Post-Intensive Care Fragmentation Among Rural Veterans: Transitions Between VA and Community Health Systems
Zachary Hahn1,2, Brian Tyler3, Charles Atwood4,5
1Department of Medicine, Pulmonary and Critical Care, VA Maine Healthcare System, Augusta, Maine, USA.
Summary
Following intensive care, Veterans experienced increased care fragmentation. Rural Veterans faced worse outcomes but similar fragmentation, with telehealth showing protective effects.
Area of Science:
- Health Services Research
- Critical Care Medicine
- Rural Health
Background:
- Intensive care unit (ICU) survivors face complex recovery pathways.
- Understanding care fragmentation and its impact on clinical outcomes is crucial for this population.
Purpose of the Study:
- To evaluate how rural residence and health system transitions influence outpatient care fragmentation and clinical outcomes among Veterans post-ICU hospitalization.
Main Methods:
- Retrospective cohort study of 80,884 Veterans post-ICU hospitalization.
- Assessed outpatient fragmentation using the modified Continuity of Care Index (mCOCI).
- Examined relationships between rurality, system engagement, and 30/90-day clinical outcomes.
Main Results:
- Post-discharge, care fragmentation and utilization significantly increased.
- Rurality and Veterans Affairs (VA) engagement did not correlate with fragmentation changes.
- Telehealth utilization was linked to a modest reduction in fragmentation.
- Rural Veterans had lower primary care follow-up and ED visits but higher readmission rates and mortality compared to urban Veterans.
Conclusions:
- Critical illness recovery involves significant increases in care fragmentation and utilization.
- Rural Veterans experienced worse outcomes but not increased fragmentation.
- Telehealth demonstrated a protective effect, potentially mitigating rural travel burdens.
- Integrated, rural-specific care models leveraging telehealth are needed for high-risk ICU survivors.
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