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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 162 Research Studies Displayed
Manojlovich M, Harrod M, Hofer T
Factors influencing physician responsiveness to nurse-initiated communication: a qualitative study.
How quickly physicians respond to communications from bedside nurses is important for the delivery of safe inpatient care. Delays in physician responsiveness can impede care or contribute to patient harm. Understanding contributory factors to physician responsiveness can provide insights to promote timely physician response, possibly improving communication to ensure safe patient care. The purpose of this study was to describe the factors contributing to physician responsiveness to text or numeric pages, telephone calls and face-to-face messages delivered by nurses on adult general care units.
Citation:
Manojlovich M, Harrod M, Hofer T .
Factors influencing physician responsiveness to nurse-initiated communication: a qualitative study.
BMJ Qual Saf 2021 Sep;30(9):747-54. doi: 10.1136/bmjqs-2020-011441..
Keywords:
Provider: Physician, Provider: Nurse, Communications, Inpatient Care
Vu K, Zhou J, Everhart A
Uptake of evidence by physicians: de-adoption of erythropoiesis-stimulating agents after the TREAT trial.
Variation in de-adoption of ineffective or unsafe treatments is not well-understood. In this study the investigators examined de-adoption of erythropoiesis-stimulating agents (ESA) in anemia treatment among patients with chronic kidney disease (CKD) following new clinical evidence of harm and ineffectiveness (the TREAT trial) and the FDA's revision of its safety warning. The investigators found that physician specialty had a dominant role in prescribing decision, and specializations with higher use of treatment (nephrologists) were more responsive to new evidence of unsafety and ineffectiveness.
AHRQ-funded; HS025164.
Citation:
Vu K, Zhou J, Everhart A .
Uptake of evidence by physicians: de-adoption of erythropoiesis-stimulating agents after the TREAT trial.
BMC Nephrol 2021 Aug 21;22(1):284. doi: 10.1186/s12882-021-02491-y..
Keywords:
Evidence-Based Practice, Medication: Safety, Medication, Patient Safety, Practice Patterns, Provider: Physician
Delaney LD, Kattapuram M, Haidar JA
The impact of surgeon adherence to preoperative optimization of hernia repairs.
This study looked at the ways that surgeon-level adherence to preoperative optimization impacts postoperative outcomes. A cohort of patients receiving hernia repair surgery were studied using data from the Michigan Surgical Quality Collaborative from 2014 to 2018. Adherence to preoperative optimization was defined as operating on patients who were nontobacco users with a body mass index of >18.5 kg/m2 and <40 kg/m2. Risk- and reliability-adjusted adherence rates were used to divide surgeons into tertiles. Across 70 Michigan hospitals, 15,016 patients underwent ventral and incisional hernia repair, cared for by 454 surgeons. Preoperative optimization rates ranged from 51% to 76%. Surgeons in the lowest tertile had higher rates of emergency department visits and serious complications versus any complication than middle and high optimization tertiles.
AHRQ-funded; HS025778.
Citation:
Delaney LD, Kattapuram M, Haidar JA .
The impact of surgeon adherence to preoperative optimization of hernia repairs.
J Surg Res 2021 Aug;264:8-15. doi: 10.1016/j.jss.2021.01.044..
Keywords:
Surgery, Provider: Physician, Provider, Outcomes
Valdez S
Do Medicare's facility fees incentivize hospitals to vertically integrate with oncologists?
Within the past decade, the U.S. health care market has undergone massive vertical integration, prompting economists to study the underlying causes and consequences of hospital-physician integration. This paper examined whether or not hospitals strategically chose to vertically integrate with clinical oncologists in order to capture facility fees, a commonly cited reason for increased consolidation in the health care market.
AHRQ-funded; HS000046.
Citation:
Valdez S .
Do Medicare's facility fees incentivize hospitals to vertically integrate with oncologists?
Inquiry 2021 Jan-Dec;58:469580211022968. doi: 10.1177/00469580211022968..
Keywords:
Medicare, Hospitals, Provider: Physician
Ellis RJ, Nicolas JD, Cheung E
Comprehensive characterization of the general surgery residency learning environment and the association with resident burnout.
