Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina.
Statewide Cancer Prevention and Control Program, University of South Carolina Arnold School of Public Health, Columbia, South Carolina.
J Rural Health. 2019 Mar;35(2):236-243. doi: 10.1111/jrh.12332. Epub 2018 Nov 14.
Patients with colorectal cancer (CRC) living in rural areas have lower survival rates than those in urban areas, potentially because of lack of access to quality CRC screening and treatment. The purpose of this study was to compare traditional physician density (ie, colonoscopy provider availability per capita) against a new physician density measure using an example case of colonoscopy volume and quality. The latter is particularly relevant for rural providers, who may have fewer patients and are more frequently nongastroenterologists.
We conducted a secondary data analysis of the 2014 Medicare Provider Utilization and Payment Database and the National Cancer Institute State Cancer Profile Database. Volume-weighted physician density scores at the state and county levels were created, accounting for (1) the physician's annual colonoscopy volume and (2) whether the physician performs ≥100 procedures per year. We compared volume-weighted versus traditional density, overall and by rurality, and examined their correlation with CRC screening, incidence, and mortality rates.
The difference between volume-weighted and traditional density scores was particularly large in rural parts of the West and Midwest, and it was most similar in the Northeast. Although weak, correlations with CRC outcomes were stronger for volume-weighted density, and they did not differ by rurality.
Our new method is an improvement over traditional methods because it considers the variation of physician procedure volume, and it has a stronger correlation with population health outcomes. Weighted density scores portray a more realistic picture of physician supply, particularly in rural areas.
与城市地区相比，农村地区的结直肠癌（CRC）患者的生存率较低，这可能是由于缺乏高质量的 CRC 筛查和治疗。本研究的目的是比较传统的医师密度（即每人均可获得结肠镜检查提供者的数量）与使用结肠镜检查量和质量的新医师密度衡量标准。后者对于农村地区的提供者特别相关，因为他们的患者可能较少，并且更经常是非胃肠病学家。
我们对 2014 年医疗保险提供者利用和支付数据库和国家癌症研究所州癌症概况数据库进行了二次数据分析。在州和县两级创建了基于体积的医师密度评分，考虑到（1）医师的年度结肠镜检查量和（2）医师每年是否进行≥100 次操作。我们比较了基于体积的密度与传统密度，整体上和按农村程度进行了比较，并检查了它们与 CRC 筛查，发病率和死亡率的相关性。
在西部和中西部的农村地区，基于体积的密度评分与传统密度评分之间的差异特别大，而在东北部地区则最为相似。尽管相关性较弱，但基于体积的密度与 CRC 结果的相关性更强，并且与农村程度无关。
我们的新方法优于传统方法，因为它考虑了医师手术量的变化，并且与人群健康结果的相关性更强。加权密度评分更真实地描绘了医师供应的情况，尤其是在农村地区。
