Provider-Level Variation in Treatment Planning of Radiation Oncology Procedures in the United States

2021 ◽  
pp. OP.20.00441
Author(s):  
Luca F. Valle ◽  
Fang-I. Chu ◽  
Stephanie M. Yoon ◽  
Palak Kundu ◽  
Puja Venkat ◽  
...  
Keyword(s):  
Treatment Planning ◽  
Radiation Oncology ◽  
Rural Areas ◽  
Female Gender ◽  
The United States ◽  
Male Gender ◽  
Future Research ◽  
Metropolitan Regions ◽  
Medical School Graduation ◽  
Imrt Planning

PURPOSE: Variation in the use of radiation oncology procedures and technologies is poorly characterized. We sought to identify associations between the treatment planning codes used to bill for radiotherapy procedures and the demographic characteristics of the radiation oncologists submitting them. METHODS: The Physician and Other Supplier Public Use File was linked to the Physician Compare database by using the physician National Provider Identifier for the year 2016. Analysis was stratified by practice setting, considering both the freestanding non–facility-based (NFB) setting and the facility-based (FB) setting. Multivariable logistic regression was used to determine provider characteristics (gender, practice rurality, and years since graduation) that predicted for the use of 3D-conformal RT (3DCRT) planning, intensity-modulated RT (IMRT) planning, and brachytherapy planning in the Medicare population. RESULTS: Three thousand twenty-nine physicians were linked for analysis. In both the FB and NFB settings together, male gender predicted for decreased likelihood of 3DCRT planning (OR, 0.70, 95% CI, 0.62 to 0.80, P < .001) and increased likelihood of IMRT planning (OR, 1.35, 95% CI, 1.19 to 1.54, P < .001). Brachytherapy planning was also more likely with increasing years since medical school graduation (OR, 1.03, 95% CI, 1.01 to 1.04, P < .001) in the combined FB and NFB settings. These significant associations persisted when examining the NFB and FB settings individually. In both settings overall, brachytherapy planning was more likely in male providers (OR, 1.75, 95% CI, 1.10 to 2.76, P = .02) and also more likely for providers practicing in metropolitan regions compared with those practicing in rural areas (OR, 3.01, 95% CI, 1.23 to 7.39, P = .02). CONCLUSION: Male gender predicts for utilization of IMRT planning, whereas female gender predicts for utilization of 3DCRT planning. Future research is warranted to better understand the role that provider gender and rurality play in the selection of radiation planning techniques for Medicare patients.

Injury Severity of Truck Drivers in Crashes at Highway-Rail Grade Crossings in the United States

2018 ◽  
Vol 2672 (10) ◽  
pp. 38-47 ◽  
Author(s):  
Waleed A. Khan ◽  
Aemal J. Khattak
Keyword(s):  
Rural Areas ◽  
Injury Severity ◽  
Transportation Network ◽  
Mixed Logit ◽  
The United States ◽  
Road User ◽  
Future Research ◽  
The Road ◽  
Grade Crossing ◽  
Driver Injuries

The physical and operational characteristics of large trucks distinguish them from other types of vehicles in terms of facility design needs and safety requirements. A critical node in the surface transportation network is the highway-rail grade crossing (HRGC) because it represents a conflict point between different modes of transportation. The focus of this research was to identify factors related to different injury severity levels of truck/truck-trailer drivers in crashes reported at HRGCs. This study utilized a mixed logit model to investigate injury severity of those drivers and relied on 2007–2014 Federal Railroad Administration (FRA) crash and inventory data involving trucks/truck-trailers. Results showed that truck/truck-trailer drivers’ injuries in crashes reported at HRGCs were positively associated with train speed, when train struck the road user (truck/truck-trailer), when the driver “went around crossing gates”, older drivers, crashes reported in rural areas, and crashes at crossings with a minimum crossing angle of 60–90 degrees. Presence of crossbucks, gates, track obstructions, and HRGCs located within 500 feet of a highway were associated with relatively less severe driver injuries. The paper provides recommendations for safety improvements at HRGCs and recommendations for future research.

