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Rural Hospitals (rural + hospital)

Distribution by Scientific Domains
Medical Sciences97%

Kinds of Rural Hospitals

  • small rural hospital
    		•

    Selected Abstracts

    REMOVING THE ROADBLOCKS TO MEDICAL AND HEALTH STUDENT TRAINING IN RURAL HOSPITALS IN VICTORIA

    AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2003
    Graeme I. Jones
    ABSTRACT Objective: To assess the extent of undergraduate health student placements in regional hospitals in northern Victoria in 1999, prior to substantial changes in rural undergraduate medical education in Australia. Method: Cross sectional postal survey with telephone follow-up in north-east Victoria. Subjects were all 17 regional and rural hospitals involved in health student teaching in North-east Victoria. Main outcome measures were the numbers, duration and discipline of health students placements and reported barriers to such placements. Results: Large regional hospitals accounted for two-thirds of all undergraduate health student placements. Smaller sites placed few allied health students. Barriers to a larger, more sustainable system of rural placements and rotations included accommodation shortages and funding constraints, particularly in smaller rural hospitals. Conclusions: Adequate resourcing of placements of a meaningful duration, stronger institutional support, and improved resourcing of regional accommodation is required to facilitate a larger, more systematic and sustainable system of medical and health student placements in rural areas. [source]

    Population Health Improvement and Rural Hospital Balanced Scorecards

    THE JOURNAL OF RURAL HEALTH, Issue 2 2006
    Tim Size MBA
    First page of article [source]

    Australian issues in the provision of after-hours primary medical care services in rural communities

    AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2006
    Kathryn Zeitz
    Abstract Objective:,In 2003 the Rural Doctors Workforce Agency in South Australia (SA) facilitated the ,SA Rural Hospital After Hours Triage Education and Training Program'. It was designed to improve communication between rural general practitioners (GPs) and nurses undertaking after-hours triage, provide training in triage for rural nurses and develop local collaborative after-hours primary medical care models that can be applied in other settings. Design:,The program consisted of a series of three workshops. The first workshop provided an opportunity for GPs and nurses to discuss local issues relating to after-hours primary medical care service delivery. This was followed by a one-day workshop on triage for nurses. A follow-up refresher workshop was conducted approximately six months later. Setting:,Twenty-three rural communities in SA. Participants:,Rural GPs and nurses working in rural communities. Results:,This paper reports on the issues highlighted by clinicians in providing after-hours primary medical care in rural and remote communities. These included community expectations, systems of care, scope of practice, private practice/public hospital interface, and medico legal issues. Conclusion:,The issues facing after-hours health services in rural communities are not new. There are many opportunities for improvement of systems. A formal program including workshops and training has provided a useful forum to commence service improvements. [source]

    Acute Stroke Care at Rural Hospitals in Idaho: Challenges in Expediting Stroke Care

    THE JOURNAL OF RURAL HEALTH, Issue 1 2006
    James G. Gebhardt MD
    ABSTRACT:,Context: Thrombolytics are currently the most effective treatment for stroke. However, the National Institute for Neurological Disorders and Stroke criteria for initiation of thrombolytic therapy, most notably the 3-hour time limit from symptom onset, have proven challenging for many rural hospitals to achieve. Purpose: To provide a snapshot of stroke care at rural hospitals in Idaho and to investigate the experiences of these hospitals in expediting stroke care. Methods: Using a standard questionnaire, a telephone survey of hospital staff at 21 rural hospitals in Idaho was performed. The survey focused on acute stroke care practices and strategies to expedite stroke care. Findings: The median number of stroke patients treated per year was 23.3. Patient delays were reported by 77.8% of hospitals, transport delays by 66.7%, in-hospital delays by 61.1%, equipment delays by 22.2%, and ancillary services delays by 61.1%. Approximately 67% of hospitals had implemented a clinical pathway for stroke and 80.0% had provided staff with stroke-specific training. No hospitals surveyed had a designated stroke team, and only 33.3% reported engaging in quality improvement efforts to expedite stroke care. Thrombolytics (tPA) were available and indicated for stroke at 55.6% of the hospitals surveyed. Conclusions: Rural hospitals in Idaho face many difficult challenges as they endeavor to meet the 3-hour deadline for thrombolytic therapy, including limited resources and experience in acute stroke care, and many different types of prehospital and in-hospital delays. [source]

    Modeling the Emergency Ambulance Pass-By of Small Rural Hospitals in Victoria, Australia

