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Change in geographic access to community health centers after Health Center Program expansion.

ABSTRACT: OBJECTIVE:To examine geographic access to community health centers (CHC accessibility) before and after Health Center Program expansion in three Southern states. DATA SOURCES:Community health center data were from the Health Resources and Services Administration (1967-2016). Population estimates and sociodemographic characteristics were from the American Community Survey (2006-2015). STUDY DESIGN:We used the two-step floating catchment area method to calculate CHC accessibility for census tracts in 2008 and 2016. We mapped census tract-level variation and used spatial regression to assess to what extent indicators of potential CHC need were associated with change in accessibility from 2008 to 2016. PRINCIPAL FINDINGS:Community health center accessibility increased by 192 percent overall, and the proportion of tracts with no accessibility decreased by 65 percent. Indicators of potential need were not associated with greater gains in CHC accessibility from 2008 to 2016, but census tracts with less accessibility at baseline saw larger accessibility increases. CONCLUSIONS:Community health center accessibility substantially increased from 2008 to 2016, but increases did not differentially impact groups with greater potential need. This approach for measuring CHC accessibility offers significant improvement in granularity over traditional CHC accessibility measures.

SUBMITTER: Evans L

PROVIDER: S-EPMC6606545 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Change in geographic access to community health centers after Health Center Program expansion.

Evans Leigh L Charns Martin P MP Cabral Howard J HJ Fabian M Patricia MP

Health services research 20190401 4

<h4>Objective</h4>To examine geographic access to community health centers (CHC accessibility) before and after Health Center Program expansion in three Southern states.<h4>Data sources</h4>Community health center data were from the Health Resources and Services Administration (1967-2016). Population estimates and sociodemographic characteristics were from the American Community Survey (2006-2015).<h4>Study design</h4>We used the two-step floating catchment area method to calculate CHC accessibi ...[more]

PMID: 30937888

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Project description:The U.S. Preventive Services Task Force has released new guidelines on obesity, urging primary care physicians to provide obese patients with intensive, multi-component behavioral interventions. However, there are few studies of weight loss in real world nonacademic primary care, and even fewer in largely racial/ethnic minority, low-income samples.To evaluate the recruitment, intervention and replications costs of a 2-year, moderate intensity weight loss and blood pressure control intervention.A comprehensive cost analysis was conducted, associated with a weight loss and hypertension management program delivered in three community health centers as part of a pragmatic randomized trial.Three hundred and sixty-five high risk, low-income, inner city, minority (71 % were Black/African American and 13 % were Hispanic) patients who were both hypertensive and obese.Measures included total recruitment costs and intervention costs, cost per participant, and incremental costs per unit reduction in weight and blood pressure.Recruitment and intervention costs were estimated $2,359 per participant for the 2-year program. Compared to the control intervention, the cost per additional kilogram lost was $2,204 /kg, and for blood pressure, $621 /mmHg. Sensitivity analyses suggest that if the program was offered to a larger sample and minor modifications were made, the cost per participant could be reduced to the levels of many commercially available products.The costs associated with the Be Fit Be Well program were found to be significantly more expensive than many commercially available products, and much higher than the amount that the Centers for Medicare and Medicaid reimburse physicians for obesity counseling. However, given the serious and costly health consequences associated with obesity in high risk, multimorbid and socioeconomically disadvantaged patients, the resources needed to provide interventions like those described here may still prove to be cost-effective with respect to producing long-term behavior change.

Project description:ImportanceUse of effective contraception decreases unintended pregnancy. It is not known whether Medicaid expansion under the Affordable Care Act increased use of contraception for women who are underserved in the US health care safety net.ObjectiveTo evaluate the association of Medicaid expansion under the Affordable Care Act with changes in use of contraception among patients at risk of pregnancy at US community health centers, with the hypothesis that Medicaid expansion would be associated with increases in use of the most effective contraceptive methods (long-acting reversible contraception).Design, setting, and participantsThis was a participant-level retrospective cross-sectional study comparing receipt of contraception before (2013) vs immediately after (2014) and a longer time after (2016) Medicaid expansion. Electronic health record data from a clinical research network of community health centers across 24 states were included. The sample included all female patients ages 15 to 44 years at risk for pregnancy, with an ambulatory care visit at a participating community health center during the study period (315 clinics in expansion states and 165 clinics in nonexpansion states).ExposuresMedicaid expansion status (by state).Main outcomes and measuresTwo National Quality Forum-endorsed contraception quality metrics, calculated annually: the proportion of women at risk of pregnancy who received (1) either a moderately effective or most effective method (hormonal and long-acting reversible contraception) methods and (2) the most effective method (long-acting reversible contraception).ResultsThe sample included 310 132 women from expansion states and 235 408 women from nonexpansion states. The absolute adjusted increase in use of long-acting reversible contraceptive methods was 0.58 (95% CI, 0.13-1.05) percentage points greater among women in expansion states compared with nonexpansion states in 2014 and 1.19 (95% CI, 0.41-1.96) percentage points larger in 2016. Among adolescents, the association was larger, particularly in the longer term (2014 vs 2013: absolute difference-in-difference, 0.80 [95% CI, 0.30-1.30] percentage points; 2016 vs 2013: absolute difference, 1.79 [95% CI, 0.88-2.70] percentage points). Women from expansion states who received care at a Title X clinic had the highest percentage of women receiving most effective contraceptive methods compared with non-Title X clinics and nonexpansion states.Conclusions and relevanceIn this study, Medicaid expansion was associated with an increase in use of long-acting reversible contraceptive methods among women at risk of pregnancy seeking care in the US safety net system, and gains were greatest among adolescents.

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Change in geographic access to community health centers after Health Center Program expansion.

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Change in geographic access to community health centers after Health Center Program expansion.

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