ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00346.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00347.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTIt is often assumed that poor birth outcomes are more common among rural women than urban women, but there is little substantive evidence to that effect. While the effectiveness of rural providers and hospitals has been evaluated in previous studies, this study focuses on poor birth outcomes in a population of rural residents, including those who leave rural areas for obstetrical care. Rural and urban differences in rates of inadequate prenatal care, neonatal death, and low birth weight were examined in the general population and in subpopu‐lations stratified by risk and race using data from five years (1984‐88) of birth and infant death certificates from Washington state. Also examined were care and outcome differences between rural women delivering in rural hospitals and those delivering in urban facilities. Bivariate analyses were confirmed with logistic regression. Results indicate that rural residents in the general population and in various subpopulations had similar or lower rates of poor outcome than did urban residents but experienced higher rates of inadequate prenatal care than did urban residents. Rural residents delivering in urban hospitals had higher rates of poor outcomes than those delivering in rural hospitals. We conclude that rural residence is not associated with greater risk of poor birth outcome. White and nonwhite differences appear to exceed any rural and urban resident differences in rates of poor birth outc

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00348.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTWe surveyed all 37 rural Washington state hospitals with fewer than 100 beds to determine how rural emergency departments are staffed by physicians and to estimate rural hospital payments for emergency department physician services. Only five hospital emergency departments (14%) were still covered by the traditional rotation of local practitioners and billed on a fee‐for‐service basis. Ten hospitals (27%) paid local private practitioners to provide emergency department coverage. Twelve other hospitals (32%) hired visiting emergency department physicians to cover only weekends or evenings. The remaining 10 rural emergency departments (27%) were staffed entirely by external contract physicians. Thus, 86 percent of rural hospitals contracted for emergency department coverage, and 59 percent obtained some or all of this service from nonlocal physicians. Most of the 32 hospitals with some form of contracted services have changed to this emergency department coverage in the last few years. The cost of these services is high, particularly for the smallest hospitals that have fewer than eight emergency department visits per day and pay physician wages of nearly $100 per patient visit. Emergency staffing responsibility has shifted from local practitioners to the hospital administrators because of rural physician scarcity and a desire to improve quality and convenience. The cost of these changes may further undermine the economic viability of the smaller rural hospit

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00349.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTThis paper reports the findings of a study of health insurance coverage and access to health services among farm families in Minnesota. The study included 1,482 families actively engaged in farming during 1989. While less than 10 percent of the population were uninsured during this period, the majority had limited coverage with high deductible and coinsurance provisions. Moreover, they were paying an estimated 15 to 20 percent more for their plans than a similar plan would have cost in the Minneapolis‐St. Paul, MN, area. With the exception of cost, satisfaction with health services was found to be very high, and there were few indications of access problem

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00350.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTThis study was undertaken to investigate issues affecting recruitment and retention of physicians in a rural north Florida community. As part of this investigation, the authors examined the relevant context of medical care and physician practice for this community. The results identify a number of problems not uncommon in rural communities and supported by previous literature. Physicians felt isolated, dissatisfied with job security and professional autonomy, and frustrated by a lack of cooperation among the major providers of health care. More importantly, upon closer scrutiny, some of the most appealing characteristics of this community for incoming physicians become its weaknesses. Access to a regional medical center nearby and nearness to a metropolitan area were both cited as positive attributes to their choice of practice location. In this community, however, these appear to have resulted in a highly divided medical system. Many of the employed and insured patients in the county prefer to get their medical care in the nearby city. At the same time three separate entities within the community—a federally funded community health center, a county public health unit, and a community hospital—are expected to provide services for the poor and uninsured. The resulting lack of a comprehensive approach to provision of services contributes significantly to the dissatisfaction among providers and to their ultimate retent

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00351.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTIn the next few years, Our Community Hospital, located in the small town of Scotland Neck, NC, will undergo a conversion through which it may serve as an appropriate model for similar small hospitals in distressed rural communities. With technical and grant assistance from the Office of Rural Health and Resource Development of the North Carolina Department of Human Resources, the hospital has begun to phase out almost all acute care services and will expand and strengthen its focus on primary care, emergency medical services, and services for elderly personsThis paper addresses four issues of greatest concern to hospital administrators, rural health professionals, academics, and rural residents interested in hospital conversions: (1) community involvement during the planning process; (2) the evolution of the program's structure; (3) financing for the project; and (4) the development of cooperation between state and federal governments, foundations, and private groups. This case study describes one possible course in addressing an acute health care problem facing rural America–the viability of rural hospital

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00352.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTMany rural hospitals are experiencing difficulties. This article explores the views of various government and hospital officials on state health policy for rural hospitals. The authors discuss how these officials define the rural hospital issues and suggest appropriate state interventions to assure hospital viability and local access to care. The authors recommend that states, hospitals, and communities decide through a formal process what level of health and medical care should be available in rural areas, and states assist in low‐cost ways those rural hospitals that are ready to change or that, with help, will be ready to make such operational changes as service reconfiguration, affiliations, and working agreements with other health care organizations to continue and improve local access to health car

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00353.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTRural‐urban comparisons have identified higher age‐, race‐, and sex‐adjusted cancer incidence and mortality rates in urban populations for most anatomic sites, suggesting that rural populations are at lower risk from cancer. Conversely, findings that rural cancer patients are diagnosed at later stages of disease, that higher proportions of rural cancer cases are unstaged at diagnosis, and that rural cancer patients are at a more advanced stage of illness when referred to home health care agencies, suggest that rural cancer patients are disadvantaged when compared to their urban counterparts.This paper summarizes rural‐urban patterns of cancer mortality, incidence, and survivorship since 1950; outlines rural‐urban differences in utilization of health care services; questions the appropriateness of using rural‐urban comparisons of cancer mortality and incidence to evaluate access to cancer care; and suggests potential approaches to the question of whether rural residents have access to cancer care comparable to that available to ur

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00354.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTA Survey of 108 hospital administrators in the eight states of the Mountain Census Region was conducted to identify frontier rural hospitals’experiences (fewer than 50 beds) in the provision of care and services to patients with HIV infection; to assess the availability of HIV care and services in these small, remote rural hospitals; and to assess the status of education and policy development related to HIV infection.Of the 62 hospitals that responded, 16 (26%) had provided care and services to HIV‐infected patients. Acute inpatient and emergency room care were the services most commonly utilized. An additional 11 hospitals reported the presence of HIV‐positive individuals in their medical service areas. Thus, nearly 44 percent of the hospitals were aware of the importance of addressing HIV infection as a local concern. Employees in the hospitals that had experienced caring for HIV‐positive persons expressed more concern about acquiring HIV infection than those in hospitals that had not. Four nursing assistants, two registered nurses, and one dietary worker had refused to provide care. HIV education consisted primarily of video programs, presentations by in‐house staff, and sending employees away to workshops. Despite this HIV education, most staff remain fearful of caring for HIV infected patients. Major concerns expressed by the hospital administrators were related to enforcing universal precautions, confidentiality, staff response, community acceptance, and cost of care. Only 30 hospitals (48%) had AIDS policies in effect, and these focused primarily on infection control and universal precautions.The results of the study indicate that frontier rural hospital administrators are aware that increasing numbers of individuals with HIV infection will seek care and services from frontier hospitals. However, current HIV education of staff does not effectively relieve fears and concerns regarding providing care, and few hospitals have developed policies to deal with HIV‐related situations. More effective HIV education programs and policies specific to potential HIV related situations need to b

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00355.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY