This study describes and compares the differences in the utilization of emergency department (ED) services among rural and urban Medicare Fee-For-Service enrollees during 2018-2021. We will identify factors associated with differences in ED use, including shifts in volume, primary diagnoses, and admission source, before and since the COVID-19 public health emergency in rural and urban areas.

The purpose of this study is to examine how rural and urban ED outpatient services transitioned and adjusted to the impacts of COVID-19. The study will address and describe the demographic, socioeconomic, and health service characteristics associated with ED service use changes and their relationship to communities that experienced disruptive changes. The study will:

• Assess whether changes in outpatient ED service volume and type across rural and urban areas remained consistent between time periods.
• Describe any changes in the array of outpatient ED services sought between the before and since COVID-19 time periods.
• Identify whether observed differences were related to demographic, socioeconomic, and/or geographic setting.
• Develop an understanding of the association between observed differences in ED use that may inform policies and other strategies to improve access to care for future disasters and public health emergencies.