Laura-Mae Baldwin, MD, MPH

WWAMI Rural Health Research Center

Phone: 206.685.4799
Fax: 206.616.4768
E-mail: lmb@fammed.washington.edu

WWAMI Rural Health Research Center
University of Washington
Department of Family Medicine
Box 354696
Seattle, WA 98195-4696

Current Projects

Do Rural Patients with Early Stage Prostate Cancer Gain Access to All Treatment Choices?
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Chronic diseases and conditions, Health services
This research will use cancer registry data from 10 states to examine the degree to which rural residents diagnosed with early stage prostate cancer access the full range of surveillance, surgical, and radiation treatment options. Study findings will inform cancer centers, advocacy groups, rural program planners, and policymakers about services and programs needed to ensure that rural prostate cancer patients can choose from among all treatment options.

Improvement in the Quality of Care for Acute Myocardial Infarction (AMI): Have Rural Hospitals Followed National Trends?
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Quality
This project will determine whether overall improvements in the quality of care for AMI among Medicare patients, as measured by adherence to guidelines, have taken place in both rural and urban hospital settings.

National Study of Rural-Urban Differences in Use of Home Oxygen for Chronic Obstructive Lung Disease: Are Rural Medicare Beneficiaries Disadvantaged?
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Chronic diseases and conditions, Medicare
To understand disparities in care among rural and urban Medicare beneficiaries, data from Medicare's Durable Medical Equipment (DME) files were used to assess rural/urban variation in the home use of supplemental oxygen.

Use of Recommended Radiation Therapy in the Rural U.S.
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Chronic diseases and conditions, Health services
This study will use cancer registry data from 10 U.S. states to examine which rural cancer patients are receiving recommended radiation therapy, and what factors influence receipt of recommended treatment. Identifying gaps in radiation therapy will inform cancer centers, rural program planners, and policy makers in rural cancer service locations and cancer support program development.

Completed Projects

Access to Cancer Services for Rural Colorectal Cancer Medicare Patients: A Multi-State Study, Lead researcher
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Aging, Chronic diseases and conditions, Health services, Medicare, Minority health
This study examined a comprehensive database to quantify the distance and access to four types of cancer services in a sample of rural, Medicare-insured, CRC patients of different racial and ethnic groups, and will inform future work designed to understand discrepancies in cancer service use by the rural elderly in different racial and ethnic groups.

Analysis of Factors that Affect the Acceptance of American Indians and Alaska Natives (AI/ANs) into Medical School Training Programs, Lead researcher
Research center: WWAMI Rural Health Research Center
Funder: Bureau of Health Professions
Topics: American Indians and Alaska Natives, Physicians, Workforce
This study surveys those American Indian/Alaska Native (AI/AN) students who applied to the University of Washington School of Medicine over two years to identify the supports and barriers they experienced in the application process, the path they have taken if rejected from medical school, and how their medical school rejection (if rejected) may have affected their plans to enter a health profession.

Availability of Specialty Health Care for Rural American Indians and Alaska Natives, Lead researcher
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: American Indians and Alaska Natives, Health services, Minority health

Breast Cancer Study, Lead researcher
Research center: WWAMI Rural Health Research Center
Funder: U.S. Department of Defense (DoD)
Topics: Aging, Women

Factors that Promote the Recruitment of American Indians and Alaska Natives into (AI/ANs) Medicine, Lead researcher
Research center: WWAMI Rural Health Research Center
Funder: Bureau of Health Professions
Topics: American Indians and Alaska Natives, Physicians, Workforce
This study identifies factors that promote the recruitment and retention of AI/ANs into medicine through interviews with AI/AN medical students enrolled at the University of Washington.

National Trends in the Perinatal and Infant Health Care of Rural and Urban American Indians (AIs) and Alaska Natives (ANs), Lead researcher
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: American Indians and Alaska Natives, Children, Health disparities, Maternal and child health, Minority health
This project examined and compared trends in prenatal care and mortality rates of rural and urban AI/AN and non-AI/AN populations in order to determine the level of disparity between these populations and their temporal changes.

Quality of Care for Acute Myocardial Infarction Patients in U.S. Rural Hospitals, Lead researcher
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Quality

