Abstract：
Rural hospices face many obstacles in delivering palliative and end-of-life care in the United States. We aimed to identify these barriers and their potential solutions. Following a systematic approach, a comprehensive literature search using relevant keywords was conducted on online databases. Additionally, we conducted a manual search to include policy documents and white papers. Key challenges reported in the literature included limited geographic barriers and access issues, limited economic support, regulatory hindrances, and difficulty training and retaining palliative care staff. This contributes to inequitable access to hospice care in rural settings. We propose several potential solutions to overcome these hurdles and improve access. Advanced practice providers should be considered to serve as physician heads in rural hospices, which would expand resources in areas with physician shortages. A single per diem payment model should be implemented for rural hospices, regardless of the level of care provided, to help offset the higher cost of care. The Critical Access Hospital program and offering cost-based reimbursement for swing-bed stays could improve access to postacute care, including hospice services. Telehealth can improve the timeliness of care and reduce travel costs for patients and providers. Another solution to consider is simulation-based training to enhance the education of healthcare providers. In conclusion, there is a critical gap in end-of-life care access in rural communities. A multifaceted approach including policy changes, financial support, and technological innovations is essential to improve hospice care access in rural populations.
摘要：
在美国，农村临终关怀医院在提供姑息治疗和临终关怀方面面临许多障碍。我们旨在确定这些障碍及其潜在解决方案。按照系统的方法，在在线数据库上使用相关关键词进行了全面的文献检索.此外,我们进行了手动搜索，以包括政策文件和白皮书。文献中报告的主要挑战包括有限的地理障碍和准入问题，有限的经济支持，监管障碍，以及培训和留住姑息治疗人员的困难。这导致农村地区获得临终关怀服务的机会不公平。我们提出了几种潜在的解决方案来克服这些障碍并改善访问。高级执业提供者应被视为农村收容所的医师负责人，这将扩大医生短缺地区的资源。农村临终关怀医院应实行单一的每日津贴支付模式，不管提供的护理水平如何，帮助抵消更高的护理成本。CriticalAccessHospital计划并为摇摆床住院提供基于成本的报销，可以改善获得急性后护理的机会，包括临终关怀服务。远程医疗可以提高护理的及时性，并降低患者和提供者的旅行成本。另一个需要考虑的解决方案是基于模拟的培训，以加强医疗保健提供者的教育。总之,农村社区在获得临终关怀方面存在严重差距。包括政策变化在内的多方面方法，财政支持,技术创新对于改善农村人口的临终关怀服务至关重要。
