Hospital Remoteness And Thirty-Day Mortality From Three Serious Conditions

Abstract

Rural U.S. communities face major challenges in ensuring the availability of high-quality health care. We examined whether hospital-specific, all-cause, thirty-day riskstandardized mortality rates (RSMRs) following acute myocardial infarction, heart failure, and pneumonia varied by hospitals' geographic remoteness. We analyzed [2001][2002][2003] Medicare administrative data, comparing RSMRs among hospitals located in urban, large rural, small rural, or remote small rural regions. We found only small mortality differences across remoteness regions for hospitalizations for the three conditions. We examine the implications of these findings for the millions of Americans who rely upon rural hospitals for their care. [Health Affairs 27, no. 6 (2008): 1707-1717 10.1377/hlthaff.27.6.1707 A m e r i c a's ru r a l c o m m u n i t i e s face considerable challenges in ensuring the availability of high-quality health care. Many hospitals have closed, and others face financial peril, leaving some rural communities without access to advanced care and emergency services.1 Moreover, geographic access to health care practitioners in rural communities has increased only marginally, leaving some people without access to basic care and more without access to specialty care.2 Compounding these challenges, rural populations are more likely to exhibit poorer health behavior, such as smoking and sedentary lifestyles, and to be limited in daily activities as a result of chronic conditions when compared with urban populations.3 However, it is not known if rural populations have worse outcomes associated with acute medical conditions-an area of research prioritized by the

Mortality and Revascularization Following Admission for Acute Myocardial Infarction: Implication for Rural Veterans

“…Our mortality findings are inconsistent with those of Baldwin et al 33 and the more recent Ross et al 31 studies, as we did not find a mortality risk for rural relative to urban veterans regardless of classification system applied. This inconsistency may be due to the different analysis strategies employed by our study (ie, patient‐level vs hospital‐level analyses).…”

“…Therefore, the VA URH classification incorporates a population density measure and defines urban as any US Census Bureau‐defined urbanized area, rural as any area not defined as urban, and highly rural as a rural territory with a population density of fewer than 7 civilians per square mile. Additionally, the RUCA coding scheme similarly uses population data (eg, US Census tracts) and these methods have been well described 30–33 . Therefore, we performed this study for the following reasons: (1) multiple rural classification systems have been applied in studies examining AMI outcomes; (2) studies have largely focused on hospital location as the unit of analysis; (3) there is a distinct lack of consensus on applying a rural definition in AMI outcomes health services research; and (4) the VA has recently adopted this PSSG URH methodology and, as yet, it remains largely untested.…”

Based On Key Measures, Care Quality For Medicare Enrollees At Safety-Net And Non-Safety-Net Hospitals Was Almost Equal

“…Fifth, we restricted our analyses to urban hospitals operating within MSAs with at least one safety net and non-safety net hospital, ensuring that our comparison was of hospitals operating within similar geographic environments. While our findings may not apply to rural hospitals, many of which represent a safety net for rural residents without ready access to acute care facilities (19), we believe this limitation is a great strength of our approach, eliminating any confounding from inclusion of non-safety net hospitals that do not operate in geographic areas that include a safety net hospital as well as confounding from inclusion of rural safety net institutions that face different challenges than do urban safety net hospitals (36, 37). …”

Hospital Strategies for Reducing Risk-Standardized Mortality Rates in Acute Myocardial Infarction

“…Use of aspirin, β-blockers, and rapid reperfusion therapy can reduce mortality in appropriate patients (3, 4); however, with the current high adherence to medication and time to reperfusion, these strategies explain only 6% of the variation in RSMRs after AMI among hospitals (5). Studies have also identified hospital characteristics that are associated with risk-adjusted mortality, such as teaching status (6), AMI volume (7, 8), safety net status (9, 10), and geographic and urban or rural location (11–15). Together, however, these factors leave much of the hospital-level variation in RSMRs unexplained (16).…”