Impact of rural residence and health system structure on quality of liver care.
Specialist physician concentration in urban areas can affect access and quality of care for rural patients. As effective drug treatment for hepatitis C (HCV) becomes increasingly available, the extent to which rural patients needing HCV specialists face access or quality deficits is unknown. We soug...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2013-01-01
|
| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3873451?pdf=render |
| _version_ | 1828158498769207296 |
|---|---|
| author | Catherine Rongey Hui Shen Nathan Hamilton Lisa I Backus Steve M Asch Sara Knight |
| author_facet | Catherine Rongey Hui Shen Nathan Hamilton Lisa I Backus Steve M Asch Sara Knight |
| author_sort | Catherine Rongey |
| collection | DOAJ |
| description | Specialist physician concentration in urban areas can affect access and quality of care for rural patients. As effective drug treatment for hepatitis C (HCV) becomes increasingly available, the extent to which rural patients needing HCV specialists face access or quality deficits is unknown. We sought to determine the influence of rural residency on access to HCV specialists and quality of liver care.The study used a national cohort of 151,965 Veterans Health Administration (VHA) patients with HCV starting in 2005 and followed to 2009. The VHA's constant national benefit structure reduces the impact of insurance as an explanation for observed disparities. Multivariate cox proportion regression models for each quality indicator were performed.Thirty percent of VHA patients with HCV reside in rural and highly rural areas. Compared to urban residents, highly rural (HR 0.70, CI 0.65-0.75) and rural (HR 0.96, CI 0.94-0.97) residents were significantly less likely to access HCV specialty care. The quality indicators were more mixed. While rural residents were less likely to receive HIV screening, there were no significant differences in hepatitis vaccinations, endoscopic variceal and hepatocellular carcinoma screening between the geographic subgroups. Of note, highly rural (HR 1.31, CI 1.14-1.50) and rural residents (HR 1.06, CI 1.02-1.10) were more likely to receive HCV therapy. Of those treated for HCV, a third received therapy from a non-specialist provider.Rural patients have less access to HCV specialists, but this does not necessarily translate to quality deficits. The VHA's efforts to improve specialty care access, rural patient behavior and decentralization of HCV therapy beyond specialty providers may explain this contradiction. Lessons learned within the VHA are critical for US healthcare systems restructuring into accountable care organizations that acquire features of integrated systems. |
| first_indexed | 2024-04-11T23:45:10Z |
| format | Article |
| id | doaj.art-34dce86498ad4a2c992818084e365191 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-11T23:45:10Z |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-34dce86498ad4a2c992818084e3651912022-12-22T03:56:39ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-01812e8482610.1371/journal.pone.0084826Impact of rural residence and health system structure on quality of liver care.Catherine RongeyHui ShenNathan HamiltonLisa I BackusSteve M AschSara KnightSpecialist physician concentration in urban areas can affect access and quality of care for rural patients. As effective drug treatment for hepatitis C (HCV) becomes increasingly available, the extent to which rural patients needing HCV specialists face access or quality deficits is unknown. We sought to determine the influence of rural residency on access to HCV specialists and quality of liver care.The study used a national cohort of 151,965 Veterans Health Administration (VHA) patients with HCV starting in 2005 and followed to 2009. The VHA's constant national benefit structure reduces the impact of insurance as an explanation for observed disparities. Multivariate cox proportion regression models for each quality indicator were performed.Thirty percent of VHA patients with HCV reside in rural and highly rural areas. Compared to urban residents, highly rural (HR 0.70, CI 0.65-0.75) and rural (HR 0.96, CI 0.94-0.97) residents were significantly less likely to access HCV specialty care. The quality indicators were more mixed. While rural residents were less likely to receive HIV screening, there were no significant differences in hepatitis vaccinations, endoscopic variceal and hepatocellular carcinoma screening between the geographic subgroups. Of note, highly rural (HR 1.31, CI 1.14-1.50) and rural residents (HR 1.06, CI 1.02-1.10) were more likely to receive HCV therapy. Of those treated for HCV, a third received therapy from a non-specialist provider.Rural patients have less access to HCV specialists, but this does not necessarily translate to quality deficits. The VHA's efforts to improve specialty care access, rural patient behavior and decentralization of HCV therapy beyond specialty providers may explain this contradiction. Lessons learned within the VHA are critical for US healthcare systems restructuring into accountable care organizations that acquire features of integrated systems.http://europepmc.org/articles/PMC3873451?pdf=render |
| spellingShingle | Catherine Rongey Hui Shen Nathan Hamilton Lisa I Backus Steve M Asch Sara Knight Impact of rural residence and health system structure on quality of liver care. PLoS ONE |
| title | Impact of rural residence and health system structure on quality of liver care. |
| title_full | Impact of rural residence and health system structure on quality of liver care. |
| title_fullStr | Impact of rural residence and health system structure on quality of liver care. |
| title_full_unstemmed | Impact of rural residence and health system structure on quality of liver care. |
| title_short | Impact of rural residence and health system structure on quality of liver care. |
| title_sort | impact of rural residence and health system structure on quality of liver care |
| url | http://europepmc.org/articles/PMC3873451?pdf=render |
| work_keys_str_mv | AT catherinerongey impactofruralresidenceandhealthsystemstructureonqualityoflivercare AT huishen impactofruralresidenceandhealthsystemstructureonqualityoflivercare AT nathanhamilton impactofruralresidenceandhealthsystemstructureonqualityoflivercare AT lisaibackus impactofruralresidenceandhealthsystemstructureonqualityoflivercare AT stevemasch impactofruralresidenceandhealthsystemstructureonqualityoflivercare AT saraknight impactofruralresidenceandhealthsystemstructureonqualityoflivercare |