There has been much needed attention regarding access to surgical care in resource-poor countries, however, there are also millions of individuals in the USA who lack access to surgical services. Twenty to 25 % of US citizens reside in rural areas but only 10–15 % of physicians practice in these areas. The relative lack of surgeons in rural areas is expected to worsen over the next decade as rural surgeons currently in practice retire.
A successful rural health care network relies on rural hospitals to provide readily accessible, high-quality care. Additionally, there must be established, formal relationships between small rural hospitals and regional hospitals to facilitate the transfer of patients when they require a higher level of care. Considering the effectiveness of a health network raises this issue of how to measure quality, safety, and value of surgical care provided at rural hospitals.
This chapter discusses the implications of surgical programs in rural USA, how rural hospitals and Critical Access Hospitals are defined, challenges facing rural surgeons, and how patients living in rural communities make decisions about seeking surgical care. We discuss rural hospitals as a system, including issues facing rural hospitals concerning regionalization of surgical programs and measures of quality and value. We conclude with a series of potential research questions that could help us better understand the role, vitality, and context of rural surgical health care.
Rural surgery Critical Access Hospital Regionalization Patient access Surgical quality Rural community
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