    THE JOURNAL OF RURAL HEALTH, Issue 4 2005
    Patrick Gleeson MBA
    ABSTRACT: Context: Many small rural hospitals struggle to attract sufficient numbers of suitable patients. Inadequate patient throughput threatens the viability of these hospitals and, consequently, the financial, physical, and social well-being of the whole community. Anecdotal evidence suggests that many emergency ambulance patients are routinely taken past their local small rural hospital to the area's major receiving hospital. Purpose: To quantify the ambulance pass-by of local small rural hospitals and identify the factors that influence its occurrence. Methods: Data were collected from the ambulance and hospital records of 3 small rural centers in central Victoria, Australia. Results: Ambulances transport a significant number of patients past their local small rural hospitals to the area's major receiving hospital. This takes less time for paramedics than bringing a patient to the local hospital first if the patient is then redirected by that hospital to the larger hospital. There is an inverse relationship between the rate of cases in which the local hospital redirects ambulances to the regional hospital and the rate of ambulance crew decisions to use the local hospital. Conclusions: If some patients are being transported directly to the major receiving hospital because paramedics are considering their own time commitments when making patient transport decisions, this could have revenue implications for rural hospitals. Attracting appropriate local ambulance patients to the smaller hospitals may provide an income source that is currently lost to the crowded major receiving hospital's emergency department. [source]

    Rural Hospitals and the Adoption of Managed Care Strategies

    THE JOURNAL OF RURAL HEALTH, Issue 3 2001
    Shadi S. Saleh Ph.D
    ABSTRACT: This research examined the performance of rural hospitals engaged in different levels of managed care activities and identified factors related to performance and competition that affected rural hospitals' likelihood of pursuing managed care as a strategy. The sample studied consisted of 139 rural hospitals in Iowa and Nebraska. Results showed that a relatively high percentage of hospitals were engaged in managed care activities, mainly through contractual arrangements. The study found that high competition in the marketplace increased the likelihood of hospitals pursuing managed care strategies, while high demand markets had a negative association with the likelihood of pursuing a managed care strategy. No significant relationship was detected between poor performance and pursuing a managed care strategy. [source]

    Rural Hospital Patient Safety Systems Implementation in Two States

    THE JOURNAL OF RURAL HEALTH, Issue 3 2007
    Daniel R. Longo ScD
    ABSTRACT:,Context and Purpose:With heightened attention to medical errors and patient safety, we surveyed Utah and Missouri hospitals to assess the "state of the art" in patient safety systems and identify changes over time. This study examines differences between urban and rural hospitals.Methods:Survey of all acute care hospitals in Utah and Missouri at 2 points in time (2002 and 2004). Factor analysis was used to develop 7 latent variables to summarize the data, comparing rural and urban hospitals at each point in time and on change between the 2 survey times.Findings:On 3 of the 7 latent variables, there was a statistically significant difference between rural and urban hospitals at the first survey, with rural hospitals indicating lower levels of implementation. The differences remained present on 2 of those latent variables at the second survey. In both cases, 1 of those variables was computerized physician order entry (CPOE) systems. Rural hospitals reported more improvement in systems implementation between the 2 survey times, with the difference statistically significant on 1 of the 7 latent variables; the greatest improvement was in implementation of "root cause analysis."Conclusions:Adoption of patient safety systems overall is low. Although rates of adoption among rural versus urban hospitals appear lower, most differences are not statistically significant; the gap between rural and urban hospitals relative to quality measures is narrowing. Change in rural and urban hospitals is in the right direction, with the rate of change higher in rural hospitals for many systems. [source]

    Acute Stroke Care at Rural Hospitals in Idaho: Challenges in Expediting Stroke Care

    THE JOURNAL OF RURAL HEALTH, Issue 1 2006
    James G. Gebhardt MD
    ABSTRACT:,Context: Thrombolytics are currently the most effective treatment for stroke. However, the National Institute for Neurological Disorders and Stroke criteria for initiation of thrombolytic therapy, most notably the 3-hour time limit from symptom onset, have proven challenging for many rural hospitals to achieve. Purpose: To provide a snapshot of stroke care at rural hospitals in Idaho and to investigate the experiences of these hospitals in expediting stroke care. Methods: Using a standard questionnaire, a telephone survey of hospital staff at 21 rural hospitals in Idaho was performed. The survey focused on acute stroke care practices and strategies to expedite stroke care. Findings: The median number of stroke patients treated per year was 23.3. Patient delays were reported by 77.8% of hospitals, transport delays by 66.7%, in-hospital delays by 61.1%, equipment delays by 22.2%, and ancillary services delays by 61.1%. Approximately 67% of hospitals had implemented a clinical pathway for stroke and 80.0% had provided staff with stroke-specific training. No hospitals surveyed had a designated stroke team, and only 33.3% reported engaging in quality improvement efforts to expedite stroke care. Thrombolytics (tPA) were available and indicated for stroke at 55.6% of the hospitals surveyed. Conclusions: Rural hospitals in Idaho face many difficult challenges as they endeavor to meet the 3-hour deadline for thrombolytic therapy, including limited resources and experience in acute stroke care, and many different types of prehospital and in-hospital delays. [source]

    Do rural hospitals lag behind urban hospitals in addressing community health needs?

    AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2009
    An analysis of recent trends in US community hospitals
    Abstract Objective:,This study examined whether rural and urban hospitals differ in their level of responsiveness to community health needs. Design:,This study used a multivariate, longitudinal research design. Research setting:,A cross-sectional survey was the setting for this study. Participants:,The participants were rural or urban hospitals in the United States. Main outcome measures:,The dependent variables were selected from the American Hospital Association hospital survey questions that are related to community health needs. The independent variable was rural or urban location. Results:,Rural hospitals improved more than urban hospitals in addressing community health needs from 1997 through 2006 for most of the indicators, especially in working with other providers to conduct a community health assessment. However, rural hospitals still lag significantly behind urban hospitals in tracking health information. Conclusions:,This study suggests that rural hospitals do not lag behind urban hospitals in addressing community health needs. Further research is needed to understand the role of community hospitals in influencing local health delivery system activities regarding the potential community benefits and their impact on improving health of local populations. [source]

    The Regulatory Environment and Rural Hospital Long-Term Care Strategies From 1997 to 2003

    THE JOURNAL OF RURAL HEALTH, Issue 1 2007
    Mary L. Fennell PhD
    ABSTRACT:,Context: Since the passage of the Balanced Budget Act of 1997, rural hospitals have struggled with the need to strategically adapt to an abundance of changing reimbursement and regulatory programs, as well as to respond to the needs of an increasingly frail elder population in need of postacute and long-term care (LTC). Purpose: This article has 2 goals: (1) to provide a summary of the many legislative acts and provisions influencing rural hospital LTC strategies during the 1997-2003 period and (2) to track changes in the LTC strategies of a national sample of rural hospitals through this 7-year period. Methods: A 3-wave panel of rural hospital discharge planners in 540 nonfederal community-general hospitals were interviewed in 1997, 2000, and 2003. Questions focused on hospital structure, discharge planning process, and reports of internal and external organizational arrangements for providing LTC services to hospitalized patients, and changes in LTC strategy since the previous interview. Descriptive statistics are presented on LTC strategies in place in 1997 and dropped or added in 2000 and 2003. Findings and Conclusions: The general shape of the regulatory environment confronting rural hospitals and their LTC strategies during the recent past can be described as complicated, rapidly changing, and at times contradictory in intended effects. There has been a large volume of strategy change during this 7-year period, without the emergence of any identifiable pattern or LTC strategy profile, other than swing-bed participation combined with home health agency ownership. [source]

    Modeling the Emergency Ambulance Pass-By of Small Rural Hospitals in Victoria, Australia

    THE JOURNAL OF RURAL HEALTH, Issue 4 2005
    Patrick Gleeson MBA
    ABSTRACT: Context: Many small rural hospitals struggle to attract sufficient numbers of suitable patients. Inadequate patient throughput threatens the viability of these hospitals and, consequently, the financial, physical, and social well-being of the whole community. Anecdotal evidence suggests that many emergency ambulance patients are routinely taken past their local small rural hospital to the area's major receiving hospital. Purpose: To quantify the ambulance pass-by of local small rural hospitals and identify the factors that influence its occurrence. Methods: Data were collected from the ambulance and hospital records of 3 small rural centers in central Victoria, Australia. Results: Ambulances transport a significant number of patients past their local small rural hospitals to the area's major receiving hospital. This takes less time for paramedics than bringing a patient to the local hospital first if the patient is then redirected by that hospital to the larger hospital. There is an inverse relationship between the rate of cases in which the local hospital redirects ambulances to the regional hospital and the rate of ambulance crew decisions to use the local hospital. Conclusions: If some patients are being transported directly to the major receiving hospital because paramedics are considering their own time commitments when making patient transport decisions, this could have revenue implications for rural hospitals. Attracting appropriate local ambulance patients to the smaller hospitals may provide an income source that is currently lost to the crowded major receiving hospital's emergency department. [source]

    Emergency department performance at a small rural hospital: An independent in-depth review

    AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2009
    Paul Tescher
    Abstract Objectives:,This study aims to provide a retrospective review of the recent performance of the emergency department of Cobram District Hospital, a small rural hospital located on the border of Victoria and New South Wales. Design:,Retrospective review. Setting:,Small rural accident and emergency department. Intervention:,All available data collected from the emergency department from the previous three financial years (July 2005 to June 2008) were compiled onto a computerised spreadsheet and analysed by two independent investigators. Main outcome measures:,Key performance indicators, including time for patient to be seen by a doctor and frequency of patient presentations to the emergency department. Results:,Cobram District Hospital has fewer than 5000 patients presenting to the emergency department each year. 12 p.m. to 12 a.m. accounts for 69% of all presentations, with three notable time periods that experience most presentations. Life-threatening emergencies represented <3% of all presentations to the emergency department. Patients in triage categories 1,3 did not met Australasian triage scale (ATS)-suggested time for maximum waiting timing, while categories 4 and 5 well exceeded ATS standards. Conclusion:,The small size and lack of dedicated emergency department staff place restrictions on the ability of an unfunded rural hospital to match the performance of major metropolitan emergency departments. ATS guidelines should be revised to improve clarity and reflect the different performance capabilities between metropolitan and rural centres. [source]

