L Gary Hart
Datos Biográficos
| ID | 1736631 |
|---|---|
| NOMBRE | L Gary Hart |
| NOMBRES | L Gary |
| APELLIDO | Hart |
| FIRMA | HART L G |
| AFILIACIONES | University of Washington |
| VERIFICADO | No |
| TOTAL DE OBRAS | 43 |
| TOTAL DE CITAS | 95 |
| TOTAL COMO AUTOR | 43 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 1984 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2010 |
| ÍNDICE H | 4 |
Quality of Care for Myocardial Infarction in Rural and Urban Hospitals
BACKGROUND: In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted. METHODS: Using inpatient records data for 34,776 Medicare beneficiaries with AMI from 2000-2001, unadjusted and logistic regression analysis compared rec…
Geographic Differences in Use of Home Oxygen for Obstructive Lung Disease
RATIONALE: Home oxygen is the most expensive equipment item that Medicare purchases ($1.7 billion/year). OBJECTIVES: To assess geographic differences in supplemental oxygen use. METHODS: Retrospective cohort analysis of oxygen claims for a 20% random sample of Medicare patients hospitalized for obstructive lung disease in 1999 and alive at the end of 2000. MEASUREMENTS AND MAIN RESULTS: While 33.7% of the 34,916 hospitalized patients used supplem…
Do International Medical Graduates (IMGs) “Fill the Gap” in Rural Primary Care in the United States? A National Study
Context: The contribution that international medical graduates (IMGs) make to reducing the rural‐urban maldistribution of physicians in the United States is unclear. Quantifying the extent of such “gap filling” has significant implications for planning IMG workforce needs as well as other state and federal initiatives to increase the numbers of rural providers. Purpose: To compare the practice location of IMGs and US medical graduates (USMGs) pra…
Trends in Perinatal and Infant Health Disparities Between Rural American Indians and Alaska Natives and Rural Whites
Objectives. We examined disparities in perinatal care, birth outcomes, and infant health between rural American Indian and Alaska Native (AIAN) persons and rural Whites over time. Methods. We compared perinatal and infant health measures for 217 064 rural AIAN births and 5 032 533 rural non-Hispanic White births. Results. Among American Indians and Alaska Natives, unadjusted rates of inadequate prenatal care (1985–1987, 36.3%; 1995–1997, 26.3%) a…
Access to Cancer Services for Rural Colorectal Cancer Patients
Context: Cancer care requires specialty surgical and medical resources that are less likely to be found in rural areas. Purpose: To examine the travel patterns and distances of rural and urban colorectal cancer (CRC) patients to 3 types of specialty cancer care services—surgery, medical oncology consultation, and radiation oncology consultation. Methods: Descriptive cross‐sectional study using linked Surveillance, Epidemiology, and End Results (S…
Access to Specialty Health Care for Rural American Indians in Two States
Context: The Indian Health Service (IHS), whose per capita expenditure for American Indian and Alaska Native (AI/AN) health services is about half that of the US civilian population, is the only source of health care funding for many rural AI/ANs. Specialty services, largely funded through contracts with outside practitioners, may be limited by low IHS funding levels. Purpose: To examine specialty service access among rural Indian populations in …
Measuring participant rurality in Web-based interventions
Researchers of Web-based health behavior change programs targeted to the US should routinely include RUCAs as a part of analyzing participant demographics. Researchers in other countries should examine rurality indices germane to their country
Prevalence and Trends in Smoking
Context: Cigarette smoking is the leading preventable cause of death in the United States. Purpose: To estimate the prevalence of and recent trends in smoking among adults by type of rural location and by state. Methods: Random‐digit telephone survey of adults aged 18 years or older who participated in the Behavioral Risk Factor Surveillance System in 1994‐1996 (n = 342,055) and 2000‐2001 (n = 385,384). The main outcome measure was current cigare…
Characteristics of Registered Nurses in Rural Versus Urban Areas
Methods: This study compares characteristics of rural and urban registered nurses (RNs) in the United States using data from the 2000 National Sample Survey of Registered Nurses. RNs in 3 types of rural areas are examined using the rural‐urban commuting area taxonomy. Findings: Rural and urban RNs are similar in age and sex; nonwhites and Hispanics are underrepresented in both groups. Rural RNs have less nursing education, are less likely to work…
Modeling the Mental Health Workforce in Washington State
