학술논문
Characteristics of Patients Hospitalized in Rural and Urban ICUs From 2010 to 2019.
Document Type
Academic Journal
Author
Harlan EA; Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI.; Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MI.; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.; Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, MI.; Ghous M; Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI.; Moscovice IS; Division of Health Policy and Management, University of Minnesota Rural Health Research Center, School of Public Health, University of Minnesota, Minneapolis, MN.; Valley TS; Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI.; Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MI.; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.; Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, MI.
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0355501 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1530-0293 (Electronic) Linking ISSN: 00903493 NLM ISO Abbreviation: Crit Care Med Subsets: MEDLINE
Subject
Language
English
Abstract
Objectives: Rural hospitals are threatened by workforce shortages and financial strain. To optimize regional critical care delivery, it is essential to understand what types of patients receive intensive care in rural and urban hospitals.
Design: A retrospective cohort study.
Setting and Patients: All fee-for-service Medicare beneficiaries in the United States who were 65 years old or older hospitalized in an ICU between 2010 and 2019 were included. Rural and urban hospitals were classified according to the 2013 National Center For Health Statistics Urban-Rural Classification Scheme for Counties. Patient comorbidities, primary diagnoses, organ dysfunction, and procedures were measured using the International Classification of Diseases, 9th and 10th revisions diagnosis and procedure codes. Standardized differences were used to compare rural and urban patient admission characteristics.
Interventions: None.
Measurements and Main Results: There were 12,224,097 ICU admissions between 2010 and 2019, and 1,488,347 admissions (12.2%) were to rural hospitals. The most common diagnoses in rural hospitals were cardiac (30.3%), infectious (24.6%), and respiratory (10.9%). Patients in rural ICUs had similar organ dysfunction compared with urban hospitals (mean organ failures in rural ICUs 0.5, sd 0.8; mean organ failures in urban ICUs 0.6, sd 0.9, absolute standardized mean difference 0.096). Organ dysfunction among rural ICU admissions increased over time (0.4 mean organ failures in 2010 to 0.7 in 2019, p < 0.001).
Conclusions: Rural hospitals care for an increasingly complex critically ill patient population with similar organ dysfunction as urban hospitals. There is a pressing need to develop policies at federal and regional healthcare system levels to support the continued provision of high-quality ICU care within rural hospitals.
Competing Interests: Dr. Harlan’s institution received funding from the National Heart, Lung, and Blood Institute (K23HL140165 and T32HL007749) and the Agency for Healthcare Research and Quality (AHRQ) (R01HS028038); she disclosed government work. Dr. Moscovice’s institution received funding from the AHRQ; she received funding from the University of Minnesota; she received support for article research from the AHRQ. Dr. Valley received support for article research from the National Institutes of Health. Dr. Ghous has disclosed that he does not have any potential conflicts of interest.
(Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
Design: A retrospective cohort study.
Setting and Patients: All fee-for-service Medicare beneficiaries in the United States who were 65 years old or older hospitalized in an ICU between 2010 and 2019 were included. Rural and urban hospitals were classified according to the 2013 National Center For Health Statistics Urban-Rural Classification Scheme for Counties. Patient comorbidities, primary diagnoses, organ dysfunction, and procedures were measured using the International Classification of Diseases, 9th and 10th revisions diagnosis and procedure codes. Standardized differences were used to compare rural and urban patient admission characteristics.
Interventions: None.
Measurements and Main Results: There were 12,224,097 ICU admissions between 2010 and 2019, and 1,488,347 admissions (12.2%) were to rural hospitals. The most common diagnoses in rural hospitals were cardiac (30.3%), infectious (24.6%), and respiratory (10.9%). Patients in rural ICUs had similar organ dysfunction compared with urban hospitals (mean organ failures in rural ICUs 0.5, sd 0.8; mean organ failures in urban ICUs 0.6, sd 0.9, absolute standardized mean difference 0.096). Organ dysfunction among rural ICU admissions increased over time (0.4 mean organ failures in 2010 to 0.7 in 2019, p < 0.001).
Conclusions: Rural hospitals care for an increasingly complex critically ill patient population with similar organ dysfunction as urban hospitals. There is a pressing need to develop policies at federal and regional healthcare system levels to support the continued provision of high-quality ICU care within rural hospitals.
Competing Interests: Dr. Harlan’s institution received funding from the National Heart, Lung, and Blood Institute (K23HL140165 and T32HL007749) and the Agency for Healthcare Research and Quality (AHRQ) (R01HS028038); she disclosed government work. Dr. Moscovice’s institution received funding from the AHRQ; she received funding from the University of Minnesota; she received support for article research from the AHRQ. Dr. Valley received support for article research from the National Institutes of Health. Dr. Ghous has disclosed that he does not have any potential conflicts of interest.
(Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)