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Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system

PURPOSE: The objective of this study is to identify how predisposing characteristics, enabling factors, and health needs are jointly and individually associated with epidemiological patterns of outpatient healthcare utilization for patients who already interact and engage with a large healthcare sys...

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Autores principales: Nuako, Akua, Liu, Jingxia, Pham, Giang, Smock, Nina, James, Aimee, Baker, Timothy, Bierut, Laura, Colditz, Graham, Chen, Li-Shiun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8830640/
https://www.ncbi.nlm.nih.gov/pubmed/35143583
http://dx.doi.org/10.1371/journal.pone.0263718
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author Nuako, Akua
Liu, Jingxia
Pham, Giang
Smock, Nina
James, Aimee
Baker, Timothy
Bierut, Laura
Colditz, Graham
Chen, Li-Shiun
author_facet Nuako, Akua
Liu, Jingxia
Pham, Giang
Smock, Nina
James, Aimee
Baker, Timothy
Bierut, Laura
Colditz, Graham
Chen, Li-Shiun
author_sort Nuako, Akua
collection PubMed
description PURPOSE: The objective of this study is to identify how predisposing characteristics, enabling factors, and health needs are jointly and individually associated with epidemiological patterns of outpatient healthcare utilization for patients who already interact and engage with a large healthcare system. METHODS: We retrospectively analyzed electronic medical record data from 1,423,166 outpatient clinic visits from 474,674 patients in a large healthcare system from June 2018-March 2019. We evaluated patients who exclusively visited rural clinics versus patients who exclusively visited urban clinics using Chi-square tests and the generalized estimating equation Poisson regression methodology. The outcome was healthcare use defined by the number of outpatient visits to clinics within the healthcare system and independent variables included age, gender, race, ethnicity, smoking status, health status, and rural or urban clinic location. Supplementary analyses were conducted observing healthcare use patterns within rural and urban clinics separately and within primary care and specialty clinics separately. FINDINGS: Patients in rural clinics vs. urban clinics had worse health status [χ(2) = 935.1, df = 3, p<0.0001]. Additionally, patients in rural clinics had lower healthcare utilization than patients in urban clinics, adjusting for age, race, ethnicity, gender, smoking, and health status [2.49 vs. 3.18 visits, RR = 0.61, 95%CI = (0.55,0.68), p<0.0001]. Further, patients in rural clinics had lower utilization for both primary care and specialty care visits. CONCLUSIONS: Within the large healthcare system, patients in rural clinics had lower outpatient healthcare utilization compared to their urban counterparts despite having potentially elevated health needs reflected by a higher number of unique health diagnoses documented in their electronic health records after adjusting for multiple factors. This work can inform future studies exploring the roots and ramifications of rural-urban healthcare utilization differences and rural healthcare disparities.
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spelling pubmed-88306402022-02-11 Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system Nuako, Akua Liu, Jingxia Pham, Giang Smock, Nina James, Aimee Baker, Timothy Bierut, Laura Colditz, Graham Chen, Li-Shiun PLoS One Research Article PURPOSE: The objective of this study is to identify how predisposing characteristics, enabling factors, and health needs are jointly and individually associated with epidemiological patterns of outpatient healthcare utilization for patients who already interact and engage with a large healthcare system. METHODS: We retrospectively analyzed electronic medical record data from 1,423,166 outpatient clinic visits from 474,674 patients in a large healthcare system from June 2018-March 2019. We evaluated patients who exclusively visited rural clinics versus patients who exclusively visited urban clinics using Chi-square tests and the generalized estimating equation Poisson regression methodology. The outcome was healthcare use defined by the number of outpatient visits to clinics within the healthcare system and independent variables included age, gender, race, ethnicity, smoking status, health status, and rural or urban clinic location. Supplementary analyses were conducted observing healthcare use patterns within rural and urban clinics separately and within primary care and specialty clinics separately. FINDINGS: Patients in rural clinics vs. urban clinics had worse health status [χ(2) = 935.1, df = 3, p<0.0001]. Additionally, patients in rural clinics had lower healthcare utilization than patients in urban clinics, adjusting for age, race, ethnicity, gender, smoking, and health status [2.49 vs. 3.18 visits, RR = 0.61, 95%CI = (0.55,0.68), p<0.0001]. Further, patients in rural clinics had lower utilization for both primary care and specialty care visits. CONCLUSIONS: Within the large healthcare system, patients in rural clinics had lower outpatient healthcare utilization compared to their urban counterparts despite having potentially elevated health needs reflected by a higher number of unique health diagnoses documented in their electronic health records after adjusting for multiple factors. This work can inform future studies exploring the roots and ramifications of rural-urban healthcare utilization differences and rural healthcare disparities. Public Library of Science 2022-02-10 /pmc/articles/PMC8830640/ /pubmed/35143583 http://dx.doi.org/10.1371/journal.pone.0263718 Text en © 2022 Nuako et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Nuako, Akua
Liu, Jingxia
Pham, Giang
Smock, Nina
James, Aimee
Baker, Timothy
Bierut, Laura
Colditz, Graham
Chen, Li-Shiun
Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system
title Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system
title_full Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system
title_fullStr Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system
title_full_unstemmed Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system
title_short Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system
title_sort quantifying rural disparity in healthcare utilization in the united states: analysis of a large midwestern healthcare system
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8830640/
https://www.ncbi.nlm.nih.gov/pubmed/35143583
http://dx.doi.org/10.1371/journal.pone.0263718
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