Investigating healthcare for rural females with complex gynecological conditions

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Our proposed Research Project valuably builds directly upon the progress and insights obtained in COBRE Pilot Project Years 1 and 2 regarding healthcare and outcomes for rural females with congenital uterine anomalies (CUAs, also known as Mullerian Anomalies), a National Institutes of Health (NIH) Sexual and Gender Minority health disparity research population. CUAs are differences of development of the female reproductive tract, impacting ~7% of the general female population, resulting in a variety of health concerns including pregnancy complications, pelvic pain, infertility, and in severe cases, absence of uterus and upper portion of vagina. Females with CUAs require a range of healthcare expertise related to diagnoses, treatment and follow up care throughout their lifetime. The proposed project provides a valuable opportunity to: (1) engage our Billings Clinic CUA patient community in focus groups to expand upon insights obtained from Year 2 key informant interviews, and to define priorities for future patient-driven research; (2) assess Mountain West health system administrative records to (a) reveal the prevalence and extent of interstate travel required to receive care for CUA patients in the Mountain West, and (b) stratify gynecological cancer risk for women with CUAs according to type of cancer and variation of anomaly; and (3) examine the financial burdens and insurance barriers related to CUA-related healthcare procedures to reveal the extent of important compounding disparities in terms of healthcare cost and access to medically necessary reproductive care for this patient community. Given our ability to continue fostering partnerships with our CUA patient and provider community, the project will support the continued quantitative and qualitative analysis of clinical outcomes and patient experiences, and strengthen collaborations with regional patients and their providers across the Mountain West. Successful completion of our aims will ultimately assure patients as research partners, foster broader collaboration opportunities with regional providers caring for these women (including for future recruitment), and reveal valuable clinical data outcomes to support a competitive R01 submission.