Researchers sought to characterize the learning environment and to evaluate associations with burnout using a cross-sectional survey administered to all U.S. general surgery residents. They found that the overall burnout rate was 43.0%, and residents were more likely to report burnout if they also identified problems with residency workload, efficiency, social support, organizational culture, meaning in work, or experienced workplace mistreatment. They recommended efforts to help programs identify and address weaknesses in a targeted fashion in order to improve trainee burnout.
AHRQ-funded; HS000078.
Citation:
Ellis RJ, Nicolas JD, Cheung E .
Comprehensive characterization of the general surgery residency learning environment and the association with resident burnout.
Ann Surg 2021 Jul 1;274(1):6-11. doi: 10.1097/sla.0000000000004796..
Keywords:
Burnout, Surgery, Stress, Provider: Physician
Rosko AJ, Gay BL, Reyes-Gastelum D
Surgeons' attitudes on total thyroidectomy vs lobectomy for management of papillary thyroid microcarcinoma.
The incidence of papillary thyroid cancer has increased in the past 25 years without a clear increase in thyroid cancer deaths. Given these findings, there has been a shift toward recommending conservative surgical options, with current management guidelines favoring lobectomy, especially for patients with papillary thyroid microcarcinoma. The aim of this study was to identify surgeons’ attitudes regarding surgical management of microcarcinomas with the hypothesis that surgeons consider other factors, in addition to tumor size, when selecting a surgical procedure.
AHRQ-funded; HS024512.
Citation:
Rosko AJ, Gay BL, Reyes-Gastelum D .
Surgeons' attitudes on total thyroidectomy vs lobectomy for management of papillary thyroid microcarcinoma.
JAMA Otolaryngol Head Neck Surg 2021 Jul;147(7):667-69. doi: 10.1001/jamaoto.2021.0525..
Keywords:
Cancer, Surgery, Practice Patterns, Provider: Physician
Chou LN, Kuo YF, Raji MA
Potentially inappropriate medication prescribing by nurse practitioners and physicians.
This study compared prescribing rates for potentially inappropriate medications (PIMs) by physicians and nurse practitioners (NPs). The authors used 100% Texas Medicare data to define physician and NP visits in 2016. Rates of visits with a PIM prescription from the same provider was measured by initial and refill visits. There were 24.1 per 1000 visits for PIM prescriptions, 9.0 per 1000 visits for an initial PM and 15.1 per 1000 visits for a refill PIM. Visits to an NP was less likely to result in an initial and refill PIM visit than a visit to a physician. There was a strong association of lower odds of a black enrollee receiving a PIM by an NP than white enrollees. There was also less likelihood of receiving a PIM refill from an NP in older patients and in those with more comorbidities.
AHRQ-funded; HS020642; HS020642.
Citation:
Chou LN, Kuo YF, Raji MA .
Potentially inappropriate medication prescribing by nurse practitioners and physicians.
J Am Geriatr Soc 2021 Jul;69(7):1916-24. doi: 10.1111/jgs.17120..
Keywords:
Medication: Safety, Medication, Provider: Physician, Provider: Nurse, Hospitalization, Practice Patterns, Ambulatory Care and Surgery
Ehlers AP, Chhabra K, Thumma JR
In the eye of the beholder: surgeon variation in intra-operative perceptions of hiatal hernia and reflux outcomes after sleeve gastrectomy.
Researchers sought to determine whether intra-operative diagnosis of hiatal hernia varies among surgeons or if it affects outcomes of laparoscopic sleeve gastrectomy. They found that surgeons who identified hiatal hernias during video review had a higher rate of concurrent hiatal hernia repairs in their practice. However, this identification was not associated with improved patient-reported reflux symptoms after laparoscopic sleeve gastrectomy. They concluded that standardizing identification and management of hiatal hernias during bariatric surgery may help improve reflux outcomes post-operatively.
AHRQ-funded; HS023597.
Citation:
Ehlers AP, Chhabra K, Thumma JR .
In the eye of the beholder: surgeon variation in intra-operative perceptions of hiatal hernia and reflux outcomes after sleeve gastrectomy.
Surg Endosc 2021 Jun;35(6):2537-42. doi: 10.1007/s00464-020-07668-4..
Keywords:
Obesity, Surgery, Provider: Physician, Provider
Links AR, Callon W, Wasserman C
Treatment recommendations to parents during pediatric tonsillectomy consultations: a mixed methods analysis of surgeon language.
