{"pk":12393,"title":"Are Rural and Urban Emergency Departments Equally Prepared to Reduce Avoidable Hospitalizations?","subtitle":null,"abstract":"Introduction:\n Attempts to reduce low-value hospital care often focus on emergency department (ED) hospitalizations. We compared rural and urban EDs in Michigan on resources designed to reduce avoidable admissions.\nMethods: \nA cross-sectional, web-based survey was emailed to medical directors and/or nurse managers of the 135 hospital-based EDs in Michigan. Questions included presence of clinical pathways, services to reduce admissions, and barriers to connecting patients to outpatient services. We performed chi-squared comparisons, regression modeling, and predictive margins.\nResults:\n Of 135 EDs, 64 (47%) responded with 33 in urban and 31 in rural counties. Clinical pathways were equally present in urban and rural EDs (67% vs 74%, p=0.5). Compared with urban EDs, rural EDs reported greater access to extended care facilities (21% vs 52%, p=0.02) but less access to observation units (52% vs 35%, p=0.04). Common barriers to connecting ED patients to outpatient services exist in both settings, including lack of social support (88% and 76%, p=0.20), and patient/family preference (68% and 68%, p=1.0). However, rural EDs were more likely to report time required for care coordination (88% vs 66%, p=0.05) and less likely to report limitations to home care (21% vs 48%, p=0.05) as barriers. In regression modeling, ED volume was predictive of the presence of clinical pathways rather than rurality.\nConclusion:\n While rural-urban differences in resources and barriers exist, ED size rather than rurality may be a more important indicator of ability to reduce avoidable hospitalizations.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Emergency Department, Rural Health, Population Health, Clinical Pathways"}],"section":"Emergency Department Administration","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3w92f149","frozenauthors":[{"first_name":"Margaret","middle_name":"B.","last_name":"Greenwood-Ericksen","name_suffix":"","institution":"University of New Mexico, Department of Emergency Medicine, Albuquerque, New Mexico","department":"None"},{"first_name":"Michelle","middle_name":"L.","last_name":"Macy","name_suffix":"","institution":"Ann & Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois","department":"None"},{"first_name":"Jason","middle_name":"","last_name":"Ham","name_suffix":"","institution":"University of Michigan, Department of Internal Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Michele","middle_name":"M.","last_name":"Nypaver","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan;\n\nUniversity of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan;\n\nUniversity of Michigan, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan","department":"None"},{"first_name":"Melissa","middle_name":"","last_name":"Zochowski","name_suffix":"","institution":"University of Michigan, College of Engineering, XTRM Labs, Ann Arbor, Michigan","department":"None"},{"first_name":"Keith","middle_name":"","last_name":"Kocher","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan;\n\nUniversity of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan","department":"None"}],"date_submitted":"2018-12-20T23:50:03+05:30","date_accepted":"2018-12-20T23:50:03+05:30","date_published":"2019-04-16T23:57:38+05:30","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12393/galley/6591/download/"}]}