Examining the Relationship Between Health Center Program Financing, Medical Services Utilization and Controlled Hypertension Among Maryland Community Health Centers from 2008 and 2013

Abstract

Using a conceptual model adapted from the Aday and Andersen’s (1974) framework, this study aims to examine the relationship between health center program financing, medical services utilization, and controlled hypertension among Maryland Community Health Centers (CHCs) in 2008 and 2013 calendar years. This study also examines other covariates in the model such as Maryland’s CHCs characteristics and characteristics of Maryland’s CHCs population at risk. There are three hypotheses in this study. First, there is a linear relationship between controlled hypertension and medical services utilization. Next, the average controlled hypertension rate among Maryland CHCs is significantly different between measurement years 2008 and 2013. Finally, the dependent variable (controlled hypertension) is linear related to the independent variables as a group.

This was a cross-sectional study using calendar years 2008 and 2013 Uniform Data System (UDS) data as well as the UDS Mapper. The sample size included 15 Maryland CHCs in 2008 and 2013 calendar years that totaled 30 data points. The study found a significant, positive relationship between controlled hypertension and medical services utilization. However, medical services utilization was no longer a predictor for controlled hypertension when race and income was controlled. Maryland CHCs’ mean controlled hypertension rate in 2013 was significantly greater than 2008 calendar year. Lastly, while Maryland CHCs’ Bureau of Primary Health Care grants had a unexpected negative relationship to controlled hypertension, it also shared a significant, linear relationship to controlled hypertension when medical services utilization, White race, and incomes 151–200% above the Federal Poverty Guidelines were constant.

Conclusions from the study includes the following key points. Not addressing the other interactions and interrelations of variables in which health policy/financing influences may indeed have unintended impacts on community health outcomes. Medical services utilization, as an independent variable is a significant predictor for controlled hypertension in Maryland CHCs. However, it does not uniquely explain controlled hypertension among Maryland CHCs. While Maryland CHCs in this study sample exceeded both the national average and Healthy People 2020 goals for controlled hypertension, further work is warranted to address the sociodemographic and socioeconomic disparities found within Maryland CHCs’ hypertensive patients.