Showing papers in "Journal of Rural Health in 1986"

Environmental responses in small rural hospitals.

Abstract: Major environmental forces are placing increased pressure on community small and rural hospitals to provide access to medical care in rural communities and to survive as free standing non-profit community institutions. This survey of chief executive officers of small and rural hospitals in two states examines their perceptions of their institution's environment and the degree to which multi-institutional arrangements are seen as an organizational response to a changing environment. Major differences among small and rural hospitals are explored.

Implementing swing-bed services in small rural hospitals.

Abstract: Since 1983, twenty-six small rural hospitals in five states have been developing models of the "swing-bed" concept as part of a coordinated national demonstration project. Based on the experiences of these hospitals, swing-bed programs use excess hospital capacity to provide short-term, post-acute care in rural communities where there are nursing home shortages, and, thus, help avoid the need for new nursing home construction. The availability of swing-bed services in rural hospitals has allowed the elderly patient to receive a full-range of long-term care services within the community to avoid transfer to a nursing home outside the community. Introduction of services also has improved patient care for all hospitalized elderly. Finally, the revenue from the swing-bed services has helped to stabilize small, rural hospitals faced with declining utilization. The demonstration has provided evidence that the swing-bed program has the potential to deliver a needed service to the rural elderly while contributing to the preservation of the small, rural hospital as a valuable community resource.

Acquisition of Small Rural Hospitals by Multihospital Systems

Abstract: The occurrence of multihospital systems, two or more hospitals owned, leased, or managed by a separate organization, represents a note-worthy change in the way health care is organized today. The impact of this for small rural hospitals, however, has only been studied indirectly or anecdotally. This investigation, using data from national surveys, systematically documents and analyzes this trend and discusses its potential impact. By 1983 almost one quarter of all small rural hospitals were affiliated with multihospital systems. This growth occurred primarily over the last few years, and was accompanied by a rapid surge in the involvement of for-profit systems. This contrasts sharply with traditional rural hospital care which had been provided primarily by nonprofit or religious institutions. There also were differences in the form of affiliation the hospitals had with their parent organizations, with the most recent movement toward management contracts. Differential changes also occurred in the patterns of affiliation by geographic region.

Education of Health Care Providers for the Rural Setting: A Family Nurse Practitioner Demonstration Program*

Abstract: Spurred by mass concern over shortages of health care providers, the country's educational system has, over the past ten years, produced an ample supply (in some areas a near glut) of health care professionals. Studies demonstrate, however, that these professionals tend to cluster in the affluent metropolitan and suburban areas. Residents of rural areas are still significantly underserved. In the heavily rural southern half of Georgia, this problem has reached a critical peak. Georgia Southern College (GSC) is a rural based college located in the heart of rural south Georgia. In order to address some of the health care problems of its constituency, GSC, with federal support, established a Nursing Department and a Family Nurse Practitioner program with a commitment to recruit nursing students from the rural area, educate them in rural settings, and provide appropriate preparation for the unique experience of working in the rural environment. The program has been very successful in producing highly skilled graduates who do stay and work in the rural areas, providing health care at reasonable costs. This paper describes the setting (rural south Georgia), the need, the program implementation, and the impact (numbers of graduates actually working in rural settings, and innovative projects initiated by graduates).

The economic costs and benefits of adding medical manpower to rural and urban communities: a human capital perspective.

Abstract: For health planners to be able to use scarce resources efficiently and effectively to improve health, it is necessary for them to have reliable information on the productivity of the major categories of health producing expenditures. The present study utilizes a human capital perspective to evaluate the economic costs and benefits of medical manpower to communities in the West South Central United States. The results of the study suggest that beyond problems of maldistribution of physicians and nurses, the larger problem from an economic effectiveness perspective may be significant excesses of medical manpower, although some rural communities could justify, economically, adding physicians and/or nurses to reduce lost human capital. The findings indicate a need to further rationalize the allocation of health care resources as well as the need to consider means other than increased spending on curative medicine (e.g., health promotion and health education) as a strategy for efficiently meeting the objective of improving public health.

Competition in health care and the rural poor: an assessment from Arizona's competitive Medicaid experiment.

