centers and Care for Vulnerable Populations

联邦合格的健康中心和弱势群体护理

• 批准号: 9926776
• 负责人: Vicki Fung
• 金额: $ 31.81万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9926776
• 关键词: Federally; Qualified; Health; Centers; Care

The Patient Protection and Affordable Care Act (ACA) substantially increased federal funding for federally qualified health centers (FQHCs), providing $11 billion from 2011 to 2015 to expand existing FQHCs and establish new health centers. The goal of this funding was to bolster the supply of primary care in underserved areas to meet some of the anticipated increases in demand for care associated with ACA insurance coverage expansion, particularly among lower-income Americans. Millions of lower-income Americans gained coverage starting in 2014 due to Medicaid expansion and the provision of low-income subsidies for marketplace coverage. To date, however, there is little evidence on whether funding increases for FQHCs are associated with improvements in care or outcomes for the communities they serve. We will examine the effects of changes in federal FQHC funding on three sets of outcomes: 1) outpatient care, including primary and specialty care visits, sources of care (e.g., FQHC vs. non-FQHC), and sentinel preventive care quality measures; 2) downstream clinical events, including emergency department visits (for emergent and non- emergent conditions), hospitalizations (overall and for ambulatory care sensitive conditions), and mortality; and 3) total and component spending (e.g., outpatient, inpatient, pharmacy). We will focus on the experience on Medicaid beneficiaries because they were a central focus of the policy and because we are able to examine comprehensive, beneficiary-level claims data on utilization, diagnoses, and spending over time, and across sites of care for this population. We will use a staggered implementation design with a dose-response model (where dose is determined by the amount of funding) to compare changes in outcomes for beneficiaries living in areas that received larger vs. smaller increases in per capita federal FQHC funding. Because funding levels could be associated with the baseline capacity or quality of the FQHCs, we will use a fixed effects estimation approach to account for unmeasured time-invariant differences across individuals, FQHCs, and local areas. We will also adjust for a range of time-changing covariates to reflect potential changes in individual- (e.g., comorbidities) or area-level demand for care (e.g., insurance coverage mix), as well as area- level provider supply using linked datasets (e.g., American Community Survey). We will examine separately the experiences of: 1) beneficiaries who were continuously eligible for Medicaid (categorically needy), before and after the funding increases (2007-2017); and 2) beneficiaries newly eligible for Medicaid in 2014 (adults with incomes <138% FPL) over the period 2014-2017, during which time there is ongoing variation in FQHC funding. The ACA's Community Health Center Fund was extended in 2016-2017 at $7.2 billion; however, funding after 2017 is uncertain. This study will provide the first information on the effects of changes in FQHC funding during a dynamic period of coverage expansion to provide actionable evidence for policymakers seeking effective and efficient approaches for improving care access and outcomes for vulnerable populations.

《患者保护和负担得起的护理法》（ACA）大大增加了联邦联邦资金 合格的卫生中心（FQHC），从2011年到2015年提供110亿美元，以扩大现有的FQHC和 建立新的卫生中心。这笔资金的目的是加强服务不足的初级保健的供应 满足与ACA保险覆盖范围相关的一些预期对护理需求的预期增加的领域 扩张，特别是在低收入美国人中。数百万的低收入美国人获得了报道 从2014年开始，由于医疗补助的扩张和市场提供低收入补贴 覆盖范围。但是，迄今为止，几乎没有证据表明FQHC是否增加了资金 随着他们所服务的社区的护理或成果的改善。我们将研究 联邦FQHC资金的变化在三组结果上：1）门诊护理，包括初级和 专业护理访问，护理来源（例如FQHC与非FQHC）和前哨预防护理质量 措施； 2）下游临床事件，包括急诊室就诊（针对紧急和非 - 紧急情况），住院（总体和卧床护理敏感条件）和死亡率；和 3）总支出和组件支出（例如门诊，住院，药房）。我们将专注于经验 医疗补助受益人是因为他们是政策的核心重点，并且因为我们能够检查 全面的，受益人级的索赔数据随着时间的流逝以及跨越的利用，诊断和支出的数据 为该人群的护理场所。我们将使用带剂量反应的交错实现设计 模型（剂量由资金数量确定），以比较受益人结果的变化 居住在人均联邦FQHC资金中获得较大的地区，而较小的人均增加。因为资金 水平可能与FQHC的基线能力或质量有关，我们将使用固定效果 估算方法以说明个人，FQHC和 当地。我们还将调整一系列改变时间的协变量，以反映潜在的变化 个人 - （例如合并症）或面积级别的护理需求（例如，保险范围）以及面积 使用链接的数据集（例如，美国社区调查）的水平提供商供应。我们将单独检查 以下经验：1）在不断符合医疗补助的受益人（绝对需要） 在资金增加之后（2007-2017）； 2）受益人在2014年刚获得医疗补助的受益人（成人 收入<138％fpl）在2014-2017期间，在此期间，FQHC正在持续差异 资金。 ACA的社区健康中心基金于2016 - 2017年延长了72亿美元；然而， 2017年以后的资金尚不确定。这项研究将提供有关FQHC变化影响的第一个信息 在覆盖范围扩展的动态期间的资金，为决策者提供可行的证据 寻求有效，有效的方法来改善弱势群体的护理访问和结果。