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
This is a preview of subscription content, log in to check access
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
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
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
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
Caropreso P. ACS rural listserv: an “underdog” success story. Bull Am Coll Surg. 2014;99(7):48–51.PubMedGoogle Scholar
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
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
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
Coulter SL, Jones SG, Payne Carden J. Patterns of care in Tennessee: use of rural vs. non-rural facilities. 2012.Google Scholar
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