Advertisement

Surgical Quality and Patient Safety in Rural Settings

  • Amy L. Halverson
  • Julie K. Johnson
Chapter

Abstract

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.

Keywords

Rural surgery Critical Access Hospital Regionalization Patient access Surgical quality Rural community 

References

  1. 1.
    Mahler H. Surgery and health for all. http://www.who.int/surgery/strategies/Mahler1980speech.pdf?ua=1. Updated 1980. Accessed 23 Feb 2016.
  2. 2.
    Bae JY, Groen RS, Kushner AL. Surgery as a public health intervention: common misconceptions versus the truth. Bull World Health Organ. 2011;89(6):394. doi: 10.2471/BLT.11.088229.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Botman M, Meester RJ, Voorhoeve R, et al. The Amsterdam declaration on essential surgical care. World J Surg. 2015;39(6):1335–40. doi: 10.1007/s00268-015-3057-x.CrossRefPubMedGoogle Scholar
  4. 4.
    Lynge DC, Larson EH. Workforce issues in rural surgery. Surg Clin North Am. 2009;89(6):1285–91. doi: 10.1016/j.suc.2009.07.003. vii.CrossRefPubMedGoogle Scholar
  5. 5.
    Thompson MJ, Lynge DC, Larson EH, Tachawachira P, Hart LG. Characterizing the general surgery workforce in rural America. Arch Surg. 2005;140(1):74–9. doi: 140/1/74 [pii].CrossRefPubMedGoogle Scholar
  6. 6.
    Nakayama DK, Hughes TG. Issues that face rural surgery in the United States. J Am Coll Surg. 2014;219(4):814–8. doi: 10.1016/j.jamcollsurg.2014.03.056.CrossRefPubMedGoogle Scholar
  7. 7.
    Rural urban commuting area codes (RUCA) data: travel distance and time, remote, isolated, and frontier. WWAMI Rural Health Research Center Web site. http://depts.washington.edu/uwruca/ruca-travel-dist.php. Accessed 17 Mar 2016.
  8. 8.
    Casey M, Hung P, Moscovice I. Critical access hospital year 8 hospital compare participation and quality measure results. http://www.flexmonitoring.org/publications/bp33/. Updated 2013. Accessed 23 Mar 2016.
  9. 9.
    Location of critical access hospitals. http://www.flexmonitoring.org/wp-content/uploads/2013/06/CAH_031816.pdf. Updated 2016. Accessed 24 Mar 2016.
  10. 10.
    Reiter KL, Noles M, Pink GH. Uncompensated care burden may mean financial vulnerability for rural hospitals in states that did not expand Medicaid. Health Aff (Millwood). 2015;34(10):1721–9. doi: 10.1377/hlthaff.2014.1340.CrossRefGoogle Scholar
  11. 11.
    Silber JH, et al. Anesthesiologist direction and patient outcomes. Anesthesiology. 2000;93(1):152–63.CrossRefPubMedGoogle Scholar
  12. 12.
    Sticca RP, Mullin BC, Harris JD, Hosford CC. Surgical specialty procedures in rural surgery practices: implications for rural surgery training. Am J Surg. 2012;204(6):1007–12. doi: 10.1016/j.amjsurg.2012.05.023. discussion 1012-3.CrossRefPubMedGoogle Scholar
  13. 13.
    Galandiuk S, Mahid SS, Polk Jr HC, Turina M, Rao M, Lewis JN. Differences and similarities between rural and urban operations. Surgery. 2006;140(4):589–96. S0039-6060(06)00418-1 [pii].CrossRefPubMedGoogle Scholar
  14. 14.
    VanBibber M, Zuckerman RS, Finlayson SR. Rural versus urban inpatient case-mix differences in the US. J Am Coll Surg. 2006;203(6):812–6. S1072-7515(06)01158-6 [pii].CrossRefPubMedGoogle Scholar
  15. 15.
    Gillman LM, Vergis A. General surgery graduates may be ill prepared to enter rural or community surgical practice. Am J Surg. 2013;205(6):752–7. doi: 10.1016/j.amjsurg.2012.01.017.CrossRefPubMedGoogle Scholar
  16. 16.
    Cogbill TH, Cofer JB, Jarman BT. Contemporary issues in rural surgery. Curr Probl Surg. 2012;49(5):263–318. doi: 10.1067/j.cpsurg.2012.01.002.CrossRefPubMedGoogle Scholar
  17. 17.
    Grzybowski S, Kornelsen J, Prinsloo L, Kilpatrick N, Wollard R. Professional isolation in small rural surgical programs: the need for a virtual department of operative care. Can J Rural Med. 2011;16(3):103–5.PubMedGoogle Scholar
  18. 18.
    Caropreso P. ACS rural listserv: an “underdog” success story. Bull Am Coll Surg. 2014;99(7):48–51.PubMedGoogle Scholar
  19. 19.
    Halverson AL, Hughes TG, Borgstrom DC, Sachdeva AK, DaRosa DA, Hoyt DB. What surgical skills rural surgeons need to master. J Am Coll Surg. 2013;217(5):919–23. doi: 10.1016/j.jamcollsurg.2013.07.001.CrossRefPubMedGoogle Scholar
