Health Care Utilization and Outcomes for Rural Traumatic Injury Survivors: A Scoping Review

Background and/or Objectives: Rehabilitation following traumatic injury requires complex coordination to utilize health care services for re-integration of patients back into their rural communities. The purpose of this scoping review is to investigate how health care utilization (HCU) and patient reported outcomes (PROs), differ for rural compared to non-rural trauma survivors.

Design: A comprehensive literature review was conducted using Google Scholar, Embase, Cochrane, ProQuest, and PubMed. Included studies evaluated HSU in rural and non-rural traumatically injured cohorts with variables of interest including type of injury and surgical interventions, discharge status, post-discharge services and patient outcomes. Draft data extraction tool includes HSU metrics and PROs.

Setting : Scoping Review

Participants : Studies were selected for inclusion if their population included rural traumatically injured survivors who underwent surgical interventions, >18 years old, or a comparator group of urban traumatic injury survivors. Survivors of emotional/PTSD trauma were excluded. Rurality was defined as population of < 49,000 or RUCA code of >3. Studies will be classified by Rural Urban Commuting Area (RUCA) codes, area deprivation index (ADI), and social deprivation index (SDI).

Interventions: Surgical Interventions

Main Outcome Measures: Definitions for HCU and outcomes of interest included age, race/ethnicity, poverty status, insurance status, zip code of primary residence, length and place of stay (hospital, rehabilitation hospital, and/or skilled nursing facility), type of healthcare visits or services, PROs and other quality of life measures (PROMIS, AM-PAC), number of ventilator days, and telemedicine utilization.

Results: An extensive literature review to define our extraction criteria identified 210 studies eligible for screening and a subsequent 103 articles of interest. Preliminary survey of these studies demonstrates overall longer length of stay for rural patients and increased hospitalization rates with increasing rurality.

Conclusions: Efforts to increase appropriate health care utilization for rural traumatic injury survivors might include the use of telemedicine into pre-hospital and post-discharge care for overall improvement of the health of rural survivors.