Effect of Type and Timeliness of Post-Acute Care on Preventable Hospital Readmissions for Rural Medicare Beneficiaries

Research center:
Lead researcher:
Project funded:
September 2009
Project completed:
January 2012

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.