Variation in local health department primary care services as a function of health center availability.

OBJECTIVES: We aim to gain a clearer understanding of the effect of colocated federally qualified health centers (FQHCs) on the delivery of primary care and preventive services by local health departments (LHDs). DESIGN: We collected data from the 2010 National Association of County & City Health Officials Profile of Local Health Departments, the 2010 Uniform Data System, and the 2011 Area Resource File. SETTING: Forty-eight states, excluding Rhode Island and Hawaii. PARTICIPANTS: The analytic sample contained data on 2107 LHDs across the country. MAIN OUTCOME MEASURES: We modeled 4 measures of primary care activity for each LHD: provision of screening for (1) heart disease, (2) diabetes, and (3) hypertension, and (4) provision of comprehensive primary care. RESULTS: Local health departments in counties with an FQHC grantee have, on average, 32% lower odds of providing hypertension screening, but having an FQHC grantee in the county does not influence LHDs' primary care provision or screening for heart disease or diabetes. However, in an alternate model examining FQHC delivery sites per capita, each site is associated with a decrease in the odds of LHDs providing primary care (4% lower odds) or screening for heart disease (2% lower odds), diabetes, or hypertension (both 1% lower odds). CONCLUSION: Local health departments are more involved in disease screening than the provision of primary care. However, larger LHDs are more likely to provide both screening and primary care. Our current study provides evidence that the availability of an FQHC in the same county as an LHD partially explains the variation in LHDs' provision of primary care services. Local health departments with colocated FQHCs can focus on more traditional public health activities, while LHDs in areas without an FQHC may find that ensuring access to care is more challenging, possibly leading LHDs to directly provide primary care services.

Organizational scope of practice: assessing the primary care and public health activities of health centers and health departments in Iowa.

The objective was to understand how Federally Qualified Health Centers (FQHCs) and local health departments (LHDs) address their shared mission of improving population health by determining the scope of primary care and public health activities each provides in their community. A brief mail survey was designed and fielded among executive directors at all 14 FQHCs in Iowa, and 13 LHDs in Iowa representing counties with and without an FQHC. This survey contained a mixture of questions adapted from previously validated primary care and public health survey instruments. Using survey responses, each FQHC and LHD was given 2 scores (each ranging from 0-100) measuring the extent of their primary care and public health activities, respectively. The overall response rate was 85.2%; the response rate was 78.6% within FQHCs and 91.7% within LHDs. Overall, FQHCs had higher scores (73.8%) compared to LHDs (27.3%) on total primary care services, while both LHDs (79.3%) and FQHCs (70.9%) performed particularly well on public health services. FQHCs and LHDs in Iowa address a variety of public health and primary care issues, including but not limited to screening for chronic diseases, nutrition counseling, immunizations, and behavioral health. However, FQHCs provide a higher amount of primary care services and nearly as many public health services when compared to LHDs. In a value-based health care delivery system, integrating to improve population health is a wise strategy to maximize efficiency, but this will require maximizing coordination and minimizing duplication of services across different types of safety net providers.

Health Centers in States With Public Health Agency Support Do Not Have Better Chronic Disease Outcomes.

OBJECTIVES: To examine the quality of chronic disease care at federally qualified health centers (FQHCs) as a function of state health agency support. METHODS: We merged data from the 2010 Association of State and Territorial Health Officials Public Health Survey, the 2011 Area Resource File, and the 2010 Uniform Data System. Using ordinary least squares regression, we modeled hypertension and diabetes control among FQHC patients as a function of state public health agency support of FQHCs, including financial support, direct collaboration, and electronic health data exchanges. RESULTS: The rate of hypertension control is 63.4%, while the rate of diabetes control (HbA1c <7%) is 41.3%. Some two thirds of FQHCs (67.1%) are in states whose public health agencies are fully engaged in FQHC-supporting activities, and approximately one third (34.6%) are in states whose public health agencies send and receive electronic health record data with FQHCs. However, none of our measures of public health agency support of FQHCs significantly predicted FQHC-specific chronic disease outcomes. CONCLUSIONS: We find no evidence that state public health agency support of FQHCs affects chronic disease outcomes for FQHC patients.