Abstract
Purpose
To visualize Triple Aim healthcare system performance according to cultural geography by mapping performance scores at the US county level.
Design
Cross-sectional, observational mapping of Triple Aim healthcare system performance for 2019.
Setting
United States of America at the county level.
Sample
Data sources include healthcare system performance indicators of 3110 US counties for 2019. Data were mapped by aggregating county level Triple Aim performance scores according to the American Nations model. Regions with individualistic cultural ideologies and communitarian ones were grouped. Descriptive data for each were collated.
Measures
Triple Aim healthcare systems performance scores across US counties and aggregated across the American Nations.
Analysis
Descriptive frequencies of adjusted performance scores are presented according to culturally distinct regional geographies.
Results
Large heterogeneity in adjusted healthcare system performance scores was observed across the US and at the county level. For the American Nations (range = −1.43 to 0.16), population-weighted performance scores were highest for Greater Polynesia whereas First Nation scored the lowest. The 2019 mean (±SD) population-weighted performance scores for individualistic and communitarian American Nation region counties were −0.50 ± 0.83 and −0.36 ± 1.01, respectively.
Conclusion
Variation of healthcare system performance is large across US regions with distinct cultural phenotypes. Cultural geographies should be included as covariates in population-based analyses of healthcare system performance. Observed heterogeneity holds potential for identification of population-based health promotion opportunities at the county-level.
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