Abstract：
BACKGROUND: The NASEM Primary Care Report and Primary Care scorecard highlighted the importance of primary care physician (PCP) capacity and having a usual source of care (USC). However, research has found that PCP capacity and USC do not always correlate. This exploratory study compares geographic patterns and the characteristics of counties with similar rates of PCP capacity but varying rates of USC.
METHODS: Our county-level, cross-sectional approach includes estimates from the Robert Graham Center and data from the Robert Wood Johnson County Health Rankings (CHR). We utilized conditional mapping methods to first identify US counties with the highest rates of social deprivation (SDI). Next, counties were stratified based on primary care physician (PCP) capacity and usual source of care (USC) terciles, allowing us to identify 4 types of counties: (1) High-Low (high PCP capacity, low USC); (2) High-High (high PCP capacity, high USC); (3) Low-High (low PCP capacity, high USC); and (4) Low-Low (low PCP capacity, low USC). We use t test to explore differences in the characteristics of counties with similar rates of primary care capacity.
RESULTS: The results show clear geographic patterns: High-High counties are located primarily in the northern and northeastern US; High-Low counties are located primarily in the southwestern and southern US. Low-High counties are concentrated in the Appalachian and Great Lakes regions; Low-Low counties are concentrated in the southeastern US and Texas. Descriptive results reveal that rates of racial and ethnic minorities, the uninsured, and social deprivation are highest in counties with low rates of USC for both high PCP and low PCP areas.
CONCLUSIONS: Recognizing PCP shortages and improving rates of USC are key strategies for increasing access to high-quality, primary care. Targeting strategies by geographic region will allow for tailored models to improve access to and continuity of primary care. For example, we found that many of the counties with the lowest rates of USC are found in non-Medicaid expansion states (Texas, Georgia, and Florida) with high rates of uninsured populations, suggesting that expanding Medicaid and improving access to health insurance are key strategies for increasing USC in these states.
METHODS: Our county-level, cross-sectional approach includes estimates from the Robert Graham Center and data from the Robert Wood Johnson County Health Rankings (CHR). We utilized conditional mapping methods to first identify US counties with the highest rates of social deprivation (SDI). Next, counties were stratified based on primary care physician (PCP) capacity and usual source of care (USC) terciles, allowing us to identify 4 types of counties: (1) High-Low (high PCP capacity, low USC); (2) High-High (high PCP capacity, high USC); (3) Low-High (low PCP capacity, high USC); and (4) Low-Low (low PCP capacity, low USC). We use t test to explore differences in the characteristics of counties with similar rates of primary care capacity.
RESULTS: The results show clear geographic patterns: High-High counties are located primarily in the northern and northeastern US; High-Low counties are located primarily in the southwestern and southern US. Low-High counties are concentrated in the Appalachian and Great Lakes regions; Low-Low counties are concentrated in the southeastern US and Texas. Descriptive results reveal that rates of racial and ethnic minorities, the uninsured, and social deprivation are highest in counties with low rates of USC for both high PCP and low PCP areas.
CONCLUSIONS: Recognizing PCP shortages and improving rates of USC are key strategies for increasing access to high-quality, primary care. Targeting strategies by geographic region will allow for tailored models to improve access to and continuity of primary care. For example, we found that many of the counties with the lowest rates of USC are found in non-Medicaid expansion states (Texas, Georgia, and Florida) with high rates of uninsured populations, suggesting that expanding Medicaid and improving access to health insurance are key strategies for increasing USC in these states.
摘要：
背景：NASEM初级保健报告和初级保健记分卡强调了初级保健医师（PCP）能力和具有常规护理来源（USC）的重要性。然而,研究发现，PCP容量和USC并不总是相关的。这项探索性研究比较了PCP容量相似但USC比率不同的县的地理格局和特征。
方法：我们的县级，横断面方法包括罗伯特·格雷厄姆中心的估计和罗伯特·伍德·约翰逊县健康排名(CHR)的数据。我们利用条件映射方法首先确定了美国社会剥夺率最高的县（SDI）。接下来,县根据初级保健医生(PCP)能力和常规护理来源(USC)进行分层，允许我们识别4种类型的县：(1)高-低(高PCP容量，低USC)；(2)高-高(高PCP容量，高USC)；(3)低-高(低PCP容量，高USC)；和(4)低-低(低PCP容量，USC低）。我们使用t检验来探讨初级保健能力相似率的县的特征差异。
结果：结果显示出明显的地理格局：高-高县主要位于美国北部和东北部；高-低县主要位于美国西南部和南部。低高县集中在阿巴拉契亚和大湖地区；低低县集中在美国东南部和德克萨斯州。描述性结果显示，种族和族裔少数群体的比率，没有保险的人，在高PCP和低PCP地区，USC比率低的县，社会贫困程度最高。
结论：认识到PCP短缺和提高USC的比率是增加获得高质量产品的关键策略，初级保健。按地理区域确定战略目标将允许制定量身定制的模式，以改善初级保健的获取和连续性。例如,我们发现，许多南加州大学患病率最低的县都存在于非医疗补助扩张州(德克萨斯州，格鲁吉亚,和佛罗里达州)没有保险的人口比例很高，这表明扩大医疗补助和改善获得医疗保险是这些州增加南加州大学的关键策略。
方法：我们的县级，横断面方法包括罗伯特·格雷厄姆中心的估计和罗伯特·伍德·约翰逊县健康排名(CHR)的数据。我们利用条件映射方法首先确定了美国社会剥夺率最高的县（SDI）。接下来,县根据初级保健医生(PCP)能力和常规护理来源(USC)进行分层，允许我们识别4种类型的县：(1)高-低(高PCP容量，低USC)；(2)高-高(高PCP容量，高USC)；(3)低-高(低PCP容量，高USC)；和(4)低-低(低PCP容量，USC低）。我们使用t检验来探讨初级保健能力相似率的县的特征差异。
结果：结果显示出明显的地理格局：高-高县主要位于美国北部和东北部；高-低县主要位于美国西南部和南部。低高县集中在阿巴拉契亚和大湖地区；低低县集中在美国东南部和德克萨斯州。描述性结果显示，种族和族裔少数群体的比率，没有保险的人，在高PCP和低PCP地区，USC比率低的县，社会贫困程度最高。
结论：认识到PCP短缺和提高USC的比率是增加获得高质量产品的关键策略，初级保健。按地理区域确定战略目标将允许制定量身定制的模式，以改善初级保健的获取和连续性。例如,我们发现，许多南加州大学患病率最低的县都存在于非医疗补助扩张州(德克萨斯州，格鲁吉亚,和佛罗里达州)没有保险的人口比例很高，这表明扩大医疗补助和改善获得医疗保险是这些州增加南加州大学的关键策略。
