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Preparing rural communities for managed care: Lessons learned

JOURNAL OF RURAL HEALTH 1999年第1期15卷 78-86页

作者： Fasciano, NJ Felt-Lisk, S Ricketts, TC Popkin, B Math Policy Res Inc Washington DC 20024 USA

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Tracking the response to the balanced budget act of 1997: Impact on medicare managed care enrollment in rural counties

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JOURNAL OF RURAL HEALTH 1999年第1期15卷 67-77页

作者： McBride, TD Mueller, KJ Univ Missouri Dept Econ St Louis MO 63121 USA

The impact of the Balanced Budget Act of 1997 on recent changes in enrollment of Medicare beneficiaries into managed care plans is examined. The Balanced Budget Act of 1997 created a ne ru payment structure for Medicare risk contracts, which, in 1998, resulted in all counties receiving either a minimum payment ol a payment with the increase restricted at 2 percent growth over the 1997 rate. Using a baseline of December 1997 and enrollment data through lune 1998, differences in early enrollment trends between urban and rural counties and between counties at various rates of payment are examined. As expected, continued enrollment increases in all counties is observed but with sol ne concerns about slow enrollment growth-and announcements of plan terminations-in counties with payment rates in the mid-range, above the floor payment but subject to the 2 percent growth. In addition, evidence of considerable changes in the benefits offered by plans and the premiums charged to beneficiaries also was observed during the first nine months of 1998. The implications for growth of managed care options in rural areas are still unclear. The floor on payments may be helpful, but constraints in payment increases and delays in implementing a blended rate can be expected to create a negative impact on decisions to market managed care plans.

关键词：卫生服务研究卫生服务使用研究 MedicareC部/立法和法学方案评价风险分担财政/统计学和数值数据乡村卫生服务/经济学乡村卫生服务/组织和管理美国人类

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A rural cancer outreach program lowers patient care costs and benefits both the rural hospitals and sponsoring academic medical center

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JOURNAL OF RURAL HEALTH 1999年第2期15卷 157-167页

作者： Desch, CE Grasso, MA McCue, MJ Buonaiuto, D Grasso, K Johantgen, MK Shaw, JE Smith, TJ Virginia Commonwealth Univ Med Coll Virginia Massey Canc Ctr Rural Canc Outreach Program Richmond VA 23298 USA Med Coll Virginia Hosp Richmond VA 23298 USA Virginia Commonwealth Univ Sch Hlth Adm Richmond VA 23298 USA Amer Soc Clin Oncol Hlth Serv Res Comm Chicago IL 60611 USA

The Rural Cancer Outreach Program (RCOP) between two rural hospitals and the Medical College of Virginia's Massey Cancer Center (MCC) was developed to bring state-of-the-art cancer care to medically underserved rural patients. The financial data were collected on 1,745 cancer patients treated at the participating centers, two rural community hospitals and the MCC. The main outcome measures were costs (estimated reimbursement from all sources), revenues, contribution margins and profit (or loss) of the program. The RCOP may have enhanced access to cancer care for rural patients at less cost to society. The net annual cost per patient fell from $10,233 to $3,862 associated with more use of outpatient services, more efficient use of resources, and the shift to a less expensive locus of care. The cost for each rural patient admitted to the Medical College of Virginia fell by more than 40 percent compared with only an 8 percent decrease for all other cancer patients. The rural hospitals experienced rapid growth of their programs to more than 200 new patients yearly, and the RCOP generated significant profits for them. MCC benefited from increased referrals from RCOP service areas by 330 percent for cancer patients during the same time period. While it did not generated enough revenue to cover costs of the program. The RCOP had a positive financial impact on the rural and academic medical center hospitals, provided state-of-the-art care near home for rural patients and was associated with lower overall cancer treatment costs.

关键词：医学科学研究中心/经济学医学科学研究中心/组织和管理社区和机构的关系/经济学费用效益分析卫生保健费用医院乡村/经济学医院乡村/组织和管理缺医地区肿瘤/治疗组织隶属关系/经济学方案评价转诊和会诊乡村卫生服务/经济学乡村卫生服务/组织和管理农村人口弗吉尼亚人类

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Delivering care to rural HIV/AIDS patients

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JOURNAL OF RURAL HEALTH 1997年第3期13卷 226-236页

作者： Topping, S Hartwig, LC UNIV SO MISSISSIPPI CTR COMMUNITY HLTHHATTIESBURGMS 39406

With HIV/AIDS on the rise in rural area, health care providers must find ways of delivering care with little or no increase in resource support. This paper examines the evolution of a rural HIV/AIDS alliance using a life cycle model to identify each stage of the alliance development and the specific issues associated with each stage. The data were collected through structured interviews and by review of background materials, including budgets, grant proposals, and program reports. The findings identify alliance strategies that can be used in other rural communities facing the challenge of serving and increasing number of HIV/AIDS patients with limited resources. Different from models, this rural HIV/AIDS alliance emerged from local government and community support into an independent, nonprofit organization operating through a network of interorganizational relationships.

