Researchers Compare Community Health Centers With Hospital Outpatient Departments and Physician Offices

A study by researchers at the Johns Hopkins School of Public Health demonstrates that access to health care for the most vulnerable segments of the population could be greatly improved by expanding the number of community health centers. The report appears in the October 25, 2000 issue of the Journal of the American Medical Association.

The study shows that community health centers are the care providers of choice for those who, for whatever reason, lack access to physician offices. The scientists found that physician offices receive the most primary care visits overall because they are more numerous than community health centers; however, community health centers still are the sites of one in every 25 primary care visits by members of vulnerable U.S. populations -- racial or ethnic minorities, people in rural areas or without health insurance, or those on Medicaid.

First author Christopher B. Forrest, MD, PhD, associate professor, Health Policy and Management, the Johns Hopkins School of Hygiene and Public Health, said, "Shoring up the nation's primary care safety net and improving access to health care for vulnerable populations are going to depend on increasing the number of community health centers in the United States. Health care providers also must strive to make their office hours more convenient and to establish long-term relationships with their patients."

The authors noted that when patients are followed by the same physician over years, the health care provider becomes familiar with patient histories, can monitor their conditions more carefully, and use health care resources more efficiently.

The researchers analyzed the results of three national surveys of primary care visits made in 1994 and 1998, then compared what had taken place when patients received primary care at three different medical venues -- community health centers, hospital outpatient departments, and physician offices.

The study's results revealed wide disparities in the rate of primary care visits made by racial and ethnic minority groups. Hispanics, for instance, made 20 percent fewer primary care visits per person than whites, and non-Hispanic blacks made 33 percent fewer primary care visits than whites. Although most primary care visits were made to physician offices, 40 percent of primary care visits by racial and ethnic minorities without health insurance or Medicaid were to community health centers and hospital outpatient departments.

The study found that continuity of care was significantly better in community health centers than in the other two health care sites. In a related finding, the researchers determined that patients visiting hospital outpatient departments underwent more imaging studies and minor surgeries, and were referred more often to specialists, than those seen in either physicians' offices or community health centers. The scientists speculate that because continuity of care tends to be more difficult to achieve in hospital outpatient departments, providers in this setting are often unfamiliar with their patients' health histories and so are forced to treat more aggressively. The authors believe further study is needed to determine whether hospital outpatient departments are appropriate sites from which to deliver primary care.

This work was conducted in the Johns Hopkins Primary Care Policy Center for Underserved Populations. The center provides research and analysis on current policies and programs relating to the organization, financing, and delivery of primary health care services, particularly to underserved and vulnerable populations. The Center also assists the research activities of the Bureau of Primary Health Care at the U.S. Department of Health and Human Services and provides timely policy analyses in response to issues identified by the Bureau and Center researchers.

Support for this work was provided by the Bureau of Primary Health Care, the Health Resources and Services Administration, Department of Health and Human Services.