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Should Measures of Health Care Availability Be Based on the Providers or the Procedures? A Case Study with Implications for Rural Colorectal Cancer Disparities
Journal article   Open access   Peer reviewed

Should Measures of Health Care Availability Be Based on the Providers or the Procedures? A Case Study with Implications for Rural Colorectal Cancer Disparities

Michele J Josey, Jan M Eberth, Lee R Mobley, Mario Schootman, Janice C Probst, Scott M Strayer and Erica Sercy
The Journal of rural health, v 35(2), pp 236-243
01 Mar 2019
DOI: https://doi.org/10.1111/jrh.12332
PMID: 30430641
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://europepmc.org/articles/pmc6436979?pdf=renderView
Accepted (AM)Open Access (License Unspecified),  Open

Abstract

Colorectal Neoplasms - economics Colorectal Neoplasms - therapy Costs and Cost Analysis - methods Costs and Cost Analysis - trends Early Detection of Cancer Health Personnel - statistics & numerical data Health Services Accessibility - standards Health Services Accessibility - statistics & numerical data Healthcare Disparities - standards Healthcare Disparities - statistics & numerical data Humans Methods Rural Population - statistics & numerical data Socioeconomic Factors
Patients with colorectal cancer (CRC) living in rural areas have lower survival rates than those in urban areas, potentially because of lack of access to quality CRC screening and treatment. The purpose of this study was to compare traditional physician density (ie, colonoscopy provider availability per capita) against a new physician density measure using an example case of colonoscopy volume and quality. The latter is particularly relevant for rural providers, who may have fewer patients and are more frequently nongastroenterologists. We conducted a secondary data analysis of the 2014 Medicare Provider Utilization and Payment Database and the National Cancer Institute State Cancer Profile Database. Volume-weighted physician density scores at the state and county levels were created, accounting for (1) the physician's annual colonoscopy volume and (2) whether the physician performs ≥100 procedures per year. We compared volume-weighted versus traditional density, overall and by rurality, and examined their correlation with CRC screening, incidence, and mortality rates. The difference between volume-weighted and traditional density scores was particularly large in rural parts of the West and Midwest, and it was most similar in the Northeast. Although weak, correlations with CRC outcomes were stronger for volume-weighted density, and they did not differ by rurality. Our new method is an improvement over traditional methods because it considers the variation of physician procedure volume, and it has a stronger correlation with population health outcomes. Weighted density scores portray a more realistic picture of physician supply, particularly in rural areas.

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11 Record Views
5 citations in Web of Science
5 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Health Care Sciences & Services
Health Policy & Services
Public, Environmental & Occupational Health
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