title: Trends in medical oncology outreach clinics in rural areas.
abstract: OBJECTIVE
  To examine the long-term trends in medical oncology outreach in Iowa, a state with a high proportion of rural residents, and to assess the involvement of the 2011 Iowa oncology workforce in visiting consultant clinics using a unique data source.
  
  
  METHODS
  Outreach locations and clinic frequencies are tracked annually in the Visiting Medical Consultant Database (Carver College of Medicine) along with the physicians' primary practice locations. Growth in the number of cities served and number of clinic days from 1989 to 2011 was analyzed using joinpoint analysis. Data from 2011 were used to estimate the trip length for participating oncologists.
  
  
  RESULTS
  The number of rural cities served by medical oncology outreach increased significantly between 1989 and 1996. Clinic days grew significantly in two periods: 1989 to 1998 and 2003 to 2005. In 2011, more than 2,100 clinic days were provided in 66 sites (95% of clinic days in rural areas). Almost half of all Iowa-based oncologists regularly participate in outreach. Oncologists staffing visiting consultant clinics in Iowa drive an estimated 21,000 miles per month.
  
  
  CONCLUSIONS
  For more than 20 years, visiting medical oncologists have brought cancer care to rural patients in Iowa. Access to cancer care in rural Iowa (ie, clinic days) increased significantly in the post-Medicare Modernization Act period (after 2005). High participation rates and travel burdens may influence oncologist training and retention strategies. Because the Affordable Care Act seeks to expand access for vulnerable populations (eg, rural elderly), it is critical to better understand the existing system of rural cancer care delivery.
authors: Tippie College of Business, University of Iowa, Iowa City, IA; and Chung-Ang University, Seoul, South Korea Thomas-gruca@uiowa.edu.
authors: Thomas S
authors: TS
authors: Gruca
authors: Tippie College of Business, University of Iowa, Iowa City, IA; and Chung-Ang University, Seoul, South Korea.
authors: Inwoo
authors: I
authors: Nam
authors: Tippie College of Business, University of Iowa, Iowa City, IA; and Chung-Ang University, Seoul, South Korea.
authors: Roger
authors: R
authors: Tracy
mesh_terms: D005843:Geography; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007484:Iowa; D008495:Medical Oncology / Q000458:organization & administration*; D009369:Neoplasms / Q000628:therapy*; D058991:Patient Protection and Affordable Care Act; D019035:Rural Health Services / Q000639:trends*; D012424:Rural Population; D014481:United States