AHCRA: Access to Health Care in Rural Appalachia

摘要 大约五分之一的美国人口生活在农村地区。美国农村 地区往往经历更差的健康和从事更少的健康促进活动相比，他们更多的 城市同行目前，城市地区的人均医疗保健临床医生人数多于农村地区 在美国的地区。尽管农村地区对医疗保健的需求更大，但美国经历了一个悖论， 农村地区获得医疗保健的机会：最需要医疗保健的美国人获得医疗保健的机会最少。 在乎虽然这种临床医生分布不均已经存在了几十年，但对原因知之甚少 临床医生选择定位在特定区域。更令人担忧的是，临床医生分布不均， 随着时间的推移恶化，迫使数百万美国人开车更远，以获得医疗保健。悬殊 获得护理的机会增加了发病率和死亡率，并增加了保健费用。 我们建议评估一种有理论基础的定量实验方法来研究 美国医疗保健临床医生劳动力分布不均的根本原因，并确定潜在的 解决这些差距的政策方法。具体来说，我们将评估工作的相对重要性， 社区和个人相关的属性为医疗居民和研究员以及医生助理 (PA)和护士执业（NP）学生使用离散选择实验（DCE）。DCE方法是 一种严格的调查方法，用于引出偏好，量化权衡，并了解决策。这 这项研究是创新的，因为它将是第一个使用DCE方法来确定增加 美国农村就业的吸引力。我们建议的研究有三个目的： 目标1将引出个人、社区和与工作相关的偏好，这些偏好会影响是否 从住院医生和研究员以及PA和NP学生中选择临床位置。 目标2将开发、试点测试和交付DCE调查，以描述最重要的属性， 他们的水平影响是否选择一个特定的临床位置。 目标3将估计最重要的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位置。 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， 制定政策选择和激励措施，增加农村地区医疗保健工作的吸引力。更 总的来说，这项拟议的研究还将为我们的研究小组提供试点数据， 与医疗保健临床医生进行研究，并确定政策选择和激励措施，以将他们留在农村地区。

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.