Family Physicians' Contributions to Rural Emergency Care and Urban Urgent Care

Peterson, Lars E.; Puffer, James C.; Nasim, Urooj; Petterson, Stephen; Newton, Warren P.

doi:10.3122/jabfm.2019.03.180338

Cited by 10 publications

(5 citation statements)

References 5 publications

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“…As such, we likely slightly underestimate the number of actual FM EPs. 4,5 Second, we are unable to account for the contributions of osteopathic EPs. Data are linked only to ACGME and ABMS; there is no equivalent osteopathic database.…”

Section: Discussionmentioning

confidence: 99%

“…We found more EPs compared with 2008 but a decrease in the density of EPs in rural areas. 2,3 Further, we found that nearly a third of rural EPs reported prior family medicine (FM) residency training; 3 FM-trained EPs-who we will refer to as FM EPs-play an important role in emergency care in the rural United States, 4,5 but this population has not been well characterized. Our goal was to characterize the 2020 population of clinically active FM EPs and identify their geographic distribution.…”

Section: Introductionmentioning

confidence: 99%

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National Study on the Contribution of Family Physicians to the US Emergency Physician Workforce in 2020

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

National Study on the Contribution of Family Physicians to the US Emergency Physician Workforce in 2020

et al. 2021

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“…There has been a discussion of emergency medicine and primary care partnership to meet the shortage of rural EM physicians [ 13 , 14 ]. As the national emergency physician workforce study showed, only 52% of physicians in large rural and 37% in small rural are emergency medicine trained.…”

Section: Discussionmentioning

confidence: 99%

Comparing Resident Procedures in Rural Versus Urban Emergency Departments

Carey¹,

Hansroth²,

Davis³

et al. 2021

Cureus

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Background: Rural rotations can be a valuable experience for emergency medicine (EM) residents. To date, there has not been a retrospective cohort study comparing procedures performed at urban versus rural emergency departments (EDs). Objectives: The purpose of this study was to compare procedures performed by EM residents in urban versus rural EDs, with the hypothesis that there will be no significant difference in the procedures performed. Methods: A retrospective cohort study was conducted comparing procedures performed by second- and third-year EM residents based on medical chart review. The procedures were counted at three locations in West Virginia, including a small rural ED, a large rural ED, and a tertiary care ED. Procedure notes were collected from September 2018 to September 2019. The final analysis included nine months, as three months did not have residents at all locations. Eight procedures were standardized based on the number of procedures performed per 100 hours worked by residents. A comparison of total procedures and complex versus simple procedures was performed. A Kruskal-Wallis H test was performed to compare resident hours for procedures between each of the three locations. To compare each of the hospitals to one another separately, Mann-Whitney U tests were performed. Results: The total resident hours worked included 1,800 at the small rural ED, 13,725.5 at the tertiary care ED, and 5,319 at the large rural ED. A p-value of 0.0311 for the Kruskal-Wallis H Test indicated a difference between at least two of the ED sites. A statistically significant difference exists (p-value = 0.0135) between the urban ED (95% CI: 0.15-0.62) and the large rural ED (95% CI: 0.54-1.53). There was no significant difference in complex versus simple procedures among the three locations (p-value = 0.4159). Conclusions: When compared with the tertiary care ED, residents performed more total procedures at the large rural ED and similar total procedure numbers at the small rural ED when standardized for hours worked. There was no significant difference when comparing complex and simple procedures among the three locations.

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“…12,13 Rural EDs experience staffing challenges, infrequent patients with critical illness, and reduced access to specialists, leading to variable sepsis guideline adherence. [14][15][16][17][18] Many rural sepsis patients are transferred to other hospitals as part of their care, but even regionalized care does not fully reduce disparities in outcomes. 14,[19][20][21][22]…”

Section: Introductionmentioning

confidence: 99%

Outcomes Associated with Rural Emergency Department Provider-to-Provider Telehealth for Sepsis Care: A Multicenter Cohort Study

Mohr

Okoro

Harland

et al. 2022

Preprint

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Objective: To test the hypothesis that provider-to-provider tele-emergency department (tele-ED) care is associated with more 28-day hospital-free days and improved Surviving Sepsis Campaign (SSC) guideline adherence in rural emergency departments (EDs). Methods: Multicenter (n=23), propensity-matched, cohort study using medical records of sepsis patients from rural hospitals in a well-established, on-demand, rural video tele-ED network in the upper Midwest between August 2016 and June 2019. The primary outcome was 28-day hospital-free days, with secondary outcomes of 28-day in-hospital mortality and SSC guideline adherence. Results: A total of 1,191 patients were included in the analysis, with tele-ED used for 326 (27%). Tele-ED cases were more likely to be transferred to another hospital (88% vs. 8%, difference 79%, 95% CI 75-83%). After matching and regression adjustment, tele-ED cases did not have more 28-day hospital-free days (difference 0.80 days longer for non-tele-ED, 95% confidence interval [CI] [-0.87]-2.47) or 28-day in-hospital mortality (adjusted odds ratio [aOR] 1.61, 95% CI 0.74-3.57). Adherence with both the SSC 3-hour bundle (aOR 0.80, 95% CI 0.24-2.70) and complete bundle (aOR 0.81, 95% CI 0.15-4.41) were similar. An a priori-defined subgroup analysis of patients treated by advanced practice providers suggested that the mortality was lower in the cohort with tele-ED use (aOR 0.19, 95% CI 0.04-0.90) despite no significant difference in complete SSC bundle adherence (aOR 2.48, 95% CI 0.45-13.76). Conclusions: Rural ED patients treated with provider-to-provider tele-ED care in a mature network appear to have similar clinical outcomes to those treated without.

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Family Physicians' Contributions to Rural Emergency Care and Urban Urgent Care

Cited by 10 publications

References 5 publications

National Study on the Contribution of Family Physicians to the US Emergency Physician Workforce in 2020

National Study on the Contribution of Family Physicians to the US Emergency Physician Workforce in 2020

Comparing Resident Procedures in Rural Versus Urban Emergency Departments

Outcomes Associated with Rural Emergency Department Provider-to-Provider Telehealth for Sepsis Care: A Multicenter Cohort Study

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