Recorded presentation

Charles E. Gessert, MD, MPH, Division of Education and Research, St. Mary's/Duluth Clinic Health System, 400 East 3rd Street, Duluth, MN 55805-1853, 218-786-8176, cgessert@smdc.org and Irina V. Haller, PhD, MS, Division of Education & Research, St. Mary's/Duluth Clinic Health System , 5AV2ME, 400 East 3rd Street, Duluth, MN 55805.

End-of-life care varies markedly from region to region, by race, religion, and other factors. However, few studies have examined rural-urban differences per se. This research compared rural and urban utilization of six medical services near the end of life. Methods: The study population was comprised of elderly residents of Minnesota and Texas nursing homes, who had severe and chronic cognitive impairment, and who died during 2000-2001. Minimum Data Set (MDS) files were used to identify potential subjects who met study criteria for cognitive impairment. Federal Vital Status file was used to verify dates of birth and death. Federal MedPAR, Hospice, Denominator and MDS files were used to document the medical services utilization near the end of life. Residents enrolled in HMOs and hospice programs were excluded, as were residents in coma and those residing in mid-size (between rural and urban) counties. Results: The study population was 3849 (1927 rural, 1922 urban). Medical service utilization within 90 days prior to death was lower for rural subjects than for urban subjects for: being hospitalized (p<.026), being hospitalized more than once (p<.011), length of hospitalization (p<.001), total hospital charges (p<.001), ICU days and feeding tube use (p<.001). Rural-urban differences in IV use were not significant. Conclusions: Rural nursing home residence is strongly associated with less intensive medical care at end of life. Additional analysis will be needed to determine how rural-urban differences in service utilization at the end of life compare rural-urban differences in utilization earlier in life.

Learning Objectives:

• Describe rural-urban differences in the utilization of medical services at the end of life.
• Describe factors that may affect the observed rural-urban differences.
• Describe how access to care may affect the observed rural-urban differences.

Keywords: End-of-Life Care, Rural Health Care

Related Web page: None.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation