Gruca Thomas S, Pyo Tae-Hyung, Nelson Gregory C
Tippie College of Business (T.S.G.) and Office of Statewide Clinical Education Programs, Carver College of Medicine (G.C.N.), University of Iowa, Iowa City, Iowa
School of Business, State University of New York, New Paltz, New York
J Bone Joint Surg Am. 2016 May 4;98(9):768-74. doi: 10.2106/JBJS.15.00946.
Patients from rural areas tend to be older and less physically active and are more likely to be obese, increasing their need for orthopaedic services. However, few orthopaedic surgeons practice in rural areas. One approach to meeting the needs of rural patients is visiting consultant clinics (VCCs). In this study, we examined orthopaedic surgery outreach in Iowa, a state with a large rural population. We assessed the involvement of the 2014 Iowa orthopaedic surgery workforce in outreach activities for the geographically disadvantaged rural population and its effect on patient travel distances.
The University of Iowa Carver College of Medicine annually tracks VCC locations and frequencies. Data from 2014 were used to estimate average trip length for participating orthopaedic surgeons and patients in all Iowa census tracts. Primary practice locations, visiting consultant clinic locations, and census tracts were classified according to the 2010 Rural-Urban Commuting Areas (RUCA) classifications.
In 2014, 4,596 VCC days were provided in 80 predominantly rural sites. Overall, as a result of VCCs staffed by orthopaedic surgeons in Iowa and adjoining states, the number of Iowan counties with an orthopaedic surgeon increased from 35 (at his/her primary practice location) to 88 (at a VCC or primary practice location) of 99. Forty-five percent of all Iowa-based orthopaedic surgeons participated in a VCC. Visiting orthopaedic surgeons drove a total of 32,496 mi (52,297 km) per month to conduct these clinics. The average driving distance to the nearest orthopaedic surgeon was reduced from 19.2 mi (30.9 km) to 8.4 mi (13.5 km) for rural Iowans as a result of monthly VCCs. Monthly VCCs improved access to orthopaedic surgeons for between 450,000 and 670,000 Iowans from a total population of approximately 3 million.
VCCs staffed by orthopaedic surgeons from Iowa and surrounding states improve access to orthopaedic care by reducing driving distances for rural patients.
农村地区的患者往往年龄较大，身体活动较少，且更易肥胖，这增加了他们对骨科服务的需求。然而，很少有骨科外科医生在农村地区执业。满足农村患者需求的一种方法是设立巡回咨询诊所（VCC）。在本研究中，我们调查了爱荷华州（该州农村人口众多）的骨科手术外展情况。我们评估了2014年爱荷华州骨科手术工作人员参与针对地理条件不利的农村人口的外展活动情况及其对患者出行距离的影响。
爱荷华大学卡弗医学院每年跟踪VCC的地点和频率。2014年的数据用于估计爱荷华州所有普查区参与的骨科外科医生和患者的平均行程长度。主要执业地点、巡回咨询诊所地点和普查区根据2010年城乡通勤区（RUCA）分类进行划分。
2014年，在80个主要为农村地区的地点提供了4596个VCC日。总体而言，由于爱荷华州及周边州的骨科外科医生提供的VCC，爱荷华州有骨科外科医生的县数量从99个中的35个（在其主要执业地点）增加到88个（在VCC或主要执业地点）。所有爱荷华州的骨科外科医生中有45%参与了VCC。参与巡回的骨科外科医生每月总共行驶32496英里（52297公里）来开展这些诊所。由于每月的VCC，爱荷华州农村居民到最近骨科外科医生的平均驾车距离从19.2英里（30.9公里）降至8.4英里（13.5公里）。每月的VCC改善了爱荷华州约300万总人口中45万至67万人获得骨科外科医生服务的机会。
由爱荷华州及周边州的骨科外科医生提供的VCC通过缩短农村患者的驾车距离，改善了他们获得骨科护理的机会。
