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. 1987 Jun;22(2):207–233.

The substitutability of outpatient primary care in rural community health centers for inpatient hospital care.

R D Deprez, B E Pennell, M A Libby
PMCID: PMC1065432  PMID: 3301745

Abstract

To determine whether outpatient medical care obtained at federally funded rural community health centers (CHCs) in Maine acts primarily as a substitute or as a complement to inpatient care, a study of 36 communities served by CHCs was conducted. The hospital use of CHC users (age- and sex-adjusted admissions, days, and length of stay) was compared with that of nonusers from the same communities in 1980. Statistically lower rates of hospital admissions and days were observed for all CHC patients and for selected groups based on their age, sex, and insurance status (specifically Medicaid or Medicare). Hospital use of CHC community populations was then compared with that of 24 comparison communities without access to CHCs, using multiple linear regression in a pre/post design. The model tested, which included rates of health center use, insurance penetration, poverty, and hospital availability, among other factors, did not detect any differences in hospital use between CHC community and comparison populations. These results and additional data presented on selected hospital diagnoses and insurance coverage suggest that treatment, and hospitalization incentives, of CHC providers may reduce hospitalization. Clinic providers lack the economic, professional, and institutional incentives to hospitalize. Additional study to determine the actual substitutability effect is indicated.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bellin S. S., Geiger H. J., Gibson C. D. Impact of ambulatory-health-care services on the demand for hospital beds. N Engl J Med. 1969 Apr 10;280(15):808–812. doi: 10.1056/NEJM196904102801505. [DOI] [PubMed] [Google Scholar]
  2. Berk A. A., Chalmers T. C. Cost and efficacy of the substitution of ambulatory for inpatient care. N Engl J Med. 1981 Feb 12;304(7):393–397. doi: 10.1056/NEJM198102123040704. [DOI] [PubMed] [Google Scholar]
  3. Berki S. E., Ashcraft M. L. On the analysis of ambulatory utilization: an investigation of the roles of need, access and price as predictors of illness and preventive visits. Med Care. 1979 Dec;17(12):1163–1181. [PubMed] [Google Scholar]
  4. Brewer W. R., Freedman M. A. Causes and implications of variation in hospital utilization. J Public Health Policy. 1982 Dec;3(4):445–454. [PubMed] [Google Scholar]
  5. Freeman H. E., Kiecolt K. J., Allen H. M., 2nd Community health centers: an initiative of enduring utility. Milbank Mem Fund Q Health Soc. 1982 Spring;60(2):245–267. [PubMed] [Google Scholar]
  6. Freiberg L., Jr Substitution of outpatient care for inpatient care:problems and experience. J Health Polit Policy Law. 1979 Winter;3(4):479–496. doi: 10.1215/03616878-3-4-479. [DOI] [PubMed] [Google Scholar]
  7. Gold M. R., Rosenberg R. G. Use of emergency room services by the population of a neighborhood health center. Health Serv Rep. 1974 Jan-Feb;89(1):65–70. [PMC free article] [PubMed] [Google Scholar]
  8. Hochheiser L. I., Woodward K., Charney E. Effect of the neighborhood health center on the use of pediatric emergency departments in Rochester, New York. N Engl J Med. 1971 Jul 15;285(3):148–152. doi: 10.1056/NEJM197107152850305. [DOI] [PubMed] [Google Scholar]
  9. Miettinen O. Estimability and estimation in case-referent studies. Am J Epidemiol. 1976 Feb;103(2):226–235. doi: 10.1093/oxfordjournals.aje.a112220. [DOI] [PubMed] [Google Scholar]
  10. Nobrega F. T., Krishan I., Smoldt R. K., Davis C. S., Abbott J. A., Mohler E. G., McClure W. Hospital use in a fee-for-service system. JAMA. 1982 Feb 12;247(6):806–810. [PubMed] [Google Scholar]
  11. Okada L. M., Wan T. T. Impact of community health centers and Medicaid on the use of health services. Public Health Rep. 1980 Nov-Dec;95(6):520–534. [PMC free article] [PubMed] [Google Scholar]
  12. Salber E. J., Feldman J. J., Rosenberg L. A., Williams S. Utilization of services at a neighborhood health center. Pediatrics. 1971 Feb;47(2):415–423. [PubMed] [Google Scholar]
  13. Ullman R., Block J. A., Boatright N. C., Stratmann W. C. Imapct of a primary care group practice on emergency room utilization at a community hospital. Med Care. 1978 Sep;16(9):723–729. doi: 10.1097/00005650-197809000-00002. [DOI] [PubMed] [Google Scholar]
  14. Wennberg J. E., Gittelsohn A. Health care delivery in Maine I: patterns of use of common surgical procedures. J Maine Med Assoc. 1975 May;66(5):123-30, 149. [PubMed] [Google Scholar]
  15. Wennberg J. E., Gittelsohn A., Soule D. Health care delivery in Maine II: conditions explaining hospital admission. J Maine Med Assoc. 1975 Oct;66(10):255-61, 269. [PubMed] [Google Scholar]

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