title: A "medical mission" at home: the needs of rural America in terms of otolaryngology care.
abstract: OBJECTIVE
  Describe the population, Medicaid, uninsured, and otolaryngology practice demographics for 7 representative rural Southeastern states, and propose academic-affiliated outreach clinics as a service to help meet the specialty care needs of an underserved rural population, based on the "medical mission" model employed in international outreach clinics.
  
  
  METHODS
  A needs assessment was conducted via review of medical licensing and practice location data from state medical licensing authorities, together with population, Medicaid, and uninsured data from state health/human services departments and the US Census Bureau.
  
  
  RESULTS
  In all states examined, there are significantly more practicing otolaryngologists per capita in urban areas compared to rural areas (P < .05), with the exception of West Virginia, where the difference was not statistically significant (P= .33). In the majority of the states examined, there were higher rates (expressed as a percentage of total county population) of both Medicaid recipients and uninsured patients in rural counties compared to urban counties. Notable exceptions include Louisiana and West Virginia, where there are higher percentages of Medicaid patients in urban areas, and Kentucky and Tennessee, where there are higher percentages of uninsured patients in the urban areas (P < .05 for each comparison).
  
  
  CONCLUSIONS
  Borrowing design elements from the international outreach clinics, which involve many US otolaryngologists, a similar medical mission model could be of benefit domestically. There are rural areas of the Southeast where visiting outreach clinics could improve access to otolaryngology care and facilitate effective use of existing "safety net" health care resources.
authors: Department of Otolaryngology, Tulane University, New Orleans, Louisiana 70112, USA. rwinters@tulane.edu
authors: Ryan
authors: R
authors: Winters
authors: Anna
authors: A
authors: Pou
authors: Paul
authors: P
authors: Friedlander
mesh_terms: D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008484:Medicaid / Q000458:organization & administration; D008507:Medically Underserved Area; D020380:Needs Assessment / Q000706:statistics & numerical data; D010036:Otolaryngology; D010038:Otorhinolaryngologic Diseases / Q000453:epidemiology / Q000517:prevention & control; D019035:Rural Health Services / Q000458:organization & administration*; D015144:Southeastern United States / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*; D000078329:Workforce