  20. 20.
    Halverson AL, DaRosa DA, Borgstrom DC, et al. Evaluation of a blended learning surgical skills course for rural surgeons. Am J Surg. 2014;208(1):136–42. doi: 10.1016/j.amjsurg.2013.12.039.CrossRefPubMedGoogle Scholar
  21. 21.
    Hesselink G, Schoonhoven L, Barach P, Spijker A, Gademan P, Kalkman C, Liefers J, Vernooij- Dassen M, Wollersheim W. Improving patient handovers from hospital to primary care. A systematic review. Ann Intern Med. 2012;157(6):417–28.CrossRefPubMedGoogle Scholar
  22. 22.
    Casey MM, Moscovice I, Klingner J, Prasad S. Rural relevant quality measures for critical access hospitals. J Rural Health. 2013;29(2):159–71. doi: 10.1111/j.1748-0361.2012.00420.x.CrossRefPubMedGoogle Scholar
  23. 23.
    Joynt KE, Orav EJ, Jha AK. Mortality rates for Medicare beneficiaries admitted to critical access and non-critical access hospitals, 2002-2010. JAMA. 2013;309(13):1379–87. doi: 10.1001/jama.2013.2366.CrossRefPubMedGoogle Scholar
  24. 24.
    Gadzinski AJ, Dimick JB, Ye Z, Miller DC. Utilization and outcomes of inpatient surgical care at critical access hospitals in the United States. JAMA Surg. 2013;148(7):589–96. doi: 10.1001/jamasurg.2013.1224.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Natafgi N, Baloh J, Weigel P, Ullrich F, Ward MM. Surgical patient safety outcomes in critical access hospitals: how do they compare? J Rural Health. 2016. doi: 10.1111/jrh.12176.PubMedGoogle Scholar
  26. 26.
    Finlayson SR. Assessing and improving the quality of surgical care in rural America. Surg Clin North Am. 2009;89(6):1373–81. doi: 10.1016/j.suc.2009.09.013. x.CrossRefPubMedGoogle Scholar
  27. 27.
    Bolin JN, Bellamy GR, Ferdinand AO, et al. Rural healthy people 2020: new decade, same challenges. J Rural Health. 2015;31(3):326–33. doi: 10.1111/jrh.12116.CrossRefPubMedGoogle Scholar
  28. 28.
    Maruthappu M, Gilbert BJ, El-Harasis MA, et al. The influence of volume and experience on individual surgical performance: a systematic review. Ann Surg. 2015;261(4):642–7. doi: 10.1097/SLA.0000000000000852.CrossRefPubMedGoogle Scholar
  29. 29.
    Markin A, Habermann EB, Chow CJ, Zhu Y, Vickers SM, Al-Refaie WB. Rurality and cancer surgery in the United States. Am J Surg. 2012;204(5):569–73. doi: 10.1016/j.amjsurg.2012.07.012.CrossRefPubMedGoogle Scholar
  30. 30.
    Chow CJ, Al-Refaie WB, Abraham A, et al. Does patient rurality predict quality colon cancer care?: a population-based study. Dis Colon Rectum. 2015;58(4):415–22. doi: 10.1097/DCR.0000000000000173.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Finlayson SR, Birkmeyer JD, Tosteson AN, Nease Jr RF. Patient preferences for location of care: implications for regionalization. Med Care. 1999;37(2):204–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Nostedt MC, McKay AM, Hochman DJ, et al. The location of surgical care for rural patients with rectal cancer: patterns of treatment and patient perspectives. Can J Surg. 2014;57(6):398–404. doi: 10.1503/cjs.002514.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Tai WC, Porell FW, Adams EK. Hospital choice of rural Medicare beneficiaries: patient, hospital attributes, and the patient–physician relationship. Health Serv Res. 2004;39(6p1):1903–22. 10.1111/j.1475-6773.2004.00324.x.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Adams EK, Wright GE. Hospital choice of Medicare beneficiaries in a rural market: why not the closest? J Rural Health. 1991;7:134 (- 0890-765X (Print); - 0890-765X (Linking)).CrossRefPubMedGoogle Scholar
  35. 35.
    Coulter SL, Jones SG, Payne Carden J. Patterns of care in Tennessee: use of rural vs. non-rural facilities. 2012.Google Scholar
  36. 36.
    Doty B, Heneghan SJ, Zuckerman R. General surgery contributes to the financial health of rural hospitals and communities. Surg Clin North Am. 2009;89(6):1383–7, x–xi. doi:10.1016/j.suc.2009.07.008.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Section of Colon and Rectal Surgery, Northwestern MedicineNorthwestern UniversityChicagoUSA
  2. 2.Department of Surgery, Center for Healthcare StudiesInstitute for Public Health and Medicine, Feinberg School of Medicine, Northwestern UniversityChicagoUSA

Personalised recommendations