Using the Homeland Security Exercise and Evaluation Program (HSEEP) Building Block Approach to Implement System Evaluation Theory (SET).

This article shares lessons learned in applying system evaluation theory (SET) to evaluate a Clinical and Translational Research Center (CTR) funded by the National Institutes of Health. After describing how CTR support cores are intended to work interdependently as a system, the case is made for SET as the best fit for evaluating this evaluand. The article then details how the evaluation was also challenged to facilitate a CTR culture shift, helping support cores to move from working autonomously to working together and understanding how the cores' individual operating processes impact each other.

Lessons Learned in Evaluating the Infrastructure of a Centre for Translational Research (CTR).

This paper shares lessons learned while evaluating the implementation of a Clinical and Translational Research Center (CTR). To meet its overarching goals the CTR consists of numerous research support units (e.g.

Rural and urban primary care physician professional beliefs and quality improvement behaviors.

Purpose: We evaluated whether primary care physicians (PCPs) from urban and rural practices differ on attitudes and behaviors related to quality improvement (QI) activities, patient relationships, and professionalism/self-regulation.

Methods: Data from a national survey that assessed physician attitudes and behaviors based on the Physician Charter on Medical Professionalism were used. Of the 1,891 survey respondents, N = 840 were PCPs (n = 274 family medicine (response rate = 67.

Osteopathic physicians and international medical graduates in the rural primary care physician workforce.

Background And Objectives: Primary care physician (PCP) shortages are a longstanding problem in the rural United States. This study describes the 2005 supply of two important components of the rural PCP workforce: rural osteopathic (DO) and international medical graduate (IMG) PCPs.

Methods: American Medical Association (AMA) and American Osteopathic Association (AOA) 2005 Masterfiles were combined to identify clinically active, non-resident, non-federal physicians aged 70 or younger.

The characteristics of registered nurses whose licenses expire: why they leave nursing and implications for retention and re-entry.

Little is known about RNs who drop their licenses and their potential re-entry into the nursing workforce. The results of this study provide insight into reasons nurses leave their careers and the barriers to re-entry, all important indicators of the current professional climate for nursing. While representing only one state, these findings suggest that RNs who allow their licenses to expire do so because they have reached retirement age or, among those who do not cite age as a factor, because many are unable or unwilling to work in the field.

Geographic differences in use of home oxygen for obstructive lung disease: a national Medicare study.

Rationale: Home oxygen is the most expensive equipment item that Medicare purchases ($1.7 billion/year).

Objectives: To assess geographic differences in supplemental oxygen use.

Which medical schools produce rural physicians? A 15-year update.

Purpose: Despite continued federal and state efforts to increase the number of physicians in rural areas, disparities between the supply of rural and urban physicians persist. The authors examined the training of the rural physician workforce in the United States.

Method: Using a national cross-sectional analysis of the 2005 American Medical Association and American Osteopathic Association Masterfile physician data, the authors examined a 10-year cohort of clinically active MD and DO physicians who graduated from medical school between 1988 and 1997.

Quality of care for myocardial infarction in rural and urban hospitals.

Background: In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted.

Do international medical graduates (IMGs) "fill the gap" in rural primary care in the United States? A national study.

Context: The contribution that international medical graduates (IMGs) make to reducing the rural-urban maldistribution of physicians in the United States is unclear. Quantifying the extent of such "gap filling" has significant implications for planning IMG workforce needs as well as other state and federal initiatives to increase the numbers of rural providers.

Purpose: To compare the practice location of IMGs and US medical graduates (USMGs) practicing in primary care specialties.

Access to cancer services for rural colorectal cancer patients.

Context: Cancer care requires specialty surgical and medical resources that are less likely to be found in rural areas.

Purpose: To examine the travel patterns and distances of rural and urban colorectal cancer (CRC) patients to 3 types of specialty cancer care services--surgery, medical oncology consultation, and radiation oncology consultation.

Methods: Descriptive cross-sectional study using linked Surveillance, Epidemiology, and End Results (SEER) cancer registry and Medicare claims data for 27,143 individuals ages 66 and older diagnosed with stages I through III CRC between 1992 and 1996.

Trends in perinatal and infant health disparities between rural American Indians and Alaska natives and rural Whites.