scholarly journals Length of Stay in Hospice Care across Racial/Ethnic Minorities over 65 Years of Age: A Descriptive Analysis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 778-778
Author(s):  
Heshuo Yu ◽  
J Scott Brown
Keyword(s):  
African Americans ◽  
Length Of Stay ◽  
Hospice Care ◽  
Descriptive Analysis ◽  
Secondary Analysis ◽  
Female Gender ◽  
The United States ◽  
Future Research ◽  
Race Ethnicity ◽  
The Relationship

Abstract Purpose This study aims to explore the relationship between race/ethnicity and length of stay in hospice care among adults over 65 years of age in the United States. This topic is understudied within a population-representative sample, particularly among non-White decedents. Methods Secondary analysis of data from the 2007 NHHCS (n=3,918). Race/ethnicity included Hispanics/Latinos, Non-Hispanic Whites, African Americans, and other races. Length of hospice stay was measured by the number of days that patients received hospice care from hospice agencies. Results The study found that African Americans have a longer length of stay in hospice agencies than Whites, even after controlling for all other factors in the model. Female gender, older age, and several diseases are covariates that significantly impact length of hospice stay. Discussion Compared to other races/ethnicities, the long length of stay in hospice among African Americans may negatively impact the quality of end-of-life care and quantity of skilled staff visits. Future research is recommended to further explore potential consequences of longer hospice stays, especially within African American communities. Studies with larger samples of minorities that integrate socioeconomic factors need to be done to better study the relationship between length of hospice stay and race/ethnicity.

Improving the Quality of Rural Nursing Care

2008 ◽  
Vol 26 (1) ◽  
pp. 175-194 ◽  
Author(s):  
Kathleen Cox ◽  
Irma Mahone ◽  
Elizabeth Merwin
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Rural Areas ◽  
Ethical Issues ◽  
The United States ◽  
Operational Definition ◽  
Future Research ◽  
Quality Health Care ◽  
Research Issues

The purpose of this chapter is to review the literature on quality of care in rural areas. Keywords related to rural quality of care were used to search CINAHL and MEDLINE databases for articles published between 2005 and 2007 (limited to studies occurring in the United States). The review consisted of a total of 46 articles. Limitations include inconsistent definitions of rural, the use of only articles available to the reviewers, an unclear understanding of the context of many of the studies, and lack of a clear operational definition of quality. The studies were grouped and discussed according to quality of workforce, practice, treatment, interventions, and technology in rural areas. Each study’s contribution to the understanding of quality health care in rural areas and to determining what was effective in improving staff, patient, or organizational outcomes in rural areas was considered. This chapter also offers a discussion of ethical issues and data quality in rural research. Issues for future research include a focus on patient safety, mental health issues, and the use of technology to improve quality of care in rural areas. Future research should also focus on demonstration studies of model applications. The nursing profession has a unique opportunity to conduct research that will contribute to the development of knowledge that will ultimately improve the quality of health and health care for individuals in rural communities.

scholarly journals Role of Pharmacists in Hormonal Contraceptive Access: A Survey of North Carolina Pharmacists

Pharmacy ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 191
Author(s):  
Gwen J Seamon ◽  
Allison Burke ◽  
Casey R Tak ◽  
Amy Lenell ◽  
Macary Weck Marciniak ◽  
...  
Keyword(s):  
North Carolina ◽  
Rural Areas ◽  
Hormonal Contraception ◽  
Community Pharmacists ◽  
The United States ◽  
The State ◽  
Public Health Issue ◽  
Future Research ◽  
Potential Barriers

