In this step students will determine the level of evidence and quality of evidence listed on the literature review matrix. Keep in mind that not all evidence is the same type of evidence or quality.

• Access Stage 2 - Quality Appraisal instructions inDHA Integrative Review Doctoral Study Guidebook located on theDHA Doctoral Project website.

• Access the below quality appraisal tools on the DHA Doctoral Project webpage.
• Appendix D-John's Hopkins Hierarchy of Evidence Guide 2022
• Appendix E-John's Hopkins Research Appraisal Tool
• Appendix F-John's Hopkins Non-Research Appraisal Tool

Healthcare Administration Research Problem Justification Sources Review three sources from below that had a "High" or "Good" quality of rating using the quality appraisal tools. If you do not end up with at least three (3) sources with a "High" or "Good" rating, continue search for sources, repeat al the steps and revise this form. Remember that research is iterative in nature.
Source 1 -3	Full Citation:
Level of Evidence:
Which Quality Appraisal Tool was used?
Which section on the appraisal form was completed?
What was the quality rating and your final decision for inclusion or exclusion in the research:

1. Patnode, C. D., Dahlem, N. W., O'Ho-O'Donovan, A., & Newberry, S. J. (2015). effects of increased primary care physician supply on health care utilization and outcomes for adults: A systematic evidence review for the U.S. Preventive Services Task Force. Annals of internal medicine, 162(2), 91-101.

• Theoretical Concept/Framework: Increased primary care physician supply Research Questions: How does increased primary care physician supply affect health care utilization and outcomes for adults? Methodology: Systematic evidence review Analysis & Results: Data was collected through search engines and databases for studies with various types of controls, stratified by data sources, and applied. Author's Conclusion or Results of Research: Increased primary care physician supply is associated with decreased hospital admission and mortality, increased preventive services, and improved access to care. Implications for further research: More research is needed to understand the full effects of increased primary care physician supply on health care utilization and outcomes. Implications for practice: Increasing access to primary care physicians can improve health outcomes. Empirical Research Source (Yes or No): Yes

2. Buco, A., Terando, P., Zelman, W., & Hill-Kayser, C. (2015). We are meeting the primary care needs of low-income populations through Federally Qualified Health Centers and Community Health Centers. Population health management, 18(3), 141-147.

• Theoretical Concept/Framework: Federally Qualified Health Centers (FQHCs) and Community Health Centers Research Questions: How can FQHCs and Community Health Centers meet the primary care needs of low-income populations? Methodology: Qualitative and quantitative data analysis Analysis & Results: Data from the Health Resources and Services Administration National Centers for Human Services, the Community Health Center Database, and the American Community Survey were used. Author's Conclusion or Results of Research: FQHCs and Community Health Centers are essential in providing access to primary care for low-income populations, closing the gaps in geographic, financial, and cultural barriers. Implications for further research: Additional research is needed to understand how FQHCs and Community Health Centers can better serve communities and explore potential strategies to increase access to primary care. Implications for practice: FQHCs and Community Health Centers have the potential to provide essential services to low-income populations and help close gaps in access to care. Empirical Research Source (Yes or No): Yes

3. Rundall, T. G., Flessner, M., & Armstrong, K. (2020). Improving Access to Primary Care: Integrating Federal Qualified Health Centers in Safety-Net Systems. Frontiers in public health, 8.

• Theoretical Concept/Framework: Federally Qualified Health Centers (FQHCs) Research Questions: How can FQHCs be used to improve access to primary care? Methodology: Qualitative and quantitative research Analysis & Results: The authors conducted a literature review, expert interviews, and account reviews. Author's Conclusion or Results of Research: FQHCs are an effective way to increase access to primary care, especially for underserved and low-income populations. FQHCs are more cost-effective than other safety-net providers, and thoughtfully constructed safety-net systems can benefit from incorporating them. Implications for further research: More research is needed to understand the potential outcomes of incorporating FQHCs into safety-net systems. Implications for practice: Integrating FQHCs into safety-net systems can improve access to primary care for underserved and low-income populations. Empirical Research Source (Yes or No): Yes

4. Hampel, C. A., Brason, F. W., Engel, C., Feldman, M., Garrett, J., Himmelstein, D., & Woolhandler, S. (2021). Patient and physician perspectives from the front lines: Accessing primary care in the low-income U.S. safety net. PloS one, 16(2), e0245991.

• Theoretical Concept/Framework: Low-income US safety net Research Questions: What are the challenges of accessing primary care in the low-income U.S. safety net from the patient and physician perspectives? Methodology: Qualitative research- interviews with patients and providers from low-income safety-net settings Analysis & Results: The results of the interviews were coded and analyzed to identify common themes. Author's Conclusion or Results of Research: Patients and providers in low-income safety-net settings face a variety of challenges when trying to access primary care, including lack of provider appointment availability, high levels of bureaucracy, and payment barriers. Implications for further research: More research is needed to identify strategies for improving access to primary care, given the unique challenges faced by patients and providers in the low-income U.S. safety net. Implications for practice: Understanding these challenges and identifying strategies to increase access to care in the low-income U.S. safety net is essential. Empirical Research Source (Yes or No): Yes

5. Glik, D. C., & Terento, C. (2018). Strategic Mapping of Federally Qualified Health Centers: Impact on Access and Cost for Underserved Populations. Health services research, 53(2), 641-656.

• Theoretical Concept/Framework: Federally Qualified Health Centers (FQHCs) Research Questions: How do FQHCs impact access and cost for underserved populations? Methodology: Qualitative and quantitative research mapping of FQHCs and primary care providers Analysis & Results: Data from government sources, medical records, and interviews was collected and analyzed. Author's Conclusion or Results of Research: FQHCs positively impact access to health care for underserved populations and cost savings from hospital utilization. Implications for further research: Research is needed to examine the cost of providing care at FQHCs and identify how FQHCs can be leveraged to increase access to care for vulnerable populations. Implications for practice: FQHCs can be a cost-effective way to increase healthcare access for underserved populations. Empirical Research Source (Yes or No): Yes