Abstract
IntroductionPatients in the rural western United States face challenges accessing trauma and surgical services and are more likely to succumb to their injuries. New Mexico, a rural and medically underresourced state, is a salient space to study these disparities. We examine how travel distance from trauma centers impacts injured patient outcomes and describe care delivery obstacles.Materials and MethodsWe conducted an explanatory mixed methods study by creating geospatial maps of New Mexico’s trauma data, incorporating linear regression analyses on patient outcomes as a function of estimated travel distance from trauma centers. We also conducted qualitative semi-structured interviews with trauma providers to illuminate and provide context for the geospatial findings utilizing a systematic, collaborative, iterative transcript analysis process. We constructed a conceptual framework describing rural trauma care delivery obstacles.ResultsGeospatial analyses revealed that most New Mexicans face long travel times to trauma centers. Comparing regression analyses using different data sources suggests that solely hospital-derived data may undercount rural trauma deaths. Interviews with 10 providers suggest that elements that may contribute to these findings include on-the-ground resource-based challenges and those related to broader healthcare systems-based issues. Our conceptual framework denotes how these elements collectively may impact rural trauma outcomes and proposes potential solutions.ConclusionsIn addressing rural patients’ needs, healthcare policy decision-makers should ensure that their datasets are comprehensive and inclusive. They must also take into account the particular challenges of underserved rural patients and providers who care for them by eliciting their perspectives, as presented in our conceptual framework.
Highlights
Patients in the rural western United States face challenges accessing trauma and surgical services and are more likely to succumb to their injuries
They must take into account the particular challenges of underserved rural patients and providers who care for them by eliciting their perspectives, as presented in our conceptual framework
Individuals living in the rural western United States face challenges accessing quality healthcare
Summary
Patients in the rural western United States face challenges accessing trauma and surgical services and are more likely to succumb to their injuries. Please discuss your journey to trauma care and/or surgery and your decision to practice at [YOUR PRIMARY INSTITUTION]. TRANSITION: I’d like to talk a bit more about your day to day work. 2) Challenges: I’d like to discuss the challenges you encounter delivering care to all patients in need on a typical day at work, if any. 3) Escalation of Care: I’d like to know what you do if you ever encounter a patient requiring a higher level/different type of care than you can directly provide, for example, a surgical subspecialty. Should large academic medical centers, like [INSTITUTION], play a role in providing surgical care to patients from rural areas of the United States? Have you ever worked in an [URBAN/RURAL] setting? à If so, where? How did those experiences at [YOUR PRIMARY INSTITUTION] and [THIS OTHER SETTING] differ? à If not, what have you not worked in such a context?
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