Within-Rural Variation in Emergency Department Visits for Ambulatory-Sensitive Conditions

Rural and frontier communities consistently face challenges with primary care access and chronic disease management. These access gaps often appear as ambulatory care sensitive condition (ACSC) emergency department (ED) visits, that are generally preventable with timely outpatient care. Rural populations consistently show higher rates of ACSC-related ED use than urban populations. But “rural” is not a single, homogeneous category, and substantial variation in health care infrastructure and geographic isolation exists within rural America. Frontier, small rural, and large rural counties differ meaningfully in provider density, distance to care, and the presence of safety-net infrastructure, yet these place types are routinely folded into broader rural-urban comparisons that obscure important within-rural differences. Because most existing evidence relies on a rural-urban binary rather than the within-rural continuum, it remains difficult to characterize which rural communities face the most severe preventable-ED-reliance patterns and why. Using 2018-2023 Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) data, this project will examine how ACSC-related ED utilization, and its structural predictors vary across frontier, small rural, and large rural America. Findings will provide federal, state, and local stakeholders with evidence on the extent and drivers of geographic variation in preventable ED reliance among the nation's rural communities.