Because they are often hospitalized outside their home community, rural Medicare beneficiaries may experience a different sequence of services after discharge than do urban beneficiaries. This study will follow beneficiaries across the continuum of post-hospital care to determine if rural beneficiaries, particularly minority beneficiaries, are more likely to experience care disruption and adverse outcomes, such as re-hospitalization.

Statement of the Problem: Potentially preventable re-hospitalizations represent both additional morbidity for patients and additional costs for Medicare. Carefully managed transitions after hospitalization can reduce these adverse effects. Rural beneficiaries, since they are often hospitalized in an urban area, may experience different and less effective post-hospital patterns of care than their urban peers.

Project goals: This project will use Medicare claims data to document the care transitions experienced by rural Medicare residents who are admitted at least once to an inpatient facility. To limit the analysis to similar patients, we will examine beneficiaries hospitalized with one of three conditions, heart failure, acute myocardial infarction, and pneumonia. By examining the beneficiaries' initial admission location, transfer location if any, type and the location of the provider utilized for post-discharge care, and the location of any readmissions, we can better understand how these patients do or do not obtain care.

Methods: We will conduct a cross sectional analysis of 2009 Medicare Claims data, using the Medicare Master Beneficiary Summary File, Carrier Claims File, Inpatient Claims File, Skilled Nursing Claims File, Home Health Claims File, and the Outpatient Claims File. Analyses will be restricted to patients with one of the three conditions of interest. For each patient, we will examine whether the initial admission was in-county or out-of-county; whether the patient was subsequently transferred to another facility; and finally, post-hospital disposition (death, discharge to community, transfer to skilled nursing or nursing home, or discharge to home health), subset by rurality and region.

We will also examine the proportion who actually receive care outpatient post discharge, such as home health care, physician visit, or some other health care encounter. Finally, we will calculate the adjusted 30-day readmission rate for discharged patients (excluding those that died), subdivided by the location of the readmitting hospital (i.e. rural/same hospital, rural/different hospital, rural/urban hospital, and so on) and subset by rurality and region.

Anticipated publications or products: A technical report summarizing project findings will be developed, along with shorter materials such as fact sheets and postcards. A short video will be developed to summarize study findings.

Publications

• Transitions in Care Among Rural Residents With Congestive Heart Failure, Acute Myocardial Infarction, and Pneumonia
  Report
  Rural and Minority Health Research Center
  Date: 08/2017
  Rural and urban hospitals vary with regard to the levels of care they are able to provide, requiring that a subset of patients be transferred from the first point of encounter to a second facility. The degree to which inter-hospital transfers occur, and the outcomes for transfer patients, have not been studied across rural and urban institutions.