Project Summary/Abstract
Approximately one in five Americans live in a rural-designated area, representing 97% of the country’s land
mass.1 The broad geographic distribution of rural America presents unique challenges for those seeking health
services, particularly when experiencing a time-sensitive emergency such as heart attack, stroke, or trauma.
Rural patients requiring time-sensitive medical care are often transferred via helicopter to urban academic
medical centers which has been shown to be a lifesaving intervention and thus considered critical healthcare
infrastructure.2,3-10 However, what is unknown, is the role of rurality in the use, cost, and outcomes of
interhospital transfer (IHT), vital information that is needed to increase access and decrease disparity in
outcomes. Identifying factors that contribute to poor outcomes for IHT patients is significantly complicated due
to a lack of comprehensive datasets that include all sources of data necessary to disentangle the complex
relationships between patient health and post-IHT outcomes disparity in relation to patient location and place-
based social determinants of health (SDOH). Current inclusion of SDOH data, data merged to other datasets
by location, are included in a non-specific manner, often classifying all patients into broad categories such as
rural versus urban and usually at the county level, or more broadly as rural designation for the entire
comparative group. This lack of consistency hinders our ability to understand the nature of IHT use—especially
in rural or underserved areas. As a result, guidelines and protocols remain flawed because they are based on
inconsistent conceptual definitions of rurality and data points that are not reliable or valid. Therefore, in order to
provide a more comprehensive and accurate understanding of the true relationship between the complicated
intervention of IHT and the role of SDOH in rural settings, new approaches to data management and analysis
are needed. The purpose of this proposal is to build an integrated data management platform that will combine
robust health system electronic health record data, transport data and social determinants of health data into a
spatial database where various geospatial manipulations, queries, and analysis can be performed. Once
established, we will use the analytic platform to conduct several analyses. Guided by the NIMHD research
framework, we will examine individual (e.g., transports), community (e.g., hospitals, transport services,
geographic distribution, census), and societal (e.g., reimbursement policy) influences on rural access to IHT. If
successful, we will be able to define and identify rural regions with limited IHT services—critical access
regions—to provide needed evidence to support improving access to care and reducing patient financial harm.
Further, data from this innovative platform will provide a dynamic analytic tool and data resource for research
and public use that currently does not exist. The dynamic capability of including updates as new datasets are
released, will provide a powerful tool to monitor and assess changes in IHT practice over time, providing a
reliable and valid system to assess the effect of policy changes and reimbursement practices in rural settings.
