# The Role of Health Centers in Reducing Disparities in Potentially-Preventable Hospital-Based Care among Dual Eligibles

> **NIH NIH R01** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2020 · $224,166

## Abstract

PROJECT SUMMARY
Approximately 10 million Americans are eligible for both Medicare and Medicaid. These dual-eligibles are a
disproportionately high-cost population with substantial and often unmet healthcare needs. They are also more
likely to be racial/ethnic minorities and experience potentially-preventable hospitalizations and emergency
department (ED) visits resulting from disparities in access to primary care. However, relatively little is known
about the relationship between primary care access and the broader continuum of potentially-preventable
hospital care, which includes not only ED visits and hospitalizations, but also observation stays, 30-day return
ED visits, and 30-day all-cause readmissions. Federally qualified health centers (FQHCs) are “safety net”
providers that receive federal funding to provide primary care to underserved populations without regard for
patients' ability to pay. FQHCs are known to reduce racial/ethnic disparities in healthcare access and quality,
but dual-eligibles' use of FQHCs has not been well studied. Moreover, modifiable organizational characteristics
that may explain variations in FQHC performance related to reducing disparities are not well understood. Thus,
the objective of this study is to characterize and evaluate the role of FQHCs in providing primary care that
lowers rates of—and reduces racial/ethnic disparities in—hospital care among dual-eligibles. The proposed
study has three specific aims: 1) To determine the extent to which FQHCs reduce hospital care relative to
receiving care from other primary care providers; 2) To determine the extent to which racial/ethnic disparities in
hospital care are reduced among FQHC users relative to those receiving care from other primary care
providers; and 3) To determine the extent to which organizational characteristics enhance the ability of FQHCs
to reduce hospital care and related racial/ethnic disparities in care. Using seven years of Medicare claims data
(2012 – 2018) rates of—and disparities in—hospital care will be modeled as a function of FQHC use and other
primary care sources. The extent to which disparities exist within or between FQHCs will also be assessed.
Finally, FQHC-specific hospital care rates will be modeled as a function of FQHC characteristics using
Medicare claims and FQHC data from the Uniform Data System. The proposed study is significant, because it
will provide evidence of the relative effectiveness of FQHCs at lowering rates of—and reducing racial/ethnic
disparities in—hospital care and identify modifiable characteristics of high-performing FQHCs for dissemination
as best practices. The proposed study is innovative because it is the first to examine the relationship between
FQHC use and racial/ethnic disparities in the broader continuum of hospital care among dual-eligibles using
quasi-experimental methods (i.e., instrumental variable and difference-in-differences analyses) to address
selection bias, and the first to model organiza...

## Key facts

- **NIH application ID:** 10180779
- **Project number:** 3R01MD011513-05S1
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Brianna Lombardi
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $224,166
- **Award type:** 3
- **Project period:** 2017-07-01 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10180779

## Citation

> US National Institutes of Health, RePORTER application 10180779, The Role of Health Centers in Reducing Disparities in Potentially-Preventable Hospital-Based Care among Dual Eligibles (3R01MD011513-05S1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10180779. Licensed CC0.

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