Transitions in Care and Healthcare Resource Use in Critically Ill Patients Living in Urban and Rural Settings: A Retrospective Cohort Study

Thomas, Abigail

Transitions in Care and Healthcare Resource Use in Critically Ill Patients Living in Urban and Rural Settings: A Retrospective Cohort Study

dc.contributor.advisor	Sauro, Khara
dc.contributor.advisor	Fiest, Kirsten
dc.contributor.author	Thomas, Abigail
dc.contributor.committeemember	Ronksley, Paul
dc.contributor.committeemember	Parhar, Ken
dc.date	2023-11
dc.date.accessioned	2023-09-28T17:31:00Z
dc.date.available	2023-09-28T17:31:00Z
dc.date.issued	2023-09-21
dc.description.abstract	Objective: To examine healthcare resource use and patient outcomes among critically ill patients who live in urban versus rural settings. Design: Retrospective cohort study. Setting: Medical, medical-surgical, and cardiovascular intensive care units (ICUs) in Alberta, Canada between January 1, 2014, and April 30, 2018. Patients: Those who survived their index ICU stay, remained in ICU for ≥24 hours before ICU discharge, and had 1-year of follow-up post-index ICU admission. Interventions: None. Measurements and Main Results: Of 20,659 patients, 25.0% lived in a rural setting at the time of their index ICU admission. Urban and rural ICU patients had similar baseline demographic characteristics, with differences in admitting location and discharge destination. Rural ICU patients were admitted to ICU from inpatient units less than urban patients (76.3%, 84.2%). Differences in discharge destination were also apparent, with rural ICU patients seeing a general practitioner as their first provider after hospital discharge (53.3%), while urban patients saw specialists (59.7%). Rural and urban ICU patients did not differ in their use of continuous renal replacement therapy, though rural ICU patients in the lowest quintile of material deprivation had lower odds of requiring mechanical ventilation during their ICU stay than their urban counterparts (OR: 0.87, 95% CI: 0.76-0.99). Rural ICU patients had greater odds of adverse events while in hospital (OR: 1.39, 95% CI: 1.09-1.78) and 30-day ICU readmission after hospital discharge compared to urban patients, regardless of social deprivation and sex. Conclusions: While critically ill patients living in urban and rural settings are similar at the time of ICU admission and have similar clinical courses in ICU, their care and outcomes differ after ICU discharge. Lack of access to care in rural areas may be related to these differences. Strategies to improve healthcare access in these areas are needed to ensure high-quality care for critically ill patients living in rural settings.
dc.identifier.citation	Thomas, A. (2023). Transitions in care and healthcare resource use in critically ill patients living in urban and rural settings: a retrospective cohort study (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.
dc.identifier.uri	https://hdl.handle.net/1880/117199
dc.language.iso	en
dc.publisher.faculty	Graduate Studies
dc.publisher.institution	University of Calgary
dc.rights	University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.
dc.subject	rural health
dc.subject	transition in care
dc.subject	critical illness
dc.subject	intensive care
dc.subject	healthcare resource use
dc.subject	epidemiology
dc.subject.classification	Epidemiology
dc.title	Transitions in Care and Healthcare Resource Use in Critically Ill Patients Living in Urban and Rural Settings: A Retrospective Cohort Study
dc.type	master thesis
thesis.degree.discipline	Medicine – Community Health Sciences
thesis.degree.grantor	University of Calgary
thesis.degree.name	Master of Science (MSc)
ucalgary.thesis.accesssetbystudent	I do not require a thesis withhold – my thesis will have open access and can be viewed and downloaded publicly as soon as possible.