Publications

• Access to Specialty Health Care for Rural American Indians in Two States
  Author(s): Baldwin LM, Hollow WB, Casey S, Hart LG, Larson EH, Moore K, Lewis E, Andrilla CHA, Grossman DC
  Research center: WWAMI Rural Health Research Center
  Topics: American Indians and Alaska Natives, Health services, Minority health
  Citation: Journal of Rural Health 24(3), 269-278
  Date: 2008
  The Indian Health Service (IHS), whose per capita expenditure for American Indian and Alaska Native (AI/AN) health services is about half that of the US civilian population, is the only source of health care funding for many rural AI/ANs. Specialty services, largely funded through contracts with outside practitioners, may be limited by low IHS funding levels. This study outlines the examination of specialty service access among rural Indian populations in two states. Results indicate that limitations in specialty care access for rural Indian clinic patients appear to be influenced by financial constraints. Health care systems factors may play a role in perceived differences in specialty access between rural Indian and non-Indian clinic patients.
• Access to Specialty Health Care for Rural American Indians: Provider Perceptions in Two States
  Author(s): Laura-Mae Baldwin, Waler B. Hollow, Susan Casey, L. Gary Hart, Eric H. Larson, Kelly Moore, Ervin Lewis, David C. Grossman
  Research center: WWAMI Rural Health Research Center
  Topics: American Indians and Alaska Natives, Health services, Minority health, Physicians
  Report Number: Working Paper No. 78
  Date: 10 / 2004
  Examines access to specialty services among rural Indian populations in Montana and New Mexico, based on a survey sent to primary care providers addressing access to specialty physicians, perceived barriers to access, and access to nonphysician clinical services. Report available upon request by contacting rhrc@fammed.washington.edu.
• American Indians and Alaska Natives: How Do They Find Their Path to Medical School?
  Author(s): Walter B. Hollow, Davis G. Patterson, Polly M. Olsen, Laura-Mae Baldwin
  Research center: WWAMI Rural Health Research Center
  Topics: American Indians and Alaska Natives, Workforce
  Citation: Academic Medicine, 81(10), S65-S69
  Date: 2006
  Describes findings of a study to understand the supports and barriers that American Indian and Alaska Native (AI/AN) students encountered on their path to successful medical school entry.
• American Indians and Alaska Natives: How Do They Find Their Path to Medical School?
  Author(s): Walter B. Hollow, Davis G. Patterson, Polly M. Olsen, Laura-Mae Baldwin
  Research center: WWAMI Rural Health Research Center
  Topics: American Indians and Alaska Natives, Physicians, Workforce
  Report Number: Working Paper No. 86
  Date: 01 / 2004
  Describes the findings of a study to understand the paths of American Indian and Alaska Native (AI/AN) students who successfully entered medical school.
• Clearing the Path to Medical School for American Indians and Alaska Natives: New Strategies
  Author(s): Walter B. Hollow, Apanakhi Buckley, Davis G. Patterson, Polly M. Olsen, Joycelyn Dorscher, Rustem Medora, Lori Morin, R. Steven Padilla, Jerry Tahsequah, Laura-Mae Baldwin
  Research center: WWAMI Rural Health Research Center
  Topics: American Indians and Alaska Natives, Physicians, Workforce
  Report Number: Working Paper No. 101
  Date: 01 / 2006
  Two recent studies examining recruitment and retention of American Indians and Alaska Natives (AI/ANs) in medical school identified significant challenges in the pursuit of a medical career by AI/AN students: the academic rigor of medical school, the needs of their communities and families, financial concerns, feelings that their perspectives on healing and spirituality were excluded from medical school, and the paucity of role models and mentors, especially those who shared their culture. Using the results of this research and their experience conducting programs to support AI/ANs pursuing health professions, the authors recommend several strategies for improving recruitment and retention of AI/AN medical students. These strategies include: 1. providing role models, advisors, and mentors; 2. providing early research opportunities by involving AI/AN communities in research on Native health issues; 3. anticipating students' traditional Native spiritual practices; 4. providing professional socialization opportunities for faculty and AI/AN medical students; 5. creating and implementing rigorous curricula that include indigenous perspectives; and 6. developing a pro-diversity institutional mission statement to inform admissions policies. The authors identify governmental and nongovernmental organizations in a position to fund and implement these strategies, as well as a list of resources. Collaboration with AI/AN individuals, organizations, and communities is critical to this effort but not a familiar role for most academic medical centers; suggestions for cross-cultural outreach and collaboration are provided.
• Explaining Black-White Differences in Receipt of Recommended Colon Cancer Treatment
  Author(s): Laura-Mae Baldwin, Sharon A. Dobie, Kevin Billingsley, Yong Cai, George E. Wright, Jason A. Dominitz, William Barlow, Joan L. Warren, Stephen H. Taplin
  Research center: WWAMI Rural Health Research Center
  Topics: African Americans, Health services
  Citation: Journal of the National Cancer Institute, 97(16), 1211-12210
  Date: 2005
  Black-white disparities exist in receipt of recommended medical care, including colorectal cancer treatment. This retrospective cohort study examines the degree to which health systems (e.g., physician, hospital) factors explain black-white disparities in colon cancer care. Black and white Medicare-insured colon cancer patients have an equal opportunity to learn about adjuvant chemotherapy from a medical oncologist but do not receive chemotherapy equally. Little disparity was explained by health systems; more was explained by illness severity, social support, and environment. Further qualitative research is needed to understand the factors that influence the lower receipt of chemotherapy by black patients.
