To determine how well the health centers funded by the U.S. federal government deliver primary health care to their patients, RTI collaborated with the Bureau of Primary Health Care (BPHC) to conduct a survey in five languages. Results from the Health Center Patient Survey will enable BPHC to further its mission to improve the health of the nation’s underserved communities and ensure access to high-quality primary health care services in the U.S.
Community-Based Preventive and Primary Health Care for Vulnerable Populations
Many vulnerable populations—such as the poor, homeless, public housing residents, migrant and seasonal farm workers, at-risk women, minorities, persons with HIV/AIDS, uninsured and underinsured, and non-English speakers—depend on federally funded health centers as their primary source of care. The Health Center Program, administered by BPHC, supports the provision of community-based preventive and primary health care services through Section 330 of the Public Health Service Act grants to health centers and community organizations.
Assessing the Health Center Program by Focusing on Patient-Level Data
To determine how well sites supported by the Health Center Program deliver access to comprehensive, culturally competent, quality primary health care, BPHC and RTI conducted the Health Center Patient Survey. The survey investigated how well HRSA-supported sites meet health care needs of the medically underserved and assessed how patients perceive the quality of their care, which will help the BPHC with future planning decisions.
In addition to informing policy and funding decisions, survey data will facilitate evaluation of the impacts of the Affordable Care Act by providing a baseline from which to compare health center patient characteristics, health-related behaviors, health conditions, access to care, and perceived satisfaction.
While other studies have examined the process and outcomes of care under the umbrella of the Health Center Program, what made the Health Center Patient Survey unique was its focus on comprehensive patient-level data. This survey was designed to provide a nationally representative view of patients served by grantees under the program.
The survey also oversampled patients within each of these funding mechanisms who identified themselves as Asian, American Indian/Alaska Native, or Native Hawaiian/Pacific Islander and those who are 65 or older. Whereas previous surveys related to the Health Center Program were conducted only in English and Spanish, this survey was also translated into Chinese, Korean, and Vietnamese. Translating the survey into these additional languages gave groups that have been typically underrepresented in similar studies an opportunity to participate. This, in turn, allowed us to capture a more comprehensive picture of patient experiences.
The Health Center Patient Survey was conducted in three stages: We recruited 169 grantee participants, contacted 520 health care sites operating within those participating grantees, and completed 7,002 patient interviews with individuals representing 42 states. Participants were recruited during visits to participating sites. To qualify, patients had to have visited a program site at least once in the prior 12 months, not including the current visit. Patient interviews were conducted using computer-assisted personal interviewing.
Health Care Patient Survey Will Help BPHC Meet Patient Needs
We collected data for the Health Center Patient Survey from October 2014 through April 2015, conducting about 68 percent of the interviews in English, 28 percent in Spanish, 3 percent in Chinese, and less than 1 percent in Vietnamese. No interviews were conducted in Korean. We exceeded goals for the total number of interviews completed as well as the number of interviews for each funding type, providing a good sample from which to assess patients’ perceptions of health center services.
Data from the Health Center Patient Survey will be used to develop reliable and valid estimates of the health problems, health care needs, and service utilization of health center patients. The data will also be employed to examine the relationships between patient characteristics and perceptions, behaviors, insurance status, health status, chronic illnesses, and other measures, controlling for potentially confounding factors. The increase in analytical sample size will allow for additional health care measures to be studied, with emphasis on racial, ethnic, and gender disparities in health care and health outcomes.
The Health Center Patient Survey will greatly enhance BPHC’s knowledge of patients, their health status, reasons they seek care, and their visit characteristics. Understanding patients’ perspectives will facilitate the BPHC’s mission to improve the health of the nation’s underserved communities and ensure access to high-quality primary health care services.