Roger A Rosenblatt
Dados Biográficos
| ID | 1736632 |
|---|---|
| NOME | Roger A Rosenblatt |
| PRENOMES | Roger A |
| SOBRENOME | Rosenblatt |
| ASSINATURA | ROSENBLATT R A |
| AFILIAÇÕES | University of Washington |
| VERIFICADO | Não |
| TOTAL DE OBRAS | 42 |
| TOTAL DE CITAÇÕES | 81 |
| TOTAL COMO AUTOR | 42 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 1970 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2002 |
| ÍNDICE H | 7 |
Quality of Care in the Rural Context
The quality of health care provided in rural areas is critical to rural patients and providers and will shape the future evolution of the rural health care system. Past research has focused almost exclusively on disease‐specific comparisons of the quality of care rendered in rural as compared with urban areas, which ignores the fact that it is the functioning of the entire system of care that determines whether or not rural residents receive high…
Rural–Urban Differences in the Public Health Workforce
Most local health departments or districts are small and rural; two thirds of the nation's 2832 local health departments serve populations smaller than 50 000 people.1 Rural local health departments have small staffs and slender budgets, yet they are expected to provide a wide array of services2 during a period when the health care system of which they are a part is undergoing change.3
Quality‐of‐Care Challenges for Rural Health
The purpose of this article is to examine the issue of quality of care in rural America and to help others examine this issue in a way that is consistent with the very real challenges faced by rural communities in ensuring the availability of adequate health services. Rural citizens have a right to expect that their bad health care meets certain basic standards. Unless rural providers can document that the quality of local health care meets objec…
Rural Health Research
Rural and urban areas have significant differences in the availability of medical technology, medical practice structures and patient populations. This study uses 1994 Medicare claims data to examine whether these differences are associated with variation in the content of practice between physicians practicing in rural and urban areas. This study compared the number of patients, outpatient visits, and inpatient visits per physician in the differ…
Coming Apart
How Well Do Birth Certificates Describe the Pregnancies They Report? The Washington State Experience with Low-Risk Pregnancies
Obstetric care and payment source
OBJECTIVES: This study examined whether Medicaid-insured women at low risk receive less adequate obstetrical care than privately insured women. METHODS: Low-risk women who were cared for by a random sample of obstetrical providers in Washington State were randomly selected. Information on all prenatal and intrapartum services was abstracted from medical records. Service information was aggregated into standardized resource-use units. Results comp…
The effect of expanding Medicaid prenatal services on birth outcomes
OBJECTIVES: Over 80% of US states have implemented expansions in prenatal services for Medicaid-enrolled women, including case management, nutritional and psychosocial counseling, health education, and home visiting. This study evaluates the effect of Washington State's expansion of such services on prenatal care use and low-birthweight rates. METHODS: The change in prenatal care use and low-birthweight rates among Washington's Medicaid-enrolled …
Interspecialty differences in the obstetric care of low-risk women
OBJECTIVES: This study examined differences among obstetricians, family physicians, and certified nurse-midwives in the patterns of obstetric care provided to low-risk patients. METHODS: For a random sample of Washington State obstetrician-gynecologists, family physicians, and certified nurse-midwives, records of a random sample of their low-risk patients beginning care between September 1, 1988, and August 31, 1989, were abstracted. RESULTS: Cer…
Access to maternity care in rural Washington
OBJECTIVES: This study sought to ascertain the effects of poor local access to obstetric care on the risks of having a neonate diagnosed as non-normal, a long hospital stay, and/or high hospital charges. METHODS: Washington State birth certificates linked with hospital discharge abstracts of mothers and neonates were used to study 29809 births to residents of rural areas. Births to women from rural areas where more than two thirds of the women le…
Is nondashmetropolitan residence a risk factor for poor birth outcome in the U.S
The regionalization of perinatal care in Wales and Washington State
OBJECTIVES. The purpose of this study was to compare perinatal regionalization and neonatal mortality in Wales and Washington State. METHODS. The 28 hospitals in Wales and the 80 hospitals in Washington State that offered maternity services and the 218,326 births that occurred in these hospitals in 1989 and 1990 were studied. Surveys were used to identify the neonatal technology and the referral policies of each hospital, and linked data from bir…
Abortions in rural Idaho
This study surveyed all family physicians, obstetrician-gynecologists, and general surgeons practicing in rural Idaho in 1994. Although most respondents provided a wide range of reproductive health services, less than 4% performed abortions, so most rural Idaho women wanting abortions must travel long distances for this procedure. Physicians report that they do not provide abortion services because of both their own moral objections and local com…
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…
The effect of federal grants on medical schools' production of primary care physicians
OBJECTIVES. Title VII of the Health Professions Educational Assistance Act of 1976 was created to encourage the production of primary care physicians. This study explored recent trends in the proportion of US medical school graduates entering primary care in relationship to Title VII funding. METHODS. The American Medical Association Physician Masterfile was used to determine the specialty choice of all students graduating from American medical s…
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…
Readmission after surgery in Washington State rural hospitals
BACKGROUND. Because of concern about the quality of care in rural hospitals, we examined readmission following four surgical procedures commonly performed in Washington State rural hospitals: appendectomy, cesarean section, cholecystectomy, and transurethral prostatectomy. METHODS. In a retrospective cohort study, we identified all patients discharged after receiving one of the foregoing procedures using the statewide hospital discharge database.…
Part 1
This set of six manuscripts describes the content and impact of the WAMI Rural Hospital Project (RHP), a research and development effort supported by the W.K. Kellogg Foundation, designed to improve the delivery of health services in six rural communities in the Pacific Northwest and Alaska. The major objective of the RHP—an activity which spanned a four‐year period from 1985 through 1988—was to assist the project communities in improving the fin…
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 …
The Wami Rural Hospital Project Part 6
The Rural Hospital Project (RHP) appeared to make a meaningful difference in the six Northwest rural communities that participated in this integrated community development and strategic planning effort. Although the methodological approach used in the evaluation precludes us from attributing observed changes in outcomes solely to the project interventions themselves, several elements of the process appear to be useful in stabilizing or expanding …
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…
The relation of obstetrical volume and nursery level to perinatal mortality
We investigated the relation of hospital delivery volume and nursery technology level to perinatal outcome in 226,164 White singleton births in Washington State, 1980-83. Level III facilities (neonatal intensive care unit) were defined by the state licensing commission. We defined the Level II (intermediate) and Level I (normal newborn) facilities using published criteria. Infants under 2000 gm born in Level III facilities had half the risk of pe…
Access to obstetric care in rural areas
Hospital discharge data from 33 rural hospital service areas in Washington State were categorized by the extent to which patients left their local communities for obstetrical services. Women from communities with relatively few obstetrical providers in proportion to number of births were less likely to deliver in their local community hospital than women in rural communities with greater numbers of physicians practicing obstetrics in proportion t…
Is nondashmetropolitan residence a risk factor for poor birth outcome in the U.S
The relation of obstetrical volume and nursery level to perinatal mortality
We investigated the relation of hospital delivery volume and nursery technology level to perinatal outcome in 226,164 White singleton births in Washington State, 1980-83. Level III facilities (neonatal intensive care unit) were defined by the state licensing commission. We defined the Level II (intermediate) and Level I (normal newborn) facilities using published criteria. Infants under 2000 gm born in Level III facilities had half the risk of pe…
Access to obstetric care in rural areas
Hospital discharge data from 33 rural hospital service areas in Washington State were categorized by the extent to which patients left their local communities for obstetrical services. Women from communities with relatively few obstetrical providers in proportion to number of births were less likely to deliver in their local community hospital than women in rural communities with greater numbers of physicians practicing obstetrics in proportion t…
The effect of federal grants on medical schools' production of primary care physicians
OBJECTIVES. Title VII of the Health Professions Educational Assistance Act of 1976 was created to encourage the production of primary care physicians. This study explored recent trends in the proportion of US medical school graduates entering primary care in relationship to Title VII funding. METHODS. The American Medical Association Physician Masterfile was used to determine the specialty choice of all students graduating from American medical s…