Objectives: We examined disparities in perinatal care, birth outcomes, and infant health between rural American Indian and Alaska Native (AIAN) persons and rural Whites over time.

Methods: We compared perinatal and infant health measures for 217 064 rural AIAN births and 5 032 533 rural non-Hispanic White births.

Results: Among American Indians and Alaska Natives, unadjusted rates of inadequate prenatal care (1985-1987, 36.

Access to specialty health care for rural American Indians in two states.

Context: The Indian Health Service (IHS), whose per capita expenditure for American Indian and Alaska Native (AI/AN) health services is about half that of the US civilian population, is the only source of health care funding for many rural AI/ANs. Specialty services, largely funded through contracts with outside practitioners, may be limited by low IHS funding levels.

Purpose: To examine specialty service access among rural Indian populations in two states.

A longitudinal analysis of the general surgery workforce in the United States, 1981-2005.

Hypothesis: The overall supply of general surgeons per 100 000 population has declined in the past 2 decades, and small and isolated rural areas of the United States continue to have relatively fewer general surgeons per 100 000 population than urban areas.

Design: Retrospective longitudinal analysis.

Setting: Clinically active general surgeons in the United States.

Growth and change in the physician assistant workforce in the United States, 1967-2000.

The physician assistant (PA) profession grew rapidly in the 1970s and 1990s. As acceptance of PAs in the health care system increased, roles for PAs in specialty care took shape and the scope of PA practice became more clearly defined. This report describes key elements of change in the demography and distribution of the PA population between 1967 and 2000, as well as the spread of PA training programs.

Measuring participant rurality in Web-based interventions.

Background: Web-based health behavior change programs can reach large groups of disparate participants and thus they provide promise of becoming important public health tools. Data on participant rurality can complement other demographic measures to deepen our understanding of the success of these programs. Specifically, analysis of participant rurality can inform recruitment and social marketing efforts, and facilitate the targeting and tailoring of program content.

International medical graduate physicians in the United States: changes since 1981.

Nearly a quarter of all active U.S. physicians are international medical graduates (IMGs)--physicians trained outside the United States and Canada.

The Washington State Nurse Anesthetist Workforce: a case study.

The purposes of this study were to describe the Washington State Certified Registered Nurse Anesthetist (CRNA) workforce and analyze selected dimensions of their clinical practice. We developed the 31-item CRNA Practice Questionnaire. After receiving institutional review board approval, the questionnaire was mailed in 2003 to CRNAs licensed in Washington with an address in Washington, Oregon, and Idaho.

Will rural family medicine residency training survive?

Background And Objectives: Rural family medicine residencies may be more threatened by declining interest in family medicine than their urban counterparts. This study examines the recent performance of rural residencies in the National Resident Matching Program as an indicator of their viability.

Methods: We surveyed all 30 family medicine residencies located in rural areas during the summer of 2004 and a geographically matched sample of 31 urban residencies.

Characteristics of registered nurses in rural versus urban areas: implications for strategies to alleviate nursing shortages in the United States.

Methods: This study compares characteristics of rural and urban registered nurses (RNs) in the United States using data from the 2000 National Sample Survey of Registered Nurses. RNs in 3 types of rural areas are examined using the rural-urban commuting area taxonomy.

Findings: Rural and urban RNs are similar in age and sex; nonwhites and Hispanics are underrepresented in both groups.

Geographic access to health care for rural Medicare beneficiaries.

Context: Patients in rural areas may use less medical care than those living in urban areas. This could be due to differences in travel distance and time and a utilization of a different mix of generalists and specialists for their care.

Purpose: To compare the travel times, distances, and physician specialty mix of all Medicare patients living in Alaska, Idaho, North Carolina, South Carolina, and Washington.

Prevalence and trends in smoking: a national rural study.

Context: Cigarette smoking is the leading preventable cause of death in the United States.

Purpose: To estimate the prevalence of and recent trends in smoking among adults by type of rural location and by state.

Methods: Random-digit telephone survey of adults aged 18 years or older who participated in the Behavioral Risk Factor Surveillance System in 1994-1996 (n = 342,055) and 2000-2001 (n = 385,384).

Problem drinking: rural and urban trends in America, 1995/1997 to 2003.

Objective: Studies examining trends in problem alcohol use for U.S. adults residing in rural locations are lacking.