The Impact of Rurality on Durable Medical Equipment Access and Discharge Planning for Tracheostomy and Ventilation Care in Nebraska

ABSTRACT Objective(s) Recognize how rurality impacts safe discharge planning and home management for complex airway patients. This study explores the distribution of durable medical equipment (DME) companies for patients with tracheostomies and/or ventilators, aiming to identify patterns in service access statewide. Methods Key informant phone surveys assessed active DME companies statewide. DME companies were identified through hospital referral lists, discharge directories, and online searches. Data collected included service radius, respiratory supplies, and ventilation types. Geographic information system (GIS) mapping visualized coverage. Rural–urban status was classified using rural–urban commuting area (RUCA) codes. Results Of 16 companies identified, 6 were closed, leaving 50 active locations. Among these, 22% ( n = 11) support invasive ventilation (average service radius 168.8 km [104.9 mi], range 80.5–402.3 km [50–250 mi]), 52% ( n = 26) serve tracheostomy patients (average service radius 129.7 km [80.6 mi], range 68.9–289.7 km [42.8–180 mi]), and 88% ( n = 44) offer noninvasive ventilation, such as CPAP/BiPAP (average service radius 116.5 km [72.4 mi], range 25.3–289.7 km [15.7–180 mi]). Among invasive ventilation locations, 18% ( n = 2) are rural (RUCA 4–10) and 82% ( n = 9) urban (RUCA 1–3). For tracheostomy, 46% ( n = 12) are rural and 54% ( n = 14) urban. Conclusion Geographic disparities limit DME access for rural patients requiring tracheostomy and invasive ventilation. Surgeons should be aware that patients may live over 1.5 h from a capable DME company. Presence of a DME company does not ensure a specific location offers specialized supplies or equipment. Realistic discharge planning is essential to ensure care continuity, reduce emergency department visits, hospital readmissions, and preventable complications. Level of Evidence 4.