Pathman Donald E, Fryer George E, Green Larry A, Phillips Robert L
Cecil G. Sheps Center for Health Services Research and Department of Family Medicine, University of North Carolina, Chapel Hill, NC 27599, USA.
J Rural Health. 2005 Summer;21(3):214-20. doi: 10.1111/j.1748-0361.2005.tb00085.x.
This study assesses whether the National Health Service Corps's legislated goals to see health improve and health disparities lessen are being met in rural health professional shortage areas for a key population health indicator: age-adjusted mortality.
In a descriptive study using a pre-post design with comparison groups, the authors calculated age-adjusted mortality rates at baseline (1981-1983) and follow-up (1996-1998) for the populations of 448 rural whole-county health professional shortage areas arrayed into 3 groups based on the number of study years they were staffed by National Health Service Corps physicians, physician assistants, and nurse practitioners (terms of 1 to 7, 8 to 11, and 12 to 15 years). The authors compared changes over time in age-adjusted mortality rates in the 3 county groups that had National Health Service Corps staffing with rate changes in 172 whole-county rural health professional shortage areas and 772 non-health professional shortage area rural counties that had no National Health Service Corps.
At baseline age-adjusted mortality was higher in all 4 health professional shortage area county groups than in the non-health professional shortage area county group. Age-adjusted mortality rates improved with time in all groups, including health professional shortage area counties both with and without National Health Service Corps support, and non-health professional shortage area counties. Essentially, baseline differences in age-adjusted mortality rates between health professional shortage areas and non-health professional shortage area counties did not diminish with time, whether or not there was National Health Service Corps support.
From the early 1980s through the mid-1990s, the National Health Service Corps's goal to see health improve in rural health professional shortage areas was met, but its goal to diminish geographical health disparities was not. Because age-adjusted mortality rates improved in all county groups, the authors conclude that improvement was likely due to a variety of factors, including decreasing poverty and unemployment rates and increasing primary care physician-to-population ratios, to which the National Health Service Corps may have contributed.
本研究评估了在农村卫生专业人员短缺地区，就一项关键的人群健康指标——年龄调整死亡率而言，国家卫生服务团（National Health Service Corps）立法规定的改善健康状况和减少健康差距的目标是否得以实现。
在一项采用前后设计并设有对照组的描述性研究中，作者计算了448个农村全县卫生专业人员短缺地区人群在基线期（1981 - 1983年）和随访期（1996 - 1998年）的年龄调整死亡率。这些地区根据国家卫生服务团医生、医师助理和执业护士的工作年限分为3组（工作年限为1至7年、8至11年和12至15年）。作者将有国家卫生服务团人员配备的3个县组的年龄调整死亡率随时间的变化与172个全县农村卫生专业人员短缺地区以及772个没有国家卫生服务团的非卫生专业人员短缺地区农村县的死亡率变化进行了比较。
在基线期，所有4个卫生专业人员短缺地区县组的年龄调整死亡率均高于非卫生专业人员短缺地区县组。所有组的年龄调整死亡率均随时间有所改善，包括有和没有国家卫生服务团支持的卫生专业人员短缺地区县以及非卫生专业人员短缺地区县。从本质上讲，无论是否有国家卫生服务团的支持，卫生专业人员短缺地区与非卫生专业人员短缺地区县之间在年龄调整死亡率方面的基线差异并未随时间而缩小。
从20世纪80年代初到90年代中期，国家卫生服务团在农村卫生专业人员短缺地区改善健康状况的目标得以实现，但其减少地区健康差距的目标未达成。由于所有县组的年龄调整死亡率都有所改善，作者得出结论，这种改善可能归因于多种因素，包括贫困率和失业率的下降以及基层医疗医生与人口比例的增加，国家卫生服务团可能对此有所贡献。
