Federally Qualified Health Center Strategies for Integrating Care with Hospitals and Their Association with Measures of Communication

Published in: The Joint Commission Journal on Quality and Patient Safety, Volume 45, Issue 9, pages 620-628 (September 2019). doi: 10.1016/j.jcjq.2019.06.004

Posted on RAND.org on November 27, 2019

by Justin W. Timbie, Ashley M. Kranz, Ammarah Mahmud, Claude Messan Setodji, Cheryl L. Damberg

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Federally qualified health centers have aligned clinical services and systems with local hospitals, but little is known about the specific care integration strategies health centers use or their impact on care. A research team examined the use of strategies by health centers to integrate care with hospitals and emergency departments (EDs) and their association with performance on measures of health center–hospital communication.


A Web-based survey was administered to health center medical directors in 12 states and Washington, DC, in 2017. The survey collected 10 self-reported measures of communication between health centers and hospitals/EDs and the extent to which health centers used different strategies to improve care integration. Health center and market characteristics that predict higher vs. lower integration activity were examined, and logistic regression was used to assess the relationship between integration activity and communication.


Between 56% and 81% of health centers participated in quality improvement projects, health promotion initiatives, guideline alignment, or executive meetings with hospitals; far fewer established notification agreements regarding hospital/ED utilization. Health centers that were larger, were located in rural areas or states with Accountable Care Organization programs, reported fewer staff shortages, and had fewer minority patients were associated with greater integration activity. Higher levels of integration activity were associated with better performance on most communication measures in both inpatient and ED settings (p < 0.05). Integration activity was not associated with health centers' receipt of notifications after patients' ED visits.


Health centers differ in the use of strategies to integrate care with hospitals. Overall, integration activity is associated with better communication.

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