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Comparative Study
. 2020 Dec 8;15(12):e0242844.
doi: 10.1371/journal.pone.0242844. eCollection 2020.

Assessing clinical quality performance and staffing capacity differences between urban and rural Health Resources and Services Administration-funded health centers in the United States: A cross sectional study

Nadereh Pourat  1   2 , Xiao Chen  1 , Connie Lu  1 , Weihao Zhou  1 , Hank Hoang  3 , Alek Sripipatana  3
Affiliations
Comparative Study

Assessing clinical quality performance and staffing capacity differences between urban and rural Health Resources and Services Administration-funded health centers in the United States: A cross sectional study

Nadereh Pourat et al. PLoS One. .

Abstract

Background: In the United States, there are nearly 1,400 Health Resources and Services Administration-funded health centers (HCs) serving low-income and underserved populations and more than 600 of these HCs are located in rural areas. Disparities in quality of medical care in urban vs. rural areas exist but data on such differences between urban and rural HCs is limited in the literature. We examined whether urban and rural HCs differed in their performance on clinical quality measures before and after controlling for patient, organizational, and contextual characteristics.

Methods and findings: We used the 2017 Uniform Data System to examine performance on clinical quality measures between urban and rural HCs (n = 1,373). We used generalized linear regression models with the logit link function and binomial distribution, controlling for confounding factors. After adjusting for potential confounders, we found on par performance between urban and rural HCs in all but one clinical quality measure. Rural HCs had lower rates of linking patients newly diagnosed with HIV to care (74% [95% CI: 69%, 80%] vs. 83% [95% CI: 80%, 86%]). We identified control variables that systematically accounted for eliminating urban vs. rural differences in performance on clinical quality measures. We also found that both urban and rural HCs had some clinical quality performance measures that were lower than available national benchmarks. Main limitations included potential discrepancy of urban or rural designation across all HC sites within a HC organization.

Conclusions: Findings highlight HCs' contributions in addressing rural disparities in quality of care and identify opportunities for improvement. Performance in both rural and urban HCs may be improved by supporting programs that increase the availability of providers, training, and provision of technical resources.

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Conflict of interest statement

The authors have read the journal’s policy, and the authors of this manuscript have the following competing interests to declare: HH and AS are employees of the U.S. Government, U.S. Department of Health and Human Services, which funded this study. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Unadjusted and adjusted predicted probabilities for health center quality indicators by urban and rural status.
Unadjusted analyses involved comparing urban and rural health center status using t-tests. Adjusted analyses were conducted using fractional outcome regression models using the logit distribution. Statistically significant at *p<0.05; **p<0.01; ***p<0.001 comparing urban vs. rural.
See this image and copyright information in PMC

References

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