Association between
Community Health Center
and Rural Health Clinic
Presence and County-Level
Hospitalization Rates for
Ambulatory Care Sensitive
Conditions: An Analysis
Across Eight US States
Janice C. Probst, James N. Laditka and Sarah B. Laditka
ABSTRACT
Background
Federally qualied community health centers (CHCs) and rural health clin-
ics (RHCs) are intended to provide access to care for vulnerable populations.
206 Social Work in Public Health and Hospitals
While some research has explored the eects of CHCs on population health,
little information exists regarding RHC eects. We sought to clarify the con-
tribution that CHCs and RHCs may make to the accessibility of primary
health care, as measured by county-level rates of hospitalization for ambula-
tory care sensitive (ACS) conditions.
Methods
We conducted an ecologic analysis of the relationship between facility pres-
ence and county-level hospitalization rates, using 2002 discharge data from
eight states within the US (579 counties). Counties were categorized by facil-
ity availability: CHC(s) only, RHC(s) only, both (CHC and RHC), and nei-
ther. US Agency for Healthcare Research and Quality denitions were used to
identify ACS diagnoses. Discharge rates were based on the individuals coun-
ty of residence and were obtained by dividing ACS hospitalizations by the
relevant county population. We calculated ACS rates separately for children,
working age adults, and older individuals, and for uninsured children and
working age adults. To ensure stable rates, we excluded counties having fewer
than 1,000 residents in the child or working age adult categories, or 500 res-
idents among those 65 and older. Multivariate Poisson analysis was used to
calculate adjusted rate ratios.
Results
Among working age adults, rate ratio (RR) comparing ACS hospitalization
rates for CHC-only counties to those of counties with neither facility was
0.86 (95% Condence Interval, CI, 0.78–0.95). Among older adults, the
rate ratio for CHC-only counties compared to counties with neither facility
was 0.84 (CI 0.81–0.87); for counties with both CHC and RHC present,
the RR was 0.88 (CI 0.84–0.92). No CHC/RHC eects were found for chil-
dren. No eects were found on estimated hospitalization rates among unin-
sured populations.
Conclusion
Our results suggest that CHCs and RHCs may play a useful role in providing ac-
cess to primary health care. eir presence in a county may help to limit the coun-
tys rate of hospitalization for ACS diagnoses, particularly among older people.
Background
Rural Safety Net Providers
Access to primary health care in the US is aected by an individual’s nancial
ability to pay for care, principally measured by insurance, and by the availability

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