    Eye injuries in rural Victoria, Australia

    CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 7 2009
    Simon Raymond MPH
    Abstract Background:, Eye injury causes significant morbidity and is a leading cause of blindness worldwide. This study investigates the incidence, spectrum and patterns of eye injury presenting to a rural hospital in Victoria, Australia. Methods:, A retrospective review of the medical records of all patients presenting with eye injury to the emergency department of Mildura Base Hospital, Victoria, Australia in year 2004 was conducted. As the emergency department of Mildura Base Hospital also acts as the outpatient department for this hospital, the series included all patients treated for eye injury at Mildura Base Hospital in year 2004, including admissions. Results:, There were 435 patients present to Mildura Base Hospital emergency department for eye injury in 2004, which represented approximately 1% of the population of Mildura. The majority of eye injuries were superficial. Fifty-six (13%) patients required specialist attention. Most patients were male (83%) and were middle-aged. The most common locations where eye injuries took place were residential homes (47%) and workplaces (32%). The most common causes of eye injuries were trade tools and machinery (47%), followed by chemicals (12%) and branches/sticks/twigs (11%). Of particular concern for Mildura is that approximately one-quarter of the patients treated at Mildura Base Hospital for eye injury in 2004 had been treated at Mildura Base Hospital for a separate episode of eye injury in the past. Conclusion:, Eye injuries represent a significant socioeconomic burden. This research contributes to the knowledge required for the design and implementation of effective preventative strategy. [source]

    Rural hospital generalist and emergency medicine training in Papua New Guinea

    EMERGENCY MEDICINE AUSTRALASIA, Issue 2 2007
    David Symmons
    Abstract The present paper describes the role of the hospital generalist in rural Papua New Guinea (PNG) and the contribution of emergency medicine training to that practice. Generalist practice in Tinsley District Hospital in Western Highlands Province is described, with emphasis on emergency surgery and anaesthesia. The potential of the PNG emergency medicine training programme for preparing generalists is discussed. Tinsley Hospital served a population of 40 000 people, with 4000 admissions and 300,400 operations performed annually. Two doctors and 50 nurses and community health workers provided care with minimal resources. The doctors provided supervision and teaching for nurses, community health workers, hospital administrators and primary health carers, including on long range medical patrols. Over 16 months, doctors performed 243 emergency surgical procedures including orthopaedics, general surgery, obstetrics and gynaecology. The generalist in rural hospitals is required to perform a wide variety of medical tasks in isolated settings yet there is no active postgraduate training programme. The Master of Medicine, Emergency Medicine programme includes rotations through the major disciplines of surgery, anaesthesia, internal medicine, paediatrics, obstetrics and gynaecology. It has the potential to train doctors in PNG for a generalist role as graduates will learn the foundations of the required skills. [source]

    Lost in translation: exploring the link between HRM and performance in healthcare

    HUMAN RESOURCE MANAGEMENT JOURNAL, Issue 1 2007
    Timothy Bartram
    Using data collected in 2004 from 132 Victorian (Australia) public healthcare providers, comprising metropolitan and regional hospital networks, rural hospitals and community health centres, we investigated the perceptions of HRM from the experiences of chief executive officers, HR directors and other senior managers. We found some evidence that managers in healthcare organisations reported different perceptions of strategic HRM and a limited focus on collection and linking of HR performance data with organisational performance management processes. Using multiple moderator regression and multivariate analysis of variance, significant differences were found in perceptions of strategic HRM and HR priorities between chief executive officers, HR directors and other senior managers in the large organisations. This suggested that the strategic human management paradigm is ,lost in translation', particularly in large organisations, and consequently opportunities to understand and develop the link between people management practices and improved organisational outcomes may be missed. There is some support for the relationship between strategic HRM and improved organisational outcomes. Implications of these findings are drawn for managerial practice. [source]

    Triage, treat and transfer: reconceptualising a rural practice model,

    JOURNAL OF CLINICAL NURSING, Issue 11-12 2010
    Elise Sullivan
    Aim., This article argues that the current model of emergency practice in rural Victorian hospitals, which relies heavily on visiting medical officers, needs to be reconceptualised if emergency services are to be supplied to rural communities. Background., Medical workforce shortages are manifesting in Victoria as a reduction in emergency care services from rural hospitals. The suggested alternative model of emergency care involves advancing nursing practice to enable a redistribution of clinical capacity across the health care team. Clinicians will need to work collaboratively and continuously negotiate their roles to meet the patient's and the clinical team's needs. Design., Systematic review. Methods., This article is based on a review of the Victorian and Australian literature on the subject of Victorian health services and policy, emergency care, collaboration, communication and rural nurse scope of practice and roles. Emergency care activity was drawn from data held in the Victorian Emergency Management Dataset and personal communications between one of the authors and hospital executives in a small selection of rural hospitals in Victoria. Results., The evidence reviewed suggests that the current emergency practice profile of rural hospitals in Victoria does not reflect the reconceptualised model of rural emergency practice. Instead, only a small proportion of non-urgent presentations is managed by nurses without medical support, and the data suggest that metropolitan nurses are more likely to manage without medical support than rural nurses. Conclusion., Reconceptualising rural emergency care in Victoria will require significantly greater investment in rural nurses' knowledge and skills to enable them to operate confidently at a more advanced level. Clinical teams that deliver emergency service in rural hospitals will be expected increasingly to work collaboratively and interprofessionally. Relevance to clinical practice., This article offers some directions for advancing nursing practice and strategies for improving interprofessional collaboration in the delivery of rural emergency care. [source]

