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Jayasree Basu, PhD, MBA, Center for Primary Care, Prevention, and Clinical Partnerships, Agency for Healthcare Research and Quality, 540 Gaither Road, Room 6048, Rockville, MD 20850, 301-427-1579, Jbasu@ahrq.gov
Objective
Past studies have consistently found severity of illness as a key factor associated with patient travel for hospital care. In this study, we examine whether the relationship between distance and severity is uniform across rural and urban areas. The study focuses on the elderly patients and uses ambulatory care sensitive (ACS) or potentially preventable admissions. These admissions have been shown to vary with access to primary care, and improving access to primary care has been a goal of many rural communities.
Study Design
A distant admission is first defined by using different local threshold values, computed for residents of rural and urban areas separately. The association of distant admission with severity is examined corresponding to each local threshold level using logistic models, and controlling for patient demographics, patient insurance categories, and county characteristics.
Data Sources/Study Setting
Hospital discharge data from the Healthcare Cost and Utilization Project (HCUP) database of the Agency for Health Care Research and Quality for New York residents hospitalized in NY, Pennsylvania, New Jersey and Connecticut, linked to the Area Resource File and American Hospital Association’s survey files for 1997.
Principal Findings
1) Controlling for severity and other patient and county factors, hospital admissions decline for both urban and rural residents as distance between home and hospital increases. However, rural residents are almost twice as likely as urban residents to make a long distance travel for hospitalization and the rural-urban disparity is higher at a higher distance. 2) The travel pattern in response to illness severity varies between rural and urban elderly. For urban residents, severity would have a significant effect only at a higher travel distance. 3) Although severity was a stronger predictor of distant hospitalization for rural residents, rural patients were more likely to choose a distant hospital when a severity occurred irrespective of the location of the hospital.
Conclusions
The study highlights an asymmetric relationship between distance and severity across patients in rural and urban areas. Rural residents are found more likely than urban residents to leave their county in response to illness severity regardless of hospital location and distance to be traveled.
Implications for policy
This urban-rural disparity could reflect inadequate capacity of rural area hospitals to treat patients with severe conditions compared to urban areas. The findings could suggest a need to better equip rural hospitals with specialized technologies to treat severely ill elderly even for a potentially preventable condition.
Learning Objectives:
Keywords: , Access to Health Care
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.