Lower Rehospitalization Rates Among Rural Medicare Beneficiaries With Diabetes

• Published in: The Journal of rural health 2012-06, Vol.28 (3), p.227-234
• Main Authors: Bennett, Kevin J., Probst, Janice C., Vyavaharkar, Medha, Glover, Saundra H.
• Format: Article
• Language: English
• Subjects: access to care; Access to Health Care; Aged; Aged, 80 and over; Beneficiaries; Computation; Counties; Diabetes; Diabetes Mellitus - therapy; Factor Analysis; Female; health disparities; Health Services Accessibility; Hospitalization; Hospitals; Humans; Influences; Male; Medicare; Medicare - statistics & numerical data; Multivariate Analysis; Patient admissions; Patient Readmission - statistics & numerical data; Patients; Physicians; Policy; Population; Readmission; rural; Rural Areas; Rural health care; Rural Population - statistics & numerical data; Rural Urban Differences; United States; Urban Population - statistics & numerical data; utilization of health services
• ISSN: 0890-765X; 1748-0361
• DOI: 10.1111/j.1748-0361.2011.00399.x

Purpose: We estimated the 30‐day readmission rate of Medicare beneficiaries with diabetes, across levels of rurality. Methods: We merged the 2005 Medicare Chronic Conditions 5% sample data with the 2007 Area Resource File. The study population was delimited to those with diabetes and at least 1 hospitalization in the year. Unadjusted readmission rates were estimated across levels of rurality. Multivariate logistic regression estimated the factors associated with readmissions. Findings: Overall, 14.4% had a readmission; this was higher among urban (14.9%) than rural (12.9%) residents. The adjusted odds indicated that remote rural residents were less likely to have a readmission (OR 0.74, 0.57‐0.95) than urban residents. Also, those with a 30‐day physician follow‐up visit were more likely to have a readmission (OR 2.25, 1.96‐2.58) than those without a visit. Conclusion: The factors that contribute to hospital readmissions are complex; our findings indicate that access to follow‐up care is highly associated with having a readmission. It is possible that residents of remote rural counties may not receive necessary readmissions due to lower availability of such follow‐up care. Policy makers should continue to monitor this apparent disparity to determine the impact of these lower rates on both patients and hospitals alike.