Research findings show how rural hospitals can make cancer care more accessible

Cancer care is more accessible in rural areas than thought, and this increased accessibility should be considered as changes are made in the health care system under the Affordable Care Act, according to new research.

Significant portions of Iowa's population were found to be an excessive distance from full-service cancer care centers that are located in larger cities such as Des Moines, Omaha/Council Bluffs, or Davenport, according to a recent study. However, the study found that number drops significantly if visiting consultant clinics (VCCs) in rural hospitals are taken into consideration.

Thomas Gruca, PhD, MBA, of the Tippie College of Business at the University of Iowa, said that rural VCCs host oncologists at least once a month from cancer centers in larger urban areas. Depending on the clinic, VCCs provide a range of diagnostic, treatment, and posttreatment services. Using data from the Iowa Health Professions Tracking Center, Gruca and other researchers found that the median driving time for Iowans to the closest site for oncology care falls from 51.6 minutes to 19.2 minutes when VCCs are included. According to federal guidelines, anything more than a 30-minute drive is considered an excessive commute to receive care.

Even from isolated rural towns, Gruca said the median travel time for cancer care dropped from 58 minutes to 26 minutes when VCCs were considered, which is within the guidelines.

“Clearly, visiting consultant clinic sites are an important mechanism for providing medical oncology services in rural communities,” Gruca said.

The study group's research found 80 VCCs in rural Iowa hospitals, serviced by 55 oncologists visiting from larger cities. He found 38 of the VCCs are visited by an oncologist once a month, 22 are visited two or three times, and 20 are visited four or more times monthly. The findings of this study were published in Health Sciences Research (2013; doi:10.1111/1475-6773.12050).

In the end, he said the proportion of Iowa's population outside of a 30-minute drive to an oncology care site drops from 42% to 10% when VCCs are included in the care centers. He said this number is important because it reframes the problem into something that can be addressed.

“When almost half the population has limited access to cancer care, you throw up your hands and say what can you do?” he said. “But if only 10% have limited access, we say, we can deal with that, that's a problem we can solve.”

Gruca said his study suggests that VCCs could play a larger role in cancer care as the health care system is reorganized by the Affordable Care Act.

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