Journal article
Rural Patients With Severe Sepsis or Septic Shock Who Bypass Rural Hospitals Have Increased Mortality: An Instrumental Variables Approach
Critical care medicine, Vol.45(1), pp.85-93
01/2017
DOI: 10.1097/CCM.0000000000002026
PMCID: PMC5161646
PMID: 27611977
Abstract
To identify factors associated with rural sepsis patients' bypassing rural emergency departments to seek emergency care in larger hospitals, and to measure the association between rural hospital bypass and sepsis survival.
Observational cohort study.
Emergency departments of a rural Midwestern state.
All adults treated with severe sepsis or septic shock between 2005 and 2014, using administrative claims data.
Patients bypassing local rural hospitals to seek care in larger hospitals.
A total of 13,461 patients were included, and only 5.4% (n = 731) bypassed a rural hospital for their emergency department care. Patients who initially chose a top-decile sepsis volume hospital were younger (64.7 vs 72.7 yr; p < 0.001) and were more likely to have commercial insurance (19.6% vs 10.6%; p < 0.001) than those who were seen initially at a local rural hospital. They were also more likely to have significant medical comorbidities, such as liver failure (9.9% vs 4.2%; p < 0.001), metastatic cancer (5.9% vs 3.2%; p < 0.001), and diabetes with complications (25.2% vs 21.6%; p = 0.024). Using an instrumental variables approach, rural hospital bypass was associated with a 5.6% increase (95% CI, 2.2-8.9%) in mortality.
Most rural patients with sepsis seek care in local emergency departments, but demographic and disease-oriented factors are associated with rural hospital bypass. Rural hospital bypass is independently associated with increased mortality.
Details
- Title: Subtitle
- Rural Patients With Severe Sepsis or Septic Shock Who Bypass Rural Hospitals Have Increased Mortality: An Instrumental Variables Approach
- Creators
- Nicholas M Mohr - 1Department of Emergency Medicine, University of Iowa College of Medicine, Iowa City, IA. 2Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA. 3Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA. 4Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO. 5Division of Critical Care, Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO. 6Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IAKarisa K HarlandDan M ShaneAzeemuddin AhmedBrian M FullerMarcia M WardJames C Torner
- Resource Type
- Journal article
- Publication Details
- Critical care medicine, Vol.45(1), pp.85-93
- DOI
- 10.1097/CCM.0000000000002026
- PMID
- 27611977
- PMCID
- PMC5161646
- NLM abbreviation
- Crit Care Med
- ISSN
- 1530-0293
- eISSN
- 1530-0293
- Publisher
- United States
- Grant note
- KL2 TR000450 / NCATS NIH HHS U54 TR001356 / NCATS NIH HHS L60 MD009764 / NIMHD NIH HHS UL1 TR000448 / NCATS NIH HHS
- Language
- English
- Date published
- 01/2017
- Academic Unit
- Health Management and Policy; Management and Entrepreneurship ; Epidemiology; Economics; Emergency Medicine; Surgery; Anesthesia; Injury Prevention Research Center; Public Policy Center (Archive); Neurosurgery; Law Faculty
- Record Identifier
- 9983996194302771
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