Assessing and Identifying Improvements for Lung Cancer Screening in a Rural Population: A Human-Centered Design and Systems Approach.

Although lung cancer claims more lives than any other cancer in the United States, screening is severely underutilized, with <6% of eligible patients screened nationally in 2021 versus 76% for breast cancer and 67% for colorectal cancer. This article describes an effort to identify key reasons for the underutilization of lung cancer screening in a rural population and to develop interventions to address these barriers suitable for both a large health system and local community clinics. Data were generated from 26 stakeholder interviews (clinicians, clinical staff, and eligible patients), a review of key systems (Electronic Health Record and billing records), and feedback on the feasibility of several potential interventions by health care system staff. These data informed a human-centered design approach to identify possible interventions within a complex health care system by exposing gaps in care processes and electronic health record platforms that can lead patients to be overlooked for potentially life-saving screening. Deployed interventions included communication efforts focused on (1) increasing patient awareness, (2) improving physician patient identification, and (3) supporting patient management. Preliminary outcomes are discussed.

Tracking Urbanization and Exurbs: Migration Across the Rural-Urban Continuum, 1990-2016.

This paper summarizes annual migration patterns across the rural-urban continuum in the USA between 1990 and 2016. We introduce a modified rural-urban continuum classification, the Rural-Urban Gradient (RUG). The RUG holds metropolitan classification constant, effectively designates exurbs, and distinguishes central city core counties in major metropolitan areas from their suburbs and exurbs. The RUG is used to compare, over time and across regions, net migration, and migration efficiency using annual county-level data from the Internal Revenue Service. Results show how migration patterns correlated with changes in demographics and housing depending on counties' location along the RUG. We also describe the extent to which rural migration flows converged in counties at metropolitan peripheries and concentrated in the South and West, thus shaping widening disparity across US rural contexts.