CCM:2010-2019年城乡icu住院患者特征分析

OBJECTIVES: Rural hospitals are threatened by workforce shortages and financial strain. To optimize regional critical care delivery, it is essential to understand what types of patients receive intensive care in rural and urban hospitals.农村医院正面临劳动力短缺和财务压力的威胁。为了优化区域性重症监护服务的提供，了解哪些类型的患者在农村和城市医院接受重症监护至关重要。

DESIGN: A retrospective cohort study.一项回顾性队列研究

SETTING AND PATIENTS: All fee-for-service Medicare beneficiaries in the United States who were 65 years old or older hospitalized in an ICU between 2010 and 2019 were included. Rural and urban hospitals were classified according to the 2013 National Center For Health Statistics Urban-Rural Classification Scheme for Counties. Patient comorbidities, primary diagnoses, organ dysfunction, and procedures were measured using the International Classification of Diseases, 9th and 10th revisions diagnosis and procedure codes. Standardized differences were used to compare rural and urban patient admission characteristics.2010年至2019年间，所有在美国接受按服务收费的医疗保险受益人，年龄在65岁或以上，且在ICU住院的患者被纳入研究。农村和城市医院是根据2013年国家卫生统计中心的县级城市-农村分类方案进行分类的。使用国际疾病分类第9版和第10版诊断和手术代码，测量患者的共病、主要诊断、器官功能障碍和手术。使用标准化差异来比较农村和城市患者入院特征。

INTERVENTIONS: None.无

MEASUREMENTS AND MAIN RESULTS: There were 12,224,097 ICU admissions between 2010 and 2019, and 1,488,347 admissions (12.2%) were to rural hospitals. The most common diagnoses in rural hospitals were cardiac (30.3%), infectious (24.6%), and respiratory (10.9%). Patients in rural ICUs had similar organ dysfunction compared with urban hospitals (mean organ failures in rural ICUs 0.5, sd 0.8; mean organ failures in urban ICUs 0.6, sd 0.9, absolute standardized mean difference 0.096). Organ dysfunction among rural ICU admis- sions increased over time (0.4 mean organ failures in 2010 to 0.7 in 2019, p < 0.001).2010年至2019年间共有1,222万4097次ICU入院，其中1,488,347次（12.2%）入院是在农村医院。农村医院最常见的诊断是心脏疾病（30.3%）、感染性疾病（24.6%）和呼吸系统疾病（10.9%）。农村ICU患者的器官功能障碍与城市医院相似（农村ICU的平均器官衰竭数为0.5，标准差为0.8；城市ICU的平均器官衰竭数为0.6，标准差为0.9，绝对标准化均值差异为0.096）。农村ICU入院的器官功能障碍随时间增加（2010年平均器官衰竭数为0.4，到2019年为0.7，p < 0.001）。

CONCLUSIONS: Rural hospitals care for an increasingly complex critically ill patient population with similar organ dysfunction as urban hospitals. There is a pressing need to develop policies at federal and regional healthcare system levels to support the continued provision of high-quality ICU care within rural hospitals.农村医院护理的重症患者群体日益复杂，器官功能障碍与城市医院相似。迫切需要在联邦和区域卫生系统层面制定政策，以支持农村医院持续提供高质量的ICU护理。