Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA.
University of Kansas Cancer Center, Kansas City, Kansas, USA.
J Rural Health. 2022 Sep;38(4):865-875. doi: 10.1111/jrh.12663. Epub 2022 Apr 5.
How care delivery influences urban-rural disparities in cancer outcomes is unclear. We sought to understand community oncologists' practice settings to inform cancer care delivery interventions.
We conducted secondary analysis of a national dataset of providers billing Medicare from June 1, 2019 to May 31, 2020 in 13 states in the central United States. We used Kruskal-Wallis rank and Fisher's exact tests to compare physician characteristics and practice settings among rural and urban community oncologists.
We identified 1,963 oncologists practicing in 1,492 community locations; 67.5% practiced in exclusively urban locations, 11.3% in exclusively rural locations, and 21.1% in both rural and urban locations. Rural-only, urban-only, and urban-rural spanning oncologists practice in an average of 1.6, 2.4, and 5.1 different locations, respectively. A higher proportion of rural community sites were solo practices (11.7% vs 4.0%, P<.001) or single specialty practices (16.4% vs 9.4%, P<.001); and had less diversity in training environments (86.5% vs 67.8% with <2 medical schools represented, P<.001) than urban community sites. Rural multispecialty group sites were less likely to include other cancer specialists.
We identified 2 potentially distinct styles of care delivery in rural communities, which may require distinct interventions: (1) innovation-isolated rural oncologists, who are more likely to be solo providers, provide care at few locations, and practice with doctors with similar training experiences; and (2) urban-rural spanning oncologists who provide care at a high number of locations and have potential to spread innovation, but may face high complexity and limited opportunity for care standardization.
尚不清楚医疗服务的提供方式如何影响癌症结局的城乡差异。我们旨在了解社区肿瘤医生的实践环境，以为癌症医疗服务提供干预措施提供信息。
我们对美国中部 13 个州 2019 年 6 月 1 日至 2020 年 5 月 31 日期间向 Medicare 报销的提供者的全国性数据集进行了二次分析。我们使用 Kruskal-Wallis 秩和检验和 Fisher 确切检验比较了农村和城市社区肿瘤医生的医生特征和实践环境。
我们确定了 1963 名在 1492 个社区地点行医的肿瘤医生；67.5%的人在完全是城市的地点行医，11.3%的人在完全是农村的地点行医，21.1%的人在城乡地点行医。仅农村、仅城市和城乡跨越的肿瘤医生分别在 1.6、2.4 和 5.1 个不同的地点行医。农村社区站点中有更高比例的单一医生执业（11.7%比 4.0%，P<.001）或单一专业实践（16.4%比 9.4%，P<.001）；培训环境的多样性较低（86.5%比 67.8%，代表<2 所医学院的比例较低，P<.001）。农村多专业小组站点不太可能包括其他癌症专家。
我们确定了农村社区中两种潜在的不同医疗服务提供方式，这可能需要不同的干预措施：（1）孤立的农村肿瘤医生，他们更有可能是单一的提供者，在很少的地点提供医疗服务，与具有类似培训经验的医生一起工作；（2）城乡跨越的肿瘤医生，他们在很多地点提供医疗服务，并有可能传播创新，但可能面临高复杂性和有限的医疗标准化机会。