A deeper understanding of the dialogue clinicians use to relay treatment recommendations is needed to fully understand their influence on patient decisions about surgery. In this study, the authors characterize how otolaryngologists provide treatment recommendations and suggest a classification framework. The investigators concluded that clinicians provide treatment recommendations in a variety of ways that may introduce more or less certainty and choice to parental treatment decisions.
AHRQ-funded; HS022932.
Citation:
Links AR, Callon W, Wasserman C .
Treatment recommendations to parents during pediatric tonsillectomy consultations: a mixed methods analysis of surgeon language.
Patient Educ Couns 2021 Jun;104(6):1371-79. doi: 10.1016/j.pec.2020.11.015..
Keywords:
Children/Adolescents, Surgery, Caregiving, Decision Making, Clinician-Patient Communication, Communications, Provider: Physician, Provider
Papaleontiou M, Zebrack B, Reyes-Gastelum D
Physician management of thyroid cancer patients' worry.
This study’s purpose was to understand physician management of thyroid cancer-related worry. Endocrinologists, general surgeons, and otolaryngologists identified by Surveillance, Epidemiology, and End Results (SEER) patients were surveyed in 2018 to 2019. The response rate was 69% with 448 physicians responding. Physicians reported their patients as quite/very worried (65%), very worried (27%), and a little/not worried (8%) at diagnosis, with half telling their patients that thyroid cancer is a “good cancer”. Otolaryngologists, private practice, and West Coast (Los Angeles versus Georgia) were associated with using the term “good cancer”. Physician response to worries were good, with 97% of physicians making themselves available for discussion, 44% referring their patients to educational websites, 18% encouraging communication with family/friends, 13% referring their patients to support groups, and 7% referring them to counselors. Physicians who perceived their patients as being quite/very worried were less likely to use the term “good cancer” and more likely to encourage patients to seek help outside the physician-patient relationship.
AHRQ-funded; HS024512.
Citation:
Papaleontiou M, Zebrack B, Reyes-Gastelum D .
Physician management of thyroid cancer patients' worry.
J Cancer Surviv 2021 Jun;15(3):418-26. doi: 10.1007/s11764-020-00937-0..
Keywords:
Cancer, Provider: Physician, Provider
Wang X, Blumenthal HJ, Hoffman D
Modeling patient-related workload in the emergency department using electronic health record data.
Understanding and managing clinician workload is important for clinician (nurses, physicians and advanced practice providers) occupational health as well as patient safety. Efforts have been made to develop strategies for managing clinician workload by improving patient assignment. The goal of the current study was to use electronic health record (EHR) data to predict the amount of work that individual patients contributed to clinician workload (patient-related workload).
AHRQ-funded; HS022542.
Citation:
Wang X, Blumenthal HJ, Hoffman D .
Modeling patient-related workload in the emergency department using electronic health record data.
Int J Med Inform 2021 Jun;150:104451. doi: 10.1016/j.ijmedinf.2021.104451..
Keywords:
Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician
Greenberg CC, Byrnes ME, Engler TA
Association of a statewide surgical coaching program with clinical outcomes and surgeon perceptions.
Investigators assessed risk-adjusted outcomes and participant perceptions following a statewide coaching program for bariatric surgeons. They found that this surgical coaching program was perceived as valuable and surgeons reported numerous practice changes. Additionally, operative times improved, but there was no significant improvement in risk-adjusted outcomes.
AHRQ-funded; HS023597.
Citation:
Greenberg CC, Byrnes ME, Engler TA .
Association of a statewide surgical coaching program with clinical outcomes and surgeon perceptions.
Ann Surg 2021 Jun;273(6):1034-39. doi: 10.1097/sla.0000000000004800..
Keywords:
Surgery, Provider: Physician, Provider Performance, Outcomes
Willard-Grace R, Knox M, Huang B
Primary care clinician burnout and engagement association with clinical quality and patient experience.
Burnout and engagement are commonly conceptualized as opposite ends of a spectrum, and there is concern that high clinician burnout and lack of engagement may adversely impact patient care. In this study, the investigators matched self-reported data on burnout and engagement for 182 primary care clinicians with data on clinical quality (cancer screenings, hypertension and diabetes control) and patient experience (Clinician and Group Survey-Consumer Assessment of Healthcare Providers and Systems [CG-CAHPS] communication scores, overall rating, and likelihood to recommend the clinic).
AHRQ-funded; HS026067.
Citation:
Willard-Grace R, Knox M, Huang B .
Primary care clinician burnout and engagement association with clinical quality and patient experience.
J Am Board Fam Med 2021 May-Jun;34(3):542-52. doi: 10.3122/jabfm.2021.03.200515..
Keywords:
Consumer Assessment of Healthcare Providers and Systems (CAHPS), Burnout, Patient Experience, Patient and Family Engagement, Provider: Clinician, Provider: Physician, Quality of Care, Provider: Nurse, Provider: Health Personnel
Goldberg DG, Soylu TG, Kitsantas P
Burnout among primary care providers and staff: evaluating the association with practice adaptive reserve and individual behaviors.
The purpose of this study was to examine the association between practice adaptive reserve (PAR) and individual behavioral response to change and burnout among healthcare professionals in primary care. Using data from the EvidenceNOW Heart of Virginia Healthcare initiative, the study’s findings showed that, as organizational capacity for change increased, burnout in healthcare professionals decreased by 51%. As healthcare professionals showed improved response toward change, burnout decreased by 84%. Increased hours of work per week was associated with higher odds of burnout across healthcare professional groups.
AHRQ-funded; HS023913.
Citation:
Goldberg DG, Soylu TG, Kitsantas P .
Burnout among primary care providers and staff: evaluating the association with practice adaptive reserve and individual behaviors.
J Gen Intern Med 2021 May;36(5):1222-28. doi: 10.1007/s11606-020-06367-z..
Keywords:
Burnout, Primary Care, Provider: Nurse, Provider: Clinician, Provider: Physician, Provider
Dymek C, Kim B, Melton GB
Building the evidence-base to reduce electronic health record-related clinician burden.
This paper looks at the evidence-base to reduce electronic health record-related (EHR-related) clinician burden. Evidence-based informatics approaches, pragmatic next steps, and future research directions are presented to improve three of the highest contributors to EHR burden: documentation, chart review, and inbox tasks. Perspectives are also offered on how EHR vendors, healthcare system leaders, and policymakers can play an integral role to make EHR easier to use.
AHRQ-authored; AHRQ-funded; HS027363.
Citation:
Dymek C, Kim B, Melton GB .
Building the evidence-base to reduce electronic health record-related clinician burden.
J Am Med Inform Assoc 2021 Apr 23;28(5):1057-61. doi: 10.1093/jamia/ocaa238..
Keywords:
Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Evidence-Based Practice, Provider: Clinician, Provider: Physician, Provider
Gettel CJ, Canavan ME, D'Onofrio G
Who provides what care? An analysis of clinical focus among the national emergency care workforce.
This study looked at the clinical focus of emergency department (ED) workers using the 2017 Medicare Public Use Files for clinicians receiving reimbursement for emergency care Evaluation & Management (E/M) services for Medicare fee-for-service Part B. Clinicians were categorized as EM physicians, non-EM physicians, and advanced practice providers (APPs). Of the 65,710 unique clinicians providing care, 59.4% were classified as EM physicians, 12.4% as non-EM physicians, and 28.5% as APPs. EM physicians have twice as much clinician median focus in comparison to EM physicians providing emergency care (92.8% vs 45.2) and APPs are focused 100%.
AHRQ-funded; HS023614.
Citation:
Gettel CJ, Canavan ME, D'Onofrio G .
Who provides what care? An analysis of clinical focus among the national emergency care workforce.
Am J Emerg Med 2021 Apr;42:228-32. doi: 10.1016/j.ajem.2020.11.069..
Keywords:
Emergency Department, Workforce, Provider: Physician, Provider: Clinician, Provider, Medicare
Sutter ME, Simmons VN, Sutton SK
Oncologists' experiences caring for LGBTQ patients with cancer: qualitative analysis of items on a national survey.
Sexual and gender minority (SGM) individuals experience cancer-related health disparities and reduced quality of cancer care compared to the general population in part due to a lack of knowledgeable providers. This study explored oncologists' experiences and perspectives in providing patient-centered care for SGM individuals with cancer. The investigators concluded that oncologists recognized their knowledge deficits and need strategies to overcome communication barriers and microaggressions among the cancer care team to provide SGM-affirming care.
