Issues that Face Rural Surgery in the United States
Nakayama DK, Hughes TG. J Am Coll Surg. 2014 Oct;219(4):814-818. doi: 10.1016/j.jamcollsurg.2014.03.056. Epub 2014 May 22.
This article discusses social and economic issues that threaten quality surgical care in rural communities.
- Rural communities have higher poverty and higher unemployment. These rural populations also have higher incidences of chronic disease, including cancer and heart disease.
- There is a critical shortage of surgeons in rural areas. Of 3,436 federally designated hospital service areas, 18% have no surgeons of any specialty and 30% have fewer than three surgeons per 100,000 population—the level defined by Ricketts and colleagues at the American College of Surgeons Health Policy Research Institute as a critical shortage.
- The economic impact of a general surgeon: one general surgeon will generate $700,000 for the practice, $1.4 million for the hospital, $2.7 million for the community, and 25.9 jobs.
Implementation of a Hospital-Based Quality Assessment Program for Rectal Cancer
Hendren S, McKeown E, Morris AM, et al. J Oncol Pract. 2014 May;10(3):e120-9. doi: 10.1200/JOP.2014.001387.
This study describes a first step in developing a program to improve rectal cancer care statewide. Michigan and other state-based surgical quality collaboratives have utilized hospital data to identity quality shortcomings and implement quality improvement programs to decrease surgical complications. Linking tumor registry data and quality improvement data will address an additional dimension of improving surgical patient care.
- A multi-hospital rectal cancer quality assessment program is feasible.
- Authors propose specific items to be included in the surgical operative report.
- Variable definitions must be standardized and clear.