The effect of expanding Medicaid prenatal services on birth outcomes
OBJECTIVES: Over 80% of US states have implemented expansions in prenatal services for Medicaid-enrolled women, including case management, nutritional and psychosocial counseling, health education, and home visiting. This study evaluates the effect of Washington State's expansion of such services on prenatal care use and low-birthweight rates. METHODS: The change in prenatal care use and low-birthweight rates among Washington's Medicaid-enrolled …
Patterns of rural hospital closure in the United States
Interspecialty differences in the obstetric care of low-risk women
OBJECTIVES: This study examined differences among obstetricians, family physicians, and certified nurse-midwives in the patterns of obstetric care provided to low-risk patients. METHODS: For a random sample of Washington State obstetrician-gynecologists, family physicians, and certified nurse-midwives, records of a random sample of their low-risk patients beginning care between September 1, 1988, and August 31, 1989, were abstracted. RESULTS: Cer…
Readmission after surgery in Washington State rural hospitals
BACKGROUND. Because of concern about the quality of care in rural hospitals, we examined readmission following four surgical procedures commonly performed in Washington State rural hospitals: appendectomy, cesarean section, cholecystectomy, and transurethral prostatectomy. METHODS. In a retrospective cohort study, we identified all patients discharged after receiving one of the foregoing procedures using the statewide hospital discharge database.…
Rural–Urban Differences in the Public Health Workforce
Most local health departments or districts are small and rural; two thirds of the nation's 2832 local health departments serve populations smaller than 50 000 people.1 Rural local health departments have small staffs and slender budgets, yet they are expected to provide a wide array of services2 during a period when the health care system of which they are a part is undergoing change.3
Obstetric care and payment source
OBJECTIVES: This study examined whether Medicaid-insured women at low risk receive less adequate obstetrical care than privately insured women. METHODS: Low-risk women who were cared for by a random sample of obstetrical providers in Washington State were randomly selected. Information on all prenatal and intrapartum services was abstracted from medical records. Service information was aggregated into standardized resource-use units. Results comp…
The regionalization of perinatal care in Wales and Washington State
OBJECTIVES. The purpose of this study was to compare perinatal regionalization and neonatal mortality in Wales and Washington State. METHODS. The 28 hospitals in Wales and the 80 hospitals in Washington State that offered maternity services and the 218,326 births that occurred in these hospitals in 1989 and 1990 were studied. Surveys were used to identify the neonatal technology and the referral policies of each hospital, and linked data from bir…
Abortions in rural Idaho
This study surveyed all family physicians, obstetrician-gynecologists, and general surgeons practicing in rural Idaho in 1994. Although most respondents provided a wide range of reproductive health services, less than 4% performed abortions, so most rural Idaho women wanting abortions must travel long distances for this procedure. Physicians report that they do not provide abortion services because of both their own moral objections and local com…
Rural health care delivery amidst federal retrenchment
This paper examines the experience of the Robert Wood Johnson Foundation's Rural Practice Project (RPP), a major non-governmental effort in the last decade concentrating on the direct delivery of rural health services. The nine RPP sites started prior to 1977 showed a slow but steady increase in their utilization levels and improvement in their financial status during their initial operational years. The tempo of their development was remarkably …
Dagger in the heart of town
Singers of Daybreak
The Growth and Evolution of Rural Primary Care Practice
The economic growth and development of 12 rural primary care practices established by the National Health Service Corps (NHSC) in the Pacific Northwest between 1973 and 1975 was examined. The 12 practices represented four types of rural health care delivery systems based on the size of the service area, the presence and type of hospital within that service area, and the number and kinds of providers in the service area. The results indicate that …
The viability of mid-level practitioners in isolated rural communities
The viability of mid-level practitioners in isolated rural communities. I Moscovice, and R RosenblattCopyRight https://doi.org/10.2105/AJPH.69.5.503 Published Online: August 29, 2011
Black Autobiography
Rural health care delivery amidst federal retrenchment
This paper examines the experience of the Robert Wood Johnson Foundation's Rural Practice Project (RPP), a major non-governmental effort in the last decade concentrating on the direct delivery of rural health services. The nine RPP sites started prior to 1977 showed a slow but steady increase in their utilization levels and improvement in their financial status during their initial operational years. The tempo of their development was remarkably …
