Shortage Areas Research Articles

Competitive advantage of car-sharing based on travel costs comparison model: A case study of Beijing, China

In recent years, car-sharing has emerged and developed in different cities in China, supplementing other urban transportation modes, but also triggering fierce competition with some of them, such as taxis. In this study, we use the car-sharing orders and GPS trajectory data of a company in Beijing, China, to discuss the competitive advantages, market, and development trends of car-sharing from the perspective of travel costs. By building a travel costs comparison model, we calculate the travel costs of car-sharing and taxis under the same travel scenario, comparing their cost differences in the dimensions of travel mileage, duration, utilization efficiency, etc., and locating the cost advantage space of car-sharing. Further, we discuss the impact of different elements of travel (such as time cost, waiting time, etc.) on the cost advantage of travel by car-sharing. The results reveal that, under the current pricing conditions, the cost advantage of car-sharing is particularly obvious when the rental duration is not too long (less than 14 h), the utilization efficiency is relatively high, and the stop time is shorter than 8 h. We also find that it makes great cost advantage of using car-sharing in periods or areas of urban taxi shortages. In the cases of short travel, car-sharing have bigger cost advantage for the middle and low-income groups. In addition, the popularity of bike-sharing can also increase the cost advantage of car-sharing, which indicates that the synergy of different travel models could promote the development of car-sharing. However, when people travel long, the cost advantage of car-sharing would be minimally affected by the elements, such as people's income and the development of bike-sharing. In other words, car-sharing would keep its cost advantage in the cases of long travel, especially when its utilization efficiency is high and the travel stop time is short.

Community-acquired Staphylococcus aureus skin and soft tissue infection risk assessment using hotspot analysis and risk maps: the case of California emergency departments

BackgroundCommunity-acquired Staphylococcus aureus (CA-Sa) skin and soft tissue infections (SSTIs) are historically associated with densely populated urban areas experiencing high poverty rates, intravenous drug use, and homelessness. However, the epidemiology of CA-Sa SSTIs in the United States has been poorly understood since the plateau of the Community-acquired Methicillin-resistant Staphylococcus aureus epidemic in 2010. This study examines the spatial variation of CA-Sa SSTIs in a large, geographically heterogeneous population and identifies neighborhood characteristics associated with increased infection risk.MethodsUsing a unique neighborhood boundary, California Medical Service Study Areas, a hotspot analysis, and estimates of neighborhood infection risk ratios were conducted for all CA-Sa SSTIs presented in non-Federal California emergency departments between 2016 and 2019. A Bayesian Poisson regression model evaluated the association between neighborhood-level infection risk and population structure, neighborhood poverty rates, and being a healthcare shortage area.ResultsEmergency departments in more rural and mountainous parts of California experienced a higher burden of CA-Sa SSTIs between 2016 and 2019. Neighborhoods with high infection rates were more likely to have a high percentage of adults living below the federal poverty level and be a designated healthcare shortage area. Measures of population structure were not associated with infection risk in California neighborhoods.ConclusionsOur results highlight a potential change in the epidemiology of CA-Sa SSTIs in California emergency departments. Future studies should investigate the CA-Sa burden in other geographies to identify whether this shift in epidemiology holds across other states and populations. Further, a more thorough evaluation of potential mechanisms for the clustering of infections seen across California neighborhoods is needed.

Factoring in temporal variations of public transit-based healthcare accessibility and equity

Access to healthcare services using public transportation (PT-based healthcare accessibility) is a crucial aspect in achieving healthcare equity as it affects individuals’ ability to receive healthcare. Previous research has focused on the spatial features of healthcare accessibility. However, less attention has been given to its temporal characteristics, which can be influenced by transit schedules, multimodal connectivity, congestion, and other factors. This study proposes a framework to better understand the impacts of temporally varying PT-based healthcare accessibility on healthcare equity. A case study of Shanghai, China is used to illustrate the temporal variation of healthcare accessibility, with a focus on hourly inter- and intra-regional disparities. These disparities are captured using the Gini coefficient and Theil index. Additionally, the study introduces bivariate local Moran’s I to identify healthcare shortage areas and evaluate the spatial autocorrelation between population density and healthcare accessibility. The findings of this study reveal that the accessibility to healthcare services experiences significant fluctuations throughout the day, leading to temporal variations in healthcare equity. Subway service quality contributes more to temporal variations than bus service quality. The lowest point of such equity is reached when PT operates at its full capacity. On a spatial level, individuals residing in newly developed regions, which surround the historical urban core or recently planned city subcenters, tend to experience decreased accessibility to healthcare via public transportation. Consequently, it results in a heightened reliance on motorized transportation in these areas. These findings provide insights that can inform the design of PT accessibility-based strategies, healthcare improvement plans and inclusive housing policies, to address healthcare equity issues in metropolitan areas. By considering both spatial and temporal factors, we can better understand the complex relationships between transportation and healthcare accessibility to promote equitable access to healthcare services and foster social equity.