AHRQ-funded; HS026120.
Citation:
Sutter ME, Simmons VN, Sutton SK .
Oncologists' experiences caring for LGBTQ patients with cancer: qualitative analysis of items on a national survey.
Patient Educ Couns 2021 Apr;104(4):871-76. doi: 10.1016/j.pec.2020.09.022..
Keywords:
Cancer, Provider: Physician, Vulnerable Populations
Friese CR, Mendelsohn-Victor K, Medvec BR
Factors associated with job satisfaction in medical oncology practices: results from a multisite survey.
This is a job satisfaction survey of clinicians from 29 ambulatory medical oncology practices conducted in 2017. The survey also examined clinician-to-clinician communication, and perceptions of patient safety. Of the 280 clinicians who responded, 85% reported that they were very satisfied or satisfied with their current position. Patient safety and accuracy of clinician communication were positively associated with job satisfaction.
AHRQ-funded; HS024914.
Citation:
Friese CR, Mendelsohn-Victor K, Medvec BR .
Factors associated with job satisfaction in medical oncology practices: results from a multisite survey.
J Nurs Adm 2021 Apr;51(4):200-05. doi: 10.1097/nna.0000000000000998..
Keywords:
Provider: Clinician, Provider: Physician, Provider: Nurse, Provider, Communications
Vemulakonda VM, Kempe A A, Hamer MK
Physician perspectives on discussions with parents of infants with suspected ureteropelvic junction obstruction.
The purpose of this study was to understand pediatric urologists' perceived role of patient characteristics on discussions about treatment of infants with suspected UPJ obstruction. The investigators found that physicians recognized a gap in data to guide surgical decisions and utilized personal experience to augment this gap. Physicians also recognized the influence of educational and language barriers on discussions with families and considered risk of loss to follow up when making recommendations, suggesting an implicit consideration of demographics.
AHRQ-funded; HS024597.
Citation:
Vemulakonda VM, Kempe A A, Hamer MK .
Physician perspectives on discussions with parents of infants with suspected ureteropelvic junction obstruction.
J Pediatr Surg 2021 Mar;56(3):620-25. doi: 10.1016/j.jpedsurg.2020.04.016..
Keywords:
Newborns/Infants, Surgery, Decision Making, Provider: Physician
Smulowitz PB, O'Malley AJ, Zaborski L
Variation in emergency department admission rates among Medicare patients: does the physician matter?
Hospitalizations account for the largest share of health care spending. New payment models increasingly encourage health care providers to reduce hospital admissions. Although emergency department (ED) physicians play a major role in the decision to admit a patient, the extent to which admission rates vary among ED physicians even within the same hospital remains poorly understood. In this study the investigators examined physician-level variation in ED admission rates for Medicare patients.
AHRQ-funded; HS025408.
Citation:
Smulowitz PB, O'Malley AJ, Zaborski L .
Variation in emergency department admission rates among Medicare patients: does the physician matter?
Health Aff 2021 Feb;40(2):251-57. doi: 10.1377/hlthaff.2020.00670..
Keywords:
Emergency Department, Hospitalization, Medicare, Provider: Physician, Provider
Rosenman ED, Misisco A, Olenick J
Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations.
This study assessed and compared team leadership and patient care in trauma resuscitations led by male and female physicians. A secondary analysis of data from a larger randomized controlled trial using video recordings of resuscitations at a Level 1 trauma center from April 2016 to December 2017 was conducted. A total of 60 participants and 120 video observations were included in the analysis. There was a weak positive effect for female leaders for both patient care and team leadership. Gender-based advantages to team leadership and clinical care were not conclusive with the exception of rejecting a strong male advantage to team leadership.
AHRQ-funded; HS022458.
Citation:
Rosenman ED, Misisco A, Olenick J .
Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations.
J Am Coll Emerg Physicians Open 2021 Feb;2(1):e12348. doi: 10.1002/emp2.12348..
Keywords:
Teams, Trauma, Critical Care, Provider: Physician, Provider
Hollenbeck BK, Oerline M, =Kaufman SR
Promotional payments made to urologists by the pharmaceutical industry and prescribing patterns for targeted therapies.
