Impact of Expanding Federally Qualified Health Centers (FQHCs) on Ambulatory Care Sensitive Conditions (ACSCs) in Maryland

The Problem: ACSCs are conditions that could have been avoided through adequate primary care services. Higher ACSC rates could reflect a problem in access to ambulatory care services. Because hospital care requires more resources and tends to be more costly than outpatient care, ACSC admissions place a burden on health care systems.

Objective: To study ACSCs in Maryland over time, identify areas where ACSC rates have been persistently high, and examine if expanding FQHCs results in lower ACSCs.

Data Source: The major sources of data for the study are Maryland Hospital Discharge data from 2000 to 2010; FQHC data files from the Health Resources and Services Administrations (HRSA); Demographic data from the RAND Center for Population Health and Health Disparities Data Core Series, and Geographic Information System (GIS) shapefiles from the United State Census Bureau/TIGER products.

Method: ACSCs are based on the Agency for Healthcare Research and Quality (AHRQ) definition of Prevention Quality Indicators (PQIs). GIS applications are used to construct service areas, find hot spots of ACSCs and determine the accessibility to FQHCs for each service area. Negative binomial panel model is used to determine trends over time and the impact of FQHCs on ACSCs.

Principal Findings: Trends in ACS hospitalizations vary by conditions and by geographical areas. However, ACS hospitalizations are quite persistent over time within service areas. In addition, the study finds a strong relationship between the proximity to FQHCs and ACSCs. Specifically, a greater distance/time to the nearest FQHCs results in higher ACS hospitalizations.

Conclusions: Expansion of FQHCs is likely to enhance access to primary care services and reduce unnecessary hospitalizations.