bluuebunny/crossref_metadata_2025 huggingface dataset:
Metropolitan and Nonmetropolitan Adolescents: Differences in Demographic and Health Characteristics*
Authors: McManus Margaret A. , Newacheck Paul W. , Weader Rebecca A.
Published: April 2008

The demographic and health characteristics of metropolitan and nonmetropolitan adolescents are examined based on a nationally representative sample of 15,181 randomly selected adolescents from the 1984 National Health Interview Survey. One third of all adolescents reside in nonmetropolitan areas of the United States. Nonmetropolitan youth differed from their metropolitan counterparts in race, population concentration in the South, poverty status, family composition, education of household head, and marital status. While the health status of metropolitan and nonmetropolitan youth were similar, their patterns of health services utilization and health insurance coverage were not. Nonmetropolitan adolescents made fewer physician visits and were more apt to delay seeking physician care than metropolitan youth. Adolescents in nonmetropolitan areas were also 39percent more likely to be hospitalized and 30 percent more likely than metropolitan youth to be without any form of health insurance protection. Despite higher rates of poverty among nonmetropolitan adolescents, they were 20 percent less likely to be publicly insured. The delivery and financing implications of these distinct metropolitan and nonmetropolitan demographic and health characteristics are discussed.
A Rural Hospital's Impact on a Community's Economic Health*
Authors: Doeksen Gerald A. , Loewen Ron A. , Strawn David A.
Published: April 2008

This research illustrates the importance of a hospital to the economic health of a community. A simulation model of a rural community in Oklahoma is used to demonstrate how the implementation of the DRG reimbursement policy has impacted a rural community, and to project how the closing of the hospital would impact the economy of the community. The results indicate that rural hospitals play a vital role in the economics of their communities. The closing of a rural hospital has a devastating impact on the community, while the DRG reimbursement policy has had a significant impact on the community.
AIDS Knowledge and Attitudes among Adolescents in the Rural Southwest*
Authors: Miller William A. , Qualtere‐Burcher Paul , Lauber Caleb , Rockow Jeffrey P. , Bauman Kay A.
Published: April 2008

ABSTRACT: A survey of adolescents living in rural southwestern towns demonstrated their knowledge of the basic transmission routes of Acquired Immune Deficiency Syndrome (AIDS). Nevertheless, misconceptions and attitudes, which may interfere with adopting safe behaviors, persist. Significant differences in knowledge did exist between the ethnic groups surveyed. Further, American Indian and black adolescents were more likely to express attitudinal biases against people who have AIDS. We conclude that current media efforts have been successful in communicating basic information regarding transmission, but there may exist a need for ethnically specific programs that focus on the misconceptions and attitudes surrounding AIDS.
Alternative Models for the Delivery of Rural Health Care: A Case Study of a Western Frontier State*
Authors: Witt De , Rowley Beverley Davies
Published: April 2008

ABSTRACT: This is a case study illustrating the wide variety of models for rural health care delivery found in a western “frontier” state. In response to a legislative mandate, the University of Nevada School of Medicine created the Office of Rural Health in 1977. Utilizing a cooperative, community development approach, this office served as a resource, as well as a catalyst, in the development and expansion of a variety of alternative practice models for health care delivery to small, underserved rural communities. These models included small, single, and multispecialty group practices; self‐supporting and subsidized solo practices; contract physicians; midlevel practitioners; and National Health Service Corps personnel. The rural health care System that was created featured regional and consortial arrangements, urban and medical school outreach programs, and a “flying doctor” service.
Education of Physician Assistants, Nurse Midwives, and Nurse Practitioners for Rural Practice
Authors: Ricketts Thomas C.
Published: April 2008

