Description of Community Health Centers (CHCs) – Similar to federally qualified health centers (FQHCs) nationwide, the CHCs are located in high-need areas, open to all residents regardless of ability to pay, governed by community boards to assure responsiveness to local needs, and provide comprehensive health and related services.1
In addition, more than half the patients at each of the four CHCs have incomes at or below poverty level, and between 17% and 46% of the patients are uninsured (). Sites varied in size and geographic location. In 2004, the number of medical encounters by site was between 30,652 and 145,398. In addition, the composition of the AA&NHOPI patient population varied by site and by geographic location. The percentage of AA&NHOPI patients at the four CHCs was 82% compared to 3.2% at FQHCs nationwide.29
In addition, all of the three states (HI – 79%; NY – 7%; WA – 9%) where the CHCs were located had a higher total AA&NHOPI population proportionally in relation to the U.S. rate (5.1%) with Hawaii having the highest proportion of AA&NHOPIs nationally.30
The majority of patients at three sites spoke a primary language other than English, and at one site, the majority of patients were Native Hawaiian and spoke English as a primary language.
Health Center Characteristics (January 1, 2004 – December 31, 2004)
Utilization Trends of Enabling Services (ES) – Across the four sites, the number of ES provided at each CHC in 2004 ranged from 7,510 to 26,847 (). The average number of services per month was 1,335 per site and ranged from 626 to 2,237 services. On average, there were 2.7 services provided per patient. The average number of users per month was 519 per site, and ranged from 201 to 975 (). The average number of users was correlated with the number of providers and/or resources to provide ES. ES providers reported that patients usually required more than one service at each visit. The most common services across all four sites were eligibility assistance/financial counseling (36%), and interpretation services (29%), followed by case management assessment (9%) and health education/supportive counseling (9%).31
Financial counseling includes enrollment assistance for public insurance programs and linkage to drug discount programs.
The diversity of ES reflects the differing needs of the population that the CHC serves. A site with patients that have many different primary languages provided high levels of on-site interpretation services. A site with one dominant primary language has more bilingual providers, and thus, provided fewer on-site interpretation services. A site located in a community with few public transportation systems provided a high number of transportation services using their own van service.
The average length per enabling service encounter was 19.5 minutes across all four sites and services, and varied by type of service. Health education took the longest service time per encounter on average across all four sites (data not shown). For one site, eligibility assistance took the longest service time per encounter, on average.
Characteristics of Patients who Utilize Enabling Services (ES) –Between 61% and 69% of ES users were female, similar to the composition of CHC patients overall, and average age of ES users varied (). Sites also varied in AA&NHOPI subgroup composition as well as primary language, and reflected the characteristics of the overall CHC population. All AA&NHOPI subgroups utilized all types of ES. Some AA&NHOPI subgroups utilized interpretation more frequently, including Chinese, Vietnamese, Korean and Filipino patients.
ES users were predominantly covered by Medicaid (20% to 67%), or other type of public insurance, which included state insurance programs. There were also many uninsured ES users (18% to 40%).
Enabling Services (ES) Users vs. Non-Users – Based on unduplicated total individual patient demographic data (June 1, 2004–June 30, 2004) and total patient encounter data (June 1, 2003–June 30, 2004) for three out of four sites, we conducted analyses between characteristics of individual ES users and non-users and found significant differences by age, gender, ethnicity, and insurance type (p<.05) (). ES users were significantly more likely to be older, female, AA&NHOPI and uninsured than non-users. Multivariable logistic regression yielded similar associations between patient characteristics and ES utilization, after controlling for other factors (). After controlling for age, gender, insurance, and ethnicity, the proportion of total patient encounters by ES users and non-users with chronic and acute conditions was not significantly different (). For both groups by total patient encounters, diabetes was the most common chronic condition, and ear, nose, and throat infections were the most common acute condition (). Patients with diagnoses of acute conditions were more likely to use eligibility assistance services than those with chronic conditions (p<.05) (data not shown).
Patient Demographics of Enabling Service Users and Non-Enabling Service Users (June 1, 2004 – June 30, 2004)****
Patient Characteristics Independently Associated with Enabling Services*****
Chronic and Acute Ambulatory Care Sensitive Conditions of Patient Encounters by Enabling Services Users and Non-Users*