Geographic differences in community oncology provider and practice location characteristics in the central United States

Purpose How care delivery influences urban‐rural disparities in cancer outcomes is unclear. We sought to understand community oncologists’ practice settings to inform cancer care delivery interventions. Methods We conducted secondary analysis of a national dataset of providers billing Medicare from...

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Vydáno v:The Journal of rural health Ročník 38; číslo 4; s. 865 - 875
Hlavní autoři: Ellis, Shellie D., Thompson, Jeffrey A., Boyd, Samuel S., Roberts, Andrew W., Charlton, Mary, Brooks, Joanna Veazey, Birken, Sarah A., Wulff‐Burchfield, Elizabeth, Amponsah, Jonah, Petersen, Shariska, Kinney, Anita Y., Ellerbeck, Edward
Médium: Journal Article
Jazyk:angličtina
Vydáno: England Wiley Subscription Services, Inc 01.09.2022
Témata:
Cancer
cancer care
Charges
Community
community oncology
data collection
Diversity training
Geography
health care access
Innovations
Intervention
Medical personnel
Medical schools
Medicare
Oncologists
Oncology
Physicians
Rural areas
Rural communities
rural disparities
rural health
Rural health care
Rural urban differences
Schools
Secondary analysis
Specialists
Standardization
Training
Urban areas
United States > US
cancer care
rural disparities
community oncology
health care access
ISSN:0890-765X, 1748-0361, 1748-0361
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Shrnutí:Purpose How care delivery influences urban‐rural disparities in cancer outcomes is unclear. We sought to understand community oncologists’ practice settings to inform cancer care delivery interventions. Methods We conducted secondary analysis of a national dataset of providers billing Medicare from June 1, 2019 to May 31, 2020 in 13 states in the central United States. We used Kruskal‐Wallis rank and Fisher's exact tests to compare physician characteristics and practice settings among rural and urban community oncologists. Findings We identified 1,963 oncologists practicing in 1,492 community locations; 67.5% practiced in exclusively urban locations, 11.3% in exclusively rural locations, and 21.1% in both rural and urban locations. Rural‐only, urban‐only, and urban‐rural spanning oncologists practice in an average of 1.6, 2.4, and 5.1 different locations, respectively. A higher proportion of rural community sites were solo practices (11.7% vs 4.0%, P<.001) or single specialty practices (16.4% vs 9.4%, P<.001); and had less diversity in training environments (86.5% vs 67.8% with <2 medical schools represented, P<.001) than urban community sites. Rural multispecialty group sites were less likely to include other cancer specialists. Conclusions We identified 2 potentially distinct styles of care delivery in rural communities, which may require distinct interventions: (1) innovation‐isolated rural oncologists, who are more likely to be solo providers, provide care at few locations, and practice with doctors with similar training experiences; and (2) urban‐rural spanning oncologists who provide care at a high number of locations and have potential to spread innovation, but may face high complexity and limited opportunity for care standardization.
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ISSN:0890-765X
1748-0361
1748-0361
DOI:10.1111/jrh.12663