• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

Do Rural vs Urban ED Patients Experience Different Rates of Mortality?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Despite the reliance on EDs in rural communities, there is limited data regarding patient outcomes after ED visits in rural hospitals or critical access hospitals (CAHs)
  • Greenwood-Ericksen et al. (JAMA Network Open, 2021) compared 30-day outcomes after rural vs urban ED and CAH visits

METHODS:

  • Propensity-matched, retrospective cohort study
  • Population
    • 20% of national Medicare fee-for-service beneficiaries from January 2011 to October 2015
  • Study design
    • Compared
      • Visits to rural EDs vs visits to urban EDs
      • Visits to CAHs vs visits to non-CAHs
    • Rural and urban ED visits were matched based on demographics, patient prior use of EDs, comorbidities, and diagnoses
    • Effect size (Cohen d) was used to overcome the impact of large sample size| Effect size reflects whether there is meaningful clinical effect
  • Primary outcome
    • 30-day all-cause mortality
  • Secondary outcomes
    • ED revisits with and without hospitalization

RESULTS:

  • 473,152 Medicare beneficiaries
    • Mean (SD) age: 75.1 (7.9) years
  • Medicare beneficiaries at rural and urban EDs experienced similar
    • All-cause 30-day mortality
      • Rural EDs: 3.9%
      • Urban EDs: 4.1%
      • Effect size 0.01
    • ED revisits
      • Rural EDs: 18.1%
      • Urban EDs: 17.8%
      • Effect size 0.00
  • However, rural ED visits were associated with
    • More interhospital transfer
      • Rural EDs: 6.2%
      • Urban EDs: 2.0%
      • Effect size 0.22
    • Fewer hospitalizations
      • Rural EDs: 24.7%
      • Urban EDs: 39.2%
      • Effect size 0.31
  • When stratified by diagnosis, patients in rural EDs with life-threatening illnesses experienced
    • More transfers
    • Similar 30-day mortality to that of patients in urban ED
  • In contrast, mortality differed for patients in rural EDs with symptom-based diagnoses
    • Chest pain
      • OR 1.54 (95% CI, 1.25 to 1.89)
    • Nausea and vomiting
      • OR 1.68 (95% CI, 1.26 to 2.24)
    • Abdominal pain
      • OR 1.73 (95% CI, 1.42 to 2.10)
  • The findings were similar for CAHs

CONCLUSION:

  • Patients in rural EDs experience mortality related to potentially life-threatening conditions at similar rates to patients in urban EDs
  • However, there was greater mortality for symptom-based conditions in patients from rural areas
  • The authors state

As emergency care practices advance, evidence suggests that rural hospitals may not be achieving the same gains as their urban counterparts

The findings of this study underscore the importance of ensuring access to local EDs in rural communities, which are endangered by increasing rural hospital closures

Learn More – Primary Sources:

Association of Rural and Critical Access Hospital Status With Patient Outcomes After Emergency Department Visits Among Medicare Beneficiaries

Want to stay on top of key guidelines and research papers?

ObGFirst® – Try It Free! »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Is the Hospital Readmissions Reduction Program Associated with Increased Post-Discharge Mortality?
Is There a Relationship Between Patient Satisfaction and Health Care Utilization, Expenditures, and Mortality?
Where Does all the Money Go? Estimated Administrative Costs Related to Physician Billing Activities

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site