Worsening Rural-Urban Gap in Hospital Mortality

Villapiano, Nicole; Iwashyna, Theodore J.; Davis, Matthew M.

doi:10.3122/jabfm.2017.06.170137

Cited by 31 publications

(19 citation statements)

References 12 publications

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“…Our findings are consistent with prior studies demonstrating a relationship between rurality and mortality, 1,2,4,5 though to our knowledge this is the first to look specifically at the uninsured population in recent years. One prior 2008 study looked at rural and urban differences in uninsured hospitalizations and found that uninsured patients in rural hospitals were more likely to be admitted for preventable conditions 17 ; however, that study did not look at differences in mortality nor at how these patterns were changing over time.…”

Section: Discussionsupporting

confidence: 92%

“…Rurality and a lack of insurance have independently been linked to worse clinical outcomes 1‐5,14 . However, little is known about how insurance status contributes to urban‐rural in‐hospital mortality disparities.…”

Section: Discussionmentioning

confidence: 99%

“…Rural areas have higher rates of death on average than urban areas, and studies show rural‐urban disparities in life expectancy and mortality are widening 1‐5 . Rural areas have a higher incidence of late‐stage cancers, lower breast cancer screening rates, and greater rates of chronic disease 6‐8 .…”

mentioning

confidence: 99%

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Trends in Hospital Mortality for Uninsured Rural and Urban Populations, 2012‐2016

Elson

Luke

Barker

et al. 2020

The Journal of Rural Health

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Purpose Rural‐urban health disparities have received increasing scrutiny as rural individuals continue to have worse health outcomes. However, little is known about how insurance status contributes to urban‐rural disparities. This study characterizes how rural uninsured patients compare to the urban uninsured, determines whether rurality among the uninsured is associated with worse clinical outcomes, and examines how clinical outcomes based on rurality have changed over time. Methods We conducted a retrospective cohort study of the 2012‐2016 National Inpatient Sample hospital discharge data including 1,478,613 uninsured patients, of which 233,816 were rural. Admissions were broken into 6 rurality categories. Logistic regression models were used to determine the independent association between rurality and hospital mortality. Findings Demographic and clinical characteristics differed significantly between rural and urban uninsured patients: rural patients were more often white, lived in places with lower median household income, and were more often admitted electively and transferred. Rurality was associated with significantly higher in‐hospital mortality rates (1.44% vs 1.89%, OR 1.32, P < .001). This association strengthened after adjusting for medical comorbidities and hospital characteristics. Further, disparities between urban and rural mortality were found to be growing, with the gap almost doubling between 2012 and 2016. Conclusions Rural and urban uninsured patients differed significantly, specifically in terms of race and median income. Among the uninsured, rurality was associated with higher in‐hospital mortality, and the gap between urban and rural in‐hospital mortality was widening. Our findings suggest the rural uninsured are a vulnerable population in need of informed, tailored policies to reduce these disparities.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Trends in Hospital Mortality for Uninsured Rural and Urban Populations, 2012‐2016

Elson

Luke

Barker

et al. 2020

The Journal of Rural Health

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“…For trauma patients, this may have contributed to a widening of the gap in morbidity and mortality outcomes between urban and rural populations. 38,39 Many rural patients simply cannot be delivered to an urban trauma center in a timely manner. Similarly, without an ability to offer local cesarean delivery capability, rural maternity care is largely unsustainable.…”

Section: Challenges To Providing Anesthesia and Surgical Care In Ruramentioning

confidence: 99%

Improving Access to Safe Anesthetic Care in Rural and Remote Communities in Affluent Countries

