title: Lower rates of EMR use in rural hospitals represent a previously unexplored child health disparity.
abstract: OBJECTIVE
  Rural hospitals face significant barriers to adoption of advanced-stage electronic medical records (EMRs), which may translate to an unexplored disparity for children in rural hospitals. Our objective was to determine whether children hospitalized in rural settings are less likely to be cared for using advanced-stage EMRs.
  
  
  METHODS
  We merged the 2009 Healthcare Cost and Utilization Project Kids Inpatient Dataset with the 2009 Healthcare Information and Management Systems Society database. Logistic regression determined the independent relationship between receiving care in a rural hospital and advanced-stage EMRs.
  
  
  RESULTS
  A total of 430 055 (9.3%) of the 4 605 454 pediatric discharges were rural. Logistic regression analysis determined that even when an extensive list of various patient and hospital characteristics are accounted for, rurality continues to be a strong predictor of a child's care without advanced-stage EMRs (odds ratio 0.3; 95% confidence interval, 0.2-0.5).
  
  
  CONCLUSIONS
  Children hospitalized in a rural hospital are less than half as likely to be treated using advanced-stage EMRs. A focus of government and hospital policies to expand the use of EMRs among rural hospitals may reduce this child health care disparity.
authors.affiliation: Departments of Pediatrics, and andrewsan@musc.edu.
authors.forename: Annie Lintzenich
authors.initials: AL
authors.lastname: Andrews
authors.affiliation: Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Abby Swanson
authors.initials: AS
authors.lastname: Kazley
authors.affiliation: Departments of Pediatrics, and.
authors.forename: William T
authors.initials: WT
authors.lastname: Basco
authors.affiliation: Departments of Pediatrics, and.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Teufel
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D055815:Young Adult
keywords: and disparity; electronic medical records; rural hospitals