PubMed Health⌕ Search

Biomedical subjects

Thomas C Ricketts

Publications and source records attributed to Thomas C Ricketts.

At least 19 recordsLinked to original sources
PubMed2006

Defining urban and rural areas in U.S. epidemiologic studies.

Among epidemiologists, there has been increasing interest in the characteristics of communities that influence health. In the United States, the rural health disparity has been a recent focus of attention and made a priority for improvement. While many standardized definitions of urban and rural exist and are used by social scientists and demographers, they are found in sources unfamiliar to health researchers and have largely not been used in public health studies. This paper briefly reviews some available definitions of urban and rural for American geographic subunits and their respective strengths and weaknesses. For example, some definitions are better suited than others for capturing access to health care services. The authors applied different definitions to breast cancer incidence rates to show how urban/rural rate ratio comparisons would vary by choice of definition and found that dichotomous definitions may fail to capture variability in very rural areas. Further study of the utility of these measures in health studies is warranted.

Catchment Area, Health↗
PubMed2006

How adults' access to outpatient physician services relates to the local supply of primary care physicians in the rural southeast.

OBJECTIVE: To examine how access to outpatient medical care varies with local primary care physician densities across primary care service areas (PCSAs) in the rural Southeast, for adults as a whole and separately for the elderly and poor. DATA SOURCES: Access data from a 2002 to 2003 telephone survey of 4,311 adults living in 298 PCSAs within 150 rural counties in eight Southeastern states were linked geographically with physician practice location data from the American Medical and American Osteopathic Associations and population data from the U.S. Census. STUDY DESIGN: In a cross-sectional study design, we used a series of logistic regression models to assess how 26 measures of various aspects of access to outpatient physician services varied for subjects arranged into five groups based on the population-per-physician ratios of the PCSAs where they lived. PRINCIPAL FINDINGS: Among adults as a whole, more individuals reported traveling over 30 minutes for outpatient care in PCSAs with more than 3,500 people per physician than in PCSAs with fewer than 1,500 people per physician (39.1 versus 18.5 percent, p<.001) and more reported travel difficulties. Otherwise, PCSA density of primary care physicians was unrelated to reported barriers to care, unrelated to people's satisfaction with care, and unrelated to indicators of people's use of services. Use rates of six recommended preventive health services varied in no consistent direction with physician densities. Among the elderly, only the proportion traveling over 30 minutes for care was greater in areas with lowest physician densities. Among subjects covered under Medicaid or uninsured, lower local physician densities were associated with longer travel time, difficulties with travel and reaching one's physician by phone, and two areas of dissatisfaction with care. CONCLUSIONS: For adults as a whole in the rural South and for the elderly there, low local primary care physician densities are associated with travel inconvenience but not convincingly with other aspects of access to outpatient care. Access for those insured under Medicaid and the uninsured, however, is in more ways sensitive to local physician densities.

Adolescent↗
PubMed2005

Urbanization and breast cancer incidence in North Carolina, 1995-1999.

PURPOSE: Breast cancer incidence rates are reported to be higher in urban compared with rural areas in the United States. We investigated the relationship between urbanization and breast cancer in North Carolina (1995-1999), and considered hospital characteristics as an explanation. METHODS: We calculated age-adjusted in situ and invasive female breast cancer incidence rates stratified by race, urbanization (Urban Influence Codes), and the presence of a hospital with a cancer registry and cancer program approval in a county. RESULTS: For white women, incidence rate ratios (IRRs) comparing the most urban with the most rural counties were 1.60 for in situ and 1.18 for invasive cancer. For non-white women, IRRs were 1.27 and 0.99, respectively. IRRs for incidence in registry hospital counties versus those without were all > 1.00 and differences were greater for in situ cancer than invasive. For most strata, urban excesses were attenuated when further stratified by registry hospital status. CONCLUSIONS: For most strata, we observed excess incidence in urban counties, but it appeared to be explained through the urban preponderance of registry hospitals. Counties with these hospitals may have higher incidence because of increased detection. Area hospital characteristics should be considered when evaluating geographic patterns of breast cancer incidence.