• Gender-Related Factors in the Recruitment of Generalist Physicians to the Rural Northwest
  Author(s): Katherine E Ellsbury, Laura-Mae Baldwin, Karin E Johnson, SJ Runyan, L Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Women
  Report Number: No. 62
  Date: 02 / 2001
  Examines differences in the factors female and male generalist physicians considered influential in their rural practice location choice and identifies the practice arrangements that attracted female generalist physicians to rural areas. Findings include: women were more likely than men to have been influenced in practice choice by issues related to spouse/personal partner, flexible scheduling, family leave, and availability of childcare; women were more highly influenced by the interpersonal aspects of recruitment; and men and women were equally likely to consider community factors, practice content, practice partner compatibility, and financial issues. Findings indicate that rural communities and practices recruiting physicians should place high priority on practice scheduling, spouse/partner, and interpersonal issues in the recruiting process if they want to achieve a gender-balanced physician workforce.
• Improving the Quality of Outpatient Care for Older Patients with Diabetes: Lessons from a Comparison of Rural and Urban Communities
  Author(s): Roger A. Rosenblatt, Laura-Mae Baldwin, Leighton Chan, Meredith A. Fordyce, Irl B. Hirsch, Jerry P. Palmer, George E. Wright, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Aging, Chronic diseases and conditions, Quality
  Citation: Journal of Family Practice, 50(8), 676-680
  Date: 08 / 2001
  Compares the quality of diabetic care received by patients in rural and urban communities in Washington State. Among the findings: Generalists provided most diabetic care in all locations. Patients living in small rural towns received almost half their outpatient care in larger communities. Patients living in large rural towns remote from metropolitan areas were more likely to have received the recommended tests than patients in all other groups. Patients who saw an endocrinologist at least once during the year were more likely to have received the recommended tests. Concludes that large rural towns may provide the best conditions for high-quality care-growing communities that serve as regional referral centers and have an adequate, but not excessive, supply of generalist and specialist physicians.
• Modeling the Mental Health Workforce in Washington State: Using State Licensing Data to Examine Provider Supply in Rural and Urban Areas
  Author(s): Laura-Mae Baldwin, Miriam M. Patanian, Eric H. Larson, Denise M. Lishner, Larry B. Mauksch, Wayne J. Katon, Edward Walker, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Mental health, Workforce
  Citation: Journal of Rural Health, 22(1), 50-8
  Date: 2006
  The authors sought to identify mental health shortage areas using existing licensing and survey data, and found that notable shortages of mental health providers existed throughout the state, especially in rural areas. Urban areas had 3 times the psychiatrist FTEs per 100,000 and more than 1.5 times the nonpsychiatrist mental health provider FTEs per 100,000 as rural areas. More than 80% of rural health service areas had at least 10% fewer psychiatrist FTEs and nonpsychiatrist mental health provider FTEs than the state ratio. They concluded that states gathering a minimum database at licensure renewal can identify area-specific mental health care shortages for use in program planning.
• Perinatal and Infant Health Among Rural and Urban American Indians/Alaska Natives
  Author(s): Laura-Mae Baldwin, David C. Grossman, Susan Casey, Walter Hollow, Jonathan R. Sugarman, William L. Freeman, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: American Indians and Alaska Natives, Children, Maternal and child health, Rural statistics and demographics
  Citation: American Journal of Public Health, 92(9), 1491-1497
  Date: 09 / 2002
  Provides a national profile of rural and urban American Indian/Alaska Native (AI/AN) maternal and infant health.
• Quality of Care for Acute Myocardial Infarction in Rural and Urban U.S. Hospitals
  Author(s): Laura-Mae Baldwin, Richard F MacLehose, Shelli K Beaver, N Every, Leighton Chan
  Research center: WWAMI Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Citation: Journal of Rural Health, 20(2), 99-108
  Date: 2004
  Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care.
  Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers. Methods: This cohort study used data from the Cooperative Cardiovascular Project (CCP), including 4,085 acute care hospitals (408 remote small rural, 893 small rural, 619 large rural, and 2,165 urban) with 135,759 direct admissions of Medicare beneficiaries ages 65 and older for a confirmed AMI between February 1994 and July 1995. Outcomes included use of aspirin, reperfusion, heparin, and intravenous nitroglycerin during hospitalization; use of beta-blockers, aspirin, and angiotensin-converting enzyme (ACE) inhibitors at discharge; avoidance of calcium channel blockers at discharge; and 30-day mortality.
  Findings: Substantial proportions of Medicare beneficiaries in both urban and rural hospitals did not receive the recommended treatments for AMI. Medicare patients in rural hospitals were less likely than urban hospitals' patients to receive aspirin, intravenous nitroglycerin, heparin, and either thrombolytics or percutaneous transluminal coronary angioplasty. Only ACE inhibitors at discharge was used more for patients in rural hospitals than urban hospitals. Medicare patients in rural hospitals had higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals (odds ratio for large rural 1.14 [1.10 to 1.18], small rural 1.24 [1.20 to 1.29], remote small rural 1.32 [1.23 to 1.41]).
  Conclusions: Efforts are needed to help hospital medical staffs in both rural and urban areas develop systems to ensure that patients receive recommended treatments for AMI.