Saturday, November 30, 2019

Commentary says rural hospitals should regionalize adult care, like they do with maternity and infant care

As rural hospitals seek new ways to survive, a commentary in The Journal of Rural Health suggests that one new model could regionalize adult health care in much the same way it has been regionalized for perinatal care, the care given before and after the birth of a child.

Image from WFPL
"Regionalization of health care is not a new approach," note the authors of the commentary, which could spark debate about ways to save rural hospitals.

The survival of rural hospitals is a real concern. Since 2010, at least 113 rural hospitals in the U.S. have closed, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina.

Mosby's Medical Dictionary defines health-care regionalization as "the organization of a system for the delivery of health care within a region to avoid costly duplication of services and to ensure the availability of essential services."

"It may be a critical tool for the survival of rural community hospitals," write the commentary authors, Catherine Clary and Dr. William Kanto of Augusta University in Georgia, and Nikki King and and Tim Putnam of Margaret Mary Health in Batesville, Ind., 40 miles west of Cincinnati.

They explain that perinatal regionalization, which designates hospitals according to their ability to care for mothers and infants and uses those levels to determine where they should be best cared for, has resulted in "the decline of neonatal mortality and improving other perinatal statistics."

"Just as not all perinatal services could be provided in every community hospital, today there are specialized life-saving services (such as stroke, cardiovascular and trauma) available that cannot be fully supported by every rural hospital," they write. "However in an organized system of care, treatment can be initiated in the rural hospital and patients appropriately transferred, insuring universal access to these services and improved patient outcomes."

They also argue that specialized regionalization of adult care could free rural hospitals to expand some services, allow "vibrant telehealth" consultations that could allow patients to stay in their home facility with continuing support; and, if the partnership is with an academic medical center, provide opportunities for strong continuing-education programs.

They say such a model would include systems and protocols developed by the hospitals, and a strong telemedicine component; result in a growing respect and trust among the providers in the region that would lead to improved care and patient satisfaction; and make sure transferred patients would be returned back to their local hospital as soon as medically possible. That way, "The patient’s family incurs less expense and travel time," they write.

Also, prompt transfer demonstrates the specialty hospital's confidence in the rural hospital and providers, increases the patient and clinical volume of the rural hospital, and allows for post-discharge care to be conducted by local providers, they write:"The local hospital is the nexus for the continuing care for the patient; local providers are available to answer questions about medications, rehabilitation, and follow-up care, reducing the chance for error and confusion."

They add that being able to return a patient to their home facility is easier if the rural hospital has a "swing bed program," which allows a hospital bed to be used as an acute-care bed or a skilled-nursing bed, like in an advanced nursing home.

The authors conclude, "The survival of rural hospitals is an essential component in providing health care to a rural community, and rural hospitals are integral to the economic development and future growth of the community. With adult regionalization, patients receive required tertiary care, but the community hospital is supported through its use for rehabilitation and continued wellness."

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