Kentucky is a rural state with majority of its residents having multiple chronic health conditions. Existing Federal Health Professional Shortage Area and Medically Underserved Area Designations have been critical in helping the Commonwealth address some of its rural health care needs. There are, however, counties or areas within Kentucky where poor health outcomes and high chronic disease burden indicate a lower population to provider ratio. The purpose of this study was to use chronic disease morbidity and mortality data to develop a state-based designation criteria to help in the identification of counties and/rural areas where health care systems are fragile, but they do not meet the current federal designation criteria.
METHODS:
We selected the following nine metrics: cancer death rates, heart disease death rates, prevalence of smoking and obesity, estimated percentage of population without health insurance, estimated percentage of the population 65 and older; estimated percentage of the population living at or below 200% FPL; and estimated percentage of the labor force unemployed. The data source for death rates was Kentucky Vital Statistics Death Records (2013-2014), prevalence rates for smoking and obesity were obtained from Kentucky Behavioral Risk Factor Survey (2011-2014) and the remaining indicators were obtained from the current census estimates. These metrics were used to (a) define the criteria to be used for determining rural areas with need and (b) to establish a population to provider ratio that addressed the counties specific level of need. The data for each factor for each county in the Commonwealth was ranked by quintile. The quintile rankings were summed up to develop a Total Rank Score (TRS). To be reclassified, using the state-based criteria the county or area (i.e., census tracts), must have population to provider ratio of, at least 1250 to 1 if the TRS is greater than or equal to 32 and 1500 to 1 if the TRS is less than 31 but equal to or greater than 28.
RESULTS:
There were 52 counties out of a total of 120 counties in Kentucky which were found to be eligible for re-classification using the proposed state-based criteria. The death rate in these counties or the percentage of the population with multiple chronic conditions was two to three times the national estimates.
CONCLUSIONS:
Reclassification of these counties for a lower population to provider ratio using the proposed criteria developed will benefit the residents by allowing opportunities to increase providers.