Journal article
Provider-to-provider telemedicine for sepsis is used less frequently in communities with high social vulnerability
The Journal of rural health, Vol.41(1), e12861
01/2025
DOI: 10.1111/jrh.12861
PMCID: PMC11635342
PMID: 38924559
Abstract
Sepsis disproportionately affects patients in rural and socially vulnerable communities. A promising strategy to address this disparity is provider-to-provider emergency department (ED)-based telehealth consultation (tele-ED). The objective of this study was to determine if county-level social vulnerability index (SVI) was associated with tele-ED use for sepsis and, if so, which SVI elements were most strongly associated.PURPOSESepsis disproportionately affects patients in rural and socially vulnerable communities. A promising strategy to address this disparity is provider-to-provider emergency department (ED)-based telehealth consultation (tele-ED). The objective of this study was to determine if county-level social vulnerability index (SVI) was associated with tele-ED use for sepsis and, if so, which SVI elements were most strongly associated.We used data from the TELEmedicine as a Virtual Intervention for Sepsis in Rural Emergency Department study. The primary exposures were SVI aggregate and component scores. We used multivariable generalized estimating equations to model the association between SVI and tele-ED use.METHODSWe used data from the TELEmedicine as a Virtual Intervention for Sepsis in Rural Emergency Department study. The primary exposures were SVI aggregate and component scores. We used multivariable generalized estimating equations to model the association between SVI and tele-ED use.Our study cohort included 1191 patients treated in 23 Midwestern rural EDs between August 2016 and June 2019, of whom 326 (27.4%) were treated with tele-ED. Providers in counties with a high SVI were less likely to use tele-ED (adjusted odds ratio [aOR] = 0.51, 95% confidence interval [CI] 0.31‒0.87), an effect principally attributable to the housing type and transportation component of SVI (aOR = 0.44, 95% CI 0.22-0.89). Providers who treated fewer sepsis patients (1‒10 vs. 31+ over study period) and therefore may have been less experienced in sepsis care, were more likely to activate tele-ED (aOR = 3.91, 95% CI 2.08‒7.38).FINDINGSOur study cohort included 1191 patients treated in 23 Midwestern rural EDs between August 2016 and June 2019, of whom 326 (27.4%) were treated with tele-ED. Providers in counties with a high SVI were less likely to use tele-ED (adjusted odds ratio [aOR] = 0.51, 95% confidence interval [CI] 0.31‒0.87), an effect principally attributable to the housing type and transportation component of SVI (aOR = 0.44, 95% CI 0.22-0.89). Providers who treated fewer sepsis patients (1‒10 vs. 31+ over study period) and therefore may have been less experienced in sepsis care, were more likely to activate tele-ED (aOR = 3.91, 95% CI 2.08‒7.38).Tele-ED use for sepsis was lower in socially vulnerable counties and higher among providers who treated fewer sepsis patients. These findings suggest that while tele-ED increases access to specialized care, it may not completely ameliorate sepsis disparities due to its less frequent use in socially vulnerable communities.CONCLUSIONSTele-ED use for sepsis was lower in socially vulnerable counties and higher among providers who treated fewer sepsis patients. These findings suggest that while tele-ED increases access to specialized care, it may not completely ameliorate sepsis disparities due to its less frequent use in socially vulnerable communities.
Details
- Title: Subtitle
- Provider-to-provider telemedicine for sepsis is used less frequently in communities with high social vulnerability
- Creators
- Kevin J Tu - University of Maryland, College ParkJ Priyanka Vakkalanka - University of IowaUche E Okoro - University of IowaKarisa K Harland - University of IowaCole Wymore - University of IowaBrian M Fuller - Washington University in St. LouisKalyn Campbell - University of IowaMorgan B Swanson - University of IowaEdith A Parker - University of IowaLuke J Mack - University of South DakotaAmanda Bell - University of Sioux FallsKatie DeJong - University of Sioux FallsBrett Faine - University of IowaAnne Zepeski - University of IowaKeith Mueller - University of IowaElizabeth Chrischilles - University of IowaChristopher R Carpenter - Mayo ClinicMichael P Jones - University of IowaMarcia M Ward - University of IowaNicholas M Mohr - University of Iowa
- Resource Type
- Journal article
- Publication Details
- The Journal of rural health, Vol.41(1), e12861
- DOI
- 10.1111/jrh.12861
- PMID
- 38924559
- PMCID
- PMC11635342
- NLM abbreviation
- J Rural Health
- ISSN
- 1748-0361
- eISSN
- 1748-0361
- Language
- English
- Electronic publication date
- 06/26/2024
- Date published
- 01/2025
- Academic Unit
- Pharmacy; Public Health Administration; Health Management and Policy; Biostatistics; Pharmacy Practice and Science; Anesthesia; Injury Prevention Research Center; Statistics and Actuarial Science; Rural Telehealth Research Center; Epidemiology; Emergency Medicine; Community and Behavioral Health; Law Faculty
- Record Identifier
- 9984648576502771
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