scholarly journals Assessing clinical quality performance and staffing capacity differences between urban and rural Health Resources and Services Administration-funded health centers in the United States: A cross sectional study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242844
Author(s):  
Nadereh Pourat ◽  
Xiao Chen ◽  
Connie Lu ◽  
Weihao Zhou ◽  
Hank Hoang ◽  
...  
Keyword(s):  
United States ◽  
Low Income ◽  
Rural Areas ◽  
Health Resources ◽  
Quality Measures ◽  
The United States ◽  
Health Centers ◽  
Quality Performance ◽  
Clinical Quality

Background In the United States, there are nearly 1,400 Health Resources and Services Administration-funded health centers (HCs) serving low-income and underserved populations and more than 600 of these HCs are located in rural areas. Disparities in quality of medical care in urban vs. rural areas exist but data on such differences between urban and rural HCs is limited in the literature. We examined whether urban and rural HCs differed in their performance on clinical quality measures before and after controlling for patient, organizational, and contextual characteristics. Methods and findings We used the 2017 Uniform Data System to examine performance on clinical quality measures between urban and rural HCs (n = 1,373). We used generalized linear regression models with the logit link function and binomial distribution, controlling for confounding factors. After adjusting for potential confounders, we found on par performance between urban and rural HCs in all but one clinical quality measure. Rural HCs had lower rates of linking patients newly diagnosed with HIV to care (74% [95% CI: 69%, 80%] vs. 83% [95% CI: 80%, 86%]). We identified control variables that systematically accounted for eliminating urban vs. rural differences in performance on clinical quality measures. We also found that both urban and rural HCs had some clinical quality performance measures that were lower than available national benchmarks. Main limitations included potential discrepancy of urban or rural designation across all HC sites within a HC organization. Conclusions Findings highlight HCs’ contributions in addressing rural disparities in quality of care and identify opportunities for improvement. Performance in both rural and urban HCs may be improved by supporting programs that increase the availability of providers, training, and provision of technical resources.

Telepsychiatry Use in Rural Areas in the United States

2020 ◽  
Vol 13 (4) ◽  
pp. 1-13
Author(s):  
Alberto Coustasse ◽  
Morgan Ruley ◽  
Tonnie C. Mike ◽  
Briana M. Washington ◽  
Anna Robinson
Keyword(s):  
Mental Health ◽  
United States ◽  
Quality Of Care ◽  
Rural Areas ◽  
Care Delivery ◽  
Mental Healthcare ◽  
Healthcare Services ◽  
The United States ◽  
Access And Quality

Rural areas have experienced a higher than average shortage of healthcare professionals. Numerous challenges have limited access to mental health services. Some of these barriers have included transportation, number of providers, poverty, and lack of insurance. Recently, the utilization of telepsychiatry has increased in rural areas. The purpose of this review was to identify and coalesce the benefits of telepsychiatry for adults living in rural communities in the United States to determine if telepsychiatry has improved access and quality of care. The methodology for this study was a literature review that followed a systematic approach. References and sources were written in English and were taken from studies in the United States between 2004 and 2018 to keep this review current. Fifty-nine references were selected from five databases. It was found that several studies supported that telepsychiatry has improved access and quality of care available in rural environments. At the same time, telepsychiatry in mental healthcare has not been utilized as it should in rural adult populations due to lack of access, an overall shortage of providers, and poor distribution of psychiatrists. There are numerous benefits to implementing telepsychiatry in rural areas. While there are still barriers that prevent widespread utilization, telepsychiatry can improve mental health outcomes by linking rural patients to high-quality mental healthcare services that follow evidence-based care and best practices. Telepsychiatry utilization in rural areas in the United States has demonstrated to have a significant ability to transform mental health care delivery and clinician productivity. As technology continues to advance access, telepsychiatry will also advance, making access more readily available.

Quality of Child Care as an Aspect of Family and Child Care Policy in the United States

PEDIATRICS ◽  
1993 ◽  
Vol 91 (1) ◽  
pp. 182-188
Author(s):  
Sandra Scarr ◽  
Deborah Phillips ◽  
Kathleen McCartney ◽  
Martha Abbott-Shim
Keyword(s):  
United States ◽  
Child Care ◽  
Low Income ◽  
The United States ◽  
Child Care Policy ◽  
Care Policy ◽  
Working Families ◽  
Low Income Families ◽  
The Impact

