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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Usual Source of Sick Care.

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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 with this rating are most likely to be effective...

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:

  • Health center patient survey
  • Provider-to-FQHC communication logs
  • Collaboration and engagement 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 children who are assigned to an FQHC as their primary and usual source of medical care. (Measures establishment of FQHC medical home relationships)
  • Number of FQHC providers and care team members trained in providing continuous, comprehensive, and coordinated care for children. (Measures workforce development for medical home roles)

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

  • Percent of FQHC pediatric patient visits that include comprehensive health assessments, screenings, and referrals per evidence-based guidelines. (Measures consistent delivery of preventive and proactive care)
  • Percent of children due for well-child visits and immunizations who receive reminder/recall communications from their FQHC care team. (Measures proactive population health management practices)

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

  • Number of health information exchange agreements and care coordination platforms that enable FQHCs to serve as effective pediatric medical homes in partnership with other providers. (Measures development of data and technology infrastructure for care integration)
  • Number of local policies and programs that support FQHCs as critical access points and usual sources of care for under resourced pediatric populations. (Measures enabling policy and funding environment for FQHC medical home sustainability)
  • Number of communities that experience improved pediatric health outcomes and lower costs of care through FQHC-based medical homes and care coordination. (Measures population health impact of FQHCs as a usual source of care)
  • Number of school districts and early childhood systems that partner with FQHCs to ensure all children have a regular source of care and are kindergarten-ready. (Measures cross-sector impact and return on investment of FQHC medical homes)

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

  • Percent of health information exchange agreements and care coordination platforms that enable FQHCs to serve as effective pediatric medical homes in partnership with other providers. (Measures development of data and technology infrastructure for care integration)
  • Percent of local policies and programs that support FQHCs as critical access points and usual sources of care for under resourced pediatric populations. (Measures enabling policy and funding environment for FQHC medical home sustainability)
  • Percent of communities that experience improved pediatric health outcomes and lower costs of care through FQHC-based medical homes and care coordination. (Measures population health impact of FQHCs as a usual source of care)
  • Percent of school districts and early childhood systems that partner with FQHCs to ensure all children have a regular source of care and are kindergarten-ready. (Measures cross-sector impact and return on investment of FQHC medical homes)

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.