Abstract: Market competition has been advocated as a possible solution to the rapidly increasing costs of Medicaid programs. However, there have been no major assessments of the impact of this approach on the rural poor. Past efforts have been located in urban areas; where existing HMOs were used to enroll the Medicaid population that elected to join the plans. In 1981 the Arizona Health Care Costs Containment System (AHCCCS, pronounced "access"), a statewide Medicaid experiment involving prepayment and enrollment in health plans, was created. Data from two state-wide, cross-sectional telephone surveys indicate that competitive Medicaid programs may be a feasible strategy in rural areas, but without innovative solutions for those ineligible for Medicaid, many of the rural poor will continue to have in adequate access to medical care.

Evaluation of Medical Center Support for Rural Physicians

Abstract: Professional isolation remains a problem for rural physicians. To address the problem, a university medical center established a Physician Support Office (PSO). The PSO offered rural physicians toll-free telephone access to patient referral, patient follow-up, library reference, and drug information services. A newsletter was also published. The service was evaluated using a quasi-experimental design. Physicians in the experimental area felt there was improvement in several medical center services, compared to physicians in the control area. Provision of library services, referral services and a newsletter contributed significantly to the usefulness of the PSO program. Nevertheless, the PSO did not produce a significant improvement in rural physicians' overall feeling of general medical center support.

Faculty time allocation in rural primary care training sites.

Abstract: This investigation examined the allocation of time by medical school faculty who served as attending physicians on a rotating basis in rural primary care centers where medical students and house staff were trained. Two quite different methods of studying faculty time allocation produced relatively consistent results. Travel and direct care of patients (with no medical students present) accounted for the largest share of faculty time. Much of the teaching time was spent in direct student contact with no patient present. Simultaneous care of patients by an attending faculty member and a medical student accounted for less than ten percent of faculty effort. It appears that in a busy rural primary care center, faculty whose mission is intended to emphasize teaching may often be thrust into the role of care providers. Despite this problem, faculty-student contact appears to be greater than that which typically occurs in the tertiary care teaching hospital environment.

The Influence of Rural Physicians' Perceptions on Referral Patterns to a University Hospital*

Abstract: The patient referral process is based on a complex set of social rewards and costs for the referring physician. For the physician or institution potentially receiving referrals, a key question is, why is one institution selected over other available choices? Factor analysis of a survey of rural physicians revealed five factors of reward and cost associated with the choice of where to refer patients. Further analysis of these factors suggested that the ability to have patients admitted and treated when necessary is central to the satisfaction of the referring physician and their willingness to continue the consultant relationship. Adequate information about the consultants was also important to satisfaction. Other factors have less influence. Further, "admissions when necessary" was the only reward/cost factor which predicted physicians who referred more to the university hospital than to other hospitals. If a university hospital wants to develop strategies to encourage referrals from rural physicians, it must be cognizant of these social reward-cost factors.

Utilization of a Migrant Outreach Nursing Service

Abstract: The utilization of an outreach primary care health service provided by nurse practitioners to the migrant farm work population on the Eastern Shore of Virginia in 1984 was examined by migrants' ethnicity, gender, and age. Seventy percent of a population of Black, Mexican American, and haitian workers and dependents were seen in 5,937 camp encounters. The population and first-encounter patient distributions were equivalent except for gender: relatively more males than females received service. First- and subsequent-encounter distributions were disproportional for ethnicity, gender, and age: subsequent service was provided more frequently to Blacks, females, and patients over 30 years of age. High penetration and subsequent rates were obtained for this comprehensive, readily accessible health service.

Establishing a Quality Laboratory In a Rural Medical Practice

Abstract: Laboratory services are not as readily accessible to the rural medical practitioner as to the practitioner in an urban setting. Thus, the office laboratory in a rural medical practice, by necessity, becomes an integral component of that practice. In addition to procedural methodologies, the rural physician must give consideration to the types of laboratory services needed, the requirements for test performance, the factors influencing test costs, the establishment of charges, the necessary protocols and paperwork, the arrangements of the laboratory work area, and the requisite quality control to insure that the office laboratory functions expediently and cost-accountable.