Physician assistants, nurse midwives, and nurse practitioners have been described as a vital and unique solution to the problem of providing adequate access to high quality health care for many Americans. Each of these classifications of health care providers has been accepted as separate professions with their own standards and identities. Their curricula and educational pathways have developed into clearly distinguishable educational tracks that complement the larger disciplines of nursing and medicine. Physician assistants, nurse midwives, and nurse practitioners have been singled out in federal legislation for their potential contribution to underserved rural communities (e.g., the Rural Health Clinics Services Act of 1977 and its subsequent amendments). This designation is partly due to the fact that certified nurse midwives, nurse practitioners, and physician assistants traditionally chose to practice in rural, underserved areas, and because their skills and practice structures were well matched to the needs and resources of rural areas. That pattern of practice, however, appears to have changed and the distribution of these practitioners has begun to resemble the distribution of physicians and other clinicians with heavy concentrations in urban areas and a growing shortage in rural and underserved areas.
An Assessment of Rural Hospital Trustees' Health Care Knowledge Base*
Authors: Rosenthal Thomas C. , Doemland Martha , Parisella. J. Scott
Published: April 2008

ABSTRACT: Rural hospital trustees are usually volunteers who serve important roles in the governance of a hospital and, therefore, in defining health care policy in their communities. Because most trustees are not health professionals, their orientation to the hospital and continuing education about the hospital present a special challenge to administrators. One hundred and three trustees from 10 rural hospitals in western New York were surveyed to better understand their demographics, their knowledge base regarding the hospital, and their roles as trustees. Sixty‐six percent of the respondents were male and the average age of the sample was 48 years. Trustees had served an average of six years and spent seven hours per month on hospital business. Eighty‐three percent recalled receiving some orientation. Answers about average hospital census, length of stay, payor type, and hospital services were correct less than 50 percent of the time. Trustees were aware that recent quality assurance guidelines increased their liability and half believed it was their most important activity. We conclude that greater effort should be applied to the orientation and continuing education of hospital trustees. Given the significant time commitment already asked of trustees, this education should be woven into the hospital governance routine.
Perspective on Farm Accident Statistics*
Authors: Rosenblatt Paul C. , Lasley Paul
Published: April 2008

ABSTRACT: The frequently cited statistics on farm accidents are based on definitions of farms accidents and on sources of data that exclude some events that could be called farm accidents and that represent only some of all the defensible perspectives on health risks in farming. As a contribution to exploring alternative perspectives on farm accident statistics, mailed surveys of 2,016 Iowa farm operators provided information on accidental injuries in their farm operations during the year preceding the survey. The majority of injuries were home treated, and hence were not events that would be reflected in accident statistics based on medical records. The data allow a breakdown by age, thus enabling an estimate of farm accident rates for children, youth, and the elderly, people whose accidents are typically excluded from farm accident statistics. Data are also presented that provide a farm operator's perspective on farm accidents, showing that many farm operators had knowledge about accidents through their own close calls and through their efforts to assist others who had farm accidents. The farm operator's perspective is also reflected in data indicating greater concern about chemical and air quality health risks than about risks from farm machinery and livestock.
Surveillance of Agricultural Injuries in Central Wisconsin: Epidemiologic Characteristics*
Authors: Stueland Dean , Lee Barbara , Layde Peter M.
Published: April 2008

ABSTRACT: We implemented a hospital‐based agricultural injury surveillance System in central Wisconsin in November 1986. The geographic area of the study is heavily agricultural, with a predominance of dairy farmers. This report describes the epidemiologic characteristics of the 913 patients seen during the first two years of the surveillance System. The majority of patients were male (77%), between the ages of 19 and 65 years of age (68.4%), and either the owner/operator of the farm (42.4%), or the spouse of the owner/operator (10.5%). Falls accounted for the greatest number of injuries in children younger than 16 years of age and in those older than age 65, while animals were the most frequent cause of injury in those between the ages of 16 and 65 years. Injuries were most likely to occur in the months of June, July, and August, which together accounted for 37 percent of the total number of injuries. Despite the limitations of the descriptive data derived front surveillance Systems, such information may be useful for determining the magnitude of a health problem and suggesting hypotheses to account for the apparent distribution of disease and injury.
Book Reviews Editor
Authors: Samuels Michael E. , Drane J. Wanzer
Published: April 2008

