A Comparison of extended-stay encounters within two provider models: Frontier Extended-Stay Clinics and Critical Access Hospitals

In 2004, the Health Resources and Services Administration (HRSA) Office of Rural Health Policy (ORHP) funded the Frontier Extended Stay Clinic (FESC) demonstration to examine the viability and sustainability of a clinic model that could provide emergency and extended-stay services in addition to primary-care services in remote areas. These clinics must be at least 75 miles away from a higher level of service and often have to provide care for patients for four hours or more because it's safer, more convenient, or more efficient and sometimes due to transportation barriers. Five extremely remote clinics—four in Alaska and one in Washington—participate in this demonstration.

In 2009, two Montana frontier Critical Access Hospitals (CAHs) joined this project for comparison purposes. A CAH must be more than 35 miles by primary road from the nearest hospital or other CAH; in areas where there are secondary roads or mountainous terrains, the distance required is at least 15 miles from another hospital or another CAH. CAHs must operate a 24-hour emergency room.

A total of 2,293 FESC extended stay encounters were analyzed and compared to 522 similar CAH encounters between September 14, 2008, and September 14, 2010, to increase the understanding of what constitutes an extended stay encounter.

We see from the data that the mean length of stay for the monitoring and observation extended-stay encounters for FESC is 5.5 hours less than the CAHs—11.7 hours vs. 6.2. It appears that, on average, these encounters are substantially shorter in FESCs than in CAHs. The mean length of stay for transfers for FESC extended stay encounters is almost the same as that of CAHs—4.8 hours vs. 4.0, respectively. FESCs and CAHs have the same discharge diagnosis in four of the five most frequently reported categories—injury, cardiovascular, pneumonia/bronchitis, and gastrointestinal.

The comparison of data between FESCs and CAHs adds depth to our understanding of what constitutes a FESC extended stay encounter. It is important to remember, that with these developing patterns, there are factors which make each facility type unique. The geographic location relative to a higher level of care, transportation options and frequency of transferring patients, age of the population, the services each facility type is certified to provide affect many aspects of the extended stay encounters. However, based on comparison data, FESC is a viable model for emergency and extended-stay care in frontier areas.