Outcomes comparison in patients admitted to low complexity rural and urban intensive care units in the Veterans Health Administration

Purpose: To 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 method: Retrospective study of adult ICU admissions identified in VHA Medical SAS (R); 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). Results: 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% Cl = [0.69, 0.80]: p < .001) and a shorter ICU length of stay (RR = 0.82; 95% Cl = [0.74, 0.91]; p < .001). This did not hold when the hierarchical data was accounted for. Conclusions: 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. Published by Elsevier Inc.