Statement of the problem: Readmission within 30 days of hospital discharge is an increasingly utilized measure of hospital care quality. Current knowledge of rural patients' care quality may be expanded by assessing how patients' use of rural hospitals, urban hospitals, and rural/urban hospital combinations and the type and timing of health services received by patients during and after hospital stays influence the likelihood of readmissions.

Project goals: The purpose of this project is to: 1) determine how location of hospitals used for initial admissions by rural patients affects readmission rates; 2) assess how the use of swing beds affects rural patients' readmissions; and 3) examine the impact of the type and timeliness of post-acute care, including home health care, skilled nursing, and physician visits, on readmissions for rural patients.

Methods: Kaplan-Meier curves and Medicare inpatient data for 2007 will be used to compare the probability of readmission for rural beneficiaries based on hospital location. The inpatient data will be matched with 5% carrier (physician/Part B), skilled nursing facility, and home health care data from the Medicare Chronic Condition Data Warehouse for beneficiaries with congestive heart failure and chronic obstructive pulmonary disease. The effect of the use of various post-acute services on readmissions will be analyzed using Cox regression while controlling for time to receive services, demographics and patient severity.

Anticipated Publications or Products: The products for this project will include a final report, a policy brief, an article that will be submitted to a peer-reviewed journal, and presentation abstracts that will be submitted to state, regional and national conferences.

Publications

• Effect of Outpatient Visits and Discharge Destination on Potentially Preventable Readmissions for Congestive Heart Failure and Bacterial Pneumonia
  Policy Brief
  Upper Midwest Rural Health Research Center
  Date: 03/2012
  This brief explores the relationship between potentially preventable readmissions and use of outpatient follow-up care, discharge destination, rural versus urban patients, and time to follow-up care. These factors were examined in a large population of Medicare patients with hospital stays for congestive heart failure or bacterial pneumonia.
• Effect of Outpatient Visits and Discharge Destination on Potentially Preventable Readmissions for Congestive Heart Failure and Bacterial Pneumonia (Final Report)
  Upper Midwest Rural Health Research Center
  Date: 03/2012
  This study explored the relationship between potentially preventable readmissions and use of outpatient follow-up care, discharge destination, rural versus urban residence of the patient, and time to follow-up care.