The role of pharmacy in healthcare continues to evolve as pharmacists gain increased clinical responsibilities in the United States, such as the opportunity to prescribe hormonal contraception. Currently, North Carolina (NC) pharmacists do not have this ability. While previous research focused on the perceptions of community pharmacists surrounding this practice, no previous research surveyed all pharmacists in a state. This cross-sectional, web-based survey was distributed to all actively licensed pharmacists residing in the state of NC in November 2018. The primary objective was to determine the likelihood of NC community pharmacists to prescribe hormonal contraception. Secondary outcomes included: evaluation of all respondent support and perceptions of this practice as advocacy occurs on the state organization level and unified support is critical; opinions regarding over-the-counter (OTC) status of contraception; and potential barriers to prescribing. Overall, 83% of community pharmacists were likely to prescribe hormonal contraception. No differences in likelihood to prescribe were detected between geographic settings. Community pharmacists reported that the most common barriers to impact prescribing were added responsibility and liability (69.8%) and time constraints (67.2%). Fewer than 10% of respondents felt that hormonal contraception should be classified as OTC (7.9%). Noncommunity pharmacists were significantly more likely to agree that prescribing hormonal contraception allows pharmacists to practice at a higher level, that increased access to hormonal contraception is an important public health issue, and that rural areas would benefit from pharmacist-prescribed hormonal contraception. Overall, this study found a willingness to prescribe and support from the majority of both community and noncommunity pharmacists. Limitations of the study included a low response rate and potential nonresponse bias. Future research is needed to address solutions to potential barriers and uptake of this practice, if implemented.

Between the Country and the Concrete: Rediscovering the Rural–Urban Fringe

2008 ◽  
Vol 7 (1) ◽  
pp. 61-79 ◽  
Author(s):  
Jeff S. Sharp ◽  
Jill K. Clark
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Secondary Data ◽  
The United States ◽  
Urban Fringe ◽  
Future Research ◽  
Research Needs ◽  
Suburban Areas ◽  
Rural Places ◽  
Practical Implications

Substantial U.S. population growth in relatively rural areas adjacent to large urban areas is sparking renewed interest in the rural–urban fringe. This research identifies some of the roots of the rural–urban fringe concept and reviews recent scholarly interest in the related exurban concept. Analysis of primary and secondary data is conducted to examine the fringe in relation to both urban/suburban areas and rural areas of Ohio, seeking to determine the extent to which the fringe is similar to or dissimilar from the suburbs or more rural areas. Comparisons are made across a number of ecological, occupational, and sociocultural attributes. Differences between incorporated (cities and villages) and unincorporated (township) areas are also considered. Findings support the notion of the fringe being distinct from the suburbs, with more modest differences compared to more rural places. Practical implications of this research are discussed as are future research needs for further understanding an increasingly important settlement area of the United States.

Regional Population-Based Workforce Shortages in General Surgery by Practicing Surgeon and Resident Trainee

2021 ◽  
pp. 000313482110298
Author(s):  
Israel Zagales ◽  
Mitchell Bourne ◽  
Mason Sutherland ◽  
Anthony Pasarin ◽  
Ruth Zagales ◽  
...  
Keyword(s):  
Population Growth ◽  
General Surgery ◽  
Rural Areas ◽  
The United States ◽  
Population Based ◽  
American Medical College ◽  
Future Research ◽  
Medical College ◽  
The People ◽  
Practicing Physicians

Background The physician shortage in the United States (US) continues to become more apparent. We aimed to evaluate the relationship between the US physician distribution from 2012-2019 by specialty at the state/regional level relative to the corresponding population growth. Methods US matched residents and practicing physicians from 2012-2019 were extracted from the National Resident Matching Program and Association of American Medical College databases, respectively. Residents and practicing physicians were divided by geographic regions (West, Midwest, South, Northeast), states, and specialties (anesthesiology, emergency medicine, family medicine, general surgery (GS), internal medicine, obstetrics/gynecology and pediatrics). Results Entering residents and physicians increased across 7 specialties from 2012-2019 with the exception of GS, which showed .2% decrease in practicing physicians. GS experienced decreases in entering residents in all US regions except the South. All specialties showed a decrease in the people-per-physician (PPP) except GS and pediatrics, which had a 4.1% and 71.3% increase, respectively. EM showed the largest growth overall, both in entering residents and overall workforce. Conclusion GS experienced slow growth of residents, decreases in practicing physicians and workforce overall, and an increase in PPP from 2012-2019. Our findings suggest that current population growth rate is exceeding the rate of physicians entering the field of GS and highlights the need for interventions to promote the recruitment of GS residents and retainment of attending physicians, particularly for rural areas. Future research to measure surgeon distribution in relation to patient outcomes and the efficacy of recent policy to address shortages can help define additional interventions to address physician shortages moving forward.

