While various studies have examined the geographic nature of the rural elderly's hospitalizations, little is known about the patterns or nature of their ambulatory care. Our earlier study of the elderly in Washington State showed that residents of remote rural areas had fewer physician visits than those from other geographic areas. This study will use Medicare data to examine whether the elderly who reside in remote small towns in Montana and Washington receive less physician care than those in or near urban areas; how travel distances and time vary by the characteristics of the elderly, physician specialties, and medical conditions; how aspects of physician usage by the rural elderly vary from community to community and how these are associated with the supply of providers and distance to other sources of care; and whether fewer visits translates into the use of fewer preventative services. Diabetic care will be used as a disease-specific case study.

Publications

• Improving the Quality of Outpatient Care for Older Patients With Diabetes: Lessons From a Comparison of Rural and Urban Communities
  Journal Article
  WWAMI Rural Health Research Center
  Date: 08/2001
  Compares the quality of diabetic care received by patients in rural and urban communities in Washington State. Concludes that large rural towns may provide the best conditions for high-quality care-growing communities that serve as regional referral centers and have an adequate, but not excessive, supply of generalist and specialist physicians.