Overcoming Geographic Barriers: Surgical Care in Rural Populations

Overview

Journal Clin Colon Rectal Surg

Date 2024 Dec 30

PMID 39734717

Authors

Sara L Schaefer

Andrew M Ibrahim

Affiliations

Soon will be listed here.

Abstract

This chapter examines the challenges rural Americans face in accessing surgical care, which is characterized by geographical barriers, a decreasing surgical workforce, and unique patient factors. The widening health care disparity between rural and urban residents highlights the need for comprehensive strategies to improve surgical care delivery to rural areas. Focusing on colorectal care delivery, encompassing the spectrum of common and complex care, exemplifies opportunities to optimize care delivery for rural populations. Here, we discuss the complex and unique interplay of challenges within rural hospital infrastructure, workforce shortages, and patient factors emphasizing financial strain, closure of rural hospitals, and limited access to specialty providers and resources. Current evidence focuses on volume-outcome relationships, the safety of common surgical care at rural hospitals, and the impact of rural hospitals joining larger health systems. Strategies to optimize care delivery include site-of-care optimization, improved care coordination, dissemination of specialty expertise, and policy programs to support the rural workforce. Recent federal policies, including the rural emergency hospital program, underscore the delicate balance between sustaining essential local health care services and the financial realities of rural health care delivery. We then conclude with evidence-based strategies to bridge the urban-rural health care gap, ensuring equitable access to high-quality surgical care regardless of geographic location.

References

Sparling A, Song E, Klepin H, Foley K . Is distance to chemotherapy an obstacle to adjuvant care among the N.C. Medicaid-enrolled colon cancer patients?. J Gastrointest Oncol. 2016; 7(3):336-44. PMC: 4880786. DOI: 10.21037/jgo.2016.02.01. View

Ramkumar N, Colla C, Wang Q, OMalley A, Wong S, Brooks G . Association of Rurality, Race and Ethnicity, and Socioeconomic Status With the Surgical Management of Colon Cancer and Postoperative Outcomes Among Medicare Beneficiaries. JAMA Netw Open. 2022; 5(8):e2229247. PMC: 9428741. DOI: 10.1001/jamanetworkopen.2022.29247. View

Curtin S, Spencer M . Trends in Death Rates in Urban and Rural Areas: United States, 1999-2019. NCHS Data Brief. 2021; (417):1-8. View

Singh G, Siahpush M . Widening rural-urban disparities in all-cause mortality and mortality from major causes of death in the USA, 1969-2009. J Urban Health. 2013; 91(2):272-92. PMC: 3978153. DOI: 10.1007/s11524-013-9847-2. View

Nikolian V, Akhter M, Iqbal E, Sutton T, Samhan A, Orenstein S . A National Evaluation of Surgeon Experiences in Telemedicine for the Care of Hernia and Abdominal Core Health Patients. World J Surg. 2021; 46(1):76-83. PMC: 8487675. DOI: 10.1007/s00268-021-06332-9. View

Doty B, Zuckerman R, Finlayson S, Jenkins P, Rieb N, Heneghan S . General surgery at rural hospitals: a national survey of rural hospital administrators. Surgery. 2008; 143(5):599-606. DOI: 10.1016/j.surg.2007.11.022. View

OHanlon C, Kranz A, DeYoreo M, Mahmud A, Damberg C, Timbie J . Access, Quality, And Financial Performance Of Rural Hospitals Following Health System Affiliation. Health Aff (Millwood). 2019; 38(12):2095-2104. PMC: 7004480. DOI: 10.1377/hlthaff.2019.00918. View

Begg C, Cramer L, Hoskins W, Brennan M . Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998; 280(20):1747-51. DOI: 10.1001/jama.280.20.1747. View

Arora S, Kalishman S, Dion D, Som D, Thornton K, Bankhurst A . Partnering urban academic medical centers and rural primary care clinicians to provide complex chronic disease care. Health Aff (Millwood). 2011; 30(6):1176-84. PMC: 3856208. DOI: 10.1377/hlthaff.2011.0278. View

10.

Etzioni D, Cannom R, Madoff R, Ault G, Beart Jr R . Colorectal procedures: what proportion is performed by American board of colon and rectal surgery-certified surgeons?. Dis Colon Rectum. 2010; 53(5):713-20. DOI: 10.1007/DCR.0b013e3181d32084. View

11.

Jiang H, Fingar K, Liang L, Henke R, Gibson T . Quality of Care Before and After Mergers and Acquisitions of Rural Hospitals. JAMA Netw Open. 2021; 4(9):e2124662. PMC: 8453322. DOI: 10.1001/jamanetworkopen.2021.24662. View

12.

Patel V, Liu M, Byrne J, Haynes A, Ibrahim A . Surgeon Supply by County-Level Rurality and Social Vulnerability From 2010 to 2020. JAMA Surg. 2023; 159(2):223-225. PMC: 10687707. DOI: 10.1001/jamasurg.2023.5632. View

13.

Lussiez A, Scott J, Kunnath N, Dimick J, Ibrahim A . Surgical outcomes and travel burden among medicare beneficiaries living in Health Professional Shortage Areas. Am J Surg. 2022; 224(1 Pt B):470-474. DOI: 10.1016/j.amjsurg.2022.01.013. View

14.

Sheetz K, Massarweh N . Centralization of High-risk Surgery in the US: Feasible Solution or More Trouble Than It Is Worth?. JAMA. 2020; 324(4):339-340. DOI: 10.1001/jama.2020.2953. View

15.

Birkmeyer J, Siewers A, Finlayson E, Stukel T, Lucas F, Batista I . Hospital volume and surgical mortality in the United States. N Engl J Med. 2002; 346(15):1128-37. DOI: 10.1056/NEJMsa012337. View

16.

Deveney K, Deatherage M, Oehling D, Hunter J . Association between dedicated rural training year and the likelihood of becoming a general surgeon in a small town. JAMA Surg. 2013; 148(9):817-21. DOI: 10.1001/jamasurg.2013.2681. View

17.

Evans H . Surgical Telemedicine: Access to Diversity. J Am Coll Surg. 2022; 234(5):969-970. DOI: 10.1097/XCS.0000000000000104. View

18.

Arora S, Thornton K, Murata G, Deming P, Kalishman S, Dion D . Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011; 364(23):2199-207. PMC: 3820419. DOI: 10.1056/NEJMoa1009370. View

19.

Aboagye J, Kaiser H, Hayanga A . Rural-Urban Differences in Access to Specialist Providers of Colorectal Cancer Care in the United States: A Physician Workforce Issue. JAMA Surg. 2014; 149(6):537-43. DOI: 10.1001/jamasurg.2013.5062. View

20.

Finlayson S, Birkmeyer J, Tosteson A, Nease Jr R . Patient preferences for location of care: implications for regionalization. Med Care. 1999; 37(2):204-9. DOI: 10.1097/00005650-199902000-00010. View