ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00193.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:Rural hospitals represent almost half of all short‐stay nonfederal general hospitals in the United States, but have been more severely affected than their urban counterparts by changes in reimbursement, regulation, and technology. Two hundred and six rural community hospitals closed during thefirst nineyears of the 1980s, and the rate of closure is accelerating. Using secondary data sources to examine the structure, role, and content of rural hospitals, small rural hospitals are described and compared to larger and nonrural hospitals. Rural hospitals differ systematically from other hospitals in the United States, with smaller daily censuses, lower occupation rates, shorter lengths of stay, and disproportionately high shares of Medicare patients. They are dominated by very small institutions, with more than 1,000 rural hospitals having fewer than 50 beds. Small rural hospitals offer a core of basic services to the populations they serve. Emergency, obstetric, and newborn services are virtually ubiquitous in rural hospitals of all sizes, and they are also more likely to offer long‐term nursing and home care services than urban hospitals of similar size. The inpatient diagnostic and procedural mix of these institutions demonstrates that they provide care for common medical and surgical conditions of low complexity. Rural hospitals are also relatively inexpensive, representing only 6 percent of total expenditures for hospital care. Given their central role in supporting the provision of health services to rural areas, the apparent appropriateness of the conditions they treat, and their relatively modest cost, it would seem reasonable to use federal policy to stabilize our previous investment in these instituti

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00194.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:Rural primary care programs were established in areas where there was thought to be no competition for patients. However, evidence from site visits and surveys of a national sample of subsidized programs revealed a pattern of competitive responses by the clinics. In this study of 193 rural primary care programs, mail and telephone surveys produced uniform data on the organization, operation, finances, and utilization of a representative sample of clinics. The programs were found to compete in terms of: (1) price, (2) service mix, (3) staff availability, (4) structural accessibility, (5) outreach, and (6) targeting a segment of the market. The competitive strategies employed by the clinics had consequences that affected their productivity and financial stability. The strategies were related to the perceived missions of the programs, and depended heavily upon the degree of isolation of the program and the targeting of the services. The competitive strategy chosen by a particular program could not be predicted based on service area population and apparent competitors in the service area. The goals and objectives of the programs had more to do with their competitive responses than with market characteristics. Moreover, the chosen strategies may not meet the demands of those markets.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00195.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:Medicare's Prospective Payment System (PPS) has introduced a new environment in which hospitals must either alter their strategies for delivering services or face closure. This is a challenge for rural hospitals that often lack the resources and supportive economic climate of their urban counterparts. Few guidelines are available to assist rural hospitals in responding organizationally to PPS‐induced constraints. This article examines the plight of rural hospitals from the perspective of strategic adaptation. A conceptual framework is proposed for studying strategic adaptations to PPS by rural hospitals. The implications for developing a sound research methodology are also discussed. On the basis of this research agenda, it may be possible to clarify how rural hospitals should adapt to PPS (and similar) constraints now, and in the futur

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00196.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:This research examines the association among characteristics of the caregiving network, primary caregiver stress and burden, and area of residence. The purpose is two‐fold: to determine whether the structure of the relationship between the caregiving network, and stress and burden is uniform across rural, small city, and urban samples; and, to assess whether stress and burden are explained by a similar set of variables within area of residence categories. The data are drawn from a matched sample of 1,388 impaired elders and their primary caregivers from the 1982 National Long‐Term Care Survey and the National Survey of Informal Caregivers. In general, the analysis shows that several characteristics of the care‐receiver and the primary caregiver have a differential effect on stress and burden across residential categories, and that, within rural, small city, and urban samples, the determinants of stress and burden are not homogeneous. When the frail elder is able to reciprocate by doing chores, babysitting, or providing some other type of assistance for the primary caregiver, however, both stress and burden are reduced in all three residential categories. Similarly, the increased provision of assistance with instrumental activities of daily living by the primary caregiver uniformly increases stress and burden. These findings suggest that interventions designed to alleviate primary caregiver stress and burden may be able to have some common components, but may also need to be tailored in some ways to specific residential environ

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00197.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:The 1980s has not been a particularly prosperous decade for many farm operators. Due to shifts in the agricultural economy, many farmers have experienced farm foreclosure and rural displacement; while many more are at serious risk of losing their farms. Within the context of the agricultural crisis, this study examines the impact of economic hardship on the probability of experiencing a farm injury. Specifically, we hypothesized that farm operators who were experiencing economic distress would be more likely to experience a farm injury. Data from the North Dakota Rural Life Poll (n=450) was used to estimate the incidence of farm accidents, as well as examine the relationship between selected farm operator characteristics and the incidence of a farm accident. The data suggests that younger farm operators with higher debt‐to‐asset ratios are significantly more likely to experience a farm accident. The study goes on to examine some of the dynamics of this relationship, and implications for farm safety education are addres

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00198.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Book Reviewed in this Article:HENK, MATTHEW L. (Ed.),Social Work in Primary Health Care.AMERICAN ACADEMY OF FAMILY PHYSICIANS COMMISSION ON HEALTH CARE SERVICES.Rural Family Practice: You Can Make a Difference.BECK, DONALD F.Basic Hospital Financial Management.AMUNDSON, B., and ELDER, W.A Prelude to Strategic Planning: Making Your Organization and Community Fit for Success.Strategic Planning Workbook.MASON, SCOTT A.; SHAMAN, HINDY; AND DUBE, MONTE.Diversifications and Conversion Strategies for Rural Hospitals.HOSPITAL RESEARCH AND EDUCATIONAL TRUST.Rural Hospital Closure, Management and Community Implications.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00199.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00200.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00201.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY