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Primary care through FQHCs linked to overall increase in preventable ED visits

Overall ambulatory care sensitive hospitalization and ED visitation rates were higher for patients who received primary care through federally qualified health centers, compared with those who do not use them, according to data published in the Journal of Primary Care and Community Health.

However, the researchers also concluded that, when the data were broken down by race, white patients who use federally qualified health centers (FQHCs) had fewer preventable hospitalizations.

“More than 10 million Americans dually eligible for Medicare and Medicaid have higher ED visit and hospitalization rates for [ambulatory care sensitive conditions (ACSCs)] because of barriers to accessing primary care,” Brad Wright, PhD, of the University of Iowa, and colleagues wrote. “Younger individuals are an especially high-cost subset of the dual-eligible population, and tend to encounter more barriers to care than older adult dual-eligibles, including greater difficulty making physician appointments, more transportation and mobility challenges, and impediments related to highly prevalent mental disorders…. [FQHCs], which provide primary care regardless of ability to pay and offer a variety of nonclinical enabling services to improve access to care, have been shown to manage ACSCs effectively.”

To find whether younger patients who are eligible for Medicare and Medicaid and receiving primary care services at FQHCs have lower rates of ACS hospitalizations and ED visits, the researchers drew from all of the Medicare Part A and Part B institutional claims from 2007 to 2010 for all dual-eligibles younger than 65 years. Participants included in the study had been enrolled in traditional fee-for-service Medicare, who received care at an FQHC or lived in a primary care service area with an FQHC.

The cross-sectional analysis included negative binomial regressions to model ACS hospitalizations and ED visits as a function of prior year FQHC use. The researchers adjusted the model for beneficiary age, sex, race and chronic diseases, as well as county fixed effects, time trends and race–FQHC use interactions.

According to the researchers, the number of younger patients who were dual-eligible and visited an FQHC during the year increased from 170,934 in 2007 to 213,663 in 2009. Receiving primary care through an FQHC was associated with a decrease in ACS hospitalization rates for white patients (2.8 per 1,000 persons), but an increase among black patients (2.5 per 1,000 persons). In addition, it was also associated with an increase in ACS ED visits, from 27 to 33 more visits per 1,000 persons per year, depending on the patient’s race.

“To our knowledge, this study is the first to demonstrate the relationship between FQHC use and potentially preventable hospitalizations and ED visits among younger dual-eligibles,” Wright and colleagues wrote. “We find that FQHC use is associated with a net decrease in ACS hospitalizations, with variation by race, and a net increase in ACS ED visits, irrespective of race.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.