Community Health Center Quality Improvement: A Systematic Review and Future Directions for Research

Background: Leaders and policymakers need an accurate appraisal of the federally qualified community health center (CHC) quality improvement (QI) literature to make informed decisions for the CHC program.

Objectives: This paper aims to (1) summarize the content and findings of CHC QI studies to date, (2) systematically rate the quality of those studies, and (3) outline 10 important areas for future CHC QI research.

Methods: We searched medical and nonmedical databases to identify QI studies in CHC settings. We systematically reviewed identified studies for the features of their QI interventions and for the methodological quality of their evaluations. We combined results from the review with input from the CHC community to generate an agenda for future CHC QI research.

Results: Eighteen studies were identified and reviewed. Interventions mainly targeted chronic conditions and screening practices and used 1 to 11 of 14 different QI tactics; evaluations comprised 14 observational and 4 randomized study designs. CHC QI interventions have been effective in improving processes of care for diabetes and cancer screening in the short term; their effectiveness in the long term and regarding outcomes of care have not been demonstrated.

Conclusions: QI interventions in CHC setting are promising, but future interventions and evaluations should answer critical basic questions about QI, including the following: What are the best models of QI? How can QI improvements be effectively implemented and sustained? What are the global effects of QI (positive and negative)? How can QI be made financially viable and sensible from both the CHC and societal perspectives?