TY - JOUR
T1 - Outcomes comparison in patients admitted to low complexity rural and urban intensive care units in the Veterans Health Administration
AU - O'Shea, Amy M.J.
AU - Fortis, Spyridon
AU - Vaughan Sarrazin, Mary
AU - Moeckli, Jane
AU - Yarbrough, W. C.
AU - Schacht Reisinger, Heather
N1 - Funding Information:
This work was supported by the Department of Veterans Affairs; Veterans Health Administration ; Office of Research and Development ; Health Services Research and Development [ IIR 09-0336 ] and the Veteran Rural Health Center - Central Region [6140] . These funding sources did not influence study design, data collection, analysis, or interpretation, nor the writing of this manuscript.
Publisher Copyright:
© 2018
PY - 2019/2
Y1 - 2019/2
N2 - Purpose: To evaluate mortality, length of stay, and inter-hospital transfer in the Veteran Health Administration (VHA) among low complexity Intensive Care Unit (ICU) patients. Materials and method: Retrospective study of adult ICU admissions identified in VHA Medical SAS®; 2010–2015 at Veterans Affairs (VA) Medical Centers. Facilities classified by the Rural Urban Commuting Area code algorithm as large rural (referred to as rural) (N = 6) or urban (N = 33). Results: In rural hospitals, patients (N = 9665) were less likely to have a respiratory (12.9% v. 18.9%; p <.001) diagnosis, more likely diagnosed with sepsis (17.6% v. 4.9%), and had a higher illness severity score (42.0 vs. 41.4; p =.01) compared to urban (N = 65,846) counterparts. Mortality within ICU did not vary across facility rurality. In unadjusted analyses, facility rurality (rural vs. urban) was associated with reduced inter-hospital transfers (OR = 0.74; 95% CI = [0.69, 0.80]; p <.001) and a shorter ICU length of stay (RR = 0.82; 95% CI = [0.74, 0.91]; p <.001). This did not hold when the hierarchical data was accounted for. Conclusions: Despite challenges, low complexity ICUs in rural VA facilities fare similarly to urban counterparts. Being part of a national healthcare system may have benefits to explore in sustaining critical care access in rural areas outside the VA healthcare system.
AB - Purpose: To evaluate mortality, length of stay, and inter-hospital transfer in the Veteran Health Administration (VHA) among low complexity Intensive Care Unit (ICU) patients. Materials and method: Retrospective study of adult ICU admissions identified in VHA Medical SAS®; 2010–2015 at Veterans Affairs (VA) Medical Centers. Facilities classified by the Rural Urban Commuting Area code algorithm as large rural (referred to as rural) (N = 6) or urban (N = 33). Results: In rural hospitals, patients (N = 9665) were less likely to have a respiratory (12.9% v. 18.9%; p <.001) diagnosis, more likely diagnosed with sepsis (17.6% v. 4.9%), and had a higher illness severity score (42.0 vs. 41.4; p =.01) compared to urban (N = 65,846) counterparts. Mortality within ICU did not vary across facility rurality. In unadjusted analyses, facility rurality (rural vs. urban) was associated with reduced inter-hospital transfers (OR = 0.74; 95% CI = [0.69, 0.80]; p <.001) and a shorter ICU length of stay (RR = 0.82; 95% CI = [0.74, 0.91]; p <.001). This did not hold when the hierarchical data was accounted for. Conclusions: Despite challenges, low complexity ICUs in rural VA facilities fare similarly to urban counterparts. Being part of a national healthcare system may have benefits to explore in sustaining critical care access in rural areas outside the VA healthcare system.
KW - Critical care
KW - Hospitals
KW - Inpatients
KW - Length of stay
KW - Retrospective studies
KW - Rural
KW - Veterans
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U2 - 10.1016/j.jcrc.2018.10.013
DO - 10.1016/j.jcrc.2018.10.013
M3 - Article
C2 - 30388490
AN - SCOPUS:85055563781
SN - 0883-9441
VL - 49
SP - 64
EP - 69
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -