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Chronic wounds provide a model for studying access to complex chronic care since they often are related to underlying health conditions and require lengthy treatment. Our goals were to describe chronic wound care utilization among rural and urban veterans and to determine the association between rural residence and wound healing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study of 160 rural and 160 urban veterans in the Pacific Northwest with an incident of chronic lower limb wound between October 1, 2006, and September 30, 2007. We followed individuals for up to 1 year, measuring wound care utilization within Veterans Health Administration and Medicare. We compared wound healing using a competing risks proportional hazards model accounting for amputation and death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Rural veterans had fewer outpatient wound care visits (6.8 vs 9.9) than urban veterans and a similar number of inpatient wound care stays (0.9 and 0.8, respectively). During follow\u2010up, 234 veterans\u2019 wounds healed (77% rural, 69% urban). The adjusted hazard ratio for wound healing was 1.11 (95% confidence intervals [CI]: 0.84\u20101.47, <jats:italic>P<\/jats:italic> = .45) for rural compared to urban veterans. The hazard of amputation was higher among rural veterans (hazard ratio [HR] = 2.65, 95% CI: 1.02\u20106.87, <jats:italic>P<\/jats:italic> = .045) and the hazard of death was lower (HR = 0.35, 95% CI: 0.12\u20100.97, <jats:italic>P<\/jats:italic> = .043).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite lower wound care utilization, rural veterans\u2019 wounds were as likely to heal as urban veterans\u2019 wounds.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jrh.12115","type":"journal-article","created":{"date-parts":[[2015,5,7]],"date-time":"2015-05-07T18:25:12Z","timestamp":1431023112000},"page":"410-420","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Chronic Lower Limb Wound Outcomes Among Rural and Urban Veterans"],"prefix":"10.1111","volume":"31","author":[{"given":"Erin D.","family":"Bouldin","sequence":"first","affiliation":[{"name":"Health Services Research &amp; Development Department of Veterans Affairs Puget Sound Health Care System  Seattle Washington"},{"name":"Department of Epidemiology, School of Public Health University of Washington  Seattle Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leslie L.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Health Services Research &amp; Development Department of Veterans Affairs Puget Sound Health Care System  Seattle Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyson J.","family":"Littman","sequence":"additional","affiliation":[{"name":"Health Services Research &amp; Development Department of Veterans Affairs Puget Sound Health Care System  Seattle Washington"},{"name":"Seattle Epidemiologic Research and Information Center Department of Veterans Affairs Puget Sound Health Care System  Seattle Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahsa","family":"Karavan","sequence":"additional","affiliation":[{"name":"School of Medicine University of Washington  Seattle Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Rice","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health University of Washington  Seattle Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gayle E.","family":"Reiber","sequence":"additional","affiliation":[{"name":"Health Services Research &amp; 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