Adequacy of Ambulatory Care Among Rural African Americans with Congestive Heart Failure, Diabetes or Asthma
Hospitalization for ambulatory care sensitive conditions (ACSCs) is higher in rural areas and, within rural areas, among nonwhites and low income persons. This project will examine treatment for ACSCs between rural African American and white residents in South Carolina who are insured by Medicare, Medicaid or the State Employee Health Plan (SHP). Drawing on outpatient and inpatient records available from these three insurers, we will calculate hospitalization rates based on all persons with the diagnosis of interest, as defined by either outpatient care or hospitalization. The level of ambulatory care will be measured by visit rates and prescription filling. Factors affecting access to ambulatory care will include the number of physicians and pharmacies in the patient's area of residence as well as the patients demographics, co-morbidities and insurance status. Hospitalization will be explored in the context of three alternative precursor situations -- apparently sufficient ambulatory care, possibly insufficient ambulatory care, and no ambulatory care. This design will allow us to delineate the relative contributions to ACSC hospitalizations of patient characteristics, such as race, residence and co-morbidity, versus system characteristics, such as physician availability and accessibility.
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