关键词：获得性免疫缺陷综合征/流行病学获得性免疫缺陷综合征/治疗非洲裔美国人欧洲大陆世系人群 HIV感染/流行病学 HIV感染/治疗卫生保健联合体/组织和管理机构间关系 Medicaid 密西西比/流行病学模型组织管理组织非盈利/组织和管理规划制订农村卫生乡村卫生服务/经济学乡村卫生服务/组织和管理美国女(雌)性人类男(雄)性

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The effects of physician in-migration to rural Colorado (1992 to 1995)

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JOURNAL OF RURAL HEALTH 1997年第3期13卷 190-195页

作者： Fryer, GE Stine, C Vojir, C Miyoshi, T Miller, M UNIV COLORADO HLTH SCI CTRDEPT FAMILY MEDBOX B1551180 CLERMONTDENVERCO 80220 USA

This paper reports the results of an analysis of the American Medical Association Masterfile. The purpose of this study was to examine changes in health care accessibility in rural Colorado from 1992 to 1995, and to describe the pattern of in-migration of physicians to nonmetropolitan statistical area counties of the state during that period. The number of direct patient care providers increased from 532 to 700 (31.6%) during the three-year period vs. a growth of 11.2 percent in the general population of nonmetropolitan statistical area counties. Of the 700 physicians serving residents of Colorado's 52 rural counties, 308 (44%) had been practicing in their community since 1992. The rate of departure from nonmetropolitan statistical area practice sites in 1992 was 26.4 percent (140 of 532). Physicians new to their rural practice locations were younger and proportionally more female, but they were similar in primary medical specialty to doctors who had remained in their 1992 sites. Population to physician and to primary care physician ratios were much more favorable for 1995 than for 1992. Accessibility to care was most improveed in counties with fewer than 10,000 inhabitants.

关键词：美国医学协会职业选择科罗拉多卫生保健调查卫生服务易得程度/统计学和数值数据卫生服务易得程度/发展趋势缺医地区医师/统计学和数值数据医师/供应和分配专业场所/统计学和数值数据乡村卫生服务/人力乡村卫生服务/组织和管理美国女(雌)性人类男(雄)性

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A model for multidisciplinary peer review and supervision of behavioral health clinicians

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COMMUNITY MENTAL HEALTH JOURNAL 1999年第4期35卷 361-365页

作者： Gillig, PM Barr, A Wright State Univ Sch Med Dept Psychiat POB 927 Dayton OH 45401 USA

The authors describe a semi-annual program for multidisciplinary peer review and supervision that is in use at two rural adult and child mental health and drug and alcohol service agencies. The program incorporates semiannual chart reviews and face-to-face discussions held with each clinician by a multidisciplinary supervisory group. Several quality improvement issues addressed by this program are described, including improved communication, improved clinical diagnosis, the establishment of service parameters, more appropriate referrals for psychiatric and other medical care, and improved clinician skills. The program represents an inexpensive approach to peer review and supervision that can incorporate university-based consultants, improve quality of care, improve clinicians' skills, and be readily applied by clinical supervisors to most behavioral health settings.

关键词：行为疗法/标准医学审核/方法精神卫生服务/组织和管理精神卫生服务/标准模型组织管理病人医疗小组/标准同行评议卫生保健/方法专业能力/标准乡村卫生服务/组织和管理乡村卫生服务/标准物质滥用治疗中心美国成年人儿童人类

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Interdisciplinary student health teams: Combining medical education and service in a rural community-based experience

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JOURNAL OF RURAL HEALTH 1997年第4期13卷 320-328页

作者： Hamilton, CB Smith, CA Butters, JM Univ Tennessee Dept Hlth Leisure & Safety Sci Knoxville TN 37996 USA

Several initiatives have been introduced over the years to address the maldistribution of health care professionals and to improve access to care for underserved rural populations. One of these is the sponsorship of community-based, service-oriented teams comprised of students from various health disciplines. This study investigated extramural training as a complement to traditional hospital-based experiences. The specific objective of the study was to determine the extent to which the nation's medical schools combine training with a rural community-based experience in the form of an interdisciplinary student health team program. In the fall of 1994, a 32-item questionnaire was mailed to the chief academic or clinical affairs administrators of the nation's 126 allopathic medical schools. A total of 104 (82.5%) medical schools responded to the survey. Eighty-six of the respondents (82.7%) reported some type of rural training or public service activity;22 (21.2%) acknowledged the sponsorship of an inter-disciplinary student health team program. Small rural communities, those with populations of 5,000 or fewer, were the focus of 76 percent of the reporting programs. Nearly two-thirds of the reporting programs were located in the South, the region with the nation's lowest physician-to-population ratio. The nursing and medical professions were most frequently represented, although a wide range of disciplines were identified as participating on the student health teams. Activities of the teams included both ambulatory care and community outreach services. The majority of the programs used team-building exercises to enhance team effectiveness. Extramural training programs offer students a realistic examination of the social, cultural, economic, and political forces that influence both individual and community health. Rural community-based programs, such as interdisciplinary student health teams, should be valued because they can strengthen the link between the sponsoring i

关键词：临床实习/方法临床实习/发展趋势社区卫生服务/人力社区卫生服务/组织和管理数据收集病人医疗小组乡村卫生服务/人力乡村卫生服务/组织和管理院校医学学生卫生专业美国成年人女(雌)性人类男(雄)性

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Health human resource development in rural China

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HEALTH POLICY AND PLANNING 1997年第4期12卷 320-328页

作者： Gong, YL Wilkes, A Bloom, G Univ Sussex Inst Dev Studies Brighton BN1 9RE E Sussex England Shanghai Med Univ Sch Publ Hlth Dept Hlth Stat & Social Med Shanghai Peoples R China

China has made significant progress in increasing the quantity of health workers in rural areas. Attention is shifting to improving the quality of health workers. This article documents several features of health workers in rural China. Many have not received formal training to a level implied by their rank and title, and there is no clear relationship between the skills of health workers and the functions they perform. Many better-qualified personnel have left lower level health facilities for more attractive employment in higher level and urban facilities. A system of professional licensing is currently being considered that will link educational requirements to employment and promotion. This article outlines some of the issues that should be taken into consideration in formulating this system. In particular, licensing may have unequal impacts on rich and poorer areas. This article argues that other regulatory measures will be necessary if licensing is to be an effective mechanism for controlling the quality of health workers, and contribute to the provision of affordable health services in both rich and poor areas.

关键词：中国发展中国家教育医学设施的规章和管理卫生设施卫生人力/发展趋势许可证组织方针人员管理卫生保健质量乡村卫生服务/人力乡村卫生服务/组织和管理乡村卫生服务/标准工作负荷量

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Teens teach skin cancer prevention

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JOURNAL OF RURAL HEALTH 1996年第4期12卷 265-272页

作者： Reding, DJ Fischer, V Gunderson, P Lappe, K Anderson, H Calvert, G MARSHFIELD CLIN FDN MED RES & EDUC 1000 N OAK AVEMARSHFIELDWI 54449 USA

Cumulative sun exposure has been linked to about 95 percent of all skin cancers. Farmers and their families, by nature of their occupations, are exposed to an abundance of sun over a long period of time and, therefore, are at an increased risk for skin cancer. Because education is known to be a primary means of health, Future Farmers of America (FFA) peer facilitators (teen educators) provided third graders in rural communities sun protection education with the hope that the message would reach the entire family. The FFA facilitators (n = 217) from 39 FFA organizations throughout Wisconsin were trained with skin cancer and sun protection information. The FFA facilitators then gave presentations on sun protection to third graders (n = 2,007) in their school districts. Control schools included 57 facilitators and 669 third graders. Evaluation involved pre-, post-, and six-month follow-up surveys testing knowledge gained by the third graders. Students who correctly responded to a question on the post-survey after incorrectly answering it on the pre-survey were said to have had a knowledge gain for that question. By using chi-square tests, the intervention group demonstrated a statistically significant (P < 0.001) higher proportion of students experiencing knowledge gain than did the control group from pre- to post-surveys for nine of the 10 questions. Summary statistics were used to describe the study population. In addition to skin cancer knowledge questions, the survey of facilitators included sun protection behavior and attitude questions. This intervention was able to use peer educators as instructors to demonstrate knowledge gain in the youths of the target population. The pilot project materials costs were $0.55 per third grade student and $3.50 per facilitator. Using a school-based organization such as FFA provided a cost-effective means of reaching the rural population.

关键词：农业家庭卫生健康教育/组织和管理健康知识态度实践同侪集群试点项目方案评价危险因素乡村卫生服务/组织和管理院校皮肤肿瘤/预防和控制美国威斯康星青少年儿童人类

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Ensuring the dissemination of cancer control demonstration projects for farmers

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JOURNAL OF RURAL HEALTH 1996年第4期12卷 349-353页

作者： Marconi, KM US HLTH RESOURCES & SERV ADM BUR HLTH RESOURCES DEVOFF SCI & EPIDEMIOL7A-07 PARKLAWN BLDGROCKVILLEMD 20857 USA

The successful dissemination of the Cancer Control Demonstration Projects for Farmers depends not only on the effectiveness of the grants funded under this program but also on factors external to the grants. In this article, three health-related external factors are examined: the cancers amenable to prevention and control, intervention methodologies, and the organization of rural health care. Changes between 1989 and 1996 in each of these factors and the effects of these changes on the dissemination of grantee findings to public health and medical practitioners are described. Suggestions are offered on actions that the National Institutes for Occupational Safety and Health can undertake to increase the likelihood of adoption of grantee findings.

关键词：健康教育信息服务肿瘤/预防和控制试点项目公共卫生管理乡村卫生服务/组织和管理美国人类

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