A retrospective analysis of the social determinants of health affecting stroke outcomes in a small hospital situated in a health professional shortage area (HPSA).

Where someone lives is a major determinant of population health. In the United States, people who live in Health Professional Shortage Areas are considered medically underserved and have a higher propensity for conditions such as stroke, hypertension, and diabetes. Our goal was to better understand the diverse needs of patients presenting to the Crouse Hospital emergency department with stroke symptoms. Crouse Hospital is a small community hospital located in a shortage area serving both urban and rural populations in and around Syracuse, New York. Despite its small size, Crouse Hospital quickly became a major comprehensive stroke center in Central New York. With this study we assessed the social factors affecting the stroke patient population in the community and compared these characteristics between those living in served and underserved areas. Informed by the social determinants of health framework, we analyzed 1731 incidents of stroke that occurred between January 2019 and January 2021, and observed that the circumstances associated with stroke varied by service category and race, with White patients and those from served areas having better stroke outcomes compared to those residing in underserved areas and those that were not White. Our analyses help us to understand the underlying factors influencing the observed disparities and allow us to move forward by implementing informed community-based interventions to decrease stroke incidence and improve post-stroke care. Using our example other small hospitals can enact similar strategies to address the social determinants affecting their patients to improve stroke outcomes in their region.

Broadening their horizons: A rural and urban nursing student exchange program in primary care

Educational strategies that allow students to experience patient care in both rural and urban settings are imperative to the recruitment and retention of nurses for medically underserved populations or health professional shortage areas. Two state schools of nursing (one urban-oriented and one rural-oriented) in the Mid-Atlantic region were awarded Health Resources and Service Administration (HRSA) project funding to educate nursing students and registered nurses in community-based primary care settings. This article will discuss an innovative rural-urban baccalaureate nursing student exchange model intended to increase understanding of enhanced RN roles in community-based primary care settings.Two project teams collaborated to create a new learning model, a rural-urban exchange, by implementing a Primary Care Camp. The camp included shared didactic content, reflection exercises, historical and cultural considerations, and clinical immersion to allow students in both programs to have on-site rural and urban learning experiences. Faculty collected informal voluntary student feedback through a debrief after their Primary Care Camp experience to assess their understanding of the enhanced RN Role in primary care and how it may affect their future nursing practice.Student feedback suggests that the students met project goals and appreciated the rural and urban exchange experience. This project is an innovative approach that offers guidance for implementing primary care education in a way that supports the current primary care RN role, builds the future workforce, and provides suggestions for replicability.

A multiple criteria decision-making approach for water allocation of environmental flows considering the value trade-offs - A case study of Fen River in China

In the water-scarce basin, the allocation of environmental flows needs to achieve the equilibrium between ecological protection and economic development. One of the challenges is the lack of quantitative analysis of the value of water in the economy and ecosystem, which could not effectively support the decision-making. This paper proposed a new multi-criteria decision-making approach that considers the value trade-offs between the environmental flows and the economic water use of rivers. The value of environmental flows was assessed using the modified equivalent factor method combined with the hydraulic method, which considers the influences of the hydraulic characteristics of rivers on value assessment. The value of the economic water use was estimated using the modified Cobb-Douglas production function. The ideal point method was applied to obtain the optimal solution of the multi-criteria decision with the objective of maximum values of the economic water use and maximum values of environmental flows (or the value of multiple recommended environmental flows). This new method was applied to determine the optimal environmental flows in the Fen River, the second-largest tributary of the Yellow River of China. The results indicated that the reasonable environmental flows were 51.1 % or 40.4 % (considering the water shortage for development) of the natural runoff of the Fen River. This work could provide a valuable reference for determining the water allocation of environmental flows in the water shortage area of China.