Rural Medicine
Associate Professor and Director, Research Section, Department of Family Medicine University of Washington School of Medicine
Diagnosis Clusters
A clustering method for the analysis of ambulatory morbidity data is presented. This approach reduces spurious variations resulting from idiosyncratic diagnosis labeling and coding habits of physicians and facilitates the analysis of the content of ambulatory medical care through the use of aggregate morbidity data. The clusters provide a tool that allows for the comparison of the content of practice based on different factors such as provider tr…
Paradox on 72nd street
The Physician as Gatekeeper
The authors studied differences in the rate of hospitalization of a random sample of all general and family practitioners in the state of Washington. The study was designed to identify nonmedical factors that affect the rate at which physicians hospitalize ambulatory patients. They found that the hospitalization rate varied greatly among physicians and that this rate appeared to be sensitive to nonmedical factors. The following independent variab…
A Prognosis for the Rural Hospital
This is the second of a two part series that summarizes what is known about the operation and performance of the rural hospital and discusses potential options and strategies for strengthening the viability of these institutions. In Part II, we focus on the economic viability of the rural hospital and examine external factors that influence the environment within which the rural hospital operates. We conclude that the future will remain precariou…
A Prognosis for the Rural Hospital Part I
The rural hospital is a vital component of the rural health care delivery system and an important institution in rural communities. In recent years, considerable concern has been expressed over the future of these institutions, many of which have experienced serious difficulties in maintaining financial viability. The problems facing many rural hospitals today result from a number of interrelated factors, both internal and external, that determin…
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 …
Patterns of rural hospital closure in the United States
The Rural Hospital Project
Rural hospitals are confronting continuing and increasing threats to their inability. A demonstration project for the Washington‐Alaska‐Montana‐Idaho region to address the problems of the rural hospital and health system is described. The assumptions underlying the project are that the rural hospital represents the most important component of the rural health care system, and the role of the rural hospital must be defined in relation to the broad…
A Lack of Will
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…
The relation of obstetrical volume and nursery level to perinatal mortality
We investigated the relation of hospital delivery volume and nursery technology level to perinatal outcome in 226,164 White singleton births in Washington State, 1980-83. Level III facilities (neonatal intensive care unit) were defined by the state licensing commission. We defined the Level II (intermediate) and Level I (normal newborn) facilities using published criteria. Infants under 2000 gm born in Level III facilities had half the risk of pe…
Access to obstetric care in rural areas
Hospital discharge data from 33 rural hospital service areas in Washington State were categorized by the extent to which patients left their local communities for obstetrical services. Women from communities with relatively few obstetrical providers in proportion to number of births were less likely to deliver in their local community hospital than women in rural communities with greater numbers of physicians practicing obstetrics in proportion t…
Part 1
This set of six manuscripts describes the content and impact of the WAMI Rural Hospital Project (RHP), a research and development effort supported by the W.K. Kellogg Foundation, designed to improve the delivery of health services in six rural communities in the Pacific Northwest and Alaska. The major objective of the RHP—an activity which spanned a four‐year period from 1985 through 1988—was to assist the project communities in improving the fin…
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 …
The Wami Rural Hospital Project Part 6
The Rural Hospital Project (RHP) appeared to make a meaningful difference in the six Northwest rural communities that participated in this integrated community development and strategic planning effort. Although the methodological approach used in the evaluation precludes us from attributing observed changes in outcomes solely to the project interventions themselves, several elements of the process appear to be useful in stabilizing or expanding …
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…
Medicine (35 obras) · Global Health Workforce Issues (18 obras) · Family medicine (17 obras) · Health care (17 obras) · Environmental health (16 obras) · Rural area (16 obras) · Healthcare Policy and Management (15 obras) · Primary Care and Health Outcomes (15 obras) · Business (14 obras) · Nursing (14 obras)