Context: Ensuring an adequate mental health provider supply in rural and urban areas requires accessible methods of identifying provider types, practice locations, and practice productivity. Purpose: To identify mental health shortage areas using existing licensing and survey data. Methods: The 1998‐1999 Washington State Department of Health files on credentialed health professionals linked with results of a licensure renewal survey, 1990 US Cens…
A National Study of Obesity Prevalence and Trends by Type of Rural County
Context: Obesity is epidemic in the United States, but information on this trend by type of rural locale is limited. Purpose: To estimate the prevalence of and recent trends in obesity among US adults residing in rural locations. Methods: Analysis of data from the Behavioral Risk Factor Surveillance System (BRFSS) for the years 1994–1996 (n = 342,055) and 2000–2001 (n = 385,384). The main outcome measure was obesity (body mass index [BMI] ≥30), a…
Rural Definitions for Health Policy and Research
The term “rural” suggests many things to many people, such as agricultural landscapes, isolation, small towns, and low population density. However, defining “rural” for health policy and research purposes requires researchers and policy analysts to specify which aspects of rurality are most relevant to the topic at hand and then select an appropriate definition. Rural and urban taxonomies often do not discuss important demographic, cultural, and …
The flight of physicians from West Africa
The migration of physicians from sub-Saharan Africa to the United States of America
BACKGROUND: The objective of this paper is to describe the numbers, characteristics, and trends in the migration to the United States of physicians trained in sub-Saharan Africa. METHODS: We used the American Medical Association 2002 Masterfile to identify and describe physicians who received their medical training in sub-Saharan Africa and are currently practicing in the USA. RESULTS: More than 23% of America's 771 491 physicians received their …
Quality of Care for Acute Myocardial Infarction in Rural and Urban US Hospitals
Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers. Methods: This cohort study used data from the Cooperative Cardiovascular Project (CCP), including 4,085 ac…
An Analysis of Medicare's Incentive Payment Program for Physicians in Health Professional Shortage Areas
Context: Medicare's Incentive Payment (MIP) program provides a 10% bonus payment to providers who treat Medicare patients in rural and urban areas where there is a shortage of generalist physicians. Purpose: To examine the experience of Alaska, Idaho, North Carolina, South Carolina, and Washington with the MIP program. We determined the program's utilization and which types of physicians received payments. Methods: Retrospective cohort design, ut…
The Role of International Medical Graduates in America's Small Rural Critical Access Hospitals
Context: Critical access hospitals (CAHs) are a federal Medicare category for isolated rural facilities with 15 or fewer acute care beds that receive cost‐based reimbursement from Medicare. Purpose: This study examines the role of foreign‐born international medical graduates (IMGs) in the staffing of CAHs. Methods: Chief executive officers (CEOs) of CAH facilities answered a telephone survey on their use of IMGs and the characteristics of those I…
Attitudes of Family Physicians in Washington State Toward Physician‐Assisted Suicide
Context: The topic of physician‐assisted suicide is difficult and controversial. With recent laws allowing physicians to assist in a terminally ill patient's suicide under certain circumstances, the debate concerning the appropriate and ethical role for physicians has intensified. Purpose: This paper utilizes data from a 1997 survey of family physicians (FPs) in Washington State to test two hypotheses: (1) older respondents will indicate greater …
Small Town Health Care Safety Nets
Context: Very little is known about the health care safety net in small towns, especially in towns where there is no publicly subsidized safety‐net health care. Purpose: This pilot study of the primary care safety net in 7 such communities was conducted to start building knowledge about the rural safety net. Methods: Interviews were conducted and secondary data collected to assess the community need for safety‐net care, the health care safety‐net…
Rural Health Care Providers in the United States
One of the most recalcitrant problems of the rural health landscape is the uneven distribution and relative shortage of medical care providers. Despite considerable efforts by federal and state governments over the past three decades to address these problems, rural provider distribution and shortage issues have persisted. The purpose of this article is to identify the challenges for rural health research and policy regarding health provider supp…
