Rural implementation of the perioperative surgical home:A case-control study

BACKGROUND Perioperative surgical home(PSH)is a novel patient-centric surgical system developed by American Society of Anesthesiologist to improve outcomes and patient satisfaction.PSH has proven success in large urban health centers by reducing surgery cancellation,operating room time,length of stay(LOS),and readmission rates.Yet,only limited studies have assessed the impact of PSH on surgical outcomes in rural areas.AIM To evaluate the newly implemented PSH system at a community hospital by comparing the surgical outcomes using a longitudinal case-control study.METHODS The research study was conducted at an 83-bed,licensed level-III trauma rural community hospital.A total of 3096 TJR procedures were collected retrospectively between January 2016 and December 2021 and were categorized as PSH and non-PSH cohorts(n=2305).To evaluate the importance of PSH in the rural surgical system,a case-control study was performed to compare TJR surgical outcomes(LOS,discharge disposition,and 90-d readmission)of the PSH cohort against two control cohorts[Control-1 PSH(C1-PSH)(n=1413)and Control-2 PSH(C2-PSH)(n=892)].Statistical tests including Chi-square test or Fischer’s exact test were performed for categorical variables and Mann-Whitney test or Student’s t-test were performed for continuous variables.The general linear models(Poisson regression and binomial logistic regression)were performed to fit adjusted models.RESULTS The LOS was significantly shorter in PSH cohort compared to two control cohorts(median PSH=34 h,C1-PSH=53 h,C2-PSH=35 h)(P value<0.05).Similarly,the PSH cohort had lower percentages of discharges to other facilities(PSH=3.5%,C1-PSH=15.5%,C2-PSH=6.7%)(P value<0.05).There was no statistical difference observed in 90-d readmission between control and PSH cohorts.However,the PSH implementation reduced the 90-d readmission percentage(PSH=4.7%,C1-PSH=6.1%,C2-PSH=3.6%)lower than the national average 30-d readmission percentage which is 5.5%.The PSH system was effectively established at the rural community hospital with the help of team-based coordinated multi-disciplinary clinicians or physician comanagement.The elements of PSH including preoperative assessment,patient education and optimization,and longitudinal digital engagement were vital for improving the TJR surgical outcomes at the community hospital.CONCLUSION Implementation of the PSH system in a rural community hospital reduced LOS,increased directto-home discharge,and reduced 90-d readmission percentages.

Feasibility study of first-year medical students identifying cardiac anatomy using ultrasound in rural Panama

BACKGROUND: There are over 15 million children who have cardiac anomalies around the world, resulting in a significant morbidity and mortality. Early recognition and treatment can improve the outcomes and lengthen life-expectancy of these patients. The NIH and WHO have promoted guidelines for screening for congenital cardiac anomalies using ultrasound in rural environments.METHODS: Our study took place in Bocas Del Toro, Panama where a mobile clinic was established for community healthcare screening and ultrasonographic evaluation by medical student volunteers and volunteer clinical faculty. This was a non-blinded, investigational study utilizing a convenience sample of pediatric patients presenting for voluntary evaluation. Seven first-year medical students were recruited for the study. These students underwent a training program for advanced cardiac ultrasound instruction, termed "Pediatric Echocardiography Cardiac Screening(PECS)".RESULTS: Ten patients were enrolled in the study. Nine patients had adequate images as defined by the PECS criteria and were all classified as normal cardiac pathology by the medical students, resulting in a sensitivity and specificity of 100%. A single patient was identified by medical students as having a pathologic pulmonic stenosis. This was confirmed as correct by a blinded ultrasonographer.CONCLUSIONS: In this pilot study, the first-year medical students were able to correctly identify pediatric cardiac anatomy and pathology in rural Panama after undergoing a 12-hour ultrasound PECS training session. We believe that with this knowledge, minimally trained practitioners can be used to screen for cardiac anomalies in rural Panama using ultrasound.

Closing the Gap in Primary Care: A Systematic Review and Interpretation

Objective: The United States faces a health care provider shortage yearly in many areas of the country, but most of all the rural areas are most impacted. The aim of this paper is 2-fold: To understand the factors that drive a medical student’s specialty choice through a systematic review article and how government initiatives consider what is important to students, to understand how other clinicians can help close the gap in primary care in the United States and what policies or barriers prevent them from doing so. Methods: This paper looks at nationally collected data, as well as meta-analysis reviews on the topic to help the reader better understand the issue of health care provider shortages. Conclusion: We must change the way we look at primary care and rural medicine. Rather than investing money in avenues that yield little return on investment, we as a nation should strategically fund and advance the scope of practice for rural medicine to make it attractive and competitive for clinicians to pursue. Being in a large deficit of clinical providers in general in our country, we must try to find new pathways to grow coverage in rural areas before our health care system is no longer equitable.

新疆南疆两县新型农牧区合作医疗参合农民受益情况调查分析

目的通过对新疆南部地区开展新型农牧区合作医疗两个县的参合农民受益情况调查分析,了解新疆南部地区两个县参合农民受益情况,为卫生管理机构制定相关卫生政策和策略提供科学依据。方法从南疆地区已开展新型农牧区合作医疗的42个县市中,采用随机抽样方法抽取两个县。结果新农合实施以来,2008年两县的平均参合率为92.25%;筹资总额2008年较2005年投入增加了209.08.%,政府筹资占75.7%,个人占24.3%,没有社会救助;住院补偿人次增加了133.05%,住院补偿金额增加了355.19%;2005年～2007年两县参合农民门诊就诊补偿人次呈现逐年增长趋势,而2008年有所降低,2008年较2005年参合门诊就诊补偿金额增加了15.45%。结论新疆南部地区两个县的参合农民住院、门诊受益情况均有提高,住院补偿金额高于门诊补偿,故应提高补偿比例,加快立法和基金管理。