Decomposing Urban and Rural Disparities of Preventable ED Visits Among Patients With Alzheimer's Disease and Related Dementias: Evidence of the Availability of Health Care Resources

Abstract

The purpose of this study was to examine the urban and rural differences in the frequency of preventable Emergency Department (ED) visits among Alzheimer's Disease and Related Dementias (ADRD) patients, with a focus on the availability of health care resources in urban and rural areas.Methods: Linked datasets of 2015 State Emergency Department Databases from the Healthcare Cost and Utilization Project and the Area Health Resource File were used. ED discharges of 7 states were included in our analysis. We performed a state fixed-effect multivariable logistic regression to estimate the variation of preventable EDs by urban and rural areas. Individual characteristics and county-level health care resources were included in the estimation. The Oaxaca decomposition was used to quantify the association of county-level health care resources and urban/rural disparities.Findings: Rural patients with ADRD had 1.23 higher adjusted odds (P < .001) of going to the ED for a preventable visit compared to urban counterparts. The decomposition results showed that the model specification explained 49.2% of the differences between urban and rural patients. Patient residence in a mental health professional shortage area is one of the driving factors (contributing to 27%-48%) that explained the urban and rural disparities. Conclusions:Our study demonstrates the importance of improving health care resources in rural areas to improve health care quality and outcomes among ADRD patients who reside in rural areas. Future research and data collection on unobserved factors, such as health care quality, will be helpful in explaining the geographic differences.

Accountable Care Hospitals and Preventable Emergency Department Visits for Rural Dementia Patients

“…We used International Classification of Diseases, Ninth Revision (ICD‐9) codes in quarters 1 to 3 and International Classification of Diseases, Tenth Revision (ICD‐10) codes in quarter 4 to identify the ADRD diagnosis (see the full list in Supplementary Tables S1 and S2). ICD‐9 codes for any ADRD diagnosis code (primary, secondary, etc) were identified from the Alzheimer's Association and previously published studies 11,21 . ICD‐10 codes used for any ADRD diagnosis were cited by the Alzheimer's Association's Cognitive Impairment Care Planning Toolkit 22…”

“…We performed a sensitivity analysis using different cutoffs for preventable ED visits and primary care–related ED use 11 . We also tested different definitions of urban and rural areas based on the RUCC 11 .…”

“…We performed a sensitivity analysis using different cutoffs for preventable ED visits and primary care–related ED use 11 . We also tested different definitions of urban and rural areas based on the RUCC 11 . We used the Oaxaca decomposition to identify and quantify the characteristics that contribute to the observed urban/rural differences in preventable ED visit rates (results shown in Supplementary Table S3).…”

“…ICD-9 codes for any ADRD diagnosis code (primary, secondary, etc) were identified from the Alzheimer's Association and previously published studies. 11,21 ICD-10 codes used for any ADRD diagnosis were cited by the Alzheimer's Association's Cognitive Impairment Care Planning Toolkit. 22 We used the New York University (NYU) ED visit algorithm to assess preventable ED visits based on the diagnoses.…”

Regional Disparities of Rehabilitation Resources for Persons with Disabilities in China: Data from 2014 to 2019

“…Instead, the research has deeply explored the following three topics: (1) specific rehabilitation issues such as cardiac rehabilitation [ 11 ], exercise-based rehabilitation for non-communicable diseases [ 12 ], community-based rehabilitation resources [ 13 ], etc. ; (2) health resource disparities including the perspectives of urban and rural communities [ 14 ], specific topics such as workforce [ 15 ] (physicians [ 16 ]), facilities [ 17 ] (institutions [ 18 ]), services, etc. ; and (3) research methods on disparity or equity, for example the Theil Index [ 19 ], Gini-coefficient [ 20 ], Atkinson index [ 21 ], etc.…”