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 美国约有五分之一的人口居住在农村地区。美国人在农村 与他们更多的人相比 城市同行。目前，与农村相比，城市地区的人均医疗临床医生更多 美国地区。尽管在农村地区需要更大的医疗保健，但美国还是遇到了关于 在农村地区获得护理：对医疗保健经验最少需求最少的美国人 关心。虽然这位临床医生的马尔代面已经存在了数十年，但关于为什么 临床医生选择定位在特定区域。更令人担忧 随着时间的流逝，迫使数百万美国人开车进一步获得医疗保健。差异 获得护理可以提高发病率，死亡率并增加医疗保健成本。 我们建议评估一种理论上的，定量的实验方法 美国医疗保健临床医生劳动力中造成的Maldistibution的原因，并确定潜在 解决这些差异的政策方法。具体而言，我们将评估工作的相对重要性 - 医疗居民和研究员以及医师助理的社区和个人相关属性 （PA）和护士从业人员（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，用于引起偏好，量化权衡并了解决策。这 研究具有创新性，因为它将是第一个使用DCE方法来识别增加策略选择的方法 美国农村工作的吸引力。我们提出的研究将针对三个目标： AIM 1将引起个人，社区和与工作有关的偏好 从居民和研究员以及PA和NP学生中选择临床位置。 AIM 2将开发，试点测试和提供DCE调查，以表征最重要的属性和 他们的水平会影响是否选择特定的临床位置。 AIM 3将估计最重要属性及其影响的相对重要性 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和决策者提供重要的第一步 设计政策选择和激励措施，以提高农村地区医疗保健工作的吸引力。更多的 从广义上讲，这项拟议的研究还将提供我们的研究团队试点数据，从中产生未来 与医疗保健临床医生进行研究，并确定政策选择和在农村地区保留它们的激励措施。