Ambulatory care sensitive hospitalizations and emergency visits: Experiences of Medicaid patients using federally qualified health centers

BACKGROUND. Federally Qualified Health Centers (FQHCs) serve as regular sou rces of preventive and primary care for low-income families within their co mmunities and are key parts of the health care safety net. OBJECTIVES. Compare admissions and emergency room visits for ambulatory car e sensitive conditions (ACSCs) among Medicaid beneficiaries relying on FQHC s to of her Medicaid beneficiaries. RESEARCH DESIGN. Retrospective analysis of 1992 Medicaid claims data for 48 ,738 Medicaid beneficiaries in 24 service areas across five states. SUBJECTS. Medicaid beneficiaries receiving more than 50% of their preventiv e and primary care services from FQHCs are compared with Medicaid beneficia ries receiving outpatient care from other providers in the same areas. Excl usions-managed care enrollees, beneficiaries more than age 65, dual eligibl es (Medicaid and Medicare), and institutionalized populations. MEASURES. Ad missions and emergency room (ER) visits for a set of chronic and acute cond itions, known in the literature as ambulatory care sensitive conditions (AC SCs). RESULTS. Medicaid beneficiaries receiving outpatient care from FQHCs were l ess likely to be hospitalized (1.5% vs. 1.9%, P <0.007) or seek ER care (14 .9% vs. 15.7%, P<0.02) for ACSCs than the comparison group. Controlling for case mix and other demographic variables, the odds ratios were, for hospit alizations, OR, 0.80; 95% CI, 0.67 to 0.95; P <0.01, and for ER visits, OR, 0.87; 95% CI, 0.82 to 0.92; P <0.001. CONCLUSIONS. Having a regular source of care such as FQHCs can significantl y reduce the likelihood of hospitalizations and ER visits for ACSCs. If the reported differentials in ACSC admissions and ER visits were consistently achieved for all Medicaid beneficiaries, substantial savings might be reali zed.