PETERKIN, KAREN, and BLACK, DONALD F. Directory of Online Healthcare Databases, 5th Ed. Oak Park, IL: Medical Data Exchange, Alpine Guild, 1990, 79 pp.—$35.
Health Care in Canada: Lessons for the United States
Authors: Reamy Jack
Published: April 2008

ABSTRACT: This paper considers various aspects of the Canadian health care system and the implications for the improved delivery of rural health care in the United States. The major aspects examined are access to care, rural hospitals, and rural physicians. A search of the pertinent literature revealed a large amount of information concerning rural physicians in Canada, but less that dealt directly with rural hospitals and access to health care in rural areas. Universal access is the cornerstone of the Canadian health care system, which is operated by each province under certain mandates of the federal government, with both providing funding for the system. The diffusion of medical technology has been slower in Canada than in the United States, which is perceived by some as a major success of the system. Little distinction is made between rural and urban hospitals in Canada, with all hospitals funded by annual global budgets from the province, rather than by direct payment for each service provided. Funding for capital items must be requested separately. This method of reimbursement allows better planning in meeting the needs of each community. Physicians in Canada are mostly private practitioners who are reimbursed by fee for service. As in the United States, there has been difficulty in attracting physicians to rural areas. However, all but one province have incentive programs to encourage physicians to practice in underserved rural areas, with some having disincentives for those locating in overserved areas. Overall, the Canadian health care system has chosen to control costs by focusing on the provider rather than the consumer and appears to be more successful in providing access to health care in rural areas of the country.
HMOs and Managed Care: Implications for Rural Physician Manpower Planning*
Authors: Weiner Jonathan P.
Published: April 2008

American health care is changing dramatically. Health maintenance organizations (HMOs) and other managed care plans are central to this change. Today, the majority of Americans living in metropolitan areas receive their care from these types of plans. The goal of this article is two‐fold. First, it will discuss the potential implications of HMOs and managed care for physician needs and supply in rural regions. Second, it will derive insight into alternative approaches for meeting rural health manpower needs by analyzing HMO staffing patterns.

As HMOs and other managed care plans expand, rural physicians, their practices, and their patients will almost certainly be affected. As described in this paper, most of these effects are likely to be positive.

The staffing patterns used by HMOs provide an interesting point of comparison for those responsible for rural health manpower planning and resource development. HMOs appear to meet the needs of their enrollees with significantly fewer providers than are available nationally or suggested by the federal standards. Moreover, HMOs make greater use of nonphysician providers such as nurse practitioners and physician assistants.
Future Trends in Nursing Practice and Technology*
Authors: Fuszard Barbara
Published: April 2008

Rural hospitals will be affected by changes in nursing anticipated in the future. Welcome changes will be the maturity and life experiences new graduates will bring to the work setting, knowledge of computers, and a broadening database. New graduates will also know various methods of care delivery, including case management, and will be able to select the delivery system that best meets the needs of the patients and institution. They will be more autonomous and possess leadership and management skills. With their knowledge of community as well as institutional nursing, they will be able to draw upon the skills of both groups to bring the two areas of nursing into continuity of care for patients. A difficulty ahead for rural hospitals is recruitment of new graduates, the majority of whom will have established families and lives elsewhere. And the practice of developing their own employees for higher levels of nursing will be compounded by the doubling of time necessary to complete nursing programs in the future.
Geographic Barriers to Child Health Services in Rural Northern New England: 1980 to 1989
Authors: Goodman David C. , Barff Richard A. , Fisher Elliott S.
Published: April 2008