The quality of child care services in the United States should be understood within a context of child care policy at the federal and state levels. Similarly, child care policy needs to be examined within the larger context of family-support policies that do or do not include parental leaves to care for infants (and other dependent family members) and family allowances that spread the financial burdens of parenthood. Maynard and McGinnis1 presented a comprehensive look at the current and predictable policies that, at federal and state levels, affect working families and their children. They note the many problems in our "patchwork" system of child care—problems of insufficient attention to quality and insufficient supply for low-income families. Recent legislation is a step toward improving the ability of low-income families to pay for child care (by subsidizing that part of the cost of such care which exceeds 15% rather than 20% of the family income) and some steps toward training caregivers and improving regulations. They note the seeming political impasse over parental leaves, even unpaid leaves, and the impact of this lack of policy on the unmet need for early infant care. We should step back from the current morass of family and child care policies in the United States and look at what other nations have done and continue to do for their working families. By comparison with other industrialized countries in the world, the United States neglects essential provisions that make it possible for parents in other countries to afford to rear children and to find and afford quality child care for their children.

scholarly journals Food Security and Climate Change: Differences in Impacts and Adaptation Strategies for Rural Communities in the Global South and North

2022 ◽  
Vol 5 ◽  
Author(s):  
Subhashni Raj ◽  
Sam Roodbar ◽  
Catherine Brinkley ◽  
David Walter Wolfe
Keyword(s):  
Climate Change ◽  
United States ◽  
Food Security ◽  
Rural Communities ◽  
Low Income ◽  
Rural Areas ◽  
Food Production ◽  
Climate Adaptation ◽  
The United States ◽  
Global North

This research highlights the mismatch between food security and climate adaptation literature and practice in the Global North and South by focusing on nested case studies in rural India and the United States during the COVID-19 pandemic. The United States is one of the wealthiest countries in the world, but also has one of the largest wealth gaps. Comparatively, India has one of the largest populations of food insecure people. To demonstrate how adaptive food security approaches to climate change will differ, we first review the unique climate, agricultural, demographic, and socio-economic features; and then compare challenges and solutions to food security posed by the COVID-19 pandemic. While both countries rely on rural, low-income farmworkers to produce food, the COVID-19 pandemic has highlighted how agricultural and food security policies differ in their influence on both food insecurity and global hunger alike. Emphasis on agricultural production in developing regions where a majority of individuals living in rural areas are smallholder subsistence farmers will benefit the majority of the population in terms of both poverty alleviation and food production. In the Global North, an emphasis on food access and availability is necessary because rural food insecure populations are often disconnected from food production.

Abstract 221: Environmental Scan of Telemedicine Networks With Services for Hypertension Management, 2016

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Carma Ayala ◽  
Zachary Russell ◽  
Farah Chowdhury ◽  
Tiffany Chang ◽  
Carla Mercado
Keyword(s):  
Low Income ◽  
Rural Areas ◽  
Access To Health Care ◽  
Gap Analysis ◽  
Diabetes Management ◽  
Health Resources ◽  
The United States ◽  
Limited Information ◽  
Environmental Scan ◽  
Number Of Patients

One of the barriers affecting continuity of hypertension care is access to health care, especially in low-income and rural areas. Telemedicine (TM) provides consultation and specialized treatment remotely, and reduces barriers of access to appropriate, high quality care. Common barriers include limited affordable transportation, job or other time constraints, and geographic isolation. TM use has increased, but there is limited information about the ease of finding TM networks and programs (TMNPs) by the general public. To address this gap, we conducted an environmental scan, during Sept.-Nov. 2016, assessing the ease of identifying existing TMNPs in the United States using simple internet searches (e.g., Google, Bing, Yahoo). First, we used the American Telemedicine Association’s 2015 Gap Analysis, Health Resources & Services Administration (HRSA) funded programs and 2013 Maryland telemedicine matrix as our template. After identifying the TMNPs, we assessed TM services provided, especially for hypertension (HTN). After compiling a consensus list of TMNPs in the US, we categorized the TMNPs based on their website’s list of services. Of the 50 states and District of Columbia (DC), we found 36 networks and 17 programs. Of these 53 TMNPs, only 1.9% (n=1) indicated that they provide TM services specifically for the management of HTN. However, there were 18 (34.0%) TMNPs that listed cardiology services. The only TMNP specifically focused on hypertension control was in the southeast, an area with a high burden of HTN. This TMNP was called the “Smartphone Medication Adherence Stops Hypertension” (SMASH), and was funded by the National Institutes of Health. The program has reported 95% control among their patient population with HTN in rural areas, including Hispanic and black adults. Other related programs included those focused on heart failure (5.7% (n=3) and diabetes management 9.4% (n=5). This initial environmental scan found most programs presented limited information about their population of interest. For example, 86.7% (n=46) did not provide information about the number of patients, area(s) served and number of partners and providers on their websites. Our results suggest common methods of obtaining information about TMNPs lack important information on TM services for HTN patients, and/or challenges in identifying existing services for patients to access. Using data collected from this environmental scan, our group will develop an exhaustive collection of data on existing TMNPs’ services (including how to participate), working directly with HRSA’s Telemedicine Resource Centers. The information from our environmental scan may produce regional and county-level telemedicine mapping to inform not only patients and their healthcare providers, but also clinicians, researchers, program managers, and decision makers on existing TMNPs that remotely provide effective HTN management.

