PMC:29010 / 2319-5271 JSONTXT

{"project":"2_test","denotations":[{"id":"11056720-10301137-23622490","span":{"begin":813,"end":814},"obj":"10301137"}],"text":"Background\nResources and personnel often limit comprehensive health services in \t\t rural areas. Yet, rural hospitals, fueled by community expectations and the \t\t need for expanded revenue sources, have expanded their scope of specialized \t\t services, which has led to the development of rural intensive care units \t\t (ICUs). Despite the growth in number and use of intensive care services [1], there is little information about the breadth or quality of \t\t these services in the rural setting [2]. This is \t\t particularly true for specialized ICU services such as mechanical ventilation, \t\t where no information exists specifically for rural hospitals. (A Medline search \t\t performed using the key words ICU, rural hospital and mechanical ventilation \t\t produced no similar literature).\nMoscovice and Rosenblatt [3] suggest that the \t\t ability of rural hospitals to provide specialized services depends on a number \t\t of factors, including the training and interests of local personnel, the \t\t ability to maintain performance standards despite a small patient volume, the \t\t extent of support resources and financial stability. In previous studies \t\t involving rural hospitals, there have been quality concerns surrounding the \t\t threshold effect, namely that sufficient patient volume may not be available to \t\t maintain requisite skills [4,5]. \t\t There is evidence that low volumes of specialized services, as frequently \t\t occurs in rural hospitals, may result in poorer outcomes [5,6,7].\nThe main objectives of our study were, therefore, to: (1) determine \t\t the quality of care provided for a specific, low-volume patient population; and \t\t (2) improve the quality of care if deficiencies were found.\nThis report provides a description of the baseline data collected for \t\t the 3-year study, including differences found in both institutional and patient \t\t variables between rural referral hospitals and rural hospitals with more \t\t limited resources. The data reported here form a snapshot of rural ICUs: the \t\t patients, institutional characteristics, and practice patterns. These baseline \t\t data constitute a necessary starting point for evaluating and improving the \t\t care given in these settings.\nOn the basis of practice variations found during the pilot study, the \t\t study design included an educational intervention that would be implemented to \t\t assist the rural ICU staff in their efforts to provide quality care. The \t\t intervention followed medical record audits and included face-to-face provider \t\t feedback, written recommendations, reference articles, seminars and telephone \t\t consultations. Specific data describing the impact of patient characteristics \t\t and process performance on mortality rates have recently been published [8]. Data describing the specific effects of the outreach \t\t educational program on patient care processes and outcomes in the treatment \t\t group versus control group have also been published [9]."}

{"project":"Colil","denotations":[{"id":"T1","span":{"begin":813,"end":814},"obj":"10301137"}],"namespaces":[{"prefix":"_base","uri":"http://pubannotation.org/docs/sourcedb/PubMed/sourceid/"}],"text":"Background\nResources and personnel often limit comprehensive health services in \t\t rural areas. Yet, rural hospitals, fueled by community expectations and the \t\t need for expanded revenue sources, have expanded their scope of specialized \t\t services, which has led to the development of rural intensive care units \t\t (ICUs). Despite the growth in number and use of intensive care services [1], there is little information about the breadth or quality of \t\t these services in the rural setting [2]. This is \t\t particularly true for specialized ICU services such as mechanical ventilation, \t\t where no information exists specifically for rural hospitals. (A Medline search \t\t performed using the key words ICU, rural hospital and mechanical ventilation \t\t produced no similar literature).\nMoscovice and Rosenblatt [3] suggest that the \t\t ability of rural hospitals to provide specialized services depends on a number \t\t of factors, including the training and interests of local personnel, the \t\t ability to maintain performance standards despite a small patient volume, the \t\t extent of support resources and financial stability. In previous studies \t\t involving rural hospitals, there have been quality concerns surrounding the \t\t threshold effect, namely that sufficient patient volume may not be available to \t\t maintain requisite skills [4,5]. \t\t There is evidence that low volumes of specialized services, as frequently \t\t occurs in rural hospitals, may result in poorer outcomes [5,6,7].\nThe main objectives of our study were, therefore, to: (1) determine \t\t the quality of care provided for a specific, low-volume patient population; and \t\t (2) improve the quality of care if deficiencies were found.\nThis report provides a description of the baseline data collected for \t\t the 3-year study, including differences found in both institutional and patient \t\t variables between rural referral hospitals and rural hospitals with more \t\t limited resources. The data reported here form a snapshot of rural ICUs: the \t\t patients, institutional characteristics, and practice patterns. These baseline \t\t data constitute a necessary starting point for evaluating and improving the \t\t care given in these settings.\nOn the basis of practice variations found during the pilot study, the \t\t study design included an educational intervention that would be implemented to \t\t assist the rural ICU staff in their efforts to provide quality care. The \t\t intervention followed medical record audits and included face-to-face provider \t\t feedback, written recommendations, reference articles, seminars and telephone \t\t consultations. Specific data describing the impact of patient characteristics \t\t and process performance on mortality rates have recently been published [8]. Data describing the specific effects of the outreach \t\t educational program on patient care processes and outcomes in the treatment \t\t group versus control group have also been published [9]."}