Objectives: To explore the association between rurality, transfer patterns and level of care with clinical outcomes of CVST patients in a rural Midwestern state. Materials and Methods: CVST patients admitted to the hospitals between 2005 and 2014 were identified by inpatient diagnosis codes from statewide administrative claims dataset. Records were linked across interhospital transfers using probabilistic linkage. Rurality was defined by Rural-Urban Commuting Areas using the 2-category approximation. Driving distances were estimated using GoogleMaps Application Programming Interface. Hospital stroke certification was defined by the Joint Commission. Severity of CVST was estimated by cost of care corrected for inflation and cost-to-charge ratios. Outcome was discharge disposition and total length of stay (LOS). Wilcoxon rank-sum, Chi-square, Fisher's exact tests and linear and logistic regressions were used. Results: 168 CVST patients were identified (79.8% female; median age = 32, IQR = 24.0–45.5). Median LOS was four days (IQR = 2–7) and patients traveled a median of 8.1 miles (IQR = 2.5–28.5) to the first hospital; 42% of patients were transferred to a second hospital, 5% to a third. More than half (58.3%) bypassed the nearest hospital. 86% visit a primary or comprehensive stroke center (CSC) during their acute care. Rurality was not significantly associated with LOS or discharge disposition after adjusting for age, sex and cost of care. Patients in CSC demonstrated greater likelihood of being discharged home compared to at a primary stroke center after adjusting for age and disease severity (p = 0.008). Conclusions: While rurality was not significantly associated with LOS or disposition outcome, care at a CSC increases likelihood of being discharge home.

目的：探讨中西部农村地区农村人口，转移方式和护理水平与CVST患者临床结局之间的关系。材料和方法：通过全州行政理赔数据集中的住院诊断代码来识别2005年至2014年之间入院的CVST患者。记录使用概率链接跨医院间转移链接。农村人口是由城乡通勤区使用2类近似法定义的。行驶距离是使用GoogleMaps应用编程接口估算的。医院卒中证书由联合委员会定义。CVST的严重程度是根据针对通货膨胀率和成本收费比进行校正的护理成本来估算的。结果是出院安排和总住院时间（LOS）。使用Wilcoxon秩和，卡方，Fisher精确检验以及线性和逻辑回归。结果：确定了168例CVST患者（女性为79.8％；中位年龄= 32，IQR = 24.0-45.5）。LOS的中位数为4天（IQR = 2–7），患者到第一家医院的平均距离为8.1英里（IQR = 2.5–28.5）；42％的患者被转到第二家医院，5％至三分之一。超过一半（58.3％）的人绕过了最近的医院。86％的患者在急诊期间去了初级或综合性卒中中心（CSC）。在调整了年龄，性别和护理费用后，农村地区与LOS或出院安排没有显着相关。在调整了年龄和疾病严重性之后，与原发性卒中中心相比，CSC患者表现出出院的可能性更大（p  = 0.008）。结论： 虽然农村地区与服务水平或处置结果并没有显着相关，但在CSC照料会增加出院的可能性。