Rural-Urban Differences in Preventable Hospitalizations Among Community-Dwelling Veterans With Dementia

Dados Bibliográficos

ID19432005
AutoresJoshua M Thorpe (University of Wisconsin–Madison), Courtney H Van Houtven (0000-0002-0783-1611, Duke Medical Center), Betsy Sleath (0000-0002-8861-6955, University of North Carolina at Chapel Hill), Betsy L Sleath, Carolyn T Thorpe (0000-0002-5970-8359, University of Wisconsin–Madison)
Ano2010
Volume26
Fascículo2
Páginas146-155
Data de publicação2010-03-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoThe Journal of Rural Health (JOURNAL)
Identificadores do periódicoISSN: 0890-765X • E-ISSN: 1748-0361
EditoraWiley (PUBLISHER • GB)
DOI10.1111/j.1748-0361.2010.00276.x
PMID20447001
PMCIDPMC3691102
OpenAlexW2038981805
IdiomaEN
Citações recebidas8
Referências citadas35

CONTEXT: Alzheimer's patients living in rural communities may face significant barriers to effective outpatient medical care. PURPOSE: We sought to examine rural-urban differences in risk for ambulatory care sensitive hospitalizations (ACSH), an indicator of access to outpatient care, in community-dwelling veterans with dementia. METHODS: Medicare and Veteran Affairs inpatient claims for 1,186 US veterans with dementia were linked to survey data from the 1998 National Longitudinal Caregiver Survey. ACSH were identified in inpatient claims over a 1-year period following collection of independent variables. Urban Influence Codes were used to classify care recipients into 4 categories of increasing county-level rurality: large metropolitan; small metropolitan; micropolitan; and noncore rural counties. We used the Andersen Behavioral Model of Health Services to identify veteran, caregiver, and community factors that may explain urban-rural differences in ACSH. FINDINGS: Thirteen percent of care recipients had at least 1 ACSH. The likelihood of an ACSH was greater for patients in noncore rural counties versus large metropolitan areas (22.6% vs 12.8%, unadjusted odds ratio [OR]= 1.99; P < .01). The addition of other Andersen behavioral model variables did not eliminate the disparity (adjusted OR = 1.97; P < .05). CONCLUSIONS: We found that dementia patients living in the most rural counties were more likely to have an ACSH; this disparity was not explained by differences in caregiver, care recipient, or community factors. Furthermore, the annual rate of ACSH was higher in community-dwelling dementia patients compared to previous reports on the general older adult population. Dementia patients in rural areas may face particular challenges in receiving timely, effective ambulatory care

Ambulatory care · Dementia · Disease · Geography · Health care · Metropolitan area · Rural area · Rurality · Dementia and Cognitive Impairment Research · Demography · Geriatric Care and Nursing Homes · Medicine · Palliative Care and End-of-Life Issues · Gerontology