PMID- 33270778
OWN - NLM
STAT- MEDLINE
DCOM- 20210119
LR  - 20220716
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 15
IP  - 12
DP  - 2020
TI  - The impact of funding for federally qualified health centers on utilization and 
      emergency department visits in Massachusetts.
PG  - e0243279
LID - 10.1371/journal.pone.0243279 [doi]
LID - e0243279
AB  - IMPORTANCE: Federally qualified health centers (FQHCs) receive federal funding to 
      serve medically underserved areas and provide a range of services including 
      comprehensive primary care, enabling services, and behavioral health care. 
      Greater funding for FQHCs could increase the local availability of clinic-based 
      care and help reduce more costly resource use, such as emergency department 
      visits (ED). OBJECTIVE: To examine the impact of funding increases for FQHCs 
      after the ACA on the use of FQHCs and EDs. METHODS: Retrospective study using the 
      Massachusetts All Payer Claims Database (APCD) 2010-2013 that included APCD 
      enrollees in 559 Massachusetts ZIP codes (N = 6,173,563 in 2010). We calculated 
      shift-share predictions of changes in FQHC funding at the ZIP code-level for 
      FQHCs that received Community Health Center funds in any year, 2010-13 (N = 31). 
      Outcomes were the number of ZIP code enrollees with visits to FQHCs and EDs, 
      overall and for emergent and non-emergent diagnoses. RESULTS: In 2010, 4% of 
      study subjects visited a FQHC, and they were more likely to be younger, have 
      Medicaid, and live in low-income areas. We found that a standard deviation 
      increase in prior year FQHC funding (+31 percentage point (pp)) at the ZIP code 
      level was associated with a 2.3pp (95% CI 0.7pp to 3.8pp) increase in enrollees 
      with FQHC visits and a 1.3pp (95% CI -2.3pp to -0.3pp) decrease in enrollees with 
      non-emergent ED visits, but no significant change in emergent ED visits (0.3pp, 
      95% CI -0.8pp to 1.4pp). CONCLUSIONS: We found that areas exposed to greater FQHC 
      funding increases had more growth in the number of enrollees seen by FQHCs and 
      greater reductions in ED visits for non-emergent conditions. Investment in FQHCs 
      could be a promising approach to increase access to care for underserved 
      populations and reduce costly ED visits, especially for primary care treatable or 
      non-emergent conditions.
FAU - Myong, Catherine
AU  - Myong C
AD  - Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, 
      Boston, Massachusetts, United States of America.
FAU - Hull, Peter
AU  - Hull P
AD  - The Becker Friedman Institute, University of Chicago, Chicago, Illinois, United 
      States of America.
FAU - Price, Mary
AU  - Price M
AD  - Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, 
      Boston, Massachusetts, United States of America.
FAU - Hsu, John
AU  - Hsu J
AD  - Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, 
      Boston, Massachusetts, United States of America.
AD  - Department of Medicine, Harvard Medical School, Boston, Massachusetts, United 
      States of America.
AD  - Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, 
      United States of America.
FAU - Newhouse, Joseph P
AU  - Newhouse JP
AD  - Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, 
      United States of America.
AD  - Department of Health Policy and Management, Harvard T.H. Chan School of Public 
      Health, Boston, Massachusetts, United States of America.
AD  - Harvard Kennedy School, Cambridge, Massachusetts, United States of America.
FAU - Fung, Vicki
AU  - Fung V
AUID- ORCID: 0000-0001-8078-5431
AD  - Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, 
      Boston, Massachusetts, United States of America.
AD  - Department of Medicine, Harvard Medical School, Boston, Massachusetts, United 
      States of America.
LA  - eng
GR  - R01 HS024725/HS/AHRQ HHS/United States
GR  - R01 HS025378/HS/AHRQ HHS/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
DEP - 20201203
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Ambulatory Care Facilities/economics/trends
MH  - Community Health Centers/economics/trends
MH  - Health Facilities/*economics/trends
MH  - Health Services Accessibility/economics/statistics & numerical data
MH  - Humans
MH  - Massachusetts
MH  - Medically Underserved Area
MH  - National Health Programs/*economics
MH  - Patient Acceptance of Health Care/*statistics & numerical data
MH  - Patient Protection and Affordable Care Act/economics/statistics & numerical 
      data/trends
MH  - Primary Health Care/economics/trends
MH  - Retrospective Studies
MH  - United States
MH  - Vulnerable Populations
PMC - PMC7714363
COIS- The authors have declared that no competing interests exist.
EDAT- 2020/12/04 06:00
MHDA- 2021/01/20 06:00
PMCR- 2020/12/03
CRDT- 2020/12/03 17:15
PHST- 2020/05/19 00:00 [received]
PHST- 2020/11/18 00:00 [accepted]
PHST- 2020/12/03 17:15 [entrez]
PHST- 2020/12/04 06:00 [pubmed]
PHST- 2021/01/20 06:00 [medline]
PHST- 2020/12/03 00:00 [pmc-release]
AID - PONE-D-20-14964 [pii]
AID - 10.1371/journal.pone.0243279 [doi]
PST - epublish
SO  - PLoS One. 2020 Dec 3;15(12):e0243279. doi: 10.1371/journal.pone.0243279. 
      eCollection 2020.