AHCRA: Access to Health Care in Rural Appalachia

AHCRA：阿巴拉契亚农村地区获得医疗保健的机会

• 批准号: 10790520
• 负责人: Chris Gillette
• 金额: $ 24.93万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-23 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10790520
• 关键词: Address; Affect; American; Appalachian Region; Area; Characteristics; Clinical; Communities; Data; Decision Analysis; Decision Making; Disparity; Ensure; Equitable healthcare; Equity; Face; Future; Health; Health Care Costs; Health Promotion; Health Services Accessibility; Healthcare; Incentives; Individual; Inequity; Life; Location; Medical; Medicine; Methodology; Methods; Mission; Morbidity - disease rate; National Institute on Minority Health and Health Disparities; Nurse Practitioners; Occupations; Outcome; Patients; Persons; Physician Assistants; Physicians; Policies; Policy Maker; Population; Positioning Attribute; Primary Care; Provider; Public Health; Research; Research Methodology; Rest; Rural; Rural Appalachia; Rural Population; Students; Survey Methodology; Surveys; Time; United States; Work; Workplace; access disparities; design; disparity reduction; experience; experimental study; health care availability; health disparity; health inequalities; health professional shortage areas; improved; inner city; innovation; mortality; negative affect; novel; pilot test; preference; recruit; rural Americans; rural area; suburb; uptake; urban area; urban disparity

ABSTRACT Approximately one-fifth of the United States (US) population lives in rural areas. Americans in rural areas often experience poorer health and engage in fewer health promotion activities compared to their more urban counterparts. Currently there are more healthcare clinicians per capita in urban areas compared to rural areas in the US. Despite a greater need for healthcare in rural areas, the US experiences a paradox regarding access to care in rural areas: Americans with the greatest need for healthcare experience the least access to care. While this clinician maldistribution has been present for decades, relatively little is known about why clinicians choose to locate in a specific area. Even more concerning is that the clinician maldistribution is worsening over time, forcing millions of Americans to drive farther to obtain healthcare. The disparity in access to care increases both morbidity, mortality, and increases health care costs. We propose to evaluate a theoretically-grounded, quantitative experimental approach to studying reasons underlying the maldistribution in the US healthcare clinician workforce, and to identify potential policy approaches to address these disparities. Specifically, we will evaluate the relative importance of job-, community-, and personal-related attributes for medical residents and fellows as well as physician assistant (PA) and nurse practitioner (NP) students using a discrete choice experiment (DCE). The DCE methodology is a rigorous survey method used to elicit preferences, quantify tradeoffs, and understand decision-making. This study is innovative because it will be the first to use DCE methods to identify policy options for increasing the attractiveness of rural jobs in the US. Our proposed study will address three aims: Aim 1 will elicit individual-, community-, and job-related preferences that influence decisions on whether to choose a clinical position from residents and fellows, as well as PA and NP students. Aim 2 will develop, pilot-test, and deliver the DCE survey to characterize the most important attributes and their levels that influence whether to choose a particular clinical position. Aim 3 will estimate the relative importance of the most important attributes and their levels that influence whether a clinician chooses a particular clinical position. This proposed research will provide policy- and decision-makers with an important first step towards designing policy options and incentives that increase the attractiveness of healthcare jobs in rural areas. More broadly, this proposed research will also provide our research team pilot data from which to generate future research with healthcare clinicians and identifying policy options and incentives to retain them in rural areas.

抽象的 大约五分之一的美国人口居住在农村地区。美国人在农村 与健康状况较好的地区相比，这些地区的健康状况往往较差，参与的健康促进活动也较少。 城市同行。目前，城市地区的人均医疗保健临床医生数量多于农村地区 美国的地区。尽管农村地区对医疗保健的需求更大，但美国在以下方面经历了一个悖论： 农村地区获得医疗服务的机会：最需要医疗保健的美国人却获得最少的医疗服务 关心。虽然这种临床医生分布不均的现象已经存在了几十年，但人们对其原因知之甚少。 临床医生选择位于特定区域。更令人担忧的是，临床医生分布不均 随着时间的推移，情况不断恶化，迫使数百万美国人开车更远的地方以获得医疗保健。差异在于 获得护理的机会增加了发病率和死亡率，并增加了医疗保健费用。 我们建议评估一种基于理论的定量实验方法来研究 美国医疗保健临床医生队伍分布不均的原因，并确定潜在的 解决这些差异的政策方法。具体来说，我们将评估工作的相对重要性， 住院医生、研究员以及医师助理的社区和个人相关属性 （PA）和执业护士（NP）学生使用离散选择实验（DCE）。 DCE 的方法是 一种严格的调查方法，用于获取偏好、量化权衡和理解决策。这 该研究具有创新性，因为它将是第一个使用 DCE 方法来确定增加 美国农村工作的吸引力我们提出的研究将解决三个目标： 目标 1 将引发个人、社区和工作相关的偏好，这些偏好会影响是否 从住院医师和研究员以及 PA 和 NP 学生中选择临床职位。 目标 2 将开发、试点测试并提供 DCE 调查，以描述最重要的属性和 它们的水平会影响是否选择特定的临床位置。 目标 3 将估计最重要属性的相对重要性及其影响水平 临床医生是否选择特定的临床职位。 这项拟议的研究将为政策制定者和决策者迈出重要的第一步 设计政策选择和激励措施，提高农村地区医疗保健工作的吸引力。更多的 广泛而言，这项拟议的研究还将为我们的研究团队提供试点数据，以生成未来的数据 与医疗保健临床医生进行研究，并确定将他们留在农村地区的政策选择和激励措施。