An empirical comparison of rural and urban safety-net hospitals

This study compares the characteristics of rural hospitals with urban safety-net hospitals and with "other urban hospitals" (non-teaching, non-safety-net urban hospitals that provide mainstream care in the United States). The objective is to examine if there are similarities between rural and urban safety-net hospitals, both of which serve underserved populations. The authors also wish to study if there are areas in which rural and urban safety-net hospitals are closer together compared to "other" urban hospitals. Based on the results, some potential areas of cooperation between rural and urban safety-net hospitals are discussed.     

福建省城乡卫生院业务运行比较

目的：为了解福建省城市农村基层卫生院现阶段业务运行情况及其影响因素。方法：在福建省各地区随机抽取67个城市和农村基层卫生院，调查其1999年的年门诊次数、年住院人次、年业务收入等项目。结果：不同地区的卫生院业务运行情况有所差别，高职称卫生技术人才是影响卫生院业务运行的重要因素。结论：改变卫生院的卫生服务模式和提高服务能力，加强卫生技术人才的引进和培养是卫生院生存和发展的关键。     

A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States.

OBJECTIVE: Two recent Institute of Medicine reports highlight that the quality of healthcare in the US is less than what should be expected from the world's most extensive and expensive healthcare system. This may be especially true for critical access hospitals since these smaller rural-based hospitals often have fewer resources and less funding than larger urban hospitals. The purpose of this paper was to compare quality of hospital care provided in urban acute care hospitals to that provided in rural critical access hospitals. DESIGN: Cross-sectional study analyzing secondary Hospital Compare data. T-test statistics were computed on weighted data to ascertain if differences were statistically significant (P=0.01). SETTING: Centers for Medicare and Medicaid Services hospitals. PARTICIPANTS: US Acute Care and Critical Access hospitals. MAIN OUTCOME MEASURES: Differences between urban acute care hospitals and rural critical access hospitals on quality care indicators related to acute myocardial infarction, heart failure and pneumonia. RESULTS: For 8 of the 12 hospital quality indicators the differences between urban acute care and rural critical access hospitals were statistically significant (P=0.01). In seven instances these differences favored urban hospitals. One indicator related to pneumonia favored rural hospitals CONCLUSIONS: Although this study focused on only three disease states, these are among the most common clinical conditions encountered in inpatient settings. The findings suggested that there may be differences in quality in rural critical access hospitals and urban acute care hospitals and support the need for future studies addressing disparities between urban acute care and rural critical access hospitals.     

A comparison of health inequalities in urban and rural Scotland

Previous research suggests that there are significant differences in health between urban and rural areas. Health inequalities between the deprived and affluent in Scotland have been rising over time. The aim of this study was to examine health inequalities between deprived and affluent areas of Scotland for differing ruralities and look at how these have changed over time. Postcode sectors in Scotland were ranked by deprivation and the 20% most affluent and 20% most deprived areas were found using the Carstairs indicator and male unemployment. Scotland was then split into 4 rurality types. Ratios of health status between the most deprived and most affluent areas were investigated using all cause mortality for the Scottish population, 1979-2001. These were calculated over time for 1979-1983, 1989-1993, 1998-2001. Multilevel Poisson modelling was carried out for all of Scotland excluding Grampian to assess inequalities in the population. There was an increase in inequalities between 1981 and 2001, which was greatest in remote rural Scotland for both males and females; however, male health inequalities remained higher in urban areas throughout this period. In 2001 female health inequalities were higher in remote rural areas than urban areas. Health inequalities amongst the elderly (age 65+) in 2001 were greater in remote rural Scotland than urban areas for both males and females.     

Small, nonteaching, and rural hospitals continue to be slow in adopting electronic health record systems

To achieve the goal of comprehensive health information record keeping and exchange among providers and patients, hospitals must have functioning electronic health record systems that contain patient demographics, care histories, lab results, and more. Using national survey data on US hospitals from 2011, the year federal incentives for the meaningful use of electronic health records began, we found that the share of hospitals with any electronic health record system increased from 15.1 percent in 2010 to 26.6 percent in 2011, and the share with a comprehensive system rose from 3.6 percent to 8.7 percent. The proportion able to meet our proxy criteria for meaningful use also rose; in 2011, 18.4 percent of hospitals had these functions in place in at least one unit and 11.2 percent had them across all clinical units. However, gaps in rates of adoption of at least a basic record system have increased substantially over the past four years based on hospital size, teaching status, and location. Small, nonteaching, and rural hospitals continue to adopt electronic health record systems more slowly than other types of hospitals. In sum, this is mixed news for policy makers, who should redouble their efforts among hospitals that appear to be moving slowly and ensure that policies do not further widen gaps in adoption. A more robust infrastructure for information exchange needs to be developed, and possibly a special program for the sizable minority of hospitals that have almost no health information technology at all.     

Trends in specialized surgical procedures at teaching and nonteaching hospitals

Teaching hospitals are the principal site of many specialized surgical procedures. The recipients of these procedures tend to be younger, male, and nonwhite and tend to reside in either the poorest or the most affluent neighborhoods. Although the numbers of these procedures performed at major teaching hospitals increased dramatically between 1989 and 1995, they accounted for only a modest proportion of hospital discharges and patient days. Concentration of specialized surgical procedures in major teaching hospitals will likely continue. This trend has implications not only for these hospitals but for health care purchasers, policymakers, medical educators, and clinical researchers as well.     

