Hundreds of the nation's nearly 1,200 community health centers, which serve millions of mostly poor people, fall short on key measures such as vaccinating children and helping diabetics control blood sugar, federal data show.
More than 20 million sought care at the non-profit, mostly privately run centers last year � double the number a decade ago. The centers are poised to take an even more central role in the U.S. health system if President Obama's health law is upheld, because it would give 30 million people health coverage starting in 2014.
A Kaiser Health News-USA TODAY analysis of 2010 health center data showed:
�Centers in the South generally performed worse than those in New England, the Midwest and California
�Nearly 75% of the centers performed significantly worse � at least 10% below the national average � in screening women for cervical cancer. The national average reflects the care of all Americans.
�About 73% performed significantly below average in helping diabetics maintain their blood sugar levels.
�Roughly 28% performed significantly below average for immunizing two-year-olds.
"We feel good about quality overall, but there is clearly room to improve," says Jim Macrae, who oversees the health centers for the U.S. Health Resources and Services Administration.
Consumer advocates worry about the implications for patients.
"Of course this (data analysis) raises a concern for us," says Cindy Zeldin, executive director of Georgians for a Healthy Future, an Atlanta-based consumer health group. "We have so many uninsured for whom the community health centers are one of the few places where they can go for primary care."
Claude Earl Fox, a top health official in the Clinton administration, says community health centers have had a good reputation for providing quality care.
"If some centers are failing to provide a certain level of care, that needs to be corrected," says Fox, who now heads the Florida Public Health Institute.
Macrae points out that some centers do better than the national average in certain areas. For instance, three out of four centers performed significantly better in helping hypertensive patients keep their blood pressure under control, and more than four in 10 do significantly better in making sure women get timely prenatal care.
The centers face greater challenges than the average doctor's office because their patients are nearly six times as likely to be poor, more than twice as likely to be uninsured and nearly three times as likely to be on Medicaid, the state-federal health insurance program for the poor.
Those that treat large numbers of migrant workers and the homeless also tend to have worse outcomes because their patients face more challenges, Macrae said.
The centers have been required to report data to the federal government since 2008 on six performance measures, including how well they care for their patients with diabetes and high blood pressure, screening rates for cervical cancer, vaccination rates for children, provision of timely prenatal care and rates of low birth-weight babies.
"We are asking for more transparency to help drive better performance," Macrae says.
Georgia was the only state to rank near the bottom on four of the six performance measures the federal government collects from clinics. Four other states � Louisiana, Virginia, Kansas and Kentucky � ranked near the bottom for three measures.
Zeldin says she's not surprised that patients at Georgia's 27 health centers fare worse, given the state's high levels of obesity and diabetes.
But there were bright spots, even in Georgia: Albany Area Primary Health Care, a center with 11 clinic sites in southern Georgia, keeps more than 80% of its diabetics' blood sugar under control.
Elizabeth Rayes, 38, of Warner Robins, Ga., credits a nurse at the center for counseling her on how to control her diabetes even though she can't afford a blood glucose meter to test herself. "They do a great job," she says.
Contributing: Paul Monies, USA TODAY
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan health policy research and communications organization not affiliated with Kaiser Permanente.
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