such as immunizations. Those studies have found that despite serving disadvantaged populations, community health centers are able to offer high-quality preventive and chronic health-care services at costs comparable with those of facilities used by the general population (Appel et al., 2006; Carlson et al., 2001; Christman et al., 2004; Eisert et al., 2008; Falik et al., 2001; Hicks et al., 2006). Community health facilities have also been found to mitigate racial and ethnic disparities in health-care delivery and services (Appel et al., 2006; Christman et al., 2004; Eisert et al., 2008).

HRSA has oversight over its grantees and has the authority to implement health-care interventions on a national scale. HRSA facilities are well positioned to develop and implement a national strategy to expand viral-hepatitis services to medically underserved and often at-risk populations. HRSA has no centralized viral-hepatitis prevention or control program and is unable to determine the burden of hepatitis B and hepatitis C infections in the patients served in its programs (Raggio Ashley, 2009). Many community health facilities already offer some viral-hepatitis services that include prevention (such as immunizations), screening, testing and medical management. However, there is little published information about these programs.

Although there are no HRSA programs at a national level that focus on viral hepatitis, there are programs for other health concerns that could be used as models. For example, the Health Disparities Collaborative is a national effort to eliminate health disparities and improve health-care delivery in HRSA service-delivery organizations, including community health facilities. The initiative includes intervention to improve health-care delivery processes and chronic health conditions, such as asthma and diabetes (Chin et al., 2004; HRSA, 2009b). It has improved the quality of care in community health facilities for specific conditions (Landon et al., 2007). Viral hepatitis is not one of the diseases included in the program, but this type of program could be expanded to include viral-hepatitis services.

HRSA’s Uniform Data Systems (UDS) tracks a variety of information at the national, state, and individual-grantee levels, such as community health centers, migrant health centers, health-care programs for the homeless, and public-housing primary-care programs. The information collected includes patient demographics, services, staffing, clinical indicators, use rates, and associated costs (HRSA, 2009a). Such data systems could potentially be modified to include collection of data on viral-hepatitis services.

On the basis of those findings, the committee offers the following recommendation to expand the provision of viral hepatitis services:

Recommendation 5-9. The Health Resources and Services Administration should provide adequate resources to federally funded community health facilities for provision of comprehensive viral-hepatitis services.



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