title: Quality of care in rural youth with type 1 diabetes: a cross-sectional pilot assessment.
abstract: BACKGROUND
  Type 1 diabetes mellitus (T1DM) presents a significant health burden for patients and families. The quality of care (QOC) among those living in rural communities is thought to be subpar compared with those in urban communities; however, little data exist to reflect this, especially in pediatric diabetes.
  
  
  OBJECTIVE
  The purpose of this pilot study was to investigate diabetes QOC among families living in rural versus urban areas. 6 QOC markers were used to compare youth with T1DM: appointment adherence, patient-provider communication, diabetes education during clinic visit, congruency with diabetes standards of care, diabetes self-management behaviors, and diabetes-related hospitalizations.
  
  
  METHODS
  Participants were rural or urban adult caregivers of youth ages 2-18 with ≥10-month history of T1DM receiving treatment at Seattle Children's Hospital, USA. Participants were from rural areas of central Washington, or urban areas of western Washington. Caregivers completed a 26-item survey pertaining to the 6 QOC markers. The 6 QOC markers were compared across 61 participants (34 rural, 27 urban), to determine how diabetes care quality and experiences differed. Data were collected over 12 months. Groups were compared using t-tests and χ2tests, as appropriate.
  
  
  RESULTS
  Compared with urban families, rural families reported significantly lower income and a 4-fold greater usage of public insurance. Among the QOC measures, rural participants were significantly worse off in the appointment adherence, patient-provider communication, and hospitalizations categories. Congruence with diabetes standards of care (foot care only) was also significantly poorer in rural participants.
  
  
  CONCLUSIONS
  The burden of travel in conjunction with the lack of resources in this rural population of families with T1DM youth is cause for concern and warrants further research.
authors.affiliation: PNWU, College of Osteopathic Medicine , Yakima, Washington , USA.
authors.forename: Kyle S
authors.initials: KS
authors.lastname: Stumetz
authors.affiliation: Seattle Children's Research Institute , Seattle, Washington , USA.
authors.forename: Joyce P
authors.initials: JP
authors.lastname: Yi-Frazier
authors.affiliation: A.T. Still University of Health Sciences, Kirksville College of Osteopathic Medicine , Kirksville, Missouri , USA.
authors.forename: Connor
authors.initials: C
authors.lastname: Mitrovich
authors.affiliation: Department of Biomedical Sciences , PNWU, College of Osteopathic Medicine , Yakima, Washington , USA.
authors.forename: Kathaleen
authors.identifier: 0000-0003-2224-2548
authors.initials: K
authors.lastname: Briggs Early
keywords: Pediatric Type 1 Diabetes; Quality of Care; Rural Health; Youth