scholarly journals Regenerating Places outside the Metropolis. A Reading of Three Global Art-Related Processes and Development Trajectories

2021 ◽  
Vol 13 (22) ◽  
pp. 12359
Author(s):  
Ludovico Centis ◽  
Ezio Micelli
Keyword(s):  
United States ◽  
Rural Areas ◽  
The United States ◽  
Global Scale ◽  
Future Research ◽  
Practical Implementation ◽  
Industrialized Countries ◽  
Art And Culture ◽  
Urban And Rural Areas

The aim of the paper is to reflect on the intersection of two relevant phenomena that unfolded in recent decades in all the most industrialized countries and economies—from the United States to Europe and Japan—as the shrinkage of vast urban and rural areas and the increasing role of culture as a driver for economic growth and social development. The attention is focused on the role of art as one of the main engines of territorial regeneration. Three case studies—Verzegnis in Italy, the Seto Islands in Japan, Marfa in the United States—have been selected to open a reflection on the relation between culture, art and regeneration on a global scale. To measure these effects, the research intertwined field explorations, access to primary and secondary texts, an original mapping of the sites and a series of targeted interviews through an extensive questionnaire. The research addresses the role played by art and culture both in the reuse of abandoned buildings and spaces and in the activation, involvement and self-empowerment of the inhabitants. The aim is not the definition of an immediately generalizable model but to reach the first synthesis, identifying general characters and opening future research paths that engage with the theoretical and practical implementation of politics related to heritage, culture and innovative regeneration processes.

scholarly journals The global infrastructure public-private partnership and the extra-territorial politics of collective provision: The case of regional rail transit in Denver, USA

Urban Studies ◽  
2019 ◽  
Vol 56 (7) ◽  
pp. 1426-1447 ◽  
Author(s):  
Andrew EG Jonas ◽  
Andrew R Goetz ◽  
Sylvia Brady
Keyword(s):  
Collaborative Governance ◽  
The United States ◽  
Public Private Partnership ◽  
Transportation Infrastructure ◽  
Future Research ◽  
Private Partnership ◽  
Public Agency ◽  
Metropolitan Regions ◽  
Territorial Politics ◽  
Contractual Agreements

Drawing upon a case study of regional transit in Denver, Colorado, this article describes and accounts for the emergence of the global infrastructure public-private partnership (GIP3) as a novel extra-territorial mechanism for financing and delivering transportation infrastructure projects across large metropolitan regions in the United States (US). Unlike traditional locally-funded public-private partnerships, a GIP3 involves a global (i.e. extra-territorial) consortium of private sector construction firms and investors which enters into a long-term contract with a regional public agency to finance, operate, maintain and deliver strategic investments in transportation infrastructure. In 2004, Denver region voters approved a sales tax increase to fund the Denver Regional Transportation District (RTD)’s US$4.7 billion FasTracks programme, a 122-mile extension of light and commuter rail along six corridors. Faced with a shortfall in regional funding, the Denver RTD subsequently entered into a contract with a GIP3 consortium to finance and deliver the Eagle P3 project, a major component of the FasTracks system to Denver International Airport. The article argues that future research on GIP3 contractual agreements needs to consider the local control of infrastructure assets and the integrity of supporting regional collaborative governance arrangements.

scholarly journals Regional Medical Campuses in Canada and the United States: A Systematic Review

