If you’re sitting in a downtown office building in a major U.S. city, access to rural healthcare may seem like a distant concern.
But consider this: About 60 million people, or more than one in five Americans, live in rural areas, according to the U.S. Census. In Florida, half the counties are rural. Getting affordable quality care to those communities is a real concern, but because of the nature of the geography, it can get complicated. Some groups even indicate it may be a key election issue.
That’s where UCF’s Rural Health Research Group comes in.
The interdisciplinary group of researchers focuses on health disparities in rural populations, costs and the operations of rural primary-care organizations. The group also studies the role of Accountable Care Organizations in rural communities. ACOs were created to encourage medical professionals to coordinate care of residents with Medicare insurance (coverage for older Americans and persons with disabilities). The ACO translates into a network of doctors and hospitals that share financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending. But like most healthcare related programs, funding, payments and reimbursements can be a challenge.
“There is a lot of need,” says Judy Ortiz, director of the research group. She holds multiple degrees including a doctorate in healthcare delivery systems and primary care. Ortiz also has another credential: Her parents were rural healthcare professionals and several of her family members live and work in rural communities. “It’s not a small population and it’s quite diverse. You’ll find older adults, veterans and other groups like Latinos disproportionally represented. With America’s demographics shifting and Latinos becoming the biggest minority, this is not something we can ignore.”
It’s that same realization that drew UCF graduate student Cristina Figueroa to the group. She was working her way through prerequisite courses for medical school when she came across a Facebook post about the research group.
“I think we have a moral obligation to make sure everyone has access to healthcare,” Figueroa says. “But there are also economic reasons. If people are healthy, they are more productive. Staying healthy is also less expensive than dealing with a crisis.”
Figueroa and her colleague Boon Phrathep, who is earning his master’s degree in statistics, are convinced that the data they collect and analyze can help improve healthcare delivery to rural communities. The data crunching can become time-consuming, but they remain motivated.
The students don’t just work with numbers. They, along with Ortiz and others in the group, conduct interviews with rural residents in Central Florida and other states as part of their research. The investigators don’t simply look at data reported to agencies. It is important that rural communities be part of the studies, the team said. That’s why interviews are conducted routinely as part of the data collection, and consultations with rural stakeholders is ongoing.
Currently, the UCF group is analyzing factors associated with reducing diabetes-related disparities among rural Latinos, funded by the National Institutes of Health. The longitudinal study expected to be complete this year looks at data from Florida, Texas and California to compare health disparities and patient outcomes of rural Latino older adult patients diagnosed with diabetes to their non-Latino white counterparts. The group is also looking to see what the impact of ACO participation by rural primary care providers (along with other factors) had on rural Latino older adult patients.
The Rural Health Research Group, which includes economics Professor Richard Hofler and nursing Professor Angeline Bushy, is familiar with ACOs.
In studies early in the history of Medicare ACOs, the group used data from hundreds of rural health clinics in nine states and analyzed the impact of one type of Medicare ACO – the Medicare Shared Savings Program – on health disparities, cost efficiency, quality of care, and health outcomes of rural older adult populations. The results were varied. Clinic personnel described the greatest benefit of participating in ACOs as being improved patient quality of care. However, measures of patient outcomes in those early years indicated that ACO affiliation had no immediate impact on diabetes-related hospitalization rates of older African-American or white rural adults. The group is currently conducting research to examine the impact of ACO participation by rural provider organizations in more recent years, considering that the effects on patient outcomes, for example, may take several years to emerge.
Using research to make a difference in the health of rural populations can sometimes seem out of reach, some of the team members say.
“But you have to see it through because it will eventually benefit people,” Figueroa says. “What we do will impact public healthcare policy and that change is going to take time. Good things always take time. So, we work.”
