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Surgical referral coordination from a first-level hospital: a prospective case study from rural Nepal

Overview of attention for article published in BMC Health Services Research, September 2017
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Title
Surgical referral coordination from a first-level hospital: a prospective case study from rural Nepal
Published in
BMC Health Services Research, September 2017
DOI 10.1186/s12913-017-2624-2
Pubmed ID
Authors

Matthew Fleming, Caroline King, Sindhya Rajeev, Ashma Baruwal, Dan Schwarz, Ryan Schwarz, Nirajan Khadka, Sami Pande, Sumesh Khanal, Bibhav Acharya, Adia Benton, Selwyn O. Rogers, Maria Panizales, David Gyorki, Heather McGee, David Shaye, Duncan Maru

Abstract

Patients in isolated rural communities typically lack access to surgical care. It is not feasible for most rural first-level hospitals to provide a full suite of surgical specialty services. Comprehensive surgical care thus depends on referral systems. There is minimal literature, however, on the functioning of such systems. We undertook a prospective case study of the referral and care coordination process for cardiac, orthopedic, plastic, gynecologic, and general surgical conditions at a district hospital in rural Nepal from 2012 to 2014. We assessed the referral process using the World Health Organization's Health Systems Framework. We followed the initial 292 patients referred for surgical services in the program. 152 patients (52%) received surgery and four (1%) suffered a complication (three deaths and one patient reported complication). The three most common types of surgery performed were: orthopedics (43%), general (32%), and plastics (10%). The average direct and indirect cost per patient referred, including food, transportation, lodging, medications, diagnostic examinations, treatments, and human resources was US$840, which was over 1.5 times the local district's per capita income. We identified and mapped challenges according to the World Health Organization's Health Systems Framework. Given the requirement of intensive human capital, poor quality control of surgical services, and the overall costs of the program, hospital leadership decided to terminate the referral coordination program and continue to build local surgical capacity. The results of our case study provide some context into the challenges of rural surgical referral systems. The high relative costs to the system and challenges in accountability rendered the program untenable for the implementing organization.

Twitter Demographics

The data shown below were collected from the profile of 1 tweeter who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 41 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 41 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 12 29%
Researcher 9 22%
Unspecified 7 17%
Other 3 7%
Student > Bachelor 2 5%
Other 8 20%
Readers by discipline Count As %
Medicine and Dentistry 12 29%
Unspecified 9 22%
Nursing and Health Professions 6 15%
Social Sciences 5 12%
Pharmacology, Toxicology and Pharmaceutical Science 1 2%
Other 8 20%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 12 December 2017.
All research outputs
#9,814,320
of 12,287,089 outputs
Outputs from BMC Health Services Research
#3,356
of 4,021 outputs
Outputs of similar age
#200,890
of 276,197 outputs
Outputs of similar age from BMC Health Services Research
#66
of 76 outputs
Altmetric has tracked 12,287,089 research outputs across all sources so far. This one is in the 11th percentile – i.e., 11% of other outputs scored the same or lower than it.
So far Altmetric has tracked 4,021 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.3. This one is in the 7th percentile – i.e., 7% of its peers scored the same or lower than it.
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We're also able to compare this research output to 76 others from the same source and published within six weeks on either side of this one. This one is in the 5th percentile – i.e., 5% of its contemporaries scored the same or lower than it.