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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.

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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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