bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dementing Illnesses in Rural Populations: The Need for Research and Challenges Confronting Investigators
Authors: Keefover Robert W. , Rankin Eric D. , Keyl Penelope M. , Wells Jane C. , Martin Joye , Shaw Jennifer 
Published: April 2008

Abstract: Expansion of the world's elderly populations has increased concerns about aging‐related medical disorders like Alzheimer's disease and other dementias. In the United States, one fourth of those older than age 65 and at greatest risk for developing dementia live in rural environments that may influence its manifestation. The objectives of this study were to determine the need for and potential benefits of further epidemiological research concerning dementia and similar disorders in rural U.S. populations and to identify pertinent methodological issues related to rural dementia research. This study employed a National Library of Medicine (MEDLINE) document search based on the key words “cognitive disorders,”“dementia,”“Alzheimer's disease,” and “rural,” followed by recovery of literature resources referenced in the bibliographies of selected articles.Nineteen studies focusing on dementia or related disorders in rural settings have been reported from around the world. While four of these were conducted in the United States, only one rural dementia prevalence study has been undertaken in this country. Because of methodological variability, comparisons of prevalence estimates between these rural studies, as well as with those from urban investigations, is difficult. Nonetheless, there is reason to believe that certain potentially dementing illnesses are more common in rural populations. There is also evidence to suggest that the screening instruments commonly used in such studies tend to misclassify rural elders as “false positive” dementia cases.Information regarding dementing disorders, particularly Alzheimer's disease, in rural populations is scarce. Preliminary observations that dementia may be more common in rural settings and that rural families are more likely to maintain their dementing elders in the community imply that further rural dementia research could yield important insights into the risk factors for these illnesses, the variables influencing their course, and the methods by which they can be more effectively managed. A determination of the reliability and validity of commonly used dementia screening instruments in rural populations would represent an important advancement in this area of research.
Rural Physician Satisfaction: Its Sources and Relationship to Retention
Authors: Pathman Donald E. , Williams Eric S. , Konrad Thomas R. 
Published: April 2008

Abstract:This study uses survey data to identify areas of satisfaction and dissatisfaction for primary care physicians working in rural areas across the country. It also identifies the specific areas of satisfaction associated with longer retention within a given rural practice, as well as the characteristics of individuals, practices, jobs, and communities associated with the areas of satisfaction that predict retention.Study subjects comprised a sample of 1,600 primary care physicians who moved to nonmetropolitan counties nationwide during the years 1987 through 1990, with oversampling of those who moved to federally designated health professional shortage areas (HPSAs). Physicians serving in the National Health Service Corps (NHSC) were excluded. Sixty‐nine percent of the eligible subjects returned completed mail questionnaires in 1991. Analyses for this study were limited to the 620 primary care physicians who worked more than 20 hours per week in towns of fewer than 35,000 population; who were neither in the military nor the NHSC; and who were not in urgent care, emergency room, or full‐time teaching positions.Analyses revealed that the areas of rural physicians' greatest satisfaction were their relationships with patients, clinical autonomy, the care they provided to medically needy patients, and life in small communities. Physicians were least satisfied with their access to urban amenities and the amount of time they spent away from their practices. Retention was independently associated only with physicians' satisfaction with their communities and their opportunities to achieve professional goals. Retention was also marginally related to physicians' satisfaction with their earnings. Among the areas of satisfaction not related to retention were satisfaction with autonomy, access to medical information and consultants, and the quality of doctor‐patient relationships. In a subsequent series of analyses of the factors that predict the three areas of satisfaction that were associated with retention (satisfaction with the community, professional goal attainment, and earnings), a variety of physician, work, and community factors were identified.These findings reveal that specific features of rural physicians, their work, and their communities predict each of the various aspects of satisfaction and that only certain aspects of satisfaction predict rural physicians' retention. There are no magic bullets to make rural physicians satisfied in all ways. Nevertheless, there are identified approaches to elevate the specific aspects of rural physicians' satisfaction important to their retention. Programs to improve the satisfaction of rural physicians should focus on those areas of satisfaction that predict longer retention and other important outcomes.
United Health Care of North Carolina
Authors: Casey Michelle , Wellever Anthony 
Published: April 2008

SummaryPhysicians. While many of the rural physicians interviewed in North Carolina would prefer not to deal with HMOs at all, they are generally positive about their relationships with United Healthcare of North Carolina. These physicians chose to contract with the HMO to obtain new patients and to retain existing patients. They are satisfied that their participation has accomplished these goals. Their reimbursement arrangements are easy to understand, and most view the payment amounts as satisfactory. The physicians regard the size of the HMOs provider network and the open‐access structure of the HMO as positive features that allow them to make referrals without the restrictions imposed by some other HMOs.To date, participation in United Healthcare of North Carolina has imposed few burdens on rural physicians. They are reimbursed on a fee‐for‐service basis, and their financial risk has been limited. They do not perceive that the HMO has had a significant impact on the way they practice medicine. This situation may change in the future if enrollees from United Healthcare of North Carolina and other HMOs constitute a greater proportion of their practices and if these HMOs move toward capitated reimbursement. The attitudes of rural physicians toward United Healthcare of North Carolina also may change if the HMO attempts to more actively manage the care provided to its enrollees.United Healthcare of North Carolina plans to eliminate physician risk sharing (in the form of withholds) and replace it with bonus payments. As one HMO executive said, the plan wants to “put incentives where they belong.” If rewarding good performance instead of punishing poor performance yields intended consequences, it may provide United Healthcare of North Carolina with a competitive advantage in rural areas. First, because such a change offers an opportunity to augment a physician's income instead of diminishing it, physicians might prefer to contract with the HMO rather than with other HMOs. Second, because bonus payments depend on performance, United Healthcare of North Carolina providers may produce outcomes that allow reductions in premium prices or expansions of benefits compared with the HMOs competitors.Hospitals. Rural hospitals cited similar motivations (attracting and retaining business) for participating in United Healthcare of North Carolina and similar levels of satisfaction with their relationships. In their experiences, the HMO has been fair in its negotiations and reimbursement. Although they contract with multiple HMOs, these rural hospitals do not perceive that HMO participation has had a significant impact on hospital operations. Because these hospitals, like many rural hospitals, rely heavily on Medicare (and, to a lesser degree, on Medicaid) as revenue sources, the future impact of managed care on their operations will depend in large part on the extent to which significant proportions of their Medicare and Medicaid patients enroll in HMOs.
Medical Associates HMO
Authors: Wellever Anthony , Christianson Jon 
Published: April 2008

SummaryMedical Associates HMO is based on a multi specialty group practice located in a small metropolitan area. That group practice regards the HMO as an important strategy for maintaining and increasing patient referrals. A substantial portion of the HMOs service area is rural; therefore, the HMOs relationships with rural providers are important because they affect its ability to attract enrollees from rural areas and, potentially, non‐HMO referrals as well. During the past few years, the competition for patients and for HMO enrollees has intensified in the HMOs market area. A major challenge facing this HMO is how to protect and enhance its market share while maintaining constructive, cordial relationships with providers in surrounding rural areas.
Rural Health Research: Rural and Urban Physicians: Does the Content of Their Medicare Practices Differ?
Authors: Baldwin Laura‐Mae , Rosenblatt Roger A. , Schneeweiss Ronald , Lishner Denise M. , Hart L. Gay 
Published: April 2008

Abstract: Rural and urban areas have significant differences in the availability of medical technology, medical practice structures and patient populations. This study uses 1994 Medicare claims data to examine whether these differences are associated with variation in the content of practice between physicians practicing in rural and urban areas. This study compared the number of patients, outpatient visits, and inpatient visits per physician in the different specialties, diagnosis clusters, patient age and sex, and procedure frequency and type for board‐certified rural and urban physicians in 12 ambulatory medical specialties. Overall, 14.4 percent of physicians in the 12 specialties practiced exclusively in rural Washington, with great variation by specialty. Rural physicians were older and less likely to be female than urban physicians. Rural physicians saw larger numbers of elderly patients and had higher volumes of outpatient visits than their urban counterparts. For all specialty groups except general surgeons and obstetrician‐gynecologists, the diagnostic scope of practice was specialty‐specific and similar for rural and urban physicians. Rural general surgeons had more visits for gastrointestinal disorders, while rural obstetrician‐gynecologists had more visits out of their specialty domain (e.g., hypertension, diabetes) than their urban counterparts. The scope of procedures for rural and urban physicians in most specialties showed more similarities than differences. While the fund of knowledge and outpatient procedural training needed by most rural and urban practitioners to care for the elderly is similar, rural general surgeons and obstetrician‐gynecologists need training outside their traditional specialty areas to optimally care for their patients.
State HMO Accreditation and External Quality Review Requirements: Implications for HMOs Serving Rural Areas
Authors: Casey Michelle 
Published: April 2008