Perinatal and Infant Health Among Rural and Urban American Indians/Alaska Natives
Objectives. We sought to provide a national profile of rural and urban American Indian/Alaska Native (AI/AN) maternal and infant health. Methods. In this cross-sectional study of all 1989–1991 singleton AI/AN births to US residents, we compared receipt of an inadequate pattern of prenatal care, low birthweight ( Results. Receipt of an inadequate pattern of prenatal care was significantly higher for rural than for urban mothers of AI/AN infants (1…
Andy Nichols (1937 ‐ 2001)
The Distribution of Rural Female Generalist Physicians in the United States
Female physicians are underrepresented in rural areas. What impact might the increasing proportion of women in medicine have on the rural physician shortage? To begin addressing this question, we present data describing the geographic distribution of female physicians in the United States. We examine the geographic distribution of all active U.S. allopathic physicians recorded in the October 1996 update of the American Medical Association Physici…
How Many Rural Doctors Do We Have
The number of physicians practicing in the nonmetropolitan areas of the United States in relation to population has increased over the past two decades, but more slowly than the number of physicians in metropolitan counties. During the same period, there was a growing acceptance of the perception that the physician workforce in the United States exceeded the number necessary to meet the requirements of an efficient health care system. This has ca…
A Tribute to the Editor, Tom Ricketts III, Ph.D
Rural Definitions for Health Policy and Research
The term “rural” suggests many things to many people, such as agricultural landscapes, isolation, small towns, and low population density. However, defining “rural” for health policy and research purposes requires researchers and policy analysts to specify which aspects of rurality are most relevant to the topic at hand and then select an appropriate definition. Rural and urban taxonomies often do not discuss important demographic, cultural, and …
The flight of physicians from West Africa
Perinatal and Infant Health Among Rural and Urban American Indians/Alaska Natives
Objectives. We sought to provide a national profile of rural and urban American Indian/Alaska Native (AI/AN) maternal and infant health. Methods. In this cross-sectional study of all 1989–1991 singleton AI/AN births to US residents, we compared receipt of an inadequate pattern of prenatal care, low birthweight ( Results. Receipt of an inadequate pattern of prenatal care was significantly higher for rural than for urban mothers of AI/AN infants (1…
Is nondashmetropolitan residence a risk factor for poor birth outcome in the U.S
Trends in Perinatal and Infant Health Disparities Between Rural American Indians and Alaska Natives and Rural Whites
Objectives. We examined disparities in perinatal care, birth outcomes, and infant health between rural American Indian and Alaska Native (AIAN) persons and rural Whites over time. Methods. We compared perinatal and infant health measures for 217 064 rural AIAN births and 5 032 533 rural non-Hispanic White births. Results. Among American Indians and Alaska Natives, unadjusted rates of inadequate prenatal care (1985–1987, 36.3%; 1995–1997, 26.3%) a…
Interspecialty Variation in Office-Based Care
Analysis of national survey data on physician-patient encounters raises questions about physician education and manpower policy. Data compiled by the University of Southern California Medical Activities and Manpower Projects and the United States Bureau of Health Professionals reveal differences among internists, cardiologists, family practitioners, and pediatricians in procedures used for diagnosing and treating several frequently encountered co…
A Comparison of the Patients and Practices of Recent Graduates of Family Practice and General Internal Medicine Residency Programs
This study compares the characteristics of the practices and patients of recent graduates of family practice and general internal medicine residency programs. National samples of 104 family physicians and 134 general internists completed questionnaires and provided log-diary data for more than 7,500 office visits and 1,100 hospitalized patients. Family physicians and general internists were generally similar in demographic and practice characteri…
The Use of Medical Resources by Residency-Trained Family Physicians and General Internists
This study compared the use of medical resources by recently trained family physicians and general internists. Analyses are based on records of 3,737 adult office encounters with 132 family physicians and 2,250 adult office encounters with 102 general internists. General internists are twice as likely as family physicians to order blood tests, blood counts, chest x-rays, and electrocardiograms for their adult patients. Internists also spend more …
