One-quarter of Medicare beneficiaries discharged from an acute hospital are discharged with post-acute care services. This multi-phase analysis examined whether discharge patterns for and use of post-acute care services by rural and urban hospitalized Medicare beneficiaries differ and, if they do, what the sources are of these different patterns. Claims data from the 2000-2001 Medicare Standard Analytical Files (SAF) were used to examine rural and urban patterns of post-acute placement in a Skilled Nursing Facility (SNF), medical rehabilitation facility, or home care following discharge from an acute hospital. A limited number of diagnoses (including hip fractures, chronic obstructive pulmonary disease, and stroke) were selected for which post-acute care is typically required and for which care is often rendered in multiple post-acute settings. Using patient level data, episodes of care were constructed for those individuals who were hospitalized in the first three months of the calendar year. The post-acute records from the corresponding home health, physician, and SNF SAFs for these beneficiaries were extracted. Claims data are supplemented with county-level provider supply measures from the Area Resource File and Medicare's Provider of Services files.

In the first phase of this study, descriptive statistics were used to determine whether there were any statistically significant rural/urban differences in utilization of post-acute services, as measured by the average number of admissions, average lengths of stay or average units of services received, or number of admissions. Separate analyses were conducted for each type of post-acute setting as well as for each diagnostic group. In the second phase of the study, the focus was on substitution of care across different post-acute care settings and the patterns of use of multiple post-acute settings within a specific episode of care.

Publications

• Patterns of Post-Acute Utilization in Rural and Urban Communities: Home Health, Skilled Nursing, and Inpatient Medical Rehabilitation
  NORC Walsh Center for Rural Health Analysis
  Date: 03/2005
  This report describes rural Medicare beneficiaries' patterns of post-acute utilization of home health services, skilled nursing facilities, and inpatient rehabilitation facilities.