Online Program

Local Health Department (LHD) Clinical Service Delivery along the Urban/Rural Continuum

Tuesday, November 3, 2015

Kate E. Beatty, PHD, MPH, Department of Health Services Management and Policy, East Tennessee State University College of Public Health, Johnson City, TN
Tyler Carpenter, MPH(c), Department of Health Services Management and Policy, East Tennessee State University College of Public Health, Johnson City, TN
Michael Meit, MA, MPH, Public Health Research, NORC at the University of Chicago, Bethesda, MD

Amal Khoury, PhD, MPH, College of Public Health, East Tennessee State University, Johnson City, TN
Paula Masters, MPH, College of Public Health-Tennessee Public Health Training Center-LIFEPATH, East Tennessee State University, Johnson City, TN
background: Rural communities face numerous health disparities related to  health behaviors, health outcomes, and access to medical care. LHDs serving rural communities  have fewer resources to meet their community needs. The number and types of community organizations (hospitals, health clinics, not-for-profits), available to partner with may be limited geographically. These factors may affect availability of clinical services in rural communities. This study will assess LHD clinical service delivery levels based on rurality.

data sets and sources: Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area (RUCA)  Both “micropolitan” and “rural” categories are considered rural by the Federal Office of Rural Health Policy. 

analysis: Bivariate analysis for 25 clinical services offered by  rurality . For each service, we compared the proportions of LHDs that: 1) directly performed, 2) contracted  with organizations, and 3) reported that the service was provided independently by organizations in the community.

principal findings:  Analyses show  significant differences in patterns of clinical services offered, contracted or provided by third parties based on rurality. LHDs in micropolitan areas provided more services directly than urban and rural LHDs (p≤0.001).  Urban LHDs were more likely to contract with other organizations (p≤0.001).

conclusions: Rural LHDs are less likely to offer, contract, or have services provided by another organization in the community, whereas larger rural (i.e., micropolitan) jurisdictions are more likely to directly provide these services.   

implications for public health practice and policy: Lower levels of clinical service delivery by rural LHDs may contribute to the access issues facing rural communities.  Health care reform brings threats and opportunities for LHD clinical service delivery. Further analyses to assess impacts on rural LHDs and identify strategies to ensure access to clinical services is encouraged.

Learning Areas:

Administration, management, leadership
Clinical medicine applied in public health
Provision of health care to the public

Learning Objectives:
Compare clinical provisions and health disparities related to risky health behaviors, health outcomes, and access to medical care compared to urban communities.

Keyword(s): Local Public Health Agencies, Rural Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have conducted public health systems research with a focus on rural public health agencies for the past 20 years, including serving as co-director of the NORC Walsh Center for Rural Health Analysis, Director of the University of Pittsburgh Center for Rural Health Practice, and in public health practice at NACCHO and the PA Department of Health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.