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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Care Coordination.

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Strategy. Federally Qualified Health Centers (FQHCs)

Approach. Collaborate with Federally Qualified Health Centers (FQHCs) to increase access to medical care for children

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Overview. Federally qualified health centers (FQHCs) are public and private non-profit healthcare 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 patients who have additional health needs regardless of ability to pay. FQHCs are located in high need communities in urban and rural areas. Often called Community Health Centers (CHCs), FQHCs can also include migrant health centers, healthcare for the homeless centers, public housing primary care centers, and outpatient health programs or facilities operated by a tribe or tribal organization.[1] 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, particularly for children.[2]

Evidence. Scientifically Rigorous Evidence. Strategies based on scientifically rigorous evidence are proven effective across multiple robust studies. While success is highly likely, local impact may vary. Monitor outcomes and use data to tailor these strategies to the community's unique needs.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Collaboration activity logs/meeting minutes
  • FQHC Referral pathway implementation and workflow data
  • Title V Joint outreach and enrollment activity data

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Direct Care (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

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

  • Number of FQHCs engaged in collaborations to increase access to medical care for children. (Shows the breadth and scale of partnerships with FQHCs)
  • Number of outreach events or campaigns conducted in partnership with FQHCs to raise awareness about the availability of medical care for children. (Indicates the joint efforts to promote the usability and benefits of FQHC services for children)

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

  • Percent of FQHC staff who receive training on providing responsive, family-centered care to children as part of the collaborative access initiatives. (Shows the capacity building and quality improvement efforts within FQHCs to better serve children)
  • Percent of FQHC pediatric visits that include comprehensive screening for non-medical influences on health and referrals to community resources, as a result of the collaborative initiatives with Title V. (Indicates the integration of whole-child approaches to care within FQHCs)

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

  • Number of community partnerships (e.g., with schools, early childhood programs, social service agencies) established to support the identification and referral of children to FQHCs for care. (Shows the development of a multi-sector network to facilitate children's access to FQHCs)
  • Number of quality improvement initiatives implemented within FQHCs to enhance the delivery of pediatric care, as a result of the collaborative access efforts. (Indicates the commitment to continuous learning and improvement to better serve children)
  • Number of children who receive enabling services (e.g., transportation assistance, language interpretation) through FQHCs partnered with Title V to overcome challenges to accessing care. (Shows the collaborations' impact on addressing social and logistical challenges to children's healthcare access)

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

  • Percent of FQHC governing boards that include representation from families and communities served, to ensure responsiveness to children's needs in the collaborative access initiatives. (Shows the level of community engagement and ownership in shaping FQHC priorities and strategies)
  • Percent of FQHC pediatric services that are provided during extended hours (e.g., evenings, weekends) or through mobile clinics, to accommodate the needs and preferences of children and families. (Indicates the flexibility and adaptability of FQHC care delivery models)
  • Percent reduction in differences in children's access to and utilization of primary care services at FQHCs, as a result of the tailored collaborative efforts. (Shows the impact of the collaborations on advancing health outcomes for children with limited access to care)
  • Percent of children and families served by FQHCs who report a strong sense of trust, respect, and partnership with their primary care providers. (Indicates the relational and interpersonal dimensions of quality care experienced by children at FQHCs)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

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

References

[1] HRSA-Health centers - Health Resources and Services Administration (HRSA). What is a health center?
[2] Gresenz CR, Rogowski J, Escarce JJ. Dimensions of the local health care environment and use of care by uninsured children in rural and urban areas. Pediatrics. 2006;117(3):e509-17.

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.