Is There a Role for the Small Rural Hospital
Rural hospitals represent almost half of all short‐stay nonfederal general hospitals in the United States, but have been more severely affected than their urban counterparts by changes in reimbursement, regulation, and technology. Two hundred and six rural community hospitals closed during thefirst nineyears of the 1980s, and the rate of closure is accelerating. Using secondary data sources to examine the structure, role, and content of rural hos…
Part 5
Rural health care facilities commonly employ community health care surveys as marketing research instruments to assess consumer utilization of and satisfaction with local services. However, there is little information on the use of survey findings as a way to design interventions to enhance consumer satisfaction and hospital viability. A community survey was administered in six Northwest rural communities as part of the Rural Hospital Project (RH…
Part 2
A major goal of the Rural Hospital Project (RHP) was to assist communities in defining an optimal scope of hospital and community health services. It was hypothesized that a rational basis for service planning would result in an expansion of locally provided health services, increased local hospital and physician market share, improved hospital workload performance, and higher levels of consumer satisfaction with community‐based services. However…
Causes and Consequences of Rural Small Hospital Closures from the Perspectives of Mayors
Mayors of rural towns whose small general hospitals closed between 1980 and 1988 were surveyed. Only hospitals that were the sole hospitals in their towns and that had not reopened were included in the survey. Of the 132 hospitals meeting these criteria, 130 (98.5%) of the mayors of their communities responded to the survey. The typical study hospital had 31 beds, with an average daily census of 12. Three fourths of the hospital closures were in …
Physician Staffing of Small Rural Hospital Emergency Departments
We surveyed all 37 rural Washington state hospitals with fewer than 100 beds to determine how rural emergency departments are staffed by physicians and to estimate rural hospital payments for emergency department physician services. Only five hospital emergency departments (14%) were still covered by the traditional rotation of local practitioners and billed on a fee‐for‐service basis. Ten hospitals (27%) paid local private practitioners to provi…
Rural Residence and Poor Birth Outcome in Washington State
It is often assumed that poor birth outcomes are more common among rural women than urban women, but there is little substantive evidence to that effect. While the effectiveness of rural providers and hospitals has been evaluated in previous studies, this study focuses on poor birth outcomes in a population of rural residents, including those who leave rural areas for obstetrical care. Rural and urban differences in rates of inadequate prenatal c…
Rural Hospital Inpatient Surgical Volume
Surgical services are an important part of modern health care, but providing them to isolated rural citizens is especially difficult. Public policy initiatives could influence the supply, training, and distribution of surgeons, much as they have for rural primary care providers. However, so little is known about the proper distribution of surgeons, their contribution to rural health care, and the safety of rural surgery that policy cannot be shap…
Market Shares for Rural Inpatient Surgical Services
Utilization of surgical services by rural citizens is poorly understood, and few data are available about rural hospitals’surgical market shares and their financial implications. Understanding these issues is particularly important in an era of financially stressed rural hospitals. In this study information about rural surgical providers and services was obtained through telephone interviews with administrators at Washington state's 42 rural hosp…
Two Decades of Experience in the University of Washington Family Medicine Residency Network
This study describes how graduates of the University of Washington Family Medicine Residency Network who practice in rural locations differ from their urban counterparts in demographic characteristics, practice organization, practice content and scope of services, and satisfaction. Five hundred and three civilian medical graduates who completed their residencies between 1973 and 1990 responded to a 27‐item questionnaire sent in 1992 (84% response…
Is nondashmetropolitan residence a risk factor for poor birth outcome in the U.S
Antitrust Immunity in Rural Washington