A comparison of health status between rural and urban adults

The objective of the study was to examine and compare health status between rural and urban adults. The data are from a 1993 statewide probability-based telephone survey of adult Kentuckians (n=662). Metropolitan Statistical Area (MSA) residents (n=264) and nonMSA residents (n=398) were compared using the Medical Outcomes Study, Short Form Health Survey (SF-20). Self-perceived urban (n=406) and rural (n=256) residents were also compared. Additional analyses were stratified by the age categories of 18–44, 45–64, and 65 years of age. Few differences in health status existed between rural and urban adults. However, rural elders (65 years) had significantly poorer health status than urban elders. After controlling for demographic variables in multiple regressions, rural elders had significantly poorer functioning (all p<.05) than urban elders as measured by the SF-20 subscales of a) physical functioning, b) role functioning, c) social functioning, d) general mental health, and e) general health perceptions. No differences between rural and urban residents were noted for the pain subscale. Although the health status of rural and urban adults is generally similar, the rural elderly have significantly worse health status than their urban counterparts.     

A comparison of health-risk behaviors of rural migrants with rural residents and urban residents in China

OBJECTIVE: To determine whether rural-to-urban migrants in China are more likely than rural and urban residents to engage in risk behaviors. METHODS: Comparative analysis of survey data between migrants and rural and urban residents using age standardized rate and multiple logistic regression. RESULTS: The prevalence and frequency of tobacco smoking, alcohol intoxication, and commercial sex involvement among migrants were generally lower than or equal to those among the 2 comparison groups. Gender, education, and income were associated with risk behaviors in most cases. CONCLUSION: Socioeconomic status appears to be more important than migration or residential locations in affecting risk behavior.     

县乡两级住院满意度及影响因素分析

目的 通过比较分析县乡两级农村住院患者满意度及其影响因素的相关性,寻找县乡两级医疗机构提高服务满意度的着力点。方法 采用整群随机抽样的方法,从山东省曲阜、沂源和莒县3个县抽取县级医院住院患者486例、乡镇卫生院住院患者421例进行住院服务满意度问卷调查。结果 县、乡级医疗机构住院患者总体满意度得分分别为（3.37±0.70）、（3.18±0.65）分,县级高于乡镇级,差异有统计学意义（P<0.01）;县级医疗机构住院患者对基本环境、服务流程、治疗效果的满意度得分分别为（3.69±0.68）、（3.81±0.61）、（3.75±0.62）分,均高于乡镇级的（3.41±0.61）、（3.47±0.60）、（3.57±0.60）分,差异均有统计学意义（P<0.01）;乡镇卫生院住院患者仅在医药费用上的满意度[（3.92±0.60）分]高于县级[（3.19±0.70）分],差异有统计学意义（P<0.01）;县乡医疗机构在病情解释、服务态度上的评价差异无统计学意义（P>0.05）。年龄、医疗总费用、个人支付金额、住院天数与县乡两级的总体满意度均呈负相关;文化程度、机构能力各因素与县乡两级的总体满意度均呈正相关。结论 加强乡镇卫生院的机构能力建设,降低县级医疗机构的就医费用是当前提高农村住院患者满意度的优先措施。     

Responses to AIDS: large urban and small rural hospitals

This study examines the assumptions that large urban hospitals will differ strikingly from small rural hospitals in their experience with AIDS patients, the staff-related problems caused by AIDS patients, and the administrative actions undertaken by the hospital in response. Results from a national stratified random sample of U.S. hospitals showed that by mid-1989 nearly all large urban hospitals had admitted AIDS patients, while only one-quarter of small rural hospitals had done so. Yet, over three-quarters of small rural hospitals have already adopted administrative policies about HIV testing of patients, and the contents of such policies differ little from those adopted by large urban hospitals. Despite similarity in official administrative responses, attitudinal differences exist. Staff fears of contagion and attitudes about isolation of HIV-positive patients are more evident in small rural hospitals; yet, recruitment difficulties triggered by staff concerns are greater in large urban hospitals.     

对统筹城乡卫生资源有关问题的思考

公平合理配置卫生资源是卫生改革与发展的重要目标之一。统筹城乡卫生资源，要充分考虑各方面的因素，积极稳妥地进行。一要按照职能任务，确立配置标准；二要全面认识问题，承认合理差距；三要把握配置重点，城乡整体发展；四要随着政策完善，逐步缩小差距。     

Determinants of the uncompensated care burden of rural and urban hospitals in Florida.

It has been projected that over the next decade as many as 700 hospitals will close due to financial pressures created at least in part by the problem of uncompensated care. Many analysts contend that smaller, rural hospitals will be disproportionately represented among those which close. This investigation uses data collected from over 14,000 inpatient records from 130 representative hospitals in Florida to examine the degree to which rural hospitals experience an uncompensated care problem which differs in source, or magnitude, from that experienced by urban institutions. The analyses show that 150 days following the provision of service, the mean per capita outstanding amount was $18 higher for patients seen in rural hospitals than those seen in urban hospitals. Further, the odds of a rural hospital patient having some outstanding balance 150 days after service had been rendered ranged from 1.2 to 1.3 times those for patients seen in urban hospitals. The location difference is not eliminated by controlling for sociodemographic differences of the patients or the circumstances surrounding the type and/or source of admission. The single most important predictor of having outstanding hospital charges is possession of health insurance. Patients with no coverage are 38.6 times more likely to have some nonzero outstanding balance than patients with some form of insurance coverage. After controlling for sociodemographic, economic, and circumstances surrounding admission, the odds increase from 38.6 to 73.6. The critical role played by insurance is further evidenced by noting that the odds of someone with third party insurance coverage having an unresolved amount greater than or equal to $250 is only .024 and only slightly higher (.048) for government coverage.