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.
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 Pulmonary, Critical Care, and Occupational Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
J Crit Care. 2019 Feb;49:64-69. doi: 10.1016/j.jcrc.2018.10.013. Epub 2018 Oct 19.
To evaluate mortality, length of stay, and inter-hospital transfer in the Veteran Health Administration (VHA) among low complexity Intensive Care Unit (ICU) patients.
Retrospective 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).
In 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.
Despite 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.
评估退伍军人健康管理局（VHA）中低复杂性重症监护病房（ICU）患者的死亡率、住院时间和院内转院情况。
本研究回顾性分析了 2010 年至 2015 年期间在退伍军人事务部（VA）医疗中心的 VHA Medical SAS®中确定的成人 ICU 入院情况。根据农村城市通勤区代码算法，将设施分为大型农村（称为农村）（N=6）或城市（N=33）。
在农村医院，患者（N=9665）更不可能患有呼吸系统疾病（12.9%比 18.9%；p<0.001），更有可能被诊断为败血症（17.6%比 4.9%），且疾病严重程度评分更高（42.0 比 41.4；p=0.01）。与城市（N=65846）相比，农村医院 ICU 死亡率没有差异。在未调整的分析中，设施的农村性（农村与城市）与减少院内转院（OR=0.74；95%CI[0.69,0.80]；p<0.001）和缩短 ICU 住院时间（RR=0.82；95%CI[0.74,0.91]；p<0.001）相关。当考虑到分层数据时，这种情况并不成立。
尽管存在挑战，但农村退伍军人事务部设施中的低复杂性 ICU 与城市同行表现相似。作为国家医疗保健系统的一部分，可能有必要探讨在退伍军人医疗保健系统之外的农村地区维持重症监护服务的方法。