Neighborhood Revitalization and the Practice of Evaluation in the United States: Developing a Margin Research Perspective

2002 ◽  
Vol 1 (2) ◽  
pp. 223-244 ◽  
Author(s):  
James C. Fraser ◽  
Edward L. Kick ◽  
J. Patrick Williams
Keyword(s):  
United States ◽  
Low Income ◽  
Community Building ◽  
The United States ◽  
Theory Of Change ◽  
Alternative Form ◽  
Neighborhood Revitalization ◽  
Research Perspective ◽  
Low Income Families

The dominant framework of neighborhood revitalization in the United States that emerged in the 1990s is the comprehensive community‐building approach based on a “theory of change” model. This framework posits that to improve neighborhoods and the quality of life of residents, programmatic efforts are needed that are “resident‐driven” and holistic in their focus. While these types of initiatives flourish, neighborhood revitalization often results in the displacement of low‐income families and marginal return for existing residents. Why this occurs in the context of initiatives purporting to aid existing residents is underexamined in the evaluation literature. We argue that researchers engaged in documentation and evaluation of revitalization initiatives need a broader framework to examine heretofore marginalized issues. We use a “margin research” methodology to demonstrate how this alternative form provides a more expansive representation of revitalization activities and outcomes.

scholarly journals Location Matters: Geographic Disparities and Impact of Coronavirus Disease 2019

2020 ◽  
Vol 222 (12) ◽  
pp. 1951-1954
Author(s):  
Tina Q Tan ◽  
Ravina Kullar ◽  
Talia H Swartz ◽  
Trini A Mathew ◽  
Damani A Piggott ◽  
...  
Keyword(s):  
United States ◽  
Low Income ◽  
Rural Areas ◽  
Geographic Location ◽  
The United States ◽  
Geographic Disparities ◽  
Geographic Disparity ◽  
Communities Of Color ◽  
Structural Inequities ◽  
The Impact

Abstract The coronavirus disease 2019 (COVID-19) pandemic in the United States has revealed major disparities in the access to testing and messaging about the pandemic based on the geographic location of individuals, particularly in communities of color, rural areas, and areas of low income. This geographic disparity, in addition to deeply rooted structural inequities, have posed additional challenges to adequately diagnose and provide care for individuals of all ages living in these settings. We describe the impact that COVID-19 has had on geographically disparate populations in the United States and share our recommendations on what might be done to ameliorate the current situation.

Results of the National Initiative for Cancer Care Quality: How Can We Improve the Quality of Cancer Care in the United States?

2006 ◽  
Vol 24 (4) ◽  
pp. 626-634 ◽  
Author(s):  
Jennifer L. Malin ◽  
Eric C. Schneider ◽  
Arnold M. Epstein ◽  
John Adams ◽  
Ezekiel J. Emanuel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
United States ◽  
Cancer Care ◽  
Medical Records ◽  
Significant Variation ◽  
Quality Measures ◽  
The United States ◽  
Recommended Care

Purpose In 1999, the National Cancer Policy Board called attention to the quality of cancer care in the United States and recommended establishing a quality monitoring system with the capability of regularly reporting on the quality of care for patients with cancer. Methods Using data from a patient survey 4 years after diagnosis and review of medical records, we determined the percentage of stage I to III breast cancer and stage II to III colorectal cancer survivors in five metropolitan statistical areas (MSAs) across the United States who received recommended care specified by a comprehensive set of explicit quality measures. Results Two thousand three hundred sixty-six (63%) of 3,775 eligible patients responded to the survey, and 85% consented to have their medical records reviewed. Our final analytic sample (n = 1,765) included 47% of the eligible patients. Patients with breast and colorectal cancer received 86% of recommended care (95% CI, 86% to 87%) and 78% of recommended care (95% CI, 77% to 79%), respectively. Adherence to quality measures was less than 85% for 18 of the 36 breast cancer measures, and significant variation across MSAs was observed for seven quality measures. The percent adherence was less than 85% for 14 of the 25 colorectal cancer measures, and one quality measure demonstrated statistically significant variation across the MSAs. Conclusion Initial management of patients with breast and colorectal cancer in the United States seemed consistent with evidence-based practice; however, substantial variation in adherence to some quality measures point to significant opportunities for improvement.

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