Despite substantial recent increases in the number of rural physicians, it is unknown whether rural children still face significant barriers to medical care. To address this question, we determined travel times in 1980 and in 1989 to child health services for the rural pediatric population of northern New England–the area with the highest per‐capita primary care physician supply of any non‐metropolitan region in the United States. The study population in 1989 included 363,443 children living in 936 nonmetropolitan towns. The study revealed important spatial relationships in health service supply and demand not identified using other methods of assessing physician availability. Although travel times to physicians decreased slightly during the decade, we found that 15.5 percent of the children in our population were more than 30 minutes from pediatricians in 1989, and travel time to emergency rooms was more than 30 minutes for 9.9 percent of the children. In contrast, only 1.8 percent of children faced excessive travel times to family/general practitioners. While towns with pediatricians were likely to also have a family physician or an emergency room, the majority of towns with family physicians had neither a pediatrician nor an emergency room. Towns with poor geographic access to pediatricians and emergency rooms had low population densities and were distant from metropolitan areas. The analysis indicates that even in rural areas of high physician supply, access to pediatricians and emergency rooms for many children remains limited, and family physicians are the dominant medical providers for children. Future work using travel time variables will clarify the relative importance of travel to medical care as a factor in rural health outcomes.
Prenatal Diet Adequacy Among Rural Alabama Blacks
Authors: Leeper James D. , Nagy Christine , MD Sandral Hullett‐Robertson,
Published: April 2008

Proper nutrition during pregnancy has a major effect on a mother's health, as well as that of her baby. This paper examines the adequacy of diet among low‐income, black, pregnant women residing in rural areas of west central Alabama. The factors associated with diet adequacy in this population are also examined. Data for this study were collected from 186 women who provided 24‐hour dietary recalls. The data indicate that these women have major deficiencies in their diets, particularly in terms of milk and milk products. Most women are receiving only about 60 percent of the number of servings of the four basic food groups recommended for a pregnant woman. Women younger than 20, unmarried or not heading their own household, receiving no post‐high school education, unemployed, experiencing an unplanned pregnancy, and not having a home visitor had less adequate diets than their counterparts. Diet adequacy had a low (r = .16) but statistically significant correlation with birthweight.
Rural Residence and Poor Birth Outcome in Washington State
Authors: Larson Eric H. , Hart L. Gary , Rosenblatt Roger A.
Published: April 2008

It 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 outcome.
Rural Community and Physician Perspectives on Resource Factors Affecting Physician Retention
Authors: Conte Susan J. , Imershein Allen W. , Magill Michael K.
Published: April 2008

This 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 retention.
Our Community Hospital: The Evolution of a Rural Primary Care Hospital
Authors: Kushner Christine , Bernstein James D. , Dihoff Serge
Published: April 2008

In 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 persons

This 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 hospitals.
State Health Policy and Rural Hospitals
Authors: Kovner Anthony R. , Kiel Joan M. , Runde Denise M.
Published: April 2008

Many 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 care.
HIV Issues for Rural Hospitals in U.S. Frontier Areas
Authors: Carwein Vicky L. , Berry David E.
Published: April 2008

A 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 be developed.
A Three‐Tier Model for the Delivery of Rural Obstetrical Care Using a Nurse Midwife and Family Physician Copractice
Authors: Hueston William J. , Murry Mary
Published: April 2008

To meet the needs of a large indigent rural population, a rural regional referral hospital in northeastern Kentucky developed a maternity program that utilizes nurse midwives and family physicians as the primary medical providers with support from obstetricians. After five years, the number of deliveries at the hospital has increased almost 30 percent, and the maternity center is now responsible for more than 70 percent of all deliveries at the medical center. Accounting for the large increase in the number of deliveries is an increasing number of women from surrounding areas who now utilize the maternity center and the hospital for their obstetric care. During the same time, there has been a corresponding decrease in deliveries to women with no prior prenatal care and a shift toward obtaining earlier prenatal care in the hospital service population. Results of the study suggest that combining the skills of nurse midwives and family physicians with surgical backup provided by a consulting obstetrician is an effective means of meeting the health care needs of an indigent, underserved rural population.
The Determinants of Utilization of Nonphysician Providers in Rural Community and Migrant Health Centers
Authors: Shi Leiyu , Samuels Michael E. , Konrad Thomas R. , Ricketts Thomas C. , Stoskopf Carleen H. , Richter Donna L.
Published: April 2008

