Rural Intermediate Care Units Have Significantly Higher Death Rates Than Urban Ones, According to Study

Jan. 31, 2024
Despite the difference in the rate of death in intermediate care units, the rate in rural and urban ICUs remains similar

Researchers found that patients receiving ventilator life support in intermediate care units in rural hospitals had significantly higher death rates than patients in the same type of unit in urban hospitals.

The study, supported by the National Institutes of Health and published in the journal Annals of the American Thoracic Society, “highlights the need for more careful evaluations of patients with breathing problems who are assigned to intermediate care units.” Those in intensive care units (ICUs) fared “similarly” across rural and urban environments.

Gustavo Matute-Bello, M.D., deputy director for the Division of Lung Diseases at the National Heart, Lung, and Blood Institute (NHLBI), part of NIH, highlights that the study “has important implications for rural hospitals when determining how to care for their sickest patients on mechanical ventilation” and “emphasizes the need to assess whether rural intermediate care units can meet the complex demands of critically ill patients.”

Led by Emily Harlan, M.D., a pulmonary and critical care physician at the University of Michigan, Ann Arbor, researchers collected data from 2010 to 2019 on 2.75 million hospitalizations of “Medicare patients (65 years or older) who were on respiratory support at rural and urban hospitals across the country. The researchers conducted separate analyses for patients admitted to the general, intermediate, and ICU wards, and another analysis of patients in all the wards combined.”

The researchers determined that patients “receiving mechanical ventilation in rural hospitals had significantly higher 30-day death rates than those in urban hospitals.” Despite this, patients specifically in the ICU across rural and urban hospitals had “a similar chance of dying.” Patients in rural intermediate care units died at a higher rate over a 30 day span – 37% died in rural hospitals versus 31.3% in urban hospitals. This can perhaps be explained by the intermediate care unit model that hospitals in the U.S. have increasingly been moving toward, as these units “use fewer resources and can be less expensive to operate than ICUs,” assisting the hospital’s bottom line.

Harlan, the study’s leader, emphasized that the study “underscores the importance of learning more about how to best use intermediate care units and highlights the need to continue investing in rural hospitals to make sure all who need it have access to life-saving care.” She also mentioned that the fact that the rate of death in ICUs across rural and urban hospitals remained much the same, rebuffing a common notion that “rural hospitals may have a lower quality of care” than urban hospitals.

NIH’s website has the press release.