Presentation description

Pneumonia is an inflammation in the lungs that can be caused by a bacterial, viral, or fungal infection, and is a leading infectious diagnosis in Emergency Departments (ED). The Veterans Health Administration (VHA) serves a disproportionate amount of rural Veterans: 25-30% of Veterans live in rural areas. In our study, we aimed to 1) compare patient provider and facility characteristics between high and low-complexity ED's and 2) evaluate health outcomes of pneumonia between high and low-complexity facilities. We hypothesized that pneumonia outcomes for patients treated in low-complexity (LC) facilities will not differ from patients treated in high-complexity (HC) facilities. We used a retrospective cohort study of ED encounters resulting in a pneumonia diagnosis in the VHA for patients above 18 years of age. Among 609,507 ED encounters, 86,321 presented to LC ED's and 523,186 presented to HC ED's. The electronic pneumonia severity index (ePSI) was similar between both facilities; 92 (LC) vs 94 (HC). Patients presenting to LC ED's were more likely to have a chronic obstructive pulmonary disease (COPD); 46% (LC) vs 39% (HC) and a Chest Tomography scan obtained; 5.2% (LC) vs 3.3% (HC). Patients presenting to HC ED's were more likely to have housing instability; 9.3% (HC) vs 6.2% (LC). Mortality was similar for 30-day, 60-day and 365-day rates; 1.4%, 4.7%, and 18% for LC ED's vs 1.5%, 5.4%, and 19% for HC ED's. This study provides patients with confidence in using LC facilities that can save time, money, and allow for easier access to health care.