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At least 847 records · Page 47Linked to original sources
PubMed2006

Rural versus urban inpatient case-mix differences in the US.

BACKGROUND: Preparation of surgeons for practice in rural settings is hindered by limited knowledge of case-mix differences between rural and nonrural surgical practices. Although surgical practice in isolated rural areas is believed to be very different from urban practice, little is known about actual inpatient case-mix differences. STUDY DESIGN: We performed a retrospective, descriptive comparison of inpatient general surgical procedures performed at rural versus urban hospitals in the US using the Nationwide Inpatient Sample database (2000 to 2001). Rural versus urban geographic designations were based on Rural-Urban Commuting Area codes developed by the Rural Health Research Institute. Inpatient surgical procedures were aggregated by the Clinical Classifications Software based on ICD-9-CM procedure codes. RESULTS: Operations on the bowel, appendix, and gallbladder constitute 61% of general surgical inpatient procedures in rural hospitals, compared with 46% in urban hospitals. Compared with urban general surgery practices, rural practices include substantially fewer operations on the stomach and esophagus (6% versus 11%), liver and pancreas (0% versus 1%), spleen and thyroid (3% versus 10%), and bowel (17% versus 19%). General surgical procedures constitute 42% of inpatient procedures in rural hospitals versus 25% in urban hospitals. A rural general surgeon more broadly trained in selected obstetric and gynecologic operations could potentially perform 66% of all inpatient procedures in rural hospitals. Addition of simple vascular cases (eg, arteriovenous fistula, vascular access), head and neck operations, amputations, and nephrectomies could increase this potential to 71% of all cases. CONCLUSIONS: Rural and urban general surgical inpatient case-mixes differ from each other substantially. Additional competence in a few surgical areas that are not currently emphasized in general surgical training could result in an increased role for general surgeons practicing in rural areas.

Diagnosis-Related Groups↗
PubMed2003

Adapting prehospital care to a large rural geographic area: a review of the Emergency Health Services Nova Scotia implementation.

Nova Scotia is building a system of prehospital care based on four principles: "Fail Safe" government ownership; "Full Service" advanced life support capable; "High Performance" resource efficiency; and "Fiscally Responsible" performance goals, incentives and penalties. Emergency Health Services Nova Scotia exercises funding and regulatory control through service provided by a private contractor. Benefits include improved fleet and equipment management, information systems, 911 dispatch and performance tracking, medical control and paramedic care, and public accountability. Problems include rural dispatch, budget costs, labour issues and stakeholder communication.

Emergency Medical Services↗
PubMed2006

The visiting specialist model of rural health care delivery: a survey in Massachusetts.

CONTEXT: Hospitals in rural communities may seek to increase specialty care access by establishing clinics staffed by visiting specialists. PURPOSE: To examine the visiting specialist care delivery model in Massachusetts, including reasons specialists develop secondary rural practices and distances they travel, as well as their degree of satisfaction and intention to continue the visiting arrangement. METHODS: Visiting specialists at 11 rural hospitals were asked to complete a mailed survey. FINDINGS: Visiting specialists were almost evenly split between the medical (54%) and surgical (46%) specialties, with ophthalmology, nephrology, and obstetrics/gynecology the most common specialties reported. A higher proportion of visiting specialists than specialists statewide were male (P = .001). Supplementing their patient base and income were the most important reasons visiting specialists reported for having initiated an ancillary clinic. There was a significant negative correlation between a hospital's number of staffed beds and the total number of visiting specialists it hosted (r =-0.573, P = .032); study hospitals ranged in bed size from 15 to 129. CONCLUSIONS: The goal of matching supply of health care services with demand has been elusive. Visiting specialist clinics may represent an element of a market structure that expands access to needed services in rural areas. They should be included in any enumeration of physician availability.

Adult↗
PubMedDate not supplied

Low-bandwidth, low-cost telemedicine consultations in rural family practice.

BACKGROUND: Telemedicine, based on the use of interactive video consultations, is being used more commonly in rural settings. This development is potentially important to rural patients because there are fewer physicians, particularly specialist physicians, in rural areas. Declining costs of telemedicine equipment and transmission have created increased access to these technologies for rural family physicians and their patients. METHODS: This study considers satisfaction levels of rural family physicians, academic-based specialists, and rural patients in 130 consultations between rural physicians, rural patients, and urban academic specialists. To increase the practicability for rural use, low-cost equipment and low-bandwidth digital telephone transmission lines were utilized. Data were collected using questionnaires that were completed by patients, family physicians, and specialist consultants after each consultation. RESULTS: All categories of participants noted very high levels of satisfaction. CONCLUSION: Telemedicine-based consultations are well accepted by rural patients, rural family physicians, and urban academic specialist consultants. This approach could offer a useful adjunct to rural health care.

Attitude of Health Personnel↗
PubMed1986

Tanzania.

Explore the source record for details and available documents.

Africa↗
PubMed1988

The Forest (Conservation) Amendment Act, 1988 (No. 69 of 1988), 17 December 1988.

Major provisions of this Indian Act on Forest Conservation are summarized as follows: "New Clauses iii) and iv) have been inserted in Section 2a of the principal Act to provide that the leasing of forest land to private persons or any authority, corporation, agency, and any other organization not owned, managed, or controlled by the Government and clearing of trees which have grown naturally anywhere in any forest land for the purpose of using it for reforestation will require approval of the Central Government. (Section 2) The scope of the existing definition of 'non-forest purposes' has been expanded so as to include therein also cultivation of tea, coffee, spices, rubber, palms, oil-bearing plants, horticultural crops, and medicinal plants. (Section 2) New Sections 3a and 3b have been inserted in Section 3 of the principal Act. Section 3a provides that anyone who contravenes any of the provisions of Section 2 shall be punishable with simple imprisonment for a period up to 15 days. Section 3b provides that if any offence has been committed under this Act by any Government department or by any authority, then the head of the department or every person directly responsible for the conduct of the authority, as the case may be, shall be deemed to be guilty of the offence and shall be liable to be punished."

Agriculture↗