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Rural Health

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Virginia rural cancer outreach program benefits patients and hospitals

Cancer is the second most common cause of death for rural Americans, who are more apt to be poor and illiterate and to have less access to cancer specialists than urban Americans. The Rural Cancer Outreach Program (RCOP) established by the Medical College of Virginia campus of Virginia Commonwealth University's Massey Cancer Center (MCC) provided rural patients with access to state-of-the-art cancer care and, at the same time, increased patient volume and profits at MCC and two rural hospitals. These are the findings of a recent study supported in part by the Agency for Healthcare Research and Quality (HS06589).

As part of the RCOP, patients diagnosed with cancer at one of two rural hospitals were seen within 1 week of diagnosis by an MCC team, including medical oncologists and nurse clinical specialists who traveled weekly to the RCOP clinic at the rural hospitals. Between clinic visits, the patients received continuing cancer care at the rural hospital from their primary care physicians based on the care plan. Cancer care was provided regardless of insurance status or ability to pay. Previously, no specific cancer services except general surgery had been available at rural hospitals. With the RCOP, chemotherapy and palliative care services, including home and hospice care, were developed at each RCOP site. Radiation was done only at MCC, which provided free daily van service.

The researchers examined cancer patient clinic logs and their charges and costs during the 2-year period prior to the RCOP program, 1987 and 1988, and during a 2-year period after full implementation, 1991 and 1992. After RCOP implementation at the first site, more than 70 percent of breast cancer patients had breast conservation compared with less than 20 percent prior to RCOP implementation. Improvements in adjuvant treatment and pain control were seen as well. The RCOP greatly increased access to academic specialist oncology care for rural patients to receive services both locally and at MCC, with a total volume increase of 452 percent. MCC increased its net profit by 68 percent, and the two rural hospitals increased profits by $2.5 million. More importantly, the cost of admitting a rural patient fell by 40 percent, consistent with findings from other research in coordinated palliative care. The total cost of care per patient declined dramatically due to a shift in outpatient care, a lower cost site of care, and coordination.

See "A rural cancer outreach program lowers patient care costs and benefits both the rural hospitals and sponsoring academic medical center," by Christopher E. Desch, M.D., Michael A. Grasso, M.S., Michael J. McCue, D.B.A., and others, in the Spring 1999 Journal of Rural Health 15(2), pp. 157-167.

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