Hawes Emily M, Adhikari Mukesh, Rains Jacob, Newton Helen, Rodefeld Lori, Clements Deborah, Fraher Erin
is a Professor, Department of Family Medicine, University of North Carolina (UNC) School of Medicine, and Research Fellow, Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina, USA.
is a Research Investigator, Cecil G. Sheps Center for Health Services Research, and a PhD Student, Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
J Grad Med Educ. 2025 Jun;17(3):296-303. doi: 10.4300/JGME-D-24-00593.1. Epub 2025 Jun 16.
While many factors influence clinician supply and distribution, community-based training is an influential policy lever to increase health care access in underserved settings. The Teaching Health Center Graduate Medical Education (THCGME) program funds training in community-based settings. Recognizing the program's impact, Congress created the Teaching Health Center Planning and Development (THCPD) program to provide start-up funding to support community-based organizations in establishing new residency programs. To date, limited data are available on THCPD outcomes. To describe THCPD program outcomes and training sites and compare characteristics of teaching health center (THC) counties to other eligible counties. We analyzed differences in county-level characteristics among communities with THCs (THCGME [n=85] and/or THCPD [n=92] programs with training sites in 180 counties) to counties with community health centers that were not participating in THCGME/PD. We conducted univariate and multivariate regressions to identify county characteristics associated with having a THC program. THCPD is supporting the development of new residency programs, projected to create 900 resident positions, in 13 states and 73 counties that previously did not have a THC. Thirty-nine THCPD-supported programs have attained accreditation, totaling 501 accredited positions at full complement. Forty-seven of the 180 counties (26.1%) with THCGME/PD sites are rural. In contrast to other eligible counties, THCs serve counties with greater proportions of Medicaid beneficiaries (adjusted OR=1.06; 95% CI, 1.04-1.08) and mental health professional shortage areas (adjusted OR=5.00; 95% CI, 1.10-22.7). THCPD is increasing the number of accredited residency programs in community-based settings with higher rates of Medicaid eligibility and a shortage of mental health care workforce.
虽然许多因素影响临床医生的供应和分布，但基于社区的培训是增加医疗服务可及性的一项有影响力的政策杠杆，适用于医疗服务不足的地区。教学健康中心研究生医学教育（THCGME）项目为基于社区的培训提供资金。国会认识到该项目的影响，设立了教学健康中心规划与发展（THCPD）项目，以提供启动资金，支持社区组织建立新的住院医师培训项目。迄今为止，关于THCPD成果的数据有限。为了描述THCPD项目成果和培训地点，并比较教学健康中心（THC）所在县与其他符合条件县的特征。我们分析了设有THC的社区（THCGME[n = 85]和/或THCPD[n = 92]项目，培训地点分布在180个县）与未参与THCGME/PD的社区健康中心所在县之间县级特征的差异。我们进行了单变量和多变量回归分析，以确定与设有THC项目相关的县特征。THCPD正在支持13个州和73个县开展新的住院医师培训项目，预计将创造900个住院医师岗位，这些地区此前没有THC。39个由THCPD支持的项目已获得认证，满员时共有501个认证岗位。在180个设有THCGME/PD培训地点的县中，有47个（26.1%）是农村地区。与其他符合条件的县相比，THC所在县的医疗补助受益人的比例更高（调整后的比值比=1.06；95%置信区间，1.04 - 1.08），且心理健康专业人员短缺地区更多（调整后的比值比=5.00；95%置信区间，1.10 - 22.7）。THCPD正在增加基于社区的环境中获得认证的住院医师培训项目数量，这些地区医疗补助资格率较高，且心理健康护理劳动力短缺。
