Results Summary

PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.


Community health centers offer a variety of services—such as transportation and health education—to help low-income patients access and use the health care they need. These services are called enabling services. They are an important piece of the care that community health centers offer. However, researchers don’t know how well these services work from the perspectives of patients and healthcare providers.

Project Purpose

The research team wanted to test a way for patients and health center staff to rate the effectiveness of enabling services.

Study Design

The research team adapted and tested an existing approach for obtaining ratings from study participants to include patients’ and clinic staff members’ opinions.

The project had three phases:

Phase 1: Developing the list of enabling services

The research team brought together 4 patients and 13 staff and health professionals from community health centers in California for a one-day group meeting. Researchers asked participants to list all the enabling services that fell into six categories: case management, language interpretation, outreach, financial advice, social services, and health education. The final list included 276 enabling services.

Phase 2: Rating the enabling services

The research team brought together a panel of four patients, five experts in health policy, and four healthcare workers and leaders from community health centers for a one-day meeting. All of the participants had knowledge about enabling services. Researchers asked the panel to rate the 276 services identified in Phase 1 on how effective they were for improving patients’ ability to access, use, and understand their health care. Panelists did not factor a service’s cost into their ratings. Panelists rated the services twice. First, they rated each of the 276 enabling services on their own. Then, after a group discussion of ratings, they rerated 181 of the services. Participants rated the enabling services on a scale of 1–9, in which 1–3 was ineffective, 4–6 was uncertain, and 7–9 was effective.

Phase 3: After the ratings

The research team calculated a score for each service. This score represented what the panel as a whole thought about how helpful each service was for patients in community health centers. The scores helped the research team identify the most and least effective services.


Each of the six categories of services received an overall rating based on the average score of effectiveness given by panelists for all of the category’s services after the group discussion. From most effective to least effective, the panelists rated categories of enabling services as follows:

  • Social services, 8.1
  • Outreach, 7.5
  • Financial advice, 7.4
  • Case management, 7.1
  • Language interpretation, 6.9
  • Health education, 6.6

Panelists’ ratings after the group discussion were more similar than their ratings before the discussion. This finding indicates that the discussion changed the way panelists thought about the effectiveness of services.

Each panelist group (patients, community health center staff, and health policy experts) rated the services similarly within the group but differently from the other groups of panelists. Overall, patients rated enabling services as more effective than did the health professionals or staff.


The selected rating method required panelists to review research, but there is little previous research about the effectiveness of enabling services. Without much research to discuss, panelists mostly discussed their own thoughts about the enabling services. The panel was also small. The discussion and ratings might be different with other groups of people. Ratings also might have been different if the panel had had more than one day for discussion.


The research team adapted and tested an existing method for obtaining ratings from study participants to include input from patients and healthcare professionals. The team found that patients, health center leaders and staff, and policy experts have different opinions about the effectiveness of enabling services. This finding supports involving patients in research about delivery of health care. The results also produced a ranking of enabling services according to their perceived effectiveness by patients, providers, and experts. This list could guide further research about enabling services.

Sharing the Results

The research team published a journal article about the research (see below).

Project Information

Robin M. Clarke, MD
University of California, Los Angeles
A Modified Delphi Approach to Defining a Patient-Centered Community Health Center

Key Dates

June 2012
December 2013

Study Registration Information


Has Results
Award Type
Funding Type
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 4, 2022