Adult↗
PubMed2005

Workforce issues in rural areas: a focus on policy equity.

Rural communities in the United States are served by relatively fewer health care professionals than urban or suburban areas. I review the geographic distribution of 6 classes of health professionals and describe the multiple government and private policies and programs intended to affect their geographic distribution. These programs can be classified into 3 categories--coercive, normative, and utilitarian--that characterize the major policy levers used to influence practice location decisions. Health workforce policies must be normative to ensure equity for rural communities, but goals in this area can be achieved only through a balance of utilitarian and coercive mechanisms.

Dentists↗
PubMed2004

The changing metropolitan designation process and rural America.

In June 2003, the Office of Management and Budget (OMB) released new county-based designations of Core Based Statistical Areas (CBSAs), replacing Metropolitan Statistical Area designations that were last revised in 1990. In this article, the new designations are briefly described, and counties that have changed classifications are identified. The new designations identify 2 categories of counties or county clusters within CBSAs: Metropolitan Statistical Areas and Micropolitan Statistical Areas. Counties designated as neither are simply referred to as "outside Core Based Statistical Areas." Among counties classified as metropolitan in 1999, 94% are still classified as such, 5% are now micropolitan, and 0.7% are outside CBSAs. The majority of counties that were nonmetropolitan in 1999 remain outside CBSAs (60%), while 28% are now classified as micropolitan and 12% have become metropolitan. The percentage of counties classified as metropolitan has increased from 27.2% to 34.7%, and the population identified as residing in these areas increased from 81% of the total US population to 83%. Some interpretation difficulties may arise in the future, as the naming system lends itself to lumping metropolitan and micropolitan together because of their common designation as CBSAs. The central problem to this classification scheme is that it tracks the urban growth of the nation and its tendency toward agglomeration of markets but pays little attention to the places that are outside CBSAs altogether.

Catchment Area, Health↗
PubMed2004

Arguing for rural health in Medicare: a progressive rhetoric for rural America.

Rural health policy is the laws, regulations, rules, and interpretations that benefit or affect health and health care for rural populations. This paper examines how rural health policy is viewed in the broader field of public policy, discusses the role of advocacy in developing rural health policy, and suggests ways to make that advocacy more effective. This paper critically reviews policy statements and policy positions taken by key opinion leaders and the leading stakeholders in rural health policy to determine how advocacy for rural communities is expressed. It is not clear how the rural health advocacy coalition is viewed by the professional policy world or the public: as an issues network pressing for fair and equal treatment or as an interest group seeking special advantages. This paper also explores the types of claims that rural advocates make in the specific context of Medicare policy to determine to what extent those claims reflect a central theme of fairness and inclusiveness in national policies versus claims that benefit special interests. The paper suggests that the rhetoric of rural advocates can be better structured to advocate for policies on the basis of a progressive sense of fairness.

Health Policy↗
PubMed2004

An analysis of Medicare's Incentive Payment program for physicians in health professional shortage areas.

CONTEXT: Medicare's Incentive Payment (MIP) program provides a 10% bonus payment to providers who treat Medicare patients in rural and urban areas where there is a shortage of generalist physicians. PURPOSE: To examine the experience of Alaska, Idaho, North Carolina, South Carolina, and Washington with the MIP program. We determined the program's utilization and which types of physicians received payments. METHODS: Retrospective cohort design, utilizing complete 1998 Medicare Part B data. Physician specialty was determined through American Medical Association data. Rural status was determined by linking the physician business ZIP code to its Rural-Urban Commuting Area code (RUCA). FINDINGS: There were 2,220,275 patients and 39,749 providers in the cohort, including 9,769 (24.6%) generalists, 21,331 (53.7%) specialists, and 8,649 (21.8%) nonphysician providers. Over $4 million in bonus payments (median payment = $173) were made to providers in HPSAs. Specialists and urban providers received 58% and 14% of the bonus reimbursements, respectively. Two million dollars in payments were not distributed because the providers did not claim them. Over $2.8 million in bonus claims were distributed to providers who likely did not work in approved HPSA sites. CONCLUSIONS: The MIP bonus payments given to providers are small. Many providers who should have claimed the bonus did not, and many providers who likely did not qualify for the bonus claimed and received it. Consideration should be given to focusing and enlarging the bonus payments to specific providers, rather than rewarding all providers equally. Policy makers should also consider a system that prospectively determines provider eligibility.

