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The following is a summary of “Characteristics of Patients Hospitalized in Rural and Urban ICUs From 2010 to 2019,” published in the June 2024 issue of Critical Care by Harlan et al.
Rural hospitals face workforce challenges and financial difficulties, highlighting the need to analyze the types of patients treated in ICUs in both rural and urban settings for improved regional critical care.
Researchers conducted a retrospective study evaluating and comparing the patient demographics and conditions treated in ICUs of rural and urban hospitals to enhance regional critical care strategies.
They examined data on all fee-for-service Medicare beneficiaries aged 65 and older admitted to ICUs across the U.S. (2010 to 2019). Hospital location was defined using a standardized classification system based on the 2013 National Center For Health Statistics Urban-Rural Classification Scheme for Counties. The International Classification of Diseases, 9th and 10th revisions diagnosis and procedure codes were used to identify diagnoses, chronic conditions, organ function, and procedures received. Standardized differences were used to compare patients with rural and urban admission characteristics.
The result showed 12,224,097 admitted patients, with around 12.2% (1,488,347) treated in rural hospitals. Cardiac, infectious, and respiratory conditions were the most prevalent diagnoses among patients admitted to rural ICUs (30.3%, 24.6%, and 10.9%, respectively). The severity of organ dysfunction upon admission appeared similar between rural and urban ICUs (mean organ failures in rural ICUs 0.5, sd 0.8; mean organ failures in urban ICUs 0.6, sd 0.9, absolute standardized mean difference 0.096). A significant increase in organ dysfunction severity was observed in rural ICUs over time (0.4 mean organ failures in 2010 to 0.7 in 2019, P<0.001).
Investigators concluded that rural hospitals were managing increasingly complex patients of critical illness with comparable organ dysfunction compared to urban hospitals, emphasizing the need for urgent policy support for high-quality ICU care.
Source: journals.lww.com/ccmjournal/abstract/9900/characteristics_of_patients_hospitalized_in_rural.352.aspx
