An Atlas of Rural and Urban Variation in Cardiac Arrest Processes of Care and Outcomes in Northern New England: Toward Improved Outcomes After Rural Cardiac Arrest

As a tertiary care center, MaineHealth receives transfers of cardiac arrest patients from all over the state. Dr. Teresa May’s project focused on answering a seemingly simple question: How are they doing at treating these patients? Finding that answer, however, requires analyzing and understanding a wide variety of data. Using Emergency Medical Services registry data and vital health records from the government, they began to explore the different factors influencing health outcomes for these patients. They noted disparities between rural and urban patients, but Dr. May says there are a lot of details that need to be considered. The patients themselves are different, the response times to emergency calls are different, and the types of treatment provided are often different. The project team is digging through a vast treasure of data to isolate the key factors impacting health outcomes across rural and urban areas with the hopes of one day standardizing care in Intensive Care Units across the region so no matter where a patient is, they will get the same and the best care. Since being awarded, Dr. May and her team have already begun to identify useful metrics that may help lead them to better care practices. The pilot has grown into a larger project under the Acute Care COBRE at MaineHealth and is being developed into an R01 application that will include many of the rural states not just across the region, but across the country.

“The thing I learned is there’s still a lot to learn. And what was really surprising was the amount of cardiac arrests that were happening across the state. I only see the patients who arrive in my ED or my ICU, but the number of patients that don’t make it to this hospital is high. And we knew that based on national data, but it’s different when you’re looking at your state and your community."

Teresa May, DO

"The Pirate's Heart: Digging for Data"

Kinna Thakarar, DO

"Injections & Infections: Using Research to Advocate for Change"

Rural Harm Reduction Access and Regional Trends

Over the past ten years, northern New England has seen a surge of infections related to injection drug use that occur as a result of unsafe injection practices. In addition to programs aimed at reducing opioid and injection drug use, many programs have been launched to mitigate the hazards of injection and provide safer options. In other words, their goal is harm reduction, and it is this programming that Dr. Kinna Thakarar of MaineHealth received her pilot award to study. One of the most common harm reduction programs are syringe services, which provide clean syringes for people who use drugs so they do not have to risk infection, but according to Dr. Thakarar, many still aren’t able to access these programs. Her pilot work found that the biggest barrier to accessing syringe service programs is distance. People living more than 10 miles from such a center are significantly less likely to use the service, but in such a rural state as Maine, that is the reality for a lot of people. Once the main barriers to harm reduction services were identified, Dr. Thakarar continued to use those lessons learned to enact programmatic change. Her philosophy is to use research as an advocacy tool, leveraging results to advocate for change that will help others. To achieve that goal, Dr. Thakarar and her team shared the results of this pilot to provide testimony for legislative bills, updates at the Governor’s Opioid Summit and the Governor’s Seminar Series, and to educate colleagues in what we as a region need to do to ensure harm reduction programs are accessible to all, especially rural communities.

“[The Pilot Project Program] gave me the experience and data to apply for additional funding. Based on the work we did for the program, I also connected with other people in the field and am forming some exciting collaborations, and so it’s also opened a lot of doors in terms of connections."

1. Thakarar K, Sankar N, Murray K, Lucas FL, Burris D, Smith RP. Injections and infections: understanding syringe service program utilization in a rural state. Harm Reduct J. 2021 Jul 17;18(1):74. doi: 10.1186/s12954-021-00524-1. PMID: 34273986; PMCID: PMC8285696.