Rural-Urban Differences in Nursing Home Risk-adjusted Rates of Emergency Department Visits

A Decomposition Analysis

Datos Bibliográficos

ID9104624
AutoresHuiwen Xu (0000-0002-4033-0659, Surgery, Cancer Control, autor de correspondencia), John R Bowblis (0000-0003-4776-4182, Department of Economics, Farmer School of Business), Thomas V Caprio (0000-0002-7216-7358, Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY), Yue Li (0009-0004-9365-9070, Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY), Orna Intrator (0000-0002-4173-0662, Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY)
Año2021
Volumen59
Número1
Páginas38-45
Fecha de publicación2021-01-01
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.0000000000001451
PMID33165147
OpenAlexW3105321673
IdiomaEN
Citas recibidas2
Referencias citadas36

BACKGROUND: Higher risk-adjusted rate of emergency department (ED) visits might reflect poor quality of nursing home (NH) care; however, existing evidence is limited regarding rural-urban differences in ED rates of NHs, especially for long-stay residents. OBJECTIVES: To determine and quantify sources of rural-urban differences in NH risk-adjusted rates of any ED visit, ED without hospitalization or observation stay (outpatient ED), and potentially avoidable ED visits (PAED) of long-stay residents. RESEARCH DESIGN: We calculated quarterly NH risk-adjusted rates using 2011-2013 national Medicare claims and Minimum Data Set 3.0, and then implemented Generalized Estimating Equation models to examine rural-urban differences in ED rates and Blinder-Oaxaca decomposition to quantify the contributions of NH and market factors. SUBJECTS: Privately owned, free-standing NHs in the United States (N=13,260). RESULTS: Over the study period, risk-adjusted rates averaged 9.8% for any ED, 3.3% for outpatient ED, and 3.2% for PAED. Compared with urban NHs, rural NHs were associated with significantly lower rates of any ED, outpatient ED, and PAED (β=-1.67%, -0.44%, and -0.28%; all P<0.01). Observable differences in market factors (nursing home bed concentration, hospital beds, and the existence of a critical access hospital) explained about half of the rural-urban differences in rates of any ED and PAED, but not outpatient ED. CONCLUSIONS: Decomposition analyses suggested that lower ED rates in rural NHs appear to be related to market availability of hospital resources. Policymakers may focus on not only reducing unnecessary ED visits but also ensuring equitable hospital access in rural areas

Emergency department · Medical emergency · Nursing homes · Emergency and Acute Care Studies · Emergency Medicine · Frailty in Older Adults · Geriatric Care and Nursing Homes · Medicine · Nursing · Emergency Nursing