"Making It Work": A Preliminary Mixed Methods Study of Rural Trauma Care Access and Resources in New Mexico.

Introduction Patients in the rural western United States face challenges accessing trauma and surgical services and are more likely to succumb to their injuries. New Mexico, a rural and medically underresourced state, is a salient space to study these disparities. We examine how travel distance from trauma centers impacts injured patient outcomes and describe care delivery obstacles. Materials and Methods We conducted an explanatory mixed methods study by creating geospatial maps of New Mexico's trauma data, incorporating linear regression analyses on patient outcomes as a function of estimated travel distance from trauma centers. We also conducted qualitative semi-structured interviews with trauma providers to illuminate and provide context for the geospatial findings utilizing a systematic, collaborative, iterative transcript analysis process. We constructed a conceptual framework describing rural trauma care delivery obstacles. Results Geospatial analyses revealed that most New Mexicans face long travel times to trauma centers. Comparing regression analyses using different data sources suggests that solely hospital-derived data may undercount rural trauma deaths. Interviews with 10 providers suggest that elements that may contribute to these findings include on-the-ground resource-based challenges and those related to broader healthcare systems-based issues. Our conceptual framework denotes how these elements collectively may impact rural trauma outcomes and proposes potential solutions. Conclusions In addressing rural patients' needs, healthcare policy decision-makers should ensure that their datasets are comprehensive and inclusive. They must also take into account the particular challenges of underserved rural patients and providers who care for them by eliciting their perspectives, as presented in our conceptual framework.

The socioeconomic impact of international aid: a qualitative study of healthcare recovery in post-earthquake Haiti and implications for future disaster relief.

We assessed healthcare provider perspectives of international aid four years after the Haiti Earthquake to better understand the impact of aid on the Haitian healthcare system and learn best practices for recovery in future disaster contexts. We conducted 22 semi-structured interviews with the directors of local, collaborative, and aid-funded healthcare facilities in Leogane, Haiti. We coded and analysed the interviews using an iterative method based on a grounded theory approach of data analysis. Healthcare providers identified positive aspects of aid, including acute emergency relief, long-term improved healthcare access, and increased ease of referrals for low-income patients. However, they also identified negative impacts of international aid, including episodes of poor quality care, internal brain drain, competition across facilities, decrease in patient flow to local facilities, and emigration of Haitian doctors to abroad. As Haiti continues to recover, it is imperative for aid institutions and local healthcare facilities to develop a more collaborative relationship to transition acute relief to sustainable capacity building. In future disaster contexts, aid institutions should specifically utilise quality of care metrics, NGO Codes of Conduct, Master Health Facility Lists, and sliding scale payment systems to improve disaster response.