Alaska↗
PubMed2003

Understanding biased selection in Medicare HMOs.

OBJECTIVE: To investigate the extent of favorable health maintenance organization (HMO) selection for a longitudinal cohort of Medicare beneficiaries, examine whether the extent of favorable selection varies with the degree of Medicare HMO market penetration in a county, and explain conflicting findings in the literature on favorable HMO selection. DATA SOURCES: A panel of 1992-1996 data from the Medicare Current Beneficiary Survey (MCBS), supplemented with linked data from the Area Resource File and Medicare administrative datasets. STUDY DESIGN: Using random effects probit estimation, we model a beneficiary's HMO enrollment status as a function of self-reported health status and Medicare HMO market penetration. DATA EXTRACTION METHODS: The MCBS data for beneficiaries residing in states served by Medicare HMOs in 1992-1996 were linked by county to the supplementary datasets. PRINCIPAL FINDINGS: We find that favorable selection persists in the cohort over time on some, but not all, measures. We find no substantial association between favorable HMO selection and HMO market penetration. We find that conflicting findings in the literature on favorable HMO selection may be explained by several methodological choices, including the choice of health status measure and the structure of the sample. CONCLUSIONS: Our results support further risk adjustment of the adjusted average per capita cost (AAPCC) payment formula.

Aged↗
PubMed2003

Use of program logic models in the Southern Rural Access Program evaluation.

The Southern Rural Access Program (SRAP) evaluation team used program logic models to clarify grantees' activities, objectives, and timelines. This information was used to benchmark data from grantees' progress reports to assess the program's successes. This article presents a brief background on the use of program logic models--essentially charts or diagrams specifying a program's planned activities, objectives, and goals--for evaluating and managing a program. It discusses the structure of the logic models chosen for the SRAP and how the model concept was introduced to the grantees to promote acceptance and use of the models. The article describes how the models helped clarify the program's objectives and helped lead agencies plan and manage the many program initiatives and subcontractors in their states. Models also provided a framework for grantees to report their progress to the National Program Office and evaluators and promoted the evaluators' visibility and acceptance by the grantees. Program logics, however, increased grantees' reporting requirements and demanded substantial time of the evaluators. Program logic models, on balance, proved their merit in the SRAP through their contributions to its management and evaluation and by providing a better understanding of the program's initiatives, successes, and potential impact.

Benchmarking↗
PubMed2002

Rural health research and rural health in the 21st century: the future of rural health and the future of rural health services research.

Rural health research is a unique field. It is neither a nested subcategory under general health services research nor a separate field of policy analysis or advocacy. Rural health research faces three potential crises: of content, of applicability, and of credibility. The content of the field is driven often by funds, its applicability is thus limited by its purview as well as its special constituency, and its credibility is challenged by its findings, sometimes contrary to accepted positions in the larger health services field. Rural health research can strengthen its position by accepting the paradoxes it presents, especially the paradox of continuing disparity in the face of substantial investment to eliminate differences, and by seeking to answer why this occurs across the rural-urban spectrum. Rural health research can answer questions about why the distribution of resources is unfair without depending solely on pure definitions

Forecasting↗
PubMed2001

Geographic information systems and public health.

Geographic information systems (GIS) and analyses based on GIS have become widespread and well accepted. GIS is not the complete solution to understanding the distribution of disease and the problems of public health but is an important way in which to better illuminate how humans interact with their environment to create or deter health.

