Com­mu­ni­ties need to ad­dress ge­o­graphic dis­par­i­ties in care ac­cess, qual­ity

Modern Healthcare - - NEWS -

If you take a med­i­cal road trip, watch out for the dis­par­i­ties

Con­sider it a twist on med­i­cal tourism, but this time we can call it the great Amer­i­can med­i­cal road trip. In fact, one of the most valu­able pieces of med­i­cal tech­nol­ogy avail­able to­day just might be a GPS nav­i­ga­tional de­vice. Or, for those who pre­fer to go the low-tech route, just open up an old-fash­ioned road at­las.

As we’ve been re­port­ing for some time now—the most re­cent sto­ries be­ing this week’s spe­cial re­port (p. 28) and last week’s cover story (March 19, p. 6)—so much of the ac­cess to health­care and the qual­ity of that care is de­ter­mined by ge­o­graph­i­cal lo­ca­tion. Pa­tients in search of health­care op­tions su­pe­rior to what’s avail­able in their com­mu­ni­ties might have to pack their bags and start driv­ing.

Cer­tain sec­tions of the coun­try, be­cause of a com­plex con­flu­ence of eco­nomic and de­mo­graphic chal­lenges, have long been des­ig­nated as un­der­served or ranked as un­der­per­form­ing—of­ten se­verely so. Other ar­eas, mean­while, have dom­i­nated the top tiers of health­care de­liv­ery, thanks to a more ad­van­ta­geous set of cir­cum­stances, es­pe­cially a long-term com­mit­ment to public-health im­prove­ment ef­forts.

Last week’s cover story, by re­porter Mau­reen Mckin­ney and head­lined “For bet­ter or worse,” de­tailed the find­ings of a new Com­mon­wealth Fund study rank­ing health sys­tem per­for­mance in more than 300 hospi­tal re­fer­ral regions na­tion­wide. It was the first study by the or­ga­ni­za­tion to ex­am­ine health­care de­liv­ery at the com­mu­nity level, and once again ex­posed vast dis­par­i­ties in per­for­mance and how where you live af­fects the type of care you can ex­pect to re­ceive.

In the low­est-per­form­ing com­mu­ni­ties, high poverty lev­els con­trib­uted to the chal­lenges fac­ing health­care providers and public-health of­fi­cials. Short­ages of pri­mary-care prac­ti­tion­ers also were cited as a fac­tor.

The top city in over­all per­for­mance was St. Paul, Minn., and one state health depart­ment of­fi­cial cer­tainly wasn’t sur­prised by the rank­ings, say­ing, “There’s a long his­tory in this state of work­ing as a com­mu­nity for the health of ev­ery­one.” The in­vest­ments have clearly paid off.

In this week’s spe­cial re­port, re­porter Paul Barr looks at a phe­nom­e­non known as a “sur­gi­cal desert,” re­flected in large sec­tions of ru­ral Amer­ica where ac­cess to a gen­eral sur­geon is nonex­is­tent or limited at best. What’s driv­ing this prob­lem? In ad­di­tion to the gen­eral mi­gra­tion pat­terns af­fect­ing ru­ral sec­tions of the coun­try, there are qual­ity-of-life is­sues and other pref­er­ences that physi­cians cite when it comes to prac­tic­ing medicine in the more re­mote parts of the na­tion. The big city is just a stronger draw for the younger gen­er­a­tions. No sur­prise there.

There also should be no sur­prise at the risks these ar­eas face be­cause pa­tients lack ready ac­cess to sur­gi­cal ser­vices. As one ru­ral sur­geon said, “If you build in a two- to four-hour de­lay in get­ting ac­cess to a real sur­geon, I can’t be­lieve it’s not go­ing to af­fect risk-ad­justed qual­ity. … When you have a low den­sity of sur­geons, mor­bid­ity and mor­tal­ity go up.”

So when it comes to the dearth of sur­geons, tak­ing the med­i­cal road trip isn’t the best an­swer. The so­lu­tion is to boost the lo­cal sup­ply of providers to meet the al­ready ex­ist­ing de­mand of pa­tients. The best an­swer to the rid­dle of ge­o­graphic dis­par­i­ties must in­clude learn­ing from the best prac­tices of com­mu­ni­ties that al­ready have made it to the top, and fix the things that are ac­tu­ally fix­able. Pri­vate com­pa­nies are al­ready us­ing in­cen­tive pro­grams, with some pos­i­tive re­sults. And as the state of Min­nesota and oth­ers that put up en­vi­able num­bers would prob­a­bly tell us, it takes sus­tained public-health in­vest­ments to make progress and to main­tain that suc­cess.

It’s al­ways best when the road to high-qual­ity health­care is just a trip around the block.

DAVID MAY As­sis­tant Man­ag­ing Ed­i­tor/fea­tures

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