Abstract: The use of nonphysician providers, such as nurse practitioners, physician assistants, and certified nurse midwives, in rural areas is critically important due to the continued primary care access problems. This study examines the major factors influencing the use of nonphysician providers in rural community and migrant health centers based on a 1991 national survey of the centers. This study demonstrates that the employment of nonphysician providers in rural community and migrant health centers is significantly influenced by both supply and demand factors. Among supply factors, there is a significant and positive relationship between the number of total staff and the number of nonphysician providers employed. There is a significant but inverse relationship between the number of physicians and the number of nonphysician providers employed, indicating nonphysician providers primarily serve as substitutes for physicians in rural community and migrant health centers. The supply of nonphysician providers, as measured by the number of affiliated training programs, is significantly related to the employment of nonphysician providers. The demand variable, geographic location, and the centers' staffing policies are also significant determinants of the use of nonphysician providers.
Economic and Health Needs of Wisconsin Migrant Farm Workers
Authors: Slesinger Doris P. , Ofstead Cynthia
Published: April 2008

Abstract: Migrant farm workers play an essential role in the planting and harvesting of crops in our agricultural production system. In the United States today, about 6 percent of the paid farm labor force “follow the crops” across the nation. This article reports on the economic and health care needs of migrant farm workers who travel from the border areas of Texas to Wisconsin each year. Surveys conducted in 1978 and 1989 show that this population remains in serious need of health care and access to financial assistance programs.

During the 11‐year interval between surveys, little change occurred in the health care status or use patterns of Wisconsin migrant workers, although housing and sanitary conditions in the work environment improved somewhat due to the passage of new federal regulations. This article discusses the problems and barriers that migrants continue to face and offers recommendations for government action.
Myth and Reality in the Rural Health Service Crisis: Facing Up to Community Responsibilities
Authors: Amundson Bruce
Published: April 2008

Abstract Rural communities, rural advocacy organizations, and policy makers persist in perpetuating two serious but related misconceptions, namely: (1) The continuing deterioration of health services in most rural communities is primarily the result of forces and factors outside of the communities themselves, and (2) the solution to reverse this deterioration will come mainly from changes in reimbursement and other types of public policy initiatives. Overemphasis on the role of external factors has created a serious imbalance in programs, resources, and policy efforts, including those supported by the NRHA, resulting in inadequate national efforts and resources to foster community‐based solutions. Suggested solutions include: (1) application by communities of a proven set of principles for organizing and developing local health services, and (2) creation of a national network to promote suck community‐based solutions.
Hardiness as a Mediator of the Effects of Stressors and Strains on Reported Illnesses and Relational Difficulties in Farm and Ranch Families
Authors: Carson David K. , Araquistain Mary , Ide Bette , Quoss Bernita , Jansa Nancy , Weigel Randy
Published: April 2008

Abstract: A greater understanding of the health‐protective and ‐promotive aspects of family hardiness may assist health professionals in preventing some illnesses or relational problems or in lessening their effects on the family. Farm and ranch families may be at particular risk due to their unique stressors and strains, including social and geographic isolation, unstable incomes, lack of or distance from community resources, and, perhaps, societal stereotypes that support the notion that these families have fewer stresses and problems than urban families. This study tested three path models focusing on the direct and indirect effects of stressors (i.e., life changes) and strains (daily frustrations), in relation to physical illness and relational difficulties (family discord and distress) reported by 188 farm and ranch husbands and wives. Three dimensions of family hardiness served as intervening variables: commitment, challenge, and control. A series of multiple regression analyses revealed that family stressors and strains unique to farming and ranching were strongly predictive of reported family illnesses, discord, and distress. Although the buffering effects of family hardiness in relation to reported illness were minimal, the hardiness dimension of challenge did have a strong mediating influence on reported family discord. In addition, the commitment and control dimensions had mediating effects on family distress. The results suggest that while stressors and strains unique to farming and ranching can have negative outcomes, hardier families may be more apt to respond to stress as challenging and growth producing rather than as debilitating.
Children with Special Health Care Needs Program: Urban/Rural Comparisons
Authors: Jr. Robert M. Saywell , Zollinger Terrell W. , Schafer Mark E. , Schmit Troy M. , Ladd James K.
Published: April 2008

Abstract: The purposes of this study were to: (1) describe both the urban and rural clients who received services from the Indiana Children with Special Health Care Needs program (CSHCN) including both demographic and clinical characteristics; (2) conduct a health care needs assessment of the CSHCN program clients in both urban and rural areas; and (3) measure the perceived quality and adequacy of the CSHCN program services.

