Rural-Urban Differences in Emergency Department Utilization for Chronic Conditions Among Children and Adults

Rural health care delivery is changing in ways that may reshape how children and adults with chronic conditions obtain timely, appropriate care. Persistent shortages of primary care and specialty clinicians, closures of rural hospitals and service lines, and the regionalization of pediatric and other specialized services can lengthen travel times and reduce local options for prevention, routine monitoring, and early intervention. When accessible outpatient care is limited, or when patients cannot obtain same-day care, emergency departments may serve as a safety net.

This study combines encounter-level data from the 2024 Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) with county-level contextual data from the Health Resources and Services Administration's (HRSA) Area Health Resources Files (AHRF). Findings will provide updated rates and characteristics of emergency department visits for selected chronic conditions, defined as the five most common conditions among children and the five most common among adults. They will show how these visits differ by rurality, patient characteristics, payer, and community health care resources. The study will address three research questions:

• How often do rural and urban patients visit the ED for the five most common chronic conditions, and how does this differ by age group (children and adults) and insurance type?
• How do the characteristics of emergency department visits for selected chronic conditions (e.g., admission source) and visit outcomes (e.g., discharge, hospital admission, or transfer) differ by rurality (rural and urban), patient age group (pediatric and adult), and payer?
• How are community characteristics, including primary care provider availability, health insurance coverage, and economic indicators, associated with the rate of emergency department visits for selected chronic conditions, and do these associations differ by rurality, patient age group, and payer?