Transforming the Rural Health Care Paradigm

Greenwood-Ericksen, Margaret B.; D’Andrea, Shawn; Findley, Scott

doi:10.1001/jamahealthforum.2020.0987

Cited by 4 publications

(1 citation statement)

References 10 publications

(6 reference statements)

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“… 12 , 43 These data highlight the degree to which AMCs tend to be concentrated, with rural regions having less access to AMC services on average. Thus, identifying strategies by which AMCs may enhance care for patients in rural and other remote locations 44 , 45 , 46 has the potential to improve health outcomes for underserved populations and widen the reach of the nation’s academic health care institutions.…”

Section: Discussionmentioning

confidence: 99%

Association of Academic Medical Center Presence With Clinical Outcomes at Neighboring Community Hospitals Among Medicare Beneficiaries

Burke

Orav

et al. 2023

JAMA Netw Open

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ImportanceStudies suggest that academic medical centers (AMCs) have better outcomes than nonteaching hospitals. However, whether AMCs have spillover benefits for patients treated at neighboring community hospitals is unknown.ObjectiveTo examine whether market-level AMC presence is associated with outcomes for patients treated at nonteaching hospitals within the same markets.Design, Setting, and ParticipantsThis retrospective, population-based cohort study assessed traditional Medicare beneficiaries aged 65 years and older discharged from US acute care hospitals between 2015 and 2017 (100% sample). Data were analyzed from August 2021 to December 2022.ExposuresThe primary exposure was market-level AMC presence. Health care markets (ie, hospital referral regions) were categorized by AMC presence (percentage of hospitalizations at AMCs) as follows: no presence (0%), low presence (&gt;0% to 20%), moderate presence (&gt;20% to 35%), and high presence (&gt;35%).Main Outcomes and MeasuresThe primary outcomes were 30-day and 90-day mortality and healthy days at home (HDAH), a composite outcome reflecting mortality and time spent in facility-based health care settings.ResultsThere were 22 509 824 total hospitalizations, with 18 865 229 (83.8%) at non-AMCs. The median (IQR) age of patients was 78 (71-85) years, and 12 568 230 hospitalizations (55.8%) were among women. Of 306 hospital referral regions, 191 (62.4%) had no AMCs, 61 (19.9%) had 1 AMC, and 55 (17.6%) had 2 or more AMCs. Markets characteristics differed significantly by category of AMC presence, including mean population, median income, proportion of White residents, and physicians per population. Compared with markets with no AMC presence, receiving care at a non-AMC in a market with greater AMC presence was associated with lower 30-day mortality (9.5% vs 10.1%; absolute difference, −0.7%; 95% CI, −1.0% to −0.4%; P &lt; .001) and 90-day mortality (16.1% vs 16.9%; absolute difference, −0.8%; 95% CI, −1.2% to −0.4%; P &lt; .001) and more HDAH at 30 days (16.49 vs 16.12 HDAH; absolute difference, 0.38 HDAH; 95% CI, 0.11 to 0.64 HDAH; P = .005) and 90 days (61.08 vs 59.83 HDAH; absolute difference, 1.25 HDAH; 95% CI, 0.58 to 1.92 HDAH; P &lt; .001), after adjustment. There was no association between market-level AMC presence and mortality for patients treated at AMCs themselves.Conclusions and RelevanceAMCs may have spillover effects on outcomes for patients treated at non-AMCs, suggesting that they have a broader impact than is traditionally recognized. These associations are greatest in markets with the highest AMC presence and persist to 90 days.

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Section: Discussionmentioning

confidence: 99%

Association of Academic Medical Center Presence With Clinical Outcomes at Neighboring Community Hospitals Among Medicare Beneficiaries

Burke

Orav

et al. 2023

JAMA Netw Open

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Optimization of physician resources in primary care during a pandemic: A ‘hot’ and ‘cold’ team approach

Patchett-Marble¹,

Orrantia²,

DeMiglio³

et al. 2023

Ethics, Medicine and Public Health

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Impact of COVID-19 on cervical cancer screening: Challenges and opportunities to improving resilience and reduce disparities

Wentzensen

Clarke

Perkins

2021

Preventive Medicine

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The COVID-19 pandemic has a major impact on a wide range of health outcomes. Disruptions of elective health services related to cervical screening, management of abnormal screening test results, and treatment of precancers, may lead to increases in cervical cancer incidence and exacerbate existing health disparities. Modeling studies suggest that a short delay of cervical screening in subjects with previously negative HPV results has minor effects on cancer outcomes, while delay of management and treatment can lead to larger increases in cervical cancer. Several approaches can mitigate the effects of disruption of cervical screening and management. HPV-based screening has higher accuracy compared to cytology, and a negative HPV result provides longer reassurance against cervical cancer; further, HPV testing can be conducted from self-collected specimens. Self-collection expands the reach of screening to underserved populations who currently do not participate in screening. Self-collection and can also provide alternative screening approaches during the pandemic because testing can be supported by telehealth and specimens collected in the home, substantially reducing patient-provider contact and risk of COVID-19 exposure, and also expanding the reach of catch-up services to address backlogs of screening tests that accumulated during the pandemic. Risk-based management allows prioritizing management of patients at highest risk of cervical cancer while extending screening intervals for those at lowest risk. The pandemic provides important lessons for how to make cervical screening more resilient to disruptions and how to reduce cervical cancer disparities that may be exacerbated due to disruptions of health services.

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Transforming the Rural Health Care Paradigm

Cited by 4 publications

References 10 publications

Association of Academic Medical Center Presence With Clinical Outcomes at Neighboring Community Hospitals Among Medicare Beneficiaries

Association of Academic Medical Center Presence With Clinical Outcomes at Neighboring Community Hospitals Among Medicare Beneficiaries

Optimization of physician resources in primary care during a pandemic: A ‘hot’ and ‘cold’ team approach

Impact of COVID-19 on cervical cancer screening: Challenges and opportunities to improving resilience and reduce disparities

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