    Factors Associated with Iowa Rural Hospitals' Decision to Convert to Critical Access Hospital Status

    THE JOURNAL OF RURAL HEALTH, Issue 1 2009
    Pengxiang Li PhD
    ABSTRACT:,Context: The Balanced Budget Act (BBA) of 1997 allowed some rural hospitals meeting certain requirements to convert to Critical Access Hospitals (CAHs) and changed their Medicare reimbursement from prospective to cost-based. Some subsequent CAH-related laws reduced restrictions and increased payments, and the number of CAHs grew rapidly. Purpose: To examine factors related to hospitals' decisions to convert and time to CAH conversion. Methods: Eighty-nine rural hospitals in Iowa were characterized and observed from 1998 to 2005. Cox proportional hazards models were used to identify the determinants of time to CAH conversion. Findings: T-test and one-covariate Cox regression indicated that, in 1998, Iowa rural hospitals with more staffed beds, discharges, and acute inpatient days, higher operating margin, lower skilled swing bed days relative to acute days, and located in relatively high density counties were more likely to convert later or not convert before 2006. Multiple Cox regression with baseline covariates indicated that lower number of discharges and average length of stay (ALOS) were significant after controlling all other covariates. Conclusion: Iowa rural hospitals' decisions regarding CAH conversion were influenced by hospital size, financial condition, skilled swing bed days relative to acute days, length of stay, proportion of Medicare acute days, and geographic factors. Although financial concerns are often cited in surveys as the main reason for conversion, lower number of discharges and ALOS are the most prominent factors affecting rural hospitals' decision on when to convert. [source]

    Rural Hospital Patient Safety Systems Implementation in Two States

    THE JOURNAL OF RURAL HEALTH, Issue 3 2007
    Daniel R. Longo ScD
    ABSTRACT:,Context and Purpose:With heightened attention to medical errors and patient safety, we surveyed Utah and Missouri hospitals to assess the "state of the art" in patient safety systems and identify changes over time. This study examines differences between urban and rural hospitals.Methods:Survey of all acute care hospitals in Utah and Missouri at 2 points in time (2002 and 2004). Factor analysis was used to develop 7 latent variables to summarize the data, comparing rural and urban hospitals at each point in time and on change between the 2 survey times.Findings:On 3 of the 7 latent variables, there was a statistically significant difference between rural and urban hospitals at the first survey, with rural hospitals indicating lower levels of implementation. The differences remained present on 2 of those latent variables at the second survey. In both cases, 1 of those variables was computerized physician order entry (CPOE) systems. Rural hospitals reported more improvement in systems implementation between the 2 survey times, with the difference statistically significant on 1 of the 7 latent variables; the greatest improvement was in implementation of "root cause analysis."Conclusions:Adoption of patient safety systems overall is low. Although rates of adoption among rural versus urban hospitals appear lower, most differences are not statistically significant; the gap between rural and urban hospitals relative to quality measures is narrowing. Change in rural and urban hospitals is in the right direction, with the rate of change higher in rural hospitals for many systems. [source]

    The Regulatory Environment and Rural Hospital Long-Term Care Strategies From 1997 to 2003

    THE JOURNAL OF RURAL HEALTH, Issue 1 2007
    Mary L. Fennell PhD
    ABSTRACT:,Context: Since the passage of the Balanced Budget Act of 1997, rural hospitals have struggled with the need to strategically adapt to an abundance of changing reimbursement and regulatory programs, as well as to respond to the needs of an increasingly frail elder population in need of postacute and long-term care (LTC). Purpose: This article has 2 goals: (1) to provide a summary of the many legislative acts and provisions influencing rural hospital LTC strategies during the 1997-2003 period and (2) to track changes in the LTC strategies of a national sample of rural hospitals through this 7-year period. Methods: A 3-wave panel of rural hospital discharge planners in 540 nonfederal community-general hospitals were interviewed in 1997, 2000, and 2003. Questions focused on hospital structure, discharge planning process, and reports of internal and external organizational arrangements for providing LTC services to hospitalized patients, and changes in LTC strategy since the previous interview. Descriptive statistics are presented on LTC strategies in place in 1997 and dropped or added in 2000 and 2003. Findings and Conclusions: The general shape of the regulatory environment confronting rural hospitals and their LTC strategies during the recent past can be described as complicated, rapidly changing, and at times contradictory in intended effects. There has been a large volume of strategy change during this 7-year period, without the emergence of any identifiable pattern or LTC strategy profile, other than swing-bed participation combined with home health agency ownership. [source]

