title: Intensive care unit utilization and interhospital transfers as potential indicators of rural hospital quality.
abstract: BACKGROUND
  Obtaining meaningful information from statistically valid and reliable measures of the quality of care for disease-specific care provided in small rural hospitals is limited by small numbers of cases and different definitive care capacities. An alternative approach may be to aggregate and analyze patient services that reflect more generalized care processes.
  
  
  OBJECTIVE
  To evaluate the applicability of intensive care unit (ICU) utilization and interhospital transfers as potential indicators of quality in rural hospitals.
  
  
  METHODS
  Secondary data analysis of ICU utilization and interhospital transfer practices in Iowa's Critical Access (CAH), rural, rural referral, and urban hospitals.
  
  
  RESULTS
  Rural hospitals have fewer resources, provide a more limited range of definitive care services, and rely to a greater extent on transferring patients to other hospitals capable of providing the required definitive care. Examining ICU utilization and interhospital transfer patterns we found (1) that lower percentages of patients receive ICU care in smaller facilities; (2) higher transfer rates for both ICU and non-ICU patients in CAH hospitals; (3) shorter average lengths of stay for ICU patients from smaller hospitals who were transferred; and (4) lower mortality rates for CAH and rural hospital ICU patients.
  
  
  CONCLUSIONS
  Examining ICU utilization and interhospital transfer patterns offers potential insights into rural hospital quality measurement and comparisons.
authors.affiliation: Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa 52242, USA. douglas-wakefield@uiowa.edu
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Wakefield
authors.forename: Marcia
authors.initials: M
authors.lastname: Ward
authors.forename: Thomas
authors.initials: T
authors.lastname: Miller
authors.forename: Robert
authors.initials: R
authors.lastname: Ohsfeldt
authors.forename: Mirou
authors.initials: M
authors.lastname: Jaana
authors.forename: Yang
authors.initials: Y
authors.lastname: Lei
authors.forename: Roger
authors.initials: R
authors.lastname: Tracy
authors.forename: John
authors.initials: J
authors.lastname: Schneider
mesh_terms: D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006764:Hospitals, Community / Q000592:standards / Q000706:statistics & numerical data; D006780:Hospitals, Rural / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007484:Iowa / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care