Date of Award
5-1-2026
Degree Name
Doctor of Philosophy
Department
Population Health
First Advisor
Partridge, Julie
Abstract
Pulmonary embolism (PE) is a significant contributor to cardiovascular morbidity and mortality in the United States. Rural populations experience challenges in the diagnosis and treatment of PE due to limited access to advanced imaging, specialty services, and multidisciplinary care teams. These disparities can contribute to delays in diagnosis, treatment, and ultimately poorer health outcomes. The purpose of this research was to examine how rurality influences pulmonary embolism diagnosis, management, and outcomes while evaluating potential interventions to improve care delivery in rural healthcare systems. Guided by Andersen’s Behavioral Model of Health Services Use, this dissertation consisted of three complementary studies designed to explore PE care from multiple perspectives. The first study conducted a scoping literature review of peer-reviewed research published between 2015 and 2025 to identify existing knowledge on PE epidemiology, diagnosis, treatment, and outcomes in rural populations. The second study utilized a retrospective cross-sectional cohort analysis of the 2022 Nationwide Inpatient Sample (NIS) to compare differences in treatment patterns, length of stay, and mortality between urban and rural PE patients. Statistical analyses, including ANCOVA and chi-square tests, were performed while controlling for age, sex, and PE type. The third study evaluated the implementation of a Pulmonary Embolism Response Team (PERT) program within a rural healthcare system in southern Illinois through a retrospective comparative analysis of patient outcomes before and after program implementation. Findings indicate that rural patients face barriers to advanced care, including higher interfacility transfer rates and reduced access to specialized interventions. While clinical factors such as age and PE severity were primary predictors of inpatient outcomes, the implementation of a rural PERT program significantly reduced time to cardiology consultation and improved multidisciplinary care coordination. Collectively, these results highlight the need for expanded rural health resources to improve PE diagnosis, treatment, and outcomes.
Access
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