ABSTRACT:The purpose of this article is to analyze state regulations regarding health maintenance organization (HMO) accreditation and external quality review; to briefly describe states’experiences implementing these regulations; and to discuss the implications of these regulations for HMOs serving rural areas. The incorporation of HMO accreditation and external quality review requirements into state HMO licensure processes and state employee contracting raises many policy issues, including several that are especially relevant to HMOs serving rural populations. A key issue is whether the linkage of accreditation and external quality review requirements to HMO licensure will be an additional deterrent to the development of new HMOs or the expansion of existing HMOs into rural areas. Other issues relate to the costs and benefits of accreditation for HMOs serving rural populations, and the potential impact of HMO accreditation requirements on efforts to expand managed care enrollment of rural Medicaid and Medicare beneficiaries and rural state employees. Nine states were identified that have regulations requiring HMOs to seek accreditation or to undergo an external quality review as a condition of licensure. Four states were identified as implementing requirements that an HMO be accredited in order to serve state employees. Many of these requirements are still in the early stages of implementation. Several states with the requirements have significant rural populations and will provide opportunities to evaluate their impact on HMOs serving rural areas, rural providers and rural consumers.
Rural Medicare Beneficiaries’Use of Rural and Urban Hospitals
Authors: Buczko William 
Published: April 2008

ABSTRACT:This report examines the use of rural and urban hospitals by rural Medicare beneficiaries. Many rural Medicare beneficiaries are treated in urban hospitals, primarily for specialized care that is not available locally. This study examines Medicare inpatient hospital discharge data for rural beneficiaries from fiscal year 1990 to fiscal year 1998. Utilization patterns by diagnosis‐related group (DRG) are examined for fiscal year (FY) 1997. The percentage of rural beneficiaries treated in urban hospitals ranged from 30 percent to 36 percent during the study period. For the most frequently occurring DRGs among rural beneficiaries, which were those for routine conditions, treatment occurred predominantly in rural hospitals. The conditions most often responsible for rural beneficiaries’use of urban hospitals during this period reflected the need for coronary and other specialized surgical care. The stability of volume and case‐mix throughout the study period underscores the viability of rural hospitals during a period of substantial change in the organization of health care provision.
A Survey of General Surgeons in Rural Missouri: Potential for Rapid Decrease in Work Force
Authors: Stevermer James J. , Supattanasiri G. Julia , Williamson Harold 
Published: April 2008

ABSTRACT:General surgeons have an essential role in the rural health care system. This telephone survey of 39 rural general surgeons in Missouri found that more than half were 55 or older. Most reported they practiced a broader scope of surgery than colleagues in urban areas, and half believed that current residency graduates are not prepared for surgical practice in rural areas. One‐fifth had sought special training experiences to prepare them for rural practice. On balance, 70 percent of the respondents’practices was general surgery, 13 percent “specialty surgery” and 17 percent primary care. Many reported feeling professionally isolated. One‐fourth had literally “returned home” to practice. The results suggest that if present trends continue, the next 10 years will see a substantial reduction in the number of general surgeons in rural Missouri.
Effects of Managed Mental Health Care on Service Use in Urban and Rural Maine
Authors: Hartley David 
Published: April 2008

ABSTRACTThis study takes advantage of a “natural experiment” resulting from the reassignment of all Maine state employees to a managed behavioral health plan in December 1992. By comparing mental health claims before and after that date, the effects of a behavioral health carve‐out on mental health utilization by rural and urban beneficiaries were investigated. Following the implementation of the carve‐out, the penetration rate, defined as the proportion of beneficiaries who sought help for an affective disorder, increased significantly in both rural and urban areas (P<0.001). However, the rural penetration rate remained significantly lower than the urban rate (before implementation, 25.8 vs. 52.2 users per 1,000 enrollees, P<0.001; after implementation, 57.8 vs. 85.8 users per 1,000 enrollees, P<0.001). Similarly, rural utilization rates, defined as the average number of outpatient mental health visits per user, were significantly lower than urban rates both before and after implementation of the carve‐out (before, 9.2 vs. 12.9 visits per user, P<0.001; after, 9.8 vs. 13.3 visits per user, P<0.001). Before‐after differences were not significant. In addition, the proportion of mental health care provided in the primary care setting increased after implementation of the carve‐out (from 9.5 percent of all visits before to 12.6 percent of all visits after, P<0.001). The increase in penetration rates can be attributed, in part, to a member education initiative undertaken during the transition from fee‐for‐service to managed care. This type of carve‐out arrangement does not threaten to reduce access to mental health services, provided the managed behavioral health organization (MBHO) managing the carve‐out is willing to accept primary care practitioners as part of its provider network.
Rural, Urban and Suburban Comparisons of Preventive Services in Family Practice Clinics
Authors: Pol Louis G. , Rouse Jenine , Zyzanski Stephen , Rasmussen Donadea , Crabtree Benjamin 
Published: April 2008

