A retrospective observational study examining interhospital transfers from six New Zealand rural hospitals in 2019

OBJECTIVE

The aim of this study was to identify the percentage of patients that were transferred from rural hospitals and who received an investigation or intervention at an urban hospital that was not readily available at the rural hospital.

METHODS

A retrospective observational study.

DESIGN

Patients were randomly selected and clinical records were reviewed. Patient demographic and clinical information was collected, including any interventions or investigations occurring at the urban referral hospital. These were compared against the resources available at the rural hospitals.

SETTING

Six New Zealand (NZ) rural hospitals were included.

PARTICIPANTS

Patients that were transferred from a rural hospital to an urban hospital between 1 Jan 2019 and 31 December 2019 were included.

MAIN OUTCOME MEASURES

The primary outcome measure was the percentage of patients who received an investigation or intervention that was not available at the rural hospital.

RESULTS

There were 584 patients included. Overall 73% of patients received an intervention or investigation that was not available at the rural hospital. Of the six rural hospitals, there was one outlier, where only 37% of patients transferred from that hospital received an investigation or intervention that was not available rurally. Patients were most commonly referred to general medicine (23%) and general surgery (18%). Of the investigations or interventions performed, 43% received a CT scan and 25% underwent surgery.

CONCLUSIONS

Most patients that are transferred to urban hospitals receive an intervention or investigation that was not available at the rural hospital.

Defining catchment boundaries and their populations for Aotearoa New Zealand's rural hospitals

Introduction There is considerable variation in the structure and resources of New Zealand (NZ) rural hospitals; however, these have not been recently quantified and their effects on healthcare outcomes are poorly understood. Importantly, there is no standardised description of each rural hospital's catchment boundary and the characteristics of the population living within this area. Aim To define and describe a catchment population for each of New Zealand's rural hospitals. Methods An exploratory approach to developing catchments was employed. Geographic Information Systems were used to develop drive-time-based geographic catchments, and administrative health data (National Minimum Data Set and Primary Health Organisation Data Set) informed service utilisation-based catchments. Catchments were defined at both the Statistical Area 2 (SA2) and domicile levels, and linked to census-based population data, the Geographic Classification for Health, and the area-level New Zealand Index of Socioeconomic Deprivation (NZDep2018). Results Our results highlight considerable heterogeneity in the size (max: 57 564, min: 5226) and characteristics of populations served by rural hospitals. Substantial differences in the age structure, ethnic composition, socio-economic profile, 'remoteness' and projected future populations, are noted. Discussion In providing a standardised description of each rural hospital's catchment boundary and its population characteristics, the considerable heterogeneity of the communities served by rural hospitals, both in size, rurality and socio-demographic characteristics, is highlighted. The findings provide a platform on which to build further research regarding NZ's rural hospitals and inform the delivery of high-quality, cost-effective and equitable health care for people living in rural NZ.