America's Rural Hospitals: A Selective Review of 1980s Research

We review 1980s research on American rural hospitals within the context of a decade of increasing restrictiveness in the reimbursement and operating environments. Areas addressed include rural hospital definitions, organizational and financial performance, and strategic management activities. The latter category consists of hospital closure, diversification and vertical integration, swing-bed conversion, sole community provider designation, horizontal integration and multihospital system affiliation, marketing, and patient retention. The review suggests several research needs, including: developing more meaningful definitions of rural hospitals, engaging in methodologically sound work on the effects of innovative programs and strategic management activities—including conversion of the facility itself—on rural hospital performance, and completing studies of the effects of rural hospital closure or conversion on the health of the communities served.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74857/1/j.1748-0361.1990.tb00682.x.pd

Folate status, homocysteine metabolism, and methylenetetrahydrofolate reductase genotype in rural South African blacks with a history of pregnancy complicated by neural tube defects.

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MENTAL HEALTH CARE FOR OLDER PERSONS: NETWORKING AS A RESPONSE TO ORGANIZATIONAL CHALLENGES -super-1

We use case study methodology to examine the degree of cooperation and coordination among organizations providing mental health care to older persons. Mail surveys and in-depth interviews were employed to gather data from human service organizations in one relatively rural county of Upstate New York. We find that organizations that are older and provide larger numbers of services tend to have a higher degree of integration with other organizations. There is little evidence of formal coordination of services. Informal cooperation, at least on an ad hoc basis, is common, though. Older persons with chronic mental health problems are relatively well served by the system. Older persons whose mental health problems are associated with the aging process are not well served by the system. The growth of mental health managed care has increased competition among many organizations, further fragmenting a weakly integrated system. Copyright 2000 by The Policy Studies Organization.