Rural Medicare Beneficiaries Have Fewer Follow-up Visits and Greater Emergency Department Use Postdischarge

Datos Bibliográficos

ID9102649
AutoresMatthew Toth (University of North Carolina at Chapel Hill, autor de correspondencia), Mark Holmes (0000-0002-6776-1301), George M Holmes (0000-0002-6169-7847, University of North Carolina at Chapel Hill, autor de correspondencia), Courtney H Van Houtven (0000-0002-0783-1611, Duke Medical Center), Courtney Van Houtven, Mark Toles (0000-0002-8469-7110, University of North Carolina at Chapel Hill), Morris Weinberger (University of North Carolina at Chapel Hill, autor de correspondencia), Pam Silberman (University of North Carolina at Chapel Hill, autor de correspondencia)
Año2015
Volumen53
Número9
Páginas800-808
Fecha de publicación2015-09-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000401
PMID26270827
OpenAlexW2408822016
IdiomaEN
Citas recibidas11
Referencias citadas38

BACKGROUND: Hospitals are focused on improving postdischarge services for older adults, such as early follow-up care after hospitalization to reduce readmissions and unnecessary emergency department (ED) use. Rural Medicare beneficiaries face many barriers to receiving quality care, but little is known about their postdischarge care and outcomes. We hypothesize that rural Medicare beneficiaries compared with urban beneficiaries, will have fewer follow-up visits, and a greater likelihood of readmission and ED use. METHODS: We conducted a retrospective analysis of elderly Medicare beneficiaries discharged home using the Medicare Current Beneficiary Survey, Cost and Use files, 2000-2010. Multivariate Cox proportional hazard models were used to assess the risk of rural residency on readmission, ED use, and follow-up care up to 30 days' postdischarge. Covariates include demographic, health, and hospital-level characteristics. RESULTS: Compared with urban beneficiaries, Medicare beneficiaries living in isolated rural settings had a lower rate of follow-up care [hazard ratio (HR)=0.81, P<0.001]. Beneficiaries in large and small rural settings had a greater risk of an ED visit compared with urban beneficiaries (HR=1.44, P<0.001; HR=1.52, P<0.01). Rural beneficiaries did not have a greater risk of readmission, though risk of readmission was higher for beneficiaries discharged from hospitals in large and small rural settings (HR=1.33, P<0.05; HR=1.42, P<0.05). CONCLUSIONS: This study provides evidence of lower quality postdischarge care for Medicare beneficiaries in rural settings. As readmission penalties expand, hospitals serving rural beneficiaries may be disproportionately affected. This suggests a need for policies that increase follow-up care in rural settings

Beneficiary · Confidence interval · Emergency department · Environmental health · Hazard ratio · Medical emergency · Multivariate analysis · Proportional hazards model · Rural area · Emergency and Acute Care Studies · Emergency Medicine · Finance · Heart Failure Treatment and Management · Internal Medicine · Medicine · Nursing · Primary Care and Health Outcomes