• Amy M J O'Shea, Spyridon Fortis, Vaughan Sarrazin Mary M Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 W, Iowa City, IA 52246, USA; Depa, Jane Moeckli, W C Yarbrough, and Schacht Reisinger Heather H Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 W, Iowa City, IA 52246, USA; .
• Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 W, Iowa City, IA 52246, USA; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA. Electronic address: amy.oshea@va.gov.
• J Crit Care. 2019 Feb 1; 49: 64-69.

PurposeTo 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 MethodRetrospective study of adult ICU admissions identified in VHA Medical SAS®; 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).ResultsIn 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.ConclusionsDespite 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.Published by Elsevier Inc.

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