Purpose This study is a scoping review of the different methods used to measure rurality in the health services research (HSR) literature. Methods We identified peer-reviewed empirical studies from 2010–2020 from seven leading HSR journals, including the Journal of Rural Health, that used any definition to measure rurality as a part of their analysis. From each study, we identified the geographic unit (e.g., county, zip code) and definition (e.g., Rural Urban Continuum Codes, Rural Urban Commuting Areas) used to classify categories of rurality. We analyzed whether geographic units and definitions used to classify rurality differed by focus area of studies, including costs, quality, and access to care. Lastly, we examined the number of rural categories used by authors to assess rural areas. Findings In 103 included studies, five different geographic units and 11 definitions were used to measure rurality. The most common geographic units used to measure rurality were county (n = 59, 57%), which was used most frequently in studies examining cost (n = 12, 75%) and access (n = 33, 57.9%). Rural Urban Commuting Area codes were the most common definition used to measure rurality for studies examining access (n = 13, 22.8%) and quality (n = 10, 44%). The majority of included studies made rural versus urban comparisons (n = 82, 80%) as opposed to focusing on rural populations only (n = 21, 20%). Among studies that compared rural and urban populations, most studies used only one category to identify rural locations (n = 49 of 82 studies, 60%). Conclusion Geographic units and definitions to determine rurality were used inconsistently within and across studies with an HSR focus. This finding may affect how health disparities by rural location are determined and thus how resources and federal funds are allocated. Future research should focus on developing a standardized system to determine under what circumstances researchers should use different geographic units and methods to determine rurality by HSR focus area.

In the U.S., the numbers of obese individuals and of obesity-related health conditions are rising. While physicians understand the need to improve patient health by promoting a healthy lifestyle, the advancement of nutrition education in medical school and residency is not keeping pace. This is evident in the inadequate time dedicated to nutrition education by medical schools and in the dissatisfaction of medical students and residents with their medical nutrition training. The aim of the current study was to investigate how food, diet, nutrition, and obesity are represented in the U.S. medical school licensing examinations (USMLE) as a potential incentive to better match medical nutrition curricula to the modern societal needs. We semi-quantitatively analyzed nutrition-related information of the USMLE Step 1, 2, and 3 Content Description documents and two test preparation books, using QRS NVivo 10. The software's coding comparison query was used as reliability statistics. We found an adequate amount of nutrition references. However, the content of the references was inadequate in that there was minimal information in regards to chronic diseases and no content related to disease prevention. Moreover, there was a lack of specifics in regards to food and nutritional science. We propose a content adjustment to the medical licensing exams to ensure that future physicians are more skilled and comfortable in fulfilling their roles as health care providers and advisors for an increasingly obese patient clientele.

Background: Since the inception of Accountable Care Organizations (ACOs), many have acknowledged the potential synergy between ACOs and health information technology (IT) in meeting quality and cost goals. Objective: We conducted a systematic review of the literature in order to describe what research has been conducted at the intersection of health IT and ACOs and identify directions for future research. Methods: We identified empirical studies discussing the use of health IT via PubMed search with subsequent snowball reference review. The type of health IT, how health IT was included in the study, use of theory, population, and findings were extracted from each study. Results: Our search resulted in 32 studies describing the intersection of health IT and ACOs, mainly in the form of electronic health records and health information exchange. Studies were divided into three streams by purpose; those that considered health IT as a factor for ACO participation, health IT use by current ACOs, and ACO performance as a function of health IT capabilities. Although most studies found a positive association between health IT and ACO participation, studies that address the performance of ACOs in terms of their health IT capabilities show more mixed results. Conclusions: In order to better understand this emerging relationship between health IT and ACO performance, we propose future research should consider more quasi-experimental studies, the use of theory, and merging health, quality, cost, and health IT use data across ACO member organizations.