    The Visiting Specialist Model of Rural Health Care Delivery: A Survey in Massachusetts

    THE JOURNAL OF RURAL HEALTH, Issue 4 2006
    Jacob Drew BA
    ABSTRACT:,Context: Hospitals in rural communities may seek to increase specialty care access by establishing clinics staffed by visiting specialists. Purpose: To examine the visiting specialist care delivery model in Massachusetts, including reasons specialists develop secondary rural practices and distances they travel, as well as their degree of satisfaction and intention to continue the visiting arrangement. Methods: Visiting specialists at 11 rural hospitals were asked to complete a mailed survey. Findings: Visiting specialists were almost evenly split between the medical (54%) and surgical (46%) specialties, with ophthalmology, nephrology, and obstetrics/gynecology the most common specialties reported. A higher proportion of visiting specialists than specialists statewide were male (P = .001). Supplementing their patient base and income were the most important reasons visiting specialists reported for having initiated an ancillary clinic. There was a significant negative correlation between a hospital's number of staffed beds and the total number of visiting specialists it hosted (r =,0.573, P = .032); study hospitals ranged in bed size from 15 to 129. Conclusions: The goal of matching supply of health care services with demand has been elusive. Visiting specialist clinics may represent an element of a market structure that expands access to needed services in rural areas. They should be included in any enumeration of physician availability. [source]

    Rural Illinois Hospital Chief Executive Officers' Perceptions of Provider Shortages and Issues in Rural Recruitment and Retention

    THE JOURNAL OF RURAL HEALTH, Issue 1 2006
    Michael Glasser PhD
    ABSTRACT:,Background: It is important to assess rural health professions workforce needs and identify variables in recruitment and retention of rural health professionals. Purpose: This study examined the perspectives of rural hospital chief executive officers (CEOs) regarding workforce needs and their views of factors in the recruitment and retention process. Methods: A survey was mailed to CEOs of 28 Illinois rural hospitals, in towns ranging from 3,396 to 33,530 in population size. The survey addressed CEO perceptions of number of physicians needed by specialty, need for other health professionals, and variables important to recruitment and retention. Findings: Twenty-two CEOs (79%) responded to the survey. Eighty-six percent indicated a physician shortage in the community, with 64% reporting the need for family physicians. CEOs also indicated the need for physicians in obstetrics-gynecology, general and orthopedic surgery, general internal medicine, cardiology, and psychiatry. In terms of needs for other health professionals, most often mentioned were registered nurses (91%), pharmacists (64%), and nurses' aides (46%). Related to recruitment and retention, most often mentioned by the CEOs was community attractiveness in general, followed by practice and physician career opportunities. Conclusions: CEOs offer 1 important perspective on health professions needs, recruitment, and retention in rural communities. While expressing a range of opinions, rural hospital CEOs clearly indicate the need for more primary care physicians, call for an increased capacity in nursing, and point to community development as a key factor in recruitment and retention. [source]

    Acute Stroke Care at Rural Hospitals in Idaho: Challenges in Expediting Stroke Care

    THE JOURNAL OF RURAL HEALTH, Issue 1 2006
    James G. Gebhardt MD
    ABSTRACT:,Context: Thrombolytics are currently the most effective treatment for stroke. However, the National Institute for Neurological Disorders and Stroke criteria for initiation of thrombolytic therapy, most notably the 3-hour time limit from symptom onset, have proven challenging for many rural hospitals to achieve. Purpose: To provide a snapshot of stroke care at rural hospitals in Idaho and to investigate the experiences of these hospitals in expediting stroke care. Methods: Using a standard questionnaire, a telephone survey of hospital staff at 21 rural hospitals in Idaho was performed. The survey focused on acute stroke care practices and strategies to expedite stroke care. Findings: The median number of stroke patients treated per year was 23.3. Patient delays were reported by 77.8% of hospitals, transport delays by 66.7%, in-hospital delays by 61.1%, equipment delays by 22.2%, and ancillary services delays by 61.1%. Approximately 67% of hospitals had implemented a clinical pathway for stroke and 80.0% had provided staff with stroke-specific training. No hospitals surveyed had a designated stroke team, and only 33.3% reported engaging in quality improvement efforts to expedite stroke care. Thrombolytics (tPA) were available and indicated for stroke at 55.6% of the hospitals surveyed. Conclusions: Rural hospitals in Idaho face many difficult challenges as they endeavor to meet the 3-hour deadline for thrombolytic therapy, including limited resources and experience in acute stroke care, and many different types of prehospital and in-hospital delays. [source]

    Modeling the Emergency Ambulance Pass-By of Small Rural Hospitals in Victoria, Australia

