Rural-Urban Differences in Nursing Home Admissions, Service Usage and DischargeThis study hypothesizes that persons from rural areas admitted to rural nursing homes will have higher functioning, receive fewer special nursing home services, and remain in care longer than rural admissions to urban nursing homes, urban admissions to urban nursing homes, or urban admission to rural nursing homes. Logistic, poisson and least squares regression will be used to evaluate the hypotheses, with rural-urban admission cohorts included as dummy variables.
This study involves the use of secondary data to conduct an in-depth examination of rural-urban differences in recent nursing home first admissions, their service utilization patters, and their discharge status over 12 months. First admissions that are age 65 or older in the 50 states and Washington DC will be included. Using zip codes of residences prior to admission and zip codes of nursing homes, project staff will develop rural-urban admission cohorts by identifying persons who remain in the same county type based upon Urban Influence Codes (UIC) as that of their residence prior to admission (for example, rural to rural) and admissions that move from one UIC-based county type to another type. The analysis will be conducted using the Nursing Home Minimum Data Set (MDS), which contains administrative data on all individuals admitted to Medicare/Medicaid certified nursing homes in the United States during 2003. The MDS data will be combined with facility-based data from the CMS On-line Survey, Certification, and Reporting data file, and a special county-level Provider of Service file containing county-level data on nursing homes and alternative sources of care, such as home health care. County-level demographic data from the Area Resource File will also be used.
To disseminate the study findings to researchers and policymakers, we will present our findings at the annual meetings of the National Rural Health Association and the Gerontological Society of America, and will seek to publish them in peer-reviewed journals, such as Health Services Research, Journal of Rural Health, and The Gerontologist.