Community Health Centers Minimize Health Disparities, But No Evidence of Recent Change.
Across the US, more than 1,400 community health centers provide primary care services to underserved communities that might not otherwise have access to care. These health centers have also adopted a number of approaches to further reduce racial and ethnic disparities in care, including monitoring control of blood pressure in hypertension, control of blood sugar in diabetes, and low birthweight by race/ethnicity starting in 2008.
But a new study led by a School of Public Health researcher found no evidence of either improved quality or reduced racial/ethnic disparities in diabetes control, hypertension control, or birthweight in community health center patients between 2009 and 2014.
The study was published in Journal of General Internal Medicine.
“The lack of change is somewhat surprising, given the substantial focus within health centers to eliminate health disparities,” says lead author Megan Cole, assistant professor of health law, policy & management. “We’ve also observed other changes over this time period that you’d think might be associated with improved outcomes, such as increased rates of insurance from the ACA and more widespread medical home participation.
“That said, moving the needle on these outcome measures is really challenging, and it’s important to note that racial disparities within health centers are narrower than those observed elsewhere.”
In 2014, about 23 million patients in the US were served by community health centers. The majority were from racial/ethnic minority groups, and nearly all had family income below 200 percent of the federal poverty level; about one-fourth were better served by a language other than English, and almost half had Medicaid coverage. Quality of care in these centers is similar to care provided in other settings, and observed racial/ethnic disparities in care are smaller, though disparities still remain. In 2009, the absolute white/black disparity for health center patients was 8.7 percentage points for hypertension control; for diabetes control, absolute white/black disparities were 3.4 percentage points, and white/Hispanic disparities were 4.4 percentage points.
The authors evaluated 1,047 centers for racial/ethnic time trends in quality outcomes between 2009 and 2014 and assessed disparities in diabetes control, blood pressure control, and birthweight both within and between centers.
The researchers found little evidence of reduced racial and ethnic health disparities, despite the fact that electronic health record adoption, medical home recognition, and insurance coverage rates increased substantially from 2009 to 2014. Two exceptions were increased rates for normal birthweight among black patients and decreased rates of diabetes control for white patients. Racial/ethnic disparities were found both within health centers—racial/ethnic differences were observed for patients served by the same health center, and between health centers—meaning minority patients were more likely to receive care at health centers where overall outcomes were worse.
“Lack of observed improvement in outcomes may indicate that some health centers, and the health care system more broadly, are not sufficiently resourced to target factors outside of the health care setting that contribute to outcomes, such as transportation, housing, food, and other social support,” the authors wrote. Additional explanations cited by the authors included variations in the extent to which health centers are able to provide non-medical services and lack of access to specialty care and medications for the uninsured.