Transitions in Care and Healthcare Resource Use in Critically Ill Patients Living in Urban and Rural Settings: A Retrospective Cohort Study
Objective: To examine healthcare resource use and patient outcomes among critically ill patients who live in urban versus rural settings. Design: Retrospective cohort study. Setting: Medical, medical-surgical, and cardiovascular intensive care units (ICUs) in Alberta, Canada between January 1, 2014, and April 30, 2018. Patients: Those who survived their index ICU stay, remained in ICU for ≥24 hours before ICU discharge, and had 1-year of follow-up post-index ICU admission. Interventions: None. Measurements and Main Results: Of 20,659 patients, 25.0% lived in a rural setting at the time of their index ICU admission. Urban and rural ICU patients had similar baseline demographic characteristics, with differences in admitting location and discharge destination. Rural ICU patients were admitted to ICU from inpatient units less than urban patients (76.3%, 84.2%). Differences in discharge destination were also apparent, with rural ICU patients seeing a general practitioner as their first provider after hospital discharge (53.3%), while urban patients saw specialists (59.7%). Rural and urban ICU patients did not differ in their use of continuous renal replacement therapy, though rural ICU patients in the lowest quintile of material deprivation had lower odds of requiring mechanical ventilation during their ICU stay than their urban counterparts (OR: 0.87, 95% CI: 0.76-0.99). Rural ICU patients had greater odds of adverse events while in hospital (OR: 1.39, 95% CI: 1.09-1.78) and 30-day ICU readmission after hospital discharge compared to urban patients, regardless of social deprivation and sex. Conclusions: While critically ill patients living in urban and rural settings are similar at the time of ICU admission and have similar clinical courses in ICU, their care and outcomes differ after ICU discharge. Lack of access to care in rural areas may be related to these differences. Strategies to improve healthcare access in these areas are needed to ensure high-quality care for critically ill patients living in rural settings.
rural health, transition in care, critical illness, intensive care, healthcare resource use, epidemiology
Networked Digital Library of Theses and Dissertations