A survey instrument was developed and mailed to all 6,459 families who participated in the Indiana CSHCN program from July 1,1990 to June 30,1992. Of the 2,722 questionnaires used in the analysis, 1,624 clients (59.7%) resided in urban counties and 2,098 (40.3%) resided in rural counties.

The most frequently noted conditions for program eligibility were asthma, ear infections, hearing impairments, heart defects, and convulsions and seizures. Asthma had greater prevalence among the urban clients while cleft lip/palate, epilepsy, and heart defects were more common among the rural clients.

The majority of program clients perceived their medical needs as being met. However, significant numbers of clients perceived unmet needs for mental health services, support groups, information about community services, resources to pay for uncovered medical expenses, and respite care. Of the 23 listed services, five were reported at significantly lower rates by rural clients as not being met: regular medical care, recreation, child care/day care, parent support group services, and speech therapy.

Quality of medical services was generally perceived as being “excellent or good,” while services related to information about community programs, child's rights in school, resources available to pay for uncovered medical expenses, as well as communication between the treatment center and the child's school were more often rated as “fair or poor.” A smaller proportion of rural clients rated physician care and availability of staff nurses as fair or poor. A larger percentage of the rural group reported that access to treatment center location was fair or poor, compared to the urban group.

Overall, the evaluation of the Indiana CSHCN program has shown that the non‐medical care component seems to be in need of change, especially in the area of information and communication. Attention needs to be focused on providing more family support such as respite or child care and support groups, better information and communications, and improved availability of mental health services to better enable the CSHCN program to meet its objectives.
Rural Hospital Inpatient Surgical Volume: Cutting‐edge Service or Operating on the Margin?
Authors: Williamson Harold A. , Hart L. Gary , Pirani Michael J. , Rosenblatt Roger A.
Published: April 2008

Surgical services are an important part of modern health care, but providing them to isolated rural citizens is especially difficult. Public policy initiatives could influence the supply, training, and distribution of surgeons, much as they have for rural primary care providers. However, so little is known about the proper distribution of surgeons, their contribution to rural health care, and the safety of rural surgery that policy cannot be shaped with confidence. This study examined the volume and complexity of inpatient surgery in rural Washington state as a first step toward a better understanding of the current status of rural surgical services.

Information about rural surgical providers was obtained through telephone interviews with administrators at Washington's 42 rural hospitals. The Washington State Department of Health's Commission Hospital Abstract Recording System (CHARS) data provided a count of the annual surgical admissions at rural hospitals. Diagnosis‐related group (DRG) weights were used to measure complexity of rural surgical cases.

Surgical volume varied greatly among hospitals, even among those with a similar mix of surgical providers. Many hospitals provided a limited set of basic surgical services, while some performed more complex procedures. None of these rural hospitals could be considered high volume when compared to volumes at Seattle hospitals or to research reference criteria that have assessed volume‐outcome relationships for surgical procedures. Several hospitals had very low volumes for some complex procedures, raising a question about the safety of performing them.

The leaders of small rural hospitals must recognize not only the fiscal and service benefits of surgical services–and these are considerable–but also the potentially adverse effect of low surgical volume on patient outcomes. Policies that encourage the proper training and distribution of surgeons, the retention of basic rural surgical services, and the rational regionalization of complex surgery are likely to enhance the convenience and safety of surgery for rural citizens.
Urban/Rural Differences in Prosthetic Dental Service Rates
Authors: Bader James D. , Scurria Mark S. , Shugars Daniel A.
Published: April 2008

There have been few reports of relative rates of provision of dental health services in rural and urban settings, a comparative measure of access to care in these populations. One part of a statewide survey of active North Carolina general dentists (n=959, response rate=47%) was designed to quantify provision of prosthetic services. To determine contrasting rural and urban rates, responses were analyzed according to dentists’self‐report of practice city size using analysis of covariance with percent of insured patients in the practice as the covariate. Mean per‐patient‐visit rates for crowns, fixed partial dentures, removable partial dentures, and extractions, as well as the distributions of treatment following tooth extraction, differed by city size, with practitioners in the smallest cities reporting treatment distributions reflecting more frequent loss of teeth and less frequent replacement. These differences in patterns of prosthetic care echo the limited existing information describing oral health status, provider supply, and receipt of care, all of which suggest that differential levels of access to care exist and lead to differences in oral health outcomes.
Contracting for Emergency Room Coverage by Rural Hospitals
Authors: Wakefield Douglas S. , Tracy Roger , Myer Mark , Wallace Robert
Published: April 2008

Obtaining adequate physician availability remains a challenge to many rural communities. To ensure 24‐hour emergency room physician coverage, many rural hospitals contracted for emergency room services from out‐of‐area and/or local physician. Survey findings for 99 rural and rural referral Iowa hospitals addressing the nature, extent, and cost of contracting physician coverage of the emergency room are presented. While nearly two‐thirds of the hospitals reported contracting for at least some emergency room coverage, the extent and costs of contracts vary widely. Advantages and disadvantages of contracting for emergency room services are discussed.
The Health of Rural Homeless Women with Young Children
Authors: Wagner Janet D. , Menke Edna M. , Ciccone Janet K.
Published: April 2008

More than 30 percent of the homeless are families with children; however, little is known about these families, particularly rural homeless mothers with children. The purpose of this study was to describe the characteristics of rural homeless mothers, their physical and mental health, and their health care practices. A descriptive cross‐sectional design was used to study a sample of 76 rural mothers with children younger than age 13. An interview schedule and the SCL‐90‐R were used to collect data about these families. The majority of the families had been homeless for more than four months, 46 percent were woman‐headed, 17 percent of the mothers reported having a physical health problem, and only 3 percent had scores on the SCL‐90‐R that were indicative of needing additional evaluation for possible mental health problems. The use of drugs was higher than expected, which puts both the mothers and their children at risk for health problems.
A Strategy to Increase the Number of Urban Family Practice Resident Physicians Who Enter Rural Practice
Authors: Foley Anthony E.
Published: April 2008

Physician geographic maldistribution is a problem in the United States health care system. Innovative strategies are needed to entice resident family physicians training in the larger, more numerous suburban and urban training programs to practice in rural areas upon completing their training. This paper describes a strategy used at St. Elizabeth Medical Center Family Practice Residency Program, Dayton, OH, to encourage rural practice. In the St. Elizabeth plan, the interested family practice resident moonlights in a rural practice provided by the local county hospital. The county medical staff covers the resident physician's practice during the frequent absences. The residency program faculty provide on‐site supervision, telephone back‐up coverage, and practice consultation. The county hospital provides billing services; the resident physician retains 100 percent of collections. The resident physician gains exposure to the knowledge, skills, and attitudes needed in rural practice. Upon completion of residency training, the physician remains in practice and is not required to pay back any expenses incurred by the hospital. Two resident physicians participate currently; three others have expressed interest in practicing in the community. A similar plan might work in parts of the United States where, like Ohio, training programs and rural communities are not far apart.
Impact of New Information Technologies on Training and Continuing Education for Rural Health Professionals
Authors: Crandall Lee A. , Coggan Janet M.
Published: April 2008

Recently developed and emerging information and communications technologies offer the potential to move the clinical training of physicians and other health professionals away from the resource intensive urban academic health center, with its emphasis on tertiary care, and into rural settings that may be better able to place emphasis on the production of badly needed primary care providers. These same technologies also offer myriad opportunities to enhance the continuing education of health professionals in rural settings. This article explores the effect of new technologies for rural tele‐education by briefly reviewing the effect of technology on health professionals’education, describing ongoing applications of tele‐education, and discussing the likely effect of new technological developments on the future of tele‐education. Tele‐education has tremendous potential for improving the health care of rural Americans, and policy‐makers must direct resources to its priority development in rural communities.
Bypassing of Local Hospitals by Rural Medicare Beneficiaries
Authors: Buczko William
Published: April 2008