    THE JOURNAL OF RURAL HEALTH, Issue 4 2005
    Patrick Gleeson MBA
    ABSTRACT: Context: Many small rural hospitals struggle to attract sufficient numbers of suitable patients. Inadequate patient throughput threatens the viability of these hospitals and, consequently, the financial, physical, and social well-being of the whole community. Anecdotal evidence suggests that many emergency ambulance patients are routinely taken past their local small rural hospital to the area's major receiving hospital. Purpose: To quantify the ambulance pass-by of local small rural hospitals and identify the factors that influence its occurrence. Methods: Data were collected from the ambulance and hospital records of 3 small rural centers in central Victoria, Australia. Results: Ambulances transport a significant number of patients past their local small rural hospitals to the area's major receiving hospital. This takes less time for paramedics than bringing a patient to the local hospital first if the patient is then redirected by that hospital to the larger hospital. There is an inverse relationship between the rate of cases in which the local hospital redirects ambulances to the regional hospital and the rate of ambulance crew decisions to use the local hospital. Conclusions: If some patients are being transported directly to the major receiving hospital because paramedics are considering their own time commitments when making patient transport decisions, this could have revenue implications for rural hospitals. Attracting appropriate local ambulance patients to the smaller hospitals may provide an income source that is currently lost to the crowded major receiving hospital's emergency department. [source]

    Comparative Performance Data for Critical Access Hospitals

    THE JOURNAL OF RURAL HEALTH, Issue 4 2004
    George H. Pink PhD
    ABSTRACT: Context: Among small rural hospitals, there is a growing recognition of the need to measure and report on the use of resources and the safety and quality of the services provided. Dashboards, clinical value compasses, and balanced scorecards are approaches to performance measurement that have been adopted by many health care organizations. However, there exists very little comparative performance data specific for critical access hospitals. Purpose: To identify how comparative performance data for critical access hospitals (CPD-CAH) might facilitate performance and quality improvement, to assess the potential benefits and drawbacks of such data, and to identify some of the critical issues in the development and implementation of CPD-CAH. Methods: Assessment of discussions by participants at a rural hospital performance improvement summit and authors' analyses. Findings: CPD-CAH potentially could improve quality of care and patient outcomes, provide comparative data and benchmarks, inform policy development, facilitate collaboration, and enhance community relations. However, CPD-CAH could also impose an unaffordable cost, produce poor information, require complex coordination, induce a negative public reaction, and result in perverse hospital behavior. Development and implementation of CPD-CAH would require including stakeholders' assessment of its desirability and feasibility, setting objectives, establishing guiding principles, developing a method, collecting and analyzing data, and disseminating results. Conclusions: CPD-CAH could significantly advance CAH performance and quality improvement. However, development and implementation would be a complicated exercise requiring academic expertise and practitioner consultation. The potential value of CPD-CAH should be carefully weighed against its potential cost. [source]

    Quality of Care for Acute Myocardial Infarction in Rural and Urban US Hospitals

    THE JOURNAL OF RURAL HEALTH, Issue 2 2004
    Laura-Mae Baldwin MD
    ABSTRACT: Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers. Methods: This cohort study used data from the Cooperative Cardiovascular Project (CCP), including 4,085 acute care hospitals (408 remote small rural, 893 small rural, 619 large rural, and 2,165 urban) with 135,759 direct admissions of Medicare beneficiaries ages 65 and older for a confirmed AMI between February 1994 and July 1995. Outcomes included use of aspirin, reperfusion, heparin, and intravenous nitroglycerin during hospitalization; use of beta-blockers, aspirin, and angiotensin-converting enzyme (ACE) inhibitors at discharge; avoidance of calcium channel blockers at discharge; and 30-day mortality. Findings: Substantial proportions of Medicare beneficiaries in both urban and rural hospitals did not receive the recommended treatments for AMI. Medicare patients in rural hospitals were less likely than urban hospitals' patients to receive aspirin, intravenous nitroglycerin, heparin, and either thrombolytics or percutaneous transluminal coronary angioplasty. Only ACE inhibitors at discharge was used more for patients in rural hospitals than urban hospitals. Medicare patients in rural hospitals had higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals (odds ratio for large rural 1.14 [1.10 to 1.18], small rural 1.24 [1.20 to 1.29], remote small rural 1.32 [1.23 to 1.41]). Conclusions: Efforts are needed to help hospital medical staffs in both rural and urban areas develop systems to ensure that patients receive recommended treatments for AMI. [source]

    Public Health Rural Health Priorities in America: Where You Stand Depends on Where You Sit

    THE JOURNAL OF RURAL HEALTH, Issue 3 2003
    Larry Gamm PhD
    Methods: Analysis of responses to a mail survey sent to 999 rural health leaders, with 501 responses. Respondents were asked to rank importance to rural health of focus areas named in Healthy People 2010 Findings: There was substantial agreement on top rural health priorities among state and local rural health leaders across the 50 states. "Access to quality health services" was the top priority among leaders of state-level rural agencies and health associations, local rural public health agencies, rural health clinics and community health centers, and rural hospitals. It was the top priority across all 4 major census regions of the nation as well. The next 4 top-ranking rural priorities,"heart disease and stroke,""diabetes,""mental health and mental disorders," and "oral health",were selected as 1 of the top 5 rural priorities by one third or more of respondents across most groups and regions. At the same time, some observed differences in rural health priorities suggest opportunities for community partnership strategies or for regional multistate policy initiatives by states sharing similar rural health priorities. [source]

