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Quality Assurance and Care Provided at HRSA-Funded Health Centers


This study assessed, among other things, the extent to which health centers had quality assurance programs and their patients received primary health services. The importance of ensuring the quality of care in health centers funded by HRSA is growing with the increases in Federal investment in health centers and numbers of patients served. The Public Health Service Act authorizes HRSA to award grants to organizations that provide care in medically underserved urban or rural areas or to medically underserved populations. Reflecting an increased Federal investment, the number of health center patients grew from 10.3 million in fiscal year (FY) 2001 to 17.1 million in FY 2008. Although health center requirements specify which services health centers must make available to patients, they do not establish specific quality standards for these services.


We collected information about the quality assurance programs for 147 health center grantees. To examine the quality of required primary health services, we contracted with medical reviewers to assess medical records for 448 health center patients (from the same 147 health center grantees) who had at least 2 patient encounters between January 1, 2006, and December 31, 2007, including at least one encounter in the last 6 months of 2007. Finally, we held several meetings and calls with HRSA staff, including staff from the Bureau of Primary Health Care and the Office of Performance Review, to assess HRSA oversight activities.


We found that almost all health centers had quality assurance programs. However, insufficient documentation prevented detailed assessments of some medical records. Health services, generally, were appropriate for most health center patients. During the period of our review, HRSA's oversight and review activities provided limited information about the extent to which individual health center patients received required primary health services.


HRSA agreed with each of our four recommendations. We recommend that HRSA (1) specify what elements should be included in quality assurance programs and, in particular, provide more guidance about how grantees conduct their periodic assessments of services; (2) provide more specific guidance concerning what information is required in patient records at health centers; (3) provide more specificity about patients' receipt of required primary health services; and (4) establish procedures to independently assess patients' receipt of primary health services and the adequacy of patients' records.