BRIDGE GERIATRIC WORKFORCE EDUCATION CURRICULUM BETWEEN 4M COMPETENCIES AND INTERDISCIPLINARY EDUCATION

Abstract In a provider shortage area, education priority strategy is more practical rather than structure investment priority strategy. In aims of establishing Age-Friendly Community in this state where primary care provider number per capita ranks 50th state, 4Ms (What Matters, Mobility, Medication, Mentation) based interdisciplinary education across medicine, dental, pharmacy, nursing, social work, physical therapy were developed and implemented. We evaluated the impact of 4Ms application on healthcare providers education by measuring served patient outcomes (1) CMS defined Merit Incentive Payment System, patient satisfaction, and healthcare cost and (2) education outcomes of healthcare providers using 4M education competencies. We adopted STEPPS interprofessional communication skill toolkit and applied simulation training with standardized patients.

EVALUATE THE IMPACT OF INTERDISCIPLINARY EDUCATION AND TELEHEALTH PRIMARY CARE: QUALITY AND EFFICIENCY

Abstract In a provider shortage area, an Interprofessional Education and Telehealth Primary Care (IPETC) for geriatrics workforce was developed in 2020. To analyze the impact of IPETC on quality and efficiency of care, we measured quality outcomes defined by the CMS defined quality measures - dementia caregiver education/referral and advance care plan, and efficiency outcomes by estimating healthcare cost savings from reducing hospitalization. Two-hundred forty-four community-dwelling adults aged 60 to 97 with mild to moderate dementia were selected in an urban safety-net primary care clinic. Propensity - demographics and comorbidity was matched. Main outcomes were (A) number of hospitalization and 90-day rehospitalization rate, hospitalization-related healthcare cost estimates from the State Inpatient Dataset using the ICD-10 codes of principal diagnosis and hospital length of stay between January-December 2021. One-hundred twenty-two patients were cared by primary care providers who received the IPETC;122 patients were by those who did not have the IPETC; (2) CMS quality measures were compared between 2019 (baseline) and 2021 of patients cared by providers with IPETC. Number of hospitalization with IPETC was fewer than those without IPETC (0.72 vs. 1.38, p < .01). Number of 90-day rehospitalization with IPETC was fewer than those without IPETC (0.14 vs. 0.30, p < .01). An average cost-saving of $20,289 per patient was observed among those with IPETC than those without IPETC (p < .001). CMS quality measures improved from 15.6% to 51.0% in dementia caregiver education/referral; 10.2% to 24.7% in documented advance care plans.

EVALUATE THE IMPACT OF INTERDISCIPLINARY EDUCATION AND TELEHEALTH PRIMARY CARE: QUALITY AND EFFICIENCY

Abstract In a provider shortage area, an Interprofessional Education and Telehealth Primary Care (IPETC) for geriatrics workforce was developed in 2020. To analyze the impact of IPETC on quality and efficiency of care, we measured quality outcomes defined by the CMS defined quality measures - dementia caregiver education/referral and advance care plan, and efficiency outcomes by estimating healthcare cost savings from reducing hospitalization. Fifty eight community-dwelling adults aged 67 to 94 with mild to moderate dementia were selected in an urban safety-net primary care clinic. Propensity - demographics and level of physical impairment was matched. Main outcomes were (A) hospitalization-related healthcare cost estimates from the State Inpatient Dataset using the ICD-10 codes of principal diagnosis and hospital length of stay between January-December 2021. Twenty nine patients were cared by primary care providers who received the IPETC;29 patients were by those who did not have the IPETC; (2) CMS quality measures were compared between 2019 (baseline) and 2021. An average cost-saving of $22,135 per patient was observed among those treated by the healthcare providers who received the IPE/telehealth curriculum training than those treated by the providers without the training. CMS quality measures improved from 15.6% to 51.0% in dementia caregiver education/referral; 10.8% to 42.8% in documented advance care plans. Innovative interdisciplinary education and telehealth primary care has shown improvement of quality and efficiency of dementia care in a provider shortage area.

TECHNOLOGY-ASSISTED CARE PLANNING IN PRIMARY CARE OF A PROVIDER SHORTAGE AREA

Abstract We applied faireness algorithm to identify and mitigate bias in healthcare system. We also developed DeepPlan soft that can assist primary care providers, patients and caregivers with providing real-time risk prediction system, for example, discussing nursing home placement and designation of power of attorney. Our DeepPlan was built using cloud database system than can be exchangeable in secure way between patients and primary care providers. We linked DeepPlan use to workforce education and now we are ready for presenting education and patient clinical outcomes of using DeepPlan in primary care in a provider shortage area.

