Introduction: Rural hospitals continue to close nationally. High fixed costs, low patient volume, and outmigration remain problematic for surviving rural hospitals. This article presents an innovative telemedicine partnership between a small, not-for-profit rural hospital and a tertiary care medical center in the southeast. The vision was to create a sustainable care delivery model where patients receive care at a rural hospital in their home community with the added benefit of clinical expertise from a tertiary care center. Methods: A single-center descriptive case study involving a 32-bed not-for-profit rural community hospital and South Carolina's only comprehensive medical center. This article details the development and implementation of this innovative care delivery model. The strategy and logic model utilized to analyze the program is described. Results: From fiscal year 2019 to 2022, Hampton Regional Medical Center saw an increased number of yearly admissions from 442 to 965. Associated, there was a 20% reduction in inpatient transfers to another facility and a 35% reduction in 30-day readmission, while seeing a more complex patient population as demonstrated by an increase in case-mix index. There was no increase in outmigration. Conclusions: While rural hospitals continue to close nationally, we describe an innovative telemedicine partnership between a small, not-for-profit rural hospital and a tertiary care medical center to build a sustainable care delivery model that can support rural hospital survivability.
ABSTRACT Objective: Most patients diagnosed with lung cancer present with advanced stage disease and have a poor chance of long-term survival. Despite the advantages of hospice care for lung cancer patients, many are enrolled late in the course of their illness or not at all. We sought to identify reasons for this pattern. Method: A list of perceived barriers to hospice enrollment was generated and used to create two self-administered surveys, one for physicians and one for caregivers. After focus group testing, the finalized instruments were mailed to physicians in South Carolina and to caregivers of lung cancer patients who died under hospice care with a local hospice between 2000 and 2004. Results: Fifty-three caregivers and 273 physicians responded to the survey. From the caregivers' perspectives, leading reasons for deferred hospice enrollment included patients' unanticipated rapid transition from well to sick and a belief that hospice means giving up hope. From the physicians' perspectives, impediments to earlier hospice enrollment included patients and caregivers overestimating survival from lung cancer and an (incorrect) assumption that patients need to be “DNR/DNI” prior to hospice enrollment. Significance of results: Lung cancer patients may benefit from earlier introduction to the concepts of hospice care and more education regarding prognosis so that an easier transition in goals of care could be achieved. A smaller proportion of lung cancer patients may benefit from earlier hospice enrollment.
