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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Veröffentlicht in:The Journal of rural health Jg. 38; H. 4; S. 865 - 875
Hauptverfasser: 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
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Wiley Subscription Services, Inc 01.09.2022
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ISSN:0890-765X, 1748-0361, 1748-0361
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Abstract 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.
AbstractList PurposeHow 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.MethodsWe 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.FindingsWe 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.ConclusionsWe 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.
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.
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. 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. 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. 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.
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.
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.PURPOSEHow 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.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.METHODSWe 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.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.FINDINGSWe 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.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.CONCLUSIONSWe 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.
Author Roberts, Andrew W.
Thompson, Jeffrey A.
Charlton, Mary
Kinney, Anita Y.
Ellerbeck, Edward
Amponsah, Jonah
Birken, Sarah A.
Wulff‐Burchfield, Elizabeth
Ellis, Shellie D.
Boyd, Samuel S.
Petersen, Shariska
Brooks, Joanna Veazey
AuthorAffiliation 5. Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
8. Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS
1. Department of Population Health, University of Kansas Medical Center, Kansas City, KS
9. Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University
2. University of Kansas Cancer Center, Kansas City, KS
4. Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS
3. Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS
7. Division of Medical Oncology, University of Kansas Medical Center, Kansas City, KS
6. Wake Forest University School of Medicine, Winston-Salem, NC
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  surname: Ellerbeck
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/35384064$$D View this record in MEDLINE/PubMed
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CitedBy_id crossref_primary_10_1007_s10552_025_02054_8
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crossref_primary_10_1016_j_conctc_2022_100981
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community oncology
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Snippet Purpose How care delivery influences urban‐rural disparities in cancer outcomes is unclear. We sought to understand community oncologists’ practice settings to...
How care delivery influences urban-rural disparities in cancer outcomes is unclear. We sought to understand community oncologists' practice settings to inform...
PurposeHow care delivery influences urban‐rural disparities in cancer outcomes is unclear. We sought to understand community oncologists’ practice settings to...
PURPOSE: How care delivery influences urban‐rural disparities in cancer outcomes is unclear. We sought to understand community oncologists’ practice settings...
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StartPage 865
SubjectTerms 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
Title Geographic differences in community oncology provider and practice location characteristics in the central United States
URI https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fjrh.12663
https://www.ncbi.nlm.nih.gov/pubmed/35384064
https://www.proquest.com/docview/2716011549
https://www.proquest.com/docview/2647655525
https://www.proquest.com/docview/2723121594
https://pubmed.ncbi.nlm.nih.gov/PMC9589478
Volume 38
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