WORKFORCE EDUCATION, TECHNOLOGY, AND EVALUATION TO REDUCE HEALTH DISPARITIES IN A PROVIDER SHORTAGE STATE

Abstract State of Nevada has been a provider shortage area and ranks 50th state of primary care providers per capita in 2022. As a result, Medicare spends highest spending per capita and highest 30-day readmission rate of vulnerable and older adults, i.e., individuals with Alzheimer’s Disease Related Dementias. To respond these challenges, geriatric workforce education program (GWEP) was launched in 2019. Along with interdisciplinary education of healthcare providers, GWEP overarched to an innovative technology, i.e., digital health and machine learning methodology aiming at mitigating bias in healthcare and predicting events, i.e., nursing home placement and designating power of attorney timelines that are useful for planning advance care in primary care. GWEP team evaluates the impact of these education and technology implementation impact on healthcare delivery efficiency, i.e., healthcare cost. in real-world payment system. This is a collaborative symposium between the Community-Engaged Research, Geriatric Education, and Patient/Person Engagement in Research Interest Groups.

Health Professional Shortage Areas and Physician Location Decisions

Health Professional Shortage Areas and Physician Location Decisions

Disparities in access to healthcare services in a regional neonatal transport network

IntroductionThe disproportionate distribution of healthcare resources in the U.S. leads to an annual estimated 68,000 critically-ill newborns transported to regional centers for intensive care. As described in the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework, patients with limited access to healthcare experience multiple healthcare settings in their journey to specialty care. Little is known about community resources for transported neonatal patients in the Pacific Northwest region. MethodsTransport data from January 2014–December 2019 identified referral zip codes for transfers to a regional neonatal intensive care unit (NICU). Using the SEIPS 3.0 framework to explore the journey of families experiencing neonatal complications, we linked referral zip codes to data on healthcare and resource access including: Health Transportation Shortage Index (HTSI); US Census Small Area Income and Poverty Estimates; public transportation availability; Health Professional Shortage Area (HPSA) and number of Federally Qualified Health Centers. Results1834 neonatal transports from 75 zip codes were analyzed. Forty percent of patients were transferred from a HPSA, one-quarter from areas with limited public transit availability (28%) and household internet access (24%). Almost all infants transferred from a high HTSI area (96%) were transported by air. ConclusionMany patients were referred from communities with high poverty and limited services. Improving patient outcomes requires population and policy level recommendations and care coordination between healthcare organizations and community services. Considering the patient family perspective within the SEIPS 3.0 framework will ensure patient centered care and an inclusive experience for families transitioning through healthcare settings.

Abstract A097: Assessing patterns of cancer screening uptake, healthcare access, health status, and the county-level Social Vulnerability Index in Louisiana

Abstract Background The Social Vulnerability Index (SVI) was originally developed to identify areas of high need prior to a disaster but it can also be used to identify medical underserved communities and areas of shortages of medical care. There are four major themes that contribute to SVI: 1) socioeconomic status, 2) household characteristics, 3) racial and ethnic minority status, and 4) housing type/transportation which can be used to examine cancer screening uptake in communities as their socioeconomic makeup contributes to the ability of individuals to access cancer screening. Cancer screenings are essential and highly effective tools when diagnosing cancer early which significantly improves chances of cancer survival and decreases chances of morbidity. This study aims to examine the association of county-level cancer screening uptake and SVI patterns in Louisiana while adjusting for healthcare utilization and self-reported health status. Methods 2020 county level age-adjusted cancer screening rates for breast, cervical, and colorectal, healthcare utilization rates, and health status rates for Louisiana were obtained from CDC’s PLACES website and SVI were obtained from CDC ATSDR. The county-level SVI was recoded into four categories: very low (0-.2499), low (0.2500-0.4999), high (0.5000-0.7499), and very high (0.7500-1.000) with high SVI implying least amount of resources. Linear regressions were used to assess the associations between screening rates and SVI quartiles while adjusting for healthcare utilization and health status variables. Results Of the 64 counties in Louisiana, the mean for county-level cancer screening rate were 1) breast cancer at 74.93% (range, 70.40%-79.90%), 2) colorectal cancer at 68.60% (range, 62.60%-75.10%), and cervical cancer at 81.57% (range, 77.4%-85.60%). The multivariable regression models showed very high SVI was associated with low cancer screening rates. When comparing very high SVI and very low SVI, the unadjusted odds ratio (OR) for cervical cancer screening, 0.25 (95% CI, 0.11-0.54) and colorectal cancer screening, 0.59 (95% CI, 0.18-0.59) showed significance. After adjusting for healthcare utilization and health status among very high SVI and very low SVI, all three breast, cervical, and colorectal cancer screening showed statistically significant associations. For uninsured rates, unadj. OR for breast, 8.95 (95% CI, 3.32-24.18) cervical, 5.16 (95% CI, 1.90-14.05) and colorectal, 7.12 (95% CI, 2.44-20.76) showed significance. For general health status, unadj. OR for breast, 9.42 (95% CI, 3.60 - 24.63) cervical, 6.64 (95% CI, 2.68 - 16.44) and colorectal, 9.94 (95% CI, 3.46 - 28.58) showed significance. Conclusions This study found that areas with very high SVI had low rates of cancer screening rates, low healthcare utilization, and high levels of self-reported fair/poor general, mental, and physical health status. These areas may benefit from community level interventions to address barriers to care and better dialogues of the importance of keeping up with routine checkup including cancer screenings. Citation Format: Malesa Pereira, Bilikisu Elewonibi. Assessing patterns of cancer screening uptake, healthcare access, health status, and the county-level Social Vulnerability Index in Louisiana [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A097.

