Summary
Federally qualified health centers (FQHCs) in Illinois demonstrated higher guideline adherence for kidney disease testing compared to non-FQHCs. Patients with low eGFR or diabetes at FQHCs were more likely to receive recommended uACR and dual testing, respectively. This suggests FQHCs may be a valuable strategy for improving care and outcomes for at-risk populations.
Editor: Deborah Sesok-Pizzini, MD, MBA, adjunct professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Guideline adherence for kidney disease testing at FQHCs
January 2026—Federally qualified health centers are community health care organizations that provide primary care and other support services to underserved and at-risk populations in the United States. These centers serve patients regardless of insurance coverage or ability to pay. The purpose of federally qualified health centers (FQHCs) is to reduce the barriers to health care access for those with low to moderate incomes. Many of these facilities treat patients with chronic conditions, such as diabetes and hypertension, which are risk factors for developing kidney disease. Due to the social and clinical risk factors for kidney disease in the FQHC patient population, it is important to understand how these entities are managing patients at risk for the condition. To this end, the authors leveraged test results from a large national laboratory to evaluate and compare guideline adherence in testing for kidney disease among those receiving care at FQHCs against those receiving care at other facilities, referred to as non-FQHCs, in Illinois. The authors used deidentified data and examined laboratory tests, including hemoglobin A1C (HbA1C), estimated glomerular filtration rate (eGFR), and urine albumin creatinine ratio (uACR), for the study. Guideline adherence and care gaps in testing were defined as uACR testing performed on people with an eGFR of less than 60 mL/min./1.73 m2 (low eGFR) and annual eGFR and uACR (dual) testing for patients with diabetes. The authors analyzed a cross-sectional laboratory data set applied to adults 18 years or older in Illinois to examine the prevalence of kidney disease and guideline adherence at the FQHCs. Adherence was defined as at least 1 HbA1C, eGFR, or uACR test conducted at Labcorp during 2023. The authors then performed a multivariable logistic regression analysis to determine whether adults treated at FQHCs were more likely to experience gaps in care than those treated at non-FQHCs. Statistical analysis was adjusted for patient demographic and clinical characteristics, including age, sex, and presence of diabetes. The laboratory results for 810,749 people who received care at FQHCs showed that these individuals were younger, more likely to be female, and had similar rates of diabetes prevalence but lower rates of kidney disease prevalence than those treated at non-FQHCs. Of interest, testing rates for kidney disease were higher in FQHCs than non-FQHCs for both uACR testing among those with low eGFR (6,209 [40.8 percent] patients versus 12,009 [26.1 percent] patients, respectively) and dual testing among people with diabetes (32,198 [61.3 percent] patients versus 24,717 [46.2 percent] patients, respectively). Among the significant study findings was that people with low eGFR treated in an FQHC were 23 percent more likely to receive uACR testing than those treated in a non-FQHC (adjusted odds ratio [OR], 1.23; 95 percent confidence interval [CI], 1.17–1.29; P <.001). In addition, patients with diabetes treated at an FQHC were twice as likely to receive dual testing than the non-FQHC cohort (adjusted OR, 2.0; 95 percent CI, 1.95–2.05; P <.001). The authors noted that despite serving at-risk, low-income populations, the Illinois FQHCs provided more guideline-concordant testing for patients with diabetes or decreased kidney function, or both, than the non-FQHCs. The authors concluded that although these data may not be generalizable to testing outside of Labcorp, they support earlier research suggesting that FQHCs are more likely than other primary care practices to demonstrate capabilities associated with enhanced access to care and lab testing and higher quality of care. Findings like this support the FQHC model as a potential key strategy for reducing gaps in care and improving outcomes for at-risk patient populations.
Fraunhofer L, Cassidy L, Meurer J, et al. Guideline adherence for kidney disease testing at federally qualified health centers. JAMA Network Open. 2025. doi.org/10.1001/jamanetworkopen.2025.33812
Correspondence: Dr. Jennifer Bragg-Gresham at jennb@med.umich.edu