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Background The World Health Organization recommends improving the quality of care in rural areas of developing countries by enhancing teamwork. Effective teamwork is especially essential for rural hospital care delivered to complex patients, which requires multidisciplinary coordination and cooperation. However, evidence on teamwork in hospitals is mostly from urban hospitals and developed countries, leaving team functioning in rural hospitals in developing countries largely under-researched. The distinctive contextual characteristics of rural areas in developing countries, such as increased diversity, impact teamwork dynamics. To advance the understanding of teamwork in hospitals in rural areas of developing countries, this study investigates the relationships among perceived similarity, multidisciplinarity, coordination and perceived quality of care in rural Chinese hospitals. Methods We conducted a quantitative study via an online survey in four rural county-level hospitals from different provincial administrative regions in China. 1017 respondents including doctors, nurses and other healthcare professionals provided valid responses. A multilevel moderated mediation model was used for data analysis. Results Perceived similarity is positively related to coordination, which in turn leads to higher perceived quality of care. Coordination partially mediates the relationship between perceived similarity and perceived quality of care. However, multidisciplinarity does not moderate the effect of perceived similarity on coordination. Conclusions Perceived similarity can promote coordination and subsequently perceived quality of care. Multidisciplinarity does not moderate the relationship between perceived similarity and coordination, and further research into the role of multidisciplinarity is called for. Hospital management may leverage the advantage of similarity to form teams whose members perceive each other as similar. The functioning of teams perceived as less similar may require additional effort to promote coordination and perceived quality of care. Such challenges caused by dissimilarity are especially relevant in the process of workforce strengthening with the aim of quality improvement towards universal health coverage in rural areas of developing countries.

Background Rural hospitals in Australia have not been afforded the same opportunities for research activity as their metropolitan counterparts. Equitable access to career and research opportunities has been identified as a potential strategy to enhance workforce satisfaction and retention in rural areas. Smaller rural hospitals show potential in being key settings for research; but minimal investment has translated into a lack of action and knowledge. Practical examples of how this can be done from an organisational structure point of view, are limited in the literature. Methods This cross-sectional study was undertaken in a rural hospital that services rural communities classed as MM4-5 by the Modified Monash Model. The study utilised the validated Research Capacity and Culture (RCC) tool to assess the impact of a rural hospital research unit on building research capacity and culture. It also explored the association between job satisfaction and research activity among hospital staff. Data analysis included descriptive statistics and linear regression. Results Seventy-four staff members completed the survey, with 15 reporting that they had worked with the research unit to complete projects. Among staff who received support from the Research Unit, there were higher RCC scores for 9 out of 20 organisational-level items. Rural hospitals staff rated the benefit of having research opportunities available (mean rating 7 out of 10) in their workplace for future career prospects. Conclusions This study provides evidence that the presence of a research unit, as part of the organisational structure, may assist in improving research capacity and culture within the rural hospital setting. It also identified areas for improvement in this context, as scores were not increased across all of the RCC domains and is an area of future development. Rural hospitals staff perceive the availability of a local research unit and research opportunities to be beneficial for their career and this has implications for rural health workforce development strategies. 

During the early COVID-19 pandemic travel in Uganda was tightly restricted which affected demand for and access to care for pregnant women and small and sick newborns. In this study we describe changes to neonatal outcomes in one rural central Ugandan newborn unit before and during the early phase of the COVID-19 pandemic. We report outcomes from admissions captured in an electronic dataset of a well-established newborn unit before (September 2019 to March 2020) and during the early COVID-19 period (April-September 2020) as well as two seasonally matched periods one year prior. We report excess mortality as the percent change in mortality over what was expected based on seasonal trends. The study included 2,494 patients, 567 of whom were admitted during the early COVID-19 period. During the pandemic admissions decreased by 14%. Patients born outside the facility were older on admission than previously (median 1 day of age vs. admission on the day of birth). There was an increase in admissions with birth asphyxia (22% vs. 15% of patients). Mortality was higher during COVID-19 than previously [16% vs. 11%, p = 0.017]. Patients born outside the facility had a relative increase of 55% above seasonal expected mortality (21% vs. 14%, p = 0.028). During this period patients had decreased antenatal care, restricted transport and difficulty with expenses and support. The hospital had difficulty with maternity staffing and supplies. There was significant community and staff fear of COVID-19. Increased newborn mortality during the early COVID-19 pandemic at this facility was likely attributed to disruptions affecting maternal and newborn demand for, access to and quality of perinatal healthcare. Lockdown conditions and restrictions to public transit were significant barriers to maternal and newborn wellbeing, and require further focus by national and regional health officials.

