Should different standards of quality of care exist for rural and urban settings and what factors contribute to these differences?

A project presented to the Department of Physician Assistant of Wichita State University in partial fulfillment of the requirements for the degree of Master of Physician Assistant.Rural and urban locations differ from each other culturally, structurally, economically, and socially. Because healthcare facilities serve the surrounding communities, the structural and cultural make up of these communities plays a large role in health care delivery. However, despite the significant difference between urban and rural communities, quality of healthcare is still determined by only one set of generalized standards of care. This leaves rural areas at a disadvantage, since they lack many of the elements that urban facilities possess such as the large patient numbers, technology, large number of healthcare providers, and specialty care. To improve the quality of care for rural patients, rural communities need to be recognized as a distinct entity and specific standards of care developed that address these unique traits. By doing so, rural health care can be recognized for the true specialty that it is instead of a substandard way of practicing medicine. Methodology: The purpose of this paper was to perform a systematic review of the literature and examine the cumulative data addressing the differences in quality of healthcare between urban and rural. This study investigates the factors that contribute to these differences, in the end making a clear distinction between urban and rural cultures and determining if these factors warrant a change in the current quality of care standards. This should demonstrate to healthcare providers that these differences can play a significant role in the quality of healthcare received. Articles used included those addressing rural adherence to acute myocardial infarction and diabetes care treatment guidelines, rural quality of care, and differences in social work and nursing in rural areas. Results: Thirty-four articles matched the criteria and were reviewed using evidence-based methods. After close analysis of the presented data, it appeared that there was a clear decrease in the quality of care in rural facilities compared to urban. However, the literature also showed a significant difference in make up of rural and urban communities. Rural communities differed from urban in many ways including: the lack of specialty care, smaller size of the community, lack of transportation, isolation of residents, shortage of healthcare providers, cultural characteristic discrepancies, increased community interaction, and decrease in economic opportunity. Conclusion: Rural healthcare was found to have a decreased quality of care compared to urban healthcare facilities. However, there are many factors that contribute to this disparity that are not considered in quality measurements. These distinctions make rural areas unique, and need to be considered when measuring the quality of care in rural areas