Several previous studies of hospital utilization by nonelderly rural residents suggest that local rural hospitals have been increasingly bypassed, often for care in urban hospitals. This resulted in lost volume for rural hospitals, detracting from their financial viability. It is not clear to what extent elderly rural residents also bypass local hospitals and whether this reflects regionalization of treatment for some conditions or avoidance of local hospitals assumed to provide inadequate care.

This study examines hospital use by aged rural Delaware Medicare beneficiaries living in a ZIP code area that has a local hospital during Fiscal Year (FY) 1987 (N=670). Most of these Medicare beneficiaries were hospitalized locally. Those beneficiaries who bypassed local rural hospitals usually did so because cardiovascular surgical procedures were required and were often only performed in large urban teaching hospitals. Beneficiaries using nonlocal hospitals were similar to users of local hospitals with respect to age and sex and traveled an average of nearly 42 miles for treatment. “Bypassing” here appears to be due primarily to regional specialization of care rather than abandonment of local rural hospitals by rural residents.
To Stay or Not to Stay: Issues in Rural Primary Care Physician Retention in Eastern Kentucky
Authors: Cutchin Malcolm P. , Norton James C. , Quan Mae Marie , Bolt David , Hughes Sarah , Lindeman Barry
Published: April 2008

An important aspect of primary care physician availability is the retention of physicians once they have located. While retention has been under‐researched compared to recruitment, it is especially important in rural areas where physician shortages already exist. This study reports the results of a retention survey completed by 132 primary care physicians in rural eastern Kentucky. The survey sets up an objective, hypothetical retention scenario and asks physicians to respond to structured questions and to an open‐ended question about factors not appearing in the survey. In response to the structured portion of the survey, physicians indicate that relief coverage is the most important factor in rural physician retention. A content analysis of 75 open‐ended responses reveals that besides the other factors in the survey, “socio‐cultural integration” is the pre‐eminent retention issue for rural practitioners. This article concludes that the role of the local rural community may be more important in retention than in recruitment. Finally, it is suggested that additional in‐depth qualitative research be conducted within the local contexts to enhance the understanding of rural physician retention processes.
Graduates' Reflections on Their Rural Medical Education: The Upper Peninsula Campus Experience
Authors: Sesney John W. , Kreher Nancy E. , Potts Michael J.
Published: April 2008

A comprehensive graduate evaluation study was conducted by the Upper Peninsula campus of Michigan State University's College of Human Medicine in 1990. The purpose of this qualitative study was to describe the effects of the program's philosophy, curriculum, and general operational features on the 56 physician graduates from the program during 1978‐1989. All practicing graduates were interviewed in their practice locations and residents were interviewed by telephone. Forty‐six percent of the upper peninsula graduates are practicing in primary care specialities (family practice, general pediatrics, general internal medicine) and 41 percent are living in cities of less than 50,000 population. The overall findings identify several factors that were significant to the graduates, such as excellent role models, problem‐focused curriculum, and early applied clinical work in an ambulatory, primary care, rural setting. Based on the data, the program attracts students who are satisfied with its innovative medical education.
Measuring and Evaluating the Performance of Vertically Integrated Rural Health Networks
Authors: Moscovice Ira , Christianson Jon B. , Wellever Anthony
Published: April 2008

Abstract: The grouting interest in health care networks is extraordinary given the lack of a common understanding of what networks are and what they can accomplish. The purpose of this article is to develop a conceptual approach to the study of vertically integrated rural health networks. This article provides a network typology, a framework for assessing network performance, and examples of measurable performance indicators. It concludes with a description of the salient research questions that need to be addressed concerning the relationships between the environment, structure, and performance of vertically integrated rural health networks.