Policy Points Policymakers should invest in programs to support rural health systems, with a more targeted focus on spatial accessibility and racial and ethnic equity, not only total supply or nearest facility measures. Health plan network adequacy standards should address spatial access to nearest and second nearest hospital care and incorporate equity standards for Black and Latinx rural communities. Black and Latinx rural residents contend with inequities in spatial access to hospital care, which arise from fundamental structural inequities in spatial allocation of economic opportunity in rural communities of color. Long‐term policy solutions including reparations are needed to address these underlying processes. Context The growing rate of rural hospital closures elicits concerns about declining access to hospital‐based care. Our research objectives were as follows: 1) characterize the change in rural hospital supply in the US South between 2007 and 2018, accounting for health system closures, mergers, and conversions; 2) quantify spatial accessibility (in 2018) for populations most at risk for adverse outcomes following hospital closure—Black and Latinx rural communities; and 3) use multilevel modeling to examine relationships between structural factors and disparities in spatial access to care. Methods To calculate spatial access, we estimated the network travel distance and time between the census tract–level population‐weighted centroids to the nearest and second nearest operating hospital in the years 2007 and 2018. Thereafter, to describe the demographic and health system characteristics of places in relation to spatial accessibility to hospital‐based care in 2018, we estimated three‐level (tract, county, state‐level) generalized linear models. Findings We found that 72 (10%) rural counties in the South had ≥1 hospital closure between 2007 and 2018, and nearly half of closure counties (33) lost their last remaining hospital to closure. Net of closures, mergers, and conversions meant hospital supply declined from 783 to 653. Overall, 49.1% of rural tracts experienced worsened spatial access to their nearest hospital, whereas smaller proportions experienced improved (32.4%) or unchanged (18.5%) access between 2007 and 2018. Tracts located within closure counties had longer travel times to the nearest acute care hospital compared with tracts in nonclosure counties. Moreover, rural tracts within Southern states with more concentrated commercial health insurance markets had shorter travel times to access the second nearest hospital. Conclusions Rural places affected by rural hospital closures have greater travel burdens for acute care. Across the rural South, racial/ethnic inequities in spatial access to acute care are most pronounced when travel times to the second nearest open acute care hospital are accounted for.

In developing countries referral of severely ill children from primary care to district hospitals is common, but hospital care is often of poor quality. However, strategies to change multiple paediatric care practices in rural hospitals have rarely been evaluated. This cluster randomized trial was conducted in eight rural Kenyan district hospitals, four of which were randomly assigned to a full intervention aimed at improving quality of clinical care (evidence-based guidelines, training, job aides, local facilitation, supervision, and face-to-face feedback; n  =  4) and the remaining four to control intervention (guidelines, didactic training, job aides, and written feedback; n  =  4). Prespecified structure, process, and outcome indicators were measured at baseline and during three and five 6-monthly surveys in control and intervention hospitals, respectively. Primary outcomes were process of care measures, assessed at 18 months postbaseline. In both groups performance improved from baseline. Completion of admission assessment tasks was higher in intervention sites at 18 months (mean  =  0.94 versus 0.65, adjusted difference 0.54 [95% confidence interval 0.05-0.29]). Uptake of guideline recommended therapeutic practices was also higher within intervention hospitals: adoption of once daily gentamicin (89.2% versus 74.4%; 17.1% [8.04%-26.1%]); loading dose quinine (91.9% versus 66.7%, 26.3% [-3.66% to 56.3%]); and adequate prescriptions of intravenous fluids for severe dehydration (67.2% versus 40.6%; 29.9% [10.9%-48.9%]). The proportion of children receiving inappropriate doses of drugs in intervention hospitals was lower (quinine dose >40 mg/kg/day; 1.0% versus 7.5%; -6.5% [-12.9% to 0.20%]), and inadequate gentamicin dose (2.2% versus 9.0%; -6.8% [-11.9% to -1.6%]). Specific efforts are needed to improve hospital care in developing countries. A full, multifaceted intervention was associated with greater changes in practice spanning multiple, high mortality conditions in rural Kenyan hospitals than a partial intervention, providing one model for bridging the evidence to practice gap and improving admission care in similar settings.