ABSTRACTNumerous studies have compared health services provided in rural and urban areas, and overall they have found that utilization is lower in rural areas. A significant factor in lower utilization is that rural residents have less access to health services. Much less is known about rural and urban utilization differences once a patient has access to a service provider. This paper focuses on preventive services received when a patient is already in a clinic. Using data from an in‐depth qualitative study of 16 family practice clinics in Nebraska, comparisons of physician‐specific preventive service rates are made across three geographic categories: rural, urban and suburban. Results from a one‐way multivariate analysis of variance show that preventive services rates for nine services examined were as high or higher in rural areas, suggesting that rural health services do not lag for patients with access.
The Impact of Immunization Record Aggregation on Up‐to‐date Rates–Implications for Immunization Registries in Rural Areas
Authors: Renfrew Brenda L. , Kempe Allison , Lowery N. Elaine , Chandramouli Vijayalaxmi , Steiner John E , Berman Stephen 
Published: April 2008

ABSTRACTProblems with poorly documented immunization records may be especially important in rural areas. To evaluate the potential impact of a regional registry in a rural region, this study quantified the change in documented immunization rates for nine primary care sites in rural Colorado resulting from the addition of public health department immunization clinic records. Manual chart reviews of immunization data were conducted at both private primary care and public health department sites in two geographic areas in rural Colorado. Data from private primary care sites were matched to data from the public health department sites. Immunization up‐to‐date (UTD) rates at each primary care site were then recalculated for 12‐and 24‐month‐olds after including data from public health department sites. Of 1,533 children, 469 (31 percent) were given immunizations at both a private primary care and a public health department site. The UTD rate (3:2:3:2) of 12‐month‐olds using only data from primary care sites ranged from 32 to 79 percent. Including the public health department data increased the rates by 0 to 26 percent (mean =11 percent) for 12‐month‐old children. The UTD rate of 24‐month‐olds (4:3:1:3 and any Hib on/after 12 months) ranged from 6 to 54 percent at the primary care sites. These rates increased by 6 to 22 percent (mean =12 percent) when public health department data were added. This “virtual” registry combining primary care and public health department data increased calculated immunization rates at primary care sites substantially, with a range of 0 to 26 percent.
Urban and Rural Dimensions of Global Population Aging: An Overview
Authors: Kinsella Kevin 
Published: April 2008

ABSTRACTIn keeping with the worldwide pattern of increased urbanization, the elderly population has become more concentrated in urban areas during the past 50 years. In developed countries as a whole, an estimated 73 percent of people aged 65 or over lived in urban areas in 1990, a figure that is projected to reach 80 percent by the year 2015. In developing nations, which are still predominantly rural, just over one‐third of people aged 65 or over lived in urban areas in 1990, projected to exceed one‐half by 2015. This article provides an overview of global data on urban elders, examines extant data on gender balances and migration patterns, and considers the importance of subnational urban/rural differences and whether rural elderly are disadvantaged relative to their urban counterparts.
Demographic and Health Issues in Rural Aging: A Global Perspective
Authors: Andmvs Gary R 
Published: April 2008

ABSTRACTThe world is witnessing unprecedented changes in population structure, so that both the absolute number and proportion of older people are increasing worldwide. For many developing countries, rapid population aging and the phenomenon of a “double burden” of both infectious disease and emerging chronic diseases represent a major challenge. Many of those who will contribute to these extraordinary transitions will live in rural areas. Many countries, especially the poorest, still have a huge burden of infectious diseases, including increasing rates of HIV/AIDS along with a graving problem of chronic diseases. A number of critical policy considerations come to the fore in examining issues associated with rural aging, including: the need for rural development policies that take account of population aging and the needs of older people; improved coordination and integration of public health and care services in rural areas; support for nongovernmental organizations and community group efforts; and greater use of new technologies for communication. The year 1999 was pivotal for aging in terms of perceptions, attitudes, public action, better research and knowledge, and improved policy decisions that will benefit all of society into this new century. The Second United Nations World Assembly to be held in Madrid in April 2002 will provide further opportunity to build upon this progress and in the formulation of a new International Plan of Action on Aging to point the way for decisive action on positive policy and program initiatives for the future.