Author ORCID Identifier
https://orcid.org/0000-0003-3198-0876
Date of Award
Spring 4-29-2025
Document Type
Thesis (Ph.D.)
Department or Program
Quantitative Biomedical Sciences
First Advisor
Erika L. Moen
Abstract
Cancer poses an enormous public health burden in the United States, which is disproportionality reflected among rural populations. Existing rural-urban cancer disparities in mortality are a function of the many social determinants of health but are largely attributable to differential access to oncology providers. One strategy for addressing rural workforce shortages is known as oncology outreach, whereby oncologists commute to satellite clinics to extend specialized care on a set cadence. While the outreach model is linked with increased proximity to cancer care for rural-residing patients, evidence is limited and mostly confined to Iowa-based populations. Questions surrounding the outreach model's generalizability, versatility, and efficacy remain unaddressed.
This dissertation uses nationwide fee-for-service Medicare claims to study the influence of oncology outreach on measures of access, quality, and the cost of care. Aim 1 assesses the association between oncology outreach and patient travel burden. Aim 2 extends this work by evaluating the association between oncology outreach and timely treatment, a measure of quality. Aim 3 leverages network analysis to quantify system-level associations between oncology outreach and measures of care coordination, a hypothesized “cost” of outreach. Aim 4 outlines a simulation framework for evaluating and optimizing potential outreach policies, in addition to testing it on two Dartmouth Health use cases.
I found that oncology outreach was associated with reduced travel burden to cancer treatment and reduced odds of treatment delay for rural-residing patients. However, I found that health systems that employ high levels of oncology outreach were associated with decreased measures of care coordination, representing a trade-off of the outreach model. Lastly, I developed a novel simulation approach for evaluating and optimizing outreach policies and demonstrated its utility within Dartmouth Health’s catchment area.
This work provides evidence supporting oncology outreach as a viable strategy for addressing oncology workforce shortages, while jointly highlighting one trade-off. In addition, it provides methodology to quantify/track such policies using administrative data and establishes an approach for evaluating and optimizing potential outreach policies. I hope this work increases our understanding of oncology outreach, leads to better usage of these arrangements, and ultimately results in more equitable cancer care delivery.
Recommended Citation
Scodari, Bruno T., "The Influence of Oncology Outreach on Cancer Care Delivery in the United States" (2025). Dartmouth College Ph.D Dissertations. 407.
https://digitalcommons.dartmouth.edu/dissertations/407
