Abstract:
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®; 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% CI = [0.69, 0.80]; p < .001) and a shorter ICU length of stay (RR = 0.82; 95% CI = [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.
journal_name
J Crit Carejournal_title
Journal of critical careauthors
O'Shea AMJ,Fortis S,Vaughan Sarrazin M,Moeckli J,Yarbrough WC,Schacht Reisinger Hdoi
10.1016/j.jcrc.2018.10.013subject
Has Abstractpub_date
2019-02-01 00:00:00pages
64-69eissn
0883-9441issn
1557-8615pii
S0883-9441(18)30977-8journal_volume
49pub_type
杂志文章abstract:PURPOSE:Liquid perfluorochemicals reduce the production of reaction oxygen species by alveolar macrophages. We sought to determine whether the use of liquid perfluorochemicals in vivo during liquid ventilation would attenuate oxidative damage to the lung. MATERIALS AND METHODS:Healthy infant piglets (n = 16) were inst...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/s0883-9441(99)90004-7
更新日期:1999-03-01 00:00:00
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journal_title:Journal of critical care
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journal_title:Journal of critical care
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更新日期:2010-06-01 00:00:00
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journal_title:Journal of critical care
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doi:10.1016/j.jcrc.2012.11.003
更新日期:2013-08-01 00:00:00
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journal_title:Journal of critical care
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doi:10.1016/j.jcrc.2017.08.008
更新日期:2017-12-01 00:00:00
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doi:10.1016/j.jcrc.2007.11.011
更新日期:2008-09-01 00:00:00
abstract:INTRODUCTION:Ventilator-associated pneumonia (VAP) is difficult to diagnose. Recent data suggest quantitative endotracheal aspirate (ETA) may be noninferior diagnostically to quantitative bronchoalveolar lavage (BAL). We hypothesized this would be the case. METHODS:Blind quantitative ETA and BAL were performed on 150 ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2008.06.012
更新日期:2009-09-01 00:00:00
abstract::The concept of permissive hypotension is a controversial topic in trauma care. While driving blood pressure to "normal" levels with large volume crystalloid infusions is not appropriate, definitive data on the target blood pressure for hypotensive resuscitation are lacking. Indeed, the concept of systolic blood pressu...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2013.11.017
更新日期:2014-04-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jcrc.2019.08.021
更新日期:2019-12-01 00:00:00
abstract:PURPOSE:To explore perspectives of adult critical illness survivors and identify important aspects to care and recovery. MATERIALS AND METHODS:A descriptive, qualitative study of adult survivors of prolonged critical illness, six-months after Intensive Care Unit (ICU) discharge, using semi-structured interviews and th...
journal_title:Journal of critical care
pub_type: 杂志文章
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更新日期:2020-06-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2010.08.012
更新日期:2011-08-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2019.07.009
更新日期:2019-12-01 00:00:00
abstract:PURPOSE:Diaries summarizing intensive care are routine practice in some countries, although evidence to support diary use is limited. The purpose of this study was to identify whether distress post-intensive care influences patients' and relatives' choice as to whether they would like to receive a diary and what inform...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2016.12.003
更新日期:2017-04-01 00:00:00
abstract::Tropical diseases are those that occur primarily or solely in the tropics, and as such include infectious diseases that are particularly prevalent in hot, humid conditions. The incidence of encephalitis in tropical countries is reported to be as high as 6.34/100,000/year. The term encephalitis implies inflammation of ...
journal_title:Journal of critical care
pub_type: 杂志文章,评审
doi:10.1016/j.jcrc.2017.11.001
更新日期:2017-12-01 00:00:00
abstract:PURPOSE:Lung ultrasound is an accurate and accessible tool to quantify lung edema. Furthermore, left ventricle filling pressures (LVFP) can be assessed with transthoracic echocardiography (TTE) by the E/e' ratio (E/e'). The present study aimed to assess the correlation between E/e' and lung edema quantified by a simpli...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2017.11.036
更新日期:2018-04-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2018.08.012
更新日期:2018-12-01 00:00:00
abstract:PURPOSE:We investigated the reproducibility of passive leg raise (PLR) and fluid bolus (BOLUS) using the Non-Invasive Cardiac Output Monitor (NICOM; Cheetah Medical, Tel Aviv, Israel) for assessment of fluid responsiveness (FR) in spontaneously breathing emergency department (ED) patients. METHODS:Prospective, observa...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2014.07.031
更新日期:2015-02-01 00:00:00
abstract:PURPOSE:The aims of the study were to assess opinions of caregivers, families, and patients about involvement of families in the care of intensive care unit (ICU) patients; to evaluate the prevalence of symptoms of anxiety and depression in family members; and to measure family satisfaction with care. MATERIALS AND ME...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2010.03.001
更新日期:2010-12-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2016.04.007
更新日期:2016-08-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jcrc.2018.11.002
更新日期:2019-02-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2018.10.009
更新日期:2019-02-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1053/jcrc.2002.36760
更新日期:2002-12-01 00:00:00
abstract:OBJECTIVE:Pneumothorax is present as a frequent complication in acute respiratory distress syndrome (ARDS). Persistent air leak (PAL) prolongs pneumothorax in 2% of cases of ARDS, increasing the rate of mortality by 26%. Pleurodesis using autologous blood (PAB) is an effective method in cases of oncological pulmonary s...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2005.10.003
更新日期:2006-06-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2009.05.010
更新日期:2010-03-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章,评审
doi:10.1016/j.jcrc.2016.04.006
更新日期:2016-10-01 00:00:00
abstract:PURPOSE:To evaluate the impact of slow-tempo music listening periods in mechanically ventilated intensive care unit patients. METHODS:A randomized crossover study was performed in a 16-bed, adult critical care unit at a tertiary care hospital. Still-sedated patients, mandating at least 3 more days of mechanical ventil...
journal_title:Journal of critical care
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jcrc.2013.01.007
更新日期:2013-08-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1053/jcrc.2002.33032
更新日期:2002-03-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2016.07.007
更新日期:2016-12-01 00:00:00
abstract:PURPOSE:The prevalence and clinical significance of lactic acidosis in diabetic ketoacidosis (DKA) are understudied. The objective of this study was to determine the prevalence of lactic acidosis in DKA and its association with intensive care unit (ICU) length of stay (LOS) and mortality. METHODS:Retrospective, observ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2011.07.071
更新日期:2012-04-01 00:00:00
abstract:PURPOSE:The ratio of right ventricular end-diastolic diameter (EDD) to left ventricular EDD (RV/LV) is a measure predictive of right ventricular failure. We hypothesized that an increase in RV/LV would be associated with poor prognosis in severe sepsis and septic shock. MATERIALS AND METHODS:This is a retrospective ch...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2018.09.025
更新日期:2018-12-01 00:00:00