Illinois FQHCs Deliver More Guideline-Concordant Kidney Disease Testing, Study Finds
Key Clinical Summary
- Patients at federally qualified health centers (FQHC) in Illinois had higher rates of guideline-recommended kidney disease testing compared with non-FQHC patients, despite greater social risk.
- Dual annual testing (estimated glomerular filtration rate [eGFR] and urine albumin creatinine ratio [uACR]) among patients with diabetes was significantly more common in FQHCs.
- Adjusted analyses showed fewer care gaps at FQHCs, even after accounting for age, sex, and diabetes status.
FQHCs serve more than 30 million people in the US and play a central role in caring for socially and economically vulnerable populations. A new Illinois-based analysis suggests these safety-net providers may outperform other settings in delivering guideline-concordant nephropathy (kidney disease) screening, despite facing greater structural challenges.
Study Findings
Researchers conducted a cross-sectional analysis of laboratory testing patterns among adults in Illinois using deidentified 2023 data from Labcorp. The study included 810 749 individuals aged 18 years or older with at least 1 hemoglobin A1c (HbA1c), eGFR, or uACR result.
The analysis compared patients receiving care at FQHCs with those treated at non-FQHC sites. Patients at FQHCs were younger on average (46.0 vs 53.1 years), more likely to be female, and had similar diabetes prevalence (20.8% vs 20.3%). Kidney disease prevalence was lower among FQHC patients (9.9%) than among non-FQHC patients (12.5%).
Despite these differences, kidney disease testing rates were consistently higher at FQHCs. Among individuals with low eGFR (< 60 mL/min/1.73 m²), 40.8% of FQHC patients received uACR testing, compared with 26.1% in non-FQHC settings. Among patients with diabetes, 61.3% of those treated at FQHCs received dual annual eGFR and uACR testing vs 46.2% at non-FQHCs.
After adjustment for demographic and clinical characteristics, patients at FQHCs with low eGFR were 23% more likely to receive uACR testing (adjusted odds ratio [aOR], 1.23; 95% CI, 1.17-1.29). Patients with diabetes treated at FQHCs were twice as likely to receive dual testing (aOR, 2.00; 95% CI, 1.95-2.05).
Clinical Implications
Nephropathy disproportionately affects individuals with diabetes, hypertension, low income, and limited access to care—characteristics common in the FQHC population. Clinical guidelines emphasize routine eGFR and uACR testing to detect chronic kidney disease early and guide risk stratification and treatment decisions.
The findings suggest that FQHCs in Illinois are effectively closing care gaps in kidney disease screening, even while caring for patients with significant social risk factors. For payers and managed care organizations, these results highlight the potential value of the FQHC model in delivering high-quality, guideline-aligned preventive care.
From a population health perspective, improved screening may enable earlier intervention, slow disease progression, and reduce downstream costs associated with advanced kidney disease. Policymakers focused on equity and value-based care may view these data as supportive evidence for continued investment in FQHC infrastructure and quality programs.
According to the study authors, the results indicate that FQHCs demonstrated more guideline-concordant testing for patients with diabetes and reduced kidney function than non-FQHC practices in Illinois. The investigators noted that, although the findings are limited to individuals tested through a single national laboratory, they align with prior research showing that FQHCs often deliver higher-quality preventive care despite resource constraints.
Conclusion
In a large Illinois laboratory dataset, FQHCs outperformed non-FQHC settings in kidney disease screening adherence. The findings underscore the role of FQHCs as effective safety-net providers and support their inclusion in strategies aimed at reducing kidney disease disparities and improving outcomes for at-risk populations.
Reference
Fraunhofer L, Cassidy L, Meurer J, et al. Guideline adherence for kidney disease testing at federally qualified health centers. JAMA Netw Open. 2025;8(9):e2533812. doi:10.1001/jamanetworkopen.2025.33812
