Disparities in Screening, Prevention, and Management of Cardiovascular Disease in Rural and Urban Primary Care
The objective of this project is to compare cardiovascular disease (CVD) screening, prevention, and management quality measures in a large national primary care registry between rural and urban practices and also assess for disparities by patient race/ethnicity composition of the practice.
Rates of preventive screening remain low in the United States as compared to recommendations, despite a strong scientific basis for their beneficial impact on health. Levels of adherence to preventive guidelines are even lower in African Americans and other racial/ethnic minority populations, socioeconomically disadvantaged populations, and underserved rural populations. Additionally, rural populations have higher modifiable risk factors for CVD than urban populations—obesity, smoking, lower rates of physical activity—and bear a disproportionate burden of CVD. Minority populations also face higher CVD risk factors. Screening, prevention, and management of CVD and its risk factors largely occur in primary care settings, particularly in rural areas.
Rates of undiagnosed and poorly treated high blood pressure are more common in rural areas, and rural populations face higher mortality rates from CVD. With an increasing emphasis on value-based payment and quality reporting in the last few years, it remains unknown if rural primary care practices have closed this gap in performance on quality measures related to CVD screening, prevention, and treatment, which may lead to decreases in the mortality gap. This information would be critical to evaluate whether changes in practice incentives can improve population health. Knowledge from the proposed study may be used by policy makers to identify quality gaps for rural populations that can be targeted with payment incentives, or extra resources, to decrease the burden of CVD, including mortality and hospitalizations, in rural populations.