Improving Quality of Care and Sustainability of Community Health Centers in the Gulf South Following the Deepwater Horizon Disaster

Background: The Primary Care Capacity Project (PCCP) aimed to expand access to quality, integrated and sustainable community-based primary care at community health centers (CHCs) serving Gulf South communities impacted by the Deepwater Horizon disaster. With its focus on CHCs, the PCCP also aimed to address access to care inequities experienced by economically disadvantaged populations. The PCCP employed three CHC capacity-building interventions: funding investments, targeted technical assistance, and a Gulf South learning community. The current study hypothesized the following outcomes for CHCs: 1) increased community access to care; 2) increased capacity for integrated mental health care services, and 3) improved sustainability of CHC growth.

Methods: The summative evaluation used secondary data collected through the Health Resources and Services Administration’s Uniform Data System (UDS). The UDS contains data from CHCs on patient demographics, services provided, clinical indicators, utilization rates, costs and revenues. Annual UDS reports were obtained directly from CHC staff, and data were abstracted from the UDS reports and entered into a database for analysis. The objective of this analysis was to evaluate if CHCs sustained growth and expansion beyond the funded project period. UDS data were also analyzed longitudinally to determine if there was an increase in select clinical capacity from 2012 (baseline) to 2017 (one-year post project period). Data were calculated at the CHC level then combined to create average results. Measures included percent change from 2012 to 2017 for the10 CHCs that provided UDS data for all five years.

Results: Data indicated an increase in visits, staffing and patients from 2012 to 2017. Ninety percent of CHCs had a sustained increase in medical staff with an overall growth of 33%, and an average CHC change of 38%. Increased staffing and new services led to growths in medical visits: there was a 9% growth overall, with a CHC average of 19%. Total visits increased overall by 19%. Seventy percent of the CHCs had sustained growth in visits from 2012 to 2017. Additionally, 70% of the CHCs had a sustained increase in patient growth. On average CHCs experienced a 31% increase in their patient population with an overall growth of 16%. Of the 10 CHCs, only three had mental health staff at the beginning of the project period. Excluding two CHCs that did not develop their mental health services, 88% (7 out of 8 CHCs) of the CHCs had an increase in their mental health staff. The overall increase was 177%, with a CHC average of 118%. Six of eight CHCs had an increase in mental health patients and visits, including three CHCs that did have any mental health patients or visits in 2012. Overall, the number of mental health visits almost doubled (99%), and the number of patients increased by 61%.

Conclusions: Study findings demonstrate that access to care growth at Gulf South CHCs was sustained for a year after project interventions ended, including integrated mental health care services, demonstrating the effectiveness of focal interventions in disaster-affected community health centers for sustained improvements to access to care.