Social Determinants of Health and Cardiologist Involvement in the Care of Adults Hospitalized for Heart Failure

Involvement of a cardiologist in the care of adults during a hospitalization for heart failure (HF) is associated with reduced rates of in-hospital mortality and hospital readmission. However, not all patients see a cardiologist when they are hospitalized for HF. To determine whether social determinants of health (SDOH) are associated with cardiologist involvement in the management of adults hospitalized for HF. This retrospective cohort study used data from the Reasons for Geographic and Racial Difference in Stroke (REGARDS) cohort. Participants included adults who experienced an adjudicated hospitalization for HF between 2009 and 2017 in all 48 contiguous states in the US. Data analysis was performed from November 2022 to January 2023. A total of 9 candidate SDOH, aligned with the Healthy People 2030 conceptual model, were examined: Black race, social isolation, social network and/or caregiver availability, educational attainment less than high school, annual household income less than $35 000, living in rural area, living in a zip code with high poverty, living in a Health Professional Shortage Area, and living in a state with poor public health infrastructure. The primary outcome was cardiologist involvement, defined as involvement of a cardiologist as the primary responsible clinician or as a consultant. Bivariate associations between each SDOH and cardiologist involvement were examined using Poisson regression with robust SEs. The study included 1000 participants (median [IQR] age, 77.8 [71.5-84.0] years; 479 women [47.9%]; 414 Black individuals [41.4%]; and 492 of 876 with low income [56.2%]) hospitalized at 549 unique US hospitals. Low annual household income (<$35 000) was the only SDOH with a statistically significant association with cardiologist involvement (relative risk, 0.88; 95% CI, 0.82-0.95). In a multivariable analysis adjusting for age, race, sex, HF characteristics, comorbidities, and hospital characteristics, low income remained inversely associated with cardiologist involvement (relative risk, 0.89; 95% CI, 0.82-0.97). This cohort study found that adults with low household income were 11% less likely than adults with higher incomes to have a cardiologist involved in their care during a hospitalization for HF. These findings suggest that socioeconomic status may bias the care provided to patients hospitalized for HF.

Employment of Certified Peer Specialists in Mental Health Professional Shortage Areas.

The current demand for mental health services is exacerbated by an ongoing shortage of behavioral health care providers in the United States. The Health Resources and Services Administration has identified 5,833 Mental Health Professional Shortage Areas (MHPSAs), many of which are rural, and could be served by Certified Peer Specialists (CPSs). This paper examines the relationship between CPS employment and MHPSA residency. Data are from a 2020 survey of 572 CPS certified in one of four states. Random effects logistic regression models were used to test the relationship between MHPSA residence and employment outcomes. Of 166 unique counties identified by participant zip codes, 47 were characterized as being MHPSAs with 14% of participants residing in one of these counties. A higher proportion of those living in MHPSAs were employed in peer support jobs (rather than other job types or unemployed) compared to those living in non-MHPSAs (68% vs. 54%, p = .020). MHPSA residential status was not a significant predictor of employment status (OR = 1.14, p = .728) but was significantly associated with greater likelihood of employment in peer support compared to other jobs, both for the entire sample (OR = 2.13, p = .026), and among those currently employed (OR = 2.90, p = .032). The greater likelihood of working in peer support among those residing in MHPSAs suggests that CPSs may leverage their credential to address shortages. As a result, peer support may become a more necessary part of the traditional service array. Policies that enable CPS to practice in MHPSAs should be encouraged.

Assessing community pharmacy services in health professional shortage areas across Wisconsin

BackgroundPrimary care health professional shortage areas (HPSAs) lack sufficient primary care providers to meet their health care needs, which contributes to worse health outcomes within underserved populations. Community pharmacies are commonly located in HPSAs and provide nondispensing services that can help address unmet health care needs. However, there is limited data on the nature, scope, and reimbursement for community pharmacy services. ObjectivesUsing survey data from the state of Wisconsin, this study compares the prevalence of and reimbursement for services provided by community pharmacies in primary care HPSAs and non-HPSAs and describes barriers to pharmacy service implementation. MethodsA survey tool on pharmacy services, reimbursement, and barriers to service implementation was developed, pilot tested, and administered to every community pharmacy in Wisconsin. Data were collected via mail and online over two waves of survey administration from November 2021 to May 2022. Pearson’s chi-squared and t tests were used to compare the prevalence of and reimbursement for services between HPSA and non-HPSA pharmacies. Content analysis was used to identify themes that described barriers to pharmacy service implementation. ResultsResponses were received from 287 of 774 eligible community pharmacies (37.1%). HPSA pharmacies were significantly more likely to be in rural areas. Regardless of pharmacy location, community pharmacies reported commonly providing a variety of services, but reimbursement for these services was considerably less frequent. The prevalence of reimbursement was <50% for two-thirds of services. Pharmacy staffing, time, and financial issues were the most commonly reported barriers to service implementation. ConclusionsCommunity pharmacies provide a diverse set of services to meet the health care needs of their patients, but often do so with inadequate staffing or reimbursement. Action is needed to support community pharmacies in meeting the health care needs of their communities and to ensure patient access to medications and pharmacy services.

Methadone prescribing by addiction specialists likely to leave communities without available methadone treatment.

Methadone treatment for opioid use disorder is not available in most suburban and rural US communities. We examined 2 options to expand methadone availability: (1) addiction specialty physician or (2) all clinician prescribing. Using 2022 Health Resources and Services Administration data, we used mental health professional shortage areas to indicate the potential of addiction specialty physician prescribing and the location of federally qualified health centers (ie, federally certified primary care clinics) to indicate the potential of all clinician prescribing. We examined how many census tracts without an available opioid treatment program (ie, methadone clinic) are (1) located within a mental health professional shortage area and (2) are also without an available federally qualified health center. Methadone was available in 49% of tracts under current regulations, 63% of tracts in the case of specialist physician prescribing, and 86% of tracts in the case of all clinician prescribing. Specialist physician prescribing would expand availability to an additional 12% of urban, 18% of suburban, and 16% of rural tracts, while clinician prescribing would expand to an additional 30% of urban, 53% of suburban, and 58% of rural tracts relative to current availability. Results support enabling broader methadone prescribing privileges to ensure equitable treatment access, particularly for rural communities.

Nurses can be key "REACH" accountable care organization partners to mitigate Medicare inequity.

We propose that Advanced Practice Registered Nurses (APRNs) can be key Accountable Care Organization (ACO) partners in mitigating Medicare inequity due to a shortage of primary care physicians. This shortage particularly impacts minority Medicare beneficiaries residing in urban and rural Health Professional Shortage Areas. In order to expand the primary care workforce to open the gateway to our health care system for these beneficiaries, we propose that APRNs provide primary care in a Medicare Neighborhood Clinic, as key partners of a modified "REACH" (Realizing Equity, Access, and Community Health) ACO model. We review the long history of ineffective efforts to alleviate the physician primary care shortage. After highlighting a report emphasizing the importance of nurses in achieving health equity, we describe the APRN role in a Medicare Neighborhood Clinic, and its potential for alleviating the primary care shortage. This clinic, as part of the modified "REACH" strategy, provides nurses with a key role in achieving Medicare equity. We contend that this strategy, as a means of APRNs providing value-based care to all Medicare beneficiaries while restraining the Medicare budget, contributes to transforming primary care for Medicare equity.

After 50 Years, Health Professional Shortage Areas Had No Significant Impact On Mortality Or Physician Density

After 50 Years, Health Professional Shortage Areas Had No Significant Impact On Mortality Or Physician Density