How Does Degree of Rurality Impact the Provision of Surgical Services at Rural Hospitals (original) (raw)
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General surgery at rural hospitals: a national survey of rural hospital administrators
Surgery, 2008
Background. Many rural residents have limited access to surgical care. Rural hospitals frequently struggle to provide surgical services due to workforce shortages and financial constraints. The purpose of this study is to describe rural hospital administrators' perceptions regarding the state of their general surgery programs and the impact that providing surgical services has on their hospitals' financial viability. Methods. A 12-item survey was mailed to a random sample of national rural hospital administrators (n=233). One hundred and eleven surveys were completed, yielding a response rate of 48%. In addition to overall descriptive analyses, comparisons were made between hospitals located in large versus small rural communities. Results. Eighty-three percent of rural hospital administrators perceived their surgical program to be very important to the financial viability of their hospital and stated that they would reduce services if the hospital were to lose its surgery program. Thirty-four percent of hospitals have a surgeon leaving within the next 2 years and more than one-third of hospital administrators are currently searching for a surgeon.
The Journal of Rural Health, 2006
R ural hospitals are vital components of the communities they serve. Aside from providing access to health care, these hospitals often serve as the economic hub for their region. Approximately 54 million people live in rural areas and are dependent on rural hospitals for the majority of their health care services. 1,2 Unfortunately, many rural hospitals are in precarious fi nancial positions given their small size and inability to easily absorb market changes. Between 1990 and 1999, 186 rural hospitals closed, and in 2000, 34% of all rural hospitals had negative total fi nancial margins. 2,3 This threatens not only the physical health of those living in rural areas but also the economic health and potential for development in rural communities as well.
Predictors of Hospital Choice among Rural Patients Seeking Elective Surgery: A Scoping Review
2022
Individuals living in rural areas represent approximately 20% of the total United States population and, compared to their urban counterparts, generally have worse health outcomes. One potentially modifiable determinant of rural public health is the surgical care-seeking behavior of rural patients. The decision of where to receive elective surgical care can have direct effects on surgery-related outcomes as well as downstream effects on rural hospitals, public health, and economies.
General surgery contributes to the financial health of rural hospitals and communities
The Surgical clinics of North America, 2009
Rural hospitals and communities often profit from the ability to provide surgical services. There can also be substantial financial costs for individuals, hospitals, and communities associated with not having access to surgical care in rural areas. Despite these advantages, limitations that include a shortage of rural general surgeons and other surgical staff and financial constraints prevent some rural institutions from offering surgical services. Few concrete data are available on this subject, and more research is needed to confirm anecdotal reports regarding the positive economic impact derived from general surgical services. It is especially important to examine and quantify the direct and indirect financial contribution that a general surgeon makes to a rural hospital and community.
Meeting Increasing Demands for Rural General Surgeons
The American Surgeon, 2015
Dynamic assessment of the effective surgical workforce recommends 27,300 general surgeons in 2030; 2,525 more than are presently being trained. Rural shortages are already critical and there has been insufficient preparation for this need. A literature review of the factors influencing the choice of rural practice was performed. A systematic search was conducted of PubMed and the Web of Science to identify applicable studies in rural practice, surgical training, and rural general surgery. These articles were reviewed to identify the pertinent reports. The articles chosen for review are directed to four main objectives: 1) description of the challenges of rural practice, 2) factors associated with the choice of rural practice, 3) interventions to increase interest and preparation for rural practice, and 4) present successful rural surgical practice models. There is limited research on the factors influencing surgeons in the selection of rural surgery. The family practice literature s...
Patterns of surgical practice in a small rural hospital 1 1 No competing interests declared
Journal of The American College of Surgeons, 1999
Background: A significant proportion of the population in the United States lives in rural areas, yet these areas are traditionally underserved in terms of surgical and other medical specialists. As a result, the operative experience of surgeons practicing in rural areas is different than that of surgeons operating in urban centers. This study was undertaken with the goal of delineating the surgical experience in a small hospital in rural Mississippi and correlating that with the training of surgical residents.
The Journal of Rural Health, 2007
Context: Surgical services are frequently unavailable in rural American communities. Therefore, rural residents often must travel long distances to receive surgical care. Rural hospitals commonly have difficulty providing surgical services despite potential economic benefits. Purpose: The purpose of this project was to identify the key challenges and describe the initial outcomes experienced by Harney District Hospital (HDH), a rural critical access facility in Oregon, as it develops a surgical program. Since few models exist, this information will be valuable for those considering offering surgical services in a rural setting. Methods: This project employed a single case study design. Qualitative information was gathered from semi-structured interviews, a focus group, reviews of historical documents, and informal observations. Quantitative data sources included HDH financial and utilization records, US Census records, and economic and demographic statistics from the state of Oregon, Harney County, and the city of Burns. Findings: HDH is learning that initiating a change such as expanding surgical services within an organization is a challenging process requiring collaboration among the administration, staff, and community. Preliminary findings indicate that the new surgical program has resulted in significant financial gains for the hospital. Conclusions: While starting a rural surgery program is a complex undertaking, there are benefits for the hospital. If a rural hospital is to be successful in this mission, collaboration and adaptability must be key components of the process.
The Economic Impact of a Rural General Surgeon and Model for Forecasting Need
2010
Converging forces are contributing to declines in the availability of rural general surgery services. A developing crisis will have profound impacts on many rural residents, hospitals, physicians and communities. While most rural communities’ attention is predominately directed to assuring primary medical care availability, more specific focus must be directed to general surgery and its interconnectedness with the sustainability of primary care and other rural services.
Differences in rural and urban outcomes: a national inspection of emergency general surgery patients
The Journal of surgical research, 2017
About 19% of the United States population lives in rural areas and is served by only 10% of the physician workforce. If this misdistribution represents a shortage of available surgeons, it is possible that outcomes for rural patients may suffer. The objective of this study was to explore differences in outcomes for emergency general surgery (EGS) conditions between rural and urban hospitals using a nationally representative sample. Data from the 2007-2011 National Inpatient Sample were queried for adult patients (≥18 years) with a primary diagnosis consistent with an EGS condition, as defined by the American Association for the Surgery of Trauma. Urban and rural patients were matched on patient-level factors using coarsened exact matching. Differences in outcomes including mortality, morbidity, length of stay (LOS), and total cost of hospital care were assessed using multivariable regression models. Analogous counterfactual models were used to further examine hypothetical outcomes, ...