As a first-year medical student,I have had the privilege of completing my Longitudinal Ambulatory Care Experience (LACE) at the Lake Elsinore Family Health Center,which is a designated federally-qualified health center (FQHC).LACE is an initiative by the University of California,Riverside School of Medicine that allows first-year medical students to gain clinical experience in a primary care clinic under the supervision of a preceptor.I have learned a lot from the population we serve and from my LACE physician,世卫组织将其大部分职业生涯致力于解决服务水平低下社区的健康差距问题。我还了解到，卫生保健是如何受到创建FQHC的积极影响的。
这些诊所可以追溯到林登·约翰逊总统的政府,它创建了社区卫生中心，作为1965年反贫困行动的一部分。The federally-funded neighborhood health centers provided health and social services to impoverished communities.Several measures were subsequently passed in Congress to provide primary care to the underserved,创造了这个词”federally qualified health center"1989。这些医疗中心根据《公共卫生服务法》获得联邦补助金，以便向医疗服务不足的人群提供医疗保健，而不管他们的支付能力如何。FQHCs是低收入社区的一个无障碍护理来源，以文化能力提供全套服务，这减少了昂贵的急诊室就诊。
The Lake Elsinore Family Health Center,an outpatient facility of the Riverside University Health System,就是这样的诊所。它位于埃尔西诺湖，California,指定的卫生资源和服务管理局医疗服务不足地区.As of 2016,the population of Lake Elsinore64岁，205，人均收入21美元，191年，超过50%的人认为是西班牙人或拉丁裔，以及4.4%的黑人或非裔美国人。A total of 14.2% are without health insurance,and 15% of its population live in poverty.
埃尔西诺湖社区中的少数民族和种族患者面临着社会经济地位较低的标志，比如低教育水平，a lack of well-paying jobs,缺乏健康保险，营养不良，交通便利，语言障碍和难以信任卫生保健提供者。Lower socioeconomic status is also associated with poor health outcomesthat include higher mortality rates from cancer,diabetes,哮喘，高血压，and cardiovascular disease.
诊所提供成人初级护理，儿科学，maternal and child health,行为健康和一系列预防服务。It provides services to community members of all ages regardless of their health insurance status or their ability to pay.通过在一个地方提供全面的医疗保健，patients are able to make multiple appointments in one day,which saves on transportation costs,离开工作或家庭的时间和日托费用。该位置还允许连续护理。
Elsinore湖家庭中心还通过雇用临床医生和工作人员来提供具有文化能力的服务，反映患者的种族多样性。研究表明当患者和提供者属于同一种族或种族时，患者会提高医疗服务的利用率，并且不太可能推迟或延迟医疗预约。FQHCs are also mandated to have translation services to allow for easier and accurate transmission of health communication and to build clinician-patient trust.这是利用亲属向非英语患者翻译敏感信息的改进，这可能会影响实际消息以及相关方之间的关系。
FQHCs serve complex patients,many with multiple comorbidities that have worsened due to lack of health care,health insurance or distrust of the health care system.这些病人更可能在急诊室寻求治疗，这就提高了医疗保健的成本。Frequent visits to the emergency department is considered a marker for unequal access to health care.然而，,研究表明社区内有一个FQHC，减少了对紧急部门的非紧急访问次数，降低医疗保健系统的总体成本和负担。
有一位病人，她是一位失业的埃尔辛诺尔湖居民，她50多岁，有公共健康保险，这表明在这个社区拥有这个FQHC诊所的重要性。她患有多种复杂疾病。She was visibly cachectic,糖尿病，高血压，with constant diarrhea,cramps in her extremities and above all overwhelmed with managing her health.她向几位不同的专家介绍了她的多重诊断。可以理解，她对下一次预约是哪个专家感到困惑，betway必威如何去赴约，她应该和谁见面。For these reasons,she returned to her primary care physician for help.
我和我的蕾丝医生彻底检查了她的病情，然后慢慢地陪她完成预约。她很感激医生花时间确保他们都制定了她理解的计划，and that it was one to which she could commit.My LACE physician developed a great relationship with this patient and she felt comfortable returning to the clinic for a simple clarification instead of the more costly route of delaying care until her condition has worsened significantly.我很感激能在她的护理中发挥一小部分作用，并希望她能够获得超出诊所所能提供的所需的护理。
Although FQHCs are an essential part of health care,they face some challenges.Due to the large volume of patients that these clinics serve,wait times for an appointment as well as delays during an encounter can be lengthy,negatively impacting patient encounter satisfaction.In addition,通常，FQHCS的供应商流动率很高，which impacts continuity of care.
尽管日程安排和供应商营业额存在挑战，FQHC目前在确保对服务不足者的公平照顾方面发挥着重要作用。Like the Lake Elsinore Family Center,they not only address the inequities in our health system,but also provide a necessary safety net for the most vulnerable in our society.