Exploring the association of social determinants of health and clinical quality measures and performance in HRSA-funded health centres

OBJECTIVE: This paper explores the impact of service area-level social deprivation on health centre clinical quality measures. DESIGN: Cross-sectional data analysis of Health Resources and Services Administration (HRSA)-funded health centres. We created a weighted service area social deprivation score for HRSA-funded health centres as a proxy measure for social determinants of health, and then explored adjusted and unadjusted clinical quality measures by weighted service area Social Deprivation Index quartiles for health centres. SETTINGS: HRSA-funded health centres in the USA. PARTICIPANTS: Our analysis included a subset of 1161 HRSA-funded health centres serving more than 22 million mostly low-income patients across the country. RESULTS: Higher levels of social deprivation are associated with statistically significant poorer outcomes for all clinical quality outcome measures (both unadjusted and adjusted), including rates of blood pressure control, uncontrolled diabetes and low birth weight. The adjusted and unadjusted results are mixed for clinical quality process measures as higher levels of social deprivation are associated with better quality for some measures including cervical cancer screening and child immunisation status but worse quality for other such as colorectal cancer screening and early entry into prenatal care. CONCLUSIONS: This research highlights the importance of incorporating community characteristics when evaluating clinical outcomes. We also present an innovative method for capturing health centre service area-level social deprivation and exploring its relationship to health centre clinical quality measures.