The Program Being Evaluated

The Southern Rural Access Program: An Initiative to Improve Access to Primary Health Care Services in Rural Areas of Eight Southern States (SRAP) was a multi-year initiative of the Foundation to improve access to primary health care services in rural areas of Alabama, Arkansas, Georgia, Louisiana, Mississippi, South Carolina, West Virginia and east Texas. Through the SRAP these eight states were funded to increase the flow of health care professionals into rural areas, develop a cadre of future rural health professional leaders, develop networks among rural health care organizations, and create revolving loan programs to purchase new resources to support access to health care. Funded activities differed across states.

About the Evaluation

Led by Don Pathman, M.D., of the University of North Carolina at Chapel Hill, the goal of the evaluation was to carry out a comprehensive assessment of the impact of the SRAP on access to primary health care services in the targeted regions of participating states. There were three primary elements of this evaluation: a system to track changes in the number of primary care professionals in states' targeted rural areas; state-individualized evaluations based on program logic documents developed by the grantees, to assess their success in implementing their initiatives and achieving their early outcome objectives; and the use of a survey involving the collection of primary phone data from grantees' target populations on a wide range of access issues.

Summary of Methods

A variety of study approaches and data sources were used in this evaluation.

• Program logics and periodic reports from grantees were used to track their success in implementing their initiatives and reaching early outcome objectives.
• Data on physicians, physician assistants and mid-level providers were being collected from several sources. Licensure data were being obtained from the medical and nursing boards of each state, and, as a second data source, physician counts were obtained from the Area Resource File.
• Population surveys assessed changes in populations' actual use of health services and changes in reported access barriers over time. The evaluation undertook a random-digit dial telephone survey of 600 rural residents in the targeted areas of each SRAP state, for a total of 4,800 completed surveys.

Knowledge and Impact

The evaluation team reported its findings on physician supply in a report to RWJF noting:

• When examining all 150 SRAP-target and 457 non-target rural counties as two large groups, the number of primary care physicians per 100,000 population were found to grow at comparable rates.
• However, in 124 high-poverty counties targeted by the program, numbers of primary care physicians per 100,000 population improved more than they did in 202 non-target high-poverty counties.
• Similarly, in the high-poverty target counties, primary care physician numbers grew at a faster rate than in the high-poverty non-target counties (the numbers grew by 4.4 percent compared to 1.7 percent).
• If the physicians-to-population ratio had grown only "proportionately the same amount over the four years" within the high-poverty counties targeted by the program as within the high-poverty non-target counties, there would have been 73 fewer primary care physicians working in the high-poverty target counties in 2005 than there actually were.
• Analysis indicates that the greater growth in the primary care physician supply in the high-poverty target counties resulted principally from lower out-migration rates in those counties.

A series of journal articles analyzed the results of the evaluation team's 2002–2003 telephone survey of target county residents on access issues. Follow the Grant Results Report link below for additional key findings.