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Focus on Chronic Care in Federally Supported Health Centers
Health centers were first developed to provide accessible, affordable, personal health care services to low income families, and they continue to do so under Section 330 of the Health Centers Consolidation Act of 1996, which is administered by the Health Resources and Services Administration (HRSA). In 2003, 890 health centers provided health care to 12.3 million patients living in rural and urban medically underserved areas.
For the past 40 years, health centers operating at the community level have provided regular access to high quality, family-oriented, comprehensive primary and preventive health care, regardless of ability to pay. Health centers serve clients that are primarily low income and minorities including migrant/seasonal farm workers; homeless individuals and families; individuals living with HIV/AIDS infection; and a large number of unemployed and impoverished people with chronic diseases. Among the 12.3 million patients who sought care in health centers in 2003, 39% were uninsured, 64% were ethnic minorities, 69% had incomes less than 100% of the poverty level, and 30% were best served in a language other than English, indicating that health centers are the safety net provider for vulnerable populations.23
The network of health centers across the Nation continues to grow as new health centers are added each year from grants distributed through the President's Health Centers Initiative. The 5-year President's Health Centers Initiative plans to add 1,200 new and expanded health centers to cover an additional 6 million people served by 2006. Increasing access to care will be important especially for those who require well-coordinated, continuous care, such as those with chronic conditions.
Among all health problems, chronic disease is the most pervasive, costly, and preventable, as 7 out of 10 Americans die each year of chronic diseases and 1 out of 10 faces major limitations in activity.24 Of all health center patients that were seen in 2003, 6% were seen for diabetes, and 2% were seen for asthma.23
Data on the quality of care received by patients receiving care from community health centers were obtained from the 2002 HRSA Community Health Center User Survey. This survey was funded by HRSA and consists of 2,129 interviews from 70 selected grantees that nationally represent 6 million CHC users. Quality measures highlighted in this section were selected because they are clinically meaningful. One treatment measure and two management measures are highlighted in this section:
|Component of health care need:
||Advice to obese patients on diet/eating habits
||Annual visit to eye doctor by patients with diabetes
||Counseling on asthma self-management
Efforts to further improve the quality of care provided to patients with chronic conditions are being addressed through HRSA's Health Disparities Collaborative, a national effort to achieve strategic system change in the delivery of primary health care. This health initiative seeks to generate and document improved health outcomes for underserved populations and transform clinical practice through evidence-based models of care. The Health Disparities Collaborative has focused on diabetes, cardiovascular disease, depression, asthma, cancer, diabetes prevention, overall prevention, access and patient flow redesign, and perinatal and patient safety.