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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Personal Doctor or Nurse.

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Strategy. Federally Qualified Health Centers. (FQHCs)

Approach. Collaborate with 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]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective. These strategies have been tested in multiple robust studies in a variety of populations and settings with consistently positive results, both on their own and in combination with other strategies. (Clarifying Note: The WWFH database calls this "scientifically supported evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

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. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models 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?")

PROCESS MEASURES:

  • Number of children served by FQHCs who have an identified personal doctor or nurse. (Measures the reach and spread of the personal PCP approach)
  • Number of FQHC primary care providers who receive training and support to develop long-term, trusting relationships with pediatric patients and families. (Measures workforce development for the personal PCP role)

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

PROCESS MEASURES:

  • Percent of pediatric patient visits at FQHCs that are with the child's assigned personal doctor or nurse. (Measures fidelity to the personal PCP model and continuity of care)
  • Percent of personal pediatric PCPs at FQHCs who use evidence-based communication and relationship-building strategies (e.g., motivational interviewing, shared decision-making) with their patients. (Measures quality of personal PCP interactions and practices)

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

PROCESS MEASURES:

  • Number of FQHCs that use empanelment and risk stratification tools to optimize assignment and support of pediatric patients to personal PCPs. (Measures use of data and analytics to strengthen personal PCP relationships)
  • Number of pediatric personal PCP champions and mentor programs established at FQHCs to spread best practices and provider satisfaction. (Measures development of provider leadership and peer support infrastructure)

OUTCOME MEASURES:

  • Number of FQHCs that demonstrate sustained improvements in pediatric care quality, utilization, and cost measures through the personal PCP approach. (Measures long-term organizational impact and return on investment)
  • Number of professional societies, training programs, and care delivery transformation initiatives that promote FQHCs and the personal PCP approach as a key strategy for strengthening primary care. (Measures influence on broader primary care system reform efforts)

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

PROCESS MEASURES:

  • Percent of FQHCs that use empanelment and risk stratification tools to optimize assignment and support of pediatric patients to personal PCPs. (Measures use of data and analytics to strengthen personal PCP relationships)
  • Percent of pediatric personal PCP champions and mentor programs established at FQHCs to spread best practices and provider satisfaction. (Measures development of provider leadership and peer support infrastructure)

OUTCOME MEASURES:

  • Percent of FQHCs that demonstrate sustained improvements in pediatric care quality, utilization, and cost measures through the personal PCP approach. (Measures long-term organizational impact and return on investment)
  • Percent of professional societies, training programs, and care delivery transformation initiatives that promote FQHCs and the personal PCP approach as a key strategy for strengthening primary care. (Measures influence on broader primary care system reform efforts)

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?

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.