Evidence map›Paper›PMID 38924559›Full record

ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2025

Provider-to-provider telemedicine for sepsis is used less frequently in communities with high social vulnerability.

Kevin J Tu, J Priyanka Vakkalanka, Uche E Okoro, Karisa K Harland, Cole Wymore, Brian M Fuller, Kalyn Campbell, Morgan B Swanson, Edith A Parker, Luke J Mack and 10 more

Abstract read
In one paragraph

Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Provider-to-provider telemedicine for sepsis is used less frequently in communities with high social vulnerability.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Kevin J TuDepartment of Cell Biology and Molecular Genetics, University of Maryland, College Park, Maryland, USA.ORCID 0000-0002-0089-3932
J Priyanka VakkalankaDepartment of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.ORCID 0000-0002-6419-3433
Uche E OkoroDepartment of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Karisa K HarlandDepartment of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.ORCID 0000-0001-9482-8447
Cole WymoreUniversity of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Brian M FullerDivision of Critical Care, Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA.
Kalyn CampbellDepartment of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Morgan B SwansonDepartment of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.ORCID 0000-0003-0558-4191
Edith A ParkerDepartment of Community & Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa, USA.
Luke J MackAvel eCARE, Sioux Falls, South Dakota, USA.
Amanda BellAvel eCARE, Sioux Falls, South Dakota, USA.
Katie DeJongAvel eCARE, Sioux Falls, South Dakota, USA.
Brett FaineDepartment of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Anne ZepeskiDepartment of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Keith MuellerDepartment of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA.ORCID 0000-0002-6533-3303
Elizabeth ChrischillesDepartment of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA.
Christopher R CarpenterDepartment of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Michael P JonesDepartment of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA.
Marcia M WardDepartment of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA.
Nicholas M MohrDepartment of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.ORCID 0000-0003-0497-5828

Funding

Viral VectorP30CA086862 · NCI · UNIVERSITY OF IOWA · PI Jon C.D. Houtman · 2000 to 2026
$70.0M
Pulmonary Toxicology Facility CoreP30ES005605 · NIEHS · UNIVERSITY OF IOWA · PI Jong Sung Kim · 1990 to 2026
$40.5M
AHRQ HHS K08 HS025753AHRQ HHS K08HS025753HRSA HHS U3GRH40003NCI NIH HHS P30 CA086862NIEHS NIH HHS P30 ES005605University of Maryland Honors College
6 · The paper itself

Abstract

purposeSepsis disproportionately affects patients in rural and socially vulnerable communities. A promising strategy to address this disparity is provider-to-provider emergency department (ED)-based telehealth consultation (tele-ED). The objective of this study was to determine if county-level social vulnerability index (SVI) was associated with tele-ED use for sepsis and, if so, which SVI elements were most strongly associated.

methodsWe used data from the TELEmedicine as a Virtual Intervention for Sepsis in Rural Emergency Department study. The primary exposures were SVI aggregate and component scores. We used multivariable generalized estimating equations to model the association between SVI and tele-ED use.

findingsOur study cohort included 1191 patients treated in 23 Midwestern rural EDs between August 2016 and June 2019, of whom 326 (27.4%) were treated with tele-ED. Providers in counties with a high SVI were less likely to use tele-ED (adjusted odds ratio [aOR] = 0.51, 95% confidence interval [CI] 0.31‒0.87), an effect principally attributable to the housing type and transportation component of SVI (aOR = 0.44, 95% CI 0.22-0.89). Providers who treated fewer sepsis patients (1‒10 vs. 31+ over study period) and therefore may have been less experienced in sepsis care, were more likely to activate tele-ED (aOR = 3.91, 95% CI 2.08‒7.38).

conclusionsTele-ED use for sepsis was lower in socially vulnerable counties and higher among providers who treated fewer sepsis patients. These findings suggest that while tele-ED increases access to specialized care, it may not completely ameliorate sepsis disparities due to its less frequent use in socially vulnerable communities.

Indexed as

SepsisSocial VulnerabilityTelemedicineAdultAgedCohort StudiesEmergency Service, HospitalFemaleHumansMaleMiddle AgedRural Populationcritical careemergency medicinehealth inequitiessepsissocial vulnerabilitytelemedicine

Identifiers

PMID38924559
PMCPMC11635342

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.