Geographic Information Systems↗
PubMedDate not supplied

Access in health services research: the battle of the frameworks.

BACKGROUND: Access is an important concept in the study of the organization, financing and delivery of healthcare services. It is also an important political symbol and policy goal. PURPOSE: This article reviews the major theoretical frameworks that have been used to support the study of access and measure the degree to which healthcare systems have met standards of access. METHOD: The article uses a critical review of the major works of the leading theorists in the field of access studies. DISCUSSION: Theories of access accept that it is a dynamic process where there is the potential for individuals and families to learn and modify their behavior. That learning and adaptation is less often explored in empirical research of access to health care. CONCLUSION: Researchers should consider the more dynamic aspects of access as they attempt to understand how to improve the health care delivery system. Access models can be used to direct the formulation of better health policy if they reflect real world processes.

Community Health Planning↗
PubMedDate not supplied

Analysis of interest group influence on federal school meals regulations 1992 to 1996.

Regulatory changes proposed by the US Department of Agriculture in 1994 promised to bring progressive changes to school meals. However, lobbying by interest groups resulted in substantial changes to the final rule. This analysis retrospectively examines the federal school meals policy-making process during 1992 to 1996. Key questions address why the policy changed and what the role of interest groups was in affecting the shape, pace, and direction of the policy. The study provides suggestions for using the experiences of 1992 to 1996 to guide future advocacy efforts and for adapting the approach for application to other food and nutrition policies.

Adolescent↗
PubMedDate not supplied

Clinical trial enrollment of rural patients with cancer.

PURPOSE: The goal of this study was to examine the effect of a rural community clinical oncology program-based cancer-care intervention program that was launched to increase the number of rural patients with cancer enrolled in clinical trials. DESCRIPTION OF STUDY: Five rural counties in eastern North Carolina served as intervention communities, and five rural counties in South Carolina served as the comparison region. The intervention counties used a rapid tumor-reporting system, a nurse facilitator who identified and prompted oncologists to enter patients into clinical trials, a quarterly newsletter to primary-care physicians about cancer treatment and clinical trials, and a health educator who focused on community-wide education regarding cancer prevention, treatment, and clinical trial information. Outcomes included changes in knowledge and attitudes about clinical trials among the primary-care providers who were surveyed and enrollment in clinical treatment trials for breast and colorectal cancer, as analyzed by comparing practice pattern data from before and after the intervention. RESULTS: The results indicate that the intervention was not effective. The proportion of primary-care physicians who were aware of clinical trials for their patients with cancer rose slightly in comparison counties (26% to 34%) but remained constant (41% to 43%) in intervention counties. Perceived patient and actual physician barriers toward clinical trial participation were reported by the physicians. A minority of potentially eligible patients with breast or colon cancer in both North Carolina and South Carolina were enrolled in clinical trials. CLINICAL IMPLICATIONS: These data suggest that different types of interventions may be needed to improve accrual to cancer treatment trials in rural communities. In addition, the role that primary-care providers play in encouraging patients with cancer to participate in clinical treatment trials needs further exploration.

Breast Neoplasms↗
PubMedDate not supplied

Numbers of minority health professionals: where do we stand?

This overview has pointed to a continuing racial and ethnic imbalance in the health professions that applies to North Carolina as well as the nation. Great strides have been made early in the development of programs to enhance racial and ethnic representation, but they have generally reached a plateau in terms of growth and progress. Resistance to affirmative action programs and subsequent uncertainty over their legal standing can be cited as one factor thwarting progress, but that issue has been resolved and schools, professions, and the North Carolina General Assembly can move forward with a clear understanding of how to proceed. A full generation has matured with the benefit of positive emphasis on increasing the proportion of minorities in the health professions. The coming generations must build and expand on the programs and initiatives that brought the nation and the state to where we are now. But these goals must be re-stated, and intensified efforts are required if any reasonable parity in representation of minorities among the health professions is to be achieved.

Cultural Diversity↗