Identifying Disparities in Care of Rural Patients with Cardiac Implantable Electronic Devices

PROJECT SUMMARY/ABSTRACT Project 2 (Zeitler): Identifying Disparities in Care of Rural Patients with Cardiac Implantable Electronic Devices Patients in rural settings have significantly worse outcomes from cardiovascular conditions compared with patients in non-rural settings, including treatment of arrhythmias with a cardiac implantable electronic device (CIED), like a pacemaker or defibrillator. These ubiquitous implantable devices store copious amounts of medical information related to device function and disease progression, among other items. These data are available to treating physicians and other clinicians through remote monitoring (RM), which relies on wireless connectivity between patients, a remote server, health care facilities, and treating physicians. Monitoring of patients with a CIED through this RM paradigm as an adjunct to periodic in-person evaluations has been associated with a variety of improved outcomes over in-person evaluations alone, ranging from improvements in patient satisfaction to decreased mortality. Thus, RM is unequivocally recommended in combination with in- person evaluations. While known disparities in RM exist among the uninsured and elderly, the geographic distribution of RM remains unstudied. A number of factors suggest that RM of CIEDs may be particularly vulnerable to geographic disparities. For one, patients in rural areas face greater barriers to connectivity, including less access to high-speed internet and less-consistent cell phone coverage. These barriers couple with the challenge of greater geographic distances that must be traveled to access in-person subspecialty services, a necessary aspect of CIED care. With the guidance of a community engagement studio, the proposed work incorporates mixed methods to: 1) better understand barriers and facilitators of RM in rural areas; 2) identify geographic disparities in CIED care; and 3) exploit variation in RM referral networks to understand characteristics associated with optimal CIED care in rural areas. These efforts will be informed and supported by expert input from the Statistics, Informatics, and Qualitative Methods Core to evaluate variation in health care delivery and outcomes, as well as the deep experience in community engagement and qualitative research methods represented by the Community Engagement and Outreach Core. Findings from this research will constitute meaningful progress towards addressing geographic disparities in arrhythmia care while, enabling achievement of investigator independence.