    Rural Hospitals and the Adoption of Managed Care Strategies

    THE JOURNAL OF RURAL HEALTH, Issue 3 2001
    Shadi S. Saleh Ph.D
    ABSTRACT: This research examined the performance of rural hospitals engaged in different levels of managed care activities and identified factors related to performance and competition that affected rural hospitals' likelihood of pursuing managed care as a strategy. The sample studied consisted of 139 rural hospitals in Iowa and Nebraska. Results showed that a relatively high percentage of hospitals were engaged in managed care activities, mainly through contractual arrangements. The study found that high competition in the marketplace increased the likelihood of hospitals pursuing managed care strategies, while high demand markets had a negative association with the likelihood of pursuing a managed care strategy. No significant relationship was detected between poor performance and pursuing a managed care strategy. [source]

    Using Telemedicine to Avoid Transfer of Rural Emergency Department Patients

    THE JOURNAL OF RURAL HEALTH, Issue 3 2001
    Lanis L. Hicks Ph.D
    ABSTRACT: Access to emergency treatment in rural areas can often mean the difference between life and death. Telemedicine technologies have the potential of providing earlier diagnosis and intervention, of saving lives and of avoiding unnecessary transfers from rural hospital emergency departments to urban hospitals. This study examined the hypothetical impact of telemedicine services on patients served by the emergency departments of two rural Missouri liospitals and the potential financial impact on the affected hospitals. Of the 246 patients transferred to the hub hospital from the two facilities during 1996, 161 medical records (65.4 percent) were analyzed. Using a conservative approach, only 12 of these cases were identified as potentially avoidable transfers with the use of telemedicine. Of these 12, 5 were admitted to the hub hospital after transfer. In addition to this conservative estimate of avoidable transfers based on current availability of resources in the rural hospitals, two more aggressive scenarios were developed, based on an assumption of increased service availability in the rural hospitals. Economic multipliers were used to estimate the financial impacts on communities in each scenario. This evaluation study demonstrates the potential value of telemedicine use in rural emergency departments to patients, rural hospitals and rural communities. [source]

    The Emergency Informatics Transition Course: A Flexible, Online Course in Health Informatics for Emergency Medicine Clinicians and Trainees

    ACADEMIC EMERGENCY MEDICINE, Issue 2009
    Michael Wadman
    Increasing emphasis on health information technology (HIT) as a mechanism to control costs and increase quality in health care is accelerating the diffusion of more advanced health information systems into emergency medicine. This has created an increased demand for informatics-trained emergency physicians to provide clinical input. In response to this need we partnered with the American College of Emergency Physicians (ACEP) to adapt an existing informatics educational program to emergency medicine. The American Medical Informatics Association (AMIA) 10X10 program is an effort to provide formal informatics training to 10,000 clinicians by 2010. Our first AMIA-ACEP 10X10 Emergency Informatics Transition Course matriculated 37 emergency physicians this fall. This 12 week online course is an adaption of the Oregon Health & Science University (OHSU) introductory informatics 10X10 course where students complete weekly assignments and participate in online discussions. At the end of the course they meet face-to-face at the ACEP Scientific Assembly where they present their projects and discuss common themes. The online design of the course proved adaptable for a widely varied enrollment. The first class contained students from the United States and four other countries, both large urban and small rural hospitals, and both new and experienced clinicians. Extensive input from the students will assist us in further refining this annual course to better meet the needs of emergency clinicians. We will demonstrate the design of this course, which we believe offers interested residents and fellows in emergency medicine a flexible opportunity to advance their informatics training. [source]

    Do rural hospitals lag behind urban hospitals in addressing community health needs?

    AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2009
    An analysis of recent trends in US community hospitals
    Abstract Objective:,This study examined whether rural and urban hospitals differ in their level of responsiveness to community health needs. Design:,This study used a multivariate, longitudinal research design. Research setting:,A cross-sectional survey was the setting for this study. Participants:,The participants were rural or urban hospitals in the United States. Main outcome measures:,The dependent variables were selected from the American Hospital Association hospital survey questions that are related to community health needs. The independent variable was rural or urban location. Results:,Rural hospitals improved more than urban hospitals in addressing community health needs from 1997 through 2006 for most of the indicators, especially in working with other providers to conduct a community health assessment. However, rural hospitals still lag significantly behind urban hospitals in tracking health information. Conclusions:,This study suggests that rural hospitals do not lag behind urban hospitals in addressing community health needs. Further research is needed to understand the role of community hospitals in influencing local health delivery system activities regarding the potential community benefits and their impact on improving health of local populations. [source]