August 14, 2015- Medicare patients in rural areas
have lower rates of follow-up care after leaving the hospital—which may place
them at higher risk of emergency department (ED) visits and repeat
hospitalizations, according to a study in the September issue of Medical Care.
The journal is published by Wolters Kluwer.
"This
study provides evidence of lower rates of post-discharge follow-up care, and
higher ED use for Medicare beneficiaries in rural settings," comments lead
author Matthew Toth, PhD, MSW. The research was conducted while Dr. Toth was at
University of North Carolina at Chapel Hill; he is now at RTI International.
Especially with new "pay-for-performance" programs tying reimbursement
to hospital performance on patient outcomes, the results highlight the need for
policies to improve follow-up care for patients in rural areas.
Differences
in 30-Day Outcomes for Patients at Rural versus Urban Hospitals
Using data from the nationally representative Medicare Current Beneficiary Survey, the study included approximately 12,000 Medicare-eligible patients with hospital admissions between 2000 and 2010. About 4,000 patients lived in rural areas; this group was further divided into patients living in large, small, and isolated rural areas (based on a standard coding system).
The
rural and urban groups were compared on three key outcomes during the first 30
days after hospital discharge: follow-up healthcare visits, ED visits, and
unplanned hospital readmissions. The comparisons were adjusted for a wide range
of demographic, health-related, and hospital characteristics.
The
results suggested that patients living in isolated areas were less likely to
receive a follow-up visit within 30 days after leaving the hospital. Compared
to those in urban areas, patients in isolated rural settings were 19 percent
less likely to receive follow-up care.
The
study also found a higher risk of ED visits within 30 days for patients living
in large or small rural areas, compared to urban patients. This risk was 44
percent higher for patients who lived in small rural settings and 52 percent
higher for those in large rural settings.
The
overall risk of unplanned hospital readmissions was not significantly different
for rural versus urban residents. However, this difference became significant
when patients were classified by the location of the hospital where they were
treated, rather than where they lived.
Thirty-day readmission risk was 32
percent higher for patients discharged from hospitals in large rural settings
and 42 percent higher for hospitals in small rural settings, compared to urban
settings.
In
addition to their impact on patient care, the findings may have important
implications for rural healthcare providers at a time of changes in healthcare
delivery and payment.
These include a recently introduced Medicare program
seeking to improve post-discharge outcomes by penalizing hospitals with
higher-than-expected 30-day readmission rates.
"Consistent
with previous [research] on safety-net and low-volume hospitals, our study
finds that rural hospitals serving elderly Medicare beneficiaries may be
disproportionately penalized under this program," Dr. Toth and coauthors
write. "If so, poor readmission outcomes among these hospitals may be
exacerbated."
The
researchers believe their findings highlight the need for measures to improve
access to care and reduce unplanned acute events for rural patients. That may
include investment in programs such as telehealth, care management,
transitional care, and policies to enhance primary care services.
"A
greater understanding of the reasons for these differences would help inform
efforts to improve care," Dr. Toth adds. "For example, are patients
of rural hospitals more likely discharged to under-resourced settings, or are
there more likely gaps in post-discharge instructions in the inpatient
setting?"
Article:
"Rural Medicare Beneficiaries Have Fewer Follow-up Visits and Greater
Emergency Department Use Postdischarge" (doi:
10.1097/MLR.0000000000000401)
###
About
Medical Care
Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association
Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association
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Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer's market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world.
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