Rural Otolaryngology Care Disparities: A Scoping Review

Abstract

Objective To broadly synthesize the literature regarding rural health disparities in otolaryngology, categorize findings, and identify research gaps to stimulate future work. Study Design Scoping review. Data Sources A comprehensive literature search was performed in the following databases: PubMed/MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar, and CINAHL. Review Methods The methods were developed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Peer-reviewed, English-language, US-based studies examining a rural disparity in otolaryngology-related disease incidence, prevalence, diagnosis, treatment, or outcome were included. Descriptive studies, commentaries, reviews, and letters to the editor were excluded. Studies published prior to 1980 were excluded. Results The literature search resulted in 1536 unique abstracts and yielded 79 studies that met final criteria for inclusion. Seventy-five percent were published after 2010. The distribution of literature was as follows: otology (34.2%), head and neck cancer (20.3%), endocrine surgery (13.9%), rhinology and allergy (8.9%), trauma (5.1%), laryngology (3.8%), other pediatrics (2.5%), and adult sleep (1.3%). Studies on otolaryngology health care systems also accounted for 10.1%. The most common topics studied were practice patterns (41%) and epidemiology (27%), while the Southeast (47%) was the most common US region represented, and database study (42%) was the most common study design. Conclusion Overall, there was low-quality evidence with large gaps in the literature in all subspecialties, most notably facial plastic surgery, laryngology, adult sleep, and pediatrics. Importantly, there were few studies on intervention and zero studies on resident exposure to rural populations, which will be critical to making rural otolaryngology care more equitable in the future.

Medicare Utilization and Reimbursement Variation Between Rural and Urban Otolaryngologists

“…19 Barriers to health care access and other disparities among rural populations have been a topic of increasing interest and importance, especially within surgical specialties such as otolaryngology. 8 Of special concern is the potential correlation between reduced health care access and lower quality care and patient outcomes. 8,[20][21][22] In fact, social determinants of health are increasingly shown to have major impacts on the most critical facets of health care such as utilization, quality, and costs, especially in the context of Medicare's Accountable Care Organization models affecting physician reimbursement.…”

“…It has been shown that regions (usually rural) with lower socioeconomic status, more severe poverty, and lower college graduation rates are also associated with reduced density of specialists, including otolaryngologists 19 . Barriers to health care access and other disparities among rural populations have been a topic of increasing interest and importance, especially within surgical specialties such as otolaryngology 8 . Of special concern is the potential correlation between reduced health care access and lower quality care and patient outcomes 8,20‐22 .…”

In Reference to “Rural Otolaryngology Care Disparities: A Scoping Review”

“…Although these studies comment on socioeconomic status, education, and ethnic disparities, rurality is often left out or briefly addressed. 1 In recent years, Cohn et al conducted 2 studies examining the relationship between maxillofacial trauma patterns and living climate (ie, rural vs urban neighborhoods). 2,3 In another study, rural patients sustained injuries from traffic accidents, sports, violence, and falls.…”

“…Although these studies comment on socioeconomic status, education, and ethnic disparities, rurality is often left out or briefly addressed. 1…”

“…The authors provide several review articles involving subspecialties of otolaryngology that highlight disparities in rural health care, including maxillofacial trauma. Although these studies comment on socioeconomic status, education, and ethnic disparities, rurality is often left out or briefly addressed 1 …”