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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 10: Adolescent Well-Visit

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Strategy. Federally Qualified Health Centers (FQHCs)

Approach. Support the provision of adolescent well-visit services at FQHCs.

Source. Robert Wood Johnson Foundation's What Works for Health (WWFH) Database

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Overview. Federally qualified health centers (FQHCs) are public and private non-profit health care organizations that receive federal funding under Section 330 of the Public Health Service Act. Governed by a community board, FQHCs deliver comprehensive care to uninsured, underinsured, and vulnerable patients regardless of ability to pay. FQHCs are located in high need communities in urban and rural areas (HRSA-Health centers). Often called Community Health Centers (CHCs), FQHCs can also include migrant health centers, health care for the homeless centers, public housing primary care centers, and outpatient health programs or facilities operated by a tribe or tribal organization (CMS-FQHC).

Evidence. Scientifically Supported. There is strong evidence that federally qualified health centers (FQHCs) increase access to primary care (Urban-Saloner 2014, Shi 2013*, Lo Sasso 2010*, Siegel 2004*, Gresenz 2006, Bodenheimer 2010*, Hicks 2006, O’Malley 2005, Cunningham 2004, Shi 2007*, Shi 2007a*) and improve health outcomes for their patients (Meredith 2016*, Wright 2015*, Ross 2012*, Goldman 2012*, Bodenheimer 2010*, Hicks 2006). An emerging body of literature is showing that FQHCs prove effective for multiple population groups.

FQHCs have been shown to perform as well as or better than non-safety net providers on measures of quality and access to care, such as continuity of care and delivery of preventive services (Shi 2013*, Shi 2012*, Goldman 2012*, Hicks 2006, O’Malley 2005) particularly for children (Gresenz 2006) and elderly patients (Ross 2012*). FQHCs that become advanced primary care practices (APCPs) or that adopt principles of the patient centered medical home may further improve health and health care (RAND-Kahn 2015, Calman 2013). By serving uninsured, underinsured, and other vulnerable patients, FQHCs can reduce disparities in access to care (Shi 2013*, Starfield 2005, Hicks 2006, O’Malley 2005, Siegel 2004*). For example, black and Hispanic patients at FQHCs appear to have fewer hospitalizations due to ambulatory care-sensitive conditions than peers who receive care elsewhere (Wright 2015*). Patients who receive most of their ambulatory care at community health centers such as FQHCs have lower overall medical expenditures than those who receive care elsewhere (Richard 2012*). Many patients continue to use FQHCs even after obtaining insurance (Ku 2011). Investments in community health centers have been shown to reduce costs for local health care systems and provide economic benefits for surrounding communities (Rothkopf 2011*, Dor 2009, Shi 2007a*, NACHC-Primary care 2007). Read more in the WWFH database report. Read more about WWFH's evidence ratings. (*Links to citations can be accessed through the WWFH database).

Target Audience. Provider/System.

Outcome. Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year. Other potential benefit includes increased continuity of care and increased access to oral health care.

Examples from the Field. Access descriptions of ESMs from across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Support the provision of adolescent well-visit services at FQHCs,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  •  Number of adolescents with and without speical needs that have access to adolescent well-visit services at a FQHC in their jurisdiction.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of adolescents with and without speical needs that have access to adolescent well-visit services at a FQHC in their jurisdiction.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of adolescents with and without speical needs that seek adolescent well-visit services at FQHC.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of adolescents with and without speical needs that seek adolescent well-visit services at FQHC.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.