State action immunity from antitrust liability has been proposed as an important tool for preserving and strengthening fragile rural health care delivery systems. Washington is a leader in the use of state action immunity, having passed a statute and having approved several applications for immunity. This paper summarizes the current status of state action immunity, both in general and in Washington, including a review of the literature and an ex…
Job Satisfaction Among Rural Physician Assistants
Because increasing numbers of physicians are being trained in specialized medicine, health professional shortage areas remain common in the United States, and the role of physician assistants (PAS) in health services provision is becoming increasingly important, especially in rural and underserved areas. By most accounts, there is a shortage of PAS in the United States, particularly in rural areas. A nationwide survey was conducted in 1994 to det…
How Well Do Birth Certificates Describe the Pregnancies They Report? The Washington State Experience with Low-Risk Pregnancies
The Distribution of Rural Female Generalist Physicians in the United States
Female physicians are underrepresented in rural areas. What impact might the increasing proportion of women in medicine have on the rural physician shortage? To begin addressing this question, we present data describing the geographic distribution of female physicians in the United States. We examine the geographic distribution of all active U.S. allopathic physicians recorded in the October 1996 update of the American Medical Association Physici…
How Many Rural Doctors Do We Have
The number of physicians practicing in the nonmetropolitan areas of the United States in relation to population has increased over the past two decades, but more slowly than the number of physicians in metropolitan counties. During the same period, there was a growing acceptance of the perception that the physician workforce in the United States exceeded the number necessary to meet the requirements of an efficient health care system. This has ca…
A Tribute to the Editor, Tom Ricketts III, Ph.D
Educating Generalist Physicians for Rural Practice
Although about 20 percent of Americans live in rural areas, only 9 percent of physicians practice there. Physicians consistently and preferentially settle in metropolitan, suburban and other nonrural areas. The last 20 years have seen a variety of strategies by medical education programs and by federal and state governments to promote the choice of rural practice among physicians. This comprehensive literature review was based on MEDLINE and Heal…
The Use of Community Surveys for Health Planning
A rural health services development program of the University of Washington School of Medicine has worked for 15 years with communities throughout the five‐state region of Alaska, Idaho, Montana, Washington and Wyoming to strengthen their health systems. In the course of that work, 56 communities were surveyed about their utilization and opinions of local health systems. This database allows the following generalizations to be made about rural No…
Andy Nichols (1937 ‐ 2001)
Rural Health Care Providers in the United States
One of the most recalcitrant problems of the rural health landscape is the uneven distribution and relative shortage of medical care providers. Despite considerable efforts by federal and state governments over the past three decades to address these problems, rural provider distribution and shortage issues have persisted. The purpose of this article is to identify the challenges for rural health research and policy regarding health provider supp…
Perinatal and Infant Health Among Rural and Urban American Indians/Alaska Natives
Objectives. We sought to provide a national profile of rural and urban American Indian/Alaska Native (AI/AN) maternal and infant health. Methods. In this cross-sectional study of all 1989–1991 singleton AI/AN births to US residents, we compared receipt of an inadequate pattern of prenatal care, low birthweight ( Results. Receipt of an inadequate pattern of prenatal care was significantly higher for rural than for urban mothers of AI/AN infants (1…
Attitudes of Family Physicians in Washington State Toward Physician‐Assisted Suicide
Context: The topic of physician‐assisted suicide is difficult and controversial. With recent laws allowing physicians to assist in a terminally ill patient's suicide under certain circumstances, the debate concerning the appropriate and ethical role for physicians has intensified. Purpose: This paper utilizes data from a 1997 survey of family physicians (FPs) in Washington State to test two hypotheses: (1) older respondents will indicate greater …
Medicine (40 obras) · Global Health Workforce Issues (27 obras) · Family medicine (21 obras) · Nursing (19 obras) · Environmental health (17 obras) · Rural area (17 obras) · Political science (16 obras) · Business (15 obras) · Health care (15 obras) · Primary Care and Health Outcomes (13 obras)