Patients with respiratory failure in rural hospital intermediate units have higher mortality rates

Rural hospitals have turned to providing ventilator life support to some patients outside of the intensive care units, delivering such care in intermediate care units.

Patients with respiratory failure have higher mortality rates in the intermediate units of rural hospitals than those in urban hospitals, according to a new federally-backed study. (Image credit: ©pongmoji - stock.adobe.com)

However, researchers have found that patients getting ventilator life support in the intermediate units of rural hospitals have a significantly higher mortality rate, according to a new study financed by the National Institutes of Health.

Rural hospitals have a higher mortality rate with respiratory patients in intermediate units than urban hospitals. The findings were published in the Annals of the American Thoracic Society.

While there was a gap in outcomes in the intermediate units, urban hospitals and rural hospitals have similar mortality rates in treating patients with respiratory failure in intensive care units, the study found. The leader of the study notes that the research doesn’t suggest a lack of quality in rural hospitals.

Researchers say the study is important because intermediate care, also described as “moderate care” or “step down” care, is used when it’s not clear that a patient will benefit from being in an intensive care unit. Researchers also note that it’s a less expensive option than treating patients in the intensive care unit.

“Intermediate care units may be appealing to hospitals in financial crisis, including those in rural areas,” the researchers wrote in the study.

However, the study suggests patients with respiratory failure in rural hospitals may be better served in the intensive care unit. Researchers found a significant difference in patient mortality in the intermediate units of rural and urban hospitals.

In rural hospitals, 37% of the patients with respiratory failure who were treated in intermediate units died within 30 days. In the intermediate units of urban hospitals, 31.3% of patients died within 30 days.

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Emily Harlan, M.D., a pulmonary and critical care physician at University of Michigan Health, led the study. Researchers examined data involving 2.75 million Medicare patients who were on respiratory support at rural and urban hospitals from 2010 to 2019.

Harlan said she hopes the research will spur more consideration of the appropriate use of intermediate care.

“This 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,” Harlan said in a statement in a University of Michigan news release.

Harlan also cautioned against drawing conclusions about the quality of care at rural hospitals. She noted that patients in the intensive care units of rural hospitals fared as well as those in the ICUs of urban hospitals.

“There is a common belief that rural hospitals may have a lower quality of care, but that’s not what we saw for the ICU patients in our study,” Harlan said in a statement.

The study poses important questions for rural hospitals in treating patients with respiratory failure, said Gustavo Matute-Bello, M.D., deputy director for the division of lung diseases at the National Heart, Lung, and Blood Institute, which is part of the NIH. Rural hospitals are typically much smaller and have fewer staff and resources than urban hospitals, he noted.

“It emphasizes the need to assess whether rural intermediate care units can meet the complex demands of critically ill patients, and the importance of carefully evaluating the processes designed to care for them,” Matute-Bello said in a statement.

Rural hospitals make up about 35% of America’s hospitals, according to the American Hospital Association. Many rural hospitals are struggling financially.

Since 2010, more than 130 rural hospitals have closed, according to a report by the American Hospital Association.

More than 600 rural hospitals are at risk of closing in the near future, according to the Center for Healthcare Quality & Payment Reform. Nine rural hospitals closed in 2023, the center said.

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