Background Hospital discharge summaries are crucial for transferring patient information to subsequent care providers, yet they often contain incomplete and incorrect medication details. This may lead to inappropriate medication therapy, medication-related problems and unnecessary patient harm. A 2014 study in Norway highlighted a low level of medication information completeness at a rural hospital. This study aimed to audit the completeness of medication information in discharge summaries from the same hospital and to identify factors that could improve medication safety in future efforts. Methods We randomly selected 240 discharge summaries from 2019 and applied seven national criteria defining the necessary medication information in discharge summaries; (1) reasons for changes in medication prescribing during hospitalization, (2) generic names, (3) administration forms, (4) dosage strengths, (5) dosage regimes stated, (6) indications for use and (7) the medication status categories new, changed, short course. A quantile regression model was applied to analyze factors associated with the medication information completeness in these summaries, adjusting for both patient- and hospital-related variables. Results From 2550 assessed medications, information completeness in discharge summaries ranged from 0.0 to 1.0, with a mean of 0.904 (SD 0.15). The criteria with lowest information completeness were ´indication for use´ and ´reasons for changes in medication use stated at discharge´. A significant factor in enhancing completeness was the use of a digital tool for compiling the medication list, which increased the completeness coefficient by 0.23 to 0.83 when applied. Conclusions The completeness of medication information in discharge summaries from Helgelandssykehuset Mo i Rana was high and has significantly improved since 2014. The use of electronic tools for compiling medication lists notably enhances information completeness, while free-text lists should be avoided. This should be considered when developing future electronic medications management systems and tools to ensure quality of medication information.

Cancer centers are increasingly affiliating with rural hospitals to perform surgery. Perioperative and oncologic outcomes for cancer center surgeons operating at rural hospitals are understudied. For patients with non-metastatic breast cancer from a rural catchment area who had oncologic surgery at an NCI-designated comprehensive cancer center (CC) or its rural affiliate (RA) from 2017 to 2022, we compared perioperative outcomes (composite of surgical site infection, seroma requiring drainage, and reoperation for margins) and receipt of guideline-concordant care (if patient received all applicable treatments) using descriptive statistics and chi-squared tests. Among 168 patients, 99 had surgery at RA, 60 CC. RA patients were older, higher stage, and more often had lumpectomy. There were no differences in perioperative outcomes (CC 10%, RA 14%, p ​= ​0.445) or guideline concordant care (RA 76%, CC 78%, p ​= ​0.846). Cancer center surgeons operating at a rural affiliate had comparable perioperative outcomes and guideline-concordant care. •There is an increasing need for oncologic specialty care at rural hospitals.•In this model cancer center breast surgeons operate at a rural affiliate hospital.•There are comparable perioperative outcomes and guideline-concordant care.

Background: Provision of essential surgery is important in achieving Universal Health Coverage. However, data on the capacity of first-level hospitals to provide surgical care are currently unavailable in Sindh Province, Pakistan. Aim: To assess surgical care services and needs in public sector hospitals in Sindh Province, Pakistan. Methods: Between May and August 2021, we examined surgical care in 15 public sector district and subdistrict headquarters hospitals in Sindh Province, using the consolidated hospital assessment tool adapted from the WHO tool for assessing emergency and essential surgical care. We analysed the data using STATA version 15 and calculated the frequency of essential surgical procedures per 100 000 population for each health facility. Results: Overall surgical beds density was 0.22 per 100 000 population, with 0.7 certified specialists and 1.4 combined certified and non-specialist physicians offering surgical and anaesthesia care per 100 000 population. Clinical support services were deficient, and only 76% of drugs for anaesthetic and surgical care were available. Outpatient procedures were performed in all facilities, while obstetrics/gynaecology, surgical and trauma-related procedures were performed in 87%, 60% and 53% of facilities, respectively. Three of the 15 hospitals performed the 3 Bellwether procedures. Conclusion: This study identified multiple deficiencies in infrastructure, workforce, governance, management, and support services for essential surgical services in Sindh Province of Pakistan. To achieve Universal Health Coverage in Pakistan, there is a need for more research on surgical services in Sindh Province to identify other gaps and implement strategies to bridge the gaps.

Between 1990 and 2020, 334 rural hospitals closed in the United States, and since 2011 hospital closures have outnumbered new hospital openings. This scoping review evaluates peer-reviewed studies published since 1990 with a focus on rural hospital closures, synthesizing studies across six themes: 1) health care policy environment, 2) precursors to rural hospital closures, 3) economic impacts, 4) effects of rural hospital closures on access to care, 5) health and community impacts, and 6) definitions of rural hospitals and communities. In the 1990s, rural hospitals that closed were smaller, while rural hospitals that closed in the 2010s tended to have more beds. Many studies of the health impacts of rural hospital closures yielded null findings. However, these studies differed in their definitions of \"rural hospital closure.\" Given the accelerated rate of hospital closures, more attention should be paid to hospitals that serve rural communities of color and low-income communities.