Term of Award

Summer 2012

Degree Name

Doctor of Public Health (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)


Jiann-Ping Hsu College of Public Health

Committee Chair

Dr. Gerald R. Ledlow

Committee Member 1

Hani Samawi

Committee Member 2

James Stephens


Author's Abstract: Ambulatory care sensitive conditions (ACSCs) resulting in hospitalizations make up a substantial proportion of health care costs, but should not because these conditions are manageable in quality primary care settings that promote prevention in an effort to avoid exacerbations that can lead to hospitalization. The use of emergency departments (EDs) as a safety net for ACSCs has increased the burden on hospitals because patients who do not regularly utilize primary care often resort to the use of EDs for treatment of ACSCs. Federally qualified health centers (FQHCs) are designed to provide consistent, high-quality primary care to all people, but provisions are in place to ensure that economically vulnerable populations also have access to quality primary care. FQHCs are primary care access points that guarantee variable rates as determined by patient income, and the patient knows ahead of time what the costs will be. In this study, hospital and ED discharges for ambulatory care sensitive chronic conditions (ACSCCs) were used as indicators of quality primary care. Hospital discharges represented indicators of low utilization of primary care leading to hospital level needs due to exacerbations of ACSCCs, and ED discharges were used as indicators of the ED as a safety net. A general linear model was used to determine per capita rate variations in hospital and ED discharges for ACSCCs in counties before and after FQHC additions. In the final model, race, payer-type, and age, overall, showed significant variations in hospital and ED discharges. Findings from this study indicated that most counties with FQHC presence had had lower hospital and ED discharge rates. Counties with multiple FQHCs showed greater improvement in discharge rates and rural counties showed the least improvement in rates, overall. There is a need for further exploration to understand reasons for increases in hospital and ED discharges for some years during the study period. Additionally, health care utilization behavior and social interactions may further inform researchers about the effects of wait times, hours of operation, co-pays, and other factors not measured in this study.