Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor.
Center for Eye Policy and Innovation, University of Michigan, Ann Arbor.
JAMA Ophthalmol. 2018 Jan 1;136(1):39-45. doi: 10.1001/jamaophthalmol.2017.5081.
As the United States considers how to best structure its health care services, specialty care availability is receiving increased focus. This study assesses whether patients lack reasonable access to ophthalmologists in states where optometrists have been granted expanded scope of practice.
To determine the estimated travel time (ETT) to the nearest ophthalmologist office for persons residing in states that have expanded scope of practice for optometrists, and to quantify ETT to the nearest ophthalmologist for Medicare beneficiaries who received surgical care from optometrists in those states between 2008 and 2014.
DESIGN, SETTING, AND PARTICIPANTS: This study used data from the 2010 US census, a 2016 American Academy of Ophthalmology member database, and a data set of claims data for a random sample of 20% of beneficiaries enrolled in Medicare nationwide from 2008 to 2014 (n=14 063 725). Combining these sources with geographic information systems analysis, the ETT to the nearest ophthalmologist office was calculated for every resident of Kentucky, Oklahoma, and New Mexico. This study also assessed ETT to the nearest ophthalmologist for Medicare beneficiaries in those states who had received surgery from an optometrist from 2008 to 2014. Data analyses were conducted from July 2016 to July 2017.
The proportion of residents of Kentucky, Oklahoma, and New Mexico who live within an ETT of 10, 30, 45, 60, or 90 minutes of the nearest ophthalmologist office.
The study included 4 339 367 Kentucky residents, 3 751 351 Oklahoma residents, and 2 059 179 New Mexico residents. Of these, 5 140 547 (50.6%) were female. Racial/ethnic composition included 7 154 847 people (70.5%) who were white, 640 608 (6.3%) who were black, and 1 418 246 (14.0%) who were Hispanic. The mean (SD) age was 37.8 (22.8) years. More than 75% of residents in the 3 states lived within an ETT of 30 minutes to the nearest ophthalmology office, and 94% to 99% of residents lived within an ETT of 60 minutes to the nearest ophthalmology office. Among Medicare beneficiaries who received surgery by optometrists, 58.3%, 51.1%, and 46.9% in Kentucky, Oklahoma, and New Mexico, respectively, lived within an ETT of 30 minutes from the nearest ophthalmologist office.
In the states where optometrists have expanded scope of practice, most residents lived within an ETT of 30 minutes of the nearest ophthalmologist office, as do half of Medicare beneficiaries who received surgical care from optometrists. These results can help inform policy makers when weighing the pros and cons of scope of practice expansion for optometrists.
随着美国考虑如何最好地构建其医疗保健服务，专业医疗服务的可及性受到了越来越多的关注。本研究评估了在允许验光师扩大执业范围的州，患者是否无法合理获得眼科医生的服务。
确定居住在扩大了验光师执业范围的州的人前往最近的眼科医生办公室的估计旅行时间（ETT），并量化 2008 年至 2014 年间在这些州接受过眼科医生手术治疗的医疗保险受益人的 ETT 到最近的眼科医生办公室。
设计、地点和参与者：本研究使用了 2010 年美国人口普查、2016 年美国眼科学会会员数据库以及 2008 年至 2014 年全国范围内 20%的医疗保险受益人的随机抽样索赔数据（n=14 063 725）的数据。通过将这些来源与地理信息系统分析相结合，计算了肯塔基州、俄克拉荷马州和新墨西哥州每位居民前往最近的眼科医生办公室的 ETT。本研究还评估了在这三个州从 2008 年至 2014 年接受过眼科医生手术治疗的医疗保险受益人的 ETT 到最近的眼科医生办公室。数据分析于 2016 年 7 月至 2017 年 7 月进行。
肯塔基州、俄克拉荷马州和新墨西哥州居民中，居住在距离最近眼科医生办公室 10、30、45、60 或 90 分钟 ETT 范围内的比例。
该研究包括 4339367 名肯塔基州居民、3751351 名俄克拉荷马州居民和 2059179 名新墨西哥州居民。其中，5140547 人（50.6%）为女性。种族/民族构成包括 7154847 人（70.5%）为白人、640608 人（6.3%）为黑人、1418246 人（14.0%）为西班牙裔。平均（SD）年龄为 37.8（22.8）岁。这三个州的 75%以上的居民居住在距离最近的眼科诊所 30 分钟的 ETT 范围内，94%至 99%的居民居住在距离最近的眼科诊所 60 分钟的 ETT 范围内。在接受眼科医生手术治疗的医疗保险受益人中，肯塔基州、俄克拉荷马州和新墨西哥州分别有 58.3%、51.1%和 46.9%的人居住在距离最近的眼科医生办公室 30 分钟的 ETT 范围内。
在允许验光师扩大执业范围的州，大多数居民居住在距离最近的眼科医生办公室 30 分钟的 ETT 范围内，接受过眼科医生手术治疗的医疗保险受益人的一半也居住在距离最近的眼科医生办公室 30 分钟的 ETT 范围内。这些结果可以为政策制定者在权衡扩大验光师执业范围的利弊时提供参考。