2018 ◽  
Vol 1 (3) ◽  
Author(s):  
Trina Fyfe ◽  
Ralitsa Akins ◽  
Pierre Gagne' ◽  
Craig Cheifetz ◽  
Sarina Petrocelly ◽  
...  
Keyword(s):  
Medical Education ◽  
Rural Areas ◽  
Basic Science ◽  
Mixed Methods Research ◽  
Healthcare Access ◽  
The United States ◽  
Future Research ◽  
Topic Area ◽  
Societal Needs ◽  
Regional Medical

Introduction The development of Regional Medical Campuses (RMCs) in Northern America has been a response to the call to increase undergraduate medical student enrollment and meet the societal needs of healthcare access by addressing physician shortages in underserved and in rural areas. We studied the literature on undergraduate RMCs in US and Canada to identify types of studies and leading themes. Methods Literature searches were performed within the following databases: Medline OVIDSP, Evidence-Based Medicine Reviews OVIDSP, CINAHL EBSCO, ERIC EBSCO, PsycInfo EBSCO, and Web of Science ISI. Articles were included in the review if they discussed undergraduate medical education in allopathic schools in Northern America (US and Canada), were written in English and related to regional medical campuses. Each article was reviewed and assessed by two of the authors, and information extracted from the literature was thematically analyzed. Results Fifty (50) articles were selected for inclusion in the final review. All selected articles fit the definition of Regional Medical Campus developed by the Association of American Medical Colleges’ Group on Regional Medical Campuses (GRMC). The GRMC has defined that RMCs could be of four distinct types: basic science campuses, where students study pre-clinical (basic sciences) courses; clinical campuses, where clerkship training is completed; longitudinal model (for example, Longitudinal Integrated Clerkships) and, usually 4-year campuses, where both pre-clinical and clinical curriculum is delivered. Thirty-six (36) of the reviewed articles (72%) specifically stated that the development of RMCs was in response to the physician shortage and limited access to healthcare in rural areas. Twenty-five (25) articles discussed program models that spanned both basic science and clinical curricula. Of the 50 articles that were included in the final review, 15 (30%) utilized descriptive methodology, and 35 (70%) involved quantitative, qualitative or mixed methods research, with some being considered “program evaluations.” Four major themes emerged from the reviewed articles: workforce, social accountability, distributed medical education, and regional versus main campus settings. Conclusion This study is the first comprehensive literature review of publications on Regional Medical Campuses and thus provides a benchmark and direction for future research in the RMCs topic area.

scholarly journals Patient Satisfaction With Medications for Opioid Use Disorder Treatment via Telemedicine: Brief Literature Review and Development of a New Assessment

2021 ◽  
Vol 8 ◽  
Author(s):  
Thomas O. Cole ◽  
Darlene Robinson ◽  
Andrea Kelley-Freeman ◽  
Devang Gandhi ◽  
Aaron D. Greenblatt ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Rural Areas ◽  
The United States ◽  
Opioid Use Disorder ◽  
Future Research ◽  
Opioid Use ◽  
Addiction Medicine ◽  
Feasible Method ◽  
Clinical Interest ◽  
Disorder Treatment

Telemedicine is increasingly being used to treat patients with opioid use disorder (OUD). It has particular value in rural areas of the United States impacted by the opioid crisis as these areas have a shortage of trained addiction medicine providers. Patient satisfaction significantly impacts positive clinical outcomes in OUD treatment and thus is of great clinical interest. Yet little is known regarding patient satisfaction with the increasingly important platform of telemedicine-delivered medications for opioid use disorder (tMOUD). The goal of this review is to provide a summary of the existing literature regarding patient satisfaction with tMOUD. We also submit a novel survey based on an existing framework designed to assess tMOUD satisfaction, and present pilot data (N = 14) acquired from patients engaged in rural tMOUD care. Telemedicine provides a feasible method for delivering MOUD in rural areas, and our survey provides a useful assessment to measure patient satisfaction with tMOUD. In light of the pressing need for innovative and technology-driven solutions to the opioid epidemic (especially in light of the COVID-19 pandemic), future research should focus on the development and refinement of tools to assess the important implementation goal of patient satisfaction.

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