The design of rural health care delivery systems often is based on concepts obtained from urban models. The implicit planning premises of successful urban models, however, may be inappropriate for many rural systems. An alternative model planned and implemented in the checkerboard region of rural northwest New Mexico has proved to be successful. This experience may be helpful to health care policymakers and planners confronted with environments that are not congruent with typical urban settings. The checkerboard region presented a challenging health planning environment characterized by formidable geographic, population, economic, and health behavior constraints. The Checkerboard Area Health System (CAHS), designed to provide comprehensive services in an area dominated by these constraints, was formed around a central diagnostic and treatment facility with six satellite clinics. The CAHS used an innovative administrative structure, extended the productivity of traditional providers by extensive use of mid-level and ancillary personnel, and created an effective referral network. These features are distinctly different from those of urban health care models. Overall, the CAHS attained a high rate of inpatient use. Additionally, the performance of the outpatient program indicates that traditional ambulatory care can be integrated with other health services that are more oriented toward health promotion and disease prevention. Finally, the emergency room at the central facility has attained an impressive record that, like the inpatient and outpatient areas, is responsive to the needs of the target population.

Adolescent↗

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An analysis of the processing of patients in a rural medical care delivery system.

A study of the processing of patients at the rural clinic of a medical care delivery system was done to describe quantitatively the movement of patients from their arrival to their departure. The data collected provided a statistical summary of the sequence and duration of observed events in the medical care process as they related to the patients. An analysis of 485 patients visits that were observed on 60 random days during a 12-month period showed that patient arrival rates were generally higher during the morning. The average visit lasted 74 minutes; 94 percent of this time was spent in the waiting and examination rooms. The period that that the patient spent unattended by clinic personnel represented three-fourths of the average patient's total time in the delivery system. Data analysis indicated that if patients were admitted to an unoccupied examination room as soon as possible after their arrival and if standing orders for the family nurse practitioner were expanded, a significant reduction would occur in the average patient's unattended visit time.

Appointments and Schedules↗