Changes in geographic access to community health centers for - - PowerPoint PPT Presentation

▶
changes in geographic access to community health centers
SMART_READER_LITE
LIVE PREVIEW

Changes in geographic access to community health centers for - - PowerPoint PPT Presentation

Jul 11, 2023 200 likes •625 views

Changes in geographic access to community health centers for low-income, nonelderly adults after increases in Health Center Program funding Leigh Evans, MPH and M. Patricia Fabian, ScD June 24, 2017 AcademyHealth Disparities Interest Group

slide-1
SLIDE 1

Boston University School of Public Health

Changes in geographic access to community health centers for low-income, nonelderly adults after increases in Health Center Program funding

Leigh Evans, MPH and M. Patricia Fabian, ScD

June 24, 2017 AcademyHealth Disparities Interest Group Meeting New Orleans, LA

slide-2
SLIDE 2

Boston University Slideshow Title Goes Here Boston University School of Public Health

BACKGROUND

slide-3
SLIDE 3

Boston University Slideshow Title Goes Here Boston University School of Public Health

Community Health Centers (CHCs) ensure access to primary care for low-income, nonelderly adults

  • CHCs provide

primary care to all regardless of ability to pay

  • Located in

underserved areas

  • History of bipartisan

support

  • Reduce health

disparities

slide-4
SLIDE 4

Boston University Slideshow Title Goes Here Boston University School of Public Health

Health Center Program funding increases

  • $2 billion from American Recovery and Reinvestment

(Stimulus) Act 2009

  • $11 billion from Affordable Care Act 2010-2015
slide-5
SLIDE 5

Boston University Slideshow Title Goes Here Boston University School of Public Health

Considering geographic access

  • Relevant to number and location of new delivery sites
  • Limited research on geographic access (accessibility)
  • Linked to patient perceptions of access, utilization, quality of

care, and outcomes

  • Research gap: Effect of policies on geographic access

to CHCs for low-income, nonelderly adults

  • Geographic access  CHC accessibility
slide-6
SLIDE 6

Boston University Slideshow Title Goes Here Boston University School of Public Health

Research objectives

  • 1. Describe location of CHC delivery sites in three

Southern U.S. states before and after Health Center Program funding increases

  • 2. Estimate CHC accessibility for low-income,

nonelderly adults using geographic information system (GIS)-based methods in 2008 and 2016

  • 3. Examine changes in CHC accessibility between

2008 and 2016

slide-7
SLIDE 7

Boston University Slideshow Title Goes Here Boston University School of Public Health

METHODS

slide-8
SLIDE 8

Boston University Slideshow Title Goes Here Boston University School of Public Health

Methods

  • Study design: retrospective, repeated measures

analysis using publicly available data

  • Study area: Arkansas, Louisiana, Mississippi
  • Contiguous
  • High proportion of low-income, nonelderly adults
  • People in the South are prone to health disparities
  • Differed in Medicaid expansion decisions
slide-9
SLIDE 9

Boston University Slideshow Title Goes Here Boston University School of Public Health

Methods

  • Data:
  • CHC delivery sites from HRSA Data Warehouse
  • Jan 1966-Sept 2016
  • Adults ages 18-64 under 200% federal poverty level

from American Community Survey

  • 5-year estimates 2011-2015
  • n = 2,444,408
  • Shapefiles from U.S. Census 2010
  • Census tracts: n = 2,483
slide-10
SLIDE 10

Boston University Slideshow Title Goes Here Boston University School of Public Health

Methods

  • Used two-step floating catchment area method (Luo

and Wang 2003)

  • Combines two approaches: drive time distance and provider-

to-population ratios

  • Resulting value is a ratio of CHC delivery sites per

potential users in a census tract

slide-11
SLIDE 11

Boston University Slideshow Title Goes Here Boston University School of Public Health

RESULTS

slide-12
SLIDE 12

Boston University Slideshow Title Goes Here Boston University School of Public Health

Changes in number of CHC delivery sites

Across 3 states Pre Post % change # CHC delivery sites 150 332 121% Arkansas

Pre Post % change # CHC delivery sites 40 95 138%

Louisiana

# CHC delivery sites 40 125 213%

Mississippi

# CHC delivery sites 70 112 60%

slide-13
SLIDE 13

Boston University Slideshow Title Goes Here Boston University School of Public Health

CHC delivery sites and population density (ppl/square mile) by census tract- Louisiana 2008 and 2016 2008 2016

40 delivery sites 125 delivery sites

slide-14
SLIDE 14

Boston University Slideshow Title Goes Here Boston University School of Public Health

Changes in geographic access for low- income, nonelderly adults (2008 to 2016)

Arkansas (n=686)

Pre Post % change CHC accessibility

(CHCs/10,000 low-income, nonelderly adults)

0.10 (1.38) 0.94 (1.89) 840%

Louisiana (n=1,136)

CHC accessibility 0.26 (0.75) 1.32 (0.97) 408%

Mississippi (n=661)

CHC accessibility 0.83 (0.97) 1.49 (1.08) 80%

slide-15
SLIDE 15

Boston University Slideshow Title Goes Here Boston University School of Public Health

CHC accessibility for low-income, nonelderly adults (CHCs/10,000 ppl) by census tract- Arkansas 2008 and 2016 2008 2016

slide-16
SLIDE 16

Boston University Slideshow Title Goes Here Boston University School of Public Health

CHC accessibility for low-income, nonelderly adults (CHCs/10,000 ppl) by census tract- Mississippi 2008 and 2016 2008 2016

slide-17
SLIDE 17

Boston University Slideshow Title Goes Here Boston University School of Public Health

Limitations

  • Assumptions in methods
  • Drive time distance
  • Stack population at population-weighted centroids
  • No crossing state boundaries
  • Lack data on CHC capacity
  • Potential access vs. perceived access or realized

access (utilization), and link to health outcomes

slide-18
SLIDE 18

Boston University Slideshow Title Goes Here Boston University School of Public Health

Summary and implications

  • Geographic access increased across all 3 states
  • Mississippi had the highest CHC accessibility ratios
  • Measuring and mapping geographic access to CHCs

can show where changes are happening

  • Considering geographic access when locating new

CHC delivery sites can promote equity in access to care for low-income Americans

slide-19
SLIDE 19

Boston University Slideshow Title Goes Here Boston University School of Public Health

slide-20
SLIDE 20

Boston University Slideshow Title Goes Here Boston University School of Public Health

Acknowledgements

  • Martin Charns, DBA
  • Howard Cabral, PhD
  • Victoria Parker, DBA
  • David Jones, PhD
  • Thomas Evans, LSLS
slide-21
SLIDE 21

Boston University Slideshow Title Goes Here Boston University School of Public Health

Thank you!!

Leigh Evans leighe@bu.edu

slide-22
SLIDE 22

Boston University Slideshow Title Goes Here Boston University School of Public Health

New CHC delivery sites by year

7 26 54 37 59 122 203 308 674 479 721 933 1493 200 400 600 800 1000 1200 1400 1600

1966 1971 1976 1981 1986 1991 1996 2001 2006 2011

Added CHC delivery sites by year- 1966-2015

* Data source: Health Resources and Services Administration; HRSA Data Warehouse

slide-23
SLIDE 23

Boston University Slideshow Title Goes Here Boston University School of Public Health

Estimating CHC accessibility

  • Two-step floating catchment area method (Luo and Wang)

1. Create catchments around each CHC and capture population within those catchments  ratio of potential patients using CHC 2. Create catchments around each census tract and sum ratios of all CHCs within the tract’s catchment

  • Resulting value is the number of CHCs per potential user in

a tract

  • It is a ratio
slide-24
SLIDE 24

Boston University Slideshow Title Goes Here Boston University School of Public Health

Two-step floating catchment area method Step 1

Presentation Title 6/24/2017 24

1/20,000 1/8,000 1/12,000 1/15,000

slide-25
SLIDE 25

Boston University Slideshow Title Goes Here Boston University School of Public Health

Two-step floating catchment area method Step 2

Presentation Title 6/24/2017 25

Sum the ratios from step 1 for all CHCs that fall within step 2 catchment

slide-26
SLIDE 26

Boston University Slideshow Title Goes Here Boston University School of Public Health

Census tracts lacking geographic access

Reductions in geographic access disparities

Arkansas (n=686)

Pre Post % change Census tracts with 0 CHCs/10,000 low-income, nonelderly adults 275 (40%) 101 (15%)

  • 63%

Louisiana (n=1,136)

CHC accessibility 231 (20%) 46 (4%)

  • 80%

Mississippi (n=661)

CHC accessibility 114 (17%) 30 (5%)

  • 74%
slide-27
SLIDE 27

Boston University Slideshow Title Goes Here Boston University School of Public Health

26% 27% 28% 400%+ FPL 19%

Family Income (%FPL)

<100% FPL 100-199% FPL 200-399% FPL 59% 26% 15%

Parent Status

NOTES: The U.S. Census Bureau's poverty threshold for a family with two adults and one child was $19,078 in 2015. Data may not total 100% due to rounding. SOURCE: Kaiser Family Foundation analysis of the 2016 ASEC Supplement to the CPS.

45% 15% 32% 5% 3%

Race

In 2015, the majority of the uninsured are low-income adults, and more than half are people of color.

Total = 28.5 Million Uninsured

Childless Adults Children Parents Hispani c White non- Hispanic

Other

Asian/Nativ e Hawaiian

  • r Pacific

Islander Black

slide-28
SLIDE 28

Boston University Slideshow Title Goes Here Boston University School of Public Health Note: Totals may not sum to 100% due to rounding. Source: Kaiser Family Foundation analysis based on 2016 Medicaid eligibility levels and 2016 Current Population Survey data.

South 91% Midwest 6% Northeast <1% West 3%

In 2016, an estimated 2.6 million nonelderly adults fall into the coverage gap, most of whom reside in the South.

Total = 2.6 Million in the Coverage Gap

Distribution By Geographic Region:

slide-29
SLIDE 29

Boston University Slideshow Title Goes Here Boston University School of Public Health

Policy context

  • Affordable Care Act extended health coverage to

many low-income Americans but left many uninsured

  • Particularly those in states that did not expand Medicaid
  • 23 million Americans stand to lose their health

coverage with the proposed American Health Care Act

  • Coverage notwithstanding, many Americans live in

areas where primary care resources are lacking

slide-30
SLIDE 30

Boston University Slideshow Title Goes Here Boston University School of Public Health

Changes in number of CHC delivery sites

Arkansas Mississippi Louisiana Pre Post % Pre Post % Pre Post % Number of delivery sites 40 95 138% 70 112 60% 40 125 213%

  • Urban sites

4 9 15 25 11 50

  • Rural sites

36 74 54 73 29 61 Across 3 states Pre Post % change Number of delivery sites 150 332 121%

  • Urban sites

30 84 180%

  • Rural sites

119 208 75%

slide-31
SLIDE 31

Boston University Slideshow Title Goes Here Boston University School of Public Health Presentation Title 6/24/2017 31

Arkansas Louisiana Mississippi

Pre Post Pre Post Pre Post CHC accessibility

(CHCs/10,000 low- income, nonelderly adults)

0.67 (1.38) 1.58 (1.89) 0.43 (0.75) 1.39 (0.97) 0.99 (0.97) 1.62 (1.08) % change 136% 223% 64%

slide-32
SLIDE 32

Boston University Slideshow Title Goes Here Boston University School of Public Health Presentation Title 6/24/2017 32

slide-33
SLIDE 33

Boston University Slideshow Title Goes Here Boston University School of Public Health Presentation Title 6/24/2017 33

slide-34
SLIDE 34

Boston University Slideshow Title Goes Here Boston University School of Public Health

Community health centers reduce health disparities

  • Community-oriented primary care model
  • Medicaid patients who use CHCs have fewer ER visits

and preventable hospitalizations

  • African American women who use CHC are less likely

than African American women overall to have low birthweight babies

  • Disparities in rates of preventive screenings across

insurance status, race, or income do not exist among CHC patients

Presentation Title 6/24/2017 34

slide-35
SLIDE 35

Boston University Slideshow Title Goes Here Boston University School of Public Health

AR CHC delivery sites 2008 and 2016

Presentation Title 6/24/2017 35

slide-36
SLIDE 36

Boston University Slideshow Title Goes Here Boston University School of Public Health

MS CHC delivery sites 2008 and 2016

Presentation Title 6/24/2017 36

slide-37
SLIDE 37

Boston University Slideshow Title Goes Here Boston University School of Public Health

CHC accessibility for low-income, nonelderly adults (CHCs/10,000 ppl) by census tract- Louisiana 2008 and 2016 2008 2016

slide-38
SLIDE 38

Boston University Slideshow Title Goes Here Boston University School of Public Health Presentation Title 6/24/2017 38

slide-39
SLIDE 39

Boston University Slideshow Title Goes Here Boston University School of Public Health Presentation Title 6/24/2017 39

slide-40
SLIDE 40

Boston University Slideshow Title Goes Here Boston University School of Public Health Presentation Title 6/24/2017 40

slide-41
SLIDE 41

Boston University Slideshow Title Goes Here Boston University School of Public Health Presentation Title 6/24/2017 41

Rates of HIV Diagnoses Among Adults and Adolescents in the US in 2015, by State