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Outcomes comparison in patients admitted to low complexity rural and urban intensive care units in the Veterans Health Administration.

O'Shea AMJ, Fortis S, Vaughan Sarrazin M, Moeckli J, Yarbrough WC, Schacht Reisinger H. Outcomes comparison in patients admitted to low complexity rural and urban intensive care units in the Veterans Health Administration. Journal of Critical Care. 2019 Feb 1; 49:64-69.

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Abstract:

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 SASĀ®; 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.





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