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Journal article
Definition and categorization of rural and assessment of realized access to care
Health services research, v 57(3), pp 693-702
Jun 2022
PMID: 35146771
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
To examine how three measures of realized access to care vary by definitions and categorizations of "rural".
Health Information National Trends Survey (HINTS) data, a nationally representative survey assessing knowledge of health-related information, were used. Participants were categorized by county-based Urban Influence Codes (UICs), Rural-Urban Continuum Codes (RUCCs), and census tract-based Rural-Urban Commuting Area (RUCAs).
Three approaches were used across categories of UICs, RUCCs, and RUCAs: (1) non-metropolitan/metropolitan, (2) three-group categorization based upon population size, and (3) three-group categorization based on adjacency to metropolitan areas. Wald Chi-square tests evaluated differences in sociodemographic variables and three measures of realized access across three of Penchansky's "A's of access" and approaches. The three outcome measures included: having a regular provider (realized availability), self-reported "excellent" quality of care (realized acceptability), and self-report of the provider "always" spending enough time with you (provider attentiveness-realized accommodation). The average marginal effects corresponding to each outcome were calculated.
N/A PRINCIPAL FINDINGS: All approaches indicated comparable variation in sociodemographics. In all approaches, RUCA-based categorizations showed differences in having a regular provider (e.g., 68.9% of non-metropolitan and 64.4% of metropolitan participants had a regular provider). This association was attenuated in multivariable analyses. No rural-urban differences in quality of care were seen in unadjusted or adjusted analyses regardless of approach. After adjustment for covariates, rural respondents reported greater provider attentiveness in some categorizations of rural compared with urban (e.g., non-metropolitan respondents reported 6.03 percentage point increase in probability of having an attentive provider [CI = 0.76-11.31%] compared with metropolitan).
Our findings underscore the importance of considering multiple definitions of rural to understand access disparities and suggest that continued research is needed to examine the interplay between potential and realized access. These findings have implications for federal funding, resource allocation, and identifying health disparities.
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Details
- Title
- Definition and categorization of rural and assessment of realized access to care
- Creators
- Whitney E Zahnd - University of IowaNatalie Del Vecchio - Fred Hutch Cancer CenterNatoshia Askelson - University of IowaJan M Eberth - University of South CarolinaRobin C Vanderpool - National Cancer InstituteLinda Overholser - University of Colorado DenverPurnima Madhivanan - University of ArizonaRachel Hirschey - University of North Carolina at Chapel HillJean Edward - University of Kentucky
- Publication Details
- Health services research, v 57(3), pp 693-702
- Publisher
- Wiley
- Grant note
- U48 DP006399 / NCCDPHP CDC HHS K23 MD015719 / NIMHD NIH HHS U48 DP006389 / NCCDPHP CDC HHS U13 DP000641 / NCCDPHP CDC HHS U48 DP006401 / NCCDPHP CDC HHS U48 DP006413 / NCCDPHP CDC HHS U48 DP006400 / NCCDPHP CDC HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Health Management and Policy
- Web of Science ID
- WOS:000765504900001
- Scopus ID
- 2-s2.0-85125660544
- Other Identifier
- 991021855181004721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Health Care Sciences & Services
- Health Policy & Services