The authors measured the association between market-level promotional payments to urologists by the manufacturers of abiraterone and enzalutamide and national prescribing patterns. They found that promotional payments to urologists at the market level were strongly associated with the specialty of the physician prescribing abiraterone or enzalutamide for the first time. They recommended that future work elucidate the effects of the shift in prescribing patterns on quality of care and financial hardship for men with advanced prostate cancer.
AHRQ-funded; HS025707.
Citation:
Hollenbeck BK, Oerline M, =Kaufman SR .
Promotional payments made to urologists by the pharmaceutical industry and prescribing patterns for targeted therapies.
Urology 2021 Feb;148:134-40. doi: 10.1016/j.urology.2020.08.080..
Keywords:
Provider: Physician, Provider, Medication, Practice Patterns
Chhabra KR, Thumma JR, Varban OA
Associations between video evaluations of surgical technique and -outcomes of laparoscopic sleeve gastrectomy.
The authors examined associations between technique and outcomes in laparoscopic sleeve gastrectomy. Technical approaches to five controversial aspects of laparoscopic sleeve gastrectomy were studied: dissection of the proximal stomach, sleeve caliber, sleeve anatomy, staple line reinforcement, and leak testing. The authors found that variations in surgical technique can be measured by video review and are associated with differences in patient outcomes.
AHRQ-funded; HS023597; HS025365.
Citation:
Chhabra KR, Thumma JR, Varban OA .
Associations between video evaluations of surgical technique and -outcomes of laparoscopic sleeve gastrectomy.
JAMA Surg 2021 Feb;156(2):e205532. doi: 10.1001/jamasurg.2020.5532..
Keywords:
Surgery, Obesity, Provider Performance, Provider: Physician, Provider, Quality of Care
Loo S, Brochier A, Wexler MG
Addressing unmet basic needs for children with sickle cell disease in the United States: clinic and staff perspectives.
The purpose of this study was to assess pediatric hematology clinic staff's perspectives regarding barriers and facilitators in addressing unmet basic needs for children with sickle cell disease. Six focus groups were held at urban pediatric hematology clinics in the Northeastern region of the U.S. Four themes emerged: families of children with SCD have numerous unmet basic needs; clinic staff felt they had a role to play in addressing these needs; staff felt their ability to address these needs depended upon caregivers' capacity to act on staff recommendations; clinic staff's ability to address these needs was limited by organizational and systemic factors beyond their control. These findings have important implications for how best to address adverse social determinants of health for this vulnerable pediatric population so that urban-based pediatric hematology clinics can more equitably support families.
AHRQ-funded; HS022242.
Citation:
Loo S, Brochier A, Wexler MG .
Addressing unmet basic needs for children with sickle cell disease in the United States: clinic and staff perspectives.
BMC Health Serv Res 2021 Jan 12;21(1):55. doi: 10.1186/s12913-020-06055-y..
Keywords:
Children/Adolescents, Sickle Cell Disease, Chronic Conditions, Social Determinants of Health, Provider: Clinician, Provider: Physician, Provider, Urban Health
Cohen C, Baird M, Koirola N
The surgical and anesthesia workforce and provision of surgical services in rural communities: a mixed-methods examination.
This mixed-methods study described the distribution of the surgical and anesthesia workforce and qualitatively explored how such workforce and other factors influenced rural hospitals' provision of surgical services. Using American Hospital Association survey data, the researchers found that within rural counties, 55.1% had no surgeon, 81.2% had no anesthesiologist, and 58.1% had no Certified Registered Nurse Anesthetist. While rural hospitals reported meeting community needs for elective and noncomplex surgeries, these hospitals continued to face significant challenges providing subspecialty surgeries, emergency surgeries, and 24-hour obstetrical services.
AHRQ-funded; HS023009.
Citation:
Cohen C, Baird M, Koirola N .
The surgical and anesthesia workforce and provision of surgical services in rural communities: a mixed-methods examination.
J Rural Health 2021 Jan;37(1):45-54. doi: 10.1111/jrh.12417..
Keywords:
Rural Health, Access to Care, Surgery, Workforce, Provider: Physician, Provider: Nurse, Provider, Hospitals