Orser

Wilson

Rotstein

et al. 2019

Anesthesia &Amp; Analgesia

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Inadequate access to anesthesia and surgical services is often considered to be a problem of low- and middle-income countries. However, affluent nations, including Canada, Australia, and the United States, also face shortages of anesthesia and surgical care in rural and remote communities. Inadequate services often disproportionately affect indigenous populations. A lack of anesthesia care providers has been identified as a major contributing factor to the shortfall of surgical and obstetrical care in rural and remote areas of these countries. This report summarizes the challenges facing the provision of anesthesia services in rural and remote regions. The current landscape of anesthesia providers and their training is described. We also explore innovative strategies and emerging technologies that could better support physician-led anesthesia care teams working in rural and remote areas. Ultimately, we believe that it is the responsibility of specialist anesthesiologists and academic health sciences centers to facilitate access to high-quality care through partnership with other stakeholders. Professional medical organizations also play an important role in ensuring the quality of care and continuing professional development. Enhanced collaboration between academic anesthesiologists and other stakeholders is required to meet the challenge issued by the World Health Organization to ensure access to essential anesthesia and surgical services for all.

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“…The new single Graduate Medical Education accreditation system for both allopathic and osteopathic physicians, along with the rapid expansion of osteopathic medical schools will change the future of the US family medicine workforce. So, more doctors, but not necessarily better access to care for rural AmericansVillapiano et al 19 report on the concurrently growing urban-rural gap for hospital mortality.…”

Section: National Data With Implications For Future Health Carementioning

confidence: 99%

Multiple Practical Facts and Ideas to Improve Family Medicine Care

Bowman¹,

Seehusen

Neale³

2017

J Am Board Fam Med

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Seconds count in a study on the best electronic health note format to reduce medical record charting time and increase accuracy. Directly observed family physician work is compared with Current Procedural Terminology (CPT) coding examples and notably under-recognized. This issue contains articles from single practices that that implemented new methods of care and other reports on practice innovations that can be more broadly implemented. We have articles on opioid medication use for acute low back pain in primary care, an electronic chronic pain consult service, a key question to identify potential opioid misuse risk, and newly implemented screening for other substances of abuse. Omissions (or gaps) in care are also highlighted: from the common types of omissions identified by primary care clinicians, self-reported low levels of substance use screening by family medicine prenatal care providers, and inadequate and inadequately available hospital discharge summaries. In addition, the most important alarm symptoms for a cancer diagnosis are reported. Seconds Count-How to Improve Electronic Health Records, and Thus Physicians' LivesIn the category of useful and practical, and some potential relief from the electronic health record (EHR) frustrations blamed for physician burnout, Belden et al 1 compared different EHR note formats (including some novel prototypes) by several excellent methods (audio, computer-screen activity, eye tracking, and field notes). The authors measured the actual time-on-task, as well as accuracy and effort. A reminder is that the few seconds' difference between the formats can add up quickly across many charts and visits. Some notes were collapsible in design. The proposed note prototypes performed better than the traditional Subjective, Objective, Assessment, Plan (SOAP) note format for speed, accuracy, and usability. It is worth looking at the appendices to see the actual note formats. Here's to having many individuals show this article to their EHR vendor! Care Innovation Reports from Single Family Medicine OfficesIn our lead article, Schwartz et al 2 discusses incorporating pharmacogenetics into a family practice for making medication decisions. A pharmacist completed medication reconciliation with patients taking a large number of medications and reviewed the completed pharmacogenetic testing, then made recommendations to the physician for medication changes. Drug-gene interactions were found a quarter of the time. In practice, I (MAB) have received pharmacogenetic reports ordered by psychiatrists for patients who have tried many different antidepressants without sufficient success. The reports seem to be useful for medication selection, but the full outcomes of pharmacogenetics on patient care are far from known. Axten et al 3 report on a novel wellness group visit model for obesity. A single family physician and collaborating dietician report on the success of this model, finding that much of the weight loss was sustained through 3 years of followup. See their excellent helpful hint...

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Worsening Rural-Urban Gap in Hospital Mortality

Cited by 31 publications

References 12 publications

Trends in Hospital Mortality for Uninsured Rural and Urban Populations, 2012‐2016

Trends in Hospital Mortality for Uninsured Rural and Urban Populations, 2012‐2016

Improving Access to Safe Anesthetic Care in Rural and Remote Communities in Affluent Countries

Multiple Practical Facts and Ideas to Improve Family Medicine Care

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