• Arjun K Venkatesh, Margaret B Greenwood-Ericksen, Hao Mei, Craig Rothenberg, Zhenqiu Lin, and Harlan M Krumholz.
• Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States of America; Center for Outcomes Research & Evaluation, Yale University, New Haven, CT, United States of America. Electronic address: arjun.venkatesh@yale.edu.
• Am J Emerg Med. 2021 Jul 1; 45: 374-377.

BackgroundRural communities face challenges in accessing healthcare services due to physician shortages and limited unscheduled care capabilities in office settings. As a result, rural hospital-based Emergency Departments (ED) may disproportionately provide acute, unscheduled care needs. We sought to examine differences in ED utilization and the relative role of the ED in providing access to unscheduled care between rural and urban communities.MethodsUsing a 20% sample of the 2012 Medicare Chronic Condition Warehouse, we studied the overall ED visit rate and the unscheduled care rate by geography using the Dartmouth Atlas' hospital referral regions (HRR). We calculated HRR urbanicity as the proportion of beneficiaries residing in an urban zip code within each HRR. We report descriptive statistics and utilize K-means clustering based on the ED visit rates and unscheduled care rates.ResultsWe found rural ED use is more common and disproportionately the site of unscheduled care delivery when compared to urban communities. The ED visit and. unscheduled care proportions were negatively correlated with increased urbanicity (r =. -0.48, p < 0.001; r = -0.58, p < 0.001).ConclusionThe use and role of EDs by Medicare beneficiaries appears to be substantially different between urban and rural areas. This suggests that the ED may play a distinct role within the healthcare delivery system of rural communities that face disproportionate barriers to care access.Copyright © 2020 Elsevier Inc. All rights reserved.

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