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在美国,在一个具有全国代表性的人口中,自我认同的农村
Dustin C Krutsinger1, Kuldeep N Yadav2,3, Joanna L Hart2,3,4,5
1Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Rural and remote health
|April 3, 2024
概括
一个以患者为中心的新农村定义提高了分类准确性. 将某些城市地区重新归类为农村地区更好地反映了居民的经验,并有助于健康差异研究.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 农村卫生 农村卫生
- 地理分类地理分类
背景情况:
- 农村-城市通勤区 (RUCA) 分类是美国卫生服务研究中衡量农村地区的标准.
- 现有的RUCA代码往往误解了农村生活,并没有考虑个人医疗保健经验或不平等.
- 需要以患者为中心的方法来准确地定义农村及其对健康差异的影响.
研究的目的:
- 开发一个以患者为中心的农村定义,使用RUCA代码.
- 评估自我认定的农村和现有的RUCA分类之间的一致性.
- 建议修订基于RUCA的分类,以更好地反映患者的看法.
主要方法:
- 美国居民进行了一项横截面的在线调查,询问他们对农村的感知和理由.
- 自我报告的农村和来自邮政编码的RUCA名称之间的一致性使用Cohen的kappa和百分比协议进行了评估.
- 根据参与者的答复,RUCA代码2-3被重新归类为农村,并分析以改善协议.
主要成果:
- 在感知农村和传统的RUCA分类之间发现了适度的一致性 (kappa=0.48).
- 在RUCA 2-3地区的个体中观察到较低的同意率 (19.6%),这是由人口密度和邻近性的感知所驱动的.
- 将RUCA 2-3重新分类为农村增加了整体一致性 (kappa=0.56),表明患者中心性得到改善.
结论:
- 以患者为中心的基于RUCA的分类对于准确评估农村对健康差异的影响至关重要.
- 将RUCA 2-3名称重新归类为农村提供了更准确和以患者为中心的定义.
- 这种修订后的分类可以很容易地在未来的医疗服务研究中实施,特别是当没有可用的自我报告数据时.
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