Table.

Monitoring for Unintended Consequences of the Rural Emergency Hospital Care Model

Domain	Anticipated benefit	Potential unintended consequences	Early signs of unintended consequences
Ensuring access	Preserve outpatient and emergency services	Greater travel burden for patients to obtain inpatient care Delays in patients receiving inpatient care	Changes in patient travel distance to care Rates of emergency presentations for access-sensitive conditions
Facilitating transfers	Align patient care needs with facility resources	Difficulty for rural hospitals to identify an accepting hospital with inpatient services Overburden nonrural hospitals with increased inpatient volume	Increased rates of delayed or rejected transfers Limited bed capacity at receiving hospitals
Strengthening continuity of care	Strengthen relationships and disseminate expertise	Fragmented care across multiple sites and multiple clinicians Redundant care leading to higher care utilization	Patients with care across sites without interoperable electronic health records Duplicate testing across sites of care
Maintaining a rural workforce	Maintain outpatient and emergency workforce	Difficulty recruiting outpatient clinicians who also need inpatient resources Less overall infrastructure to recruit outpatient clinicians	Loss of clinicians who provide inpatient and outpatient services Increase vacancies for outpatient clinicians